Part I: A PCP NewCo Designed for Indian-Americans

In the US we make up 1.2% of the population and 18% of all doctors, but don’t have solutions targeted towards our community.

Formerly-nominated, current and future Surgeon Generals of America

BIG PICTURE: Asian Americans are the fastest growing ethnic group in the US. Healthcare delivery is becoming community-specific. Let’s talk about the principles that might shape a primary care experience if it was designed for a subset of Asians: Indian-Americans.

Part I (this article): The Community’s characteristics and how those might shape our healthcare preferences and needs.

Part II (forthcoming): Translating those characteristics into a potential go-to-market/rollout plan for a NewCo.

I wrote the below as I’m exited by how a new healthcare trend may help my community— as always, would love your feedback/comments. Find me on twitter @Rsiddhanti.

Quick background on targeted Primary Care Provider (PCP) services:

We now live in the age of specialization. If the last 10 years were about producing products and services with the most wide appeal, the next 10 will be about personalization. Healthcare is no different.

Due to the rise of the healthcare technology stack which allows companies to reach consumers more easily, healthcare companies can finally target sub-populations and their associated needs. This means that outcomes and dollars aren’t just the target metrics — healthcare companies are now bragging about their Net Promoter Scores (NPS).

The consumer experience now matters. Healthcare was previously built on the premise that all care is equal, no matter who receives it or how. That’s no longer the case.

There has been a rise in community-targeted healthcare delivery solutions. Richard Park, the founder of CityMD, has founded a medical group serving the ethnic Chinese community. Folx Health, designed for the Trans community, recently raised a$25M round led by Bessemer. Also, community doesn’t have to be gender/sexuality or ethnicity — it could mean a bias towards certain types of care, like Parsley Health targeting holistic care.

[speaking on Folx Health] “At a high level, 2% of the population identify as transgender,” said Cheatham. “At that math, when we looked at that, we were able to see a multibillion-dollar market opportunity not just to provide [hormone replacement therapy], but to provide a healthcare destination for this community.”

Indian-Americans are 1.2% of the population; we can definitely make the business case for healthcare services targeted towards us.

Before going straight to the vision/rollout of such a company, let’s think about the community’s key characteristics and how that might shape care delivery.

What are the Indian-American community’s characteristics, and how would they impact what we want out of our healthcare experience?

Our opinion of the healthcare industry:

• We’ve all had a close family member get treated for a serious health issue. That experience largely defined our now strongly-held opinions on how healthcare is delivered in this country. It’s not a great opinion and you’ll have to work hard to change our mind.

We are more heterogenous than we may seem:

• We’re experts in being judgmental and pointing out differences within our own community. While another family might have the exact same healthcare situation, learning simple facts about them can make their case irrelevant to us (e.g., they eat meat). Work around this as you deliver care and reference other cases.
• Our income inequality is extreme — worse than any other community in the US. Our background, habits, consumption preferences, communication styles changes along income spectrum. The services/experiences/pricing needs to be targeted accordingly, there is no one-size-fits-all.

Biases we bring to the table which impact how we listen to and interpret care recommendations:

• Mental health is (wrongly) not a thing. Talking to someone about our thoughts and feelings sounds ridiculous to us. You need to tread lightly on these topics and introduce them differently than perhaps you would with others.
• Indian-Americans, writ large, are (wrongly) not very accepting of the LGBTQ community. Understand that an Indian-American in the LGBTQ community may have a very different way of approaching and treating health issues related to their gender/sexuality, which their family may know nothing about.
• Similarly, we (wrongly) judge our women for not being married with kids around age 30 and beyond — these strong stigmas may lead to changes in how women want to receive care related to gender-specific health issues, especially in the 25–35 age band.
• While our diets are a big factor contributing to our health, it’s very hard for us to change them because our food is our identity. Taking away our spices, our chai, our sweets and our Haldirams snacks is like talking away our soul. Suggest diet and other changes which can reasonably be incorporated into our lifestyle.
• We’re especially sensitive about a few aspects of our body: Especially skin color, hair length and thickness (or lack thereof), and brain health. Be extra sensitive when these items are potentially impacted.

Habits of ours you’ll need to accommodate for in the doctor’s office:

• Our rich heritage of Ayurveda has us more pre-disposed towards home-made and herbal remedies over prescribed ones. Don’t give us a pill when chyawanprash will do. Whenever possible give us holistic health recommendations and connect us to those types of resources.
• We believe what see on WhatsApp. Posts from our former Hostel-mates and Batch-mates hold a lot of sway. Ensure there is time during the care experience to address these latest trends/fads.
• Like other communities: We’re cheap and will only spend if absolutely needed. Also we don’t like surprises. Tell us in advance how much we are going to spend and what we are getting for our money. On the flip side, if we go out of our way to capitalize when we think we’re getting a good deal.

Who and how to convince us of healthcare recommendations:

• The women are the true leaders of our community’s heart and soul. At the end of the day, they are making the key decisions about what is best for the family. Understand that’s who you need to convince, whether its a procedure recommendation or a behavioral change.
• Credentials matter, diplomas matter. They won’t just be seen by anyone for anything. “Wait, he’s only a D.O.?!” , or “Wait, this doctor isn’t even married?!” is common. Be strategic about who is delivering care in what capacity.
• We’re skeptical of everything and think most 3rd parties are trying to trick us or sell us something. After all, that’s what India was like. Make clear that you have nothing to gain when recommending additional procedures, tests or referrals.

Force Multipliers that would help us feel better during our care journey:

• We do most everything as a community: traveling, eating, praying, you name it. When want it, we need to be able to “flip the switch” and leverage our community to help take care of us (e.g., give them the latest news, give them times they can come to our house and deliver food). These can be online or offline communities.
• Rich or poor, we are educated and can do the research. Give us options and some time to discover for ourselves what we think the best course of action is. We’ll be much more bought-in to our care if we’ve consulted those we trust.
• We don’t need the internet for a second opinion — we can just call our doctor aunt or uncle. And it doesn’t matter if they’re not the right type of doctor. We need to be able to share outside opinions with you and connect in key friends/relatives in the decision-making process.

Our top health issues:

• Heart disease: We are 25% of the world’s population but 60% of the world’s heart disease patients. While studies are ongoing, we know we’re pre-disposed for it and need solutions designed for early identification and long-term holistic treatment. Cardiology must be baked into the core service offering of primary care.
• Diabetes: We have roughly 3x the relative risk of being diabetic, compared to whites and other minority groups. And what’s worse, our lifestyle factors are likely contributing factors but like everyone else, this is very tough to change. Endocrinology must be baked into the core service offering of primary care.

What did I miss? What did I get wrong? As always, would love your feedback/comments. Find me on twitter @Rsiddhanti.