IPO Alert: Key Considerations for Broach Lifecare Hospital Limited Investors

Broach Lifecare Hospital Introduction

Broach Lifecare Hospital Limited was founded in 2023 and operates boutique hospitals under the brand name “Maple Hospitals”. The company specializes in providing comprehensive healthcare services, particularly in cardiology, including both non-invasive and interventional procedures.

Key Services

• Non-Invasive Cardiology:
  • 2D Echocardiography, Electrocardiography, Tread Mill Test, Holter monitoring, and more.
• Interventional Cardiology:
  • Coronary angiography, stenting, primary PCI for acute myocardial infarction, and various other advanced procedures.
• Diagnostic and Therapeutic Services:
  • Endovascular revascularization, deep vein thrombosis treatment, and peripheral angioplasty

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Brief about

Summary of the business

Company acquired the proprietorship concern of Dr. Jaykumar Narendra Vyas, our Promoter comprising of the Hospitals i.e. Dr. Vyas’s Heart Hospital and Dr. Vyas Hospital pursuant to a Business Transfer Agreement dated July 17, 2023 (“BTA”). Thereafter, Company was converted into a Public Limited Company and the name of Company was consequently changed to ‘Broach Lifecare Hospital Limited’

History

Broach Lifecare Hospital Company was incorporated as “Broach Lifecare Hospital Private Limited” pursuant to a certificate of incorporation bearing CIN U86100GJ2023PTC140499 dated April 25, 2023, issued by the Registrar of Companies, Central Registration Centre. Further, in accordance with the main objects, Company acquired the proprietorship concern of Dr. Jaykumar Narendra Vyas, our Promoter comprising of the Hospitals i.e. Dr. Vyas’s Heart Hospital and Dr. Vyas Hospital pursuant to a Business Transfer Agreement date July 17, 2023 (“BTA”).

Promoters & Board of Directors

• The Promoters of Broach Lifecare Hospital Company are Dr. Jaykumar Narendra Vyas and Dr. Shachi Jaykumar Vyas.

Board of directors

Share Holding pattern

Strength

• Clinical Excellence and Affordable Healthcare
• Strategic location
• Strong empanelment
• Ability to attract and retain high quality doctors, consultants and medical support staff
• Experienced Promoters, management team with a strong execution track record.

Strategies

• Increase our service offerings through addition of equipment – Cath lab Machines
• Medical Tourism and CRM software
• Increasing our association and empanelment

Industry Outlook

Healthcare has become one of India’s largest sectors, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services, and increasing expenditure by public as well as private players.
India’s healthcare delivery system is categorised into two major components – public and private. The government, i.e., the public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Healthcare Centers (PHCs) in rural areas. The private sector provides the majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros, tier-I, and tier-II cities. India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost-competitive compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe. The low cost of medical services has resulted in a rise in the country’s medical tourism, attracting patients from across the world. Moreover, India has emerged as a hub for R&D activities for international players due to its relatively low cost of clinical research.

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MARKET SCENARIO

Indian Market Scenario

• The Indian health care sector is expected to record a three-fold rise, growing at a CAGR of 22% between 2016–22 to reach US$ 372 billion in 2022 from US$110 billion in 2016
• As of August 18, 2023, more than 2.20 billion COVID-19 vaccine doses have been administered across the country.
• By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.
• As of 2021, the Indian healthcare sector is one of India’s largest employers as it employs a total of 4.7 million people. The sector has generated 2.7 million additional jobs in India between 2017-22 over 500,000 new jobs per year.
• India’s public expenditure on healthcare touched 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21, as per the Economic Survey 2022-23.

