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2
…because passion drives perfection…
…and perfection drives
performance
3
Outline
• Indian Healthcare opportunity at inflection point
• Legacy problems, Recent transformation, Rising aspirational middle-class, Effect of health insurance and government
schemes driving demand for better healthcare
• Total opportunity size in Rs. 11.7 trillion, other industry data
• Shalby - A proxy for the huge opportunity of growth in the Indian Healthcare space
• Profile and brief timeline, About the Promoters, Proven track-record of growth and expansion, Pioneer in joint
replacements in India, Well-poised for the next phase of expansion and growth
• Snapshot
• No. of Hospitals, No. of Beds, FY18 Revenue/EBITDA/PAT (absolute and %), IPO, 10-Year CAGR Revenue, 10-Year CAGR
EBITDA
• What makes Shalby deliver a superior performance – our unique Business Model
• Lowest Capex and Opex per bed due to optimal use of real-estate, in-house planning teams, fully-committed team of
doctors, focus on surgeries with higher ARPOB, Centralised procurement, Gradual ramp-up of operational bed capacity
4
Outline
• Relevant and Low cost Expansion
• Role of OPDs and SACE in identifying where to go, optimal capacity of ~200 bed capacity, catchment area, focus on
underpenetrated markets in India and continue with OPDs to expand reach into newer geographies
• Current Expansion in Progress: Nashik, Vadodara, Mumbai
• Case of Expansion & Specific Growth Drivers for Shalby
• Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle – case study, Shalby’s leadership in
joint replacement, huge scope for organic growth and operating leverage, 5x growth on current infra possible without major
capex
• Developing similar expertise to capitalise on next growth cycles in other specialties
• Performance Review
• Revenue mix, Operational parameters, maturity profile, profitability and B/Sheet snapshot
• Key developments during the period
• Strengths and Differentiators
• Global leadership in Joint Replacement, Experienced promoters with hands-on involvement, strong brand, optimized
business model now being replicated, unleveraged Balance Sheet
5
1 Indian Healthcare
is at an Inflection Point
6
The Opportunity Set
Population and Population Growth Rate of India Spilt of Indian Healthcare Industry by Segments
(Historical and Expected)
Total market size (2016): INR 9.2 trillion
CAGR (2014-2020)
9% 4%
100%= 0.9%
1.27 billion 1.29 billion 1.32 billion 1.35 billion
13%
54+ years 100% 2.6%
6%
35-54 years 80%
1.6%
68%
7
Source: National Commission Population Frost & Sullivan analysis.
The Opportunity Size
Spilt of Public and Private Hospitals in India Indian Healthcare Delivery Industry size (2015-2020)
11.7
10
30%
8.5
7.3
70%
6.2
5.4
Private
Corporate
Hospitals
account to less
Public Hospitals Private Hospitals than 10% of the 2015 2016(E) 2017(E) 2018(E) 2019(E) 2020(E)
total Private
Hospitals
8
Source: Frost & Sullivan analysis.
