Chapter 1 - The Indian Landscape Population Demographics Diseases and Risk Factors... 14

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3 Table of Cotets Chapter 1 - The Idia Ladscape Populatio Demographics Diseases ad Risk Factors Chapter 2 - Itroductio to Welless De ig welless ad prevetive care Scope of welless ad prevetive care Aciet welless ad prevetive care practices i Idia Welless ad prevetive healthcare measures for disease prevetio Chapter 3 - Market sizig of welless ad prevetive healthcare i Idia The market size of Idia welless idustry Key market drivers ad treds Govermet iitiatives to promote the welless idustry Chapter 4 - The Welless Ecosystem The Welless value chai ad key stakeholders Customers Providers Direct Parters Idirect Parters Curret regulatory eviromet ad health isurace Chapter 5 - Role of Health Isurace Health Isurace ad Welless Programs Global best practices Key challeges ad costraits

4 Chapter 6 - Lookig Ahead Commercially viable products which ca be covered uder welless ad prevetive healthcare 6.2. Iclusive strategy across the demad ad supply value chai Chaels of distributio Strategy to expad coverage of welless ad prevetive healthcare products ad services 6.3. Iovative ways of acig welless ad prevetive healthcare products ad services Sustaiable welless ad healthcare acig optios Evisaged role of IRDAI as catalyst i promotig welless ad prevetive healthcare for all 6.5. Quality assurace process for welless ad prevetive healthcare products ad services 2

5 Foreword by FICCI The eed for quality healthcare has see a eormous growth ad customer cetricity i the value added service offerigs is of paramout importace with the risig competitio. Also, this is complemeted by the icreasig awareess about prevetive care with a focus o the idividual well-beig. Welless as a cocept is udergoig a cotiuous shift ad expadig i all directios to ow have three aspects that are covered welless durig, prevetive care, durig ipatiet ad post-hospitalizatio care. For a smooth adoptio, these welless bee ts eed to be embedded with a simple ad a iovative desig. We would like to ackowledge ad thak the healthcare commuity for their cotributio to the health care idustry ad to patiets. Isurers ad healthcare idustry leaders are cotributig to policy chage, quality improvemets ad health system improvemet. This idustry has a lot more to see i the ear future. The Federatio of Idia Chambers of Commerce ad Idustry (FICCI) has set up a task force with key represetatives from the health care idustry, regulators ad isurers to deep-dive ito issues that the ursig professio faces. The task force has put together the various advacemets that the welless idustry has come across with the eed that caused such a progress. This paper holds recommeded reforms that cover the welless evolutio holistically ad we hope that this paper will pave the way for stakeholders, policy makers ad regulators to take iitiatives to build o the eed for well-beig of a idividual ad support the trasformatio that the welless idustry is udertakig. This will be i keepig with Idia's visio to be globally competitive, locally relevat ad to deliver cost-effective health care. We are thakful for the support of the Isurace Regulatory Authority of Idia ad the Isurace ad healthcare providers for the developmet of the report. Goig forward FICCI would like to work closely with IRDAI ad healthcare idustry to make actio plas for achievig the reforms. We would also like to thak the FICCI Health Isurace Committee, FICCI Isurace Task Force ad the FICCI Healthcare team for their cotributios ad utirig effort. Mr Atoy Jacob Co-Chair, FICCI Health Isurace Committee & CEO, Apollo Muich Health Isurace Mr G Sriivasa Chair, FICCI Health Isurace Committee & CMD, The New Idia Assurace Mr Girish Rao Co-Chair, FICCI Health Isurace Committee & CMD, Vidal Healthcare Services 3

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7 Message from EY Strog ecoomic growth i Idia sice last ftee years has brought sigi cat chages i dietary habits, utritioal status ad lifestyle that resulted i a shift commuicable to o-commuicable diseases beig more commo. Idia's healthcare idustry is growig at a sigi cat pace ad is complemeted by the simultaeous icrease i the health risk awareess amogst idividuals drivig the evolutio of welless ad prevetive care market where i employers, welless ceters etc., are desigig iovative ad embedded welless programs to cotiuously egage ad work towards the well-beig of a idividual. Today's youg populatio which accouts to 47% of the total populatio would be eterig the elderly phase years dow the lie - welless ad healthcare advacemets together could brig about a collaborated balace i the well-beig of the idividual. However, the welless idustry i its curret form is fragmeted ad uregulated. Brig ito lie to the ideti ed eed of a idividual well-beig, IRDAI has rolled out the ew set of Health regulatios i July, 2016 allowig welless icetives as a part of the Isurace products, this move marks just the begiig of a major trasitio i the health care ad welless idustry. While this shift will brig its ow set of challeges due to greater trasparecy ad compliace requiremets, the key driver would be efficiet maagemet from desig (how easily does the welless icetive embed itself ito a idividual's lifestyle) to implemetatio (Digitally itegrated ad drive processes, customer ease, accessibility etc.). We are grateful to FICCI for givig us this opportuity to collaborate ad be a part of the value added services task force. The iteractios with the members of the task force gave us a chace to explore optios that ca play a sigi cat role i the evolutio of the welless idustry ad the rise of welless marketplaces. At EY, we are drive by our purpose of 'Buildig a Better Workig World'. We rmly believe that ofte the geesis of a creative solutio is askig the right questios. We hope this report ad the recommedatios i it will just be the start of that jourey. Roha Sachdev Global Isurace Emergig Markets Leader Parter ad Leader - Fiacial Services Advisory EY Naredra Gapule Parter - Fiacial Services Advisory EY Irvider S Lail Director - Fiacial Services Advisory EY 5