Strong growth in healthcare expenditure over the years

• Healthcare has become one of India’s largest sectors, both in terms of revenue and employment. The industry is growing at a tremendous pace owing to its strengthening coverage, service and increasing expenditure by public as well private players.
• Between 2016–22, the market is expected to record a CAGR of 22.52%.
• The total industry size is estimated to reach US$ 372 billion by 2022.
• The e-health market size is estimated to reach US$ 10.6 billion by 2025.
• In November 2021, the Government of India, the Government of Meghalaya and the World Bank signed a US$ 40 million health project for the state of Meghalaya. This project will improve the quality of health services and strengthen the state’s capacity to handle future health emergencies, including the COVID-19 pandemic.
• This is due to rising income, easier access to high-quality healthcare facilities and greater awareness of personal health and hygiene.
• Greater penetration of health insurance aided the rise in healthcare spending, a trend likely to intensify in the coming decade.
• Economic prosperity is driving the improvement in affordability for generic drugs in the market.
• The budgeted spending on the health sector by the federal and state governments was 2.1% of Gross Domestic Production (GDP) in FY23 and 2.2% in FY22, up from 1.6% in FY21. The Government is planning to increase public health spending to 2.5% of the country’s GDP by 2025.

GOVERNMENT INITIATIVE

Some of the major initiatives taken by the Government of India to promote the Indian healthcare industry are as follows:

• In the Union Budget 2023-24:
• Under the Union Budget 2023-24, the Ministry of Health and Family Welfare has been allocated ₹. 89,155 crore (US$ 10.76 billion), an increase of 3.43% compared to ₹. 86,200.65 crore (US$ 10.4 billion) in 2021-22.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated ₹ 3,365 crore (US$ 0.41 billion).
• Human Resources for Health and Medical Education was allotted ₹ 6,500 crore (US$ 780 million).
• National Health Mission was allotted ₹. 29,085 crore (US$ 3.51 billion).
• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted ₹ 7,200 crore (US$ 870 million).
• In July 2022, the World Bank approved a US$ 1 billion loan towards India’s Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission.
• To promote medical tourism in the country, the government of India is extending the e-medical visa facility to the citizens of 156 countries.
• In May 2022, the Union Government approved grants for five new medical colleges in Gujarat with a grant of ₹ 190 crore (US$ 23.78 million) each. These colleges will come up in Navsari, Porbandar, Rajpipla, Godhra and Morbi.
• In November 2021, the Government of India, the Government of Meghalaya, and the World Bank signed a US$ 40- million health project for the state of Meghalaya. Project will improve the quality of health services and strengthen the state’s capacity to handle future health emergencies, including the COVID-19 pandemic.
• In September 2021, Prime Minister Mr. Narendra Modi launched the Ayushman Bharat Digital Mission. The mission will connect the digital health solutions of hospitals across the country with each other. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
• In September 2021, the Telangana government, in a joint initiative with World Economic Forum, NITI Aayog and HealthNet Global (Apollo Hospitals), launched ‘Medicine from the Sky’ project. The project will pave the way for drone delivery of life saving medicines and jabs in far-flung regions of the country.
• According to a spokesperson, the Indian government is planning to introduce a credit incentive programme worth ₹ 500 billion (US$ 6.8 billion) to boost the country’s healthcare infrastructure. The programme will allow firms to leverage the fund to expand hospital capacity or medical supplies with the government acting as a guarantor and strengthen COVID- 19-related health infrastructure in smaller towns.
• In July 2021, the Ministry of Tourism established the ‘National Medical & Wellness Tourism Board’ to promote the medical and wellness tourism in India.
• In July 2021, the Union Cabinet approved continuation of the National Ayush Mission, responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.
• In July 2021, the Union Cabinet approved the MoU between India and Denmark on cooperation in health and medicine. The agreement will focus on joint initiatives and technology development in the health sector, with the aim of improving public health status of the population of both countries.
• In June 2021, the Ministry of Health and Family Welfare, in partnership with UNICEF, held a capacity building workshop for media professionals and health correspondents in Northeastern states on the current COVID-19 situation in India, to bust myths regarding COVID-19 vaccines & vaccination and reinforce the importance of COVID-19 Appropriate Behaviour (CAB).

