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TORAVEJ
MARKET ANALYSIS AND
OPERATION MANAGEMENT
BY
MS. SIWAPORN FUENGFOOSIN
AN INDEPENDENT STUDY SUBMITTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF MASTER OF BUSINESS ADMINISTRATION
(GLOBAL ENTREPRENEURSHIP) INTERNATIONAL MASTER
IN BUSINESS ADMINISTRATION
FACULTY OF COMMERCE AND ACCOUNTANCY
THAMMASAT UNIVERSITY
ACADEMIC YEAR 2017
COPYRIGHT OF THAMMASAT UNIVERSITY
Ref. code: 25605802043231UQS
TORAVEJ
MARKET ANALYSIS AND
OPERATION MANAGEMENT
BY
MS. SIWAPORN FUENGFOOSIN
AN INDEPENDENT STUDY SUBMITTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF MASTER OF BUSINESS ADMINISTRATION
(GLOBAL ENTREPRENEURSHIP) INTERNATIONAL MASTER
IN BUSINESS ADMINISTRATION
FACULTY OF COMMERCE AND ACCOUNTANCY
THAMMASAT UNIVERSITY
ACADEMIC YEAR 2017
COPYRIGHT OF THAMMASAT UNIVERSITY
Ref. code: 25605802043231UQS
(1)
Independent Study Title Toravej - Market Analysis and Operation
Management
Author Ms. Siwaporn Fuengfoosin
Degree Master of Business Administration
(Global Entrepreneurship)
Major Field/Faculty/University International Master in Business
Administration
Faculty of Commerce and Accountancy
Thammasat University
Thesis Advisor Surapit Promsit, Ph.D.
Academic Years 2017
ABSTRACT
Toravej is a telemedicine startup which provide online application form
for healthcare professional and patient to connect to each other anywhere at any time.
Our aim is to provide healthcare accessibility to all Thai population in affordable price
for quality healthcare and our team will provide affectionate care to each individual
equally. In this paper, we will show step by step on how we identify the problem, how
Toravej started, what we have learnt throughout the experiment by using Metamo
process taught in IMBA.
Keywords: Telemedicine, Toravej, Online consultation, Healthcare
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ACKNOWLEDGEMENTS
I would like to thanks my family and my boyfriend who support me
throughout this learning journey for almost 2 years. It was not easy and I had to sacrifice
my time to take care you guys for this master degree journey. Thanks, my co-founders:
Navapol and Sophon who never give up on the project even how hard this project seems
like. Without you both, we would have not come this far. I also would like to share my
gratitude to our Toravej healthcare providers i.e. P’Nan, P’June, Dao and P’Aom who
sacrifice their busy doctor’s schedule to help answering questions from patient in our
platform. Thanks for all friends who give comment on how we can create better platform
or better content in our Facebook/Website. Thanks Dr.Ikk (from Ruckdee), Dr.Nawanan
( from Ramathibodi hospital) , Dr. Maew ( from ChiiWii) , Dr. Arun, Dr. Phongsak,
Dr. Worawut ( Retired doctor from Siriraj) , Dr. Paradorn ( Director of Samitivej
Chonburi), Dr.Kongsak (ex-CEO at RingMD Thailand), Justin (RingMD CEO) who share
us perspective on telemedicine business.
Lastly, I would like to thanks IMBA classmates, IMBA coordinator (Aui
and Neoy) who help support myself throughout this IMBA journey. This is such a great
learning for me
Ms. Siwaporn Fuengfoosin
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TABLE OF CONTENTS
Page
ABSTRACT (1)
ACKNOWlEDGEMENTS (2)
LIST OF TABLES (8)
LIST OF FIGURES (9)
LIST OF ABBREVIATIONS (11)
CHAPTER 1 ORGANZATION & MANAGEMENT TEAM 1
1.1 Background 1
1.2 Vision/Mission/Goal 2
1.2.1 Vision 2
1.2.2 Mission 2
1.2.3 Goal 3
1.3 Direction and Future Plan 3
1.4 Management Team 3
CHAPTER 2 MARKET ANALYSIS 5
2.1 Market Analysis 5
2.1.1 USA 6
2.1.1.1 Healthcare System Introduction 6
2.1.1.2 Telemedicine in USA 7
2.1.1.3 Example of Telemedine Business in USA 10
(1) Teladoc 10
(2) Lemonaid 11
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(3) Grandrounds 12
2.1.2 India 13
2.1.2.1 Healthcare system introduction 13
2.1.2.2 Telemedicine in India 14
2.1.2.3 Example of Telemedicine Business in India 17
2.1.3 Thailand 18
2.1.3.1 Healthcare System Introduction 18
2.1.3.2 Telemedicine in Thailand 20
2.1.3.3 Example of Telemedicine business in Thailand 24
(1) SOS Specialist 24
(2) ChiiWii 24
(3) OOCA 26
(4) RingMD 26
(5) See Dr.Now 27
(6) Optimize Care 28
2.2 Competitive Analysis 28
2.2.1 Threat of New Entrants 28
2.2.2 Treat of Competitive Rivalry 29
2.2.3 Bargaining Power of Suppliers 29
2.2.4 Bargaining Power of Customers 29
2.2.5 Threat of substitutes 30
2.3 Legal Feasibility 30
2.3.1 Sanatorium Act B.E. 2541 30
2.3.2 National Health Act B.E. 2550 31
2.3.3 Law regulating healthcare professional 31
2.3.3.1 Medical Professional Act B.E. 2525 32
2.3.3.2 Pharmaceutical Professional Act B.E. 2537 32
2.3.3.3 Nursing and Midwifery Professional Act B.E. 2528 32
2.3.3.4 Dental Professional Act B.E. 2537 32
2.3.4 Announcement from national health committee on guideline 32
to use social media for healthcare professional B.E. 2559
2.3.5 Drug Act B.E. 2535 32
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2.4 Opportunity Area 33 CHAPTER 3 SUMMARY OF PRODUCT & SERVICE 37
3.1 Product Development 37
3.2 Design Elements 38
3.2.1 Opensource 38
3.2.2 Outsystem 38
3.2.3 Blockchain 39
3.3 Toravej Potential Feature 40
3.4 Implementation 41
3.4.1 Website 42
3.4.2 Facebook 42
3.4.3 Rocket Chat (first prototype) 42
3.4.4 Skype (Second prototype) 43
3.4.5 Mobile Application 45
CHAPTER 4 OPERATION MANAGEMENT 45
4.1 Selection Process 48
4.1.1 Diseases/Conditions 49
4.1.1.1 Wellness/Preventive 50
(1) Stress/Mental Health 50
(2) Contraception & Sexual Wellbeing 50
(3) Acne 51
(4) Baby 51
4.1.1.2 Chronic Care 51
(1) Hypertention and Dyslipedemia 51
(2) Diabetes 53
(3) Allergy 54
4.1.2 Healthcare Professionals 55
4.1.3 Customers/Patients 55
4.2 Design and Measurement of the Model 55
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4.3 Management of Quality 64
4.4 Improvement Program 64
CHAPTER 5 SUMMARY OF MARKETING STRATEGY 66
5.1 Marketing Segmentation 66
5.1.1 Patient 66
5.1.1.1 Rural Patient 66
5.1.1.2 Urban Patient 66
5.1.2 Healthcare Provider 66
5.2 Marketing Mix 67
5.2.1 Product 67
5.2.2 Price 67
5.2.3 Place 67
5.2.4 Promotion 67
5.2.5 People 67
5.2.6 Process 68
5.3 Competitive Analysis 68
5.3.1 Four Corner's Analysis 68
5.3.1.1 Drivers 68
5.3.1.2 Management Assumption 68
5.3.1.3 Strategy 68
5.3.1.4 Capacity 69
5.3.2 SWOT Analysis 69
5.4 Marketing Plan 70
5.4.1 FaceBook 70
5.4.2 Website 71
5.4.3 Word of Mouth 71
5.4.4 Competition 71
5.5 Brand Strategy 72
5.5.1 Brand Name 72
5.5.2 Brand Logo 72
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CHAPTER 6 SUMMARY OF SALE STRATEGY 73
6.1 Sale Policy & Process 73
6.1.1 Sale Process 73
6.1.1.1 Facebook Post 73
6.1.1.2 Facebook Boost 75
6.2 Channel 76
6.2.1 Online tool 76
6.2.2 Offline tool 77
6.3 Pricing 77
6.3.1 RingMD 77
6.3.2 ChiiWii Live 78
6.3.3 See Doctor Now 78
6.3.4 OOCA 78
CHAPTER 7 SUMMARY OF FINANCIAL PROJECTION 79
7.1 Assumption/Forecast 79
7.1.1 Revenue 79
7.1.2 Cost 79
7.2 Pro-forma Income Statement 81
7.3 Pro-forma Statement of Cash Flow 81
7.4 Pro-forma of Financial Position 82
7.5 Remarks 83
CHAPTER 8 CONCLUSION 84
REFERENCES 86
BIOGRAPHY 88
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LIST OF TABLES
Tables Page
3.1 Summary of Key Features from Players in international markets 37
4.1 Criteria and Result for choosing condition and disease for Toravej 49
in Thailand
4.2 Feedback from customer and provider from 1st Design 57
4.3 Healthcare Providers per Disease/Condition Toravej obtained for 2nd 59
Prototype testing.
