Startup Mantra: iCardin, a med-tech startup grassrooting neurocare -

Startup Mantra: iCardin, a med-tech startup grassrooting neurocare


For a population of 1.4 billion, there exists 2,500 neurologists in India; one neurologist per 560,000 people, as against the World Health Organisation’s (WHO) recommendation of one neurologist per 100,000 people.

Most neurologists are in tier-1 cities in India. This massive gap in neuro-care prompted Sameer More to launch iCardin, a healthcare discovery platform that offers end-to-end care for patients with any neurological disorder, such as epilepsy, Alzheimer’s, dementia, Parkinson’s, and migraine, among the many.

iCardin (Nuclius Health) is now on a mission to build the maximum number of stroke-ready centres as part of a patient-centric neuro-care programme across Maharashtra and India.

In the beginning

Sameer More comes from an IT background with core experience in software product building, marketing and business development.

After a short stint in some software companies, More founded Teevra Infosystems which helped early-stage startups and mid-sized tech companies with product marketing, sales enablement and design services.

Says More, “I was consulting with a couple of healthcare companies in the US and one of my friends there was looking for second opinion on paediatric neurology for his baby’s treatment. I could connect him to one a neurologist from the National Institute of Mental Health and Neuro-Sciences (NIMHANS) in India. During that time, I felt, a ‘second opinion’ is a critical aspect which is sought by people.”

Second opinion, first

Being from a non-medical background did not deter More from starting a medical-services company. He says, “Neurology, cardiology and cancer are chronic critical illnesses which usually lead to disability or death. So, in June 2020, we started a company providing the ‘second opinion’ to patients or their families for cancer, neurological and cardiological problems. We were doing consultations in five countries – South Africa, Dubai, Saudi Arabia, Malaysia and India. In seven months, we did 5,000 second opinion consultations. We realised during this period that 65% to 70% of consultations were about neurological disorders or problems, and most of these were from India. Further analysis of the calls revealed that more than 50% of neurological consultations were related to ‘strokes’ (commonly referred to as paralysis) by people who were suffering from it. This analysis helped us realise that besides a ‘second opinion’, there is a bigger problem that is largely unaddressed.”

The Second Opinion was purely an online model. It was successful due to aggressive digital marketing, especially during Covid.

“We could manage and control the medium and hence, we could create a good level of awareness. Our multilingual call centre got maximum calls from Mumbai, Kolkata, NCR Delhi region, Hyderabad, Bengaluru and Chennai within India. We had an eight-member team and tied up with several consultants and pathology labs,” More added.

Pivot

More and his team were primarily focussed on cardiology and neurology. Hence, their startup was named iCardin – Card stands for cardiology, N stands for neurology and i stands for online/remote operations.

While the bigger problem of cardio-neuro consultations (second opinion) still exists, More had to make a hard choice. While he was deliberating his strategy and future plans, the Covid-19 pandemic had also forced some changes in mindsets. A lot of hospitals and doctors had started offering consultation services online and hence, the second-opinion problem was being addressed to a certain extent.

Says More, “We observed that nobody talked about paralysis prevention. So, we started reinventing the wheel and we brainstormed about ways in which we can prevent paralysis. We started studying this problem in December 2020 and in next two months we realised that the ‘paralysis prevention’ aspect is missing. Although a lot of neurologists and hospitals are suggesting that paralysis can be prevented if the patient is attended to within the first four hours, almost none were working rigorously on that aspect and there was no ecosystem built around it.”

Problems identified

More and his team identified three main problems while working on the paralysis issue. First, that people were not aware of the medical conditions and primary steps to be taken if a person suffers from stroke. Even if the patient is taken to a physician or a small hospital, a lot of time is lost and there was lack of medical infrastructural facilities to diagnose and treat.

Says More, “Usually, the first call is made to a physician and by the time he checks and advises treatment a lot of crucial time is lost. Staff in smaller hospitals and their setup is inadequate to treat patients suffering from stroke since there are no dedicated neurologists and CT Scan facilities in case of critical or emergency cases. Statistically speaking, In India, of 20 people suffering from paralysis strokes, only one gets proper treatment in time, which means only five per cent get treatment on time. Hence, we thought of venturing into this space dedicatedly.”

Building an ecosystem

With just 2,500 neurologists in India, they simply don’t have the reach to cater to patients, especially in tier 2, 3 cities like Satara. Emphasising this point, More says, “Paralysis prevention is a core aspect and comprehensive neurological care is our vision. We are trying to build an ecosystem around paralysis prevention and comprehensive neurological care. Not only we lack neurologists in numbers, but we lack awareness about medical conditions like epilepsy, migraine, Alzheimer’s, shaky hands… At our call centre, three-to-four of 10 complaints are about such conditions which only a neurologist can treat properly.”

