HUGS' iDoc Telehealth System

Very few people in the Philippines have an idea of their health condition due to differing economic priorities and lack of knowledge on the benefits of preventive care.  Even if Filipinos want to stay healthy, the lack of access and resources provide limited options, even for traditional medical services, especially if you stay outside the major cities.  In addition, less than 15% of the population have any form of private medical insurance.  In a country where primary care is a challenge, there is still no implementation of universal healthcare which translates to over 90M people paying out-of-pocket for all their medical expenses.  HUGS created iDoc Telehealth to leverage on the Filipino's love for cellphones, particularly texting, social media, and entertainment.  According to the WHO, Filipinos have an average of more than one cellphone per person.  Our solution includes direct and interactive care with accompanying mobile apps that keep track of individual medical information, data, and lab results, making medical care more accurate.  And because there are also several millions of Filipinos working all over the world, our solution gives them an opportunity to speak with fellow Filipino medical practitioners as well as using our above mentioned web and mobile app solutions to monitor their dependents back home.

Aside from preventive health, our solutions also help those with chronic or lifestyle illnesses monitor their condition to keep them under control.  These include the most common illnesses in the country, including heart disease, cancer, diabetes, hypertension, pulmonary disease, obesity, etc.  We do this by using our interactive platform that allows us to monitor several health trackers including blood pressure, heart rate oxygen saturation, blood sugar, weight, etc.

We at HUGS have developed the iDoc Telehealth system, which is an inclusive solution that provides unlimited virtual access via voice, SMS, email or instant messaging to healthcare providers for anyone anywhere at a cost less than 50 cents a day.  For a bit more, one can also get physical access to nurses, doctors, nutritionists, mental health practitioners, diagnostic and imaging tests, and even access to procedures at medical facilities.  iDoc Telehealth is basically a data- and tech-driven platform that empowers anyone who wants to be more proactive in staying healthy.  The solution also includes a cloud-based electronic health record (EHR) system, a Health Risk Assessment (HRA) tool, and web/mobile applications that ensure correct and efficient medical care through a comprehensive assessment of all available medical information.  After consolidating as much medical data available, including HRA results, everyone gets  a tangible health rating.  What iDoc tries to do is to guide everyone in maintaining or improving their health status with the help of iDoc’s interactive team and partners.  The iDoc medical team has the task of consolidating all medical information and helping the client-patients make informed choices using constant communication portals.  HUGS makes a case for investing in human assets, including one’s personal health to ensure long-term productivity.  

What the pandemic has taught us is that everyone needs to be in good health and it can be fatal to disregard it.  The number one prerequisite in keeping a job or staying in school is to be healthy.  Our simple mission is to try and give everyone a better quality of life through proper health.  This is a positive step in trying to move the country out of its third world status. 

HUGS and iDoc Telehealth tries to reach every Filipino, both locally and around the world.  We remove the guess work in wellness and disease care so that everyone can remain healthy and productive.  Both the local health infrastructure and national health insurance are plagued with problems stemming from political and economic issues.  The poor and underserved will benefit from easily accessible and affordable basic primary care, while anyone with a chronic lifestyle illness or disease can help keep their medical condition under control so they can continue with their lives and hopefully ensure quality time at work and with their family.  This will also lessen the burden on individuals and families to care for the chronically ill.

The cofounders of HUGS have more than 60 years combined experience in clinical medicine, public health, & managed care.  This includes working with the country's biggest government and private hospitals, as well as big corporations and conglomerates for their employees healthcare.  The team also has extensive experience working with medical insurance brokers and is adept in packaging health benefits for different groups.  Being educated in University of the Philippines, we have been taught to engage in social enterprises that can benefit the masses.  We also work with socio-active groups and NGO's such as Rotary International and different cooperatives across the country through the Cooperative Development Authority (CDA).  Because of the logistical challenges that comes with the more than 7,000++ islands in the Philippines, coupled with over 100 local dialects, our plan is to create iDoc Telehealth hubs across the country with its own medical partnerships and synergies so that communication and referrals will be more direct and coordinated.  HUGS also works with local government units (LGU's) to be able to reach every citizen and to help the government in anyway we can to provide our own version of Universal Health Care.

HUGS strives to be what is currently known in first world countries as an Accountable Care Organization (ACO).  Aside from our basic data- and tech-driven platform, HUGS tries to partner with providers with similar advocacies in an effort to create better health outcomes, no matter your economic status.  In the Philippines, 90% of the wealth is controlled by less than 5% of the population.  Anything successful usually winds up in the hands of a certain family or conglomerate to maximize its retail potential and this was true for HUGS as well as we were courted by a large HMO to sell.  True to our vision, we will try to keep agnostic in terms of other medical providers but are willing to partner with those who share our advocacy.  

