In their first joint interview, Dr Azad Moopen, a pioneer of the GCC's healthcare sector, and his daughter Alisha, the newly appointed deputy managing director at Aster DM Healthcare, outline their ambitious plans for the future
“What are we doing? All of us are doing sickcare. When are we going to do healthcare? That is the big question.”
It’s not often you sit down for an interview with one of the GCC’s biggest business leaders and they start criticising the $80bn industry they have been a major part of for over three decades.
“Definitely I’m a workaholic and I’m glad she has it. That gives me peace of mind”
It’s an even bigger eye-opener when it is coming from someone as soft-spoken as Dr Azad Moopen, the founder and chairman of Aster DM Healthcare, one of the biggest integrated healthcare providers in the Gulf.
A trained medical doctor who moved to Dubai from Kerala in 1987, his empire now includes 25 hospitals, 115 clinics and 231 pharmacies in nine countries, employing around 20,300 staff. While he is quickly moving through the AED1bn ($272 million) five-year development plan he announced in 2015, and is considering expansion plans as far afield as Australia and even a listing in London, he believes the healthcare industry needs to move with the times and catch up with the fast-paced technological advances disrupting other traditional industries. Where is the Uber or the Airbnb or the Netflix of the healthcare sector? Dr Moopen is hoping the answer will be Aster DM Healthcare.
“Healthcare has traditionally been very slow in adopting technology, it is a weak spot… It is still the same thing which happens now that was happening 50 years back.
“You need a doctor, you make an appointment, then he prescribes some tests. Then you go back to him, get a prescription and go to the pharmacy and so on. While it has changed in other industries, healthcare is the same. There will definitely be disruption,” he says.
Dr Moopen sees a future where instead of patients going to hospitals for procedures and to pharmacies for drugs, heathcare operators like his will become involved much earlier in the cycle, offering technology-based methods for customers to improve their lifestyle and health so they never have to step foot in a hospital at all. He also wants to see more pre-emptive, real time monitoring so customers can highlight any health problems and tackle them before they have time to develop into expensive medical emergencies.
“Healthcare has traditionally been very slowly in adopting technology. It is a weak spot”
So, where is this disruption going to come from? Dr Moopen may have passed the official retirement age a year ago, but the self-confessed workaholic is determined to remain at the forefront of the industry and is taking it upon himself to push forward the changes the industry desperately needs.
“We are focusing very heavily on innovation.” This is something I have heard many company leaders say in interviews over the last few years, but Dr Moopen is putting his money where his mouth is and, in August, announced the setting up of the Aster Innovation and Research Centre. Based in Bangalore, the facility aims to leverage advances in digital health research, such as artificial intelligence, cognitive psychology, blockchain, the Internet of Things and behavioural economics. The centre will do this by partnering with universities, start-ups and industry partners and will be led by Dr Satish Prasad Rath, MD, a post-graduate medical doctor and digital health scientist with experience leading research and innovation labs at Xerox Innovation Group, Wipro Technologies, Intel labs and Philips Research. Dr Moopen says the project “is likely to produce a quantum leap” in the future of the healthcare system.
As the healthcare titan pushes for fast-paced change within the industry, his own company is changing too. Earlier this summer, his daughter Alisha Moopen was appointed deputy managing director of the group.
In their first exclusive interview together, Alisha points out that she is moving up the ranks of the company at a time when a seismic shift is taking place within the healthcare industry.
“When you go back in time, what you had usually was bedside assistance, where the doctors would come to the patient. This moved to having brick and mortar in hospitals, mainly with the industrial revolution, because suddenly you had X-ray machines, you had CT machines and you couldn’t obviously take these to people’s homes. So, you shifted the care from homes to hospitals. Also, because there was a lot of infectious and communicable diseases, you actually wanted to quarantine people so that they’re not spreading it amongst the population. Now, if you fast-forward, things have changed a lot. You don’t have as many people with infectious diseases… Managing healthcare is changing,” she says, pointing out that advances in technology will increasingly see the shift back to the home, but now doctors will be able to use technology to monitor and treat patients remotely, rather than tending to them at their bedside.
“Things have changed a lot. You don’t have many people with infectious diseases”
The changes are already showing some positive results in a practical sense: “The technology has helped get people back on their feet much faster. Earlier, when you do knee replacements people were in bed for 15 to 20 days. Now, you can actually have the person back on their feet in two days, so there is that benefit,” Alisha points out.
Dr Moopen announced his five-year AED1bn masterplan two years ago and while bricks and mortar are still important – with AED750 million already spent on new hospitals in the United Arab Emirates, Oman and Saudi Arabia – he believes that when it comes to announcing the next five-year development plan in three years it will be focused more on innovation and technology than building more concrete assets.
“What we will be doing may be different from what we did: Starting 25 clinics in a year or 50 pharmacies in a year, that may be change… There is a trend for this to gradually shift to more of an offline situation where you don’t require actually a bricks and mortar consultation, maybe it will be an online consultation, with the delivery of medicine at home,” he says.
Already, Aster DM Healthcare is embracing new ways of doing things and using technology to improve efficiencies.
All his hospitals’ intensive care units are fed into a centralised network and artificial intelligence monitoring and algorithms can then alert a specialist doctor who can interpret if a patient needs attention. The doctor doesn’t even need to be located in Dubai – the specialist can be in a facility in India or anywhere in the world, and monitoring patients’ vital systems in dozens, if not hundreds, of beds in multiple countries.
“We have looked at things in Europe, in the United Kingdom and going to Australia and Finland,”
“There is a huge change happening,” he says, pointing out that this use of expertise for a wider pool of patients will become the norm, especially as networks improve over time.
“With 5G coming there is going to be a significant change in the way which healthcare is looked at, according to what we foresee. For the benefit of the patient and... much more cost effective.”