4.4 Customers/Patient information and feedback after use our service 62
4.5 Provider information and feedback after use our service 63
4.6 Service Improvement 65
5.1 Strength and Weakness of RingMD, See Doctor Now, OOCA 69
5.2 Toravej SWOT Analysis 70
5.3 Facebook Strategy in Toravej 2nd Prototype 71
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LIST OF FIGURES
Figures Page
2.1 Type of Health Insurance in USA (census.gov, 2015) 6
2.2 USA Healthcare Delivery 7
2.3 USA Age Distribution 2016 (United State Age Structure, 2016) 8
2.4 Teladoc 10
2.5 Teladoc B2B2C Strategy 10
2.6 Teladoc Interface Model 11
2.7 Lemonaid webpage 12
2.8 Lemonaid Operation 12
2.9 Grandrounds Operation 13
2.10 India Public Insurance Scheme 14
2.11 India Population Age Distribution 16
(India Population Age Distribution, 2014)
2.12 World Health Partner Model (Kartik Deshpande, 2012) 18
2.13 Hospital Outside Bangkok Stats (MICKAEL FEIGE, 2015) 19
2.14 Summary of Health Insurance Scheme in Thailand 20
2.15 E-health strategic work scheme (Analysis of eHealth Strategy, 2015) 21
2.16 Summary of ehealth situation in Thailand (Kijsanayotin) 22
2.17 www.sosspecialist.com 24
2.18 ChiiWii Chatroom 26
2.19 RingMD Operation 27
2.20 See Dr. Now Operation 28
2.21 Summary Table on Five Force Strength to Successful Telemedicine Business 30
2.22 Toravej CANVAS 33
2.23 Relevant Healthcare Statistic in 2015 (Healthcare Statistic, 2015) 34
2.24 Summary of Healthcare Resource from medical council of Thailand and 34
national statistical office
2.25 Toravej Opportunity 35
2.26 Toravej Competitiveness 36
3.1 Outsystems Platform (Platform) 39
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3.2 Customer/Patient Interface in Toravej 40
3.3 Healthcare Professional Interface in Toravej 41
3.4 Service Administrator Interface in Toravej 41
3.5 Toravej Telemedicine Facebook page 42
3.6 Rocket Chat Consultation Screen 43
3.7 Example of Provider Screenshot on mobile phone having Toravej Account 44
3.8 Mobile Features in Skype (2nd Prototype) 45
3.9 User Journey 46
3.10 Provider Journey 46
3.11 Admin Journey 47
3.12 Toravej Mobile App Feature 47
4.1 Toravej Operation Framework 47
4.2 Hypertension Guideline recommended in Thailand 52
4.3 Diabetes Monitoring Guidance (Association, 2017) 53
4.4 Clinical Practice Guidance for Allergy Rhinitis 54
(Clinical Practice Guideline: Allergic Rhinitis, 2015)
4.5 Toravej 1st Design Operation 56
4.6 1st Design of instruction to use Toravej 57
4.7 Toravej 2nd Prototype Testing Criteria 58
4.8 2nd Design for Instruction on how to use Toravej 60
4.9 Toravej 2nd Design Operation 60
5.1 Toravej Logo 72
6.1 Example of FB Post 74
6.2 Example of FB Layout 74
6.3 Example of Articles on website match with FB post 75
6.4 Comparison between boost and non-boost post 76
6.5 Example of Facebook Infographic content 77
7.1 Revenue Cost (Forecast from 2018-2022) 79
7.2 Toravej Cost (Forecast 2018-2022) 80
7.3 Cash Flow (Forecast 2018-2022) 82
7.4 Financial Position (Forecast 2018-2022) 83
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LIST OF ABBREVIATIONS
Symbols/Abbreviations Terms
WHO World Health Organization
B2B Business to Business
B2C Business to Consumer
B2B2C Business to Business to Consumer
ICU Intensive Care Unit
WHO World Health Organization
USA or U.S. United States of America
USD United State Dollar
BHT Thai Baht
OECD The Organisation for Economic Co-
operation and Development
GDP Gross Domestic Product
WHP World Health Partner
UC Universal Coverage Scheme
SSS Social Security Scheme
CSMBS Civil Servant Medical Benefit Scheme
SME Small and medium-sized enterprises
ICT Information and Communication
Technology
ENT Ear, Nose, Throat
VDO Video
B.E. Buddhist Era
PaaS Platform as a service
MADP Mobile application development
platform
IRIS Intelligent Resilient Information
System
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COPD Chronic Obstructive Pulmonary Disease
FB Facebook
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CHAPTER 1
ORGANZATION & MANAGEMENT TEAM
1.1 Background
World Health Organization (WHO) describes definition of good health system
as the system which can deliver quality services to all people, when and where they
need them. Does Thailand health system fall into this definition today?
Thailand, as a developing country, encountered several healthcare problems in
different dimensions. To being with, due to the scarcity of healthcare professionals in
rural area comparing with urban (2,558 vs 226 patients per one doctor respectively,
statistic from Ministry of Health 2015) , there is not enough healthcare accessibility to
people living in countryside. Moreover, doctors are overloaded in some hospitals, which
ultimately could result in poorer service quality. In urban area, patients wasting their
time just for a few minutes checkup or follow up with doctors or a lab result. Some
patients’ need 24/ 7 healthcare service but their physicals are not competent. These
problems can be unraveled by bringing doctors to meet patients at anywhere and
anytime via our platform and communication model.
Toravej will act as the front line of basic healthcare needs. Toravej will provide
accessibility to affordable and quality healthcare service for people in rural area. It will
also provide faster healthcare solution to people in urban communities. By using 2 ways
interactive real time streaming platform (web/phone application) , patients and doctors
can communicate and consult each other at anywhere any time. Through Toravej,
physicians and healthcare professionals, who believe in providing healthcare at
minimum cost and using technology to save life, will be able to better patients’ quality
of life. By partnering with pharmacy store, doctors community, government agency,
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telecommunication provider and local community leaders, Toravej aims to be Thailand
most successful private telemedicine company ( B2C - patients to doctors) that can
answer immediate patients need with mobility.
1.2 Vision/Mission/Goal
Toravej is a startup that connects patients and healthcare professionals via a 2-
way interactive platform. We aim to provide faster and easier healthcare solutions to
patients who have questions or concerns on self- care practice. Moreover, by using
Toravej patients will enjoy healthcare consultation at affordable price level. We
envision that every community in the world will have accessibility to quality health
care one day.
1.2.1 Vision
Toravej will provide accessibility to affordable and quality serviced
healthcare for 700,000 people in rural area and faster healthcare solution to 260,000
people in urban communities, by using 2 ways interactive real time streaming
technology that patients and doctors can communicate anywhere at any time by 2020.
With Toravej, physicians and other healthcare professionals, who wants to minimize
healthcare cost through modern platform, will be able to create more sustained
healthcare system, save life and improve people's quality of life.
1.2.2 Mission
To provide exceptional quality healthcare services with three " A"
approaches: AFFECTIONATE service with care, ACCESSIBLE anywhere anytime,
and AFFORDABLE to all.
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1.2.3 Goal
1) To become Thailand officially private telemedicine company
(Business to Consumer B2C - patients to doctors) that can answer immediate patients
need with mobility.
2) To raise awareness of telemedicine and its benefit in Thailand for at
least 10,000 people per year.
3) To assist in creating a more sustainable healthcare system with lower
cost and more accessibility for Thailand by 2020.
4) To be able to specify our targeted customer and targeted diseases
within three months after the launch.
1.3 Direction and Future Plan
Toravej is scalable domestically and/ or internationally through variety of
healthcare services. For the initial phase, we will be focusing on basic diseases with
urban communities. By categorizing level of complexity for each disease, we will
deviate and refer complicated issue to nearby hospital. With success, the next phase will
be extending the service to rural areas. This will include building a small health center
(or clinic) equipped with basic telemedicine equipment that can send data through cloud
technology for doctors or specialist in the urban area to analyze. Other possible services
are medicine delivery, emergency monitoring and home care delivery, ICU visitation
monitoring, and selling medical equipment (telemedicine compatible).
1.4 Management Team
There are 3 co-founders in Toravej. We all have diverse background but sharing
passion on saving life, improving healthcare access at minimal cost, and creating better
patients’ quality of life. We value each individual expertise and experience in their work.
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The team has a good combination that can support each other. Here is the brief
biography of our management team.
1) Navapol Tiawphaibul (Murf) , Chief Technology Officer (CTO) , BBA in
Management Information System, University of Notre Dame, USA. currently studying
MBA ( entrepreneurship) at Thammasat University. 10+ years experience with IT
consulting in financial industry.
2) Siwaporn Fuengfoosin ( Tape) , Chief Operating Officer ( COO) , B. Sc
(Pharmacy) with 1st honor degree, Chulalongkorn University and currently studying
MBA ( entrepreneurship) at Thammasat University. Having 6 years regulatory
experiences on health care products in 3 continents from company in fortune global 500
list
3) Sophon Vijitmethavanich ( So) , Chief Financial Officer ( CFO) , B. A.
(Economics) with 1st honor degree, Thammasat University and currently studying MBA
(entrepreneurship) at Thammasat University. Having 2 years experience as economist
experts and now working as strategic analyst at Bank of Thailand.
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CHAPTER 2
MARKET ANALYSIS
2.1 Market Analysis
Word Health Organization (WHO) recommend their member states to leverage
today’ s modern communication technology, for example internet, computer or cell
phone to enhance global health problem world is facing nowadays on 4 different areas:
Access, Equity, Quality and Cost-Effectiveness (WHO, Telemedicine Opportunities and
Developments in member state, 2010).
Telemedicine, according to WHO definition (WHO, 1997), is
“The delivery of health care services, where distance is a critical factor, by all health
care professionals using information and communication technologies for the exchange
of valid information for diagnosis, treatment and prevention of disease and injuries,
research and evaluation, and for the continuing education of health care providers, all
in the interests of advancing the health of individuals and their communities”
Telemedicine services quite vary depending on how developed the country is.
In United State of America ( USA) , European countries and Australia, they use
telemedicine toward diagnosis and clinical management while in developing countries
such as India, ASEAN countries (Heinzelmann PJ, 2005) primarily focus on linking
healthcare professional to healthcare professional or primary hospital to higher level of
hospital. In order to fully assess the healthcare market to understand healthcare
structure, business model and environment, Toravej is going to use PESTLE model to
analyze three different countries; USA representing country which is very successful in
urban telemedicine model, India representing country which successfully operating
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telemedicine in rural area and Thailand representing country which Toravej would like
to penetrate and operate in.
2.1.1 USA
2.1.1.1 Healthcare System Introduction
USA is one of the most well- known country which having
modern technology to assist their healthcare system. In States, healthcare operation
mainly owned by private sectors while the main payer is federal and state government.
Before Obama’s care implementation, USA citizen rely on 2 types of insurance: Private
Plan (Employer Sponsored Insurance) or Government Plan (Medicare and Medicaid)
Figure 2.1 Type of Health Insurance in USA (census.gov, 2015)
In term of healthcare delivery in US, it can be divided into 3 layers which
primary care is the fundamental care of community. The description of each layer can
be found in figure 2
In term of payment, US system used co-pays and deductibles scheme which
means each patient will need to pay up front (deductibles) and after that will co-pays on
certain treatment or medicine depending on agreement with insurance provider.
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Figure 2.2 USA Healthcare Delivery
2.1.1.2 Telemedicine in USA
The cost of healthcare in USA is listed as top countries in term
of healthcare spending when compare with other OECD countries. Telemedicine is
another promising solution to improve health outcome while reducing overall
healthcare expenditure. However, they are some challenges/barriers for company to
fully operating this type of business in States. PESTLE model will be used to assess
each individual area of telemedicine environment in USA
PESTEL
Politic (P)
During Obama’s president era (2009-2017), telemedicine business received a
lot of support from US government. This due to the fact that Obama’s team focusing
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on healthcare reform in United States i.e. affordable healthcare insurance to USA
citizen called Obama’s care. Anyway, with new president Donald Trump, the political
direction may shift and this might result on infrastructure of telemedicine business in
USA
Economic (E)
In U.S National health expenditure reach 3.1 trillion USD which counting as
18% of U.S GDP in 2014. Many service sectors including telemedicine business want
to play in this area hoping will reduce the overall cost of health expenditure.
With the stable economic growth at 3.5% in year 2016, low interest rate (less
than 1%) and inflation rate at 2.1 percent year-on-year in December, 2016 suggest that
starting up a business is supportable by overall US economy.
Social (S)
In 2016, the population growth rate in USA is equal to 0.73% when compared
to year 2015 (US population, 2015). Following the global trend, age distribution of
U.S. population showing that in next 10 years, more than 20% of the population will
have age more than 60 years old as figure 3
Figure 2.3 USA Age Distribution 2016 (United State Age Structure, 2016)
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The health-conscious trend in young adult also affect the demand of healthcare
business in the States. More and more people starting to exercise, keeping their diet and
check out healthcare information on internet by themselves. With internet, it pushes the
barrier of not having enough information into full of information but will need to
validate the data.
