Exclusive: Aster DM Healthcare’s Alisha Moopen on where the UAE-based firm is headed

For most people living in the GCC, Aster DM Healthcare needs no introduction.

The healthcare empire with more than 320 establishments across nine countries and growing is one of the most renowned and successful in the region, as well as the Middle East, India and Far East.

Born out of the vision of Dr Azad Moopen more than 30 years ago, the company has grown from a single clinic in Dubai to a sprawling enterprise that employs nearly 20,000 people in its hospitals, clinics, diagnostic centres and retail pharmacies.

The company has been a major part of the growth of healthcare in the Gulf, and continues to be so. And while Dr Moopen is still firmly leading affairs as chairman and managing director, recent years have seen the company’s stature enhanced by another Moopen – Alisha, daughter of the founder who serves as executive director and CEO of hospitals and clinics in the GCC.

Bringing additional energy, passion and sharp business acumen to the ever-growing organisation, Moopen junior has certainly made her mark since joining in 2012; but while healthcare has always been part of her life, it was far from certain that she would follow her father’s footsteps into the industry.

“Dad used to work 16 to 18 hour days, and everything we would hear was about patients, the lives that have been impacted, and taking care of the people around you. So it’s always been a part of my life,” explains the former Ernst and Young audit executive.

“My son had an accident when he was a year and a half, and that was probably my closest encounter with healthcare in a vulnerable sense, and it shook my life to the core a bit. That’s when it sort of hit me that I want to be back in healthcare and that I belong in healthcare.

“The calling was always very strong, but it had seemed like I was following the usual ‘doctor/healthcare’ path, and I didn’t want to do that completely. So I did my own thing for six or seven years. But there is some part of our personality that is ingrained in helping others. I kept trying to tell myself that as an auditor I was taking care of the financial health of companies, but it wasn’t fulfilling enough. So I found myself back in healthcare.”

Moopen adds that she had her father’s support, but there was no pressure to follow through with her return to the industry if it didn’t feel right to her.
“Dad always used to say that the platform is always available, but only if it makes sense to you and if it’s something you’re truly passionate about – otherwise you can’t do it justice,” she says.

“Healthcare is so challenging because you’re dealing with people who are sick day in, day out, and you have the good stories and you have the sad stories. So to be able to build the relationships, the trust, and everything else is a challenge. You need to have the understanding that it’s something that really means something to you.

“So I came back to see whether it made sense for me, and I can’t think of anything else [I’d rather do]. There is such a feeling of impact, of fulfilment, that I was not able to find elsewhere.”

Since joining Aster, Moopen has helped to guide Aster through a period of evolution for the company, as well as for the healthcare industry.

The introduction of mandatory healthcare insurance, the rapid speed of technological developments and a long-awaited IPO have all had an effect on the organisation and wider industry, making the past few years an exciting time for Moopen.

“These are things with extremely far reaching consequences,” she says.

“The mandatory insurance that Abu Dhabi came out with, and then Dubai – this has been by far the most positive decision for healthcare in the region, and I think it’s only a matter of time before other countries follow suit.

“It’s been a very interesting transition for us because you always had the upper segment of society being covered by their own private insurance or employer insurance, but a vast majority of the population – who are actually in the lower segment – did not have access to good quality healthcare.

“So this [mandatory insurance] really made it a possibility to give people access to good healthcare.

“We’ve only seen the complete implementation over probably the last six months, but we’ve already seen the growth – we’ve seen the impact that it’s had on people. They don’t have to wait months to see a doctor because they’re trying to save for their families back home.

“So that’s one of the most positive developments in healthcare that has happened in the recent past.”

The knock-on effects for Aster have also been large, with an influx of new patients necessitating a sharpened focus at the healthcare provider.

Having already established different brands to cater for different segments of society – Medcare for the upper-income population, Aster for middle-income workers, and Access for low-income workers – the company was well set-up for the increase in patient numbers. But the rise in volume, as well as other shifts in terms of business, represented a major shift for Aster.