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9 Value Added Services Task Force FICCI taskforce o 'Value added Services" was costituted o the advice ad directio of Chairma - IRDAI. The taskforce comprised of members lead by Mr. Ashish Mehrotra - MD & CEO, Max Bupa Health. The taskforce has created a recommedatio paper o 'Value added Services' products, with a focus o welless ad prevetive care. Workig Group Members: Mr. Ashish Mehrotra, MD & CEO - Max Bupa Health Isurace Compay Limited Ms. Priya Gilbile, Seior Vice Presidet - Health Risk Maagemet, Max Bupa Health Isurace Compay Limited Mr. Amit Bhadari, Head - Uderwritig, Claims operatios & Products, ICICI Lombard Dr. Gayatri Mahidroo, Director - NABH Ms. Gomathi V, VP - Swiss Re Ms. Mallika Rohit, AVP Products - ICICI Prudetial Life Isurace Dr. Sadip Budhiraja, Cliical Director - Head ad Cliical Directorate, Max Healthcare Max Bupa resources aliged with the taskforce egaged extesively with them to uderstad their views ad take iputs which have bee icorporated i the paper. EY as kowledge parter for the iitiative brought i their global expertise ad helped idetifyig global best practices i the welless space. The Max Bupa ad EY team comprised of: Mr. Irvider S Lail, Director - Advisory Services, EY Mr. Amit Motwai, Maager - Performace Improvemet, EY Ms. Astha Gupta, Seior Cosultat - Performace Improvemet, EY Ms. Vidhya Alahari, Seior Cosultat - Performace Improvemet, EY Mr. Abhayedra Sigh, Head - Health Risk Maagemet Aalytics, Max Bupa Ms. Meeakshi Gadhi, Geeral Maager - Healthcare Purchasig, Max Bupa Mr. Mohit Desai, Chief Maager - Digital, Max Bupa Mr. Sharad Chadra, Seior Maager - HRM Aalytics, Max Bupa Ms. Sabeea Grim, Geeral Maagemet - Project Maagemet, Max Bupa Mr. Vieet Gupta, Seior Maager - Products, Max Bupa Mr. Vieet Kumar, Geeral Maager - Strategy, Max Bupa 7

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11 Message from Task Force Leader Ashish Mehrotra Welless has come to the forefrot i the last decade o accout of escalatig healthcare costs, sharp rise i critical ad lifestyle illesses ad lack of prevetive care. Icreasig icidece of lifestyle diseases like diabetes ad hypertesio has prompted healthcare professioals to promote welless by ecouragig behavioral chages. Welless products have the ability to i uece behavior ad improve people s health hece lowerig healthcare costs. Health isurace ow plays a sigi cat role i eablig access to healthcare i Idia for a sizeable populatio. Health isurace itegrated with welless offerigs results i better health ad value for customers, superior actuarial dyamics for isurers ad a healthier society. Icetivizig healthy behaviors of customers will help boost peetratio of welless based health isurace products, tailored to the evolvig health eeds of customers. With this aim, FICCI Health Isurace Committee costituted a taskforce with idustry experts, to come up with a recommedatio paper o Value added Services products, with a focus o welless ad prevetive care. This paper aims to put forward the voice of Health Isurace Idustry to the Govermet ad ecourage policy reforms suitable for developmet of the Idustry, to esure health isurace is more iclusive ad takes care of overall wellbeig ad health of the citizes of Idia at large. This report is a result of extesive deliberatios amogst the task force ad FICCI health isurace committee members ad elaborate research ad cotet developmet by EY team. We hope this paper accomplishes the scope of de ig welless, layig out the existig spread available ad provides speci c recommedatios to brig every etity of the ecosystem o to a commo platform ad work towards the commo goal of idividual wellbeig. 9

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13 Executive Summary Welless programs are predomiatly icreasig i the society as the healthcare ad isurace providers attempt to reduce costs of chroic diseases ad claims respectively, by icreasig the awareess aroud health risks ad ecouragig well-beig of a idividual, employers strive for a healthy workforce, ad idividuals tur out to be ispired to take cotrol of their ow health through techological advaces that quatify welless ad its impact o the upcomig health risks. However, this idustry is still fragmeted ad uregulated with a huge potetial for developmet. Each welless offerig differs i its ow way, yet most are drive by similar objectives: cotiuous egagemet ad participatio to improve health. This paper aims at brigig out the vastess ad eed for the idustry, existig spread ad speci c recommedatios to brig every etity of the ecosystem o to a commo platform ad work towards the commo goal of idividual well-beig. With the progress of time, welless as a cocept has take up a multi-dimesioal de itio, ecompassig the idividual's desire for oe's ow well-beig, uiqueess ad collective welfare. Primarily i ueced by societal chages ad idividual's lifestyle treds, this revolutio has also bee ehaced by exteral factors such as globalizatio ad a greater awareess of the eed for welless amog idividuals. Welless players, i aligmet to above treds have respoded by shiftig their focus from traditioal offerigs like curative healthcare ad value orieted mass products to ew geeratioal offerigs like prevetive healthcare, luxury products ad persoalized services. However, the ed customer reach of the welless is still limited due to the regulated eviromet of the isurace or healthcare providers ad the regulators have ow take their rst steps to ecourage welless ad this will drive the today's fragmeted idustry to shape ito beig a marketplace providig a commo platform for various well-ess aggregators. As the govermet takes steps to alig itself with the ecosystem, it is importat to simultaeously address the challeges of desig ad implemetatio that outlie the effectiveess of the welless offerigs ad the ease at which they are made available to each of the etities i the value chai to adopt to the shift. For example, pairig a life isurace policy with a welless pla ecourages customers to take a actio to improve their persoal health as well as reduce their premiums. The isurer may realize improved experiece ad be able to develop ew ad iovative products. 11