Technological (T)
USA is one of the top countries in the world which has many advanced
technology and innovation. Looking to gadget and device market, there are google
watch, fitbit and another advanced device developing in USA. With the support from
government in prior years, the technological shift for telemedicine is approaching with
more active in R&D for automation and AI technology to create a lower cost and more
precise diagnostic in healthcare industry. Unfortunately, these technological
infrastructure is still cover only key cities like New York or San Francisco while for
rural city still don’t get benefits from these technologies.
Environmental (E)
Not Applicable
Legal (L)
In USA, there is a federal law and state law in which company need to comply.
Application of some law especially in telemedicine area is not fully clear and subject
to interpretation from one state to another. Based on Deloitte analysis report, telehealth
consultation is legally in every States but only 30 states (including District of Columbia)
are allowed for commercial reimbursement. For healthcare professional to be able to
give consult to patient, providers must have valid license in order to operate in each
individual States. Some States don’t allow providers from another state to give consult
to their citizen.
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There are also other type of regulations governing not directly to telemedicine
business but across categories, for example, discrimination law, consumer protection
law, Health Insurance Portability and Accountability Act (HIPPA) and health & safety
regulation.
2.1.1.3 Example of Telemedine Business in USA
(1) Teladoc
Teladoc is the first and the largest telehealth platform,
delivering 24/7 on-demand healthcare anytime, anywhere via mobile device, internet,
video and phone. Connecting patient to health professionals on various type of
conditions such as upper respiratory diseases, dermatological condition, sexual health
and psychological condition
Figure 2.4 Teladoc
Business Model
Teladoc using B2B2C Strategy in order to reach to their target customer – greater detail is found in figure 5
Figure 2.5 Teladoc B2B2C Strategy
Teladoc
• Providing 26 healthcare plan to
customer
• Collect money from client ‐ per member per month basis
(Main Revenue) and from client or
subscriber directly on actual visit fee
6,000 Clients
• Example of clients: Health insurance company, lited
company
12M subscribers
• More or less employee in the big coorperate such as HP, Pepsi, Accenture and Bank of America
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According to Teladoc financial report in year 2015 (Teladoc Annual Report,
2015) , company charge customer from 40 USD per visit and promising less than 10
minutes waiting time before meeting consulting with healthcare professional.
Altogether in year 2015, there are approximately 576,000 visits while the subscription
rate increase about 4.1 million members.
Figure 2.6 Teladoc Interface Model (2) Lemonaid
Lemonaid aims to create a cheaper and faster way on primary
care disease by creating a platform for patient to complete the online checklist on their
symptom and then the doctor will check from theirs. With the help of technology, the
process will complete within 3 minutes. Lemonaid picks disease which patient are
unlikely want to meet healthcare professional directly, for example, erectile dysfunction
or birth control pill. Then they extend it to other type of diseases such as acne, acid
reflux, hair loss etc. The focus is on primary care which thousand and thousand people
are facing in daily life.
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Figure 2.7 Lemonaid webpage
Business Model
B2C. Company currently operate in 14 states (Arizona, California, Connecticut,
Florida, Georgia, Illinois, Michigan, New York, Ohio, Oregon, Pennsylvania, Rhode
Island, Virginia, and Washington) after launch the business for over 2 years. They
charge 15 USD per visit fee on website or mobile application
Figure 2.8 Lemonaid Operation
(3) Grandrounds
Grandrounds provides remote care team to employee from their
organization customers. They help employee getting to the best physician in the field
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that covered by employer insurance. They provide a care coordinator who will help
ensure there will be someone walk you through every single process and even remind
you to go hospital or take a pill today. They also build up patient record by having record
specialist sit in the company. Thus, employee can access their record at anyway at any
time as long as you have profile with GrandRounds.
Business Model
B2B2C. Company is committed to provide high quality service with
personalized care from end- to-end. Their key revenue come from the employer who
want to reduce their Employer Sponsored Insurance but don’ t want to compensate the
benefit given to their employee. Currently Grandrounds also operate in other countries
as well.
Figure 2.9 Grandrounds Operation
2.1.2 India
2.1.2.1 Healthcare system introduction
India is the 2nd largest population in the world with 1.3 billion
people based on United Nation survey in July 2016, with estimated of healthcare
expenditure around 82 billion USD (4.1% of total GDP) . The infrastructure of India
healthcare system is complicated. Within public sector (account for 21 billion USD
equaling to 26% of total healthcare expenditure) itself the ownership can divided to
central, states or local government. Each public healthcare facilities will register with
one of the public ownership which then link to how to reimburse public health insurance
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scheme. The private sector (account for 61 billion equaling to 74% of total healthcare
expenditure) , on the other hand, is less complicated as can divided to two types: Profit
vs Non-profit.
According to National Health Profile 2015, 80% of population in India do not
have healthcare insurance. This means when these people get sick they have to pay for
healthcare service by themselves ( out of pocket) . For those who fall under public
healthcare insurance scheme, there are included but not limited to, the following
scheme:
Figure 2.10 India Public Insurance Scheme
2.1.2.2 Telemedicine in India
The key health problem in India is inequality between rural and
urban area. Most health resources e.g. healthcare professionals, equipment are located
in urban area which owned by private sector. Telemedicine, in India, then become an
excited with strong positive sign which can help government not only save the overall
healthcare budget, leverage healthcare resource from urban to rural but also increasing
accessibility to patient in rural area. PESTLE model will be used to assess each
individual area of telemedicine environment in India
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PESTLE
Politics (P)
India government try to create better framework on health policies and
regulation as health is national agenda for India. States support emerging business that
want to increase accessibility of healthcare or lower the cost of healthcare in India.
States help business to set up entity easily and even give additional benefits to health
tech business. Anyway, from the infrastructure standpoint, spending or support by
government directly to healthcare facility is still lacking. Public spending on health from
government is extremely low at 1.1% of GDP which only equal to one-fourth of total
healthcare expenditure.
Economic (E)
India GDP growth 7.6% in 2015 which shown strong economic position. Interest
rate and inflation rate are quite high when compare with other developing countries (at
6% and 3.7% respectively).
Social (S)
India is one of few countries in the world where the growth rate of population
is high at 1.2%. This reflects the age distribution curve of India population as in diagram
below. Unlike other countries, aging society won’t become key social concern for India
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Figure 2.11 India Population Age Distribution (India Population Age Distribution,
2014)
Language barrier is another cultural aspect which business need to be prepared.
India has 22 official languages in a country. This number doesn’ t include number of
dialect or regional languages using in rural area in India.
Traditional belief on healthcare treatment also play important role in India
healthcare system. Rural people still trust Ayurveda or traditional medicine more than
western medicine.
Technological (T)
The healthcare infrastructure is lacking even though India is one of the well-
known country having IT expertise. Anyway, other type of technologies which can
support telemedicine business e.g. mobile application, smart phone or smartcard are so
developed in India.
Environmental (E)
Not applicable
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Legal
Similarly to most of developing countries, India regulation for standard or how
to control telemedicine business are still lacking. Some of regulation may present but
government couldn’t control the nature of private sector as they are the main healthcare
provider for India and government themselves can’t provide effective model according
or follow the law to patient.
2.1.2.3 Example of Telemedicine Business in India
There are several telemedicine businesses in India. If divided by
delivery care model, there are 3 steps:
1) Specialty to District Hospital Model
This is for providers to providers to discuss on consult on
patient’s case without needed to travel across country
2) Primary Care
This is to provide connection between medical practitioners
and patient to consult their medical problem with affordable price. In India,
telemedicine businesses in this type is focusing on diagnostic so that it enables
treatment procedure to kick off e.g. e-healthpoint, iClinic, Sky Health Center.
3) Franchise Service Model
This is to provide operating tools for entrepreneur. World
Health Partner (WHP) is the example of this model. WHP launched in India and Kenya
while sharing similar type of operation i.e. patient pay 1 USD fee per doctor visit and
they sell their add-on services such as selling generic drugs.
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Figure 2.12 World Health Partner Model (Kartik Deshpande, 2012)
2.1.3 Thailand
2.1.3.1 Healthcare System Introduction
Thailand Healthcare spending is around 4% of GDP which is
around 16 billion BHT. The first 4 billion BHT is spent in private sector while another
12 billion is spent by government (MICKAEL FEIGE, 2015). This evidence proves that
public sector is the main driver of healthcare spending in Thailand. The large amount
of government spending on healthcare comes mainly from the Ministry of Public Health
and from insurance schemes i.e. national universal healthcare, social security and civil
service scheme.
When we looking into the segment of hospital in Thailand we
can see that hospitals are divided by level of the sophistication of medical services they
can provided (primary, secondary or tertiary care) and main funding (public or private).
There are around 1,000 public hospitals outside Bangkok (คณะอนกรรมการสถตสาขาสขภาพ,
2557-2558) and more than 70% of that only provide primary care service to patients – see
figure 13. On the other hand, there are 321 private hospitals in Thailand (The 2012
Private Hospital Survey, 2012) which at least provide secondary to tertiary care to
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patient. Inequality of people in rural vs urban area on accessibility to secondary and
tertiary healthcare in public sector is a real concern we found from this statistic.
Figure 2.13 Hospital Outside Bangkok Stats (MICKAEL FEIGE, 2015)
The large amount of money government spending in healthcare system is
insurance. There are 2 key types of health insurance in Thailand.
1) Government Plan
- Universal Coverage (UC) . This insurance covers for all Thai Citizen as long
as they have valid identification card. With this plan, individual will get assigned on
which public hospital they can go for healthcare service. Only in emergency case that
they can visit other public hospital. This scheme is fully funded by government.
- Social Security Scheme (SSS). This insurance is mandatory for private sector
employee. Source of funding come from three parties: Employer, Employee and
Government. Each employee will receive a benefit card which assigned hospital they
can goes to for healthcare service. Most of Thai employee will automatically get UC
and SSS plan but in general the assigned hospital is different
- Civil Servant Medical Benefit Scheme (CSMBS) . This is a fringe benefit to
support government employee including dependents and retirees. The healthcare benefit
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provided into this scheme is much more than UC and SSS as the budget per head is a
lot higher.
2) Private plan – fully paid by each individual and normally the plan offers by
private insurance companies. There are many types of plans to choose depending on
disease criteria, age, condition and budget.
Figure 2.14 Summary of Health Insurance Scheme in Thailand.
2.1.3.2 Telemedicine in Thailand
Telemedicine is not a new concept for Thailand. Historically, in
1995-1998, Thai Government developed telemedicine platform to assist rural hospital
where having limited of healthcare professional resources (Apply Using Telemedicine
System to Support Health Care, 2014) . However, after a while, the project got
abandoned (WITOOLKOLLACHIT, 2014) due to several reasons. Firstly, it was about
IT infrastructure and lack of requisite IT skill among healthcare professional. Secondly,
patients had lower level of acceptance. Lastly, the budget to support and maintain the
project was lacking during economic crisis and political change. In 2015, government
would like to re-activate telemedicine project (Analysis of eHealth Strategy, 2015) but
still not seeing the concrete plan on how to do so.
