Digitizing Healthcare with Helium Health's Goke Olubusi

Goke [00:11]: The biggest thing I advocate for, I'd say on the African continent, is the need for people to start making data-driven decisions. There is no gut, there is no gut, there's no this is how I feel or how we've done this. Forget all that, it's just data, data-driven decision-making.

Justin [00:27]: That's Goke Olubusi, the co-founder and CEO of Helium Health, whose electronic medical record solution and other products are providing the digital infrastructure for the healthcare sector in Africa.

Goke [00:37]: Fun fact, on average, more than two-thirds of the time, the hospitals, when they sign up for Helium, when they tell us their average monthly patient visits before we sign them up, when you look back at the data and you correlate it, it's always off more than two-thirds of the time, off by 30 to 50%. That's how off it is. They don't even know how many patients they see.

Justin [00:58]: Goke and I spoke earlier this year, several months into the COVID-19 pandemic and shortly after Helium announced their $10 million Series A. This episode with Goke commences our new ten-episode conversational series. We're exploring the businesses and entrepreneurs that are digitizing analog and fragmented industries, and Helium Health is no exception. Helium's competition is with pen and paper. And in this episode, we'll hear more on their endeavor to digitize healthcare on the continent, their open and interoperable approach, how the founders' lack of healthcare experience led them to go door-to-door to hospitals across Nigeria during the startup’s earliest days, and the impact of a digital healthcare system on the ability to make more data-driven decisions.

Justin [01:30]: Before we get started, we'd like to thank our partner, MFS Africa, for their sponsorship of the entirety of this conversational series. MFS Africa is building the infrastructure to make digital payments easier in Africa and their competition is with cash. Their API hub connects over 200 million mobile wallets and other stores of value across the continent. Later in this episode, we'll hear more from Goke about the second-order effects of digitizing healthcare. One such opportunity is credit and lending, made possible by data. It's something I talked to Rachel Coleman about. Rachel works on SME lending projects with the World Bank.

Rachel [01:59]: For me, I think the most interesting space and the space that potentially offers the most impact is this SME lending space. But, it's also the most complicated. And this is because you're not just assessing if the person is going to be able to repay a loan based off of their willingness to repay the loan, but you're also assessing is their business actually going to grow and are they're going to generate revenue so that they can repay the loan. You need more data and often this data is not available. And so for me, a lot of my time is spent thinking about how do we generate that data, or how do we tap into alternative data streams that might be able to give us some insights into how a business is performing so that we can make better lending decisions.

Rachel [02:45]: We're going to look at the transaction histories, we're going to tap into all the kind of alternative data streams that are out there, but then we also need to know about the history of the business. And in many developing countries, the history of the business is not systematically tracked. Some of the most important tools are on digitizing the histories of businesses when it comes to how they've performed over the years. And so, a lot of the first order work I think is around digitizing this kind of information that can lead to better assessments on if the business can actually absorb this kind of financing. Then, you can think about how do we then digitize that decisioning to get to faster processes in the actual lending field. But, if you don't have data to begin with, it's hard to start automating because you're starting from a place of not enough information.

Justin [03:41]: Later in the show, we'll hear from Rachel again on the work that goes into digitizing and automating SME lending on the continent. One more quick announcement before we get started. Each Sunday, we send out our weekly newsletter, The Flip Notes, which you can subscribe to on our website, theflip.africa. For those already subscribed, The Flip Notes will take on a slightly new form this year. Bite-size insights, including notes from newly published podcast episodes and essays, and other thoughts from what we're reading, thinking about, and seeing in the ecosystem. It's thoughtful insights and updates straight to your inbox. We hope to see you there. And now without any further ado, the co-founder and CEO of Helium Health, Goke Olubusi.

VO [04:16]: You’re listening to The Flip, the podcast exploring more contextually relevant stories from entrepreneurs around Africa.

Justin [04:26]: Can we get a little bit deeper into the problem that Helium Health is solving and speak a little bit about what the healthcare sector looks like Nigeria and elsewhere on the continent?

