Sagility India IPO: Worth the Investment or?

Sagility India Introduction

Sagility India Limited is a healthcare solutions and service provider established in 2022. Initially incorporated as Berkmeer India, the company focuses on offering services to U.S.-based health insurers (payers) and healthcare providers, including hospitals, physicians, and medical technology companies

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Brief About Sagility India

History of Sagility India

Company was originally incorporated as ‘Berkmeer India Private Limited’ as a private limited company under the Companies Act, 2013 pursuant to a certificate of incorporation dated July 28, 2021, issued by the Registrar of Companies, Karnataka at Bengaluru. Subsequently, pursuant to a resolution passed by our Shareholders at the EGM held on August 25, 2022 the name of our Company was changed to ‘Sagility India Private Limited’ and a fresh certificate of incorporation was issued by the Registrar of Companies, Karnataka at Bengaluru on September 13, 2022. Subsequently, our Company was converted from a private limited company to a public limited company, pursuant to a special resolution passed by our Shareholders at the EGM held on May 21, 2024 and the name of our Company was changed to ‘Sagility India Limited’, and a fresh certificate of incorporation was issued to our Company by the RoC, on June 20, 2024.

Summary of the business of Berkmeer India Private Limited

Berkmeer India Private Limited provide technology-enabled business solutions and services to clients in the U.S. healthcare industry. Berkmeer India Private Limited is a pure-play healthcare focused services provider, and clients include Payers (U.S. health insurance companies, which finance and reimburse the cost of health services) and Providers (primarily hospitals, physicians, and diagnostic and medical devices companies)

Customer concentration of Sagility India

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Revenue breakup of Berkmeer India Private Limited

Product wise break-up

(₹ in millions)

Revenue contribution from Geography presence

Subsidiary companies of Sagility India

Industry Outlook

Healthcare operations overview

Healthcare payer operations value chain functions

Healthcare payers engage in a diverse set of activities to ensure operational efficiency and seamless experience for the individuals they cover, referred to as members. These activities can be categorized into seven broad value chain segments across front- and back-office, as shown in the process map below. The process map excludes non-business process operations such as pureplay Information Technology (IT) development and SaaS, IT services, and maintenance.

• Claims management: This refers to the process of receiving, adjudicating, and paying or denying claims submitted by healthcare providers or members often through technology-enabled tools.
• Payment Integrity: Payment integrity refers to the process of ensuring accuracy, transparency, and compliance in financial transactions related to healthcare services, claims, and reimbursements. It involves verifying the validity of claims, detecting, and preventing fraud, waste, and abuse, coordinating benefits in case of multiple payers and optimizing cost management, through analytics and technology solutions.
• Clinical management: Clinical management is a coordinated approach to healthcare that involves organizing and overseeing member (patient) care. It focuses on optimizing health outcomes, improving quality of care, and controlling costs by ensuring appropriate utilization of services and resources along with leveraging population health insights through technology for effective care management.
• Provider network operations (Provider engagement): Provider network operations or provider engagement is an intrinsic process that includes credentialing and maintaining an accurate provider directory in a Payer’s network, as part of regulatory requirements in the U.S. This segment focuses on maintaining and updating a network of healthcare providers, including hospitals, clinics, and physicians, using integrated technological solutions, to ensure members have access to quality care.
• Member engagement: This segment comprises activities that are aimed at supporting member relationships and interactions for smooth navigation of benefits and coverage often through tech-enabled analytics and platform solutions.
• Risk adjustment and support services: This segment focuses on activities aimed at securing accurate reimbursements and improving health plan performance metrics through processes such as risk adjustment coding, ratings support, and compliance reporting.
• Product development: This segment focuses on the design and development of health insurance plans along with the management of agents and broker networks.

Healthcare provider operations value chain functions

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Apart from core care delivery, healthcare providers undertake a wide range of activities to reduce administrative burden, improve efficiency, and ensure robust patient experience. The processes involved can be categorized into five broad value chain segments across front-office and back-office, as shown in the process map below. The process map excludes non-business process operations such as pureplay IT development and SaaS, IT services, and maintenance.

