Thoughts on India's femtech market
After researching the Indian women’s health tech space recently in detail, sharing some key findings & insights about the market -
Female health market can be classified into three segments primarily -
PCOS/thyroid problems
Pregnancy and related problems
Menopause
The majority of health issues faced by a teenage girl to an old lady can be covered in these.
Typical behaviours women showcase in offline vs online settings -
Offline - If they already have a doctor/gynaecologist in the same city they live, there is a very less chance that they will go change their doctor. Even if the doctor is unavailable, they will wait, go back to the same doctor again and again - find appointments , when the doctor is available. They wont try a new doctor unless the existing one has a problem, or they have a new problem which the doctor cannot address.
Online - Digitally, women are always up for experimentation. Maybe we should go try that platform out, see if the solution is better. Their behaviour seems pretty different from offline than online. So as a company, its difficult to retain the customers for a long period, because they are just trying your product out. Habit formation as it happens in offline settings does not end up happening in online.
This tendency of women while using online solutions is that they like to try. They like to compare something out there that's better than what they are currently using. You see this happening in skincare, clothes, footwear etc and the same happens when trying out online healthcare solutions. Your product solution can help in going from say point A to B , in spite they are always in search of a newer solution that can take them to point A to Z. Also the friction to try out is quite low in an online setting. So many women just come to visit platforms for experimentation. (Even in case of PCOS, they are always searching)
This creates a problem for many companies who are offering just online solution, as habit formation becomes challenging.
But what comes out as a striking behaviour is that women are hesitant to pay; even for their own wellness, until it becomes a burning problem. Even if they are earning, there's still very little willingness to pay in our society.
Yes, this behaviour is changing (as seen prominantly in urban women), but it's still quite slower than it should be. The vast majority of Indian women are yet to catch up. This can partly be attributed to cultural conditioning of always deprioritising their health over their family’s.
So the question while building femtech solutions isnt whether the problem statement they are trying to solve exists or not. Or whether you can appropriately solve the problem. It's more on the willingness of users to use your solution (beyond just trying) and pay for it, that's a bigger thing to crack.
If you are building an online solution for female health, things to keep in mind -
For women, sharing intimate details about their health, especially about your periods or your pregnancy or your sexual health, they're not super comfortable unless they know who they're speaking to.
In an online scenario, if they have to do the entry on the phone, they are happy to enter. But if they have to talk over the phone and explain it to the doc, they are hesitant.
When we talk about women’s health, the majority of times it requires at least one scan. Starting from something as simple as an ultrasound. Ex - PCOS also needs an ultrasound. So everybody in every stage needs a scan (scans are different from blood tests). Which means a physical touchpoint becomes necessary if you are to provide value to the user. Otherwise the user has to end up figuring out everything by themselves if you only provide a consultation touch point.
The ‘care continuum’ (end to end care) model breaks when the user has to visit multiple touch points to get the full care required. If you are able to cover the entire journey of patient care, the value provided in terms of recovery is much higher, which means you are able to retain patients more. And from a business model perspective, you are able to earn more across different services & reduce CAC across each of them.
(For ex - Care continuum for PCOS would look like - Symptom checker, Doctor consultation, Lab tests, Ultrasound, Treatment plan, Nutritionist, Health Tracker, Required doc checkins while in treatment)
Acquiring doctors -
One model is where the doctor takes the entire or a percentage fee you charge the patient. Here it doesn't matter how many patients visit.
Another model is where you have to commit to a certain number of patient visits to the doctor. For ex - in a month, you will have at least 100 visits from the platform. But at the very beginning until you build such a demand, it becomes difficult to commit as your economics takes a hit.
Extremely popular doctors ask for huge amounts of money. Their expectations aren't based on whether you get them a patient or not. They need payment for the time they are coming irrespective of getting a patient.
4. But the bigger problem is that if you want people to trust your platform, you need to bring doctors who are trustworthy, not the kind playing around with patients.
How would you judge a doctor? It's difficult. From a legal standpoint, you can do the doctor KYC. But from an experiential standpoint, it becomes hard to judge. How is their behaviour, how are their results with their past patients? And you can't ask details about past patients to talk to, due to doctor patient confidentiality.
While the monetary part is something that you can sit and discuss and agree with the doctor. But the difficult part is to evaluate, is this the right person for the platform?
From a Business Model perspective-
- Providing just a consultation service is hard to scale or break even
- Consultations dont have high margins even if online; and if you increase prices it reduces demand unless you’re in a premium segment.
- If you just build a specialty teleconsultation service, its hard to retain users. They already get this service and similar doctors on Practo so why would they choose your service if theres no differentiation?
- Habit formation in online is tough, hence retention is harder
Pairing with products or physical services so as to provide a care continuum helps improve retention and customer LTV. When you provide touch points of different services, CAC reduces as you don't have to acquire users multiple times.
Even from a market perspective, there aren't many only online services existing anymore.
Cloudnine is speciality for pregnancy & has offline operation. Procedures are where the majority of their revenue comes from. Consultation helps in acquiring users, who then convert as customers for offline procedures.
Whats missing & can be built-
- What seems to be missing from a solutions perspective is end to end care with a very detailed digital journey coupled with a physical touch occasionally. You come to us and we take end to end care of you without you feeling lost in the system, taking the burden off of figuring out who I need to see, where can I get my scans/tests data, what specialists to talk to physically, track your treatment journey digitally
- This could have scope because outside of a larger hospital or an independent practitioner, there is no middle ground or specialty clinics for women. Either you have a gynaecologist sitting in their own clinic or you go to a multi specialty. There's nothing in between. And these are extremely physical spaces, they're not digital journeys.
- The product could look like for ex- there’s a user looking to get pregnant. Minute they start thinking about it, they’ll go talk to a doctor asking what do I do? The doctor tells you, watch what you eat, keep an eye on your ovulation cycle, what is your hormone level etc. And the things you should avoid doing.
So the goal is to kind of make this a physical as well as a digital journey for the user. This journey is completely different from someone who will come and say my periods are irregular. Depending on the user’s concern, the app has its own journey
- Ex- For somebody with a period problem - it could be very early stage PCOS, PCOS already diagnosed or a thyroid problem. These are three different journeys in that first bucket.
Then for fertility journey, there could be three buckets - one, you're looking to get pregnant. Two, you're already pregnant. Three, you have trouble getting pregnant.
Then on the menopausal side; menopause as a concept is generally thought as a very linear concept, thinking women go through same menopausal issues. But a lot of women have a lot of other issues around menopause, especially around endometriosis or osteoporosis and these would have own set of journeys.
- And a lot of these problems have to do with your in person visits, scans, tests.
Building a digital product for all these use cases without confusing the users could be complex, but there needs to be a way to track your end to end health both digitally and physically (maybe having a Swiggy interface which has different usecases on bottom nav bar and these individually have their own journey once clicked on)
- And from a business model perspective, users interact with the product through two channels- time they spend on the digital platform (X), and time spent in physical touchpoints like clinics or labs (Y). The value user derives and pays for will come from both, the total experience i.e X + Y. However, the revenue today will be largely driven by Y.