Goke [04:35]: I'm going to make three points that point to the core issues across the continent. The first is that people still do things, especially running healthcare, healthcare administration, care provision, almost every aspect of healthcare is still not digital, everything's still on paper. So, it's not just the hospitals and the medical records themselves, but even the processes of like insurance administration and communication and gathering data, the whole process is still manual, and that is a core problem. We still don't have a digital healthcare system.

Goke [05:03]: Second problem is there's no data. If you don't have digital systems, there's no way to actually collect data because you can't collect data manually. It has to be automated, it has to be at the point of care, and we don't have that. At the very foundation is the need for a digital system in the first place.

Goke [05:19]: And lastly, the fragmentation problem. The trend you see across the continent, and I'll use Nigeria for this example, you have tens of thousands of hospitals. However, you don't have a single player who has more than let's say, 20, 25 locations. So, it's a heavily fragmented system. It's still largely analog, still not gone digital yet, and the few instances where you have a digital system, it's all functioning in isolation. That interoperability isn't there. So, there's that big need to go digital and our job is just to accelerate this, make sure it's done properly.

Justin [05:52]: And from an ecosystem perspective, apart from those three categories, there's also the conversation around public versus private hospitals and insurance. And I know in Nigeria, in particular, it's a lot of out-of-pocket billing. So, where does all of that sort of fit into the problems and how you're addressing the problems from that perspective?

Goke [06:11]: So, when we think about healthcare, we really think about the four Ps; healthcare providers, payers, patients, and we just added a fourth P internally, it refers to public health and public health partners. And really, the drive we're pushing for here is a digitization of each of these four components. Healthcare providers, and the process of care provision should be digitized and data-driven. The payer processes as well from the insurance administration standpoint, and even from the direct to individual standpoint, access to even funding sources, to funds to be able to cover your healthcare, all of this stuff is a big part that needs to be digitized.

Goke [06:49]: When you look at a place like Nigeria, just like you said, insurance penetration is less than 5%. People are mostly paying out of pocket for care. A lot of these things can be changed even from the insurance provider standpoint. Insurance providers, they want to offer more care, but there's no data to help them decision on how to price this. So, provider standpoint, the payer standpoint, the patient's standpoint as well, where patients can access their medical records from wherever they are, they can request healthcare services.

Goke [07:19]: And finally, on a public health standpoint, actually helping the governments and decision-makers to be able to understand data and start making data-driven decisions, huge, huge part of our work. And really, you can't not work with a public sector and the government, if you're talking about healthcare, especially in Africa, right? More than half the care is provided by the public sector, either it's donor-funded or internally funded. Regardless of the source, there's a need for us to deliver value.

Goke [07:43]: I think one of the biggest issues I have is that it's hard for entrepreneurs, especially think about it, right? From a tech founder's perspective, you want to start a company, you want to solve a problem. Everyone tells you, and you know, you don't want to deal with the government, right? You want to sell to the private sector. But, you can't be in healthcare and not do that. And also, we got to start getting some ingenious methods in working with the government and tackling public health issues, because think about this, we're all in a pandemic now, a real crisis, and we're leaving it in the government's hands, isn't that crazy?

Goke [08:15]: We didn't leave anything else in the government's hands, but the most important thing where like what pretty sure they'll figure it... They haven't figured out a lot of things, I highly doubt they'd be the ones to solve this problem. So, I'm just saying that from a public sector standpoint, we definitely have to work with the public sector and figure out different creative ways to make that happen, partner with them, find value in every way we can, because it's an important aspect of care provision, and not a responsibility we can abdicate.

Justin [08:39]: Yeah, absolutely. So, from a fragmentation perspective, I'm curious just to get your view on how the problem actually gets solved. So, is this sort of one of those things where no one else has been willing to come along and go door to door to every single healthcare provider to try to get them on the platform? What is the conversation like with these people? I mean, there's very much the narrative, I would say, and maybe it's a misconception about healthcare being underfunded, but what implications does that also have when you're going to these small doctor's offices and saying, "Here's this new fancy, shiny digital solution that we want you to implement and pay us for it," what does that look like?

