Glocal aims to be a protocol and technology driven model facilitated by doctors – Express Healthcare

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Dr Sabahat S. Azim, Founder and Chairman, Glocal Healthcare Systems in interaction with Viveka Roychowdhury talks about Glocal’s journey so far, major milestones achieved, future plans and more…

As a doctor, you joined the IAS, but quit to become an entrepreneur “to fix the healthcare system in India”. Can you explain how Glocal Healthcare Systems, which you founded in 2010, is different from other healthcare facilities available in India?

When I quit the IAS to start Glocal Healthcare, the idea was to develop a model that would take healthcare where it does not reach, at a price point that most people can pay and quality that they deserve and can trust. For this, we had to re-imagine the way modern healthcare is designed and delivered. We focused on the principles of Lean Healthcare and standardisation to take healthcare to the masses.

We adopted a zero-based approach to design and costing. The focus was on reducing capital expenditure by focusing on the most needed services and providing high clinical excellence in them. With iteration, we were able to build the lowest cost hospitals in the least time in India. Glocal hospitals are in tier 3 cities, where most organised chains do not work. These hospitals are among the better designed hospitals in terms of efficiency and economy yet adhere to all quality parameters. The design effectively optimises the movement of man and material, thus maximising efficiency and reducing costs by eliminating excess space in the buildings.

Instead of being a doctor-driven model, Glocal aims to be a protocol and technology driven model facilitated by doctors. While good doctors are the core of any healthcare service, protocols allow for ensuring good quality care that is independent of the skills of the doctor. We realised that acute care is most in demand in smaller towns and rural areas. Our protocol based model helped our hospitals specialise in acute care. Glocal hospitals are good at saving lives. The survival rate in our ICUs is close to 90 per cent, which is much higher than the national average and even higher than the US.

Primary care has been a difficult model to crack. To solve the issue of high costs and unavailability of doctors in rural areas, we leveraged technology. We coded the entire medical knowledge, humanly impossible for a doctor to remember, into a semantic clinical decision support system, with machine learning capability. With integrated devices and the technology platform, our digital health solution is like “healthcare in a box” which can help doctors efficiently provide quality healthcare for the majority of the cases even in areas where they cannot physically reach. The standardisation based on evidence-based protocol reduces medical errors making healthcare more accountable. Thus, all our clinics are “Digital Dispensaries” in rural areas, where doctors join digitally from cities.

Because of all the above, Glocal facilities are able to provide the lowest cost healthcare services in the organised industry in India, with patient satisfaction in excess of 96 per cent.

How has Glocal managed its cash flows to be sustainable over the last 13 odd years, as your model is not completely profit driven?

Managing the cash flows has been a roller coaster ride. Glocal became profitable in 2015 serving the poorest of the poor, as 85 per cent of its patients were the poor covered under RSBY. However, the administration of the policy changed hands and things started going downhill. We finally stopped RSBY patients, but a large part of our payment remained pending. We had to re-invent the model, where patients would directly pay for the services they received. This also meant moving out of very small and poor areas for viability. We went through a painful process of converting to a cash business when demonetisation happened. We incurred heavy losses during this period. We raised two rounds of bridge financing to stay afloat. We led an exercise on cost cutting and conserving cash. By 2019, we were back to profitability.

What is your response to US based UpHealth’s claims that after paying around Rs 2,100 crore in cash, stock, and debt to acquire 94.81 per cent of Glocal, they have not been allowed to take over management control?

Glocal and its shareholders entered into a Share Purchase Agreement on 30 October 2020 with UpHealth Holdings which is a wholly owned subsidiary of UpHealth Inc., a company based in the US. However, it was later realised that UpHealth Group committed egregious fraud on Glocal and its shareholders and the $110 Million worth of shares that it issued as a swap to the shareholders of Glocal where shares worth a very negligible amount and the warranties that UpHealth gave in the SPA and Options Agreements were false. Besides the growth capital that it had committed to Glocal was never infused, and the autonomy to Glocal which was promised through the Board position in UpHealth Inc. was not given. Besides, UpHealth committed various acts of destruction of value and data theft.

Accordingly, Glocal filed appropriate complaints with the police which were registered as FIRs 196/2022 and FIR 105/2023 in Technocity Police Station on 15th Oct 2022 and 1st June 2023. A forensic report by Alvarez and Marsal and legal opinions were also submitted. These are under active investigation. It also filed cases in the NCLT and the Commercial court while UpHealth Holdings started an arbitration against Glocal and its shareholders which is pending.

UpHealth got an emergency arbitrator order asking Glocal to submit its financials to the auditors of UpHealth and for both UpHealth and Glocal to refrain from using the share application account until pendency of suits. This order was enforced in the High Court of Calcutta, which is under appeal.

Meanwhile the Commercial Court in Rajarhat on the anti arbitration suit filed by Glocal, while abstaining from giving an ad interim injunction before UpHealth has filed its rebuttal, determined that prima facie a criminal fraud has been committed by UpHealth Inc. which needs a full fledged trial. Glocal has accordingly issued a Notice to UpHealth Inc for termination of the SPA. Separately, UpHealth Inc. plea for dismissal of suit against them by their own shareholders has been rejected by the US Delaware Court of Chancery and will proceed for trial. These cases are all sub judice and decisions will be taken by the appropriate courts.