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Figure 2.15 E-health strategic work scheme (Analysis of eHealth Strategy, 2015)
In Thailand, nowadays telemedicine is used widely for hospital to hospital for
complicated disease which doctor in rural area may want to consult specialized doctor.
For example, in Samitivej hospital, they run telemedicine campaign with Doernbecher
Children’s hospital in USA for exchanging pediatric case or in Siriraj Hospital where
they set telemedicine center for doctor to exchange knowledge.
To fully analyze telemedicine industry in Thailand, we will use PESTLE model
to assess to each individual area of telemedicine environment in Thailand
PESTLE
Politics (P)
Government campaign on industry 4.0 to support electronic health platform, e-
health strategy from ministry of health in 2015, Article 44 which release in order to
help entrepreneur in healthcare sector together with plan on budgeting financial
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healthcare especially in UC scheme. These factors contribute a positive sign for
telemedicine business from political standpoint
Figure 2.16 Summary of ehealth situation in Thailand (Kijsanayotin)
Economic (E)
Thailand currently using economic policy to lower interest rate so that it
stimulates the growth of SME and startups business in the country. In parallel, per
capital income is increasing among Thai population and the healthcare sector keep
increasing in both values and size. These factors create positive signal from economy
point of view. Anyway, since global economy still slowing down, company should
monitor on the change and impact to Thailand as well
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Social (S)
Thailand will become an aged society by 2022 as the number of senior citizen
is expected to account for 19% of the total population (MICKAEL FEIGE, 2015) . This
in line with global trend.
Patient awareness and Health & Beauty focus are becoming a trend in society.
With the access to internet through mobile, gadget or computers, people now have
access to healthcare information easily. The problem is to validate which information is
reliable and which one is not.
Human and cultural factors are another challenging area. Not every person is
willing to adapt to new approach especially in healthcare practice. Telemedicine is still
at early phase from both from provider and customer’s standpoint.
Technological (T)
Healthcare ICT infrastructure is lacking. Government server and power to
support the main database still need to improve. The connection from the server to client
server is lacking. Software using in each health facility doesn’t connect to each other
(No server integration). No recognized national method for treating patient information
in a different way than other types of privacy information. There is also limited internet
connection in remoted area of Thailand which may impact the expansion of
telemedicine business.
Legal (L)
Feasibility part and in-depth research can be found in section 2.3
Environmental (E)
Not applicable.
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2.1.3.3 Example of Telemedicine business in Thailand
Based on our research, there are few Thai-owned private entity
doing telemedicine business commercially in Thailand. Most of usage in telemedicine
is focusing in healthcare professional to healthcare professional from big to small type
of hospital. Anyway, there are some ideas and startups in early stage which focusing in
this area. The examples are:
(1) SOS Specialist
SOS specialist is a website platform
(http://www.sosspecialist.com/) for doctors to answer patients question online without
charging fee. It was founded by Doctor Adulchai (Game) and his doctor’s friend in
Siriraj hospital. His idea is to leverage internet technology to assist patient who seek
for consultation and at the same time prevent patient to follow incorrect health
treatment recommendation suggested on internet. In the website, SOS specialist
divided group of health condition per type of healthcare provider into 16 groups:
Physical Therapy, Psychology, Eyes, Dental, Skin, Radiology, Surgery, Gynecology,
ENT, Laboratory, Internal Medicine, Family Planning, Alternative treatment,
nutrition and pediatric.
Figure 2.17 www.sosspecialist.com
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In addition, SOS specialist also has Facebook page using to promote reliable
health news to follower (https://www.facebook.com/SOSspecialist)
The program funded by Thai Health Promotion Foundation
(2) ChiiWii
Chiiwii is a Thai owned website platform
(https://www.chiiwii.com/) to consult doctor. Depending on your application and
condition, you may or may not need to pay for consultation. Their operation doesn’t
include diagnosis, treatment and drug prescription. It provides only healthcare
information so that patient can make the right decision or educate patient on how to
take care of themselves.
Unlike SOS, Chiiwii doesn’ t provide specialist in each filled
to answer patient question directly and privately. Instead Chiiwii creates chatroom for
providers and patient who may face similar condition to talk and assist each other. More
than one providers and come to conversation and write their opinion on case. In total,
they have around 24 healthcare professionals mainly doctors as providers while the
number of user in the website is still limited.
In addition, Chiwii also has Facebook page using to promote
their website platform (https://www.facebook.com/chiiwiidoctor/)
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Figure 2.18 ChiiWii Chatroom
In July 17, ChiiWiii launch another platform called ChiiWii Live which
provided online live consultation in VDO format. The business model shift from free
consultation to payment model anyway this platform only focus on certain area i.e.
Woman related diseases area.
(3) OOCA
OOCA is Thai owned website platform (https: / /www.ooca.co/ )
focusing on mental health problems e.g. depression, problem at work or in family. At
OOCA, patient can talk to therapist or psychologist privately through VDO call.
Customers will call providers or setting up on- line schedule with providers at their
preferred time. OOCA charge patient based on provider price set.
(4) RingMD
RingMD is international owned website and mobile platform
(https: / /www.ring.md/ ) to consult with variety of doctors and wellness experts from
anywhere at any time. RingMD started in Singapore and received fund by Singapore
Government to run telemedicine platform. RingMD launched their application in many
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countries such as Singapore, Hong Kong, Philippines, India, Pakistan and Thailand. In
Thailand, the launch is still at early phase.
To use RingMD, patient and providers will join the community by downloading
the application then patient will pick providers who they want to talk to, pay money via
credit card and then set schedule with providers. When the time approach connects
online with doctor. Unlike other application, RingMD allow providers to set up the price
they want to charge patients. The range start from 100 BHT per 20 minutes up to 20,000
BHT per 20 minutes. RingMD will get 20% service fee from each operation.
Figure 2.19 RingMD Operation
(5) See Dr.Now
See Dr.Now is Thai launched application on April, 2017 which
fully funded by group of doctors. Similarly to other applications, See Dr.Now focusing
on provide healthcare service from doctors to patients by using online application form
for doctors to speak to patient by video call appointment. They provide various type of
doctors such as family medicine, mental health, internal medicine, dentist,
ophthalmologist and neurology. Patient will need to register with the platform, accept
term & agreement, then freely type condition they are facing, paid money through credit
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card (490 BHT for 10 minutes discussion, if passed that 10 minutes charge 49 BHT per
minute).
Figure 2.20 See Dr. Now Operation
(6) Optimize Care
Optimize care ( http: / / www. optimizecare. com/ ) is website
platform focusing on finding healthcare checkup package which most suitable to each
person, make reservation then after customer finished checkup the website will give the
result through their mobile phone.
2.2 Competitive Analysis
Portor’ s Five Forces model is selected to analyze competitiveness of
telemedicine business in Thailand market including the attractiveness of this type of
business in Thailand.
2.2.1 Threat of New Entrants
Creating online application for healthcare is quite easy but to make it
big enough to create economy of scale is not. As mentioned in Thailand telemedicine
startup example session, most startups are still at early phase and not yet having their
brand recognition or reach to big market size. To sustain and secure model, telemedicine
business will need to create proprietary product differently from players in the market,
must have healthcare expertise who understand healthcare sector, generate brand
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loyalty among customer and make them hardly to switch to other type of application.
In addition, business will need to follow law and regulations which may impact how to
operate business. At this stage, telemedicine regulation in Thailand is not yet clear to
business owner.
2.2.2 Treat of Competitive Rivalry
Telemedicine startups still in early phase of S-curve in Thailand. The
overall growth rate of telemedicine industry in Thailand is still small when compare to
other developed market. Players in markets are limited and mostly provide the same key
benefit to customer i.e. consult with doctor anywhere at any time but various in price.
When analyzing each business example closely will see that the optional benefits are
what driven business or making consumer attach with the brand e.g. electronic medical
record, doctor’s recommendation, variety of doctors or diseases each business focusing
on or after-care service.
2.2.3 Bargaining Power of Suppliers
Healthcare professionals are key suppliers for telemedicine service.
In some specialty which doctors are limited such as neurology, pediatrician, the
bargaining power of healthcare providers are extremely high which may impact
business cost structure. On the other hand, family medicine doctor is not as limited as
specialize doctor so business can pick and choose the most suitable providers they
would love to work with. These suppliers require legal and/or liability protection from
platform otherwise they might not decide to join in the community.
2.2.4 Bargaining Power of Customers
Depending on what type of customers we are referring to, the level of
bargaining power of customer will be different. In city center where people have access
to affordable with high quality of healthcare service, using telemedicine may be add-on
service for them. Thus, for this type of customers the bargaining power to business will
be high because of high switching cost. Unlike those customers who don’t have easy
way to access to affordable and quality healthcare, telemedicine may be the only option
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for them to connect & consult with specialize healthcare provider all at once. For latter
consumer, the bargaining power will be fairly low
2.2.5 Threat of substitutes
Creating VDO, message or payment type of application is not hard
for substitute to copy same function to do another telemedicine business. In healthcare
business, the cheapest service doesn’t attract customer the most. The quality one with
affordable price are the one customer would go for. Healthcare is a service sector thus
the more trust business gain from patient, the better for business. This will create brand
loyalty and make it hard for customer to switch to other brands.
Figure 2.21 Summary Table on Five Force Strength to Successful Telemedicine
Business
2.3 Legal Feasibility
Legal feasibility is one of the key important area for operating telehealth
platform. If not studying in greater detail, it can create critical issue in term of business
operation. Here are relevant Thai regulations which critical for telemedicine business.
2.3.1 Sanatorium Act B.E. 2541
This directive indicates the description and practice if your business
incline to be Sanatorium. In the definition given in the act itself, it describes that any
place or vehicle which provide for medical, medicine, midwifery or dentistry practice
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with/without profit earning (exclude sale of drug) are classified as Sanatorium and will
need to comply with rules and regulation written in the act accordingly.
Telemedicine business, based on definition, should not fall into
Sanatorium type of classification. This is because online platform doesn’ t have actual
place or fall into vehicle definition of its. Also, the way telemedicine business operate
doesn’t replace Sanatorium but more like screening or assist those healthcare facilities
to manage patient easier. However, business need to be aware on setting up regional
center for telemedicine consulting. This may fall under Sanatorium definition.
2.3.2 National Health Act B.E. 2550
In section 7 of this act indicates on the right of citizen shall have
personal health information kept in confidential. No one can share information which
will cause damage to the owner unless they allow to. No person can request other person
medical record. The penalty for not complying is to imprison for not more than 6 months
or to pay fee not more than 10,000 BHT or both.
This clause interprets that health information is personal and
confidential data. Sharing information without consent from the owner is illegal.
Anyway, the regulation didn’t specific in greater detail on how business should secure
those data in the system especially in digital format. Thus, for telemedicine business
choosing software to operate is still not limited. Nevertheless, the consent form to
ensure providers and system admins can access to patient healthcare information as
needed is required when operating business.
Note the Data Protection Act is still in draft in Thailand.