Goke [09:16]: Here's what we were trying to drive at when we started the company, started 2016. We're all sitting down together and we're saying, imagine a scenario where I can have access to data, and tell how many women under the age of 35 were diagnosed with high blood pressure in the last three hours in this local government in Lagos. We just wanted that to be possible, and that was what we were trying to answer. We started going around, who can tell me anything about healthcare, who can give me any kind of insights. Because when you do dig deeper into a lot of the reports that are available and you dig deeper into the source of the data, you're like, this is wrong, this is wrong, this is wrong, this is wrong. It almost seemed as if everything was wrong and no one could tell you anything with any real sense of precision or accuracy, and that was a concern.

Goke [10:09]: And there was then this other thought that all these hospitals are already filled with people who are on their phone every day, the nurses are on their break, they're watching YouTube, they're watching Netflix, they're watching Iroko. There's already phones there, there are devices. Everyone's tweeting and everyone's WhatsApping, but the concept of providing care through a digital medium, or recording that care, et cetera, having this kind of digital accountability system wasn't there at all. We're looking at this and we said, we can bring this together, right? And we can just have a system that enables them to do their jobs using the system. It actually works. And if we could get it to actually work, people would adopt it. And when you have a big enough reach, you actually have the data visibility you need to really help drive public health.

Goke [10:53]: So, we started thinking about that. We can do this, we can do this. And here's what we did, we started knocking on the door of every hospital we could, and we did this for a very long time, a stupidly long time. The amount of time that it would only be a very naive set of young people to do. That's one of the things I want to point out about this whole process. One of the reasons this worked was because again we weren't healthcare people. We were very naive or stupid enough to believe that this was going to work. But more importantly, we're stupid enough to knock on the doors of doctors and hospitals, city by city, across Nigeria and across Africa for months.

Goke [11:24]: I remember the first day, one of my co-founders, his mom lent us this car that looks like a golf cart. There were three of us, we'd get in the car, we type hospital in Google Maps, and we'll go. We'll figure out our way to get in to meet the chief medical officer or the director of the hospital, and when we're done with that hospital, we'll put hospital on Google Maps again, and we'd go. The whole point was, this is one of those issues where I believe it takes an impossible... And this is why we even ended up starting the company. We'd looked at the problem year after year and everything was the same and the solutions we were seeing, weren't the big picture solutions.

Goke [11:55]: So, Helium having a medical records platform in Nigeria, this is not the solution, because then, think about it, in every country you're going to have people, you already have this, local teams building with their own resources, which is almost all the time-limited, because again, Helium's $10 million Series A was a huge deal, when contextually that should not be a lot for healthcare on the African continent, right? You have all these people, they're building the exact same thing.

Goke [12:21]: So, we're trying to tackle this problem, we're doing our own version trying to solve the same problem. And in every country, you have multiple teams building the exact same product. Why are we doing this? So, I was imagining this, and that's what we were all imagining. Imagine a world where there was one system that could run, there's one structure, one fundamental standard, there was interoperability and people weren't repeating all these resources, like everyone wasn't trying to build the same thing, people we were building other things or building things on top of this thing. That's the world we want it to get to. Obviously, it's a very big vision, we know this is a long-term game. We knew it was going to take us like years of our lives and probably even decades to accomplish, but we believe it's absolutely worth it, and we also don't see anyone approaching it the way we are, bringing together all the pillars of healthcare in an open system. It's a whole different ballgame, and that really is because that's what the continent needs.

Justin [13:11]: I love the whole idea of it being an open ecosystem. How do you balance, or have you had to think about balancing the desire for it to be open and interoperable versus the opportunity specifically for Helium Health? I mean, this goes without saying that there's upside for Helium Health in being open as well, but how do you balance those things?

Goke [13:31]: So, open is an interesting term. It means a lot of different things, right? Some people think open source, open platform. When I think about openness, I mean just the willingness to grow what we're doing and to share information and insights and data, to integrate with other systems and putting that mission and goal over our own gain, whether it's financial or otherwise for the short term. So, putting that long-term vision ahead of everything else, that's what our goal is. And let me tell you this now, there could be a hundred Helium Healths doing exactly what we're doing.

