Medium Healthcare Consulting

At the 9th International Healthcare Conference organized by VOICE OF HEALTHCARE, Dr Nitiraj Gandhi our Managing Partner, moderated a thought-provoking panel discussion on “The Role of Healthcare Providers in Building Resilient Healthcare Systems.” Hospitals and other healthcare providers form the backbone of healthcare ecosystems, ensuring quality care, operational efficiency, and equitable access. The discussion highlighted innovative strategies from leading national and international providers, emphasizing capacity-building and collaboration as key drivers for strengthening healthcare systems and improving patient outcomes. A major thrust area identified was the integration of healthcare institutions and educational training, ensuring that medical education is both practical and immersive. From simulation-based learning and hands-on training in real healthcare settings to cross-border knowledge exchange programs, capacity-building initiatives are evolving to create a workforce that is better equipped, technologically adept, and ready to tackle real-world challenges. As healthcare continues to transform, collaboration, innovation, and adaptability remain crucial. At Medium Healthcare Consulting, we are committed to supporting healthcare organizations through strategic interventions and performance improvement initiatives that drive meaningful impact. Kudos to all the panelists for their invaluable insights and to the organizers for facilitating such an engaging dialogue on the future of healthcare! Puneet Tyagi Graphic Era Hospital @Yuh-Shin Kuo Dr.Aathithya Sp SP Medifort Hospital Dr Komal Patel Parul University Manuj Mittal (MT Guru) Dr. Naveen Nishchal Pinky Chahar Khushbu Sharma Dr. Samir Singh Jalaj Singh Mehta Bobby Ramesh Anuradha Moturi #HealthcareLeadership #ResilientHealthcare #MedicalEducation #HealthcareInnovation #CapacityBuilding #FutureOfHealthcare

With normal deliveries going out-of-fashion, we are witnessing an alarming trend, even more so with private hospitals. There is a reason why it is called normal. There is ample evidence to suggest that c-sections carry significant risks both for the mother and the newborn such as surgical injuries, blood loss, increased risk in future pregnancies, scar tissue formation, and breathing issues for the babies. Hence, it should be chosen only when there is adequate clinical justification. The reality however is quite different. There’s a joke that the only way you can have a normal delivery is if your gynecologist gets stuck in traffic. Or one-in-a-million chance of the mom-to-be getting stuck in a flight*. Southern states (except to a certain extent Kerala) are worrisome. Telangana leads the pack with over 60% of deliveries being C-sections, and in private hospitals, that number shoots past 80%. The WHO recommended norm of c-section being 10-15% of the total is well-forgotten. Most of the well-known maternity brands in the country - national or regional – will have c-section rates upwards of 70%. Cloudnine, as the largest player in the segment doing ~30,000 deliveries a year, is no different. This is even though gynecologists at Cloudnine earn the same for both types of deliveries and have no financial incentive to discourage normal deliveries. We all know that c-sections mean higher hospital bills because of consumables, higher clinicians’ fees and greater length of stay. But, contrary to popular belief that c-section is all about money, the reasons may be quite different. So, what gives? For starters, convenience. Why wait for a natural delivery to happen at an unearthly hour, say at 3 AM when you can schedule a C-section ‘when you want’. Narratives get crafted subtly to normalize c-sections. On the mothers’ part, who wants to go through pain anyway? A number of advanced countries manage to avoid such aberrations because of their continued focus on midwifery. In the Indian context, midwifery can do wonders even otherwise because a vast majority don’t have access to gynecs. It could be a boon to improve maternal and neonatal health. But in the absence of large-scale government support, we’re barely scratching the surface. So, what’s the fix? Stronger guidelines, better patient education, and a serious push for midwifery-led models. Otherwise, at this rate, normal deliveries might go the way of landlines - something we tell the next generation about with disbelief. What do you think? Are we too far gone, or can we turn this trend around? #Healthcare #MaternalHealth #CSection #HospitalManagement #Hospital #Consulting *On a Delhi-Bengaluru Indigo flight, a pregnant woman delivered a baby mid-air, with the assistance of Dr. Sailaja Vallabhaneni, a gynecologist from Cloud Nine Hospital, who was also on board. Cloudnine Group of Hospitals, Motherhood, Fernandez Hospital , Ankura Hospitals, Apollo Cradle

