253: Why Healthcare Startups Fail in India | Dilip Kumar (Rainmatter)

Speaker A: Healthcare is very complicated. And when you speak about in the Indian context, it becomes even more complicated because we are dealing with a population size which is unique in the world. Now, to suddenly come in and infuse technology and say that, hey, I have a magic LLM model which is going to solve for everything, it's a very hard pill to digest. We are not a, uh, country which would always appreciate premium. I fundamentally believe that anything which can drive an outcome is good. So earning trust is very important and earning trust is very hard. You can't earn trust quickly. That makes this building business in healthcare super. Dilip Kumar is an entrepreneur turned investor, podcast host and endurance athlete. After a remarkable health transformation, he's channeled his passion into helping others scale both startups and themselves foreign.

Speaker B: Welcome to the Startup Operator podcast. Thank you so much for making the time.

Speaker A: Thank you, Roshan. Look forward.

Speaker B: Yeah, so I've been following on X for a while and you put out these really thoughtful threads on healthcare. Uh, great summaries for anyone who is not from the sector. I mean, who can kind of look in and find out what is happening there, uh, really in India, I mean, there's just so much potential, uh, to solve really large, meaningful problems in healthcare. So this podcast, I really want to focus on all those opportunities and challenges. Uh, but before that, to give, uh, an understanding of where you're coming from, uh, I'd love for the audience to know a little bit about you. Uh, from what I read, you've been a founder before and now you're an investor. And from speaking to a lot of founder friends and investors, I know that the two mindsets are very different. Right, right. Uh, what did you have to unlearn when you switched from being a founder to an investor?

Speaker A: Yeah, first of all, that transition was more of a serendipity. Uh, it was not intentional. Um, uh, unlike most of the folks in the ecosystem who are venture capitalists or in the VC space, uh, I don't have such credentials. Right. I mean, I didn't go to a B school. Uh, I never worked as an analyst or a principal in any fund. I've been a builder for most, if not all.

Speaker B: Uh, that's probably a better thing.

Speaker A: Yeah, I don't know about that.

Speaker B: Because there's less MBAs in VC.

Speaker A: No, but, uh, I mean, yeah, not to diss on MBAs, but hey, my

Speaker B: wife is an MBA.

Speaker A: Yeah. But, uh, you know, I mean, since I've been building, uh, for most part of my career and there was a point in stage where I, uh, was trying to figure out what to do next. So I had clearly some uh, things in my to do list what I don't want to do. So this was very much not part of my list as well. But it just so happened that I was sitting with uh, Nitin, who was also my investor in my last company and uh, he just bounced his idea. Hey, why don't we put together this way, uh, of uh, investing in companies which is perhaps not to be seen or uh, it's not been done and what uh, could we do differently there? So I started thinking, uh, and the playbook of the VC industry has not been reimagined for a long while. So as a builder I thought, okay, maybe this could be an opportunity to build something again which is not there. So that just been uh, uh, driving uh, anchor so far. Right. I mean to do things which are uh, not obvious in the VC industry, but also be more useful to founders who are trying to build something.

Speaker B: Right. Amazing. So you're taking a builder's mindset to investing and doing a lot of things from first principles. And that is very, very evident from your threads as well. Um, so you rightly put it right. I think healthcare is very different from your typical investing and let's say FinTech or SaaS or elsewhere. I mean you can't really move fast and break things. There are real consequences. You're dealing with people's lives here. So could you talk about how healthcare investing per se is very different?

Speaker A: Yeah, sure. So if you look around healthcare, uh, it's a, uh, space or a category which has existed for thousand odd years since human, uh, life has existed. When people have had illnesses, they have gone through pandemics, uh, and you always need a certain cure. So for a large part of history, if you kind of go back, you would see it has been more health cure than health care. Uh, right. Uh, and then for the past 10, 15 years this idea of preventive health started coming that, okay, instead of me going and sitting next to a doctor, what can I do to minimize those reasons so that I am not there visiting the clinic or a doctor or the hospital? And there that gave the seed of a lot of businesses which came in to say that, okay, how can we keep people healthy? So the definition of healthcare largely has been that people have sickness, they have illness, so let's cure them. And then, you know, somewhere in, you know, early 2000s, I would say that this idea came up that, okay, how can we keep people healthy and fit? Uh, and then possibly, you know, the next spectrum Would come that, okay, if they are already sick and ill, maybe we can cure which was already there. Now looking from a business standpoint, what uh, businesses existed, hospitals existed. Right. Uh, they were the only standalone businesses for the longest of time in the history of healthcare. And you have seen all different kind of investors and money coming in healthcare, right? Hospitals, uh, in particular, you have had private equity guys coming in, you have had large hedge funds coming in, you have seen these companies go and become in public markets. And I think in the last five to seven years in particular specifically post pandemic, this, uh, entire space has kind of gone through a certain reimagination because people have built a temperament around I want to stay healthy, I want to eat, uh, alternatives which are healthier, I want to move more. I'm conscious about my sleep, I'm conscious about my mental health, I'm m conscious about my stress and anxiety levels. And, and therefore this plethora of uh, products and solution suddenly became relevant and therefore it opened up opportunities for entrepreneurs and builders to build this. So problems were always there, but there were, I would say, no, uh, temperament to adopt to do these solutions. Now that awareness is kind of built in, uh, it just becomes a little more easier. I won't say it's absolutely easier, but a little more easier for entrepreneurs to build something because they don't have go and educate people. Uh, you know, some set of awareness is there and therefore an opportunity to build meaningful, long lasting businesses in health.

