Seeing people in pain and finding a solution for them wasn’t new for senior surgeon and breast cancer specialist, Dr Sandhya Ravi. But one evening, she couldn’t help but feel a little pensive and dejected – she had diagnosed three young women with breast cancer.
Unfortunately, this is far too common. Studies show that at least one woman is diagnosed with breast cancer every four minutes in India.
An alarming 17.3 lakh new cancer cases are likely to be reported by the end of 2020, according to a Cancer India Statistics report.
But why the three women being diagnosed with cancer hit home harder for Sandhya was because during their checkup, she realised that all three could have prevented breast cancer if they had made the right lifestyle choices.
Keen to do something, she got in touch with her friend, Sudhir Pai, a CA, who was, at that time, the CEO Of Vikram Hospital. They discussed at length how and why lifestyle and noncommunicable diseases were growing.
That discussion culminated in Prameya Health, which they launched in 2016 in Bengaluru. The healthcare platform works as a preventive and supportive care provider.
“The vision of Prameya Health is to build healthy communities by empowering individuals to take charge of their health, lead a healthy lifestyle, and be happy,” Sandhya says.
Soon, Ranga Shetty, a healthcare technologist, came on board as a co-founder. Ranga brought with him over three decades of experience in the IT sector, both in the US and India, and has been nurturing startups in the healthcare-IT industry.
Prameya has designed programmes with evidence-based protocols for preventive and supportive care. The team believes in the holistic Functional, Emotional, Nutritional and Spiritual (FENS) methodology. The programmes are broadly categorised as follows:
1. SAHAI FENS Cancer Support Programmes: These are specifically targeted at the unmet supportive care needs of patients with cancer. They include awareness sessions, lymphedema care, cancer nutrition, yoga therapy, grooming and prosthesis support, art and dance therapy, relaxation techniques, etc.
2. Arogataam Programmes: Lifestyle change programmes to help individuals reverse lifestyle diseases such as obesity, diabetes, hypertension, high cholesterol, fatty liver, and PCOD.
3. Pragnyaa: These wellness programmes are designed for musculo-skeletal disorders, breathing problems, and cognitive impairment.
How does the model work?
The team follows two models of delivering the services. The first is through tailor-made individual sessions that can be delivered in person or through the platform; the second includes group therapy sessions, which are delivered at a physical centre.
“For the Lifestyle Change programmes, we begin with a wellness assessment, doctor consultation, and fitness assessment. These assessments help develop a baseline for the patient and work out a possible outcome. This sets the right expectation and gives the patient a clear path,” Sandhya says.
For the cancer support programme, they start with a free awareness session. The aim of this awareness sessions is to give a snapshot of the extended programme and allow doctors to assess if the patient is ready for the programme.
The three-month programme begins with a goal setting session followed by a series of sessions such as yoga, nutrition, counselling, relaxation, meditation, lymphedema care, grooming, using prostheses and wigs, and dance and art therapy.
The fees range from Rs 750 for one nutrition consultation to Rs 9,000 for a three-month group therapy session for cancer patients. The three-month personalised Lifestyle Change Programme is priced at Rs 29,000.
Building the team
Sandhya explains that the infrastructure costs to set up a centre are minimal as the main requirements are a hall with the right ambience to accommodate a batch size of at least 15 people for group sessions and a few consultation rooms for one-on-one consultations.
“Working capital requirements for putting a team together, writing protocols for each session, creating collaterals etc. were the major investments in the first 24 to 36 months. Tech intervention is critical for reaching out to a larger section of society and costs of building online delivery platforms are also quite significant,” she says.
Prameya has spent close to Rs 1 crore in creating infrastructure, protocols, POC, etc. in the last four years.
The philosophy of Prameya was to offer a healthy life with a holistic approach and reduce/ eliminate dependence on medication. So, they decided to build a team of nutritionists, fitness experts, counsellors, and doctors.
Dr Lalitha Priya, a senior nutritionist and an associate of Dr Sandhya, joined, followed by Swati Raghavendra, a senior yoga therapist specialising in restorative and therapeutic yoga.
Dr Sandhya’s long-time friend and associate Dr Bapsy, a senior oncologist, decided to step in as an advisor and start the Sahai cancer programme. A renowned oncologist with an experience of four decades, she worked with Dr Sandhya to put together a team of oncologists, psycho-oncologists, and counsellors to address the unmet needs of cancer patients.
Anuvinda Sadanandan joined as a psycho-oncologist to help cancer patients cope with their diagnosis and treatment-related emotional and psychological problems. Madhusudan Bhavaraju stepped in to help with marketing activities and the development of the tech platform, while Dr Shravya Shiva runs fitness and dance therapy initiatives.
While most people understand the importance of lifestyle changes and preventive care, many look for quick-fix solutions.
“The sheer volume of patients and workload puts all these professionals at a disadvantage. It is more challenging and difficult to offer a platform to educate and guide patients to change lifestyle sustainably, than it is to prescribe medications,” Dr Sandhya says .
In case of patients with diseases such as diabetes, hypertension etc, the determination of the individuals to follow a disciplined lifestyle is lacking, she explains, adding that busy lives make it tough to find time to think of staying healthy and fit.
“The challenge for cancer patients and their families is the acceptance of such a devastating diagnosis , getting ready for treatment, high cost, running around and coping with disruption of routine etc. The thought of supportive care, taking nutritious food, maintaining optimum fitness levels, building mental strength to go through treatment, etc. takes a backseat, even though it’s one of the most important aspects of treatment and plays a major role in getting best outcomes,” Sandhya says.
The third and most difficult part is the willingness to pay for such things. Initially, the team modelled the concept on preventive healthcare and focused on primary prevention by connecting to individuals who had no disease but had risk factors for lifestyle-related diseases.
“The response was so poor that we had to change to secondary prevention, support, and reversals. We realised Prameya is not going to be an overnight success. We have to make people understand this really works, is beneficial in the long run, and therefore worth paying for.”
The promoters of Prameya come from a strong research background. So they decided to use the free programmes, which was a proof of concept , to work on a research publication.
“We completed a study of our model and presented at one of the prestigious oncology conferences in Singapore, and were awarded the best poster at the event. We also tweaked the offerings so a patient could opt for a single session instead of a complete three-month package. This helped patients to enroll for specific needs and experience Prameya,” Sandhya says.
Building a differentiator
According to recent estimates by FICCI and EY, the wellness industry will grow at a CAGR of nearly 12 percent for the next 5 years, and reach an estimated high of Rs 1.5 trillion by the end of 2020. The growth is being attributed to the increase in disposable incomes and rising prevalence of non-communicable diseases.
There are startups like AyurUniverse, which combines Ayurveda and wellness, and Carer, Samara Mahindra’s startup focused on a holistic approach to cancer care. Prameya, focused on a FENS model, offers a mix of support and preventive care.
The team claims to have made a revenue of Rs 80 lakh, 50 percent of which has come in FY20.
“We will investing another Rs 1 crore to develop a tech platform for online programmes . The set-up time, including team and protocols, for the first centre is about 12 to 15 months. For subsequent centres, it will be less than three months,” Dr Sandhya says.
(Edited by Apoorva Puranik)
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