2.3.3 Law regulating healthcare professional.
This is the laws which describe the practices and qualifications of
healthcare providers. These includes, but not limited to, the following:
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2.3.3.1 Medical Professional Act B.E. 2525
2.3.3.2 Pharmaceutical Professional Act B.E. 2537
2.3.3.3 Nursing and Midwifery Professional Act B.E. 2528
2.3.3.4 Dental Professional Act B.E. 2537
Healthcare professionals are required to have professional licenses before
perform any medical professional activities. Thus, from the company standpoint it is
critically to check on these licenses validity before allow them to talk to patient.
2.3.4 Announcement from national health committee on guideline to
use social media for healthcare professional B.E. 2559
This guideline announced on 24 March 2560 in purpose to govern
and give healthcare professional guidance on what is appropriate or not appropriate on
providing healthcare service on social media. This guideline was written by considering
laws regulating healthcare professional together with section 7 of National Health Act.
Telemedicine business also fall into social media definition in this
guidance. In summary, the guideline itself giving instruction for healthcare professional
to be careful on online consultation with patient. The key principles are respecting for
the law, for professional ethics, respect human dignity and protect patient privacy
information.
2.3.5 Drug Act B.E. 2535
This regulation describes about relevant drug regulation framework
in Thailand. What we would like to emphasize here is that there is no section saying
either allows or prohibits internet pharmacy operations. There is currently no
mechanism that regulates, accredits or certifies internet pharmacy sites.
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2.4 Opportunity Area
Following from Thailand analysis and review from above chapter, Toravej
believes we find a huge opportunity area on doing telemedicine business in Thailand as
shown in CANVAS below
Figure 2.22 Toravej CANVAS
We will be early movers in this area in Thailand. If we could add pre-screening
question into our service, we will be the first business who implementing clinical
guidance to prescreen patient using telemedicine platform in Thailand. Together with
the increasing demand of consumer in healthcare ( e. g. aging society, increasing
populations who have chronic diseases) we believe Toravej will be the answer for
providers, patient and to government in a large scale.
In order to determine which patient or diseases primary we should focus on we
used statistic review from National Statistical Office Thailand together with
professional healthcare and customer interview as primary criteria. In figure 23,
summary of key healthcare statistic, Toravej believe that Thailand telemedicine
opportunity lies in both acute and chronic healthcare diseases. We must solve the pain
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of their waiting time together with make the consultation schedule most suitable for
patients
Figure 2.23 Relevant Healthcare Statistic in 2015 (Healthcare Statistic, 2015)
Figure 2.24 Summary of Healthcare Resource from medical council of Thailand and
national statistical office
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On the other hand, from figure 24 Summary of healthcare resource statistics, it
shows that Thailand still lack of healthcare professional especially in rural area.
Based on Toravej extensive research of Thailand market. We understand the
pain of patient and limited number of healthcare professional outside Bangkok. Thus,
we summarize Toravej’s opportunity as in figure 25
Figure 2.25 Toravej Opportunity Direct competitor and Indirect Competitors
Following from example of telemedicine businesses emerging in Thailand and
traditional healthcare approach, Toravej believe our position and key competitiveness
when compare to both sides are listed as figure 26
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Figure 2.26 Toravej Competitiveness
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CHAPTER 3
SUMMARY OF PRODUCT & SERVICE
3.1 Product Development
Toravej develop product based on learning from key players in international
markets (referring to examples in Chapter 2 Market Analysis part) . There are features
which are common among telemedicine and some unique interface depending on their
type of customers, condition/diseases, business model or their limitation. Description of
each core and unique features are describe in table below
Table 3.1 Summary of Key Features from Players in international markets
Players Core Feature Unique Feature
Teladoc - VDO call
- Phone call
- Live Chat
Message/Photo/attachment
- Appointment
- Subscription
- Payment
- Intelligent Algorithms to
choose available doctors
per condition required
- Personal Health Record
Lemonaid - Live Chat
Message/Photo/attachment
- Prescription print
- Subscription
- Payment
- Pre-Screening questions
prior to consult with
doctors
On top of key features in the application, user experience is another important
element of how successful the platform will be. Based on research and interview,
Toravej found that the front end (to consumer/patient) interface must be user friendly,
simple and present in non-technical language while on the back end (to provider) the
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interface must present in more technical way ( similar to interface hospital/ clinic
currently has).
Toravej then mix and match advantage and disadvantage to our prototype.
3.2 Design Elements
3.2.1 Opensource
To minimize the cost for prototype testing, Toravej would like to do
our first prototype through opensource. We evaluate the system which have medical
system already in place so that we only need to work on our focusing feature.
Additionally, opensource is free of charge. Unfortunately, to create proper webpage
from opersource requires more man hours than our first thought (further explanation in
3.4.4 Rocket Chat our first prototype). We then decide to move on to the next software.
3.2.2 Outsystem
To enable 24/7 healthcare service delivery, Toravej needs to ensure
server up and running all the time. During our research development, we found another
platform called outsystem.com that provide combination of both platform (PaaS) and
mobile application (MADP) technology. The most important thing for Toravej is this
system requires minimal code compilation and having flexibility for us to pick and
choose on features in its tool box.
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Figure 3.1 Outsystems Platform (Platform)
Cloud service back up should be in place to prevent any data loss. There are
several clouds providers in the field which can be integrated to outsystems to store the
data i.e. Google Cloud Platform (using mostly in Android mobile application), Microsoft
Azure (enable to connect with Microsoft system) , Amazon Web Service or IRIS cloud
(provided by CAT telecom in Thailand)
The key concern for Toravej about this system is the maintenance cost. As
Toravej is still at early stage, the budget is key constrain for using these branded
companies.
3.2.3 Blockchain
In order to secure patient information record in the system, Toravej
needs to have great data security technology. Blockchain is another possible tool
Toravej can leverage the benefit on data encryption and data distribution to small blocks
across database network. With this process, it is unlikely that anyone can hack your
information and have it all at one times.
The limitation of the system though is about server performance and
latency.
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3.3 Toravej Potential Feature
After software reviews, market analysis, user and providers interview, team
decided that Toravej is going to provide two types of communication to users/providers
1) Direct communication – this will come with core features i. e. VDO call,
Message, Phone call, Picture upload between customer/patient and provider
2) Asynchronous tools – this will be a supplement tools for users i.e. schedule
for appointment, reminder/notification. This features will help facilitate and
improve direct communication features between both parties.
There are 3 main characteristics in Toravej: Healthcare providers,
Customer/Patient and Service Administrator. Each user will have different working flow
and thus won’ t see the same screen/interface. Here is our initial thought on feature and
screen of each user
Figure 3.2 Customer/Patient Interface in Toravej
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Figure 3.3 Healthcare Professional Interface in Toravej
Figure 3.4 Service Administrator Interface in Toravej
3.4 Implementation
In term of product & service, Toravej creates several channels to promote and
invite people to use our platform
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3.4.1 Website
Toravej registered domain under http://www.toravej.com. The website
is currently live to the public. We build this website to create credibility of the brand,
recruiting both patient and providers and at the same time prepare all users for the next
launching step. In addition, we provide healthcare articles every week to remind our
consumer on what are we are currently operating. This articles link tightly with our
weekly articles on Facebook.
3.4.2 Facebook
We created Facebook page called Telemedicine Toravej – โทรเวช ปรกษา
สขภาพ ออนไลน to post interesting fact about healthcare and telemedicine knowledge. We
hope through this channel we can acquire more users into our panel. We leverage
Facebook channel as intermediate platform for further instruction + preparation for users
who want to try our platform.
Figure 3.5 Toravej Telemedicine Facebook page
3.4.3 Rocket Chat (first prototype)
Our first prototype created for testing consumer’s and provider’s need
is coming from open source. We started by input those core direction communications
while leaving the developing of Asynchronous tools to later stage. The opensources we
choose called Rocket. Chat. We set up our own channel at https: / / tele. toravej. com.
Customer/Patient and Healthcare Provider can access the system through desktop or
mobile application. We aim to use this platform to test user satisfaction rate, feedback
from both ends and understanding whether they like the core features Toravej provided
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to them or not. Anyway, after several round of testing we found that Rocket.Chat come
with a lot of technical problems as following
o Cannot use VDO call if you use mobile phone
o Incompatibility of browser and require specific version of browser to see
picture uploaded.
o Complication of registration for users
o Lack of notification message so users don’ t know whether they receive any
response yet.
At the end we also learn that building purely core feature without Asynchronous
tools is not a wise way to do. Having schedule appointment will allow both parties to
talk to each other without need to wait online. Also, the platform will need to have
service coordinator who indicate which customer/patients will go see which healthcare
providers to reduce the traffic block within the system.
Figure 3.6 Rocket Chat Consultation Screen
3.4.4 Skype (Second prototype)
After several technical problems with Rocket Chat, Team decided to
use Skype as next platform for testing. Skype solves rocket. chat issue in term of
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compatibility, user-friendly and notification system. Skype can operate both in website
and mobile application. To keep our doctor privacy, team decided to create Toravej
account for each provider so that it doesn’t mix up with their personal account so doctor
keep their private life out of their professional life. This approach is also recommended
by announcement from national health committee on guideline to use social media for
healthcare professional B.E. 2559.
Figure 3.7 Example of Provider Screenshot on mobile phone having Toravej Account
Once each provider having their account, patient will be the one who add doctor
ID and then consult within skype. From the features standpoint, Skype can provide
service such as
1) VDO call for real time face to face consultation
2) Voice call for real time phone call consultation
3) Voice Record for leaving voice message for further response
4) Chatting feature for typing both real time and leaving message for further
response
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5) Picture for patient to send references/evidences for doctor to prescreen and
give proper recommendation on each case
6) Share location for provider and admin to suggest nearest service if patient
need abruptly service from nearest hospital.
Figure 3.8 Mobile Features in Skype (2nd Prototype)
3.4.5 Mobile Application
In parallel, Toravej also design how our mobile application will look
like. We create mock ups and think of user journey in every bit of detail – see figure
below. This will be our next step once we officially launch and obtain funding from
stakeholders.
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Figure 3.9 User Journey
Figure 3.10 Provider Journey
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Figure 3.11 Admin Journey
Figure 3.12 toravej mobile app feature
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CHAPTER 4
OPERATION MANAGEMENT
4.1 Selection Process
According to several researches, business models and opportunity area in
Chapter 2 Marketing Analysis part together with Qualitative interview with healthcare
providers, the operation management for Toravej will be divided into 3 key phases:
Wellness/Prevention, Acute Care and Chronic Care
Figure 4.1 Toravej Operation Framework
Toravej’ s framework derives from understanding the lifecycle of health
condition in individual’s life.
- Wellness/Prevention will focus on protecting customer from having disease,
giving suggestion to customer who want to have healthy life
- Acute Care will focus on solving patient condition/symptom at that present
time. It may require or not require diagnostic from healthcare providers.
- Chronic Care will focus on patients who got diagnosed but need follow up for
advices or may need 2nd opinion from healthcare providers
Our selection process is divided into 3 key areas: Disease/Condition, Healthcare
professional and patient/customer
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4.1.1 Diseases/Conditions
Condition/Disease is the top of the list which Toravej need to address
first. Our criteria to choose on which diseases and conditions are listed as below
Criteria: 1) The market size needs to be big enough.