On 14th September 2023 in another case filed by Needham & Co LLC against UpHealth Holdings for non payment of fees, the Trial Court in New York awarded $31 Mn plus interest to Needham, for the liability they had hidden from their books. As a result, UpHealth Holdings Inc., with whom Glocal and its shareholders had executed the SPA, has filed for Insolvency under Chapter 11 in the US. It also proves that they never had the money to pay for their liabilities and were defrauding everyone. Filing of the Chapter 11 case also means that their debt of about $172 million becomes payable immediately even though the enforceability of collection would get delayed through the proceedings. It implies that UpHealth Inc., the parent of UpHealth Holdings Inc., is also effectively insolvent right now and the NYSE has stopped trading of UPH shares. The net value of UPH shares that were allocated to Glocal’s shareholders is zero. This has been a gigantic fraud on Glocal and its shareholders.

Glocal received Express Healthcare’s Public Health Award for adopting digital dispensaries in Nabrangpur, Odisha way back in 2018. What are the more recent projects taken up by Glocal to address accessibility and affordability issues, as most quality healthcare facilities tend to be concentrated in metros and there is a lack of such facilities in rural areas?

We are grateful for the recognition offered by Express Healthcare. After the Digital Dispensaries (DD) in Nabarangpur, Glocal expanded the model to several underserved and remote rural areas. We expanded from two to 15 DDs in Keonjhar. We set up an additional 38 DDs in Odisha with support from the National Health Mission.

We evolved a larger version of the digital dispensaries in Kachchh, Gujarat, with one onsite GP doctor, full-fledged lab, and an ambulance.

In 2021 we started a project in MP to offer Specialist Doctor consultations through Digital Dispensaries in 550 rural PHCs across 20 districts.

Another landmark achievement was setting up an advanced acute care digital hospital, with a long lasting permanent structure of steel and glass, in Dimapur, Nagaland in just 100 days in 2021.

How has Glocal evolved over the last 13 years? What would you count as the major milestones from a corporate perspective and secondly, from a patient health PoV?

Glocal started in 2011 with a 30-bed hospital in a small town called Sonamukhi in West Bengal. We went through several iterations, a 50-bed model and finally in 2015, a 100-bed acute care model which is viable in a tier 3 or tier 2 city with a population of 1 lakh+ and a catchment population exceeding 1 million. This was a major milestone – a hospital model that works for smaller towns in India, serving the poor, saving lives and is financially viable. In 2016, a 38-year-old poor patient who was clinically dead was revived by our Krishnanagar hospital team. Since then, we have established ourselves as experts in acute care.

We used the data from our hospitals to develop the digital technology for primary care. We set up the first Digital Dispensary in Mousuni, an island in the Sundarbans. People who were not even connected to an electric grid, for the first time had access to modern healthcare – a major milestone. We have progressively refined and improved the digital dispensary and extended our reach to some of the remotest parts of India. The next milestone was proving the digital dispensary at scale, which happened in 2021, running more than 600 digital dispensaries. In 2021 during COVID and in the face of adversity, we built HelloLyf HX, a 200-bed acute care digital hospital for the Government of Nagaland in just 100 days. This is India’s first completely digital, state of the art hospital made to last and withstand the highest level of seismic activity, built in record time and cost. In 2022 we crossed 1 million patients annually, on our way to serving 2.4 million patients annually.

How has Glocal leveraged new age tools like digital health, telemedicine, as well as medtech advances like PoC devices to expand their reach to deserving poor patients? Any stats in terms of patients treated, improved patient outcomes etc.

Glocal has successfully maximised the use of technologies like the Internet of Things (IoT), Point of Care (PoC) devices and Artificial Intelligence (AI) in the delivery of healthcare.

Litmus DX, an AI-enabled Clinical Decision Support System (CDSS) based on standardized, evidence-based protocols for improved quality and reduced medical errors, forms the backbone of our services.

Litmus MX is a physical health terminal integrated with IoT and PoC devices, providing complete primary and emergency healthcare including remote patient examination, tests, investigations, diagnosis, patient information gathering, health record management and doctor consultation through a centralised digital platform.

These technologies power the digital dispensary of Glocal, which takes modern healthcare to the remotest corners, wherever 3G internet is available. Glocal has cumulatively run more than 800 digital dispensaries. Glocal offers digital doctor consultations to 6000-7000 patients every working day, at this rate it will serve more than 2 million patients in a year. In an independent survey 94 per cent of the patients were found to be BPL. About 99 per cent telehealth patients found the digital dispensaries accessible and 100 per cent rated the services above average.

About 6 per cent of the patients have been diagnosed with non-communicable diseases like diabetes and hypertension, which are being managed through Specialist doctors’ advice. It will take a longer term study to prove the improvement in health outcomes.

What are the future plans for Glocal, especially on the UpHealth front?

We believe that it was never the intention of UpHealth to run or grow Glocal Healthcare. They have defrauded Glocal and its shareholders. They never provided the growth capital they promised and stalled our own efforts at it. UpHealth Holdings has filed for Chapter 11 Bankruptcy and the various cases are sub-judice, which the courts will decide. Meanwhile, Glocal’s work of providing affordable healthcare to the poor and underserved will continue unhampered. Both the hospital and primary care model have been proven at scale. The HelloLyf HX acute care digital hospital is the template for future hospitals. We are ready to scale up.

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