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15 Chapter 1 The Idia Ladscape 1.1 Populatio Demographics The demography of a coutry helps to uderstad the challeges ad opportuities it presets for sustaiable developmet. Health characteristics, e.g. burde of diseases, productive years lost, ad cost of health care are key drivers of ecoomic growth for emergig markets like Idia. Accordig to estimates, withi 10 years, Idia will surpass Chia to become the world's most populous coutry. However, the pace of growth will slow as the coutry reaches replacemet fertility. Some key statistics of Idia's curret populatio are highlighted below: 1. Secod most populous coutry with 1.31 billio people (52% male ad 48% female) 2. Idia's populatio is equivalet to 17.84% of the total world populatio 3. The populatio desity i Idia is 441 per Sq. Km % of the populatio (428 millio) live i urba areas 5. The media age i Idia is 26.6 years 6. Crude birth rate per 1000 is Fertility rate (live births per woma) is Life Expectacy at birth is 67 years 9. Uder ve mortality is 53 for every 1000 live births 10. Ifat mortality is 40 for every 1000 live births Idia's populatio today is relatively youg, primarily due to high birth rates. The populatio pyramid i the gure shows that youg people (below age 25) accout for a much higher proportio (47%), while the elderly (65 ad older) accout for a mere 9%. This broad base is evidet for both male ad female. As this youg populatio eters the workforce, it becomes a major growth driver for the ecoomy. Also, this youg populatio will eed better health protectio whe they eter the elderly phase years dow the lie ad carry the potetial to chage the dyamics of the isurace idustry. Replacemet fertility meas that childre bor to each couple are o average replacig the dyig populatio without icreasig the size of the populatio Uited Natios Populatio Divisio Estimates,

16 Populatio Pyramid - Idia (2015) Female 1.2 Diseases ad Risk Factors Male There has bee a major epidemiological trasitio i Idia i the last 25 years, ad the burde has shifted from commuicable to o-commuicable diseases (NCDs). The major reaso is the chage i the ecoomic coditios, resultig i a shift towards a uhealthy lifestyle. Curretly Idia is sufferig from high morbidity ad low mortality, caused by the triple burde of ifectious, commuicable ad o-commuicable diseases. I Idia, the occurrece of NCDs ad the resultat morbidity becomes eve more prevalet i a agig populatio. Chroic NCDs have icreased over ve-fold i the agig populatio, especially those above 60 years. The atioal health pro le for 2015 attributes over 50% death to NCDs. Figure below shows the projected disease shift betwee year 2005 ad Idia Disease Pro le Idia Disease Pro le Projected Ijuries 11% Other Chroic Diseases 16% Cacer 8% Cardiovascular Diseases 29% Commuicable Diseases 36% Ijuries 12% Cacer 12% Cardiovascular Diseases 36% Other Chroic Diseases 19% Commuicable Diseases 21% Yadav, S. ad Arokiasamy, P. Uderstadig epidemiological trasitio i Idia. Global Health Actio,

17 Primarily, there is growig cocer to address the icreasig burde of o-commuicable diseases, which are resposible for two-thirds of the total morbidity burde ad just over half of deaths⁴. Recogizig the gravity of situatio, i , the govermet started the Natioal Programme for Prevetio ad Cotrol of Cacer, Diabetes, Cardiovascular Diseases ad Strokes (NPCDCS). Curretly this programme is beig implemeted i 35 states ad uio territories, ad is expected to cover etire coutry by the ed of 2017⁵. However, this iitiative is very recet ad it will take sigi cat effort ad time to arrest the growth of Nocommuicable diseases. Rise of No-Commuicable Diseases Strog ecoomic growth i Idia sice last ftee years has brought sigi cat chages i dietary habits, utritioal status ad lifestyle. As a result, o-commuicable diseases have become more commo, egatively impactig morbidity ad mortality. Accordig to the World Health Orgaizatio, oe i four Idias will die from a o-commuicable disease before the age of 70.⁶ No-commuicable diseases curretly accout for 53% of the total deaths ad 44% of disability-adjusted life years (DALYs) lost⁷. Higher socioecoomic groups are more susceptible to cardiovascular diseases ad accompayig risk factors like obesity, diabetes, hypertesio ad elevated lipids⁸. Whe compared to global averages, Idias get cardiovascular diseases or diabetes 10 years earlier i their lifespa. This icreases the chaces of premature mortality i the productive workgroup of years. Table below illustrates the trasitio betwee commuicable to o-commuicable diseases for mortality, betwee year 1990 ad Most otable is the rise of Ischemic heart disease ad stroke⁹ Rak Disease Rak Disease 1 Lower respiratory ifectios 1 Ischemic heart disease 2 Diarrheal diseases 2 Chroic obstructive pulmoary disease 3 Preterm birth complicatios 3 Cerebrovascular disease 4 Tuberculosis 4 Lower respiratory ifectios 5 Neoatal ecephalopathy 5 Diarrheal diseases 6 Ischemic heart disease 6 Tuberculosis 7 Other eoatal disorders 7 Diabetes 8 Chroic obstructive pulmoary disease 8 Chroic kidey disease 9 Tetaus 9 Neoatal preterm birth 10 Neoatal sepsis 10 Road ijuries 11 Stroke 11 Neoatal ecephalopathy 12 Road ijuries 12 Other eoatal disorders 13 Self-harm 13 Tetaus Commuicable, Materal, Neoatal ad Nutritioal diseases No-commuicable diseases Ijuries ⁴ WHO Mortality ad Morbidity Data, 2015 ⁵ Miistry of Health (2015) ⁶ Who.it. WHO Idia: rst to adapt the Global Moitorig Framework o ocommuicable diseases (NCDs).2015 ⁷ Health Risk Factors Idia, Swiss Re, 2015 ⁸ Subramaia, S., Corsi, D., Subramayam, M. ad Davey Smith, G. Jumpig the gu: the problematic discourse o socioecoomic status ad cardiovascular health i Idia. Iteratioal Joural of Epidemiology, 42(5), pp , 2013 ⁹ The State of Health i the Commowealth: Idia pro le, IHME (2015) 15