Goke [14:00]: I talk about our playbook all the time. It's always interesting. Whenever I get a meeting with competitors, and they're all being so secretive, and I'm like, "Oh, here, I'm going to send you every slide of every piece of our product and every part of our strategy documents." Because again, you could have a hundred people doing this exact same thing in multiple parts of the continent, including within Nigeria alone, you could probably do 100 more. That's how large the opportunity is. There's only so much Helium can do. If I 10x my resources, we still would not be scratching the surface.

Goke [14:30]: We need entrepreneurs, we need people to build health tech companies. This is also painful for us because years go on, and we want Helium's growth and Helium's achievements to be a catalyst for more people to want to start healthcare companies, but we even see less of that. We started noticing that people are feeling more threatened by it. They're like, "Oh yeah, if there's Helium, you know, maybe we shouldn't do this." No, there's so much room, there's so many problems to solve. There's only so much we can do. When we're talking about healthcare, it is not the kind of problem that can wait, we all suffer for it.

Justin [15:00]: I'm wholeheartedly with you there too. And you just talked a bit about the problem being so big, that it just requires so many other players and such a level of collaboration amongst other players. I think it brings up a topic in terms of how you go about more broadly being able to solve the problem at greater scale. I know that Helium is expanding in both directions. You're looking at geography, but then you're trying to go more full-stack, and I think that you're offering access to credit and different things obviously from a data perspective. So, how do you balance those things go wide versus deep, and continue to service more deeply the existing hospitals now versus then trying to expand and to add more providers to the platform, both in Nigeria and outside of the country as well?

Goke [15:46]: So essentially, we're trying to do both, right? We're growing our services and products we offer while also expand into geographically. But, I think one of the reasons we're doing that is because we understand that problem, the main problem, or the best problem to solve in every country, isn't necessarily the same thing. As we expand to different countries and different regions, for that specific region, we're capitalizing on the product that will be the, I guess, golden ticket, right? That will be the one that can gain the most traction and can give us the quickest penetration so we can roll out or extend our suite of products. And also even looking at acquisitions as well in North Africa and East Africa and different parts of the continent.

Goke [16:23]: So, that's where that's coming from. Now that we have this full end to end suite, as we go into different countries and penetrate different regions, we get to optimize for whatever is best for that market. Then, another thing that's important to us is also the local context as well. For example, as we expand into Kenya, the team will be from Kenya, will be Kenyan medical professionals, the Kenyan engineers, and that will be what the team has made of. Because I think the problem needs to be at the heart of the people solving it, and I think that always makes for a unique factor.

Justin [16:52]: I saw that you've made a couple of acquisitions already very early on in the life cycle of the company. So, what was that thought process? I mean, that that's sort of an anomaly relative to a lot of other startups, just either being able to, or even thinking at such an early stage that they could be acquirers.

Goke [17:09]: Yeah, and that goes back to that thing I said about us having a long-term strategy from inception. Another important component about healthcare is market consolidation. Everyone joins everyone eventually, both the pharma companies and the insurance companies and the providers, because you're all solving problems the same, and to do that you need a lot more data, and a lot of that data ends up being siloed with insurance providers or with the EMR company. That's why you see pharma companies buy EMR companies because it's the same information we need. We're selling to the same people, and you start to see that you're replicating efforts, you need consolidation. So, an inevitable trend in healthcare is consolidation both vertically and horizontally. You can see this everywhere, every country, same set of things. It's a very normal trend.

Goke [17:53]: We knew this early on. That's why we were always open. We're always open to acquisitions and mergers, because it's about getting to that goal sooner. Also because we also have a good understanding and framework behind how we think about this. We know the kind of people we can work with, we have our framework for assessments, we have our framework for acquisitions. So, it's something we've thought a lot about, and I think it's one of the things that we also want to change, one of the narratives we want to change. You don't see a lot of M&A activity in Africa, and that in itself devalues the market, that in itself over-complicates the problem.