The software that is used by iDoc is a white labeled solution we get from India which is very intuitive and affordable.  Sad to say that there are no local solutions of the same calibre available.  HUGS has successfully partnered with a large pharmacy chain (Watsons Pharmacy) to be its sole telemedicine partner and have 2 large diagnostic centers (Hi-Precision and New World Diagnostics) with branches nationwide, as partners as well.  HUGS also a Ophthalmology Center (Asian Eye) as a partner and is currently in talks with other medical specialists to expand its coverage. Financial support will be used to expand these partnerships, including tailor-fitting the software for our clients, and developing a marketing scheme to create awareness about the iDoc Telehealth system.

As I mentioned, in the Philippines everyone is never more than 3 feet from their cellphones.  It has become a part of everyone's life and involved in every aspect of their daily activities.  HUGS knew that in order to create a paradigm shift from intermittent and reactive care to that of continuous and proactive care, we must be able to do this from a portal that is accessible, affordable, and convenient, otherwise it will fail.  

The most common reason for personal bankruptcy is excessive medical bills.  You fail to stay healthy, one loses their job or fails to go to school and their circumstances worsen.  It was easier to initially approach companies because they had the budget and they understood that an investment into their human assets was an investment in productivity and profitability.  We want to spread that advocacy to each individual so they can understand the significance of good health in terms of productivity in their lives.  This will eventually cascade to create a health population/workforce that can uplift the country from its third world status.

1. Develop a digital marketing campaign, particularly social media, to create awareness about iDoc Telehealth and proper preventive care for the masses.
2. Partner with the leading Telecom industry players to lower our telemedicine cost and to make iDoc even more affordable.
3. Partner with other healthcare providers to expand iDoc's coverage and to create a more extensive medical network for a better and holistic medical experience. 
4. Coordinate and work with national and local government units, as well as the Department of Health, to reach the farthest corners of the country through key personnel and politicians with similar advocacies.

Our most important metric is the number of people who subscribe or who fall under our care.

Once under our care, we need know how many are actively participating in terms of making use of the iDoc Telehealth app, filling up the EHR, answering the HRA, knowing their health rating, and discussing with the iDoc Care Coordinators on how to maintain or improve their health status.

For corporations, we keep track of their epidemiological numbers and their medical utilizations costs.  Staying healthy should be reflected in savings in the long term.

For individuals, improvement of their certain health trackers (weight, blood pressure, blood sugar, etc.), as well as their health rating will be the goal in risk mitigation that will lead to a happy and healthier life.

The Philippines faces a lot of challenges stemming from its inefficient and ineffective government system where bad politics results in bad leaders whose only intention is to enrich themselves at the expense of the country's development.  As a result, basic social rights, including healthcare have not been prioritized.  Add to this, the country's poverty level is >16% and the government spends only approximately 4% of its GDP on health as compared to double digit spends by its neighbors and first world countries.  It is no surprise that morbidity and mortality rates are one of the highest in the region, and the ave life span of Filipino's are almost 5 years shorter than average.  The vicious cycle begins with malnutrition that contributes to poor attendance and performance in the school.  A poorly educated individual has a poor understanding of the priorities in life which lead to poor lifestyle choices.  The individual develops poor health, is unable to work, and is unable to feed him/herself and his/her family, thus passing the problem to the next generation.  Acute band-aid solutions don't work, because of lack of sustainability and other health issues developing as one gets older.  Statistics show that more Filipinos are willing to pay for private out-patient consultations rather than public(68% vs 24%), but are relegated to public facilities (64%) once they need confinement.  It thus becomes a matter of having a reliable system that can provide continuous care and to avoid the necessity of confinement due to deterioration of a disease.  It sad to say that up to 7% of the population are willing to go to informal practitioners such as herbalists or quack doctors to get treatment.  The Filipinos deserve a better solution, especially now that the pandemic has magnified the importance of a healthy lifestyle that will ensure survival and quality of life.  Now, more than ever, people have a better understanding on why they should prioritize their health.

As for our own theory of change, this is our concept:

PROBLEM: Lack of basic health services that include primary care and a preventive medicine approach. There is also a lack of medical infrastructures, screening procedures, a cohesive system with personalized care and not one that still caters to a one-size fits all model.  And of course the continuously escalating cost of quality medical attention.

DESIRED STATE:  A predominantly healthy population with decreased morbidity and mortality rates, decreased spending on more expensive treatment for complicated diseases by treating them earlier, and a more productive population that ultimately lives a happier and longer life. 

BENEFICIARIES:  Everyone, but more immediately the underserved who have no access or cannot afford other options.  

