Eight years after setting up its first clinic in Mumbai, QI Spine Clinic has reportedly prevented over 8000 spine surgeries. Founders Nithij and Anuj Arenja currently have 22 clinics across four cities and plan to expand to 80 clinics in the next five years, with a pilot clinic in the US to go live in a few months. A review of their clinical and business strategy
A choreographer with severe slipped disc starts dancing again. An 80 year old with osteoarthritis avoids spine surgery. A wheelchair bound housewife starts walking again. A 54-year-old runs 15 marathons despite disc derangement. A 40 year old professor suffering from severe back pain recovers within 12 weeks of specialised spine therapy.
The common link to all these cases is the Mumbai based QI Spine Clinic (the Clinic), positioned as India’s first specialised medical service dedicated to the non-surgical treatment of back and neck conditions. The Clinic was born out of the pain and personal experience of one of the founders, Nithij Arenja, who was unwilling to undergo spine surgery while dealing with his own obesity and back pain.
His search for a conservative non-surgical path of treatment towards recovery from back pain led him and brother Anuj to collaborate with global experts. The result was a proprietary, technology enabled spine rehab programme that employs a data driven approach combining custom built software, predictive analytics, devices and services to deliver superior patient outcomes and patient efficiency.
Business strategy
QI Spine Clinic is one of the ventures of Arenja Holdings, an investment house that specialises in the promotion and incubation of greenfield healthcare ventures. The group has investments in a couple of healthcare ventures besides the Clinic ranging from gyms (QI Lifecare), health and fitness equipment (Trinity Healthtech), and ambulatory cardiac care (New Heart). With a focus on common chronic lifestyle related diseases, these businesses claim to leverage advanced technologies and evidence based protocols, aiming to change the conventional approach to prevention, diagnosis, treatment and even reversal of these diseases. QI Spine Clinic’s tag line is ‘Reversing Spinal Disorders’ while New Heart is about ‘Reversing Cardiac Disorders’.
Since its launch in 2011, the Clinic claims to have a success record of 91 per cent in treating even the most severe conditions and having prevented over 8000 surgeries that were prescribed. They currently have 22 clinics spread across four cities (Mumbai, Pune, Delhi and Bengaluru). Anuj Arenja, CEO, QI Spine Clinic reveals that they plan to expand to 80 clinics in the next five years and will also be opening in other countries like the US, where the pilot clinic will be operational in a few months. Though most clinics, spanning approximately 1500 feet, have been fully owned by the promoters to date, they planned to take the franchisee route where required, especially in tier 2 cities. This strategy will certainly allow them to expand much faster, once they find like minded partners.
While Anuj cannot reveal names and details of external funding, he indicates that they are supported by senior professionals in the healthcare industry as well as private equity players in their personal capacity. As of now, their expansion will be funded internally and by regional partners.
Global burden of back pain
There clearly is a need for such services. A 2010 study on the global burden of lower back pain revealed that back pain is the #1 cause of disability in the world. Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, low back pain (LBP) ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (Disability-adjusted life years – DALYs).
More recently, in March 2018, The Lancet published three papers on low back pain to highlight the global impact of this problem and the associated social and economic factors and personal and cultural beliefs. According to the authors, disability due to back pain has risen by more than 50 per cent since 1990. Globally, years lived with disability caused by low back pain increased by 54 per cent between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries.
In India, 50 – 80 per cent of individuals suffer at least one episode of back pain in their lifetime. As Anuj explains, the global point prevalence of low back pain LBP was 9.4 per cent. DALYs increased from 58.2 million in 1990 to 83 million in 2010. As prevalence and burden increased with age, an ageing demographic profile unfortunately means that incidence of LBP will only increase.
At an individual level, back and neck pain results in missed work days (absenteeism due to lower back pain is four days per year on an average, surgery patients can lose up to 48 work days per year). It is estimated that disability in basic movement like sitting, standing, twisting, bending which may hamper certain occupations. Slipped disc, disc bulge, and disc herniations, mechanical lower back pain, sciatica, spondyloarthopathy, spondylolisthesis, cervical radiculopathy/neck pain/cervical spondylosis are some of the common conditions that are treated at the Clinic.
Healing the healer
Patient testimonials reveal that back ache and spinal disorders do not spare healthcare professionals. In fact, they tend to show up with the most severe manifestations of neck and back pain as they ignore it or look for quick fixes till it becomes unbearable.
Consider the case of a 62 year old gynaecologist. When her back aches first made their appearance, she thought she could recover fast just with painkillers as she led an active lifestyle and exercised regularly at her gym. When the backaches got worse, she signed up for physiotherapy sessions. These sessions gave temporary relief and allowed her to resume her work, only to lay her up again. After years of sporadic episodes, which got more frequent, her pain became so severe she was bed ridden. An MRI revealed micro fractures in her spine which finally prompted her to turn to QI Spine Clinic.