2) Contain minimal risk for both providers and customer as our
operation goes on
3) Condition/Diseases do not require much physical examination
or if needed patient/customer can perform it themselves and
give certain information to providers
4) Comply with law and regulations
5) Easily to find providers to work for us
Based on these criteria together with information from market
analysis in Chapter 2 and from survey, the summary information to pick diseases and
condition we want to work for are indicated in below table
Table 4.1 Criteria and Result for choosing condition and disease for Toravej in Thailand
Criteria Wellness/Preventive Acute Care Chronic Care
Market Size (million)
65 65 11.7*
Risk to providers and customers
Low High Low as already diagnosed
Minimal physical examination
Yes Require physical examination
Depends
Comply with law and Regulation
Yes Unclear on which condition can
perform through online channel
Yes
Easy to find providers
Yes Yes Yes
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Based on the criteria given Toravej believe we should focus on
Wellness/Preventive and Chronic Care at our initial phase as it both fit most with our
selection criteria. We then analyze further on which conditions in wellness/preventive
phase we should focus and which diseases in chronic care we should considering.
4.1.1.1 Wellness/Preventive
In market analysis part and product development phase, we
have learnt that the condition we are going to pick for wellness/preventive should match
with our platform. Using online channel won’ t compromise the service but should
enable and enhance customer participation even more. There are 3 conditions which we
would like to focus on
(1) Stress/Mental Health
More and more people in Thailand society are under stress
condition. According to Ministry of Health statistic, more than 5% of Thai population
are diagnosed as depression. These number doesn’t count temporary type of stress which
everyone facing on daily basis. Mental health problem normally gets relieve by
speaking to psychologist or psychiatrist. Sharing information to the expert and let them
ask customer questions to bring them back to normal stage is the key to solve stress
problem. Toravej believe that treatment like this require minimum face- to- face
interaction between providers and customers. Thus, it should be able to replace by
message, phone call or VDO call in our platform. Another model which proven how
important this condition is OOCA as they only focus on this problem in their business
model
(2) Contraception & Sexual Wellbeing
Contraception is another interesting area Toravej would like
to test. Lemonaid started with this area as the first condition for their prescription model.
Contraception topic is not wildly spoken in Thailand. Most Thai people still shy to
discuss this topic unlike in developing country that they focus on this area to prevent
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sexual disease and able to control unwanted pregnancy. Thus, Toravej believe bring this
topic to discuss online in secured platform would increase the chance of promoting the
correct usage of contraceptive to population more than traditional method (going to
pharmacy store).
(3) Acne
Acne is the problem in which most people experience in
their teenager time. One of our customer target is youngster who understand and love
to learn on new technology provided (more detail on target customer refer to chapter 5
marketing strategy). The common problem found in teenagers is acne as they are living
in hormone adjustment period. Thus, Toravej would like to focus on this condition so
that we can secure youngster target market. Anyway, since acne is skincare disease,
there might be limitation in term of technology e.g. the resolution of picture sharing to
skin doctor or resolution/stability of VDO call during discussion.
(4) Baby
New parent who recently have their first baby mostly have
so many questions about symptom their kid has. Nowadays Gen-X and Gen-Y parents
seeks for their answer through internet or asking their friend who shared the same
experience before. This is an opportunity Toravej see and would like to explore further.
What if we provide pediatric service, will these new parents use it? Are they willing to
pay for this type of service?
4.1.1.2 Chronic Care
Per Chapter 2 Market Analysis chapter, more than 11 million
people in Thailand are having at least 1 chronic disease. The Top 3 common group of
chronic diseases founded in Thailand are
(1) Hypertention and Dyslipedemia
Cardiovascular disease with total number of patient at 7. 8
million people in Thailand. Cardiovascular disease is a class of diseases which impact
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heart or blood vessel. Normally includes coronary artery diseases, myocardial infarction
(or heart attack), Arrhythmia, rheumatic heart disease, heart failure, thrombosis and other
forms of heart disease. The underlying common condition for cardiovascular diseases
coming from high blood pressure and high blood cholesterol. Telemedicine would not be
able to treat people for cardiovascular diseases itself but we can monitor the underling
condition before it gets worse.
Hypertension (High blood Pressure) and Dyslipidemia are two chronic diseases
which Toravej would like to monitor and test through our platform. The monitoring
condition for these two diseases is straight forward and have clinical guidance
published domestically and internationally.
Figure 4.2 Hypertension Guideline recommended in Thailand (Peera Buranakitjaroen,
2015)
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(2) Diabetes
Number 2 of chronic diseases founded most in Thailand is
diabetes, endocrine system and metabolic disorder at 3 million. This also a class of
diseases which include diabetes, thyroid, adrenal gland disease into one. Toravej at
initial phase will only focus on Diabetes as it is another common disease which do not
require much physical examination. The device to check blood sugar level is sold
broadly in drug store and medical device store. On top of that the clinical guidance for
monitoring is recognized domestically and internally which allow opportunity for us.
Note that there are several complications which patient may face after got diagnosed as
diabetes. If those complications are severe, providers will need to refer patient to
hospital.
Figure 4.3 Diabetes Monitoring Guidance (Association, 2017)
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(3) Allergy
The third common chronic disease found in Thailand is chronic
respiratory diseases at 1.5 million patients. This class again is a group of diseases which
combine with Tuberculosis, Chronic Obstructive Pulmonary Disease (COPD) , asthma
etc. What Toravej would like to focus is Asthma and Allergy area in which there are a
lot of patient suffering from while from provider side there is a clear instruction or
treatment which can relief customer pain.
Figure 4.4 Clinical Practice Guidance for Allergy Rhinitis (Clinical Practice Guideline: Allergic Rhinitis, 2015)
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4.1.2 Healthcare Professionals
Recruiting healthcare professionals to join in Toravej’s platform is
another key success for our business. Our criteria to choose healthcare providers is quite
straight forward. Firstly, those providers much specialize in the condition/diseases we
are focusing on. Secondly, those healthcare providers must have valid relevant medical
license before entering our system. Thirdly, they must have good service mindset and
understand the limitation of Toravej’s system as we just started developing. Last but not
least, they have to be able to provide us feedback after using our platform so that we
can keep on continuing improving our service model.
4.1.3 Customers/Patients
Marketing Channel and Promotion introduce to customer/patient to
aware of Toravej is discussed in chapter 5 marketing strategy and chapter 6 sale
strategy. What would be discussed in this part is more on screening and onboarding
process for customer/ patient before they meet our healthcare professionals through
Toravej’s platform. The selection criteria to choose customers/patient to use Toravej are
1) The condition or diseases they are facing are matching with what
condition/diseases we are focusing on
2) Customer/patient must sign agreement with us prior to proceed to
next step
3) They are willing to share their experience on Toravej’s platform so
that we can use that comment to improve our system
4.2 Design and Measurement of the Model
First Design
Toravej first started by creating our own domain called Rocket Chat in
April 2017 - further detail on 3. 4. 3 Rocket Chat ( first prototype) . We designed our
platform in secured system where allow us to track conversation of both providers and
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customer so that we understand their comfort zone and their limitation on healthcare
online consultation for each specific disease. Our designed flow of procedure interaction
based on figure 43 and 44. The procedure kick off by patient ask question on Facebook
then admin will quickly validate whether patient condition match with providers we
have i.e. skin disease or drug-related problem. Once patient pass validation criteria,
admin will give providers ID account in Rocket Chat for further consultation about
disease/symptom. Customer/patient will then need to download the app from AppStore
(Apple) or Google Play (Android) or enter domain https://tele.toravej.com on laptop. Next,
register user account with us and type doctor ID as admin given earlier to consult with
specialist in greater detail.
Figure 4.5 Toravej 1st Design Operation
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Figure 4.6 1st Design of instruction to use Toravej
We were launched the product for almost a month and there are only 3-4 users
come to try our product. We interviewed each of them to ask for further feedback on
how we can improve our system – Table 3
Table 4.2 Feedback from customer and provider from 1st Design
Who Condition What do
they like?
What needs to be
improved?
Customer
Patient 1 Skin Disease -Free
consultation
-Great service
-Will repeat
use next time
-Conversation is not
interactive. Should have
appointment service
-When refer to hospital
for further consultation,
there is no hospital
recommended
Patient 2 Skin Disease
Patient 3 Vitamin/Food
Supplement
Provider
Dermatologist N/A N/A -Service is hard to use.
-Can’t see notification
when patient ask
question unless logging
in.
Pharmacist N/A Has time to
think and
review answer.
Don’t need to
response right
away
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Based on both customer and provider feedback, we need to solve problem of
non-continuity of conversation between customer and providers. In addition, we learnt
that the system need to be more user-friendly which requires less behavior change from
our user’s standpoint.
Second Design
We re-design our platform based on what we learnt from our mistake in the
first design (Rocket chat) combine with 3 new specialty from providers. We think the
most appropriate platform we should use is Skype. Skype solves rocket.chat issue in
term of compatibility, user-friendly and notification system. The capacity of domain
for collecting picture or recording video is also higher. Having said that we then set our
initial measurement for product our 2nd prototype testing under wellness/ preventive and
chronic are present in figure below
Figure 4.7 Toravej 2nd Prototype Testing Criteria
Since Toravej broaden the scope of diseases and conditions we want to test in
2nd prototype we then need to recruit more providers to join the platform. In total,
Toravej able to secure 5 providers i.e. Happy Coach for mental stress, Pharmacist for
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drug relevant questions, Dermatologist for skin diseases, Family Medicine for chronic
disease case and Pediatrician for kid’s specific treatment.
Table 4.3 Healthcare Providers per Disease/Condition Toravej obtained for 2nd prototype testing.
Operation Category Provider needed Status (passed recruitment
criteria)
Wellness – Stress Happy Coach Secured
Wellness – Contraception Pharmacist Secured
Wellness - Acne Dermatologist Secured
Chronic - Hypertension Family Medicine Secured
Chronic - Dyslipidemia Family Medicine Secured
Chronic - Diabetes Family Medicine Secured
Pharmacy Pharmacist Secured Kids Pediatrician Secured
New platform was launched in June 17 and the free consultation with providers
ended on 31st Jul 2017. Total time for testing is 2 months. We started by updating our
registration instruction to infographic type of message and used it as material for
promoting to get attraction from potential customers.
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Figure 4.8 2nd Design for Instruction on how to use Toravej
Following from what we learnt in rocket chat, we know that Skype will only be
the platform for consultation but in term of promoting user to know and try our service
it will be in Facebook & Line. Once patient/customer has question, they will either
follow steps in figure 46 to talk to providers in skype or they will ask question directly
to admin via messaging on Facebook and then admin will pre-screen question before
advice patient to connect to specialist doctor in skype.