• Patient access: Focuses on ensuring that the patients have timely and efficient access to healthcare services, including appointment scheduling, registration, and insurance verification while leveraging technological solutions such as online portals and scheduling systems to improve efficiency.
• Medical billing: This segment encompasses activities that are aimed at accurately billing patients or their insurance providers for healthcare services rendered through activities such as clinical documentation improvement and medical coding, often utilizing technology solutions such as billing and coding systems to streamline processes and ensure accuracy.
• Claims management: This segment focuses on getting accurate reimbursements from payers or patients through error-free claim submissions and proficient resolution of denials.
• A/R management: Responsible for managing and collecting outstanding payments owed to the healthcare providers either by patients or health plans with technology solutions deployed to track and optimize the accounts receivable process.
• Care management: This segment is focused on the coordination and optimization of healthcare services for patients to ensure comprehensive and effective care.

The U.S. healthcare industry is characterized by complex services, stringent compliance requirements, intricate performance measures, and multifaceted payment workflows. These challenges necessitate the involvement of specialized service providers who possess the expertise to navigate and manage these complexities effectively.

US healthcare operations spend

The healthcare operations spend (defined by and limited to the value chain mentioned above) in the US has grown at a CAGR of approximately 3.2% from 2014 to 2023 and was valued at approximately US$201.1 billion (₹16.8 trillion) in 2023. This spend is expected to grow at a CAGR of approximately 5.2% to reach approximately US$258.9 billion (₹21.6 trillion) in 2028, driven by the rise in aging population, increasing prevalence of chronic diseases, and various governmental initiatives aimed at enhancing healthcare services, among other factors.

Split of operations spend by healthcare payers and providers

The healthcare payers are estimated to contribute approximately 68.7% or approximately US$138.2 billion (₹11.5 trillion) to the overall operations spend of US$201.1 billion (₹16.8 trillion) in 2023. The healthcare provider market had a comparatively smaller contribution of approximately 31.3% or US$62.9 billion (₹5.2 trillion) in 2023.

The healthcare payer operations spend is expected to grow at a CAGR of approximately 4.8% to reach US$174.8 billion (₹14.6 trillion) in 2028. While the insured population has grown at a CAGR of approximately 1.3% from 2019 to 2022, the growth in the payer operations spending has outpaced this rate. This trend is expected to continue due to factors such as rising consumerism and changing care models, among other factors. On the other hand, the healthcare provider operations market is expected to grow at a CAGR of approximately 6.0% to reach US$84.1 billion (₹7.0 trillion), driven by factors such as increasing demand for healthcare services and complexities in billing, among other factors.

Tailwinds driving growth in the US healthcare market

The following factors are expected to drive growth in the US healthcare market:

• Rise in aging population: The United States population aged 65 years and older as of July 1 is projected to increase from approximately 57.8 million in 2022 to approximately 71.2 million by 2030, growing at a CAGR of approximately 2.6%. This growth is expected to accelerate the share of 65-and-older population from approximately 17.3% in 2022 to approximately 20.6% of the total population in 2030 according to the US Census Bureau. As the elderly population grows, the demand for numerous age-related procedures and geriatric care will also increase, given their vulnerability to frequent illnesses. This will lead to a surge in demand for healthcare services, an increase in physician/hospital visits, and greater utilization of resources, thereby, fuelling growth in the healthcare industry.
• Increasing prevalence of chronic diseases: The number of people suffering from chronic diseases is rising steadily in the United States. According to the CDC, as of 2022, 6 in 10 adults in the US have a chronic condition and 4 in 10 adults have two or more chronic conditions, highlighting the burden of chronic disease in the U.S. Chronic diseases such as diabetes, cardiovascular diseases, asthma, cancer, etc. require frequent physician visits, medical care, diagnostic tests, and expensive prescription drugs. As the incidence of chronic diseases rise further, the demand for recurring services such as preventive care, outpatient care, and wellness management will accelerate, resulting in the growth of the healthcare market.
• Shift towards value-based care: Value-based care emphasizes quality, provider performance, and patient outcomes over the traditional fee-based model, thus, prioritizing holistic patient experience and effective results. By 2030, the CMS is targeting to have 100% of traditional Medicare beneficiaries and most of the Medicaid beneficiaries in an accountable care relationship, with advanced primary care serving as key means to attain this objective. CMS’ shift to value-based care and reimbursement will prompt healthcare enterprises to prioritize patient outcomes and deploy preventive strategies, thus, emphasizing outcome-oriented care delivery. This drive necessitates efficient care management operations, enhancing patient satisfaction and healthcare outcomes. As a result, the healthcare payers and providers will need to invest in solutions that lead to actual, long-term impact on improvement in member/patient health, thus driving growth in the healthcare market.
• Increased consumerization in the US healthcare industry: The growing emphasis on proactive wellness initiatives is encouraging members and patients to seek personalized services to manage their health and treatment decisions. As a result, this has driven the need for transparent processes, elevated customer experience, and nuanced solutions that can attend to patient and member requests 24*7. Consequentially, healthcare payers and providers are investing in interoperable solutions, tailored care plans, and targeted outreach efforts to ensure comprehensive member experience. As the healthcare consumerization journey evolves further, it is expected to increase the demand for a range of healthcare services, including wellness programs, and disease management initiatives, thus, accelerating growth in the US healthcare market.
• Shift in care delivery models: Following the COVID-19 pandemic, the US healthcare industry has seen a surge in the adoption of non-traditional care delivery models like remote patient monitoring, telehealth, and home-based care. According to CMS, this trend has been notably reflected in the significant increase in spend by home healthcare agencies that increased 6% in 2022 to reach US$132.9 billion (₹11.1 trillion), a notable acceleration from growth of 0.3% in 2021. Furthermore, the expanded coverage of remote monitoring services to additional healthcare providers who can now bill for these services as per Medicare Physician Fee Schedule 2024 has increased accessibility for such types of innovative care options as per CMS. This spurt in the growth of non-traditional care is expected to drive investments from healthcare enterprises into new capabilities around home-based care, telehealth etc., thus, enabling them to diversify their service offerings and cater to evolving patient preferences.
• Increasing push by the government to enhance healthcare services: While the U.S. healthcare expenditure is steadily growing, the US government and CMS has implemented several policy initiatives and guidelines such as CMS Framework for Health Equity, and HHS Roadmap for Behavioural Health Integration to improve the healthcare outcomes for the US population. The primary objective of these programs is to ensure comprehensive and equitable healthcare coverage to the US population irrespective of race, ethnicity, orientation etc. with a keen emphasis on addressing social determinants of health. In fact, as per a proposed rule on health equity, CMS has recommended to incorporate health equity experts on utilization management committees of Medicare Advantage organizations for annual review of their utilization management policies. These concerted efforts underscore the government’s commitment to ensuring robust healthcare services coverage for the populace, thus signalling a conducive environment to the growth of healthcare industry.
• Growth in health insurance coverage: Rising healthcare costs, coupled with the prevalence of chronic diseases, are driving a surge in demand for comprehensive health insurance plans in the US. As a result, individuals and families are increasingly seeking health insurance plans that offer a wider range of benefits, including preventive care, specialist consultations, and coverage for prescriptions. In fact, as per the recent reports from the US Department of Health and Human Services, the national uninsured rate reached an all- time low of 7.7% among all US residents in the first quarter of 2023. This highlights the growing awareness among the population about the importance of extensive health coverage, thereby emphasizing the continued expansion of the US healthcare market.

Challenges in the US healthcare market

While the US healthcare market has shown resiliency in overcoming some of the pain points faced by the industry, there is a likelihood of several challenges that may impact the sector. However, the industry is proactively taking steps to mitigate these challenges by engaging external vendors for outsourcing support. Some of the challenges are mentioned below:

• Shortage of healthcare talent including physicians and nurses: Labor shortages in the healthcare industry not only affect operational efficiency but also has an impact on patient/member care and experience. According to the U.S. Department of Health and Human Services, the US healthcare industry projects a shortage of 68,020 primary care physicians and 337,970 registered nurses by 2036. This scarcity may likely translate into reduced access to care, longer wait times for patients, and potential dissatisfaction among care-seekers, eventually resulting in deferred treatments and a drop in healthcare revenues. Further, doctors may face increased workloads and burnout, leading to attrition and rise in operational costs for healthcare facilities as they compete to retain talent. As a result, the quality of care, adoption of innovation, and eventually, profitability, may get compromised, further impacting the overall growth of the healthcare industry.
• Enterprise consolidation and rise in cost of care: The US healthcare market continues to witness a flurry of consolidations across both – payer as well as provider enterprises. While consolidation does offer opportunities for efficiency, it also brings about significant risks, impacting factors such as competition, access, and pricing. In fact, according to the National Association of Insurance Commissioners, the net premium per member per month (PMPM) as of December 31 increased by 6.7% in 2022 compared to 2021, rising from US$296.0 to US$316.0. As a result, consumer demand for healthcare services and insurance products may get affected, potentially exacerbating health disparities and impacting the growth of the healthcare industry.
• Increasing friction between payers and providers impacting member experience and treatment journeys: The increasing friction between payers and providers poses an emerging challenge that may impact member experience and treatment journeys in healthcare. For example, a review conducted by the Office of Inspector General reveals that Medicaid managed care organizations deny approximately one out of every eight requests for the prior authorization of services, highlighting the gravity of the situation. Factors such as systematic problems with MCO prior authorization processes, limited use of external medical reviews, and administrative problems with MCO prior authorization decisions contribute significantly to these denial rates. These conflicts over utilization reviews, reimbursement rates, denials, and billing practices may lead to a subpar patient experience, as patients face delays in accessing care and disruptions in the treatment plans, ultimately resulting in poorer health outcomes. As a result, patients may seek alternative care options or delay treatments, eventually, impacting growth of the healthcare market.
• Escalating revenue pressures amid regulatory changes: As regulatory changes unfold, healthcare enterprises may face escalating financial strains. The conclusion of the Public Health Emergency (PHE) post-COVID-19 lifted off waivers, exacerbating challenges in maintaining financial stability. Further, Medicaid redeterminations are expected to result in loss of coverage for certain ineligible individuals, thus, diminishing access to care. Additionally, the Inflation Reduction Act is expected to alter the financial dynamics, as payers now face increased financial responsibility, rising to 60% in the catastrophic phase for Medicare Part D according to CMS. This may lead to tighter margins for healthcare enterprises and impact their growth prospects.
• Impact of potential slowdown in 2024: While the concerns around recession in the US diminish on account of improved economic outlook, the impact of a recession on healthcare remains considerable, given its significant contribution to the US GDP. In the wake of the recession, government healthcare spending may face constraints as tax revenues decline, prompting the reallocation of resources. As a result, healthcare being a significant contributor to the US GDP may face budgetary pressure. Further, healthcare providers may experience reduced demand for non-urgent services due to financial strain on members who lose employment coverage, resulting in deferred treatments, and loss of revenue, thus, impacting the growth of healthcare.
• Increasing frequency of cybersecurity incidents: Healthcare organizations are prime targets for cyber-attacks due to the vast amount of sensitive patient data they handle. According to the U.S. Department of Health and Human Services, over the past five years, there has been a 256% increase in large breaches reported to the Office for Civil Rights (OCR) involving hacking and a 264% increase in ransomware. The recent example of Change Healthcare’s cyber outage has cost United Health Group, its parent company, nearly US$872.0 million. These incidents can lead to financial losses impacting the already stretched margins, breach in patient confidentiality, and disruption in critical healthcare operations, thus, inviting regulatory scrutiny and impeding the growth of the healthcare ecosystem. However, the US healthcare industry is already taking steps to mitigate the effects of these challenges by seeking outsourcing support from external vendors. Let us look at some of the major drivers of outsourcing in the US healthcare market below.

Trends driving growth in the US healthcare outsourcing market

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Healthcare payers and providers are seeking third-party support to gain capabilities that enable them to deal with the challenges such as evolving regulatory landscape, increasing patient expectations, and burdening clinician pressure among others. The following trends list down the drivers behind the outsourcing spends of the healthcare payer and provider enterprises:

• Continued staffing shortages propelling an increased demand for third-party support: As detailed out in the previous section, the US healthcare industry is likely to face an acute shortage of clinical talent. Healthcare providers, when faced with worsening staffing challenges and an ageing population, face far-reaching consequences that not only strain existing clinical talent but also increases the risk of errors. Moreover, the shortage of resources leads to delays in reviewing medical records, assessing medical necessity, and undertaking authorization procedures, leading to suboptimal patient experiences, lower Star ratings and potential revenue loss for payers. As a result, the demand for service providers who can offer skilled talent (e.g., nurses) with domain expertise for services such as clinical management, through a cost-effective delivery model is expected to increase. This will ultimately enable in-house enterprise clinical staff to focus on core care processes, which will positively impact patient care and improve their care journeys.
• Regulatory changes accelerating emphasis on better member engagement: Evolving regulatory changes in the healthcare market are compelling enterprises to enhance their capabilities to remain compliant. For instance, with the end of Public Health Emergency (PHE), states have resumed conducting annual Medicaid eligibility reviews, necessitating assistance with processes such as outreach and member engagement and eligibility verification.