Speaker B: Right. Fantastic. Um, so you know, anytime I go to a hospital, right. Or visit the doctor, I come away thinking of like at least 15 solutions I could build. Right? I mean, right from how the appointment works to like, you know, how you're treated at the clinic or the hospital to finally the care and the post care. Right. Um, but I mean healthcare is different, right? I mean you can't have a tech mindset per se to solving things in healthcare, which has been the case like the last 15 years if you look at it. I mean people have tried to build apps and people have tried to integrate technology and so on and so forth, but there's a undeniable human element in healthcare that uh, requires like a deeper introspection on how to solve it. Right. Uh, and I see that you put out a thread sometime back on this specific aspect. If you could talk about it a little more.

Speaker A: Sure. No, see, you know, healthcare is very complicated. Uh, right. And when you speak about, in the Indian context, it becomes even more complicated because we are dealing with a population size which is unique in the world. Right. And if you see other markets, let's say the developed markets, uh, you know, it's fairly systematic, it's fairly organized, it's fairly structured and then there are intricacies and nuances which are very different. So at a very top level, if you see, right. For a lot of developed countries, healthcare is paid for. So there's always a payer. You know, mostly it's the employer or it's the insurance, uh, insurance companies or it's the government which kind of pays to a large extent for your healthcare.

Speaker B: Right.

Speaker A: Now when you come to India, healthcare, uh, is totally an out of pocket, uh, expense.

Speaker B: Right?

Speaker A: So individuals have to pay even though they might have an insurance, but they have to pay for it. Uh, right. And then you will also. And insurance covers only this much spectrum which is like, you know, if you go through a surgery, if you go through a certain hospitalization. But uh, almost everything around OPD to consultations, to diagnostics, is paid by the end consumer. Right. So that itself changes this entire economics of running a healthcare business. Now then when you go deeper and then understand who are the system players of this ecosystem, it's huge, right? Right. From a doctor to a uh, nursing staff, to an administration, to an owner of the hospital, to a policymaker, to someone who is sitting as a regulator. It's very, very complex now to suddenly come in and infuse technology and say that hey, I have a magic LLM model which is going to solve for everything. It's a very hard pill to digest because there's so many stakeholders. Even if a doctor wants, it may not go sit well with the hospital administrator, even if the hospital administrator wants maybe the policy, uh, holder, uh, the regulator might say that, look, it doesn't comply with a certain policy of it. Right. So it's very complicated. And that's one reason we have haven't seen yet genuinely technology making real impact on healthcare outcomes per se, because it's a long tail. I mean we have of course had adoption of technology, but these are all very MIC segments like a CRM, uh, um, uh, patient management system or uh, you know, I took this diagnostic, it comes to my app and all of that. Right. But real technology outcomes, uh, from a front end and from a back end point of view, it takes time. I mean I feel that this, there's some bit of technology which has happened on the hardware side. So you will see the big guys like a GE or affiliates which has done remarkable work in building this huge

Speaker B: diagnostic, uh, even in the pricing models. And so On.

Speaker A: Right, right, right. But, but I think a lot of that evolved. Uh, and to really penetrate deep, to say that technology has made a massive impact on healthcare, we have to kind of see big time now. Uh, also, you know, we have to keep in mind that in India, culture changes in every 10 kilometers. Right. So where we are sitting right now, if you go left, right, 10 kilometers or radius, it's a very different fabric of culture right now think about this massive country, what we have got. You know, we are talking about multiple Bharats today. Uh, right. So the way the people behave there, the way people treat health, the way people perceive healthcare is very, very different. So what will work in certain sets of, uh, uh, you know, places will not work everywhere. Now, this is, this is exactly how we are so different from rest of the world. Like, what will work in Finland will work across the country. You know, what will work with Germany will work across Germany. But that's not true in India. And all this thing really makes it challenging to kind of, you know, come out and say that, look, technology has made a huge impact.