ADVANTAGES IN INDIA

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• Strong Demand
  • Rising income, greater health awareness, lifestyle diseases and increasing access to insurance will contribute to growth.
  • The healthcare sector, as of 2021, is one of India’s largest employers, employing a total of 4.7 million people.
• Attractive Opportunities
  • India’s public expenditure on healthcare touched 2.1 % of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21, as per the Economic Survey 2022-23.
  • Two vaccines (Bharat Biotech’s Covaxin and Oxford- AstraZeneca’s Covishield manufactured by the Serum Institute of India) were instrumental in medically safeguarding the Indian population and those of 100+ countries against COVID-19.
• Policy and Government Support
  • The Government aims to develop India as a global healthcare hub.
  • Public health surveillance in India will further strengthen the health systems.
  • In the Union Budget 2023-24, the government allocated ₹ 89,155 crore (US$ 10.76 billion) to the Ministry of Health and Family Welfare (MoHFW).
  • In March 2021, the Parliament passed the National Commission for Allied & Healthcare Professions Bill 2021, which aims to create a body that will regulate and maintain educational and service standards for healthcare professionals.
• Rising Manpower
  • Availability of a large pool of well trained medical professionals in the country.
  • The number of allopathic doctors with recognised medical qualifications (under the I.M.C Act) registered with state medical councils/national medical council increased to 1.3 million in November 2021, from 0.83 million in 2010.