Further, despite CMS raising payments for Medicare Advantage Programs by 3.7% in CY 2025, the decrease in effective growth rate along with rising medical inflation could adversely impact the financial health of Medicare Advantage-focused payers. Successfully navigating this complex and evolving regulatory landscape not only requires more resources to focus on administrative processes but also necessitates investments in staff training and technology upgrades, leading to higher operating expenses for healthcare organizations.

As a result, healthcare enterprises are expected to increasingly turn to outsourcing service providers who can handle the entire gamut of administrative processes including eligibility verification, member engagement, clinical documentation, prior authorizations, and claims management while staying abreast of regulatory compliances and mitigating the risk of penalties.

• Transition to ICD-11 to elevate the requirement for experienced and certified coders for optimal reimbursements: The new coding standard, i.e., ICD–11 coding system has over 55,000 codes to classify diseases, disorders, injuries, and causes of death, compared to the 14,400 in ICD-10, amounting to nearly 4x as many codes as ICD-10, according to the CDC. As countries prepare for this transition, it would bring a plethora of challenges for the healthcare entities in the form of increased administrative work, uptick in the demand of coding talent, higher expenditure on coder training, and need to update technology systems to accommodate the expanded code sets.

The healthcare enterprises that are inadequately prepared for this transition may experience an uptick in rejected claims, decrease in operational efficiency, and consequently, a drop in revenue. This serves as an opportunity for service providers to assist healthcare enterprises by coupling certified coding talent with modular and robust technology to ensure comprehensive delivery of services across coding, billing, claims, and multiple other processes.

• Increasing data breaches underscoring the surge in demand for robust data security to ensure compliance and safeguard patient information: According to the U.S. Department of Health and Human Services, there have been over 4,900 healthcare data breaches of 500 or more records that were reported to Office for Civil Rights (OCR) from 2015 to 2024. These breaches have resulted in the exposure or impermissible disclosure of over 520 million healthcare records.

Amidst escalating cybersecurity incidents, the healthcare payers and providers are expected to seek outsourcing partners with robust systems and capabilities to bolster their defenses against evolving cyber threats. As a result, the demand for service providers with future-proof systems that can ensure data security, patient privacy, and compliance with industry regulations such as HITECH and HIPPA is anticipated to increase.

• Shift toward proactive healthcare to drive enterprises to develop capabilities in preventive clinical management such as disease management, population health analytics, and remote patient monitoring: The shift toward value-based care, especially for chronic and other diseases that require long term care management, is driving the push for proactive health management that necessitates coordination across different care delivery settings including home-based care. While this shift is driven by the objective of reducing healthcare costs and improving patient outcomes, it also leads to complexities that require capabilities for preventive clinical insights, accurate risk identification, and seamless services without care gaps.

As a result, the demand for service providers who can support healthcare enterprises in areas such as SDoH (data intake and analytics), utilization review, remote patient monitoring, population health management, risk identification and stratification, and other clinical services is expected to increase.

• Medical Loss Ratio (MLR) requirements prompting payers to optimize administrative spending: According to the CMS, the MLR regulations established by Affordable Care Act in the United States require several healthcare payers to spend at least 80% of premium dollars on clinical care and quality improvements, with the remaining portion designated for administrative costs and profits. Furthermore, the payers are required to provide rebate to their customers if they are unable to meet the MLR standards. Given the increasing burden of chronic diseases and higher utilization for several organizations, payers find it difficult to manage administrative expenses, thus, prompting a need for optimization. This is expected to compel payers to resort to outsourcing non-core functions such as member engagement, claims processing etc. to streamline operations and reduce administrative overheads, while enabling them to maintain MLR standards and ensure compliance.

Healthcare operations outsourcing penetration by market segments

The total outsourced operations spend in the US healthcare market grew at a CAGR of ~6.1% from CY 2014 to CY 2023. As a result, in 2023, the aggregate outsourcing penetration rate in the US healthcare operations market stood at 21.5-23.5%, resulting in a total outsourced operations spend of approximately US$ 45.0 billion (₹ 3.8 trillion). The healthcare payer market had a relatively higher outsourcing penetration at 22.0-24.0%, while the healthcare provider market had a relatively lower outsourcing penetration at 19.5-21.5% in 2023.

Further, the growth in the outsourced operations market is expected to outpace the growth in the insourced market. While the overall healthcare outsourced operations market is expected to grow at a CAGR of approximately 8.7%, the payer outsourced market is forecasted to grow at a CAGR of approximately 7.0% from 2023-28. The provider operations outsourced market, on the other hand, is expected to grow at a CAGR of approximately 12.5%.