Figure 4.9 Toravej 2nd Design Operation
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Within 2 months testing time, we obtain feedback from customer on condition
they come for consultation, sex, channel they prefer asking question, their satisfaction
rate and payment service. While in provider’ s end, we ask them for feedback and
additional suggestion if they have for our service. Table 5 and 6 show customer’s and
provider’s feedback to our service respectively. Based on the result, we found out that
women tend to ask health-related question online more than men (13 vs 3 respectively),
conditions that patients want to consult online are Mental & Stress, Skin, Pharmacy and
Sexual/Contraception cases. While for chronic and pediatric cases, we haven’ t got any
questions from customer so far.
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Table 4.4 Customers/Patient information and feedback after use our service
Who? Condition come for consultation Channel of asking
Satisfaction Rate
Will you use Toravej Service Next time?
Will you pay for service?
Any other suggestion?
1. Female Stress Skype 8/10 Yes Yes Paid not more than 500 Baht/hour
2.Male Stress/Depression Skype N/A
3.Female Stress Line N/A
4.Female Skin - Allergy Rocket Chat N/A
5.Female Skin - Keloid Rocket Chat N/A
6.Male Pharmacy - Baby Rash Line 9/10 Yes Maybe
7.Female Pharmacy - Store Line 8/10 Yes Yes Add medicine delivery service
8.Male Pharmacy - Flu Remedy Line 8/10 Yes Maybe
9.Female Pharmacy - Drug Interaction Line 9/10 Yes Yes
10.Female Sexual Wellbeing- Discharge FB 7/10 Yes Yes Suggest to have more reliable schedule for doctor
11.Female Skin - Wound FB/Skype 8/10 Yes Yes
12.Female Contraception FB 10/10 Yes No Paid not more than 50 Baht
13.Female Contraception FB 9/10 Yes No
14.Female Pharmacy - Vitamin/Food Supplement
Rocket Chat 10/10 Yes Yes
15.Female Pharmacy - Vitamin Line 10/10 Yes Maybe
16.Female Wound Operation FB N/A
Female13 Male 3
Mental & Stress (3) Skin (3) Pharmacy (6) Sexual/Contraception (3) Other (1)
Skype (2) Line (6) FB (5) Rocket Chat (3)
Average 8.72
(from 11 responses)
Yes (11) Maybe (0)
No (0) N/A (5)
Yes (6) Maybe (3)
No (2) N/A (5)
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Table 4.5 Provider information and feedback after use our service
Who? Channel of asking
No. of customer served
Satisfaction Rate
Will you continue be our providers?
Any other suggestion?
Happy Coach Skype 3 6/10 Yes Suggest to filter patient’s condition and symptom before pass through specialist
Dermatologist Skype 3 8/10 Yes Able to diagnostic but can’t provide treatment right away. Recommend to use other channel for communication i.e. FB or application rather than using Skype (because not all people use this app)
Pharmacist Skype/Line/ FB Message
10 9/10 Yes Need pool of doctors because in some case require more than just pharmacist guidance. Also, want to see patient record before give any advice.
Pediatrician Skype 0 N/A Yes
Family Medicine Doctor
Skype 0 N/A Yes
Average = 7.66 Yes (5) No (0)
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4.3 Management of Quality
Providing superior quality and experience is Toravej’s key goal to customers.
We manage our quality service by following standards
1) Recruit only known background providers who has extensive clinical practice.
All providers must have valid medical license before entering our system.
2) Patient information must be kept confidentially
3) Pre-screening conditions by pharmacist to ensure that customer’s symptom
can be consult in Toravej’s platform
To ensure Toravej provides great service to customer, we asked customer and
provider to do survey on satisfaction rate after using our service. On average, we
received score at 8.72 from customers while from providers end we got score at 7.66.
This means that both ends satisfy with online service and model we have provided. We
also asked customer whether they will use our service next time and we found that 100%
of customer said that they will use our service next time. However, not all of them are
willing to pay for the service. On the opposite site, we also asked provider whether they
want to still be our providers after our thesis submission and all of them said yes. This
somewhat make Toravej believe we come to the right pathway.
4.4 Improvement Program
During first to second design operation phase, Toravej improved variety of
services in communication channel, promotion material, number of providers and
category Toravej operate, prescreening questions and on response rate – Table 7
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Table 2.6 Service Improvement
1st Design (Through Rocket Chat)
2nd Design (Through Skype)
Communication Method Chatting/Picture Chatting/Picture/VDO/ Notification
Schedule appointment No Yes
Promotion Material on Social Media (FB and Line)
Only in text Text & Infographic
Number of Category Operation
2 8 Wellness (Stress,
contraception, Acne), Chronic (Hypertension,
Dyslipidemia, Diabetes), Kids, Pharmacy
Number of Providers 2 5 Adding providers chat room
so providers can consult each other (if needed)
Prescreening patient None Yes (by person)
Response Rate Approximately 47 mins after patient ask question on
Within 15 mins after patient ask question on Facebook
As for future phase, Toravej will need to incorporate both provider’ s and
customer’s feedback to improve our service, for example, develop our own application
to support payment program, prescreening question using decision tree method
(electronically) and obtain key patient records for patient’s further visit.
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CHAPTER 5
SUMMARY OF MARKETING STRATEGY
5.1 Marketing Segmentation
Toravej would like to provide online platform which connect healthcare
providers to customer/patient who need the service at anywhere at any time. We then
divide our marketing segmentation into 2 targets: Patient and Provider
5.1.1 Patient
5.1.1.1 Rural Patient
Rural patient suffers from not having access to proper hospital
or specialize healthcare expert. We target our service to people who live far away from
healthcare service center but still having internet access in the area.
5.1.1.2 Urban Patient
Urban patient suffers from long wait line and traffic in
community in order to go to hospital for follow up or though minor disease. We target
4 groups of customer: Chronic Disease Patient who already get diagnosed and only need
follow-up check, Family which prone to seek for quick consultation from doctor e.g.
new parents, family having elderly, Employee in start- up which don’ t have health
welfare provided and lastly youngster who familiar with technology and willing to
absorb new type of healthcare service.
5.1.2 Healthcare Provider
Toravej target to obtain 2 groups of healthcare providers: Doctor and
other healthcare expert. Our target two type of doctors who would love to join our
platform i.e. volunteer doctor who having spirit to improve Thailand healthcare system
and young doctor who want to earn additional income through our platform.
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5.2 Marketing Mix
5.2.1 Product
Toravej is an online platform for patient and healthcare provider to
connect anywhere at any time through chat message, phone call or even VDO
conference call. We are neither the application or a website. Those are just the tool to
get to our product. Our real product is service that will enhance healthcare accessibility
on affordable price from affectionate care provider.
5.2.2 Price
Our price need to be in comparison or lower than traditional
healthcare solution. This to prove our motto on affordable price. Based on survey, we
will set our price around 100-300 BHT per consultation and 500-1,000 BHT for one-
month subscription membership.
5.2.3 Place
Toravej is online platform. For some business type of model e.g. B2B
model, we will sell add on service such as drug delivery thus we need to partner with
local drug store together with hospital chain.
5.2.4 Promotion
Main social media we used to day is Facebook. We post healthcare
content every day to potential customer.
5.2.5 People
We need to recruit providers who affectionate on helping people. This
will then increase our satisfaction rate of customer/patient. Overall healthcare industry
is fighting on premium service. Having great providers in the team will be another key
competitive advantage for Toravej.
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5.2.6 Process
Toravej need to provide easiest way for consumer and provider to meet
up. The minimum sign- up information and provide step by step guidance so they
familiar with our interface.
5.3 Competitive Analysis
5.3.1 Four Corner's Analysis
We will use Four Corner’s Analysis as a model to analyze our direct
competitors i.e. RingMD, See Dr.Now and OOCA. ChiiWii.com is a free consultation
platform so we leave them out from analysis
5.3.1.1 Drivers
All telemedicine company would like to be the 1st well known
platform which having most users so that they can gain profit at later stage. Anyway,
none of the company succeed into that level yet.
5.3.1.2 Management Assumption
Every key competitor in Thailand are having great perspective
on telemedicine industry even though Thailand still lack of healthcare infrastructure
and support from providers as they scare of the uncertainty of law and regulation in this
field. On top of that asking consumers to change behavior from going to traditional
method to online application it is not easy at all. These companies need to work together
to strengthen and gain bargaining power to negotiate with government.
5.3.1.3 Strategy
RingMD penetrate Thailand market by hire local staff then
focus on more business to business more than to consumer directly. They also leverage
connection with government to enable to rural market. While Thai startup such as See
Doctor Now and OOCA are targeting to consumer directly through their brand
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awareness channel. They use social media and startup community to promote
themselves on wider community.
5.3.1.4 Capacity
We analyze strength and weakness of our direct competitors
and presenting in table below
Table 5.1 Strength and Weakness of RingMD, See Doctor Now, OOCA
Strength Weakness
RingMD - Experience in
International market
- Networking with
key stakeholders
- Not user friendly to
customer
- Not targeting any
particular
diseases/condition
See Doctor Now - Owned by group of
doctor thus
obtaining providers
to work for them is
easy
- Very expensive charge
and must pay before
receive consultation
OOCA - Created by
healthcare
professional team
- Focus on small market
size i.e. mental health
only
5.3.2 SWOT Analysis
Toravej will use SWOT model to analyze the potential of ourselves with industry
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Table 5.2 Toravej SWOT Analysis
Strength - Having Pre-screen question to
reduce waiting time for patient
and ensure each customer is
suitable to use our platform
- Start with secure market i.e.
chronic disease. These patients
can then turn to our customer for
acute and preventive care later.
Weakness - Lack of dedicated provider i.e.
Doctor
- Lack of coder to help develop
application
Opportunity
Toravej believe telemedicine will be
next big thing. Proving by more and
more startup coming to this area and
recently government announce
regulation on how healthcare
professional should use social media for
consultation
Threat
Unclear in Law and regulation of what
we can do and can’t do. In order to see
successful telemedicine business, the
regulation will need to enable business
in many ways.
5.4 Marketing Plan
5.4.1 FaceBook
We promote our business through Facebook channel. At our first
prototype, we delivered 3 types of content: Telemedicine information to enable
customer to know more about this technology, Healthcare content which relevant to our
focus diseases and condition so that consumer aware of what we want to do, Advanced
health technology to show how innovate the healthcare has been though.
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We shifted content on Facebook to be more consistency during our
second prototype so that it captures better target audience and at the same time match
with provider’s availability.
Table 5.3 Facebook Strategy in Toravej 2nd Prototype
Day Content Toravej’s Providers
Monday at Noon Skin Common Disease Dermatologist
Wednesday at Noon Baby Common Problem Pediatric
Friday at Noon Drug related problem Pharmacist
Sunday at Noon Mental illness Happy Coach
Special occasion Chronic Disease Family Medicine
5.4.2 Website
We created website www.toravej.com to increase creditability among
customers and potential investors that our business is real. In the website, there will be
a content on how to use our service, about us which giving information about who we
are and what we want to accomplish, article sections which deliver 4 stories relevant to
area we operate every week.
5.4.3 Word of Mouth
All founders at Toravej use word of mouth to promote our brand
recognition. We told strangers, friends, families, social media on our existence and let
them share it further
5.4.4 Competition
Toravej attends 2 business competitions i.e. Swiss Innovation which
already passed to the final round and Grand4app funded by Bayer. We would love to
use this opportunity to promote ourselves to panel, judges and media to obtain not
awareness. At the same time may attract potential investors or funded from each
competition
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5.5 Brand Strategy
Toravej aims to connect providers and consumer to receive a quality service
through online platform. Our brand will represent this key mission to society.