Goke [18:25]: I remember one of the first EMR companies we acquired, what I said to the founder was "Bro, you and I are going to go into a price war for no reason. The market is already... They're already struggling to understand the concept of EMR. They're trying to understand how do we even pay for this, but you and I want to go in a price war? It's pointless. With our own efforts, we can devalue and destroy the market before it even starts. Why? Why? For what? What are we fighting for? We have the same goal, we have the same vision, we hold the same values."

Goke [18:53]: I think having that approach, even the person, the founder I was talking about, he himself was like, "Whoa." He was mind blown that someone would have that approach, because most people have given up on collaboration within Africa, and I think that's nonsense. We are about to really turn that around.

Justin [19:10]: You know, it raises a question to me, which is, are there certain things about healthcare in Africa that are irreconcilable. And back to the thing before, about how so many people say that the solution is an allocation of more resources, I see on some level how Helium is compelling people to make better data-driven decisions, which maximizes efficiency and stretches the dollar further. But beyond that, I mean, are there certain elements to the problem, do other things need to happen beyond what you're doing in order for the problem to get closer to being solved? What's your thought on that?

Goke [19:43]: So, I'll say this, there is a lot of money that goes into healthcare in Africa. You don't even understand. There's a lot of money, billions of billions of dollars, tens of billions of dollars are going to healthcare in Africa. And if I asked you or anyone, let's go deep into where this actually, where do these funds go? It would almost feel like we're playing a magic trick and funds would disappear. It was going poof. The outcomes aren't matching the available resources. So, we're not even here thinking about a scenario where there are even more resources, blah, blah, blah. If you just directed what we already have in the right places, and you shed light on it, you unlock a whole new world. I think that in itself is so fascinating because the resources we have now are being, both on a micro level and a macro level, misdirected so much that it's... Us even being able to solve that one problem would change the whole landscape.

Justin [20:44]: Yeah. And so, maybe there's an important narrative shift that the issue isn't the fact that the sector is under-resourced, the issue is just that it's woefully inefficient.

Goke [20:54]: Absolutely, and this sentence you just gave is exactly what we say internally. And what we add to that is we always say, "And the goal is to drive data-driven decision-making both on a micro level and a macro level." That's what unlocks this, right? Soon as people start thinking data first, because you should be able to tell me if a country says they spent this much on healthcare, we should be able to take it down to the... We should be able to direct every dollar to an individual person. This is not a strange concept, and this is not an impossible task, but we can't do that. I look forward to that day.

Justin [21:34]: Thanks again to MFS Africa for their sponsorship of our exploration into the startups and entrepreneurs digitizing analog and fragmented industries across the continent. Earlier in the show, we heard from Rachel Coleman with the World Bank on the crucial need for data in the SME lending space. We also talked about, once we have more data, how to get to faster and automated lending decisions.

Rachel [21:53]: One thing that I'm constantly stressing in the work that I do is you need to not only build the models for lending decisioning, but you also need enough data to be coming in to train these models and see how they're performing. And this takes time unless you have incredible volume. And so I think it's really important to be thinking about the potential, but also the work that needs to go into making strong models that are not biased and are constantly being updated and managed appropriately.

Rachel [22:23]: This is possible with consumer lending because of the volume that's going through and the value of those loans. But, when you get into SME lending, especially at the larger value loans, you're not going to see as many loans going through so it's going to take longer to train those models. And it's a little bit more complicated because you're not just assessing if they repaid the loan simply because they had the money to repay the loan, but you're also going to think about, did their business just have a really bad six months and maybe they really could repay the loan, but they went through kind of this rough patch. It's more complicated than just did you repay a $20 loan? It is definitely thinking about how does a business ebb and flow and how can you create a financial product and a model that reflects that life cycle. And I think for me, that's the most interesting space, but it's definitely a lot harder.

VO [23:27]: That's it for this episode of The Flip. For those hoping for our regular retrospective conversation with Sayo and me, that's coming as a dedicated episode at the end of our conversational series. For now, please don't forget to hit subscribe on your favorite podcast app if you haven't already to get upcoming episodes straight to your feed. Next week, we head to Kenya to talk insurance as a service. We'll see you then.