18 Major No-Commuicable Diseases No-commuicable diseases iclude respiratory diseases, orthopedic problems, hypertesio, cardiovascular diseases (CVDs), diabetes, cacer, etc. However, followig are the four major o-commuicable diseases, resposible for 43% of mortalities i 2014: 1. Cardiovascular Diseases - Cardiovascular diseases (CVDs) will be the largest cause of death ad disability by 2020 i Idia ⁰. Cardiovascular diseases cause aroud 45% deaths of ocommuicable diseases ad 29% deaths of all diseases combied. Approximately 2.6 millio Idias are predicted to die due to coroary heart disease, which costitutes 54.1 % of all CVD deaths. Nearly half of these deaths are likely to occur i youg ad middle aged idividuals (30-69 years). Primary reaso for this situatio is late diagosis of the disease, ad lack of prevetive care. 2. Diabetes - After cardiovascular diseases, diabetes is takig the highest toll o Idia's health i category of o-commuicable diseases. Idia is ow both, the cardiovascular disease ad the diabetes capital of the world. I year 2015, there were 69.1 millio reported cases of diabetes; this umber ca reach to 109 millio by 2035.The average age of a diabetic is 40 i Idia, 10 years youger tha i developed coutries ⁴. Late diagosis is a factor for diabetes, due to lack of prevetive care i Idia. This causes the disease to be i advaced stage, by the time patiet reaches out for medical care. 3. Chroic Respiratory Dieases - It is estimated that 30 millio patiets i Idia are sufferig from chroic respiratory diseases, out of which 22 millio are sufferig from chroic obstructive pulmoary disease (COPD) ⁵. COPD, most commo amog me due to smokig behavior, causes 6 times icrease i cases of respiratory disease. 4. Cacer - Accordig to estimates, as of 2015, there were 3.9 millio people sufferig from cacer with reported cases of 1.1 millio ⁶. The most commo cacers i me are those of the oral cavity, esophagus ad lug while i wome the mai sites are the cervix, breast ad ovaries. Major Risk Factors Major risk factors causig o-commuicable disease burde i Idia are listed below: 1. Tobacco: I Idia cotext, tobacco is resposible for oe third of all the cacers. Idia is secod largest cosumer ad third largest producer of tobacco. Accordig to Global Adult ⁰ FoodNavigator-Asia.com. Idia bracig for heart disease, 2015 Natioal Health Pro le, Cetral Bureau of Health Itelligece, 2015 Health Risk Factors Idia, Swiss Re, 2015 Iteratioal Diabetes Federatio. (2016). ⁴ M, Bhasali A, Ajaa RM, Pradeepa R, Joshi SR, Joshi PP, et al. (2014).Kowledge ad awareess of diabetes i urba ad rural Idia: ICMRs ⁵ Subramaia, S., Corsi, D., Subramayam, M. ad Davey Smith, G. Jumpig the gu: the problematic discourse o socioecoomic status ad cardiovascular health i Idia. Iteratioal Joural of Epidemiology, 42(5), pp , 2013 ⁶ EY; Call for Actio: Expadig cacer care i Idia July,

19 Tobacco Survey , there were aroud 275 millio tobacco cosumers i Idia i both smoke ad smokeless form, likely to cause 1.5 millio estimated deaths aually by 2030 ⁷. 2. Dietary risks: Oe of the major reasos for rise of o-commuicable diseases i Idia is chage i dietary prefereces over last 20 years. With icreasig urbaizatio i Idia, vegetable ad ber rich diet is o a declie ad is beig replaced by processed food ad soft drik. These foods ad driks are high i fat ad sugar, resposible for icreasig the overall caloric itake. These dietary habits further coupled with sedetary life style are resposible for cardiovascular diseases ad diabetes. 3. Obesity: Due to dietary habits ad sedetary life style, Idia has see a surge i obese people. Idia ow raks umber 5 i the rakig of coutries by obesity prevalece. Obesity is also a key reaso for host of ailmets like cardiovascular diseases, diabetes ad respiratory disorders. 4. High blood pressure: Trasitio from agraria life style to city life ad high stress jobs has led to icrease i blood pressure. High blood pressure ad hypertesio are mai reasos for cardiovascular diseases. Hypertesio is directly resposible for 57% of all stroke deaths ad 24% of all coroary heart disease (CHD) deaths i Idia ⁸. I Idia, raised blood pressure icreased from 5% i the 1960s to early 12% i 1990s, to more tha 30% i 2008 ⁹. 5. Air Pollutio: With icrease i motor vehicles ad idustrializatio, air pollutio is becomig a big problem i Idia. Air pollutio cotributed aroud deaths i Idia durig 2010 ⁰. Idia capital Delhi has the world's highest average levels of PM2.5 at 153 μg/m3. The ext three highest cities are also i Idia ad they rage from μg/m. ⁷ WHO, Global Tobacco Epidemic Report, 2015 ⁸ Gupta R. Treds i hypertesio epidemiology i Idia. J Hum Hypertesio 18:73 78, 2004 ⁹ WHO, World Health Day Report, High Blood Pressure, 2013 ⁰ Health Risk Factors Idia, Swiss Re,

20 Chapter 2 Itroductio to Welless The term welless has bee used i several ways ad there are differet views o what welless ecompasses. However, there is a geeral agreemet that the followig characteristics de e the welless paradigm: 1. Aspirig towards evolvig process of achievig full-potetial 2. Multidimesioal ad holistic 3. Positive ad affirmig Hece, welless is a active process through which people become aware of, ad make choices towards, a more successful ad healthy existece. Moder welless cocept icludes both primordial ad prevetive healthcare shiftig disease maagemet from reactive to prevetive. I Idia, traditioal medicie ad prevetive practices such as Ayurveda, Yoga ad Meditatio have always stressed o welless, i.e., healthy mid i a healthy body ad aliged to deliver overall well-beig. 2.1 De ig welless ad prevetive care Welless is viewed from a holistic perspective ad represets a perceived positive state of beig ad embraces a body-mid-spirit cocept. Several orgaizatios, istitutes ad scietists have made a attempt to de e welless i the past. Some select de itios are preseted below: Istitutios/ Orgaizatios # Istitutios/ Orgaizatios De itio 1. World Health Orgaizatio Welless is a state of complete physical, metal ad social well beig, ad ot merely the absece of disease or i rmity 2. The Natioal Welless Istitute A coscious, self-directed ad evolvig process of achievig full potetial 3. NABH (Natioal Accreditatio Board for A state of a healthy balace of the mid ad body Hospital & Healthcare Providers) that results i overall well beig 4. Arizoa State Uiversity Welless is a active, lifelog process of becomig aware of choices ad makig decisios towards a more balaced ad ful llig life 18