5.5.1 Brand Name
We choose our brand as “Toravej” because it has the meaning in Thai
word as telemedicine. The name itself may not be that catchy to teenagers but it does
represent perspective of what Toravej can cover almost everything in telemedicine
world.
5.5.2 Brand Logo
Figure 5.1 Toravej Logo
Our logo represent value we would like to provide to patients. The clock in letter
O is representing time reduction while the J at the end we present it under stethoscope
symbol which is what doctor normally wear for examination. The social medical with
Wi-Fi symbol at the end also suggest the value “anywhere at any time” motto we offer
to patient.
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CHAPTER 6
SUMMARY OF SALE STRATEGY
6.1 Sale Policy & Process
Online Healthcare consultation is a new concept in Thailand market. First
mission of Toravej is to educate both consumers and providers on how leverage
technology into service. Having said that team decided that we won’t charge money for
consultation as we want to focus on evaluate an appropriate platform which is user
friendly for our stakeholders first. Our Sale Process thus mainly focus on attract people
to use our service rather using traditional method.
6.1.1 Sale Process
We learnt from first prototype that there are several issues we need to
solve in order to gain potential customers to use our service. We need to promote more
consistent information about healthcare in a nicer and better way. It cannot be just
random content in an article format anymore.
6.1.1.1 Facebook Post
As described in Marketing Plan section, our Facebook content
in second prototype is specific to what Toravej’s operate. The post is systematic so that
audience can expect what will come today at what time. Toravej creates content
ourselves so it comes in a more user friendly way i.e. infographic format and not present
in technical format as it hard for audience to understand.
Each post on Facebook consist with 4 maximum pictures to
ensure target audience see all picture in one scroll. Each picture must represent itself
without need to read further detail. Anyway, if our target audience love to read full
detail they can click into the full article information provided in Toravej website. This
way we believe we get more engagement and awareness from audience.
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Figure 6.1 Example of FB Post
Figure 6.2 Example of FB Layout
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Figure 6.3 Example of Articles on website match with FB post
6.1.1.2 Facebook Boost
In order to reach to maximum audience, Toravej decided to use
boost function on Facebook. We targeted population age 18-40 years old, living in city
center area i.e. Bangkok and Chiang Mai, interested in health and well-being, has mobile
and tablet device, able to access 3G/4G service as we believe they are initial customer
who will use our service and spread through their friends.
We choose to boost Toravej Facebook Page by using function
“Reach” as we want potential customers to see our ads as much as possible. While for
our post content we boost it by using function “engagement” as we want customer to
like, comment and share post so our credibility and reputation becomes more concrete.
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Figure 6.4 Comparison between boost and non-boost post
6.2 Channel
Traditional healthcare service commonly provided in offline tool.
Customer/Patient need to physically present in hospital/clinic/drug store in order to get
consultation or treatment. Toravej think differently we want to test whether an online
tool is an option for healthcare consultation when comparing with offline tool.
6.2.1 Online tool
The first online tool Toravej used is Facebook. We used this social
media to promote diseases we are operating in, promotion we are running and
availability schedule of our providers. In addition, we also share content we are
promoting on Facebook into Line application to capture bigger audiences
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Figure 6.5 Example of Facebook Infographic content
6.2.2 Offline tool
We promote ourselves in a business competition i.e. Swiss Innovation
and Grant4app. We did put poster in startups business and in office to raise awareness
of our business.
6.3 Pricing
Charging appropriate price for healthcare consultation is critical area for
telemedicine business. If the price is higher than traditional method, then customer
might not convert to use telemedicine and at the same won’t reduce overall expenditure
in healthcare. If the price is too low, then it is unlikely that we can recruit experienced
providers to join the team. As Toravej has not yet charge money when patient come for
consultation in our service, we then review other Thai Telemedicine startups on their
pricing strategy so we learnt pros and cons of each model.
6.3.1 RingMD
In RingMD the person who set up the price is providers while
RingMD will gain 20% service charge from every consultation. The price varies from
100 – 20,000 Baht per 20 minutes consultation. If consultation last longer than 20
minutes, you will get charge per minute. This strategy helps RingMD able to recruit
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more providers in variety of fields. However, it doesn’t attract patient as they don’t know
which type of doctor they should go consult and what would be their budget for each
consultation.
6.3.2 ChiiWii Live
ChiiWii.com is a free consultation platform but recently in July, 2017
ChiiWii launched ChiiWii Live which focus on woman related problem and charge
consultation fee for 300 Baht upwards per 15 minutes if consult with doctor while for
non-doctor type will charge from 120 Baht upwards per 15 minutes. The advantage of
this model is customer know exactly what they need to pay. This price is the cheapest
among all telemedicine startup as well.
6.3.3 See Doctor Now
See Doctor Now charge one standard price at 490 baht per 10 minutes
talk which claimed as proper timing for healthcare consultation in hospital. If
consultation last longer than 10 minutes then the service will charge 49 baht per one
minute. Similar to ChiiWii Live, patient can expect on what price they need to pay.
However, the price is high compare to other Thai telemedicine business.
6.3.4 OOCA
OOCA focus on mental health disease, the price start from 300 baht
onwards. Some may charge up to 2,000 baht per 15 minutes consultation. Each providers
can set up the price and time for consultation.
Toravej believe the appropriate model for us is to set up standard price
like See Doctor Now and ChiiWiii live. As Toravej is a new startup and not yet fully
operated if we are going to charge price the range should be 100- 300 baht per
consultation. We would also introduce one-month subscription model so that patient can
ask multiple times within a month. The subscription fee would be around 500-1,000
baht per month.
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CHAPTER 7
SUMMARY OF FINANCIAL PROJECTION
7.1 Assumption/Forecast
7.1.1 Revenue
The main revenue of Toravej is payment fee after using the service.
There is potential subscription model which are in our plan: Price per visit at 300 Baht
and Price per month for subscription model at 1,000 Baht. Assuming the first official
launch next year Toravej will gain 10 patients per day. Thus, approximately in a year
Toravej will gain 3,650 people
Figure 7.1 Revenue Cost (Forecast from 2018-2022)
7.1.2 Cost
In Toravej, there are 4 type of cost which occur during business
operation. These are administrative expense, marketing expense, IT and System
maintenance expense and other expense
1) Administrative Expense: mainly expense is salary for full time and
part time officer working for Toravej
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2) Marketing expense: mainly expense is to promote our brand to be
recognized in healthcare market. This expense may spend on
Facebook, YouTube and Google Ads
3) IT and System maintenance: mainly expense is server renting,
renewal etc
4) Other expense: these are office renting (co-working space) , legal
consultation, part time accountant.
Figure 7.2 Toravej Cost (Forecast 2018-2022)
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7.2 Pro-forma Income Statement
To gain profit in healthcare business, the brand itself need to gain “trust” from
patient. We forecast that Toravej need more than 5 years in order to gain initial benefit
from the investment.
7.3 Pro-forma Statement of Cash Flow
Toravej need initial capital at 1,500,000 baht which potentially come from self-
funding, Swiss Competition and angle investors which see potential of our business
model. We expected that in our 3rd year we will need to raise more funding
(approximately at 500,000 baht) for extending business at double digit growth.
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Figure 7.3 Cash Flow (Forecast 2018-2022)
7.4 Pro-forma of Financial Position
Toravej business model is classified as service operation so there will be no
inventory kept at our back office. Since our business model is either pre- paid
(subscription model) or post-paid after consultation (pay per visiting) thus we won’t have
account receivable. Cash will be main asset we have in our initial phase.
In term of liability and equity, Toravej decided that we won’t get the loan from
financial institution or other creditors. The only way to raise fund to our business is
through equity by selling our stock to potential investors.
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Figure 7.4 Financial Position (Forecast 2018-2022)
7.5 Remarks
To improve financial projection, Toravej should also pursue B2B strategy i.e. be
partner with Thai insurance company so that Toravej gain constant monthly revenue
and at the same time promote our service to insurance’s client to gain more subscription
to our business model.
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CHAPTER 8
CONCLUSION
Telemedicine concept is still at early stage in Thailand. Toravej did several
rounds of testing to understand what criteria are important for creating successful online
healthcare service. We conclude that there are several aspects required for telemedicine
startups. These are but not limited to below items
1) Create a user-friendly operation for customers and healthcare
providers
We realized that if we want customer to shift behavior from going to tradition
hospital for consultation to use our service we need to make the system easiest to access.
We can’t just ask customer to follow instructions to access our service but we must
guide them in every process in a timely manner. Otherwise, they will drop out and use
other approach. Thus, it is necessary to have engagement communication with customer
at initial phase. These can come in pre-screening question format or a person who act as
mediator officer to screen patient and response in a high content level before pass
through specialist doctors. This service not only help engage customer but also reduce
time of providers when they consult with patients.
In term of service, telemedicine business need to have at least a chatting box
and picture sending-receiving function. Most users especially those who consult on
intimidate type of diseases prefer chat feather more than a phone call or VDO call. Only
those who already familiar with providers will use phone or VDO call.
2) Education on benefits and limitation of online consulting service are
needed for both customers and providers
Online consultation without having physical contact with patient bring both
pros and cons to Toravej. From customer ends, Toravej needs to advertise ourselves
more to ensure patient think of us first especially in skin, pharmacy, mental health and
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sexual-wellbeing where we currently doing well. This cannot be done only through post
or page boosting on Facebook. It requires ads on google as well so every time consumer
search healthcare question on google our Toravej page pop up on the first page. This
will help promote awareness of our brand to bigger audiences. Not just rely on words
of mount, Line and Facebook.
In parallel, Toravej also need to educate customers and providers on what
type of symptoms and diseases we can consult online. At this stage, it seems like
customer don’t know limitation and think Toravej can replace hospital which is not true.
While from provider’s end, they are not yet confident on how much they can do in term
of diagnostic or treatment without risking on their professional career. This unbalance
expectation between customer and provider can create potential problem in the future.
3) Required support from government
Telemedicine requires a lot of support in term of regulation and re-
imbursement process. In term of regulation, it needs guidance to set a clear rule on what
CAN and CANNOT be done in telemedicine. This piece of regulation will help
telemedicine startups including Toravej to focus and create effective business model in
line with regulation.
In addition, if using telemedicine consultation and can’ t reimburse to
government plan i.e. Universal Coverage (UC), Social Security Scheme (SSS) and Civil
Servant Medical Benefit Scheme (CSMBS) , then it is unlikely to make customer shift
to online consultation. There are some customers willing to pay extra for the service but
Toravej believe it would create bigger impact if government allow to reimburse
telemedicine service in government healthcare plan. Overall, it should reduce Thailand
healthcare expenditure anyway.
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BIOGRAPHY
Name Ms. Siwaporn Fuengfoosin
Date of Birth May 15, 1987
Educational Attainment
2010: Bachelor of Science: Pharmaceutical
Work Position Regulatory Manager
Procter and Gamble Company