The Philippines has a reputation for being the text (SMS) capital of the world.  We believe that having so many Filipinos all over the globe working for all types of organizations or migrating to all types of cultures have made it imperative for Filipinos to adapt to telecoms that will keep them in touch with their loved ones.  Being a very maternal and family oriented society, there is a constant need to keep in touch no matter where one can find themself.  That being said, Filipinos are also a very hospitable and welcoming type of people.  We always look for the personal "touch" or contact with one another.  As my mother always said, always remember to say hello and thank you personally.  Even if technology may seem cold or impersonal, we made it a point to add the personal touch, whether it be a voice or a face behind the technology.  Patient-clients are coming to us when they need help and are sharing things that are very personal and confidential.  We must be able to relay the feeling of compassion.  In fact, HUGS has 3 major business tenets and these include compassion, science, and technology.  This is arranged in the proper priority.  Being medical professionals we have an oath to treat people no matter the circumstance.  The science is about best practice guidelines which has become much easier to know because of big data and the sharing of information.  The IOT has given us access to all available data on how to best treat a medical problem.  The technology part is partly for knowledge and data sharing, as well as convenience.  Dr. Eric Topol's 2 books, "The Creative Destruction of Medicine" and "The Patient Will See You Now" has depicted how the internet has shifted the power of medicine to the patient's side.  We agree that they no longer have to be passive passengers in their journey towards health.  They now have the tools to research for themselves and to check their providers capabilities and qualifications.

What iDoc does is to provide both the client and ourselves a platform to share information to arrive at the best possible outcome for everyone concerned.  At the forefront of our solution is our web- and mobile-based iDoc Telehealth portal and application.  

The iDoc Telehealth app's features include a personalized electronic health record (EHR), storage for all medical results or images, health trackers, monitoring plans, direct links to medical personnel, health blogs, and wireless connectivity to personal sensors.  We always consider this a tool.  At the core of iDoc are the Care Coordinator nurses, physicians, nutritionists, and mental health practitioners who will connect with our client-patients via the portal of their choice, whether it be voice call, SMS, instant messaging (Viiber, Messenger or What's App), or email.  All in the effort to manage their health-related issues.  We are also able to send them medical certificates, online prescriptions (eRx), and online referrals (eRefer) for diagnostics, imaging, or procedures.  Though we are currently using a stable of Family Medicine trained primary care physicians, we are slowly growing our network of specialist physicians for virtual as well as face-to-face consultations.

You may wonder why we call our solution Telehealth instead of the more conventional telemedicine, but we purposely named this because we pride ourselves in providing a more holistic and continuous type of care, looking out for long term solutions, as compared to a one-time consultation that telemedicine connotes. 

We are looking forward to the use of blockchain technology to ensure the security of all our data.  We also feel that machine-learning and AI will make medical diagnosis and decision-making easier and more accurate.  We are also certain that virtual reality will take the patient-doctor experience to a new level that will also help us treat people with complicated conditions no matter where they are.  HUGS feels that there is no justification to not make use of technology to improve the living conditions of anybody who needs it.  We just feet that this would work much faster if both the private and public sector can work hand-in-hand to make this a reality.

Part of the reason we decided to create HUGS and iDoc is that the Philippines is way behind in terms of health technology,  There is no one regulating the telemedicine space and the only body who has explored this was an entity created by a national university to study the use of telemedicine,  There is also nothing like the HIPAA laws except for a general Data Privacy law passed a few years ago.

To be honest, we have not prioritized any of the above, except that our leadership sets about creating a work culture that is free from discrimination of any kind.  We also ensure we give everyone, applicants and employees alike, an opportunity to grow and move up on the organization.  We reward hard work through our KRA system accompanied with multiple appraisals at every level from both clients and management.  Decisions are made by a team and everyone is encouraged to give their opinion, whether in favor or against.  In fact, I encourage different points of view. 

HUGS Inc. is basically an Accountable Care Organization (ACO), a new concept in healthcare that puts more emphasis on value outcomes. Another way to describe HUGS is a combination “Healthcare Contractor and Integrator”. As a contractor we provide Consultancy, Management and Medical Services. As an integrator we work with other providers to ensure better results in health outcomes.  We use technology and systems innovation to maximize resources and to create cost-effective, sustainable ecosystems and client-centric solutions. 

COMPETENCE

We have 3 major areas of competencies:
I. Health Technology
II. Institutional Health Management
III. Managed Healthcare

I. Health Technology
Our core business is centered on our iDoc Telehealth System. iDoc is an independent subscription portal accessed by Voice calls, SMS, email, VOIP or Instant Messaging (Viber, WhatsApp, & Messenger). Members have access to daily unlimited calls to our physicians, nurses, nutritionists, mental health practitioners, and other medical professionals. They can avail of online prescriptions (eRx) and referrals (eRefer) to our partner pharmacy (Watsons) and diagnostic center (Hi-Precision). All iDoc members can avail of the cloud-based electronic health records (EHR) and its health tracking/monitoring capabilities accessed via their web browser or mobile app on any of their devices. This allows a more personalized, proactive and holistic approach to health where prevention is prioritized over reactive care.