21 Dictioary # Dictioary De itio 1. Merriam - Webster The Quality or state of beig i good health especially as a actively sought goal 2. The America Heritage Welless is a coditio of good physical, metal ad Medical Dictioary emotioal health, especially whe maitaied by a appropriate diet, exercise ad other life style modi catios 3. Dictioary.com A approach to healthcare that emphasizes prevetig illess ad prologig life, as opposed to emphasizig treatig diseases Scietists # Scietists De itio 1. Dr. Bill Hettller Welless is multidimesioal ad holistic, ecompassig lifestyle, metal ad spiritual wellbeig, ad eviromet 2. Jack Travis Welless is a way of life - a lifestyle choice to move towards optimal health ad achieve your highest potetial 3. Rickhi ad Aug Welless meas focusig o practices that bee t oe or all three dimesios - body, mid ad spirit 4. Myers, Sweeey ad Wittmer Welless is a way of life orieted toward optimal health ad wellbeig i which the body, mid ad spirit are itegrated by idividual to live more fully withi the huma ad atural commuity As evidet, welless ecompasses several key dimesios that iclude physical, emotioal, psychological ad social attributes. These factors cotribute to welless i a series of complex ad iteractig ways. Welless, ulike health, is more tha absece of diseases ad ivolves a holistic perspective of a idividual. It ivolves wide rage of huma experiece such as persoal growth, family, educatio, commuity developmet, medical care, coachig ad work. Key features characterizig welless are highlighted below: Holistic, multidimesioal Body-mid-spirit cocept Perpetual, coscious, self motivated Prevetig illess, life style choice Welless Overall wellbeig Balaced ad ful llig life 19

22 Based o the above, welless may be de ed as: A coscious, self motivated, cotiuous ad holistic approach to overall well beig ecompassig physical, metal, emotioal ad social health ad eablig a disease free, balaced ad ful llig life 2.2 Scope of welless ad prevetive care A holistic ad multidimesioal perspective to the cocept of welless ecompasses 8 dimesios. Each dimesio is equally vital i the pursuit of optimum health ad acts ad iteracts i a way that cotributes to icreasig the quality of life. Ability to uderstad ourselves ad cope with the challeges life ca brig Ability to maitai a healthy quality of life that allows us to get through our daily activities without udue fatigue or physical stress Emotioal Ability to establish peace ad harmoy i our lives Ability to relate to ad coect with other people i our world Social 8 Dimesios of overall wellbeig Itellectual Ability to ope our mids to ew ideas ad experieces that ca be applied to persoal decisios ad group iteractio Ability to get persoal ful llmet from our jobs or our chose career elds while still maitaiig balace i our lives Evirometal Ability to recogize our ow resposibility for the quality of the air, the water ad the lad that surrouds us Ability to take ratioal acial decisios Oe ca reach a optimal level of welless by uderstadig how to maitai ad optimize each of the dimesios of welless. These are brie y discussed further below: Physical welless Physical welless is the ability to maitai a healthy quality of life that allows us to get through our daily activities without udue fatigue or physical stress. The ability to recogize that our behaviors have a sigi cat impact o our welless ad adoptig healthful habits (a balaced diet, exercise, routie checkups etc.) while avoidig destructive habits (tobacco, drugs, alcohol, etc.) will lead to optimal Physical Welless. 20

23 I geeral, physical welless icludes physical activity, utritio ad self care, ad ivolves prevetive ad proactive actios that take care of oe's body. Some of the key services uder the scope of physical welless are listed below: # Services Select service providers 1. Fitess ceters Talwalkars, Gold's Gym, Aytime Fitess 2. Alterate therapy Kottakal Arya Vaidhyasala, Dr. Batras, Soukya, Nirvaa Naturopathy 3. Nutritioal care/ dieticias Health Total (Ajali Mukherjee), Rujuta Diwekar, Pooja Makhija's 4. Aual health check ups Public ad private hospitals, cliics, diagostic ceters 5. Disease Maagemet Kartavya Healtheo, Apollo Sugar 6. Vacciatio/ prevetive care Public immuizatio services, hospitals 7. Corporate welless Truworth, FitHO 8. Diagostic labs Metropolis, SRL Diagostics, Apollo Pathlabs, NM Medical 9. Pharmacies/ chemist Medieazy, NeMeds, Noble Medicals, Apollo Chemists 10. Beauty care VLCC, Kaya Ski Cliic 11. Rejuveatio Aada Spa (destiatio), Four Foutai Spa (day) 12. Health trackig equipmet & Fitbit, Garmi, Mis t wearable Emotioal welless Emotioal welless is the ability to uderstad ourselves ad to cope with life's challeges. The ability to ackowledge ad share feeligs of ager, fear, sadess or stress; hope, love, joy ad happiess i a productive maer cotributes to our Emotioal Welless. Emotioal welless is coceptualized as awareess ad cotrol of feeligs alog with a realistic ad positive view of the self, co ict ad life circumstaces. The ability to cope with stress ad maitai ful llig relatioships with others also ehaces oe's emotioal welless. Some of the key services uder the scope of emotioal welless are listed below: # Services Select service providers 1. Couselig services Parivartha, Talkitover, Optum 2. Stress maagemet Truworth welless 3. Telephoic help lie services 1to1help.et, Huma Dyamic 4. Persoal developmet programs Learig ad developmet istitutios, Maagemet developmet programs 5. Ager maagemet CRBT Idia 6. Healig services Eergy healig ceters, Yoga ceters 21

