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When family and business cohere
BY ANY measure, nurturing a familybacked start-up - particularly one in the tremendously promising yet potentially fraught field of telemedicine - is a challenge.
But for the Koh family, it has been a journey fired by a vision, painstaking planning and a single minded commitment to building a sustainable business. In barely a year since its launch, digital healthcare provider WhiteCoat - brainchild of siblings Natalie and Bryan Koh - has streaked past a number of milestones. It has an estimated 50,000 customers, a market value estimated in the tens of millions of dollars, and is on the cusp of a partnership with a large insurer that is expected to expand its customer base exponentially. It is also eyeing regional expansion. Through it all, the venture has cemented the proverbial ties that bind. The co-founders are children of veteran banker Edmund Koh, president UBS Asia Pacific of UBS Group AG and member of the UBS Group executive board.
As the three tell it, WhiteCoat is inspired by Natalie, 33, a practicing cardiologist, whose vision is to deliver "accessible, affordable healthcare, anytime, anywhere", so that visits to the doctor are as convenient and hassle-free as an app on your phone. Bryan, 31, WhiteCoat chief executive and founder, is a qualified lawyer who worked for six years in the mergers and acquisitions department of Allen & Gledhill. He oversees WhiteCoat's strategy and runs the business hands-on, seeing to the smooth execution of various protocols and occasionally even delivering medicine to clients himself.
AND of course there is Mr Koh, who has provided seed funding and strikes a fine balance between entrepreneurial and strategy coach and father. A third sibling, Gerald, has qualified as a doctor and is serving his housemanship. Says Mr Koh: "I'm proud as a father but demanding as an investor. For those two roles you need to find a balance and it's more intuitive than any rationality you can provide … One thing I am glad about the three of us. I manage a lot of generational shifts in wealth. In some cases the second generation can barely talk to their fathers for five minutes without walking out of the room.
"Through our Sunday brunches, every Sunday brings us closer. I've groomed great bankers who have gone on to bigger jobs than me - why not do this for my children? This project that turned into a business has brought us very close as a family."
WhiteCoat is one of the first telemedicine start-ups approved under the Ministry of Health's regulatory sandbox, called Licensing Experimentation and Adaptation Programme (LEAP). Its business model marries brick-andmortar healthcare with digital efficiency. That is, WhiteCoat employs doctors - a team of six at the moment - who consult with patients electronically. Medicines are physically delivered within one to two hours of the consultation. Compared to typical clinic waits of one to two hours, a consultation via WhiteCoat takes an estimated 11.5 minutes including payment. The average bill size is S$40 including the cost of medicines and delivery.
SAYS Bryan: "Our vision is to bring accessible, affordable healthcare to people, anytime, anywhere. We want to look after the whole spectrum of individuals, from the healthy to those at risk and unwell … If you take your experience the last time you visited a clinic, do you ever say you had a good experience? Most of the time we associate clinic visits with waiting time to see a doctor, and you wait to collect medicine. You go in with a simple condition, but because you wait with others who are coughing and sneezing, you may catch something worse."
Natalie says: "Medicine takes time to catch up with digitisation because it comes with liability and regulations. But if done right, imagine how far we can go … WhiteCoat is in for the long game. We have in view what we think healthcare should look like in this era, underpinned by good governance and responsibility to our patients. A good doctor takes ownership of the care, and our patients are owed accessible and affordable care, a doctor in their family. It's no longer a one-way street, but a conversation."
WhiteCoat is designed simply and intuitively, features which belie the thorough planning that has gone into the various interfaces. Patients, for instance, are given a choice of whether they prefer to see the first available doctor or a doctor of their choice. There is an algorithm to match patients to doctors based on factors such as age and gender. The services range from general medical consultation for ailments such as fever and sore throat, to chronic disease management for conditions including diabetes and hypertension.
The doctors are able to issue specialist referrals and medical certificates electronically. If medicines are prescribed, patients are issued a QR code which must be matched upon delivery.
THE firm has assembled a panel of doctors who must have at least 10 years of medical experience, including three to five years in family medicine. The most senior is Dr Yii Hee Seng who is executive chairman of WhiteCoat's medical advisory board and consults with patients himself. He was previously with Raffles Medical Group and has over 30 years of experience in family medicine under his belt. Associate Professor Dr Goh Lee Gan, who is at the forefront of family medicine education at the National University of Singapore, also sits on the medical advisory board. From the concept's genesis to execution, the elder Mr Koh has stepped up as a mentor with an active voice, even if he takes a back seat in day to day operations. He has committed some S$5 million to the venture. One of the principles he firmly espouses is that WhiteCoat must be for-profit.