If hospitals had star ratings like hotels, it would be easier for a patient to do some price benchmarking. More than just an operational metric, ARPOB is a statement of where a hospital aims to position itself in the market, the way it defines its core target segment. At the top of the ladder, we have Artemis and Max. For a successful play in the high-premium segment, you focus on international patients and reduce scheme patients. Given that your patients are likely to be quite demanding, you need to have top-notch clinical talent pool and constantly upgrade the level of medical technology. ‘Value’ operators like NH or KIMS, for example, constantly face pricing pressure and, hence, need to keep a tight lid on cost to achieve reasonable margins. However, ARPOB also tells a story beyond pricing, as there are other determinants, such as ALOS. Beyond that, Rainbow, despite being a specialized pediatric player, sits lower in the mid-premium range, showing that a specialty focus limits positioning capabilities. KIMS, a dominant force in South India, has steadily grown and has made a strategic choice to stay firmly in the value segment. Of course, high ARPOB does not necessarily indicate higher profitability; for example, both Max and KIMS have EBITDA margins of ~30% and a RoCE of ~35% despite having significantly different ARPOB values. So, if hospitals did have a five-star rating system, where would you position them? #HospitalStrategy #HealthcareBusiness #ARPOB #MarketPositioning #HealthcareConsulting Artemis Hospitals, Max Healthcare, Fortis Healthcare, Apollo Hospitals, Medanta, Rainbow Children's Hospitals, Aster DM Healthcare, HCG Hospitals, Narayana Health, KIMS Hospitals

Healthcare is a numbers game, and this comparison across markets speaks volumes about how hospitals are structured, perform, and deliver care. Here are some insights: Bed-to-Revenue Efficiency >Apollo in India has ~9,500 beds and generates ~$1,160M in revenue. Meanwhile, IHH Singapore achieves a similar revenue with just ~800 beds. >Insight: High ARPOB (Average Revenue Per Occupied Bed) in Singapore ($7,000/day) underscores the premium healthcare positioning compared to price-sensitive markets like India ($700/day). Occupancy Rates Max India leads with 78% occupancy, slightly ahead of other Indian and international markets (~70%). Singapore is an outlier at 61%. >Insight: Lower occupancy in Singapore might indicate a more elective, non-emergency care model with higher margins compensating for fewer patient days. EBITDA Margins EBITDA margins are strong for Siloam (30%) and Türkiye IHH (30%), with Indian players like Apollo (25%) and Max (27%) holding their ground. >Insight: Efficient cost structures and high ARPOB in Türkiye and Indonesia translate to robust profitability, showcasing emerging market potential. Price vs. Value >Adjusted for purchasing power (PPP), India ($2,900 - 3,800/day ARPOB PPP) is still more competitive on price than Malaysia ($4,150/day) and Türkiye (~$7,550/day). >Insight: This affordability gap positions India as a prime destination for medical tourism, leveraging its high-quality yet cost-effective care model. Takeaway: Healthcare systems globally reflect market nuances - from affordability and access to operational efficiencies. For investors, operators, and policymakers, understanding these metrics isn't just academic - it’s the key to driving meaningful impact in care delivery. What stands out to you from these numbers? Let’s discuss. #healthcare #consulting #hospitals #international #emerging #markets Apollo Hospitals, Max Healthcare, Fortis Healthcare, Siloam Hospitals Group, IHH Healthcare

