Twenty-four years between the ward and the boardroom

Mandate

Turn the expansion plan in the listing documents into hospitals that could be staffed, and give the board a disciplined basis for acquisitions and partnerships.

Outcomes

• Opened focused hospitals at Chandrapur, Yavatmal and Durg for ₹505 Cr against a ₹930 Cr plan; average EBITDA breakeven in 21 months against 38.
• Recommended declining a ₹780 Cr acquisition in Indore and led the ₹265 Cr purchase of a 210-bed hospital in Bhopal, whose EBITDA margin rose from 9 to 17 per cent.
• Kept the diagnostics subsidiary against a ₹1,050 Cr offer; revenue rose from ₹410 Cr to ₹580 Cr and EBITDA margin from 14 to 21 per cent by FY2025-26.
• Negotiated a fifteen-year agreement to operate a 300-bed trust hospital in Sagar; occupancy rose from 48 to 73 per cent.
• Introduced post-investment reviews for every project above ₹100 Cr at two and four years after commissioning.

Decisions in context

I became chief strategy officer in April 2021, when Kesarvan had seven hospitals and 2,280 beds and was still recovering from the pandemic. The managing director's brief was blunt: the expansion plan we had described to investors in 2019 could not be staffed as written, and the board needed a better way to judge acquisitions. I rebuilt the plan around the specialists each city could keep, which produced three focused hospitals instead of three large ones. I also introduced post-investment reviews, beginning with our own Bilaspur hospital, and changed acquisition papers so that consultant concentration and payer receivables come before valuation. By March 2026 the group had twelve hospitals and 3,240 beds, revenue of ₹3,140 crore and net debt of 1.1 times EBITDA. I lead 34 people and present to the board at every strategy review.

Reason for the move

Current role. Not seeking an executive move; considering one independent directorship with the Kesarvan board's consent.

Mandate

Prepare the company's growth case for listing and build a diagnostics business alongside its hospitals.

Outcomes

• Led the ₹210 Cr acquisition of Prabhavali Pathology Laboratories in 2018 and its integration as Kesarvan Diagnostics.
• Wrote the strategy and use-of-proceeds sections of the listing documents for the November 2019 offering.
• Supported the 200-bed Bilaspur hospital, opened in 2019, whose slow ramp-up later prompted the post-investment review process.
• Planned the conversion of wards and laboratories during the pandemic, adding testing capacity across the diagnostics network in 2020.

Decisions in context

Kesarvan's founder approached me in late 2016, when the company had six hospitals, ₹1,320 crore of revenue and a private-equity investor expecting a listing within three years. I joined as vice president of corporate development with a team of nine. My first large task was the acquisition of Prabhavali Pathology Laboratories in 2018 for ₹210 crore, which became Kesarvan Diagnostics and drew directly on what I had learnt at Ankurit. I then wrote the strategy chapters and the use-of-proceeds plan for our November 2019 listing. I also supported the Bilaspur hospital, which opened the same year with a multi-speciality plan we could not staff; that misjudgement taught me more than the successes did. When the pandemic arrived, I helped plan which wards to convert and how to expand testing across the laboratory network.

Reason for the move

Promoted to chief strategy officer in April 2021.

Mandate

Grow the network beyond Pune through acquisitions of small laboratories and contracts to run laboratories inside hospitals.

Outcomes

• Acquired and integrated seven small laboratories for a combined ₹185 Cr.
• Built a hub-and-spoke courier network that cut median sample turnaround for routine tests from 26 to 14 hours.
• Signed contracts to run laboratories inside 38 hospitals.
• Closed two loss-making regional laboratories and folded their work into the reference laboratories.