“Our biggest focus was on making sure we were able to service and take care of patients, because the volume has increased multi-fold,” explains Moopen.

“There is a natural complexity that comes when there is a huge influx of patients into a system – it shakes the system a bit. There is a certain load that the units are used to, and suddenly it increases tremendously.

“So service levels, and making sure we’re able to maintain the levels that we cater to and the experience we want our patients to have – that was a learning experience for us.

“Healthcare is very sensitive – it requires a very different level of care, compassion and trust building. When there is stress on the load, some of the soft elements can experience a negative impact, and we wanted to make sure that didn’t happen. From having 100 people in a clinic suddenly rise to 200 people, we wanted to make sure people went out feeling they had the right amount of time with the doctor, not waiting for hours, and getting the right medical attention.”
Another change, adds Moopen, was that business went from having a cash element to being entirely insurance based – a shift that led to some important diversions from traditional patterns.

“Suddenly you’re faced with a slightly different setup – the payer and the person you are serving are different people,” she explains.

“Before you would have a patient coming in and the patient would pay for the service. Now it’s not the patient any more, it’s the insurance company, and that dynamic has changed slightly because insurance went from being about 40, 50 or 60 per cent to almost 95 per cent, and that means there is some amount of negotiations and conversation that happen with them.”

It lead to another topic that Moopen also believes is a key part of today’s healthcare industry – a topic that she believes the industry is “struggling with” to some extent: balancing the equation between different stakeholders.

She explains: “While insurance companies have to make sure the cost is as low as possible, governments have to make sure the patients get the best care and their population is under a good healthcare system, and there is a bias towards thinking that healthcare providers will try to abuse the system.

“All more mature nations are trying to build an equation where everyone’s incentives are the same. It needs to be only based on the outcome for the patent. They health outcome must be the only indicator, and nobody should have any other agenda.

“I think this is a transitory phase that the region is going through … and I think that the evolution and the maturity will come into the system in the next few years, which requires a lot of dialogue.”

It is through this dialogue that Moopen believes the UAE in particular can be a front runner in advancing the industry.

“The good thing about Dubai and the UAE is the openness to having the best system that works for all parties,” she says.

“I think they very openly endorse a win-win police, with an objective that is very clear. This insurance has been rolled out for the benefit of the people, and health is the primary criteria and the only criteria. Anyone else has to be facilitators – whether insurance provider, healthcare provider, or anybody else, health needs to be the primary objective.

“Because this objective is very clearly defined, there is openness for people to discuss it. We’ve had conversations with all the stakeholders and there needs to be tripartite agreements to ensure the population is taken care of.”

The executive director further explains that the ethos laid down by her father when setting up the company more than 30 years ago helps Aster take a lead in achieving this broad objective.

“Our chairman’s philosophy has always been that in healthcare profit and only be a by-product – it can’t be the objective,” she says.

“Our primary goal will also be to make sure that the patient gets taken care of and put on course for healing. With that sort of mentality we need to make sure we are sitting on the table with the decision makers and other parties. We don’t want at any point to have to compromise any care element for our patients, so we take a lead to engage in these conversations because it’s extremely important that everyone is on the same page.”

As if the changes brought about by mandatory insurance haven’t been enough to adapt to, Aster DM Healthcare recently went through a major development of its own that has taken some time to get used to.

“The past year has been an inflection point for the company because we did the public listing in February this year,” says Moopen.

“So the entire focus for the past 12 months has been building up to the IPO and then going through it. It’s a big shift for the company, going from a privately held company. Obviously we’ve had investment and private equity along the journey over the past 10 odd years, but this new identity as a publicly listed company is a very different experience.”

Talk of an IPO had been on and off for some years before the February move, which aimed to raise $153.34m and was subscribed 1.3 times. Investors bid for 48.5 million shares of the 37.4 million on offer on the Indian exchanges.

Aster announced that the proceeds would pay off some debt, but largely go towards financing its business development.

“It has been a big change for us internally,” continues Moopen.

