It feels now, when I look back, that everything that home healthcare company Portea did since its inception in 2013 was leading up to the moment that was Covid-19. Since April, Portea has managed over 1 lakh Covid-19 patients at home in six states across India and that too almost completely remotely. Very few of these patients have needed any further hospitalisation. How did Portea build this capability in the midst of a raging pandemic? That story spans seven years! Read on.
Serendipity played a leading role in getting the major players behind Portea together. In 2013, the same year I joined Accel, two Americans in Delhi, Zachary Jones and Karan Aneja, conceptualised Portea as a home healthcare venture. At that time, we at Accel were exploring the opportunity in the healthcare delivery business outside the typical hospital environment. The thesis was that the business should be able to provide any healthcare support that does not require a hospital visit and we connected with Karan and Zach. Serial entrepreneurs and investors Meena Ganesh and K. Ganesh had just exited their previous venture, TutorVista and were also exploring opportunities in the healthcare segment, as Meena had experienced first hand the struggle of getting quality care at home for a family member who was going through a chronic illness. Meena and Ganesh reached out to Accel, the stars aligned and Karan and Zach sold their idea to Meena and Ganesh and Accel and VenturEast invested in the new entity, Portea Medical.
In its first phase—the first three years of operation—Portea focused on primary and post operative medical care, like physiotherapy and nursing care. The company aggressively built up operational capabilities and established a leadership position in the market. However, it was clear even then that the market opportunity was much larger and Portea needed to move up the medical value chain. In India, hospitals are considered the only go-to option for any health-related issue, from lab tests to routine checks. In fact, statistics show that 80% of hospital visits are for non-tertiary requirements, which is why even large multi-speciality hospitals in India run their own Out Patient Department or OPD services. The primary reason for this dependence is the fact that much of primary care in India is broken and beyond the top cities, quality healthcare is a challenge. But, at the same time the growing middle class population is demanding and willing to pay for better ongoing, short-term and long-term healthcare services at home.
Portea’s plan was to offer all the possible medical support that could be provided at home and followed the inorganic route to quickly scale up services in multiple areas of specialised home healthcare operations. It acquired specialty pharmaceutical distributor MedybizPharma in 2016, medical equipment rental and seller Health Mantra India in 2016, and surgery care platform connecting patients with hospitals PSTakeCare in 2015. Through these acquisitions and through internal scale up of capabilities, Portea expanded its service offerings to include diagnostic services, post-surgical care at home, renting out medical equipment or devices like nebulizers or oxygen concentrators, and supervised delivery of specialised medication. By 2018, the company’s service expansion proved to be exactly what customers demanded and Portea was doing about 100,000 to 125,000 visits a month and was working with between 300,000 and 400,000 patients a year.
Not one to sit on past laurels, Meena and team decided the time was right to focus on Portea 2.0. As a first step, the team undertook a massive internal exercise to understand where Portea could next add value and support patients. Portea reached out to patients and key industry stakeholders like hospitals and and Key Opinion Leaders (KOL) and saw an unmet need of high-end medical care like ICU services and Critical Care that could be provided at home and realised that the company needs to move up the medical value chain even further.
At that time, when a patient was discharged after a surgery, he needed to go back into the hospital to clean up the wound and for related care. That's a perfect use case for Portea. Why would a patient want to go back into the hospital, when he or she could get that done at home? Portea knew there were strengths it could play to. Critical care and chronic disease management are two areas that need greater expertise, something Portea already had. Portea started its Intensive and Specialised Care services in early-2019 to offer specialised at home care for patients facing critical diseases like cancer or those who needed post accident or post surgery continued care, including ICU support at home. Along with that, Portea also started chronic disease management for diabetes patients.
In the beginning of March 2020, as the new service verticals at Portea had started scaling up, the Covid-19 crisis flared up in India. I remember brainstorming with Meena earlier, as both of us had done a lot of reading up about the disease and its impact in other countries. We were discussing how Portea should be at the forefront of addressing Covid-19 head on when and if the disease reaches India. Of course, none of us anticipated the magnitude or the scale of the crisis.
In the initial weeks, our discussions revolved around how we could potentially take up hotels and put up Portea staff to manage asymptomatic or mild cases. At the start of the pandemic, there was no distinguishing between patients - they were either Covid-19 positive or not. Our thought process at the time was that Covid-19 patients could be managed at such a facility where Portea would provide the medical clinical guidance and we could have doctors remotely monitoring the patient with devices enabling this process. We were also discussing converting large halls into isolation facilities.