Speaker B: Right. Yeah. In general, I feel aligning incentives in healthcare is a supremely difficult challenge. Right. I mean, um, you can take any kind of economic model, whether it's like, um, uh, say the US or the UK or Canada, uh, or China elsewhere, no one's got that perfect answer. I mean, there's always incentives that are misaligned with all of these stakeholders here. Um, for example, we have the lowest doctors per thousand, we have the lowest beds per thousand, and so on. Uh, so the healthcare is incentivized to get these people out as soon as possible. Right. But that may not give the most attentive care that, um, you know, patient, uh, deserves.

Speaker A: Yeah. In fact, you know, I mean, I want to add there that the doctor patient ratio, what India has got, is actually even better than us and rest of the rest of the developed countries. Right. But yet it is convoluted because the ratio is very skewed in terms of who the patient is. Uh, right. So, I mean, I think, uh, if the number, I mean, I have to look up the number, but I think for every thousand, uh, patients, we have some 8.3 odd doctors. I mean, that's the ratio, I think. Right. I have to correct the number. We have to look it up, but that's actually slight better than, uh, U.S. and Europe.

Speaker B: Oh, really?

Speaker A: Yeah. But the challenging part is because of the accessibility bit of it. Right. So number of doctors available and the patients available, the ratio seems to be okay. But to get to that, uh, patients, that's challenging. But therefore that ratio gets even more skewed. Uh, which is not the case in, you know, rest of the world.

Speaker B: You mean to say that there's access to healthcare, um, but quality access is uh, um, challenging or I didn't quite understand that.

Speaker A: No. So access to. So for example, when I say, let's say you have X number of doctors and the patient majority of that access is by only percentage of patients, which is, see most of the doctors, if you see the penetration would be in the metros, right? So people in the metros would have an easier access to the patient than patient than people in, you know, beyond metros.

Speaker B: So it's not evenly distributed.

Speaker A: Yeah. So from a population size point of view, the ratio is better, right? The number of doctors available, number of patients. But really from an access point of view, people who are not in metros, their access is hard. So from a survey point of view, we might stand better in comparison to the U.S. or Canada. Uh, uh, but that's not as how it is in the ground reality.

Speaker B: So the first generation of startups, perhaps in any domain, tries to take a model that's been successful elsewhere and copy it. Here you had this happening, let's say in E commerce, uh, in a bunch of the consumer Internet and uh, fintech and so on. But you have said that for reasons where the fact that the models are extremely different in US and China, those models or those solutions that have thrived there cannot work in India. So what do you see the way out? How should a, uh, founder who's thinking of building in India, for India, uh, think about building a viable business?

Speaker A: Sure. Like I said, the contours are very different. Uh, what's in the US A simple fact that the payer is different itself makes this entire definition of the operating of the business very different. The economics change is there itself right now. Ah, if someone wants to build in India, they have to think first principles, right? I mean who is the customer, right? What is he more concerned for? What will he pay for? And build solutions around those fabric. Right. So we are not a country which would always appreciate premium. Right. Uh, the larger audience will not maybe, maybe less than 4%, 5% of the population would perhaps, you know, figure out premium, uh, experiences and services. So it really depends on the aspiration of the founder.

Speaker B: But that's a large number as well, right? I mean it is large in the population.

Speaker A: Yeah, but it also depends. But the healthcare problem is beyond that. Healthcare problem is for the 100% of population, uh, right. So the, because the paying parity is different, right? So it's an aspiration of the founder. For whom are they building? Are they building for 1 million people? Are they milling for 10 million people? Are they building for 500 million people? Because problem of healthcare exists throughout ah, this is unlike a problem where say that okay, Fintech, um, you know uh, Fintech could be said that. Okay, it's not maybe uh, a uh, need or a problem statement. Let's say from a solution point of. For everyone, right? Or let's say uh, anything E commerce, right? I mean uh, people in the rural India would be happy to just walk, walk in and get their stuff, uh, quick commerce again an example, right? Even in metros today there are pin codes where Q commerce doesn't uh, exist because, because that set of population is happy to go out and walk into the Kirana store and come back. But healthcare is not like that. Everyone needs healthcare, everyone needs access to healthcare. What we need is access to quality healthcare, right? Uh, we have doctors, we uh, have government hospitals. But people know that there is a huge trust deficit there. People don't trust the quality of the services or doctors available. There are very few good institutions, government institutions which can have very good healthcare, uh capacity in terms of service. But then they are burdened with uh, so much of footfall, right? So what could builders do is to really go to the ground where I can say that look, am I building for that few percentage, 2, 3, percentage of the people who are earning beyond whatever 40, 50 lakh rupees, 30 lakh rupees of annual income that is also a sizable uh, target audience to build or am I really building for an audience which is much larger because healthcare exists and therefore the aspiration depends, uh, how do they really go and therefore the business model will depend, uh, how do you build it? Do you go digital first or do you go offline first or do you go hybrid? Everything would depend basis on A, your aspiration and B, for whom are you building, right?