“Now the benefit is we have access to capital markets. If we have large projects we want to undertake, it becomes easier for us to progress on some times.

“But I don’t think it really changes the course of the business as we had intended it.”

Technology, on the other hand, does. In recent years, healthcare has been identified as one of the industries most affected by technological advances.

Quoted by Inc.com, Dr Emmanuel Fombu called artificial intelligence “arguably the single biggest disruptor for the healthcare industry”, helping to free up doctors’ time, assist in the discovery of new drugs and treatments, and more. Add to that the benefits of virtual reality, augmented reality, remote diagnoses, healthcare trackers, genome sequencing, nanotechnology, robotics, 3D printing and more, and it should be little surprise that the rapid march of technology is having a major say on the present and future of healthcare.

And as Moopen explains, Aster has worked hard to move with technological developments, while also retaining the all-important human touch.

“We have to come up with hybrid models, and that’s what we’ve been trying to do,” she says.

“The whole premise of technology is that it needs to make things easier. It needs to make the patients feel more engaged or customers more engaged, and it needs to ideally make healthcare costs cheaper.

“People will not shift overnight to a new system. If you’ve gone to a GP or paediatrician for 10 years of your life, even if you have a system where you can call a doctor online you might not do that because you want the doctor you’re used to.

“So what we’ve tried to do is use pieces of technology that will make life for the patients easier. For example, we introduced an online pharmacy. People don’t want to finish seeing a doctor and then wait half an hour for the medication, so we said ok, why don’t you upload your prescription online and we’ll have the medicine delivered to you. It’s not taking anything away from the patient by saving them that half an hour.”

A bigger example of technology’s potential impact, according to Moopen, is the power of data.

“You cannot deny that with the predictions and predictive technology that’s coming from big data right now, the biggest benefit is going to be for healthcare,” she argues.

“As a region and as an industry, it’s only now that people are trying to collect the data in the format and the template that’s required for us to make logical analysis and conclusions that will help us make assumptions and go in certain directions with diagnoses. It’s a really big shift.

“As a company we see around 18 million people a year, which is a huge segment of the populations in the countries we serve. If we were able to build those data sets and get the right algorithms, that’s the next phase of healthcare and it’s something we’re keen on developing.”

Away from technology, Aster’s plans continue to be expansive and ambitious. One such example is Saudi Arabia, which is looking to the region’s – and the world’s – private sector to fulfil its Vision 2030 aims.

Healthcare is one of the diversification plan’s main focus areas, with goals to increase private healthcare expenditure from 25 per cent in 2016 to 35 per cent of total expenditure by 2020. The vision has highlighted areas of opportunity for foreign investors, including additional private medical facilities, increased usage of information technology, healthcare education, enhanced professional development, local manufacture of pharmaceuticals and more.
And for Moopen, the future for Aster in the kingdom looks bright.

“We’ve been in Saudi for the last five years and we have quite big plans there,” she says.

“We put things on the back-burner because of the oil prices and the movement over the last year and a half, but things seem to have made a positive shift over the last three to six months.

“I was in Saudi last week, and the kind of transition you can see overall in the kingdom is significant. And their focus is to have a lot more private involvement in sectors like healthcare, so we do have the advantage of being one of the first movers from outside the kingdom into the kingdom for healthcare.

“The healthcare requirements in Saudi are significant, and some of the models we have used here in the UAE would go well with the requirements in the kingdom. A lot of the focus has typically been on hospitals there, but I think there has to be more of a focus on primary care, which is one of the strengths we come in with as a company.

“Some of the rules in Saudi are getting rewritten right now, and we are actively pursuing our plans for the kingdom.”

Growth in Saudi Arabia would significantly enhance Aster’s reach and impact, but it is by no means the only avenue through which the company can do this.
Another is the Aster Foundation – the non-profit charitable and philanthropic arm of Aster DM Healthcare.

