Healthcare for the Emerging Middle Class

Healthcare in the United States is changing more rapidly than ever before. From rising costs, evolving policy and reimbursement environments, changes in patient access and infrastructure, and a greater focus on clinical outcomes, it’s clear that this continual market disruption is leading to mounting pressure on incumbents to maintain their ability to drive revenues, and in turn, attractive returns for their shareholders[i].

In emerging markets however, members of the rapidly growing middle class have large unmet healthcare needs, representing a compelling opportunity for successful companies to fuel future business growth. Often, established companies attempt to target these opportunities by re-purposing existing solutions for a new audience, but effective design requires a deep contextual understanding and a different approach. When looking for healthcare opportunities in emerging markets, local teams on the ground are less susceptible to preconceived notions and are more in tune with local needs than organizations that seek to re-purpose existing solutions from established markets. Large, multinational organizations—those viewing these new markets from a distance—should take notice.

The United States will always be a major market for healthcare, but the booming emerging middle class is becoming harder and harder to ignore. Not convinced? A recent study by Goldman Sachs indicates the emerging middle class is expected to reach a staggering 4.9 billion people by the year 2030, a near threefold increase from the estimated 1.8 billion already measured in the year 2009[ii]. In other words, today’s emerging middle class is already a whopping six times larger than the entire population of the United States. With such striking populations in countries like China, India, and Brazil, greater accessibility to disposable income for the emerging middle class will have significant implications for the global healthcare economy.

In terms of healthcare around the globe, focus has been shifting away from treating infectious disease and more towards management of chronic disease as this emerging middle class adopts a more sedentary lifestyle, accompanied by a consequent rise in obesity, cardiac disease, and diabetes. Over 60 million people are currently diagnosed with diabetes in India alone, with another 30 million already in a “pre-diabetic” stage[iii]. While striking in terms of the number of people affected, this demographic provides an open door for affordable, accessible, and effective healthcare provision. Additionally, the lack of legacy healthcare infrastructure, the prevalence of self-paying patients, and less burdensome regulations provide an attractive new market opportunity for established companies and start-ups alike.

In order to succeed in these new healthcare markets, companies must no longer re-align existing solutions and offer these as cut-down versions. Effective design must recognize significant differences in infrastructure, culture, and constraints; delivering even more on access, outcomes, and value to better align with new customers. In this day and age, teams with feet on the ground and local networks are well-positioned to deliver solutions with the speed and flexibility to support rapid pilot deployment, clinical testing, and early ROI validation.

Jana Care is a prime example of how locally-tuned innovation—stemming from cultural insights and fewer constraints—can lead to meaningful solutions to address unmet healthcare needs. When Jana Care created its Aina device and Habits program, it set out to develop a type 2 diabetes management system for the urban middle class in India by aligning with local customer needs, leveraging the prevalence of smartphone usage-- expected to reach 364 million in India by the end of 2014[iv]-- and incorporating a coaching system based on the landmark Diabetes Prevention Program.

Jana Care approached Continuum to partner on the development of a smartphone-based glucometer designed to work with existing colorimetric test strips, then combined it with an accompanying smartphone app to link in with its coaching and support system. This holistic approach allows patients to track metrics such as glucose levels, weight, food, and physical activity and receive custom intelligent feedback on diabetes management, delivered as a series of sixteen interactive video sessions complete with daily lifestyle tips to promote healthier day-to-day behavior. And since the system was designed to be simple and scalable, it can be supported by India’s existing infrastructure of nurse educators, bypassing the major limitation of bandwidth in a country with just one endocrinologist for every one hundred thousand diabetics. This coupling of accessible and affordable diagnostics with clinically-proven coaching methodology has allowed Jana Care to create a high value system focused on clinical outcomes.

Jana Care’s offering is enabled by the flexibility and agility of a locally-based team rather than a larger, more traditional company viewing their customers from afar. Starting with a small, dedicated team, Jana Care chose to focus its resources on the core user experience and clinical deployment, and developed a platform technology with the potential for new applications in the areas of HbA1c, lipids, creatinine, and hemoglobin testing. With Continuum’s support and in less than eight months, Jana Care has demonstrated accuracy matching strict ISO standards required for CE and FDA approval, is moving quickly towards clinical trials, and is gaining commercial traction with its first pharmaceutical partner.

Through its focus on clinical outcomes, convenience and overall value and by designing for the local opportunity rather than stripping cost out of an existing solution, Jana Care has created a system that offers significant benefits to patients while positioning itself for rapid growth. Companies—large and small—must be prepared to invest in a similar way if they are serious about new growth in emerging markets.