Speaker B: Uh, sometimes I wonder why we have so few doctors actually, you know, I mean it feels like the supply has been capped almost artificially. Right?

Speaker A: Ah, I mean, I wish I had an answer. I mean if you look around, everyone wants to be a YouTuber and AI engineer, right? So uh, it's a very hard job, you know, And I sometimes feel that it's also sometimes goes down to be very less appreciative and also a thankless job, right? Because in the world where we live,

Speaker B: I mean they work around the Clock,

Speaker A: they work around the clock. They're not much appreciated. Uh, they don't get any social media fame. Uh, most of the engineers and designers and you know, podcasters and you know, startup are getting all the fame. Uh, and they're just you know, going out and helping these patients. So I mean again, you know, it's a existential question that okay, uh, it has to really come intrinsically that okay, I want to be a doctor. Like back in the days, 40, 50 years back, it was considered more as a noble profession that I want to bring an impact in someone's life and therefore Dr. Is today it's more of a high agency opportunity that where is that I can make more impact.

Speaker B: Huge economic liability as well. Right. Financial liability as well, given the fee structure and whatnot. Um, when you look at these other ecosystems, right. Whether it's China or us, what are like one or two things that you feel could be different about India? What are some things that we could copy from them?

Speaker A: It's a tricky one to answer, I think because each of these countries are culturally so different. I'm sure there would be some commonalities. Uh, one of course, I mean I feel often is that for example US has done a very good job in creating regulations where you could bring a certain product and solution from a builder point of view and it kind of quickly goes through the checks and balances to hit the market. Whether if it's a nutritional food product in fda, via FDA or elsewhere. Right. In India it's a bit tricky. Uh, right. I mean uh, the regulation wise there's fssai, uh then there is cdc, SEO before medical devices. Um, so I think uh, that being one from a policymaking point of view, but also generally from a temperament point of view, I think one thing is that when we often compare to us is that consumers there have a, ah, existing ah, knowledge and temperament in terms of understanding basics about health. For example nutrition. Right. People know what nutrition is. Uh, they know things, uh, you know, fitness, uh, any greater awareness, there's a greater awareness. Right. And that has also probably happened I would assume because they had a culture, they had a culture early on to send kids to go and play. Uh, fitness was, you know, I mean I'm not saying US is a healthy country, not. But generally there has been a certain uh, culture, uh, where they appreciate and they encourage people to stay fit early on. In India it's more like a midlife crisis. Right. When you, you, when you cross path with a situation, then you realize this is what I want to Do. So I think maybe I, I can't talk much about China because China is more like a black hole. You really don't know what's happening there. But if you compare the US and other Western countries, I think this general part, that uh, there is a general awareness of, uh, staying healthy, uh, which is what we are lacking, uh, in India right now.

Speaker B: But I think post Covid, we've had a greater sense of uh, health in general. Uh, people are a little more aware, I would say. People have been trying to protein max also. Right. Uh, I saw the thread that you put out, which was super insightful, uh, on uh, how we're building protein products in companies and so on. Right. I mean, um, do you think supplements as a market in India, Right. I mean, do you think it's just beginning to bloom, you think?

