Capital, technology and scale: The business blueprint for India’s critical-care future

For Dr Satya Garimella, the Co-Founder, CPR and Chief of Cardiology, Baptist Floyd Hospital, Louisville, USA, and Krishna Kottapalli, Co-Founder, CPR and a healthcare entrepreneur & startup advisor, the challenge of expanding access to critical healthcare is also a question of building a sustainable, scalable operating model.

Their experience spans both healthcare entrepreneurship and infrastructure creation-from building SCIO Health Analytics into a business acquired by EXL to setting up 11 ICUs across four states through Compassionate Patient Response (CPR). In this conversation, they discuss the business principles behind scaling healthcare, including capital efficiency, funding, partnerships, technology adoption, and the need to make critical-care infrastructure financially and operationally sustainable, particularly in India’s Tier 2 and Tier 3 markets. Edited excerpts.

Economic Times (ET): You co-founded Compassionate Patient Response (CPR) during the COVID-19 pandemic after witnessing critical shortages in under-resourced Indian hospitals. What were the biggest gaps you saw on the ground, and how much of that problem has India managed to address since then?


Satya Garimella (SG): CPR has helped set up 11 ICUs across four states. We saw large gaps in infrastructure, particularly in Tier 2 and Tier 3 towns and for the urban poor. Challenges include the number of beds, availability of personnel, lack of equipment, and lack of funds for sustaining an entity. However, since the crisis, there has been a growing focus on addressing the issue of increasing beds, improving diagnostics, and a tremendous forward leap into mass production of vaccinations.

ET: You built SCIO Health Analytics from a startup to an acquisition by EXL and later held leadership roles across the healthcare technology sector. What lessons from scaling a healthcare business can be applied to building sustainable healthcare infrastructure through CPR?

Krishna Kottapalli (KK): Healthcare is a key sector in the development journey of any country and is also typically regulated both in the US and India. Scaling a healthtech business in the US requires patience, thinking long-term, and being aware of the roles State & Federal government play, and finally, staying focused on the mission and keeping in mind that all of this is being done to increase access, improve quality of care, and drive down costs to make it affordable.

The SCIO Health Analytics journey from startup to being acquired took about 10 years, and it continues to thrive within EXL. We had to also raise funding from investors at the right time to help with growth.

We are applying similar principles as we build CPR for the long term. CPR’s mission is to expand access to critical care for the entire population, irrespective of geography and income. There are similar dynamics in understanding the State and Central Government’s role in providing healthcare access. Also encouraging the adoption of technology in areas of interoperability, digital health, and AI will play a key role.

In both SCIO and CPR, we have core guiding principles of being capital efficient, operating ethically and transparently, and treating investors' (donors') money as if it were our own money.

ET: What have you learnt about the challenges of building and sustaining critical-care capacity in smaller and under-resourced hospitals, beyond simply providing the equipment?

SG: The challenges are manifold. These include a lack of personnel, including physicians and trained nurses, and technicians. There is a total lack of availability of biomedical services for the expensive equipment. Thus, we often give them at least a few years of maintenance so that the capex is utilized. Several of these places also struggle with sustainability and insurance payment issues. In fact, after donating capex to one of our donors, we had to be involved in jump-starting the NICU by donating funds for hiring personnel since no one was coming forward to help. After 6 months of support, the NICU is thriving after finding a local sponsor.

ET: CPR has raised more than $1.5 million, set up 11 ICUs across four states and impacted more than 10,000 lives. How do you identify hospitals that need intervention, and how do you measure whether the capital deployed is actually improving patient outcomes?

KK: CPR primarily works with hospitals that provide critical care to the poor and needy either free of cost or at a very subsidized rate. The types of hospitals we primarily work with are non-profit hospitals (who charge nominal rates) or trust and government hospitals who provide care free of cost.

Then we go through thorough diligence often to see if the ICU can become an oasis for healthcare, drawing community and services together. We apply a rigorous framework focused on compassion, integrity, diligence, and sustainability to evaluate the needs of the hospital. Often, we see that the requirements do not match the necessary needs. We also verify if the civil works and personnel to support the ICU are in place. Once we have the needs assessment done, we go out and take 3 vendor quotes, and we make sure we get quality equipment for the right price. Only then will we deliver the procured equipment as well as the maintenance needed to run it. We are highly diligent in running this evaluation process and treating the funds as if they were our own.

We get quarterly impact metrics and patient testimonials from each of the hospitals, which we go through thoroughly as well as present it to our donors. Our impact is literally saving lives, from newborns all the way to adults.

ET: From your experience as a cardiologist and cardiac electrophysiologist in the US, what are the biggest lessons India can draw from the American healthcare system when it comes to critical care, clinical training and hospital preparedness and where should India avoid simply replicating the US model?