24 Spriritual welless Spiritual welless is the ability to develop cogruecy betwee values ad actios ad to realize a commo purpose. Spiritual welless ca be cosidered to be the broader cocepts of beliefs ad values, seekig meaig ad purpose i existece ad establishig harmoy with self, others ad uiverse. Some of the key services uder the scope of spiritual welless are listed below: # Services Select service providers 1. Meditatio services Aada Sagha, The Art of Livig Foudatio, Tushita 2. Yoga Isha Foudatio 3. Life coachig services CRBT Idia, Tvam Itellectual welless Itellectual welless is the ability to ope our mids to ew ideas ad experieces that ca be applied to persoal decisios, group iteractio ad commuity bettermet. The desire to lear ew cocepts, improve skills ad seek challeges i pursuit of lifelog learig cotributes to our Itellectual Welless. Itellectual welless icludes egagemet i creative ad stimulatig activities, as well as the use of resources to expad kowledge ad focus o the acquisitio, developmet, applicatio ad articulatio of critical thikig. Services such as, educatio/ skill developmet, critical thikig skills, time maagemet skills fall uder the gambit of Itellectual welless. Social welless Social welless is the ability to relate to ad coect with other people i our world. Our ability to establish ad maitai positive relatioships with family, frieds ad co-workers cotributes to our Social Welless. It ecompasses the degree ad quality of iteractios with commuity ad ature. Peer acceptace, attachmet/ bods with others ad social skills are regarded as fudametal to social welless. Occupatioal welless Occupatioal welless is the ability to get persoal ful llmet from our jobs or our chose career elds while still maitaiig balace i our lives. Our desire to cotribute i our careers to make a positive impact o the orgaizatios we work i ad to society as a whole leads to Occupatioal Welless. Occupatioal welless also icludes cotributio of oe's uique skills ad talets to the commuity i rewardig, meaigful ways through paid ad upaid work. Some of the 22

25 services such as, professioal learig developmet, career services, how to maitai work life balace fall uder the scope of social welless. Evirometal Welless Evirometal welless is the ability to recogize our ow resposibility for the quality of air, water ad lad that surrouds us. The ability to make a positive impact o the quality of our eviromet, be it our homes, our commuities or our plaet cotributes to our Evirometal Welless. It icludes idividual relatioship with ature ad commuity resources. Fiacial Welless Fiacial welless is the state of beig fully aware of oe's acial state ad budgets. It icludes savig ad maagig aces i order to achieve realistic goals ad has the ability to take ratioal acial decisios. 2.3 Aciet welless ad prevetive care practices i Idia I Idia, welless is a cocept which has bee i existece sice aciet times. Traditioal medicial ad health practices such as, Ayurveda ad yoga have propouded the cocept of metal ad bodily welless. Most of the aciet welless cocepts have largely focused o basic eeds of a idividual withi the eed hierarchy, amely health, utritio ad relaxatio. The priciples of these aciet holistic systems are playig a big role i the emergig welless movemet today. Some of the key Idia traditioal medicial ad health practices that are itegral to welless ecosystem are listed below: # Services Select service providers 1. Ayurveda Traditioal system of medicie which is based o the idea of balace i bodily systems ad uses diet, herbal treatmet ad yogic breathig 2. Yoga Yoga is a group of physical, metal ad spiritual practices ad disciplies 3. Naturopathy Its form of alterative medicie employig a wide array of atural modalities icludig homeopathy, herbalism ad acupucture as well as diet ad life style couselig 4. Uai Uai system of medicie is based o the cocept of equilibrium ad balace of atural humours (blood, bile, black bile ad phlegm) 5. Sidda It's a traditioal medicie origiatig i aciet Tamilakam i South Idia 23

26 2.4 Welless ad prevetive healthcare measures for disease prevetio As discussed i chapter 1, Idia may be at uique risk from No-Commuicable diseases (NCDs) such as, hypertesio ad diabetes. WHO has ideti ed that most NCDs are result of four particular lifestyle related behavioral risk factors tobacco use, physical iactivity, uhealthy diet ad harmful use of alcohol. They lead to four key metabolic/ physiological chages e.g., raised blood pressure (BP), overweight/ obesity, raised blood glucose ad raised cholesterol levels leadig to diseases like cacer, stroke, ischemic heart diseases ad heart failure. May chroic diseases are prevetable through lifestyle choices or early detectio ad maagemet of risk factors. The best way to ght these diseases is to prevet it ad welless programs itroduce people to tools which ca help them to prevet chroic coditios. Welless programs promote healthy behaviors such as eatig a well balaced diet, regular physical activity, takig aual health checkups, quit smokig etc ad choices like healthy diet ad physical activity are critical to cotrollig chroic diseases. Some of the key welless ad prevetive steps iclude: Physical activity Beig active for at least 150 miutes per week ca reduce the risk of chroic disease Aual health check ups Periodically gettig screeed for chroics Nutritioal care Havig a well balaced diet icludig fresh fruits ad vegetables Stress Maagemet Work life balace ad maagig stress Quit Smokig Smoke free life is the most crucial step to good health Well structured welless programs promote behavioral chages that ca play a crucial role i decreasig chroic health care cost burde ad also help people to lead successful healthy life. 24

27 Chapter 3 Market sizig of welless ad prevetive healthcare i Idia 3.1 The market size of Idia welless idustry Idia welless idustry has see a sigi cat evolutio from beig restricted to tess ad femiie beauty to a more all-ecompassig subject of physical, metal ad emotioal welless. I its curret form, welless idustry icludes ve major sub segmets - the beauty care, utritio care, tess cetres, alterative treatmets, therapy ad rejuveatio. Durig FY15, the Idia welless idustry was estimated at ~INR 85,000 crores. Bolstered by icreasig awareess, push from the isurace idustry ad govermet, it is expected to grow at a CAGR of ~12% for the ext 5 years. From its curret size this idustry ca achieve ~INR 1, 50,000 crores by FY20. With sigi cat scope for peetratio especially i areas like utritio, rejuveatio ad tess the Idia welless market is a huge busiess opportuity waitig to be haressed. The lie ad carry the potetial to chage the dyamics of the isurace idustry Segmet level projectio for FY20 While this sector as a whole is expected to early double by 2020, some sub-segmets will outperform others. While beauty care ad utritioal care would retai their share, tess ad rejuveatio would sigi catly icrease their market share. This growth also i ueces the addressable market that various players ca look out for ad has bee discussed i more detail i the subsequet sectio. While most sub-segmets have a healthy growth, drivig forces such as, lifestyle diseases, icreasig stress levels ad blurrig of geder boudaries have led to higher growth of segmets like tess ad rejuveatio. INR 85,000 crores 1% CAGR 12% 15% INR 1,50,000 crores 2% 12% 19% 41% 16% 40% 27% 27% FY 15 FY 20 Beauty care Nutritioal care Fitess ceters Alterate therapy Rejuveatio 25