However, in the first days of the outbreak in India the Government and its agencies and hospitals were directly managing every aspect of the pandemic response, with even private hospitals not being roped in. That changed in April as it became increasingly clear that moving everyone who tested positive to hospitals would just break the healthcare system. The breakthrough for Portea came in April, when the Delhi Government reached out to the company to assist in home management of Covid-19 patients who didn’t need to be in hospital. There were already best practices gleaned from the experience of Italy and other countries on how countries need to deliver care at home before the cases start to climb. It was clear that Portea would be able to make a big difference, as it already had many years of providing high quality home healthcare.
Portea focused on quickly ramping up capabilities and leveraged its various service verticals, from its expertise in getting medical devices to the homes of patients to remote monitoring.The company rolled out remote monitoring of Covid-19 patients first in Delhi and scaled this up to six states pan India. It had to deal with many challenges on the way and had to find solutions for them on-the-go.
One of the challenges was payments, as some governments were not able to pay or there were delays. But Portea needed to get the operations going in each location fast, as every day made a big difference in the health of patients. Portea was able to tap the grants offered by Action Covid Team (ACT), a consortium formed by Indian startups and other entities. Other organisations sponsored the remote monitoring initiatives.
Like I said, speed was of the essence and Portea built all the medical SOPS with the governments, did the process development and the technology platform modifications in a span of just two weeks.
Considering the scale and the tight timelines, Portea had to also hire hundreds of new staff, train them virtually and get them to start working remotely in the midst of a pandemic to manage the case loads!
Portea was able to rise up to this challenge with minimal hiccups and has so far managed the care of over one lakh Covid-19 patients at home. This care has also been delivered almost entirely remotely. The company has also launched this service to corporates and apartments in a significant way as the need emerged.
The ability to offer care at home so the patient feels safe and confident is the biggest differentiator that Portea has to its advantage. This is something no organisation can build on the fly in the midst of a pandemic.
Portea already had experience not just in delivering home healthcare, but also in leasing out medical equipment, administering specialised medications, critical and chronic care at home and remote monitoring. Portea has been able to provide such seamless care at scale because of the backend capabilities that it has already built and tested out in ‘normal’ times pre-Covid-19. Portea’s team was always a distributed one and remote monitoring and management were built into all levels of Portea’s processes.
Portea already had end-to-end care protocols in place, when it came to managing patients at home as in regular times also its business is focused on care coordination. The only real difference in Covid-19 home healthcare was that patients needed to be monitored completely remotely as much as possible. It was able to leverage its expertise to come up with the protocols for home isolation, like what vitals to be checked and tracked, the systems to record each patient’s vitals, number of checkins by the staff per patient per day. Even when it came to the Covid-19 home care medical kit, Portea’s expertise was useful in deciding what needs to be included. The home care kit includes everything from basic medicines like Vitamin C to pulse oximeters to track the blood oxygen level. This kit is enough for the patient to be isolated at home for 14 days from a medical care point of view. Plus, the price of such kits is a sensitive matter for the government as people across income levels need to be able to afford the kit. Portea was able to make the kit exhaustive and affordable.
Portea’s capabilities in offering Covid-19 care at home to those not requiring hospitalisation has been recognised by the Governments and others. For instance, recently in Karnataka Portea along with another company won the tender to manage the home quarantining of patients in the state. Similarly, within Swasth, the voluntary consortium of over 100 organisations and other stakeholders in the healthcare sector, Portea is steering the home healthcare piece. With the number of infections and cases continuing to climb even at the time of publishing this post, delivery of Covid-19 care at home is a very important focus area for all state governments and Portea’s well-tested capabilities will hold it in good stead.
Portea is now discussing with district and state governments on other areas it can provide support, like remote monitoring of ICUs in smaller districts so patients do not have to travel to cities for getting care and losing precious time in transit.
As the team starts creating its vision for Portea 3.0, the Covid-19 experience will be useful and will shape its next phase. There are still gaps in the healthcare service cycle for a patient, especially in preventive care and continued care. Portea has shown before and during Covid-19 that delivering quality healthcare support to patients at home is an important link in the healthcare ecosystem. Covid-19 has made it even more clear that home healthcare will be an important pillar for healthcare in India and globally.