Decisions in context

I joined Ankurit in May 2012, having worked on the commercial diligence for its investor the year before; I disclosed that to the chief executive before accepting. The company had revenue of ₹160 crore from laboratories around Pune and an investor who wanted it to triple in five years. I led the strategy and expansion team, buying seven small laboratories for ₹185 crore and integrating their staff, systems and doctors' relationships. We built a courier network that brought samples from collection centres to reference laboratories at Pune, Nashik and Belagavi, and won contracts to run laboratories inside 38 hospitals. Revenue reached ₹470 crore in 2016–17. The work taught me that an acquisition is decided in the months after completion, and that a laboratory's reputation with local doctors does not survive a careless change of name or a slower report.

Reason for the move

Invited by Kesarvan's founder to lead corporate development at a hospital group preparing to list, where my clinical training would count for more.

Mandate

Lead commercial diligence on hospital and laboratory acquisitions for private-equity and strategic investors.

Outcomes

• Led commercial diligence on nine hospital and laboratory transactions with a combined enterprise value of about ₹2,400 Cr.
• Introduced referral-concentration analysis by consultant and referring source as a standard part of the firm's diligence.
• Advised one investor against a transaction whose key surgeons later left the hospital.

Decisions in context

As engagement manager I led teams of three to six consultants on commercial diligence for private-equity and strategic investors buying hospitals and laboratories. Over three years we worked on nine transactions with a combined enterprise value of about ₹2,400 crore. The defining case came in 2010, when I reported that three surgeons produced nearly half of a hospital's surgical revenue on contracts they could end at will. The investor proceeded, and two of the three had left within a year. After that I made referral concentration, by treating consultant and by referring source, a standard section of every report we wrote. I also learnt how investors read diligence: they want the risk priced, not merely described. By 2012 I wanted to be accountable for what happened after a deal closed, and I left to join an operating company.

Reason for the move

Wanted to own the outcomes of expansion and integration rather than advise on them.

Mandate

Prepare feasibility studies and market assessments for hospital projects in smaller cities.

Outcomes

• Prepared feasibility studies for fourteen hospital projects in cities with populations between three and twelve lakh.
• Recommended against three of the fourteen projects, all of which the promoters later abandoned or scaled down.
• Built a district referral model from outpatient and laboratory data that the practice adopted for later studies.

Decisions in context

I joined Kalvert Mehra Advisory in July 2006 to work on feasibility studies for hospital promoters, most of them doctors or business families planning their first hospital in a smaller city. I prepared fourteen studies in three years, travelling to towns across Maharashtra, Madhya Pradesh, Gujarat and Karnataka to count beds, interview general practitioners and sit in outpatient queues. I recommended against three projects, an unpopular view with clients who had already bought land, and all three were later abandoned or scaled down. I also built a model of where a district's patients actually went for care, using outpatient registers and laboratory volumes rather than population ratios alone. The practice adopted it for later studies. What I learnt, without yet knowing how much it mattered, was that the promoters who struggled were rarely short of patients; they were short of doctors.

Reason for the move

Promoted to engagement manager.

Mandate

Reduce waiting times for admission and improve the use of beds and theatres.

Outcomes

• Cut the time from a patient's discharge to a ready bed from 5.5 hours to 2.4 hours.
• Reduced average length of stay for planned surgical patients from 6.1 to 4.8 days with the surgical departments.
• Set up the hospital's first desk for cashless admissions through insurers' third-party administrators.

Decisions in context

I joined Indumati Seva Trust Hospital in June 2002 as a management trainee, two months after completing my diploma. It was a 450-bed charitable hospital whose reputation rested on honorary consultants who gave it part of their week. I ran the admissions and bed-management desk, and from 2004, as assistant manager, the operations of the surgical floors, with a team that grew to 22. Patients waited days for planned surgery while beds stood empty for hours between discharges, so we redesigned discharge rounds, housekeeping and pharmacy clearance, and cut bed turnaround from 5.5 hours to 2.4. With the surgical departments we reduced length of stay for planned procedures from 6.1 to 4.8 days. I also set up the hospital's first desk for cashless admissions through insurers' administrators. I left in 2006 to see many hospitals rather than one.

Reason for the move

Wanted to see how many hospitals worked, not one, and joined a healthcare consultancy.