Legacy Issues of India Healthcare
• Always been an underdog due to lack of infrastructure and expenditure from the government
• In the private space, it was charitable trusts who contributed to healthcare, but even this has waned
from 1980s
• Tier II and Tier III towns are served by Nursing Homes – started by doctors themselves
• The burgeoning population of India poses a serious challenge to healthcare access
• And yet…
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Conducive Government Policies
Despite Challenges
Swastha Bharat, Smriddha Bharat. Demographic
dividend realization impossible without proper
healthcare
Rashtriya Samaj Beema Yojana: 100 mln families
will get Rs 500,000 per year for their families to
cover secondary and tertiary hospital expenses
10
Recent transformation
• Private sector investment has been increasing due to change in mind-set and better returns on
investment
• Healthcare businesses can also be profitable as long the costs are affordable
• The advent of information technology has given a fillip to the healthcare business making it both
controllable and scalable
• Rising aspirational middle-class today is not averse to paying for quality healthcare services
• Impact of health insurance, government schemes and emergence of medical tourism - key drivers
of positive change
11
2 Shalby Limited
A proxy for growth in the Indian Healthcare space
12
Promoter
Qualifications Achievements
Academic Qualifications: • Over two and a half decades of professional work experience
• MBBS across UK, USA and India. Serving as Director, Department of Knee
• MS (Orthopaedics) Replacement at Shalby Hospitals since 1993
Professional Qualifications • Dr. Shah innovated zero ‘0’ Technique in 2011 and was awarded the
• AO Basic Course Double Helical Award 2017, for the innovation
(London) Reduction of surgery time: 2.5 hours to 22 minutes
• F.A.O.A.A (Switzerland) Reduction in patient stay: 15 days to 3 days
• F.A.I.S.F (Germany) Drastic fall in infection rates due to minimum incision
• President of Indian Society of Hip & Knee Surgeons (ISHKS) for the
year 2010-11
13
Management Structure
CEO
EA to CEO
Group GM –
COO Surat COO North COO Central
Finance & CAO SG Unit CAO Krishna
Cluster Cluster Cluster
Accounts
14
Our Journey so far…
Started professional Operationalized First Commissioned Shalby Jabalpur
practice with a 6-bed Multispecialty Hospital of the [Bed Capacity: 233]
facility group Shalby SG Commissioned Shalby Indore
[Bed Capacity: 201] [Bed Capacity: 243]
Acquired Shalby Mohali
[Bed Capacity: 145]
Revenue growth – 100 Acquired Shalby Vapi Bed capacity grown 10 times
times in first 10 years [Bed Capacity: 146] in 10 years – to 2012 beds
Incorporation of Company Acquired Krishna Shalby Commissioned:
[Bed Capacity: 220] Shalby Jaipur [Bed Capacity: 237]
Shalby Naroda [Bed Capacity: 267]
Shalby Surat [Bed Capacity: 243]
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Reach and Presence - Hospitals
Network of Hospitals in India with bed capacity
Ahmedabad
SG – 201 beds
Krishna – 220 beds
Vijay – 27 beds
Mumbai – 50 beds,
to be increased to
150
Ahmedabad
Vadodara – 150 beds (Naroda) – 267 beds
Vapi – 146
beds
Surat – 243 beds
Kenya
Tanzania
Presence in UAE
UAE (2)
SACE
SACE
OPD Clinics
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Current Scale of Operations
FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18
Revenue CAGR – 31% for 11 years EBITDA CAGR – 40% for 11 years
• Best in class operational metrics despite lower operating bed/ bed capacity ratio and lower occupancy rates
• Based on current infra 5x Revenue and EBITDA growth possible without any major capex
20
Years represent Financial Years EBITDA calculated on total revenue FY 12 to FY 17 – Data as per restated consolidated financials
Best in class economic returns
ROCE % RoE %
Net Block (Rs in Mn) ROCE (%) Shareholders' Equity (Rs in Mn) RoE (%)
88% 32% 7,615
6,870 31%
28%
66% 5,420
18% 20.0%
51% 17% 17.0%
4,003
36%
26% 2,496 9% 11%
20% 22% 2,508 6%
15% 1,257 14% 14% 12%
2% 1,461 1,835
362 354 330 309 428 1,104 362 203 259 345 481 844 1,041
FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18
21
4 Our Unique Business Model
is the key to our outperformance
22
Our Business Model – features
Optimising Capex and Opex
23
Our Business Models…
No fixed
Operate and Manage rental
Fully owned [Revenue Sharing]
Unique
revenue No security
sharing deposit
model
Efficiency is
No
paramount minimum
guarantee
24
Typical concept of 200 (±20%) bed capacity set-up
25
The Shalby Way
26
5 Expansion Strategy
27
Low Cost and Relevant Expansion
28
Expansion strategy across the country
Simultaneously
hire local doctors
Patients visit our and train them at
clinics across Ahmedabad who
Punjab
Set-up Maharashtra
outpatient
clinics where
we have a strong
brand recall
29
Expansion Plans in Progress
Investment Plans for Upcoming facilities
Total capex planned – Rs. 1.6 bn for addition of 538 beds @ Cost per bed – ~Rs. 3 mn
30
6 Case for Expansion
31
Case study - the Cardiac growth story in India
2014
~ 2,00,000
surgeries and
Facilities 10-15 kms away
8,00,000 CAGR – 29% in 30 years.
