Unlocking the Next Healthcare Frontier (Pt 2) - Can India Lead the Global Surge in Concierge Medicine?

In our first article, we explored the emergence of concierge medicine in the US, where doctor-led models operate independently, often outside traditional healthcare frameworks. Positioned as replacements rather than extensions of conventional care, these models underscore the healthcare system's shift toward privatisation and personalised care. While concierge medicine is disrupting the US  healthcare system by addressing the systematic inefficiencies in primary care, its implications for India will follow a very different trajectory.

Concierge Medicine in India: Enhancing, Not Replacing, Existing Healthcare

Concierge medicine in India is rapidly emerging as a valuable addition to the existing healthcare system, offering personalised care that helps patients navigate the complexities of traditional healthcare. By delivering tailored services and dedicated attention, it addresses gaps in accessibility and enhances the patient experience, enabling individuals to maximise the resources available in both public and private sectors. Rather than replacing the existing system, concierge medicine will work alongside it, providing a more efficient, patient-centric approach.

The growing demand for such services is further catalysed by India’s evolving healthcare infrastructure, creating an environment where concierge medicine can thrive and contribute to improved healthcare delivery:

Healthcare in the Digital Era | ABDM

Launched in 2020 as part of the Digital India Campaign and aligned with the National Health Policy, the Ayushman Bharat Digital Mission (ABDM) aims to create a secure and interoperable health information network that enhances accessibility, affordability, and efficiency in healthcare delivery.

At the heart of ABDM is the Digital Health ID (ABHA), which empowers citizens to manage their medical records with portability across healthcare facilities. The Health Facility Registry provides visibility for registered providers, while the Health Professional Registry connects verified professionals for seamless care, including remote consultations. A user-friendly app securely stores and shares health data, with the integrated Consent Manager ensuring strict privacy compliance in line with India’s Digital Personal Data Protection Act.

To achieve these goals, ABDM prescribes common health data standards and develops core modules, including registries for health facilities and healthcare professionals, to enable interoperability. This facilitates seamless data exchange among healthcare providers, even when they use different digital systems. By digitising healthcare processes and integrating diverse resources, ABDM aims to bridge gaps among stakeholders and create a unified, efficient healthcare ecosystem.

Expanding Healthcare Coverage

The PMJAY is to ensure financial protection against catastrophic health expenditure and access to affordable and quality healthcare for all.  The budget allocation was increased to INR 7200 crores in FY 2023-24 – a threefold increase since its inception in 2018-19.

PM-JAY is the largest health assurance scheme in the world, covering over 10.74 crore poor and vulnerable families (~50 crore beneficiaries) that constitute the bottom 40% of the Indian population who will receive an annual health coverage of Rs. 5 lakhs per family, for secondary and tertiary care hospitalisation. Since its inception 5 years ago, this scheme has facilitated over 59M hospital admissions, amounting to a cost exceeding INR 74,000 Cr (Source). Currently, the scheme provides 919 Health Benefit Packages (HBPs), covering 1,670 procedures under 26 specialities.

In 2022-23, General and Health insurance companies covered 55Cr lives under 2.26Cr health insurance policies and collected INR 89,492 Cr as health insurance premiums, marking a 23% growth from the previous year.

During the same period, General and Health Insurers have settled 2.36Cr number of health insurance claims and paid INR 70,930Cr towards the settlement of health insurance claims. The average amount paid per claim was INR 30,087.

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Flipping the Script: How India’s Healthcare Challenges Make it Perfect for Concierge Medicine

In India, primary healthcare/family medicine operates differently than in the West, with patients having direct access to primary care providers. While there are opportunities for improvement, a notable challenge exists in tertiary care, where the patient journey tends to be complex and fragmented, ripe for concierge medicine solutions. The tertiary healthcare system has primarily been focused on interventions rather than comprehensive, continuous care. Additionally, most processes operate in silos rather than as part of an integrated, cohesive framework.

India faces a unique healthcare paradox: patients require greater access to quality, affordable hospitals, while doctors seek a larger patient base.  Despite accounting for 20% of the global disease burden, only 40% of hospitals in India offer high-quality, advanced treatments. This challenge is compounded by low utilisation rates across hospital infrastructure, even among larger chains. In the top 60 cities, hospital infrastructure utilisation remains below 30%, rising to only 60% in the best-performing larger chains.

In India, the concierge medicine model takes on a unique dynamic, flipping the narrative seen in the U.S. on its head. While in the U.S., concierge medicine addresses overburdened healthcare systems, in India, it has the potential to tackle the low utilisation of healthcare infrastructure.

On the provider side, this model can transform underutilised hospital resources and idle capacity into efficient, premium care delivery systems. Optimising existing infrastructure allows hospitals and doctors to engage more meaningfully with patients, improving outcomes and operational sustainability.