28 Products Services CAGR Drivers Beauty care Cosmetic Products Massager & persoal equipmets Salos, Beauty ceters, Treatmets 11% Ÿ Icreased acceptace for orgaized players ad cosequet spurt of such players Ÿ Evolutio of cocept beauty from a woma subject to beig geder eutral. Hece, brigig i whole ew target audiece i the form of adolescet to youg & middle aged me. Nutritioal care Health food & beverages Dieticia 12% Ÿ Icreased awareess ad utilizatio of utritioal foods especially drive by the supplemets market Fitess ceters Exercise equipmets Gym, Yoga, slimmig 18% Ÿ Icreased peetratio ad acceptace for orgaized players Ÿ Growig focus towards ill effects of obesity Ÿ Icreasig adolescet obesity i Idia Alterate therapy AYUSH products AYUSH treatmets 7% Ÿ Govermet push i this segmet Ÿ Research (i cojuctio with Coucil for Scieti c ad Idustrial Research CSIR) ad subsequet policy drive marketig of herbal products like ati-diabetic formulatios are likely to a play a key role Rejuveatio Massager & persoal equipmets Spa, Saua, Massage ceters 20% Ÿ Icreasig stress levels especially i tier 1 cities will cotribute to the proliferatio of rejuveatio cetres Ÿ Domestic ad Iteratioal Tourism has bee aother key cotributor i this segmet ad will cotiue to play a sigi cat role especially i the Souther cetres Ÿ Icreasig focus o metal health 26

29 Welless addressable market Iclusios Fitess products ad services Fitess services ad equipmet e.g. Gold s Gym Slimmig products services e.g. VLCC Yoga & meditatio cetre Dace classes ad other tess activities such as sports Exclusios Beauty care products ad services Hair, skicare ad other cosmetic products Cosmetic surgeries Salos providig basic facilities such as hair cut ad shavig Alterative therapy Products ad services related to AYUSH e.g. Kottakal Arya Vaidhyasala, Dr. Batras Nutritioal care Dietary supplemets ful llig the eeds of mierals, vitamis, proteis Services of dieticia ad utritioalist e.g. Health Total (Ajali Mukherjee), Rujuta Diwekar Health orieted food ad beverages Food products of all kids icluded forti ed products, low level of uhealthy igrediets amog others Rejuveatio Spas, massage ceters ad saua e.g. Aada Spa (destiatio), Four Foutai Spa (day) Practitioers of welless programs Idividual or etities egaged by employers for spreadig awareess INR 50,000 Cr with services beig about 22,500 Cr (FY 15) The estimated addressable welless market relevat for health isurers is about INR 55,000 Cr ad excludes beauty care products ad services alog with health orieted food ad beverages. 3.2 Key market drivers ad treds A multitude of factors such as, youg populatio, risig disposable icomes are cotributig to rapid growth of welless idustry i Idia. Govermet focus towards welless, iclusio of welless as a segmet i health isurace ad icreasig awareess about lifestyle diseases are set to drive this growth story ito a expoetial trajectory. Key cotributory factors have bee elaborated below. Risig Lifestyle diseases, obesity, diabetes As highlighted i chapter 1, Idia is the diabetes capital of the world. I additio, other lifestyle diseases like hypertesio ad obesity are o a steep rise too. I fact diseases drive by chagig eviromet like Asthma, allergic siusitis etc. are icreasig as well. Alterative therapies, tess ad utritioal supplemets have foud huge cogizace amogst the atrisk populatio ad those livig with such lifestyle diseases. Risig awareess of healthy lifestyle amog Idias While lifestyle diseases are witessig a worryig growth tred, Idias are also icreasigly becomig aware of the importace of a healthy lifestyle. I fact workplace welless has gaied tractio ot oly i the private sector but also the govermet sector. Rapid urbaizatio Cesus 2011 estimated the urba Idia populatio at 31.16% growig at CAGR of 1.2%. With curret govermet pushig for smart cities ad focus shiftig to tier 2 ad below cities Source: Cesus Provisioal Populatio Totals - Idia 27

30 this tred is here to stay ad oly icrease i the future. Icreasig urbaizatio supported by the huge i ux of ew products ad service providers across all segmets - are re-de ig the way welless was perceived by the Idia customers. Risig Disposable icome Disposable icome i Idia grew by 8% from 2014 to 2015 ad touched a all-time high. This growig purchasig power ad risig i uece of the social media has lead to icreasig demad of welless products ad services. This has resulted i growth i almost all subsegmets with larger sectio of customers seekig almost all welless services ad products. Push from health isurace idustry Yoga has foud a place i the welless ad prevetive packages of most private health isurers. Discouts ad premium relaxatio based o tess ad welless have also made their way ito Idia isurace packages. Icreasig health isurace peetratio (~19% CAGR for the idustry from ad ~24% CAGR for the retail segmet i the same period) ca hece drive the Idia cosumer towards welless i a big way. 3.3 Govermet iitiatives to promote the welless idustry Govermet of Idia has take cogizace of the fact that wellbeig ad welless of the citizes of the coutry ca brig dow that health care expediture. The iitiatives ragig from "Make i Idia" to "Iteratioal Yoga Day" have idicated the same. 1. To broad base ad provide focussed attetio to developmet of Educatio ad Research i Ayurveda, Yoga ad Naturopathy, Uai, Siddha ad Homoeopathy, the Miistry of AYUSH was formed i Iteratioal Day of Yoga observed world over o Jue 21 as proposed by Govermet of Idia. ⁴ 3. The Miistry of AYUSH recogized the huge demad for Yoga experts at atioal ad iteratioal level ad ideti ed Quality Coucil of Idia to develop a Volutary Scheme for Evaluatio ad Certi catio of Yoga Professioals. The focus of the Scheme for Volutary Certi catio of Yoga Professioal, as it is beig called, is to certify the competece of Yoga Professioals who provide Yoga lessos/classes. ⁵ 4. Saitatio: Swacch Bharat Abhiyaa ⁶ is oe of the key areas for prevetive healthcare is clealiess. Maiteace of the hygiee ad clealiess helps reduce the icidece of ifectios acquired i hospitals ad health care cetres. 5. mhealth iitiatives: GOI has iitiated multiple mhealth iitiatives targetig health ad welless. Some promiet oes beig mcessatio program ad mdiabetes program. Both will be utilizig mobile techology ad social media to spread awareess to help quit tobacco ad maage diabetes respectively. I additio multiple mobile apps (Swasthya Bharat App) ad atioal level portals (Natioal Health Portal) with geeral health ad diseases iformatio have bee lauched i the past oe year. ⁷ ⁴ ⁵ catio.qci.org.i/ ⁶ ⁷ 28

