“COVID HAS GIVEN US A ONCE-IN-A-LIFETIME OPPORTUNITY TO CHANGE THE WAY WE DO BUSINESS IN HEALTHCARE.”
Interview with Dr. Amit Varma, Managing Partner, Quadria Capital
The COVID pandemic forced healthcare providers and stakeholders to rethink how they provide medical services, sparking innovations in care delivery and financing. Quadria Capital’s Managing Partner Dr. Amit Varma, who we interviewed for this month’s newsletter, identified telemedicine, remote diagnostics and monitoring, and consumer health as three areas where interesting change was underway. Dr. Varma, whose private equity firm focuses on mid-size companies in Asia, explained what Quadria looks for when investing in a company, why telemedicine will never be the same, and what these innovations have meant for his own healthcare treatments and practice.
What do you prioritize when evaluating new healthcare models and innovations?
We look at three things. The first is efficacy, which is about improving things in a way that leads to greater outcomes. We want to know what impact a newer model will have if you transplant it onto an existing system. Second is do-ability. Does it fit? Just because it was done well in one geography does not necessarily mean that it will do well somewhere else. And that leads to the third consideration: local environment. I may want to do robotic techniques in emerging Asia, but will I be able to find the technicians and nurses who have been trained on those systems? Can I ensure that I can get the necessary spare parts if the machine breaks down?
Can you point to three things that make for successful healthcare companies?
Firstly, it’s all about people—quality and training—and more importantly that we keep on training them to improve. The second thing is the cost structure and how to make companies profitable so they can keep reinvesting. The third thing we are very obsessed with is looking at quality parameters. Just because patients in developing countries cannot afford to pay as much as those in a developed country does not mean they should get shoddy quality.
Where do you see the big disruptions and investment opportunities in healthcare services?
While COVID has been one of the greatest disrupters of our lives and has brought a lot of pain and suffering, it has given us a once-in-a-lifetime opportunity to change the way we do business in healthcare. When I was practicing as a doctor before COVID, every time I wanted to change the way we treated a patient, I would be told ‘this is not how we do things.’ But since the pandemic, I can go to senior doctors and say: ‘I am very sorry but the medicines that you use are no longer available in the market due to supply chain issues, we’ll have to move to this one instead.’ And I stopped getting any kind of resistance. So, I see a great opportunity to reset healthcare in many areas.
Take for example telemedicine. Quadria started a telemedicine company ten years ago, but it never went anywhere. Insurers weren’t interested, hospitals wanted their doctors onsite. Now suddenly telemedicine is everywhere and for chronic care issues, it will be the future. For example, I have hypertension; my doctor saw me once, we did the necessary test, after that he puts me on chronic medication. Then every month I do a 15-minute call with my doctor, give my blood pressure readings, my medications are adjusted or left alone. Six months later, I go back in person for new exams. That’s now. But in pre-COVID times, doctor and patient would have insisted meeting in person each time, a huge resource waste, especially for people in rural areas.
Second, I see an explosion in remote diagnostics and monitoring. Seventy percent of the world’s population live in rural areas. Lack of access to diagnosis and treatment at early stage has been the bane of medicine. We see many patients showing up at metropolitan hospitals with advanced renal disease, cancers, and heart disease that should have been picked up earlier.
The third thing is innovations in healthcare financing. If our patients cannot afford health services, we need to find new ways to make care financially accessible. We are seeing innovations in insurance products, including with wellness insurance that aims to keep the insured person healthy.
The other disruption I see is with consumer health. More and more, companies will go straight to the customer, bypassing doctors and hospitals. For example, dialysis and diabetes clinics used to be the domain of large hospitals, but now you have them in nearly every neighborhood which is more convenient for patients. You can provide the same quality at half the cost.
What do the recent supply chain disruptions mean for pharma production models?
This the first time where we see supply chain disruption not because of a lack of supply, but because of limited movement due to travel shutting down. This has triggered a big pivot to local manufacturing, which is a great thing. Every single major country is focused on making production home grown. For example, India had fallen into the habit of relying on cheap imports of active pharmaceutical ingredients from China. Then China shut down and India lost 40 percent of its supply. So entire business models had to be rethought. In Indonesia, the Philippines, and Vietnam we are seeing a similar emphasis on local production.
The second thing the pandemic has highlighted is the importance of scale. There is no point being a small retailer in pharma anymore, you need to be big to get the efficiencies in cost. I see a lot of aggregation of smaller companies. Whether this is a good or bad thing we will see.
The third impact is that the developing world has become a real market. Previously, an Indian pharma manufacturer’s profitability would be determined by how much they sold in the United States. Now that it is no longer as easy to sell in the U.S. due to supply chain issues and regulations favoring local production. This creates a great opportunity to grow markets in the rest of the world. In our own portfolio, we are starting to see this pivot. This change can lead to democratization of healthcare.
Along with IFC, Quadria is a founding signatory of the Investors for Health Forum and of Ethical Principles for Health Care (epihc.org). What do you hope these initiatives can achieve?
I’ve been associated with IFC for more than a decade. Our mutual desire to make a difference is what has helped us to forge a great relationship. These initiatives have three core objectives: improving quality of care, bringing ethics into how we practice the business of medicine, and bringing about greater integrity. IFC is well positioned to be leading such initiatives because of its size, reach and its intent to do things differently. There are many healthcare businesses out there looking for such platforms.
This interview has been edited for length and clarity.
Published in March 2022
Dr. Amit Varma is Co-founder and Managing Partner at Quadria Capital, one of the largest healthcare-dedicated private equity funds in Asia. Dr. Varma has over 30 years of experience in critical care medicine, operations, M&A and private equity in Asia and the United States. He holds a medicine degree from the University of Delhi, sub specialty degree from the University of Pittsburgh and State University of New York along with business degree courses exposure in the United States. Dr. Varma continues to practice as a critical care physician on a part-time basis through which he remains connected to clinical medicine, patients, and physicians.