Stepping his game up, More also observed that big hospitals have a dedicated setup, but they don’t have geographical reach for paralysis prevention. Sensing a business opportunity here, he decided to tie-up with boutique hospitals. Collaborating with boutique hospitals, iCardin started expanding its network of stroke-ready and neurological care facilities.

iCardin partners with leading neurologists, neurosurgeons and physicians in India to provide emergency care as well as other services for patients dealing with neurological disorders.

‘Incubating’ neurology centres

More and his team met experts with the Maharashtra Neurology Association and 30 hospitals from December 2020 to February 2021. Says More, “At any hospital in India, the average yearly occupancy is not more than 70%. So the remaining 30% remains unused. Although dedicated neurologists are not available in smaller cities and hospitals, they have the required infrastructure and healthcare to cater to neurological patients. We came up with a business model in which we use the vacant infrastructure and healthcare staff at such facilities and we provide them with dedicated neurologists, physicians, investigation, awareness and marketing activities. Small 100-bedded hospitals, which usually get their business through one specialty, can easily get additional revenues with this model.

“Now we are extremely laser focussed on paralysis prevention. When people call on our numbers, our physicians’ guide them and become their care managers. We call them ‘Care Buddy’. The treatment for patient is then suitably decided. This way we ‘incubate’ our own neurology centres. We started our first centre in Lokmanya Hospital, Nigdi, on March 17, 2021. The second and third centre was started in Pune city in June and September 2021, respectively,” More added.

Asset-light, but operations heavy

Neurologist Dr Amitkumar Pande, with 15 years of experience as a practising doctor, was closely involved in iCardin from its initial days. It was Dr Pande’s suggestion to focus on paralysis or stroke patients that More picked up on. Says More, “He is now a co-founder and heads clinical operations and neurological research. Dr Pande brought in a very strong clinical background and iCardin had strong marketing and medical operations. We have an asset-light business model, but we are operations heavy. Apart from our core team of eight members, we have another seven-member team of medical experts on our panel, including three neurologists and two neurosurgeons. We are also talking with the Maharashtra Neurology Association as some of members have shown interest to be on our panel.”

“We are closely associated with Boehringer Ingelheim, a pharma company with strong presence in Europe and Asia and manufacturer of an injection called TPA for thrombolysis on stroke patients,” adds More.

iCardin plans to go pan-India within three years. “Big and small hospitals from Indore, Gwalior, Chennai, Bengaluru, Hyderabad are already approaching us. In next five years, we are aiming to build a full-stack healthcare organisation in neurology, where patient experience is an extremely important aspect,” More claims.

“The hospital where we run our centres provides us with requisite medical infrastructure, healthcare professionals (intensivists in ICU, RMOs in casualty) and other healthcare staff. iCardin is responsible for arranging neurologists, neurosurgeons, neuropathy, physicians trained under neurologists at the centre,” More says.

What the docs say

“Electromyography and Nerve Conduction Velocity – EMG NCV is an extension of a clinical examination when clinicians, physicians and neurologists need any confirmation for their clinical observations of a stroke patient. In both, neuropathy (nerve degeneration) and myopathy (muscle degeneration), we detect abnormal sounds and waveforms through EMG machine which indicates worsening muscles and nerves connection. The accuracy of this machine can be around 95 per cent. Nowadays portable machines are available due to which patient need not be shifted for merely conducting this test,” says Sudarshan Wankhede, Neuro Intervention Specialist; NIMHANS, Bengaluru.

Advisor speak

“iCardin is aiming to address a very relevant area in healthcare, the severity of which is unknown to a majority of the population. I am happy to be a part of the iCardin story where we are targeting the neurology space in order to create a meaningful and sustained impact in peoples’ lives, says Madhurjya Lahkar, advisor, iCardin.

Funding

More primarily comes from a B2B background. Commenting on his experience about venture capital funding, More says, “Right networking helped me a lot. Initially I was talking to healthcare professionals, doctors, neurologists who had the domain expertise from clinical and patient perspective. However, venture capital is very important for a B2B2C business model like iCardin.”

“VCs are someone who could trust our vision and team at this early-stage. I also spoke to Anand Deshpande of Persistent Systems, who is one of my mentors. In April 2021, I met Madhurjya Lahkar, who is an investment banker and also an investor in early-stage start-ups with special interest in tech. We had discussions over three months and then in July 2021 he introduced iCardin to our investor Jitendra Patel. Patel is an UK-based investor and operates the Grandbydale drugstore business in Liverpool. We pitched him and we signed our termsheet in the next 1.5 months,” More says.

•Bootstrapped (till September 2021) – Rs30 lakh

•$100k invested by Jitendra Patel



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