31 Chapter 4 The Welless Ecosystem 4.1 The Welless value chai ad key stakeholders Welless, as we have discussed, has 8 dimesios to it which further gets distributed ito several products ad services. The differet elemets of the welless ecosystem start from us, ad exted ito a uiverse of providers, regulators ad facilitators. The gure below highlights major participats: AUTHORITIES l Life Isurace l Geeral Isurace l Health Isurace Isurers Adjacet Idustries l Healthcare l Retail l Hospitality l Educatio sector l Media & may more REGULATORS l Corporates Employers l Govermet Offices l Awareess iitiatives l Govermet iitiatives l Petitios ad causes Educatioal Media Direct Parters Idirect Parters Welless Marketplaces Techology /data providers l Marketplace parters l NGOs l Provider/Services aggregators l Techology parters l Researches l Cotact Ifo. aggregators ASSOCIATIONS l Awareess Iitiatives GOVERNMENT Authorities iclude govermet, regulators ad associatios icludig trade bodies. Authorities play a multi-taskig role of creatig ad eablig the idustry, protectig ed users' iterests, facilitatig healthy practices ad regulatig the players. Direct parters iclude isurers, employers ad educatioal media. They play a role of creatig awareess, ecouragig welless behavior ad facilitatig the executio of healthy behavior. Idirect parters iclude adjacet idustries such as healthcare, media, retail, hospitality, gamig ad educatio. They play a key role of providig varied optios aroud products ad services to ed users ad creatig a experiece which could result ito habits. They also capitalize o the growth of the welless sector to geerate additioal reveue streams leveragig their existig competecies. 29

32 Providers iclude all players ivolved i providig products ad services across segmets of welless sector de ed earlier Customers Customers are the ed cosumers of the welless services/products. The welless customer has udergoe steep trasitio. The welless customer today demads service aroud three major elemets ease, experiece ad excellece Ease - Majority of welless customer lies i the age group of years ad expects easy access ad service provisio (olie bookig, olie paymets, packaged services etc). Experiece - Welless as stated before evolved to iclude emotioal ad spiritual welless. Experiece hece becomes a extremely importace eed from customer stadpoit. Rejuveatio ad welless cetres specially have the ous to provide ot oly welless service but deliver o the welless experiece for their customers Excellece - The welless customer expects excellece i services ad products bought. Hece movig ito the future quality ad service excellece are extremely importat aspects of customer eeds i this idustry Providers Health care ad acillary service providers offer products ad services which directly impact the cosumers' welless; hece their role is critical i the ecosystem. Various providers could be classi ed basis segmets discussed above viz. tess ceters, utritioal care, rejuveatio ceters ad alterate therapy. Providers, however, face a umber of challeges i the Idia market which eed to be addressed by authorities: Lack of accreditatio ad other recogized authorities to develop credibility of welless services Substadard facilities ad poor ifrastructure especially i the uorgaized sector due to low costs Difficulty i implemetig a cotrol mechaism by govermet for both orgaized ad uorgaized players Direct Parters At this stage of evolutio of welless, direct parters iclude isurers, employers ad educatioal media. They play a major role of itroducig the customer to the cocept of welless: Awareess: Makig the customer aware of the importace of prevetive care ad wellbeig 30

33 Motivate: Ecourage customers to adopt healthy lifestyles Facilitate: Assist i desigig welless programs icludig ifrastructure requiremets ad platform for implemetatio Isurers Isurers play a vital role i welless sector as they are coected to customers directly through health isurace pla ad are able to i uece their behaviour. The role for isurers icludes: Icreasig cosciousess amog policyholders o welless ad its bee ts Boostig healthy behaviour amog policyholders through appropriate tools Maitaiig sustaied focus o welless iitiatives ad facilitate the executio of healthy behaviour through icetives ad other rewards We will discuss the role of isurers i detail i the ext chapter. Employers Aother direct parter i the ecosystem is employer who ca directly i uece employees to take up welless iitiatives. Rise of chroic diseases directly impacts costs of health isurace for employers, ad affect productivity of employees. As a result, a umber of big ad small employers have started basic welless programs for their employees. These programs iclude employee assistace program (cousellig), medical iformatio maagemet, coductig workshops, ad orgaizig osite programs amog others. These programs could be carried out by professioal compaies, isurers or iteral team of employees. Educatioal Media Lastly, Educatioal Media is oe of those direct parters who have the ability to drive the etire ecosystem to a commo platform. The educatioal media ca help chaelize the commuicatio of each ad every etity of the ecosystem such that it reaches the right places. For example, a customer's eeds are to be commuicated to the providers ad a provider's offerigs ad their importace to the customer. Eve the cocered regulatory bodies eed to be made aware ot oly about the customer's issues ad eeds, but also about the provider etwork's abilities ad capabilities to address the same Idirect Parters Idirect parters leverage o the busiess eed of the various stakeholders i the ecosystem to offer persoalized value to various ivolved etities. The prime focus factor for idirect parters is to lead iovatio i eld of techology ad ifrastructure. 31