Speaker A: Yeah, I mean, you're right. Uh, I think post pandemic the market has opened up both from a consumer point of view and from a brand point of view. There are way more brands right now. Like my inbox alone get at least 10 to 15 emails every week. Uh, right, someone trying to build something in, uh, you know, supplements or nutraceuticals. Yeah, all types. Right. Uh, and sometimes I feel there are more brands than, uh, consumers out there in the market. Um, but for sure, I think because the awareness is there, two things has happened. A, I think the current generation, I mean people call it the Gen Z population. Right. There is a much more keenness to try new products and there is also an openness to spend on products which was not there maybe five, seven years back. Uh, people are spending, they are not sitting on the decision for a long time to think whether I should buy it or not. Right. Because quick commerce have kind of made it much easier. Distribution is much more easier. So if you want to buy a product, you go to a social media, see an ad, you can quickly go to quick commerce. In 10 minutes it's there on your doorstep, uh, which earlier I, um, mean that logistically it was a friction because you have to see an ad, you have to watch a TV for that. Then you have to wait for that to come to your local modern trade or a general store and then walk in there and then confuse yourself across all the brands. So all that, uh, fabric has changed, uh, which has of course now opened up these opportunities. Uh, but I think good products will win. I mean even though there's a lot of noise, I feel there's of course way too much, like you say, proteinization. And across all the spaces, whether it's supplements or nutraceuticals. But I think good products will win because the consumers uh, today know they also have the toolkit to filter what is good, uh, or bad. There's enough of knowledge out there, there are enough podcasts out there, content out there, so you don't have to earlier. You'll have to, you know, wait for 10 people to use it and then to tell you the experience. Right now all you know is just go to X or social media and post about it and you know in five minutes you have a survey done for yourself. Yeah, yeah, so, so that is democratized uh, decision making and, and therefore it's also is opening up opportunity for brands.

Speaker B: So in my opinion, I think two things have kind of improved adoption on that front. One is that obviously we have rising discretionary income, um, so people don't mind trying something new. The cost of the decision is a little less, um, you know, I mean it's a little less compared to like our parents generation and so on. And second is more importantly we have this feedback loop that you mentioned, right? I mean there are enough content out there that you know, you can't escape with a bad product as such. One, um, thing that we also saw over the last like 5, 10 years, especially post Covid, is this whole quantified self movement.

Speaker A: Right.

Speaker B: I mean it started with perhaps the Apple watch and then you know, you had all kinds of like rings and so on and so forth. Do you think that that's kind of plateauing right now? If you think it is plateauing then you know, what is the next evolution on that front?

Speaker A: Yeah, I think with any uh, like everything there is always a trend. Right. Uh, self quantification, if you go back to history, has always existed. Even back in the 70s, uh, right. People were quantifying what they eat, how much are they eating, they were tracking how much of time they're spending under the sun. But it just become mainstream over the last five, seven years. So there has been this cult so called uh, uh, tribe, if I may call uh, of people who were experimenting and these are, these are basically uh, geeks who are trying to quantify every bit of it and eventually trying to see that if that can be productized. So it has existed. Um, I think uh, with everything you know, it, it would hit a certain ceiling point and because it's uh, they would always be powered users who will continue to uh, do that. Like I know a bunch of people who would have all their fingers with rings and bands and multiple you know, glucose monitors. And all of that, but there would be people who will continue to experiment. But I think from a mainstream point of view, people adopted and realized, you know, it may overwhelm them. So I don't see this happening like a mainstream thing. Uh, they would be in the corner of Internet people who will continue to do it and post it on a Reddit or elsewhere. Uh, but, uh, yeah, I don't think, you know, this would become like a mainstream trend.

Speaker B: I think we have to move beyond, um, just measuring, right? I mean, um, like classic case is my mom, uh, right. She's absolutely opposed to any of these things, right. I mean, she says, why do I have to know all of this? And okay, it's bad enough that I have to get all these numbers every once in a while. Let's say every three months or, you know, a couple of times a year. I mean, I can't live with the fact that there are numbers every day. Right? Uh, so I suppose, you know, the next evolution, people really want to, uh, understand why a certain thing is a certain number. Right? And basis that what should I do? Right? I mean, should I increase my calorie intake or should I reduce it, or should I have more protein or should I, you know, walk another thousand steps, etc. Etc.

Speaker A: Yeah, if you look at the existence and the history of variables in particular, uh, so far, the generation has been to tell you what is happening with you, right? How much of sleep you have done, how much of steps you have tracked, what's happening with your glucose monitor. I think the next generation would also tell you why that's happening with you, right? Right. Why did you suddenly get a, you know, spike in your glucose? Why did you, you know, why did your resting heart rate drop? Uh, and then the generation would actually tell you, the next generation after that would tell you, uh, that how can you close that loop? What can you do to do that? So some bit of it is already happening in some variables, right? For example, you know, a few rings would tell you that, okay, you should now go out and you know, walk because get some sun. Get some sun. Uh, right. Or maybe you just had your meal, uh, and uh, your glucose had uh, a spike. Maybe you should do a 20 minute walk. Right? But I think for all this thing to happen more meaningfully in intelligent way, you need data.

Speaker B: Uh, so only the starting point.