Back from the IFC - International Finance Corporation Healthcare Conference in Bali - where the conversations were as vibrant as the location! The conference had some of the global thought leaders share their views on subjects ranging from universal health coverage challenges to tech-driven care models. Some of the notable speakers were Budi Sadikin (Hon. Health Minister of Indonesia), Farid Fezoua, Viren Shetty, Sejal Mistry, Dr. Vedha Sampath, Tathagato Rai Dastidar, Leona A. Karnali, CFA, FRM, Claudia Martínez, Geetha Tharmaratnam, Biju Mohandas, Vikram Vuppala, Alka Goel, Sylvana Q. Sinha, Esq. Some key takeaways that stood out: >UHC needs political will & money: Countries aim for 100% health coverage, but budget constraints are real. Sustained investment and policy commitment are non-negotiable. >Value-based care is here to stay: Health systems are shifting from service volume to patient outcomes—better care, not just more care. >Tech is rewriting the rulebook: AI, digital health, and data analytics are no longer future bets—they’re today’s enablers of seamless, efficient healthcare. >Women’s health deserves the spotlight: Bridging investment gaps in women-led healthcare businesses can unlock $400B in global GDP by 2040! Yet, funding for women’s health remains disproportionately low. >NCDs are the ticking time bomb: Prevention must take center stage, or we risk unsustainable healthcare costs. Governments, insurers, and providers need to work together on proactive models. >Health equity and profitability can coexist: Investors are shifting focus from pure ROI to impact-driven models—integrating health equity isn’t just ethical, it’s strategic. >Public-private partnerships (PPPs) are essential: Scaling innovative solutions requires collaboration across stakeholders—governments, insurers, hospitals, and tech players need to align incentives. The conference wasn’t just about networking - it was about rethinking the future of healthcare. The challenges are huge, but so are the opportunities. The big question: How fast can we adapt? #HealthcareInnovation #DigitalHealth #ValueBasedCare #UHC #HealthEquity #IFCHealthcare Ravee Diksshit, Om Manchanda, Dr Chandan Bhasin

Congratulations to Dr. Athishara Pisipati and Karan Nanivadekar: the two bright, young sparks in our team on their well-deserved promotion. Now, they both are Associate Consultants. Athishara, in a short span of a year, worked on multiple engagements in areas ranging from geriatric care and ‘mother & child’ to infertility treatment and cardiology. She has not only got used to a structured approach to problem solving, but learned enough finance, as she says, to create a balance sheet, which actually balances! Karan, the only Gen Z member in our team, has become the go-to resource for secondary research when it gets tricky. His contribution on some of the challenging projects we had from Bill & Melinda Gates Foundation and Tech Mahindra Foundation has been quite remarkable. We continue to be relentlessly focused on fueling the dreams of our team members and helping them achieve it. Such milestones tend to serve as the testimony of our philosophy. Dr Nitiraj Gandhi Ruchi Dixit Dr Chandan Bhasin

At Medium, we know that behind every spreadsheet, strategy, and slide deck, there is a person with unique passions and quirks. And it is the diversity (and commonality) of these interests, which creates such a thriving team. “Beyond the day job” is the series to share their stories. Meet Dr Chandan Bhasin. When he's not immersed in healthcare projects, he’s busy collecting stories - some from history, some from the future, and some in the form of terrible (but delightful) puns. Here is a glimpse in his own words: “For me, collecting coins isn’t just a hobby - it’s about making ‘cents’ of history. Holding a Mauryan punch-marked coin from 300 BC or a medieval Chola-era piece is the closest I’ll get to time travel (until someone finally invents a working flux capacitor). My collection spans from British, French, and Dutch colonial coins to far-flung finds from Vanuatu and French Polynesia - because if history is everywhere, why should my collection stay in one place? If coins take me to the past, science fiction launches me into the future - no seatbelt required! I started with H.G. Wells and Jules Verne, but soon found myself orbiting Asimov, Philip K. Dick, Cixin Liu, Douglas Adams, and Andy Weir. AI, interstellar travel, dystopian futures - there’s nothing like a good reality-bending read. After all, real life doesn’t come with space battles (yet!). Gaming is another passion, because why stick to one reality when you can hop between galaxies, kingdoms, and alternate dimensions? Whether I’m negotiating intergalactic diplomacy in Mass Effect, saving Hyrule in Zelda, taking down the Covenant in Halo, or catching ‘em all in Pokémon (yes, including Pokémon Go - because cardio is always better when it involves Pikachu), gaming keeps me in the race. And then, there’s travel. Until recently, I hadn’t travelled much beyond India - fast forward to today, and I’ve been fortunate to visit a range of countries, collecting experiences (and the occasional coin) along the way. And as you would have noticed, I have a soft spot for puns. It’s in my DNA. What can I say? I’m a Punjabi. Between consulting, collecting, and cracking puns, life keeps me on my toes.” Do comment if you share any of his interests! #LifeAtMedium #ThePersonBehindTheLaptop #HealthcareConsulting #BeyondWork #behindthedayjob