US healthcare outsourcing supplier landscape

Categorization of service provider landscape and details of services provided:

There are 4 broad categories of service providers within the healthcare industry:

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• Healthcare specialists: These firms focus exclusively on the healthcare market. Healthcare specialists leverage their deep domain and process expertise to offer robust offerings across multiple value chain segments to clients. CorroHealth, Sagility, Shearwater Health, and Omega Healthcare are some examples of healthcare specialists having capabilities in both healthcare payer and provider markets. While some firms such as Omega Healthcare has a stronger presence in the provider (RCM) space, players such as Sagility uniquely stand out as a tech-enabled healthcare services specialist with integrated offerings in payer and provider markets.
• Broad-based IT and business services firms: These companies typically offer a blend of IT services (e.g., software development and implementation, IT maintenance support) and business services across various industries, including healthcare. In the healthcare sector, they may provide services to payers, providers, or both, such as claims operations, revenue cycle management (RCM) operations, provider network operations (provider engagement) services, and other vertical-specific processes. Accenture, Cognizant, and EXL are some examples of broad-based IT and business services firms. While this category of firms also provides industry-agnostic services such as human resources, finance, and accounting services, etc., some of them do not have an integrated offering for healthcare.
• Product-focused companies: Companies that specialize in providing products or solutions for the healthcare industry, such as electronic health records (EHR) systems, health information systems, analytics solutions, etc. Their business model often incorporates a license-based engagement as well as partnerships with service providers for bundled offerings. Optum, Cotiviti, FinThrive, and Epic Systems are some examples of product- focused companies.
• Broad-based CX firms with presence in the healthcare market among other verticals: In healthcare, these companies prioritize enhancing the experience and satisfaction of members/patients by offering front-end services such as member support, inquiries, issues, etc. through traditional contact centers as well as digital channels. These firms typically have limited capabilities on the back-office operations such as utilization management, claims management amongst others which limits their ability to provide integrated end-to-end healthcare offerings. ResultsCX is an example of a broad-based CX firm with a presence in the healthcare market.

The typical value propositions and focus areas of the 4 broad categories of service providers are given below:

Digital adoption in healthcare

While the service provider landscape is extensive, differentiation requires strategic investments in digital solutions. However, the adoption of these technologies in healthcare depends on various factors driving the pace of digital adoption.

Factors that will determine the pace of digital adoption in healthcare:

There are multiple factors that will determine the pace of digital adoption in healthcare services. Some of the notable factors are described below:

• Timeframe associated to achieve interoperability across multiple platforms and systems: Interoperability in healthcare enables different systems to access, integrate, and use data seamlessly, improving care coordination and reducing redundant processes. Multiple regulatory provisions such as CMS Interoperability and Prior Authorization rule and Health Information Technology for Economic and Clinical Health (HITECH) Act promote interoperability by focusing on adoption of electronic data exchange through APIs and incentivizing adoption of EHRs respectively. However, achieving full interoperability still presents multiple technical and non-technical challenges, such as standardizing diverse systems, replacement cost concerns, and privacy issues. Overcoming these requires collaboration among stakeholders to establish shared standards, data exchange protocols, and supportive policies, thus, necessitating the need to develop modular and flexible solutions capable of integrating with diverse set of existing systems.
• Wider acceptance of proactive and digital patient care initiatives: The healthcare landscape is rapidly embracing proactive patient care initiatives, fuelled by the recognized advantages of prevention and early intervention, alongside increased regulatory backing for preventive care and remote monitoring policies. However, the adoption of digital care initiatives is contingent upon organizational readiness to support modern infrastructure and compliance with regulatory standards. As a result, healthcare enterprises will require real-time analytics and automation capabilities that can ensure seamless care delivery and improved outcomes by identifying potential health risks, predicting disease progression, and ensuring right intervention.
• Pace of modernization of legacy EHR/EMR systems: Many healthcare providers are grappling with outdated technology infrastructure, which consists of fragmented modules and databases that are ill-equipped to handle the vast data volumes generated from modern digital solutions. Furthermore, transitioning from legacy systems to new-age systems demands substantial investments in financial resources and technical expertise. As this transition progresses, the adoption of digital solutions is expected to accelerate, resulting in improved data accessibility, enhanced member experience, and robust predictive capabilities such as fraud detection, thus enhancing operations across multiple processes.
• Training and enablement of digital healthcare workforce: The adoption of digital solutions in healthcare necessitates comprehensive training and the acceptance of a digitally proficient healthcare workforce among patients and members. This entails providing targeted education programs to equip staff with the necessary skills to effectively utilize new technologies. As enterprises increase investment in developing and providing such training programs, the impact on optimizing operations, enhancing decision-making processes, and improving service delivery shall be realized.

