1. Ambulatory Surgery Centers, India
Nova Business Model & Value Proposition
Mr. Suresh Soni, Chairman & CEO,
Nova Medical Centers
2nd September 2011
©2011. Nova Medical Centers. Strictly private and confidential

2. Ambulatory Surgery Centers | 2
Indian Healthcare growing exponentially
… to $280Bn by 2020
Indian Healthcare
In $Bn $280Bn
India's healthcare However, the spend
spend ($40Bn) is represents a meager
CAGR
Growth of growing at 16%, well 4.1% of GDP as
22%
ahead of 8% GDP compared to global
180
growth average of 9.7%
©2011. Nova Medical Centers. Strictly private and confidential
25%
$ 40Bn By 2020, Private
17% Significant
healthcare spend in
100 investment
India is estimated to opportunity
20
20
be ~$180Bn
2010 2020
PRIVATE PUBLIC

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Very Active Investment Interest in Healthcare
… from PE / VC’s
Private Healthcare Delivery Source of Funds
2011 Stand Alone Surgery Centers / Tertiary
FDI / Venture Capital / Private
& Hospitals / Medicities / Other
Equity / Private Funds
beyond Innovative Models
Corporate Chain Private Funds /
2000 Multi Specialty Hospitals Foreign Direct Investment (FDI)
©2011. Nova Medical Centers. Strictly private and confidential
1990’s Standalone Multi Specialty Hospitals Private Funds / Debt
Group / Single Specialty Practice /
1st Corporate Hospital Established Family / Private Funds
(Apollo)
1980’s Single Practice / Nursing Home Self Funded

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The Last Decade has seen large number of
Investments in the Healthcare Segment
1 2
382 M&A deals worth $19.4Bn 275 deals in Venture Capital &
Including Increasing buyouts by Private Equity worth $2.9Bn
large corporate hospitals for • AIG & JP Morgan invested ~$100Mn
immediate scale in Narayana Hrudayalaya
Example: Fortis’ acquisitions of • Warburg Pincus’ investments in Max
Wockhardt, Malar, Hiranandani of $33Mn
Hospitals • Recently, Sequoia invested $20Mn in
Vasan Eye Care
©2011. Nova Medical Centers. Strictly private and confidential
3
Foreign Direct Investments
• Singapore-based Parkway Group
Healthcare JV with Apollo Group
• Columbia Asia Group, US started
operations in India
• Max collaboration with Singapore
General Hospital

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Healthcare Providers command significant valuation premiums
But Wealth Creation is solely benefitting Promoters and Investors
Enterprise Value Multiple
(EV) Revenue EBITDA EV / EBITDA
RECENT DEALS
3,000 350 ~110 27x
27x
560 200 20 28x
28x
©2011. Nova Medical Centers. Strictly private and confidential
475 ~330 ~32 15x
15x
PUBLIC COMPANIES
6,142 2,027 324 18x
18x
7,330 1,467 498 14x
14x

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Nova’s Ambulatory Surgery Centers seek to provide
better economics to all stakeholders
FINANCIAL
BENEFITS
to…
DOCTORS Doctors
VALUE Patients
©2011. Nova Medical Centers. Strictly private and confidential
created by MANAGEMENT TEAMS
Insurance Companies
ADMINISTRATIVE STAFF
Investors

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Nova has introduced a unique Ambulatory Surgery model in
India
Compact 10,000 – 12,000 sq ft
leased center
Clinically Proven Procedures
undertaken by experienced
surgeons
©2011. Nova Medical Centers. Strictly private and confidential
Use of Advanced Equipment, Patients are pre screened
technology and surgical techniques to avoid complications
reduce recovery time
Each center has Recovery & discharge occurs
− 5 Operating Theatres from 2 – 72 hours after surgery
− 15-20 Pre and Post Op Rooms
is performed. 90% of patients are
− 8–10 OPD Consultation Suites
− Pathology Lab, Radiology & Pharmacy discharged the same day.
− Preventive Health check
Nova Patients Save 15-20% as compared to corporate Hospitals