Speaker A: Yeah. So only more and more people use it. You know, the systems will have the data and then therefore they will become intelligent. So, um, and I think your mom is right. I mean, like I said, uh, it's each to its own. Right? I mean, um, uh, you know, some people also get stress and anxious. Right. I know people around me, a few people who would say that, hey, I got a very good sleep, I felt, but the sleep score said that I was horrible, you know, so you, you go in that rut of that okay, who's right now. So it can also uh, give you a stress and anxiety. But I feel that right now you just have to. It's like saying that it doesn't make sense. I mean, I don't know if it makes sense for you to check your bank balance every one hour.

Speaker B: Right.

Speaker A: Or even for the day. Yeah, I mean, I mean you're good if you can do it once in a week or once in a month. Right. I mean it's not going to make any difference in your decision making. But these are all guardrails. So health in that context is from that perspective just a guardrail to tell you a system. Check that. Okay? This is what's happening in your body every hour, every minute. If you're going to check, it's really going to make you anxious. Yeah, right.

Speaker B: Speaking of, uh, mental health is another huge domain, right. And there's a lot of scope, uh, I feel, uh, on that front, I mean, but apart from apps or systems that kind of connect, uh, let's say counselors or psychologists or psychotherapists to uh, end patients. Have you seen anything else on that front? Um, you know, in the startups that you meet and so on. Any, any other solutions on that front?

Speaker A: Yeah, mental health is also a topic which is also um, moving very fast. Um, I think the first generation of solution providers in mental health was, hey, I will connect you to this set of curated mental health therapists and professionals I have, uh, and you can just come and make a choice and you can book an appointment and talk to them. And then came this wave after ChatGPT, uh, the AI models became so intelligent that why would you need a human, uh, intervention? The AI model itself is smart enough, but what it lagged what uh, it uh, it had a lot of intelligence but it didn't have emotional quotient. Uh, right. So you still and mental health, uh, mental therapy is a, ah, process where it's very iterative. Right. Uh, it requires a lot of emotional quotient. It's just not about, hey, I'm feeling stressed today, what should I do? And hey, this is what you should do instead. Okay, Tell me, how was your day? What happened? Uh, what made you stress by the way? Did you Experience this. So it's very iterative process. So then there's this, like I said, the generation which came in with uh, apps, which is more of a DIY app where you talk to a uh, chatbot, uh, which is powered by uh, AI. Uh, I think the future uh, would also, I mean I've been meeting a bunch of guys who are also layering variables on top of it like EEG devices where your headgears are there and that would give you signals and that will also do some course correction in giving this simulation on your uh, front uh cortex, uh, to. To just like your. How you'll go and lift weights on your. In your gym. You're doing that for your uh, brain. Uh, right. So I think the future would be uh, a mix of all. There would be a set of people who would definitely require human intention for a longest time. There would be some people who may require after human intention may require, be on maintenance mode. So they may continue to maybe uh, chat with uh, an AI tool. Uh, and then there would be people who would also maybe use these uh, variables uh to you know, to get interim um, adaptations. Uh, but in general I think AI, sorry, the mental health uh category is um, evolving a lot. Large part is also, you know, most people don't even know today that they at first place requirements. Yeah, uh, you know, mental health support. So that definition itself taboo subject. For sure it is taboo. Uh, and the definition is also just getting, Getting built right now. Right. I mean the point that look, it's very easy if you, if you put up way, uh, you know, if uh, you put up weight, uh, you know, you know that okay, you have to go for a run or you want to go and get to the gym. But when do you know that you need a uh, help in mental health? That clarity is not there yet. So I think uh, that ecosystem has to get built and then therefore opportunities for the solutions providers will be there.

Speaker B: Right. Um, any thoughts at all on let's say alternate medicine? Right. Because especially in India, I mean we have a rich tradition dating back to thousands of years of let's say Ayurveda, um, and some other forms. Right. Uh, and I think the government also is like made some strides on that front in terms of formalizing it, making it a little more um, let's say in tune with a modern scientific process and whatnot. But uh, do you get pitches at all from you know, from these kind of startups and so on?

Speaker A: Yeah, I mean all the time.

Speaker B: Right.

Speaker A: I mean we get pitches all the time. People building with uh, you know, elements around Ayurveda, uh, uh, you know, all of that. Uh, but like I said, I mean, and I mean I fundamentally believe that anything which can drive an outcome is good. Else, uh, it's just fox. Right? I mean, you don't know. Uh, I mean there are a lot of. Unfortunately we also live in a world where there are a lot of quacks. We are surrounded with misinformation, uh, because all of us are gullible people. Right? Uh, people are telling you that you have a problem and promising you, hey, take, uh, my solution and I will fix for it and people will go for it. The challenge is to understand whether uh, you can measure the progress and eventually can that drive an outcome to it. But look, if Ayurveda can solve for it, uh, great. Uh, I have no particular, uh, you uh, know, uh, opinion on it. But like, like I said, I mean if people are getting a certain outcome, I think it's a, it's a, it's a good thing. And the fact that it's come from India, I think we can truly be, make a possible global product, uh, or a brand from here.