angioplasties
Currently growing @ 2-3%
2004
~ 50,000
surgeries
1994
~5000 Wide procedure penetration –
surgeries
to Tier 2 and 3 cities
1984
~500
surgeries
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Source: Industry reports
Knee Replacement - the big opportunity
2017
~1,75,000
surgeries
2010
Last year, In
~54,000 United States
surgeries ~0.8 mn knee
replacements in
a population of
2000 ~300 mn
~6000
India has a
surgeries similar affording
population.
Hence, direct
potential to
grow to 8 lacs
Knee
1994 Asian replacements
~300 population 15 Hence huge
times more
surgeries prone to
potential for
growth based
Arthritis of knee
than their on incidence
western counter rates
parts
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Snapshot
Reach & Presence
1,150
Vijay – 27 beds
48 Outpatient clinics
Vapi – 146 beds
Mumbai – 50 beds,
to be increased to
150
Successful
Historically conclusion of the Jaipur, Surat and
highest revenue IPO of INR 5,048 Naroda units
during the million and listing operationalized in
quarter & year Wide procedure penetration
on the stock FY18
–
exchangesto Tier 2 and 3 cities
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Financial Highlights Q4FY18
1110.36 16.50%
174.20
9.10%
13.42% 78.70
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Operational Performance Synopsis
(INR in million)
Note: The operational bed count of 1,150 considers 50 operational beds at Zynova-Shalby Hospital, Mumbai, for which no other operational parameters
2
are tracked
Financial Highlights Q4FY18 (INR in million)
40
Financial Highlights Q4FY18
41
Financial Highlights FY18
11.16%
3942.35
22.26% 21.88% 9.24% 440.15
3284.29
843.55
303.62
716.39
42
Operational Performance Synopsis
(INR in million)
Note: The operational bed count of 1,150 considers 50 operational beds at Zynova-Shalby Hospital, Mumbai, for which no other operational parameters
48
are tracked
Financial Highlights FY18 (INR in million)
Expenses
Materials & Consumables 947.71 24.58% 784.87 24.39% 20.75% 0.19%
Fees to Doctors and Consultants 898.06 23.29% 774.76 24.07% 15.91% -0.78%
Other Operative Expenses 398.38 10.33% 315.56 9.81% 26.25% 0.53%
Employee Costs 447.96 11.62% 376.89 11.71% 18.86% -0.09%
Administrative Expenses 319.57 8.29% 249.79 7.76% 27.94% 0.53%
Total Operational Expenses 3,011.68 78.12% 2,501.87 77.74% 20.38% 0.38%
Operational EBITDA 843.55 21.88% 716.39 22.26% 17.75% -0.38%
Other Income 87.12 66.04 31.93%
Total EBITDA 930.67 782.43 18.95%
Finance Cost 121.34 102.15 18.78%
Depreciation & Amortization Expense 224.32 160.08 40.13%
Profit before tax (PBT) 585.01 520.20 12.46%
Tax Expense 144.86 216.58 -33.11%
Profit after tax (PAT) 440.15 303.62 44.97%
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Revenue Composition FY18
Specialty Mix Payee Profile
2.3%
15.0%
16.4%
4.1%
6.1%
54.2%
9.8% 21.0%
60.3%
10.8%
80.89% 78.12%
75.50% 77.74%
7.98%
6.02% 7.76% 8.29%
7.20% 9.96%
11.71% 11.62%
6.94% 7.85%
9.81% 10.33%
60.3% 62.3% 59.5% 24.90% 26.12%