II. Institutional Health Management (IHM)
IHM has three major facets:
1.Clinic Management Services (CMS) for compliance consultancy and contracting for all government mandated (DOLE, DOH, DTI, IATF, etc.) requirements including medical staffing, medicine and supplies provisions, program implementation, and diagnostics/procedures referrals;
2 Preventive and Occupational Medicine Services to assist in implementing Health and Safety Standards and to provide strategies and programs to supplement the company’s Health and Safety committees focused on wellness and disease-specific prevention; and
3. Health Tech Innovations including iDoc Telehealth’s EHR, Health Risk Assessment (HRA), Health Ratings, Health blogs, and Mental Health support. There is an and-to-end COVID-19 plan called Health@Work/Home Plan and an optional Sick Leave Management system to provide validation, mitigate losses, improve treatments, and deliver analytics; All services are geared towards preventive medicine and wellness maintenance.

III. Managed Healthcare
HUGS also provides Health Benefits Management that includes provider coordination, system design, utilization monitoring, treatment audits, and medicine purchasing/dispensing analysis. This also includes evaluating healthcare systems to offer cost effective alternatives for provision and funding of medical services and benefits anchored on holistic care, preventive programs, clinic practice guidelines, and health analytics. Lastly, HUGS provides turn-key solutions for the design, construction and operations of medical facilities such as primary clinics, specialty centers and general hospitals.

We initially boot-strapped our incorporation and initial operating expenses on the prospect of immediate clients.  When this did not materialize we were forced to scramble and sell services that we were accustomed to.  The low hanging fruit for HUGS were corporate clients and the services they needed, either government mandated or as part of their benefit plan.  Employees make up a majority of those with private medical coverage mostly because companies have the budget for it.  

HUGS was able to secure more corporate clients while continuing to improve the iDoc Telehealth System.  When we were satisfied with iDoc's capabilities, we were able to secure both corporate and retail o clients, albeit at a slow but steady state.  This was without any marketing effort and even if we have grown in the shadow of the pandemic, our thrust for the next 5 years is to increase awareness and try to get iDoc trending so that as many people as possible can try and experience its benefits. 

PLANS FOR 2022

As discussed in the Strategic Planning with the Executive Committee, these are the goals for 2022:
IHM  
1. To pursue Marketing and Sales initiative via 3rd party, brokers, and full-time sales/biz dev person  
2. Search for Elderly Care Facility investor/developer (HUGS with existing business plan)

iDoc Telehealth  
1. To fund capex for infrastructure and capacity-building 
2. More corporate synergy and retail sales initiatives  
3. Consider developing proprietary software but continue to concentrate on improving Patient-Doctor experience which should be the priority.

Managed Care  
1. Finalizing the contract with the telecom client and to seek investor for operating capital

 FINANCIAL PROJECTIONS AND MODELING

As can depicted on our Annual Operating Plan, relying on just our current business with minor marketing input will make HUGS barely break even. We created 3 financial scenarios composed of our current business/clients with minimum new clients, a current-plus model composed of businesses/clients HUGS has a good chance of engaging with this year, and maximum potential revenues model in case we are successful in pursuing all our prospects.     

Whatever the case, it is imperative that HUGS strengthen and add to its IHM offering and to invest in capacity and marketing of iDoc Telehealth to sustain growth. The adoption of telemedicine for mainstream medical practice provides another opportunity for iDoc for retail clients.  Finalizing the Managed Care contract with our telecom client will provide good revenues and potentially new prospects in terms of large corporations or groups.  

HUGS is relying on its Finance team and Directors to complete and tweak the projections while continuing to support HUGS in terms of potential opportunities and clients.  With improving financials and continued corporate governance, HUGS can hopefully attract investors to help it increase capacity and reach more client-patients.  Having a successful social enterprise with high impact is a goal we continue to aspire for.

After initial boot strapping we partnered with a large labor cooperative that also served as a client.  Once HUGS built up its client portfolio, we were able to finance our growth, ever so humble it may be.

Two and half years in and having successfully completed a pilot, HUGS survived with some short-term loans until we became profitable.  We are currently increasing our authorized capital and looking for funding to finance our marketing, capacity building, and partnerships.

Our first experience with outside funding was our first convertible loan early this year.  We are open to securing additional investments in exchange for equity as long as the investor will bring more than money.  We need partners who will share our advocacy as well as our desire to create a sustainable business model.