SEGMENTS OF HEALTHCARE SECTOR

RECENT TRENDS

• Shift from communicable to lifestyle diseases
  • With increasing urbanisation and problems related to modern-day living in urban settings, currently about 50% of spending on in-patient beds is for lifestyle diseases – this has increased the demand for specialised care. In India, lifestyle diseases have replaced traditional health problems.
  • Most lifestyle diseases are caused by high cholesterol, high blood pressure, obesity, poor diet and alcohol.
• Expansion to Tier II and Tier III cities
  • Vaatsalya Healthcare is one of the first hospital chains to start focus on tier II and tier III cities for expansion.
  • To encourage the private sector to establish hospitals in these cities, the Government has relaxed taxes on these hospitals for the first five years.
• Emergence of telemedicine
  • Telemedicine is a fast-emerging sector in India. Virtual care – constituting teleconsult, telepathology, teleradiology and epharmacy – is experiencing a stimulus in India. Major hospitals (Apollo, AIIMS, Narayana Hrudayalaya) have adopted telemedicine services and entered into a number of PPPs.
  • In September 2020, according to a study (survey of consumers, doctors and stakeholders from pharma companies and global EY research) by EY, in collaboration with the Indian Pharmaceutical Alliance, the domestic telemedicine market is expected to reach US$ 5.5 billion by 2025.
  • By March 25, 2022, the Health Ministry’s eSanjeevani telemedicine service crossed 3 crore tele-consultations. Moreover, eSanjeevani telemedicine set a new record by completing over 1.7 lakhs consultations in a single day.
• Rising adoption of artificial intelligence (AI)
  • Rising adoption of AI-based applications has enabled people to talk directly to doctors, physicians, and get expertise for the best treatment.
  • It is also capable of solving problems of patients, doctors, and hospitals, as well as the overall healthcare industry.
  • In April 2021, Tata Trust’s initiative called India Health Fund (IHF) announced the onboarding of two AI start-ups— TrakItNow Technologies – an IoT and AI-based solution that is in development stage with immense potential to impact mosquito borne diseases, and Stellar Diagnostics (SDIL).
• Introduction of digital vaccine delivery platform
  • In December 2020, a new COVID-19 vaccine delivery digital platform called ‘CoWIN’ was prepared to deliver vaccines. As a beneficiary management tool with different modules, this user-friendly mobile app for recording vaccine data is in the process of establishing the ‘Healthcare Workers’ database, which is in an advanced stage across all states/UTs.
  • In July 2021, India made its COVID-19 vaccination platform, CoWIN, open source for all countries. Almost 76 countries have displayed interest in leveraging the CoWIN platform to manage their national COVID-19 vaccination drives.
• Increasing penetration of health insurance
  • In FY21, gross healthcare insurance stood at 29.5% of the overall gross direct premium income by non-life insurers segment.
  • Health insurance is gaining momentum in India. Gross direct premium income underwritten by health insurance companies grew 13.3% YoY in FY21 to ₹ 58,572.46 crore (US$ 7.9 billion).
  • In June 2021, the government announced that the ‘Pradhan Mantri Garib Kalyan Package (PMGKP) Insurance Scheme for Health Workers Fighting COVID-19’, which was launched in March 2020, has been extended for one more year. The insurance scheme provides comprehensive personal accident cover of ₹ 50 lakh (US$ 68,189.65) to all healthcare providers, including community health workers and private health workers. It was drafted by the government for the care of COVID-19 patients and those who may have come in direct contact with COVID-19 patients and were at risk of being infected by the virus. The scheme is being implemented through New India Assurance Company (NIACL).
• Focus on universal immunization programmes (UIP)
  • As of December 2020, under universal immunization programmes, ~1.54 lakh ANMs (auxiliary nurse midwives) are operating as COVID-19 vaccinators. For further expansion of vaccinators, the government plans to take collaborative effort with states and UTs.
• Technological initiatives
  • Digital Health Knowledge Resources, Electronic Medical Record, Mobile Healthcare, Electronic Health Record, Hospital Information System,
  • PRACTO, technology-enabled care, telemedicine and Hospital Management Information Systems are some of the technologies gaining wide acceptance in the sector.
  • In June 2021, the Uttar Pradesh government announced the introduction of automatic medicine dispensing machines to expand the primary healthcare industry and clinical centres in the country. The state health department has been nominated to design an action plan and install ‘Health ATMs’ walk-in medical kiosks, with combined medical devices for basic laboratory testing, emergency offerings, cardiology, neurology, pulmonary and gynaecology testing services that will be operated by a medical assistant in all 75 districts of Uttar Pradesh.
  • In June 2021, AstraZeneca India signed a memorandum of understanding (MoU) with Docon Technologies, a Bengaluru-based health startup, to digitise 1,000 clinics across India by implementing customised electronic medical record (EMR) systems in clinics to offer doctors access to a patient’s complete medical history.
  • In December 2021, Eka Care became the first CoWIN-approved organization in India, through which users could book their vaccination slot, download their certificate and even create their Health IDs.
• Point of care treatment
  • It encompasses any tests that are performed at or near a patient and at the site where care or treatment is provided. Results are typically available relatively quickly so that they can be acted upon without delay.
  • The most common point-of-care tests include blood glucose monitoring, home pregnancy tests, tests for hemoglobin, fecal occult blood, rapid strep, as well as Prothrombin Time/ International Normalized Ratio (PT/INR) for people on the anticoagulant warfarin.
  • It further helps to alleviate emergency room overcrowding by reducing the time it takes to treat people and thus shortens their stays.

STRATEGIES ADOPTED

• Cost Leadership
  • Private players in the industry are making their supply chains efficient and leveraging economies of scale to reduce costs. One such example is Narayan Hrudayalaya (NH), where healthcare is provided at an affordable cost.
  • NH reduces costs by high procurement of medical supplies, high-volume by highcapacity utilization, staff productivity and good human capital management (i.e.,training).
• Differentiation and Diversified Business Approach
  • Players in the industry are trying to differentiate themselves by providing multiple healthcare services under one roof.
  • Offering a range of healthcare and wellness services under a single brand has become a trend. Patients and healthcare services-seekers find it convenient. Demand of such arrangements boosts the healthcare sector.
• Co-Development
  • Key players in the industry are focusing on start-ups for co-developing innovative healthcare solutions. In December 2020, a cohort of six health-tech start-ups – Aarogya AI, BrainSight AI, Fluid AI, InMed Prognostics, Wellthy Therapeutics and Onward Assist – were selected by the India Edison Accelerator. This start-up partnership programme focused on Indian mentors, creating strategic partners to co-develop healthcare solutions.
• Mergers & Acquisitions (M&A)
  • The healthcare and pharmaceutical sector in India had M&A activity worth US$ 4.32 billion in the first half of 2022.
  • In January 2023, private equity investor Advent International confirmed that it has entered into a definitive agreement to acquire a significant stake in Suven Pharmaceuticals.
  • In November 2021, Flipkart Group announced its foray into the healthcare sector through the launch of Flipkart Health+. As part of this development, Flipkart has signed definitive agreements to acquire a majority share in Sastasundar Marketplace Limited, which owns and operates SastaSundar.com, an online pharmacy and digital healthcare platform.