The technological advances increasingly open to patients and the mainstream popularity of wellness gadgets are also having an impact on the healthcare system. “An Apple Watch or whatever apps you have, this will help you to know a problem before it happens. For example, diabetes management which is affecting 20 to 25 percent of the population in many countries. If you have constant monitoring of your blood sugar… then the chance of you having a complication is so low,” Dr Moopen says.
Looking specifically at the United Arab Emirates, the trends within the local market are also shifting, with the growth in lifestyle-related diseases and an increasingly aging population.
According to the World Bank, the percentage of the UAE population aged over 65 years of age will increase from 1.1 percent in 2018 to 4.4 percent by 2030 Dr Moopen points out that, on average, 80 percent of a person’s expenditure on healthcare is spent in the last 20 percent of their life. So, if the UAE’s population demographic is getting older, then the cost of healthcare is only going to increase dramatically over time. On top of an aging population, the International Diabetics Federation has reported that, across the GCC, 73 percent of deaths in 2015 were classed as non-communicative diseases (NCDs), including conditions like cardiovascular diseases, cancer, respiratory diseases and diabetics, and this was due to the fact many residents in the region live sedentary lifestyles and have bad diets. Dr Moopen believes that the remote monitoring approach he outlined earlier will become commonplace if the region is to combat the growth of NCDs.
As the company looks to expand its scope and focus, it is also planning to scale up its geographical reach - in its bid to become one of the top ten healthcare operators in the world - and is actively looking at potential new markets as far afield as Australia.
“I think if we want to go outside these geographies [the GCC countries], which itself have a lot of opportunities for the next few years, we want to look at something which is more from an acquisition model,” says Alisha.
“I don’t think we have any intention of going Greenfield and setting up from scratch… We have looked at things in Europe, in the United Kingdom [and]… going to Australia, Finland… That’s something which we are reviewing.”
Africa is also on their radar but is likely to be more of an operating model, such as managing clinic networks, rather than investing in hospital facilities.
So how will they fund the international ambitions and their next five-year plan? Aster DM Healthcare made its debut on the Bombay Stock Exchange in February last year, raising $153 million from a 10 percent stake, and is seriously considering listing on the London Stock Exchange within the next three years.
“We are listed in Mumbai now, so should we be listed in London also? Should we be listed in Dubai also? We are looking at those opportunities,” Dr Moopen says.
“The next two or three years we will be looking at opportunities for a listing in other markets also… So, what’s happening is that in India they are now seriously considering allowing dual listing so we can, without much effort, list the company in London also, if that comes through. Otherwise it is an effort to delist here [in India] and go to London. So, we are looking at this opportunity.”
Alisha adds that a massive key factor in the decision will be the impact of the Brexit process, which is still unclear. “When we were taking the call two, three years ago we knew that that [Brexit] was something which might be coming up. So, we said we will take a measured approach, as in, when the time arises. And now, once you see how that impacts the London Stock Exchange, does it make sense for us to go over there? I guess those [issues] are sort of depending on how the market perceives it… We can take a call,” she says.
With his daughter ready to eventually take over the reins, what does the iconic chairman – who was this month honoured as Visionary of the Year award at the CEO Middle East Awards 2019 – plan to do in the future? “I’m a workaholic and I’m happy that she has it, so that’s a good thing. That gives me peace of mind.” Retirement? “It’s already too late for me to retire, I’m now past 65,” he laughs. “So, I’m looking at maybe a three to five-year period to get out of the active management.” With his new innovation lab seeking to answer the big questions and move the industry towards real, transformational healthcare, the time away from the daily grind of management will let him focus on brainstorming what the next phrase of the sector will look like and help secure his legacy.
“Medicines delivered at home? Yes, if there is statutory approval for that, that can happen and it’s happening in many countries. But, beyond that, how might it really be used? Only time will tell. But we will be there, and we are strategising,” says Dr Azad Moopen, the founder and managing director of Aster DM Healthcare.
“Both Abu Dhabi and Dubai have complete comprehensive [health insurance]. So that significantly increases the number of people who access healthcare, so that is a big change…. We have been hearing for a long time that Saudi Arabia [will get universal healthcare coverage], the eight million expat population is already covered through insurance, [but] the 22 million local population is not covered. We have been hearing that it’s going to be now covered completely, as well as even in Bahrain… Every year we hear that it is going to be covered,” says Dr Moopen.
Earlier this year the latest results of the Arab Youth Survey, which carried out 3,300 face-to-face interviews with Arabs aged 18 to 24 years in 15 countries, found that 31 percent of respondents said they knew someone who suffered from mental health issues, such as anxiety and depression. At the same time 54 percent believe quality mental healthcare is difficult to access for most in the Arab World. “I think this is another clear trend which is emerging,” Alisha Moopen, deputy managing director at Aster DM Healthcare, says.
“What you don’t really have is a lot of data around mental health, because of the taboo around it. Technology is going to make a huge impact on this because a lot of times people don’t want to go to the facilities, like talking to the psychiatrist or going to the psychologist,” she says, adding that things like online consultations will become more common.
“Mental health we are looking at seriously. It can be done without physical contact,” says Dr Moopen.
“You’re seen a rising incidence of depression, anxiety and those sorts of attention deficit disorders. So, I think there is an emerging trend, that mental health is becoming more and more prevalent. We are also, as an organisation looking at how we can look at that as another [trend] within healthcare,” Alisha adds.
Another trend within the Arab Youth Survey was drug use, with 57 percent of respondents says they believe illegal substances are too easy to get and half saying there should be more rehabilitation and counselling services for addicts.
“That’s not an area we have looked at so far, to be honest,” Alisha says. “I think governments would like to keep this [trend] to themselves.”