SG: No healthcare system is ideal. Every system has its own challenges. Certainly, in the West, the training facilities are robust and well-spread for critical care, including fellowships, and the training is highly standardised. Also, funding for healthcare and research is much more structured, with many opportunities and penetration to multiple geological locations. From an epidemiological point of view, local diagnostics can sample many more viruses than elsewhere. Certainly, replicating the US model is not recommended because of redundancies, and challenges in India are very different depending on the terrain. Telehubs with vastly improved connections for healthcare delivery can be one solution until we expand our bed capacity.

ET: One of the biggest challenges with CSR-funded healthcare projects is moving from a successful pilot to a programme that can operate at scale. What does it take to convince CSR funders, hospitals, and governments to commit to a multi-year model?

KK: The key to moving from a successful pilot to ongoing is to first do thorough due diligence of the project upfront. Once that is done the speed of procuring and implementing becomes important. We strive to finish implementing our projects in 6-8 weeks. This directly affects how fast the funds are deployed and the impact created, which is a key thing that donors look for. Beyond the capital equipment needs, if there are operational expenses that need to be covered, we will look to find a Public Private Partner who can run the project on an ongoing basis. These done methodically lead to ongoing successful and scaled programs, which gives all stakeholders the ability to think and operate in a multi-year construct.

ET: India is looking towards 2047 as a long-term horizon for healthcare transformation. What would a truly pandemic-resilient and equitable Indian healthcare system look like by then, particularly for patients who live far from major cities?

SG: That is a tough one. Our vision is that the availability of ICU beds within a 30 - minute travel distance will be ideal. Certainly, it can be bridged with telehealth solutions. Sample collection for epidemiological surveillance of new viruses should be available for a pandemic-resilient society. India has tremendous potential with the mass production of vaccines and being a global leader, and building infrastructure to accommodate at least another 100,000 ICU beds will be an asset to face the challenge.

ET: Digital health, AI, and data interoperability are increasingly being positioned as the next big levers for Indian healthcare. Where do you see the most immediate and meaningful opportunities for technology to improve access, affordability, and quality of care?

KK: All the above levers have a part to play, including digital health, AI, and data interoperability, in order to advance the Indian healthcare system. The near-term opportunities for technology include aspects like driving wide adoption of ABDM, which was created to do for healthcare what UPI has done for payments. This will help create a shared, interoperable infrastructure layer for all the stakeholders in the ecosystem, including hospitals, insurance companies, and patients.

Similarly, initiatives such as teleHealth, telemedicine, wellness applications, and patient-facing applications can go a long way in driving access, affordability, and quality of care

In order for AI to be adopted on a larger scale, data interoperability and digital health need to gain wider adoption. We see the use of AI in two areas: clinical and care delivery, and automation of administrative functions. Indian healthcare is still at an early stage, but we see potential, especially if there is enough risk capital that flows in to accelerate innovation.

ET: CSR and philanthropy can help build healthcare infrastructure, but projects often struggle once the initial funding ends. What needs to change in the way CSR-funded healthcare programmes are designed so that they become sustainable hospital capabilities rather than onetime interventions?

SG: CSR funding is mostly towards capex. That is only one part of the solution. They should also help in the sustenance of funded hospitals. Funding should also be sequential and constant monitoring of performance metrics is needed. Funding should also encompass healthcare research, digitalisation and standardisation. Particularly, digitalization should be addressed so that the challenges can be understood and solutions can be found which can bring about uniformity and standardization of healthcare delivery.

ET: Looking ahead to 2047, can India realistically build a healthcare system where geography or income no longer determines access to critical care? What role will startups, philanthropy, CSR, investors, and public-private partnerships need to play in making that ambition achievable?

KK: India has a golden opportunity to democratize healthcare in a responsible manner by 2047. If done correctly, this will lead to achieving the three important aspects of critical care-ease of access, affordable pricing, and lasting clinical outcomes. All this should be done with guiding principles to accommodate the vast geography and income variations across India.

The Indian healthcare system is at an inflection point with the emergence of private and public insurance, consolidation and expansion of mega hospitals, formulation and implementation of digital and interoperability health strategies like Ayushman Bharat

Digital Mission and the related technology stack, and the growth of India-based MedTech companies.

To support all of these there is a need for significant innovation and, hence, the emergence of startups, which in turn needs risk capital from investors and public-private partnerships between research institutions and the government. There is a need for capital to expand critical care infrastructure, especially at Tier 2 and Tier 3 hospitals. This can come from CSRs and philanthropists for deserving hospitals. Finally, there are specific non-profit hospitals, like trust-based or government-owned ones, that from time to time need funds to support their operational expenses. CSRs and public - private partners can provide these to make the hospital sustainable.