Speaker B: Right. If I am, let's say in my early 20s and I want to start up in healthcare, um, what are some three, four ideas that you would fund?

Speaker A: Uh, yeah, I mean I think the idea catalog is so long. Um, instead of telling what I would fund, I can perhaps tell, uh, how you should look on finding ways to figure out your own idea catalog. Would that, would that make sense?

Speaker B: Yeah, sure.

Speaker A: Yeah. So I think first is to kind of just look around yourself. Uh, right. Uh, like I said in the beginning, for whom do you want to build? Do you want to build for people like yourself? Do you want to build for people around you? It could be your parents, it could be a younger siblings, uh, it could be a different gender. Uh, do you want to, it could be from people who are from a different start, uh, of society. Right? And uh, what is this most painful, uh, friction in their life? Uh, and everyone, you know, the fundamental truth is everyone wants to stay healthy. Even if you go down to the road and see that guy who is uh, a daily wage earner, uh, he also wants to, he wants to stay healthy. The more than people who are in the air conditioned offices. Because if he's not healthy next day, morning, he will not earn his wages, right? But he's not thinking about protein, he's not thinking about carbs, he's not thinking about weights. He's thinking about survival, right? Uh, what do I eat so that I can be healthy and tomorrow I can go back and do my physical work. Right. So the opportunities are everywhere.

Speaker B: Right.

Speaker A: Do you want to build for pain or do you want to build for vitamin? You know, is it need or is it want? Uh, it's up to your patience, it's up to your endurance. If you're wanting to build for, if you, if you want to build for a want opportunity, you have to see for time because it, it won't be equal to that idea.

Speaker B: You also have to find that kind of TG as well.

Speaker A: Right, of course.

Speaker B: Who can afford to pay for a want?

Speaker A: Yeah. So preventive care for a larger part is a want business.

Speaker B: Right.

Speaker A: I want to stay healthy, uh, curator, which the hospital business is a need business. Once you're pain, you won't make a choice. Do I stay in the pain for a long time? You want to get to a doctor as quickly as possible. You want to get to the medicine as quickly as possible. So it purely bases on the aspiration of the founder, you know, how they want to build it. Second, and the most important part is that whoever you want to build for, you have to build a huge trust protocol around you. Very, very important. Right. And that's what I see almost all startup entrepreneurs in particular, uh, missing it out. I mean they may have the greatest tech of the world and they may have the greatest scale of the world, but no amount of venture money will help you earn trust. Right. Trust is not about throwing ads on social media and asking customers to click. Trust is not about hiring the best influencer or a celebrity and making them wear your T shirt and tell your slogan. Trust is genuinely earning that absolute trust amongst consumers to say, hey, I resonate with who you are, I resonate the problem statement for what you're building. I, uh, am willing to try your product and services. If you think 40, 50 years back that is what hospitals have done. Doctors have earned the trust naturally, because of their pedigree, because they are doctors. Even today, if you see around in your family, regardless of, uh, even though we have so much of these, um, doctor discovery, uh, platforms, most people even today agnostic to the age would still ask each other, hey, which is the doctor you trust? And this is even after you have the biggest, uh, you know, discovery platform out there. Right. So earning trust is very important and earning trust is very hard. You can't earn trust quickly. That makes this building business in healthcare is super hard because you have to earn with time. It's a slow process.

Speaker B: Yeah. And you think that funds themselves have to evolve to kind of suit this kind of building. Because uh, your typical 8, 10 year fund with uh, you know, uh, with the kind of multiples that you have to see right on the business may not work. Right. I mean um, do you think, I mean you need like more patient capital to kind of step in and like build.

Speaker A: Yeah, I mean I think uh, depending on the type of businesses you want to enter, uh, and support, uh, funds have to kind uh, of resonate with that. Uh, it is not easy. Like I mean I don't think you can get a meaningful outcome in health care in three to five years. It's not possible. Right. Unless it's like a GLP1 drug and it's proven. But you have to understand that it has taken them. I don't know how many years of R D and how much of money has gone in that business. And these are not businesses which have got private equity money or venture capital. These are all large public companies which can afford to spend a billion dollar plus in R D. Small startups can't. So funds obviously will have to think in a way. But again you can't say what is right or wrong because every fund manager has a certain uh, template. Uh, right. I mean they're designed in such a way that uh, during this X time period they want to get an X return. Uh, that of course makes it harder for them to kind of look out for winners.