"When Natalie came up with the concept, it was along the lines of saving the world. I said - sure, but unless it's profitable, use your own money. She was upset. I told her - because if you just do it to help people, when you run out of cash and you think it's too difficult, you won't continue. But when you run it for profit, you'll never run out of cash and you need cash to help people. Worthy causes are good if they can be profitable and then altruism can come into play.
"The second principle is that this is a business. I will always hire people I can fire, son or no son. It's the basis of running a business. You can't have someone you can't fire.
"My children - (Natalie) is very creative, noble and driven. (Bryan) is business-like, hardnosed and pragmatic. When you have both, you know to let the dreamer dream and create and let the pragmatic businessman plan and execute. It's good to have both as a businessman."
BRYAN says: "My sister has good ideas, but my dad has helped bring in a lot of structure. We bucket the ideas - what's the minimum viable product? I decant the ideas and table them to my dad. My dad refines them - have you thought about how to strengthen this aspect? Are there loopholes where you are accountable? If we're putting money in, it has to make sense."
Just 12 months into its operation, WhiteCoat is already attracting interest from investors keen to take a stake. Says Bryan: "We've spoken to various investors but we didn't want to take easy money. My dad and I are aligned in that. If we seek funding, we want it with a strategic investor who can become a partner and help us grow not just in Singapore but also outside Singapore."
The firm aims to expand in countries such as Philippines, Indonesia and Thailand, populous nations which can benefit from the convenience of telemedicine particularly in rural areas.
Mr Koh says: "From day one, when this started, I was clear that I didn't want this to be a numbers game, like getting 5,000 doctors immediately. That's a numeric platform game to raise funds. We don't need to raise funds as a family.
I want WhiteCoat to deliver high-quality healthcare at a sustainable cost - consistently, predictably, anytime, anywhere, all the time. When they get the quality right, they'll attract the next 16 doctors, the next 30 or 90. I'm not allowing a platform where anyone can just hop on like a bus and there is no common destination for the people.
"I've also told the doctors - never be afraid to tell patients they need to come in physically to see a doctor. And, if patients can't afford it, to waive the cost. We know from our data if it's a recalcitrant patient and if it's abuse … Quality always sustains a business, not quantity. Quality will drive quantity, but quantity will not drive quality."
Bryan says WhiteCoat expects to break even in two years by around 2020. The team of doctors will double to 16 this year. The firm will also explore operating on a 24-hour mode, and allowing doctors to consult from their homes. At the moment, doctors maintain office hours. The operating base is at Apex @ Henderson.
ONE of WhiteCoat's goals is to help inject efficiency into Singapore's healthcare system and in the process, help to keep a lid on rising costs. Bryan says: "While we're clear that we provide affordable care, the business must be scalable. We have a steady stream of doctors wanting to join us, but our doctors and patients have to be periodically matched and scaled up at the same time. And we need to keep the price point attractive. One thing often overlooked is that GPs can treat chronic ailments as well. In Singapore, there is a mindset that hospital or in-clinic care is superior. So, many go to the A&E or a specialist at the first instance, when actually a lot can be settled at the primary care level where we fit in.
"We see costs going up in hospitals and specialist care. But primary care has been relatively stagnant. We're not the drivers of cost. If we can penetrate the primary care network not only for acute but also for chronic cases, we can bring down overall costs."
Natalie says: "Oftentimes patients get admitted because they've run out of medicines, and sometimes hospital stays are prolonged. But what if surveillance of patients can be done from the home? Patients can be triaged according to the degree of illness, and monitored in homes and communities in line with the national drive towards community healthcare - that's where telemedicine can bridge the gap."
To be sure, there are occasional arguments between father and children on strategy and execution. Says Mr Koh: "Sometimes when we argue, I ask - are you talking to me as a son or an investor? But it's always good to let off steam. What you want is a sparring session that takes the discussion to another level. As a father it's sometimes difficult emotionally - it's easier to talk to staff. In talking to my children, I also need to know when to step out of it, listen to them and give in ... Investors who approach us think we're already in series B or C funding. Most Asian unicorns are built in four to five years. I don't know if they will succeed, but as a betting man and investor - not as a father - I think they will succeed." w