How Accessible is PE/VC Funding to Regional Players? A focus on East India Vrinda Mathur Healthcare and Life-sciences Advisory © Grant Thornton India LLP. All rights reserved. About Grant Thornton A cohesive global organization and leading professional services firm in India Ranked among Total global More than 38,500 people based in over 130 countries revenues $4.5bn (2013) top 5 in all major markets including India Grant Thornton 2,000 International people in over Member firm within 11 and over 70 0 offices © Grant Thornton India LLP. All rights reserved. cities one of the largest fully integrated Assurance, Tax & Advisory firms in India CONTENTS Key Points for PE/VC Funding Healthcare Stats Dealscape: India and Regional © Grant Thornton India LLP. All rights reserved. Regional Deals: Case Studies Glaring Statistics on Indian Healthcare Scenario India ranks 112th on the WHO ranking of the world’s health systems. Healthcare spending accounts for a mere 4% of India's GDP, far below OECD's average of 9.5% Doctor-to-patient ratio for rural India, as per the Health Ministry statistics, stands at 1:30,000, well below the WHO’s recommended 1:1,000. Of the 1.35 mn hospital beds, only 48% are functional Merely 20% of India’s 1.2 billion population is covered by health insurance • least developed among all zones • hospital projects in Tier II towns getting funded by high interest borrowings from banks making projects unviable and most recently through select PE/VC investments • resistance from skilled staff to settle in this region • high number of private nursing homes but very few multi specialty/ network of hospitals East India Healthcare Scenario © Grant Thornton India LLP. All rights reserved. Key Healthcare Investment Trends in India: 2011- 2013 Healthcare has seen US$3.5bn worth of transactions during 2011-13 Multi Specialty Hospitals have seen maximum volumes with an average US$50mn ticket size followed by Single Specialty hospitals with an average US$20mn ticket size 70 M&A and PE Activity between 2011-2013 60 Average Deal Size (US$ mn) • • Multi Specialty Hospital ~ US$ 7 bn 50 Pharma Pharmaceuticals 40 Diagnostic Centres ~ US$ 3.5bn Healthcare Medical Devices 30 Primary Care Services Single Specialty Hospital 20 ~ US$ 1 bn 10 Biotechnology 0 0 20 40 60 No. of deals © Grant Thornton India LLP. All rights reserved. 80 100 120 140 MedTech PE Investment Trends in India- Healthcare : 2011- 2013 Continuous Uptick in Volumes and Values Deal Volume 13 2011 24 2012 40 2013 Deal Value US$ mn US$219 mn 2011 US$577 mn 2012 US$639 mn 2013 3 5 2 3 8 8 4 4 Single Specialty 15 15 6 4 Multi Specialty Hospital Primary Care Services 10 158 152 102 14 37 316 474 6 Diagnostics Centre 103 12 51 • Single and Multi Specialty Hospitals have seen significant traction in PE/VC investments • Deals in this space, particularly single specialty hospitals have happened at 3x-4x 1yr forward revenue multiples © Grant Thornton India LLP. All rights reserved. Geographic Distribution of PE Deals in India: 2011 till date North 2011 Volume 107 US$ mn 2458 Pharma/Healthcare Volume 5 US$ mn 42 West 2011 Volume 127 US$ mn 2486 Pharma/Healthcare Volume 4 US$ mn 7 2012 123 2298 2013 151 3893 2014 79 1464 8 107 16 219 5 52 South Volume US$ mn Pharma/Healthcare Volume US$ mn © Grant Thornton India LLP. All rights reserved. 2012 92 2293 2013 110 2935 2014 YTD 56 772 8 125 16 512 2 25 East 2011 Volume 14 US$ mn 354 Pharma/Healthcare Volume 1 US$ mn 3 2011 125 3476 2012 180 2756 2013 176 3126 2014 YTD 86 1344 8 209 21 669 35 648 12 270 2012 6 30 2013 15 118 2014 7 65 1 5 5 45 2 3 Key Healthcare Investments in East India Year Investor 2011 Sequoia Capital,Elevar Equity 2012 Matrix Partners 2013 2013 2013 Ennovent GmbH; Ankur Capital Advisors Swedfund International AB; Deutsche Investitions- und Entwicklungsgesellschaft mbH; Quadria Capital Angel funding through the Intellecap Impact Investment Network 2013 Lighthouse Funds 2013 SIDBI Venture Capital Ltd 2014 Samridhi 2014 Arun LLC, Mumbai Angels © Grant Thornton India LLP. All rights reserved. Investee Sub sectors Glocal Healthcare Systems Pvt Ltd Enhance Aesthetic and Cosmetic Studio Pvt Ltd Multi Specialty Hospital Dermatology & Cosmetology ERC EyeCare Pvt. Ltd. Eye Care N.A. Medica Synergie Pvt Ltd. Multi Specialty Hospital 25.7 iKure Techsoft Pvt Ltd Primary Healthcare N.A. Suraksha Diagnostic Pvt Ltd Glocal Healthcare Systems Pvt Ltd Kanungo Institute of Diabetes Specialities (KIDS) iKure Techsoft Pvt Ltd Diagnostics Centre Multi Specialty Hospital Diabetes Specialities Primary Healthcare US$ mn 3.2 5.5 9.0 4.0 2.9 0.1 Key Takeaways: Seeking PE/VC Funding PRE ▪ Positioning the growth story – a robust business plan ▪ Clarity on Fund requirement and Utilization ▪ Timing of the fund raise DUIRNG ▪ Groundwork (systems, financials, controls etc) ▪ Right team in place to scale business ▪ Quantum/ willingness of divestment POST ▪ Approach the right set of funds ▪ Visibility of financial and strategic plan post funding © Grant Thornton India LLP. All rights reserved. Case Study of Regional Healthcare Players raising PE/VC PE Funding: Mewar Ortho (Rajasthan) and Meditrina (Kerala) Highlights • Promoter run chain of specialty hospitals in Non metros/ non urban areas • Closely held family business entailed evaluation of the merits and demerits of each funding route. • Significant narrowing down of target investors Challenges • Limited or No exposure to external fund raising & Closely held family run business • Showcasing the profitability of the centres & network • Deciding on the domestic expansion strategy (tier II cities only) • First such transaction in the specialty orthopaedic space and in specialty cardiac space in India © Grant Thornton India LLP. All rights reserved.