INDIAN HEALTHCARE SECTOR IS POISED TO GROW

• Growing Demand
  • Rising income and affordability.
  • Growing elderly population, changing disease patterns.
  • Rise in medical tourism.
  • Better awareness of wellness, preventive care and diagnosis.
• Policy Support
  • Encouraging policies for FDI in the private sector.
  • Reduction in customs duty and other taxes on life-saving equipment.
  • NRHM allocated US$ 10 billion for healthcare facilities.
  • National Health Insurance Mission to cover entire population.
• Focus
  • Expanding R&D and distribution facilities in India.
  • Use of modern technology.
  • Providing support to global projects from India.
• M&A
  • Rising FDI and private sector investment.
  • Lucrative M&A opportunities.
  • Foreign players setting up R&D centres and hospitals in India.

RE-EMERGENCE OF TRADITIONAL MEDICAL CARE

• Market Size and Services Offered
  • Indian ayurvedic industry is expected to reach US$ 9 billion by 2022.
  • Ayurveda and Unani medicines consist of more than 90% of plant-based formulations.
  • The sector has broadened its offerings and now includes services on diet and nutrition, yoga, herbal medicine, humour therapy and spa.
• Leading Brands and Players
  • Many big players such as Apollo, VLCC and Manipal Group are setting up wellness centres across India with traditional healthcare remedies as the focus of their offerings.
• Developing Infrastructure
  • In January 2021, the PM Cares fund allocated ₹ 201.58 crore (US$ 27.55 million) for the construction of 162 additional dedicated pressure swing adsorption medical oxygen generation plants inside the country’s public health facilities.
  • In July 2021, the Union Cabinet approved continuation of the National Ayush Mission, responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.
• Notable Trends
  • The traditional medical sector is developing a traditional knowledge digital library to prevent companies from claiming patents on such remedies. There is a growing interest from numerous PE firms in the traditional healthcare sector in India.
• Recent Developments
  • The Government of India approved the continuation of the ‘National Health Mission’ with a budget of ₹ 36,785 crore (US$ 4.44 billion) under the Union Budget 2023-24.
  • In November 2022, six pharmaceutical companies were chosen by the Indian Council of Medical Research to produce monkeypox vaccines – Serum Institute of India, Biological E, Dr. Reddy’s Laboratories, Hester Bioscience Ltd., Indian Immunologicals Ltd., and Reliance Life Sciences.
  • In July 2022, the Indian Council of Medical Research (ICMR) released standard treatment guidelines for 51 common illnesses across 11 specialities to assist doctors, particularly in rural regions, in diagnosing, treating, or referring patients in time for improved treatment outcomes.

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Competition

Broach Lifecare Hospital operate in a competitive atmosphere. We face varying levels of competition in each micro-market we operate from. Our competition consists of both institutionalized hospitals that have a pan-Indian presence and local physicians and clinics that operate only in particular towns and cities. Some of our competitors may have greater resources than those available to us. We believe that we have been able to gain a competitive edge over our competition as a result of constant innovation, technical expertise and skilled doctors.

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Broach Lifecare Hospital believe that our experience and reliability record with our patients will be key to overcome competition posed by such organized and unorganized players. We believe that we are able to compete effectively in the market with our quality of services and our reputation.