8. 8
Each Nova Center Offers a Comprehensive Range of Services
Operating Theaters
Five state of the art operating theaters
IVF
Fully Equipped Pre and Post Operating
Lab, Ovum pick up Recovery
and Embryo Typical Nova center has 16-20 beds with
transfer. ICU facilities and 2-3 rooms for short stay
Radiology Services
©2011. Nova Medical Centers. Strictly private and confidential
X-ray, Ultrasound, Echo, ECG, Pathological Labs
and TMT, C-Arm (Routine, Biochemistry, Hematology,
Special, DSA). Micro-Biology, Cytology &
Histopathology, Serology
including tumor markers
Pharmacy
Doctor’s Outpatient
Clinics
Health Checkups

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Major Specialties covered at Nova Ambulatory Centers
©2011. Nova Medical Centers. Strictly private and confidential
Paediatric surgery

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ASC's are Eco Friendy & provides better value
… to all stakeholders
Conventional ASC’s
100 Bedded Hospital
Eg: Nova
Land Acquired Leased
Space required 60 – 70,000 sq ft 10 – 12,000 sq ft
# of OT’s 5 5
Staff At least 300 staff 35 & Support Staff
©2011. Nova Medical Centers. Strictly private and confidential
Insurance Mandatory 24 hour Stay Stay not Mandatory
Initial Set up costs ` 120 – 130 crores ` 10 - 12 crores
Monthly Optg Costs ` 2 - 3 crores ` 35 – 40 lakhs
Break Even Time 5-7 years 8 – 10 months

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Nova has introduced a Unique Ambulatory Surgical care
model in India
Each center is a 70:30 partnership between Nova Holding Company & 40
experienced surgeons
Each Surgeons can invest up to Rs ` 10 lakhs
Each center costs `10 – `12 crores to build
Nova Medical centres have low Operating Costs of
Rs 30 lacs per month
40 Surgeons performing 2.5 surgeries a month
will achieve break even
©2011. Nova Medical Centers. Strictly private and confidential
Typically Cash flow positive in One year from
inception
Owner doctors receive:
• Higher professional fees
• Profit Sharing
• Very Significant equity appreciation

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Only Nova's Unique Business Model allows Equity
Ownership and Wealth Creation for Professional Doctors
• Non-owner doctors receive
30-40 % professional fees in
less than stellar facilities, no
Significant Equity national branding, no profit
Appreciation sharing or equity
(8 – 10x consideration
of initial investment)
Marginal to Nil
Terminal Value for
Practice
©2011. Nova Medical Centers. Strictly private and confidential
Performance Profit Share from
No Equity or Profit
Linked Incentive large Investment by sharing for Doctors
(PLI) Nursing Home
Owner
10 – 20% of surgical
Package paid as
30 – 34% Professional Fees Professional fees
Professional Fees (less affiliate
charges)
Nova Ambulatory Nursing Homes Corporate
care Model Hospitals

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Nova Business Model has achieved been
accepted by all stakeholders
Clinical Proven
Undertaken over 6,000+ Surgeries with Superior
Outcomes .
Doctor Acceptance
Over 300 doctors under Nova fold across 5 cities
©2011. Nova Medical Centers. Strictly private and confidential
Insurance Empanelment
All major insurance companies/ TPA’s have
empanelled Nova to undertake ~ 800 surgical
procedures without 24 hour mandatory
hospitalization
Patient Acceptance
Over 97% patient satisfaction

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Nova business model creates value for all
stakeholders in the Healthcare Industry
MULTI-FOLD ADVANTAGES
FOR PATIENTS, SURGEONS, HEALTHCARE PROVIDERS
AND INSURERS & TPAS
Patients
• 15-20% cheaper package rates compared to Corporate Hospitals
• Better Outcomes
• Faster Discharge & Recovery at home reduces chances of HAIS
Surgeons
• Higher Professional Fees, Profit Sharing and Ownership interest leads to
©2011. Nova Medical Centers. Strictly private and confidential
significantly improved economics for Surgeons
• Pride of Ownership without large Investment
• Flexible work schedule and improved lifestyle
Insurance & Corporate Employers
• Significant cost Savings
• Increased Productivity for work force as operated employees return faster to work
• Pan India footprint and strong brand offers consistent expectations and easy to
manage relationships