“There was a quote I came across that I keep circulating back to that says ‘the law of nature is to give’. Nothing in nature does anything for itself. The sun gives warmth not for itself but for others; the flower gives fragrance not for itself but for others to enjoy; and the river flows but the water is not for itself – it’s for others.

“That’s the same principle that each of us here uphold: we want to give back. We always say the more you get, the more you need to give back. So while in healthcare you are inherently giving back, we also have the foundation, which is giving without any other funding around it other than personal funding and company funding.

“There are limits as to what you can do as a corporate entity and there are desires for us to do whatever support and help we can do as individuals and a company for the societies we operate in. So that’s what the foundation does, and it’s intrinsically linked to healthcare. All of our projects are around healthcare, in India, Syria, the Philippines, and Africa.”

Targeting regions that require support and where it believes it can make a difference, the foundation runs projects in India, Syria, the Philippines, Africa and elsewhere. And with a ready supply of 2,000 doctors and 8,000 nurses, it has the resources to go big on its initiatives.

“We do a lot of free consultations, free surgeries, and we mobilise and create programmes that are specific in nature. For example, we did one of children with congenital heart diseases in the Philippines, sponsoring 50 kids for surgery,” says Moopen.

“Last year was a big year for us because it was our 30-year anniversary, and the focus for the entire company was giving back. Aster@30 was aimed at giving back and we did it under specific buckets. We did free investigations for people who need support, free surgeries, working with pharma companies, and so on.”

She goes on to explain that there is a vicious circle of poverty and a lack of access to healthcare – a circle she and Aster are keen to break.

“If you look at 2017 data, there were 836 million people in extreme poverty in the world, and poverty by definition and extension means that healthcare is compromised. Along with that, healthcare causes poverty. Around 100 million people every year end up moving to the poverty line because of healthcare costs. And 150 million people end up in severe financial catastrophe because of healthcare costs.

“The idea of the foundation is to make sure healthcare reaches people when there’s an absolute need for it. And while we might not be able to help 836 million people, we have at least been trying to create a system that facilitates care.

“We want to create a virtuous cycle of goodness where people are keen and eager to support and help, because there’s so much that needs to be done.”

A large part of creating this groundswell of support comes in the form of Aster Volunteers – a programme open to all-comers who wish to donate their time or skillset in a positive way.

Introduced as part of Aster@30, Moopen says the idea was to “create a movement where you would build a culture of giving back”, where Aster connects people to opportunities and “be part of this spirit of humanity”.

With more than 8,000 people already signed up to the initiative – both from inside and outside Aster – the first few months have proved promising.

“People just want the opportunity to serve,” says Moopen.

“At the end of the day it’s people who make the difference. Any problem can be solved; poverty doesn’t need to be a reality tomorrow, climate change doesn’t have to be a reality tomorrow; all these healthcare issues should not be a reality tomorrow. The only thing that’s going to make a difference is people’s mindset.

“Aster Volunteers goes back to your basic DNA of serving and instilling intuit a spirit of humanity. We hope we will be able to crate a movement for humanity that will start to make a better world.”

To take things a step further, earlier this year Moopen was given a worldwide platform from which to advocate for improved healthcare access and quality.

In June, she was named a Young Global Leader by the World Economic Forum, one of 100 international peers taking part in a five-year programme to solve and mitigate a range of challenges in the region and across the world.

And for Moopen, the strength of the YGL community represents an exciting opportunity to be proactive.

“I think the biggest incentive or attraction for me is to interact with like-minded people,” she says.

“A large number of people coming into this community are working on new technologies, new solutions, because we can’t do what we’ve done forever or we’ll end up going in the same circle. We have to find new ways of doing things.

“For me, it’s not about getting into the programme – it’s more that I hope I can be part of creating solutions where healthcare can be accessible to all – where healthcare is people’s birth right. That’s the goal and aspiration and hope with YGL.”

If Moopen’s time with Aster so far is anything to go by, it also seems the aspiration for her entire healthcare career. And with her drive, passion, business nous and solid corporate platform, she is already proving to be a shot in the arm for the region’s healthcare industry.