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COLLABORATIONS/TIE UPS/ JOINT VENTURES

Other than the empanelment agreement with 4 PSU insurance companies, 15 Private Insurance companies, 8 Third Party Administrator (TPA) companies to provide medical treatment and healthcare as per the terms of their agreement our Company has not entered into any collaboration/Tie Ups/ Joint Ventures.

SWOT ANALYSIS

• Strengths
  • Reputation for Quality Care: Broach Lifecare Hospital Limited is known for providing high-quality healthcare services, which enhances patient trust and loyalty.
  • Experienced Medical Staff: The hospital boasts a team of highly skilled and experienced medical professionals, ensuring top-notch patient care.
  • Advanced Medical Technology: Equipped with state-of-the-art medical technology, the hospital can offer advanced diagnostic and treatment options.
• Weaknesses
  • High Operational Costs: Maintaining advanced medical technology and a skilled workforce can lead to high operational expenses.
  • Limited Geographic Presence: The hospital’s services are limited to specific regions, which can restrict its market reach and growth potential.
  • Dependence on Key Personnel: Reliance on key medical professionals can be a risk if they leave the organization.
• Opportunities
  • Growing Healthcare Demand: Increasing awareness and demand for quality healthcare services present significant growth opportunities.
  • Expansion Potential: Opportunities to expand services to new regions or introduce specialized medical services.
  • Government Healthcare Initiatives: Government initiatives and funding for healthcare can provide financial support and growth opportunities.
• Threats
  • Intense Competition: The healthcare sector is highly competitive, with many hospitals vying for market share.
  • Regulatory Changes: Changes in healthcare regulations and policies can impact operations and profitability.
  • Economic Fluctuations: Economic downturns can affect patients’ ability to afford healthcare services, impacting revenue.

Business risk factors

• Broach Lifecare Hospital Company has been formed specifically for the purpose of acquisition of the business of Dr. Vyas’s Hospital (proprietorship concern of our Promoter i.e., Dr. Jaykumar Narendra Vyas) thus we have limited operating history as a Company which may make it difficult for investors to evaluate historical performance or future prospects.
• Broach Lifecare Hospital are highly dependent on our doctors and other healthcare professionals, as well as other key personnel and the loss of, or inability to attract or retain, such persons could adversely affect business and results of operations.
• Broach Lifecare Hospital operations are geographically located in Bharuch and Ankleshwar in Gujarat at present and any localized social unrest, natural calamities, etc. could have material adverse effect on business and financial operations.
• Broach Lifecare Hospital are a boutique hospital, primarily provide services relating to interventional cardiac services. Any material impact on our earnings from these fields will impact financial condition and results of operations significantly.
• Broach Lifecare Hospital have not entered into tie-ups with Governmental agencies for providing medical services under various government schemes.
  • Broach Lifecare Hospital registered to provide medical services under various government schemes such as Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
• Most of radiology and diagnostic imaging equipment contain radioactive and nuclear materials or emit radiation during operation which could make us liable for damages.
• Broach Lifecare Hospital derive a significant portion of our revenues from our tie up arrangements with insurance companies, third party administrators and corporations. The loss of any one or more of major customers would have a material effect on our business operations and profitability.
• Broach Lifecare Hospital industry is highly regulated and requires us to obtain, renew and maintain statutory and regulatory permits, accreditations, licenses and comply with applicable safety, health, environmental, labour and other governmental regulations. Any regulatory changes or violations of such rules and regulations may adversely affect our business, financial condition and results of operations.
• Broach Lifecare Hospital Company is dependent on limited number of external suppliers for its medicine and consumables requirements. Any delay or failure on the part of such suppliers to deliver products at acceptable prices, may adversely affect our business, profitability and reputation.
• Broach Lifecare Hospital ability to provide affordable healthcare depends on the maintenance of a high volume of patients, occupancy rates, managing operating and effective capital management. Any increase in such costs could adversely affect business, financial condition and results of operations.

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Broach Lifecare Hospital Limited IPO Details

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