Albert Einstein said, “Necessity is the mother of all inventions”, and these words came true for Dr Suman Katragadda, CEO & Founder, HEAPS Health Solutions, a global health tech platform and SaaS provider.

The founding idea to launch healthcare solutions came after Dr Suman, while recovering from surgery, suffered lapses in post-operative care. Instead of complaining, he wanted to fix the problem and hence came up with the idea of creating an AI-driven, systematic post-operative care management system. HEAPS was thus born as a culmination of his real-world, first-hand experiences as a patient, a thought leader and a problem-solver in the health space while working with PwC.

Suman realised that post-operative care management lacked transparency with a lax adherence to protocols across the globe. Under his visionary leadership, his team of technologists developed Post Discharge Care Management (PDCM) and Health Compliance & Risk Management (HCRM) at HEAPS, which has emerged as a pioneering technology for the company.

Heaps Health Solutions leverages advanced data analytics, AI and ML to revolutionise healthcare delivery and payment models. With patients, insurance companies, hospitals and large corporates, Heaps has built a robust platform with extensive research from five million patient interactions along with a team of medical professionals, specialists, doctors, clinicians, and domain experts in India and the US. The platform enables patient care management and coordination supported by ML/AI features and customises care management plans for each patient or policyholder. 

Suman did his masters in computer science from Kent State University and went on to pursue his master’s and PhD in statistics from the University of Tennessee, Knoxville. Before launching HEAPS, he worked as a director at PricewaterhouseCoopers. Analytics India Magazine interacted with Dr Suman, who gave us insights into Heaps Health Services and how AI influences the health ecosystem.

AIM – Give us a brief journey of Heaps Health Solutions so far.

Dr Suman – Heaps started in early 2021 to develop a care management and coordination platform for the global healthcare system. Our goal is to proactively engage patients through our AI-enabled platforms to ensure optimised costs without compromising on the quality of care. In the case of an integrated healthcare system, our platforms form the backbone for the payer-provider integration. We operate on a SaaS model and work with key stakeholders such as patients, insurance companies, hospitals and large corporates. We offer Post-Discharge Care Management and Health Compliance and Risk Management (HCRM) in India and USA. We are currently present through our strong pipeline of this service in the USA, Singapore and Bangladesh and have offices in Mumbai, Hyderabad and Bangalore. We plan to start operations in the MENA, Australia and the EU.

AIM – What was the inspiration behind launching the organisation?

Dr Suman – In the absence of information transparency and accountability of care, the payer, the provider, and the patient are all disconnected, resulting in mistrust in the system. Furthermore, the information is stored in silos with each stakeholder and is typically unstructured, so it can’t be analysed right away. To bring information transparency and care accountability to the system and ultimately create trust, we believed it had to be interconnected. In order to interconnect and create a win-win opportunity for all payers, patients, and providers, we found that care management and coordination is the missing piece and hence started working towards building the platform. 

AIM – What are the business objectives behind Heap Health solutions?

Dr Suman – The primary objective is to reduce the rate of avoidable hospitalisation and repeat hospitalisation, reduce the average cost of care by establishing alternative care delivery models with provider partners in the network and coordinate early interventions. Ultimately, we want to be the patients’ trusted partners. 

AIM – How are you leveraging data analytics, AI and ML into the company?

On the platform, personalised care management plans are developed using data analytics, AI and ML. Medical conditions and procedures can have long and thorough protocols/clinical questions. Our care management platform incorporates our back-end intelligence engine, which generates information about patients’ touchpoints and clinical questions the care manager should ask. They are based on probability scores of whether a patient will get into a situation requiring immediate intervention from the clinician. Concepts from NLP are used to extract clinical conditions and symptoms from unstructured data and understand the context relevant for extracting content. Through continuous tracking and monitoring mechanisms, the system’s AI features learn patient behaviours and automatically design interventions through select channels that maximise patient responses. These are a few AI/ML use cases. Our team has identified more use cases and developed AI/ML models that hopefully can be rolled out as a product in the future to insurance companies, hospitals, and patients. 

AIM – What are the tech stacks that you are using?

Dr Suman – We use AWS Cloud for infrastructure, AWS Cloud Services like EC2, RDS, Lambda, Cloudfront and S3 Postgres database, Node.js, Angular, Python, DevOps with Git, and DevSecOps with SonarQube.

AIM – What is the current customer base, and who are they (their background)?

Dr Suman – Currently, we have health insurance companies, hospitals, and corporate groups as our customers. We help health insurance companies cut down on their claims ratio. We help hospitals retain their patients. With a demonstration of improvement in overall quality of care, we help them get into value-based care contracts with our network of insurance companies. For corporate groups, we help them manage the health of their employees and dependents with our care management programs to control the growth in the premium rates year on year. 

AIM – Can anybody in India from a remote location utilise Heaps Health solutions?

Dr Suman – Technically, yes. However, right now, we are in the B2B space. There are huge volumes in the B2B which are yet to be captured. We do have plans to take it to the B2C eventually. We are in the process of designing a few pilots in select cities to understand the plan design and also the consumer’s willingness to spend on such plans to determine the right pricing. Based on our pilot project’s outcome, we will determine how quickly or how aggressively we can go into the market in the B2C space. 

AIM – What are the challenges faced by you to date, and how did you overcome them?

Dr Suman – The biggest challenge we faced was gaining payer and provider adoption of these platforms in the beginning. At the leadership and management level, an extensive education process is required to help them understand and get convinced of the benefits that could be gained from it. Both hospitals and insurance companies have benefited greatly from our initial pilots with early adopters. By March 2023, we should have at least 80 per cent of the private insurance companies on the platform. On the hospital’s side, all we value is creating a high-performance network of 500 to 600 hospitals across India that is geographically spread and whose costs are optimised while the quality of care is not compromised. By March 2024, we should be able to form a complete network of small, medium, and large hospitals in the network. 

AIM – How is the company or product perceived within the industry?

Dr Suman – The phrase care management is used in a loose sense in the industry and often gets mixed with care delivery. In my view, they are two different things. Hospitals are usually incentivised on the utilisation of services. The more utilisation of services, the more money they make. This may not be good for insurance or a patient since we operate on a fee for service payment model in India. Similarly, insurance makes money when there is low utilisation of services. This, technically, may not be optimal for patients. Since the incentives are misaligned, it is difficult for them to work together unless it is an integrated healthcare system. 

If payers, providers, and patients are the three pillars of the healthcare ecosystem, there is a strong need for entities like Heaps to emerge as a fourth pillar that is more patient-centric with the goal of optimising care without compromising on the quality of patient health outcomes and still ensuring win-win opportunities for both payers and providers through creation of a virtual integrated healthcare system. The industry has been a necessity for many; the patients, the hospitals and the insurers have long been looking for tech-driven solutions. However, most practices have been opaque and lack transparency. Heaps aims to change that while helping all stakeholders derive more value than ever before.

AIM – What are the features that support the primary message/chief differentiator?

Dr Suman – The Heaps platform is built on three major pillars – Clinical Science, Artificial Intelligence and Consumer Behavioural Science in healthcare. It is the only platform in the space of care management and coordination that is highly automated, from generating personalised care management plans to intervening with patients at the right time to change their behaviours so that the cost of care is optimised without compromising on the quality of care. 

The key features of the platform are: 

· Personalisation of care management plans and computation of disease severity scores

· Dynamic updation of scores based on latest clinical and behavioural data; auto-upgrade or downgrade on severity levels for optimal allocation of resources

· Intervention and channel mix optimisation to change behaviours; continuous education and awareness campaigns to patients.