Unfortunately, neck and back aches can strike at any age. A 36 year old anaesthesiologist found that he could not walk properly nor bend due to back pain. A 35 year old clinical hypnotherapist got back pains after a caesarean section.
Healthcare professionals like dentists and ophthalmologists have the highest risk of developing back pain due to awkward postures and prolonged work hours. In fact, according to QI Spine Clinic, 70 per cent of dentists suffered from back pain as their work requires them to bend at awkward positions to perform dental surgeries, procedures and even regular check-ups. This makes them one of the most vulnerable segments in the medical community to suffer from back pain.
More such patient testimonials on the Clinic’s site reveal a common refrain that the approach and staff impressed the doctor patients with their “scientific approach to back problems.” Far from promising overnight relief, the staff cautioned that results would take time but their patience would be rewarded with more permanent relief and importantly, an awareness to changed lifestyles, postures, etc. to proactively prevent or reduce the severity of future episodes.
Data-driven clinical edge
QI Spine Clinic claims to help patients tackle back and neck conditions with non-surgical precision rehabilitation and treatment, using the latest isolation and pain management technologies to first diagnose the cause and then treat it.
Explaining some of the treatment guidelines followed and the success rate, Anuj says, “85 per cent of back pain is caused due to mechanical issues in the spine. Surgery is required in less than 5 per cent cases after conservative management of the condition has failed. In fact, globally, a physiotherapist’s or chiropractor’s consent is required before a patient undergoes spine surgery. In India, the scenario is different. Most patients suppress their pain by self medicating with painkillers which provides temporary relief. Few try physiotherapy but the pain keeps returning.”
The USP of QI Spine Clinic’s spine therapy is that is it guided by technology from Germany. “The QI Approach is a four step programme which eliminates all randomness in treatment through data intelligence and ensures that very precise and guided care is delivered to the patients through their journey. Our smart algorithms grade the case type, remove subjectivity and suggest a treatment plan which has guaranteed outcomes,” according to Anuj. He points out that most treatments fail because of lack of diagnosis. At the heart of the QI approach, is advanced diagnostic technology, like the spine function test (DSA) which pinpoints the exact cause of pain which then becomes the base of a customised treatment plan. Their cell repair technology reduces pain and activates healing at a cellular level and isolation technology ensures targeted treatment to the exact areas of a patient’s spine.
The advantage of avoiding spine surgery makes the QI approach an attractive proposition, provided patients have the patience to set aside time for the sessions and make the lifestyle changes required. Arenja admits that their treatments and procedures are not covered by insurance, though they are in talks with a few to explore this possibility. He points out that very few primary care categories are currently covered by Indian insurance providers. The average treatment cost ranges from Rs 6000 – Rs 25000 compared to surgery which ranges from Rs 3 to 6 lakhs. Though the cost of treatment may seem steep, the value proposition goes beyond the costs, as there is no post-surgery care required. Anuj points to feedback videos from patients as proof that the programme works, stating that they are the only clinic chain to have over 2900+ Google reviews across centres with an average rating of 4.7 stars. According to Anuj, patients from low income groups are treated free of charge.
Prevention better than cure
The good news is that proactive patients can benefit from QI Spine Clinic’s approach as well. “Early diagnosis, personalised correction of ergonomics and preventive spine health check-ups is where our guidelines can help,” says Anuj pointing out that there are many ways to prevent back and neck pain but getting treatment on time is most important. Most patients waste time and money and end up delaying their treatment by going to different doctors and hospitals. He stresses that visiting a spine specialist first can prevent their problem from getting worse.The Clinic has been spreading awareness of these methods in the general community as well as among physicians by regularly conducting workshops in societies, engaging in patient education programmes and corporate events and also conducting health talks in schools. This is besides participating in regular continuing medical education (CMEs) and other doctor events. The Clinic also conducts workshops, like a recent one for dentists at Mumbai’s Nair Dental College and at a health talk at a United Nations event in Delhi.
Future prospects
Given the ageing demographic and increasing stress in urban lifestyles, the incidence of neck and back pain is only going to increase. QI Spine Clinic’s future growth hinges on increasing the awareness about neck and back pain as a potentially chronic problem as well as collaborating with physiotherapists and orthopaedic surgeons to increase awareness about better treatment protocols. While the founders are prepared to experience some push back from physiotherapists who see the Clinic as a competitor and orthopaedic surgeons who advocate spine surgery, the founders consider themselves collaborators rather than competitors. Expansion into new cities will be successful not just by identifying the right real estate to attract a sizeable patient pool but more importantly, getting this collaborative clinical network in place.