From the patient's perspective, the core purpose of concierge medicine remains universal: providing better, personalised, and accessible care. For Indian patients, this translates into bridging the gap between quality and affordability, ensuring access to advanced treatments and a superior healthcare experience tailored to individual needs.

While the drivers of concierge medicine may differ between the U.S. and India, the ultimate goal - health outcome and patient experience - remains steadfast.

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Indian Tertiary Care Market is Primed for Concierge Medicine

The patient journey in India is nuanced, with healthcare historically focused more on core intervention than continuity of care. This often leads to fragmented services, where various components of the patient journey operate in silos rather than as part of an integrated process. As a result, care coordination and long-term health management are often inadequate, highlighting the need for a more cohesive and patient-centric healthcare model.

To tap into the Indian tertiary healthcare, the concierge healthcare models must work in tandem with providers, patients, and payors, rather than simply emphasising privatisation. While certain aspects of the value-based care journey may involve out-of-pocket (OOP) expenses, the core interventions must align with payor considerations to ensure accessibility and affordability.

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State of Tertiary Care in India

India's healthcare expenditure reached $150B in FY20 and is expected to double to $300B. Approximately 70% of this expenditure ($105B) is allocated to in-patient care, with surgeries accounting for over 70% of spending in this category.

India conducts around 30M surgeries annually, which is significantly below the country's actual needs as outlined by the Lancet Commission on Global Surgery (LCoGS). According to LCoGS, low- and middle-income countries (LMICs) require 5K surgeries per 100K people annually to address the surgical burden of disease. Given India’s population of approximately 1.4B, this translates to a need for ~50M surgeries per year.

The rate of surgeries in India is somewhere between 166 and 3,646 surgeries per 100,000, depending on the setting, population, and other factors. This falls well short of the estimated requirement and highlights a significant gap in surgical care.

As India continues its developmental trajectory, there is potential to align its healthcare infrastructure with global benchmarks, achieving a standard of 23,000 surgeries per 100,000 people - a level observed in high-income countries.

There are several untapped clinical pathways across different stakeholders:

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HexaHealth | Scaling Concierge Medicine in Tertiary Care

HexaHealth is an integrated healthtech platform designed to offer a comprehensive, one-stop solution for surgical services, with a clear focus on enhancing health outcomes. The company is creating a patient-friendly and transparent continuum of surgical services.

‍Creating a Patient-friendly & Transparent Continuum of Surgical Solutions

In the surgical care journey, the pre-operative and post-operative phases are often overlooked, despite being rich sources of critical patient data. This data holds the potential to significantly influence surgical interventions and, ultimately, improve health outcomes, yet it remains underutilised in shaping care strategies. HexaHealth works with various stakeholders, across providers, patients and payors to bridge the gap, ensuring that every phase of care is accounted for and optimised to deliver better patient outcomes.

• Pre-op: From the pre-surgery stage, they assist patients by providing essential information about their condition, procedure care, and access to the right doctors and hospitals. They also streamline processes such as insurance clearance, pre-authorisation, and financial assistance.
• During the surgery or hospital stay:  HexaHealth supports patients from admission to discharge, ensuring a seamless experience while providing regular updates throughout the process.
• Post-surgery: HexaHealth goes beyond basic care by offering comprehensive guidance, coordinating follow-up appointments with surgeons, and facilitating essential services such as diagnostics and physiotherapy. Additionally, the company provides specialised programs in critical areas like eye care, weight management, and liver transplants, solidifying its position as a leader in delivering unparalleled patient experiences.

‍Seamlessly Integrated into the Healthcare Ecosystem

HexaHealth enhances, rather than replaces, existing healthcare providers. By delivering high-quality leads and boosting provider utilisation, addressing the underutilisation discussed earlier, it creates a win-win for all stakeholders.

The company has established partnerships with over 350 hospitals, including marquee names such as Manipal Hospitals, Narayana Health, Apollo Hospitals, and Artemis Hospitals, among others. Notably, these are deep, strategic engagements secured through multi-year contracts, reflecting the trust and value HexaHealth brings to its partners.

HexaHealth serves as the primary platform for all surgical requirements for patients, while also aiding payors in demand generation, cost savings, and customer retention.

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Delivering Outcomes That Matter

HexaHealth is dedicated to creating a seamless healthcare continuum by collaborating with all stakeholders and keeping patients at the heart of its mission. Built on a foundation of trust and measurable health outcomes, the company stands out as a trusted ecosystem partner.

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This commitment has resulted in $20M in annualised GMV, over 1,000 surgeries performed each month, and, most importantly, enhanced health outcomes.