Generative AI and its value promise for healthcare

Generative AI refers to the application of artificial intelligence techniques that can generate new content in the form of text, images, videos, audio, and more. This technology is built on underlying models that are trained on large, extensive datasets. Some of the prominent GenAI models in the market include OpenAI’s GPT, Google’s Gemini, and Meta’s LLaMA.

GenAI has the potential to improve organizational productivity by streamlining a variety of tasks, thereby increasing efficiency, optimizing processes, and enhancing the overall patient/member experience. While it has numerous applications in healthcare, most can be grouped into the following categories:

While GenAI shows promise in simplifying tasks with low-to-moderate complexity, the solutions still require human- in-the-loop engagements in the healthcare industry due to the degree of risk involved and regulatory concerns. Human intervention ensures that AI-generated outputs are reliable and error-free, particularly in critical decision-making processes. Moreover, the dynamic nature of healthcare demands adaptability and contextual understanding, areas wherein human expertise complements AI capabilities.

Emerging use cases of generative AI in the healthcare industry

Numerous use cases for GenAI are emerging across healthcare payers and providers in areas such that are aimed at enhancing patient care and improving operational efficiency. While majority of the use cases are still in pilot/testing stage, examples of the notable ones are as follows:

While these use cases do provide an opportunity to enhance existing processes, their impact will be subject to the factors driving digital adoption in healthcare such as interoperability and modernization of legacy systems, among others. Furthermore, careful considerations will have to be given to several challenges and risks associated with Gen AI to ensure its safe and effective implementation.

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Management of Berkmeer India Private Limited

Promoters & Board of Directors

• Promoters are Sagility B.V. and Sagility Holdings B.V.

Board of directors

Share Holding pattern

Ipo details of Sagility India

Financial of Sagility India

Key Performance Indicators of Sagility India

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Assets & Liabilities of Sagility India

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Profit & Loss of Sagility India

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Cash Flow of Sagility India

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Capital structure of Sagility India

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SWOT ANALYSIS of Sagility India

• Strengths
  • Strong Client Relationships: Sagility India has maintained enduring relationships with major U.S.-based payers and healthcare providers, highlighting trust and reliability.
  • Specialized Services: The company offers comprehensive claims management, clinical management, payment integrity services, and revenue cycle management tailored for the U.S. healthcare sector.
  • Experienced Management Team: Sagility India benefits from a seasoned management team with extensive experience in the healthcare services industry.
  • Positive Financial Performance: The company has shown improving cash flow from operations and annual net profits over the last two years.
• Weaknesses
  • Limited Geographical Reach: Sagility India’s operations are primarily focused on the U.S. healthcare market, which may limit its growth potential in other regions.
  • Negative Cash Flows: Despite recent improvements, the company has experienced negative cash flows from operating, investing, and financing activities in the past.
  • High Competition: The healthcare services sector is highly competitive, with many players offering similar services, which can impact market share and profitability.
• Opportunities
  • Expansion into New Markets: Sagility India can explore opportunities to expand its services to other countries, tapping into new customer bases.
  • Technological Advancements: Investing in new technologies can improve efficiency and competitiveness in the healthcare services market.
  • Strategic Partnerships: Forming partnerships with other companies can help Sagility India enhance its service offerings and market reach.
• Threats
  • Economic Downturns: Economic instability can affect project funding and demand for healthcare services, impacting revenue.
  • Regulatory Changes: Changes in healthcare regulations can increase compliance costs and affect operations.
  • Intensifying Competition: The healthcare services sector is highly competitive, with many players offering similar services, which can impact market share and profitability.

Risks of Sagility India

• The healthcare services industry is highly competitive and if we are unable to compete effectively, it may adversely affect our business, financial condition and results of operations.
• Our business is solely focused on the U.S. healthcare industry and may be adversely affected by factors affecting the U.S. healthcare industry, including a decline in the growth of the U.S. healthcare industry, reduction in outsourcing and other trends.

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