[Note: This article is rart of The Junction Series. We will be covering the HealthTech sector in detail at\u00a0The Junction 2017\u00a0in\u00a0Jaipur. Learn more about\u00a0The Junction here!]\r\nTo move forward, you have to give back - Oprah Winfrey\r\nNidhi Saxena is a serial entrepreneur. She has over 16 years of successful experience in companies like GE, Wipro, Hexaware and more. So her interest in healthtech is no coincidence. As she tells, \u201cIn June 2008, I started with a drug development and support company Karmic Lifesciences Inc, that I successfully exited in 2014. So, after working 6-7 years in this segment and with a thought to make a deep social impact, healthcare came out as a natural choice to me.\u201d\r\n\r\nAnd when her father, who was operated at a renowned hospital in Delhi, faced trouble with post-operative care, her conviction to step into this segment strengthened further. \u201cWhile a surgery might be 3-4 months affair, the treatment of diseases like Cancer, Alzheimer's, Parkinson's, etc. continues for an indefinable period. These patients not only require long term support or rehabilitation services but proper medical care in a positive environment. And what could be a better place than home for this - which was exactly the thought that laid the foundation of Zoctr,\u201d she adds.\r\n\r\nLaunched in January 2015, Mumbai-based Zoctr Health aims to aggregate home health, telehealth, and remote patient monitoring services, specifically targeting the post-operative care segment. The startup is backed by prominent corporate and angel investors such as BCCL\u2019s Brand Capital; Sandeep Parwal, MD at SPA Capital Services Ltd, and Organic Wellness' founder, Krishan Gupta.\r\n\r\nNow, almost after two years of launching Zoctr, with a team of 50 core members and 400 blue collar workforce, Nidhi is constantly driving the company with an aim to create an impact on people's lives and contribute to the society.\r\nZoctr\u2019s Game Changing Bets: Remote Monitoring, Mother And Child Care\r\nInitially, Zoctr kept on its radar the patients suffering from chronic and terminal illness such as cancer, stroke, cardiac, kidney, etc. Later, the company also laid its focus on post-operative care which is not long-term but acute. For instance, in cases such as knee replacement or gall bladder surgery, then the patient is on bedrest for 3 to 4 months, but requires care with precision.\r\n\r\nThe next big segment for the startup is post-pregnancy care, which involves both mother and newborn care. The segment offers a higher monetisation aspect, as the families are ready to pay higher than the normal patients as mother and the child both need to be taken care of.\r\n\r\nHowever, in the long-term, Nidhi considers remote monitoring to be the ultimate game changing plan for Zoctr. Healthcare being a people intensive business requires a doctor, a nurse or any attendant from the family to be on the patient\u2019s bedside 24x7 to have a close watch (depending upon the state of health). As she adds,\r\n\u201cWe want to change this (business) with technology,\u201d says Nidhi. She further adds, \u201cWe have proposed a bedside device or a wearable device for the patient. The device will transfer the patient\u2019s details, including his vitals, heart rate, blood sugar, blood pressure, respiratory rate and more to the doctor on real time basis. Also, with the Zoctr app, patients will be able to easily maintain a diary on their regular mood swings - an activity which helps in tracking the progress of patients with neural disorders.\u201d\r\nThe idea is to collate data remotely and get the remote doctor capable of generating alerts in case of emergency and provide the patient with the first-aid as quick as possible. He will be in a position to call up the patient, use the app to start a video chat, or even get the ambulance automatically if some parameters are met.\r\n\r\nIn simple terms, while sitting in the US, one can get access to the health details of their loved ones living in India, say their 80-year-old father, for a nominal amount. On top of it, one can also schedule regular monthly visits to doctors and the nursing staff to keep a check on their health state or actually calling the medical team only when it is required. Thus, saving money and getting the timely diagnosis without any hassle.\r\nThe Utmost Challenge: To Get A Disciplined Blue Collar Work Force\u00a0\r\nNidhi mainly talks about three challenges - affordability, brand acceptance, and management \u00a0of blue collar workforce.\r\nAffordability was a challenge and is, even today, to a great extent because medical insurance does not cover a large part of women\u2019s care. Patients are still paying out of their own pocket. The second challenge Zoctr faced was in building credibility and trust for the services among the clients. However, Nidhi believes, with the\u00a0presence in more than 67 cities, several senior doctors on the team and a website and an app to flaunt - they now have a brand name and are slowly gaining the trust of the people.\r\n\r\nThe most difficult part of starting up for Zoctr was \u2018to manage the blue collar workforce.\u2019 As Nidhi tells,\r\n\u201c Where on one side we were trying to deal with customer orientation, getting good high-quality staff posed another challenge for us. Not only there are typical discipline and attitude issues with these workers, but you can not trust if a nurse even with 10 years experience, has got her basics right. As at the end, they will be the face of our brand, it has to be sort out.\u201d\r\nIn order to combat this, the\u00a0Zoctr team focussed on building a strong fundamental base to set up a strong training and quality assurance process. For every worker that associates with Zoctr, psychographic profiling and police verification is done. While video cameras are kept for child care, the startup can also track their resources on GPS. Also, an emergency button is available in the app for patients and staff, which can trigger an emergency alarm and get the Zoctr team activated in five seconds.