51.2% 24.07% 23.29%
8.9% 9.2%
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4 Year Trend
Bed Count Split Operational Parameters
4.14
39,904
2,012 4.03 34,173 32,671
31,564
3.99
1,295 1,265
907
951 3.70
823 781
593
335
196 252 271
• ARPOB dropping is due to de-risking by way of expansion to newer geographies and increased multispecialty focus,
which has altered our specialty mix
• Decreasing ALOS is a positive sign as it means early discharge for the patients and increased bed turnover rate for us 48
Maturity Profile - FY Mar’18 (Annual Performance)
5 years + 38%
(SG; Vijay; 418 42% 3.94 594
Krishna; Vapi) 62%
2-5 years
(Jabalpur, Indore) 22% 335 38% 3.58 476
30%
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Balance Sheet Standalone
(Rs. in Millions) (Rs. in Millions)
Statement of Audited Assets and Liabilities STANDALONE Statement of Audited Assets and Liabilities STANDALONE
As at As at As at As at
Particulars 31/03/2018 31/03/2017 Particulars 31/03/2018 31/03/2017
ASSETS EQUITY AND LIABILITIES
NON- CURRENT ASSETS EQUITY
Property, plant and equipment 6,480.55 3,120.37 Equity share capital 1,080.10 874.09
Capital work-in-progress 376.48 2,207.02 Other equity 6,672.36 1,711.34
Goodwill 81.97 -
Total Equity 7,752.46 2,585.43
Intangible Assets - 1.61
NON- CURRENT LIABILITIES
Intangible assets under development 2.24 2.27
Financial liabilities
Financial Assets
Borrowings 749.83 2,854.04
Investments 9.10 94.10
Loans 77.70 - Other Financial Liabilities 46.23 22.47
Other Financial Assets 229.37 19.12
Deferred Tax assets 111.56 71.61 Provisions 13.71 15.18
Other non current assets 74.79 363.69 Deferred Tax Liabilities (Net) - -
Other Non-current Liabilities 128.41 88.77
Total Non-Current Assets 7,443.76 5,879.79
TOTAL NON-CURRENT LIABILITIES 938.18 2,980.46
CURRENT ASSETS
CURRENT LIABILITIES
Inventories 118.81 75.58
Financial assets
Financial liabilities
Investments 13.54 4.30
Borrowings 157.16 229.72
Trade Receivables 601.49 334.58
Cash and Cash Equivalents 108.83 115.82 Trade Payables 479.93 391.78
Other Bank Balances 1,042.29 41.21 Other Financial Liabilities 445.30 577.81
Loans - 86.07
Other Financial Assets 158.94 153.69 Other Current liabilities 45.04 43.51
- -
Provisions 6.06 7.51
Current tax asset 97.03 81.30
Other Current Assets 111.06 47.59 Current tax liabilities 3.54 3.71
Assets classified as held for sale 131.92 - TOTAL CURRENT LIABILITIES 1,137.03 1,254.04
54218 2,383.91 940.14
TOTAL LIABILITIES 2,075.21 4,234.50
Total Assets 9,827.67 6,819.93
TOTAL EQUITY AND LIABILITIES 9,827.67 6,819.93
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Shareholding Pattern
Shareholding as on 31st March 2018
Trust Others
0.94% 0.16%
FIIs/ DIIs and Retail
19.49%
FIIs – 6.28%
DIIs – 6.28%
Retail – 6.93%
Promoter
79.41%
Strong brand,
Experienced global Optimized
promoters with Business Model Unleveraged
leadership in
hands-on now being Balance Sheet
Joint
involvement Replacement replicated
52
Thank you