At the recently concluded VCCircle Healthcare Summit, Ratan Jalan shared his views on ‘How regional hospitals are shaping the future of healthcare ecosystem in the country’. Gautam Khanna (Hinduja Hospitals) and Abhishek Kapoor (Regency Health), two renowned hospital CEOs in the country, added their nuanced perspectives to the discussion.   Given the vast geographical spread and a population of 1.45 billion people, almost every State in the country offers enormous potential. Uttar Pradesh alone, for example, offers potential for adding at least 10,000 quality beds and have 25-30 hospitals with 200+ beds. A regional hospital, like Regency, has the right DNA to have a low-cost structure without compromising quality and address the local social-cultural uniqueness almost intuitively. And that’s what would fuel the success and growth of regional hospitals in the country. We, at Medium, have delivered spectacular results through performance improvement projects for quite a few regional hospitals across the country. Moderator in Session: Sreeja Biswas, Senior Correspondent, VCCircle #Healthcare #Summit #Hospital #Regional #Consulting

Super excited to share that Dr Nitiraj Gandhi has joined us as Managing Partner. Nitiraj is an accomplished healthcare leader with proven expertise in a career spanning more than 15 years. He brings a nuanced understanding of the business function, operational complexities and digital landscape in healthcare. He has worked with reputed hospitals like Reliance Foundation Hospital and Columbia Asia Hospitals in India heading different functions. He also worked in leadership positions in EY, IQVIA and THB prior to joining Medium. He has the experience of conceptualising and commissioning four large hospitals. He has enabled digital transformation in two of the largest hospital chains in India. He has also led due diligence for some of the global PE firms. In his last assignment at EY as a Project Director, he helped Everstone triple the value of their investment in Sahyadri Hospitals. He serves as an assessor at HIMSS International and Bureau of Indian Standards (Health Informatics Committee). He is a qualified physician and has done his Masters in Hospital Administration from Tata Institute of Social Sciences, Mumbai. Please join us in welcoming him to this new role. #team #leadership #vision #growth #healthcare #consulting #digital #quality

At the recently concluded VCCircle Healthcare Summit, Ratan Jalan shared his views on ‘How regional hospitals are shaping the future of healthcare ecosystem in the country’. Gautam Khanna (Hinduja Hospitals) and Abhishek Kapoor (Regency Health), two renowned hospital CEOs in the country, added their nuanced perspectives to the discussion.   Given the vast geographical spread and a population of 1.45 billion people, almost every State in the country offers enormous potential. Uttar Pradesh alone, for example, offers potential for adding at least 10,000 quality beds and have 25-30 hospitals with 200+ beds. A regional hospital, like Regency, has the right DNA to have a low-cost structure without compromising quality and address the local social-cultural uniqueness almost intuitively. And that’s what would fuel the success and growth of regional hospitals in the country. We, at Medium, have delivered spectacular results through performance improvement projects for quite a few regional hospitals across the country. Moderator in Session: Sreeja Biswas, Senior Correspondent, VCCircle #Healthcare #Summit #Hospital #Regional #Consulting