\r\n\r\n\u201cWe understand that gaps are still there, so we are working on creating a full proof system wherein we can train or retrain the in-house resources to make sure they are delivering high-quality medicinal expertise along with the soft skills. One can see it as a loop, binding in - training, feedback, monitoring, and quality assurance - all together," says Nidhi.\r\n\u201cWe Are Making 35%-40% Gross Margins By Focussing Only On Three Verticals\u201d\r\nThe Healthcare sector already has well-established players like Practo, Lybrate, Netmeds, Healthkart and more. Specifically, in the home healthcare segment, Portea Medical and Care 24 already own a major market share. Also coming up are \u2018Transition Care\u2019 facilities such as SuVitas- a Hyderabad-based post-hospitalisation rehab facility.\r\n\r\nNidhi accepts that there is a battle to fight. However, she also believes that Zoctr has already built pockets of profit, to make them succeed. As she explains,\r\n\u201cThe first differentiator for us is our focus on the domain. So, while Portea or other companies are focusing on physiotherapy, low-end attendant services, etc., our positioning is very clearly - critical condition care, as opposed to general care. 70% of our business is a critical business. So our billing and gross margins are much higher than any other company in India. Portea and others are not even making money on gross margins because their sales and marketing costs are huge. In our case, we are able to make 35-40% gross margin by focussing only on three verticals - Cancer, Neuro-Psychiatric\/ Geriatric conditions, and post-ICU care.\u201d\r\nTechnology forms another differentiator for Zoctr. \u201cWe manage an entire workflow wherein once you register on the app\/ website and book a nurse, within 20 minutes you will get confirmation on the booking as well us complete work profile of the nurse. Also, electronic health records of the patient are maintained, wherein the patient can be in touch with the doctor, on a real-time basis. And a doctor will have the list of patients on his\/her dashboard, where he can see the daily parameters, vitals, put any corrective action, change any treatment, talk to the patient, video chat, etc.\u201d\r\n\r\nNidhi also believes that because of its far superior technology, it is able to use an aggregator model. As she adds,\r\n\u201cWhen I say aggregator model, I mean all nurses may not be on the payroll. They are all registered on the app just like Uber drivers are registered. We are registering thousands of nurses at the backend, creating capacity every day. So, while Portea has a 200% bench cost, we have a bench cost of mere 6%, making our margins much better. Also, we are able to aggregate people via our app and are placing leads within two - three hours of booking."\r\nIoT-Enabled Wearable Devices Linked To Healthtech Will Be The New Norm\r\nZoctr is currently working with over 100 hospitals across cities such as Mumbai, Bengaluru, Ahmedabad, Pune, Delhi, and Kolkata. As claimed by Nidhi, the team is supporting 300-350 patients per month as of now and is further planning to scale to 1,000 patients per month in the next six months. \u201cThis is roughly 12K to 15K patients per year, which is pretty high considering the per patient average of INR 40K billing per month.\u201d\r\n\r\nAlso, it is planning to expand presence in 15 Tier II cities such as Jaipur, Nagpur, Lucknow, and more in a year\u2019s time with the franchise model. \u201cHere, we will be tying up with local; doctors where they can use the Zoctr brand, training, services etc., to drive local operations and we will be guiding them garnering training, marketing and leads support."\r\n\r\nWhen asked what innovations does she expect in the overall \u00a0healthcare market, which is projected to reach $62 Bn by 2020, Nidhi says,\r\n\u201cWe talked about remote monitoring and remote wearables. The next big thing is - IoT-enabled homes - like there would be sensors inside the patient's home, so when he goes to the loo, then his urine and stool will be auto analysed and the data will be available on the system which will then tell him what to eat. If he has asthma, then there would be drones who will measure the pollen count or if the oxygen supply is below a certain number, sensors will open up the oxygen cylinders automatically.\r\n"Physiological activities, whether you are waking, sleeping, excreting, happy, unhappy, all these will be captured by the sensors. Also, you will be wearing devices on your hand, which will track your vitals anytime, anywhere you go. So, IoT-enabled wearable devices linked to health tech who analyse 100\u2019s of data points daily will be a norm - this is a big innovation,\u201d she predicts.\r\nEditors note\r\nAccording to a United Nations Population Fund report, the number of people aged 60 and over in India will increase from 100 Mn in 2011 to 300 Mn by 2050. And of these 300 Mn, 200 Mn will suffer from chronic ailments such as cancer, cardiovascular diseases, diabetes and more. Another report reveals that at present the average medical expenditure of Indians in a private hospital comes to around INR 32,375. Moreover, if we talk about life threatening diseases such as cancer, then, according to a 2004 research, the spend in a home increases 36-44% more than in other households with similar demographics.\r\n\r\nThere is no doubt that startups like Portea Medical, Care24, Zoctr, who are working to provide affordable home-based care for life-threatening diseases, are the need of the hour. But in an era of constant disruption and a largely unconnected sector, whether Zoctr will be able to achieve its tall claims remains to be seen.