With increasing high prevalence of high cost chronic conditions, increasing cost pressure and growing emphasis on value based healthcare, care and case managements have emerged as salient services among payers and providers.

The goal of these services are to better manage cost/ utilization, improve quality metrics and patient satisfaction.

However, many payers and providers remain frustrated that despite increased investment in such services, only a small fraction of patients are reached with infrequent engagement, sometimes causing additional friction in the referral chain.

In theory, even only a small improvement in patient outcomes would come with high returns. There is a lot of potential, but traction has been limited. Lack of physician time, physician incentives, patient compliance and cost of service are key barriers for such programs to be effective.

In most emerging countries, there are additional challenges to overcome:

● Access to physicians is difficult and requires long wait times

● High out-of-pocket patient co-pay results in high outcome expectations by the patient

● Physicians treat more patients than in more mature countries. Physicians are rushed and see so many patients per day, there is very limited time for long-term patient follow-up

● Physicians treat more patients than in more mature countries. Physicians are rushed and see so many patients per day, there is very limited time for long-term patient follow-up

● The amount of data quickly becomes overwhelming for the physician, nursing staff.

● There is no apparent funding mechanism available (reimbursement, patient pay) to incentivize physician to engage with patient outside of hospital setting

● Providing services outside of public hospital setting is in a grey area, while encouraged, still requires explicit release by the hospital

● Physicians often receive benefits from distributors to supplement their low compensation which adds cost to overall healthcare without adding value.