Speaker B: So let's talk about your own health and fitness, which is super inspiring. Uh, you shared the story on uh, X and uh, other platforms as well. Right? I mean uh, so you were a busy founder and you had neglected your health like uh, a lot of us do. And there was this one moment where you kind of change things around. Right. Could you, could you share some of that stuff?

Speaker A: Yeah, I mean uh, uh now it seems to be like a very you

Speaker B: know, 10 years back.

Speaker A: It's been, yeah it's this is uh, I think year 20, um 15, uh around 10 years now. Um, I know like you said, I mean I've been since I've been an entrepreneur for most part of the year. I mean building a company, hustling valuations, raising money, you know, product, that has been the priority. Uh, and there was a point of time where I uh, realized that everything was going backwards. Uh, you know, point in case, particularly you know this uh, fiscal year end, you need to submit this medical uh, bills for your reimbursement. Right. And I think some 15, 20,000 rupees a year where you get this medical reimbursements. And um, when my accountant asked that and I went to him, I uh, realized that I had almost 4 to 5x of what the expectation amount was. And that was turning out to be almost 50, 60% of my annual income. And uh, not that I was earning a lot. I mean as an entrepreneur you don't in cash, a lot of money. But even whatever I was uh, taking home had spent some more than 60, 70% of that money to my uh, medical bills. And these are not surgical surgery, uh, bills. These are just OPD and diagnostics. So that was that eureka moment for me that what am I doing? You know, it just, instead of building, I'm just breaking. Uh, and uh, yeah, I mean I uh, think uh, everyone has to go through a suffering, uh, to really pause and figure out uh, what to do.

Speaker B: I know there's like a universe amount of uh, healthcare advice out there, right, in terms of getting fit and getting healthy and so on. But what were like the top three things for you that moved the needle the most?

Speaker A: For me in particular, it was getting to a sport, uh, and just being consistent to it. Like for me it was running. Uh, I, for the longest time before that had possibly seen all the gyms in my locality. Like most people had signed up and lost money, but it never came to me very naturally.

Speaker B: Right.

Speaker A: But running in my case in particularly, it just was very organic. Uh, right. That feeling of getting out early in the morning when the city's, you know, half sleep and snow traffic, uh, uh, and you're just out all alone. M. I know it's very cliche to say it's meditative, but it's felt like that, you know. And as an entrepreneur, that's your me time. You know, you're kind of having uh, stand up meeting with yourself, uh, to say that, you know, what happened previous day and what's going to happen to you, uh, the next day. So running came to me naturally and I just had to build a consistency to it. Uh, you know, just a very natural way of doing that. Uh, but then fast forward. I won't say that running should be the only tool. I mean you have to look from a very holistic way. It took me some time, uh, and for the past few years I'm looking at more from a holistic way. Uh, then, I mean running is one bit of it. Now strength building is one. You know, how do you build strength? Because as you age, uh, you know, you lose muscles. So you have to be very, very mindful about uh, you know, if not building a lot of muscles, but at least maintaining what you've got. Uh, so, yeah, I mean, running was that anchor, uh, to me in the early days.

Speaker B: Wow. Fantastic. Okay, uh, so we're going to do something unusual since we spoke about health and fitness. I mean, we want to end the podcast with a few push ups at least. Okay. Inspire people. Okay. Uh, yeah. Can we switch to.

Speaker A: Yeah. Are you sure, uh, are you sure that you don't want to embarrass me?

Speaker B: I'm at my heaviest in about, uh, five years right now, so. But, ah, yeah, I mean, why not?

Speaker A: Okay, sure. Yeah, we can do that.

Speaker B: All right, let's go.

Speaker A: Form matters. Five, five. Okay, let's go.

Speaker B: Listen.

Speaker A: Five, six, seven, eight, nine, ten. All right.

Speaker B: Ten.

Speaker A: Okay.

Speaker B: Four, five, six, seven, eight, nine, ten.

Speaker A: So your viewers have to comment on the form.

Speaker B: I already know they say my form is screw you guys.

Speaker A: Yeah, uh, they are the farm police. 6, 9, 10, 11. Go down dip.

Speaker B: 15.

Speaker A: Okay. Oh, uh, man. 1, 2, 3, 5,

Speaker B: 10, 11, 12, 13, 14, 15, 30.

Speaker A: Cap out.

Speaker B: We're gonna need a stretcher to get me.

Speaker A: Okay, why don't we do this one together? We cap 20.

Speaker B: Yeah, let's cap on.

Speaker A: Okay. Good call. Yeah. All right. Okay, let's go. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Okay. They should at least get, uh, 20 times more comments.