Max Healthcare Institute Ltd

Dear Shareholders,

It gives me immense pleasure to present to you our annual report for FY 2023-24, showcasing our journey and achievements in the year gone by. At Max Healthcare, we recognise that growth and sustainability are intimately intertwined. As we continue to expand our reach and services, we are committed to doing so in a responsible and environment-friendly manner.

Our goal is to provide high-quality, patient-centric care while minimising our ecological footprint. By investing in advanced technologies, adopting green practices, and fostering a culture of sustainability, we aim to create a healthier future for our patients, staff, and the communities we serve. Through continuous innovation and improvement, we strive to set new standards in the healthcare industry, ensuring that our growth is not only sustainable but also beneficial to all. Today, we are one of the largest healthcare providers in the country, with 20 hospitals, over 4,300 beds, and more than 19,500 highly qualified doctors, trained nursing staff, analytical pathology team, physical therapist and support staff. Last year, we treated ~25 Lakh patients in our OPD, admitted ~2.32 Lakh patients in our network hospitals, and performed over 1 Lakh surgeries. While we took good care of our patients in the hospitals, we also worked hard at reducing our environmental footprint and made significant progress in achieving our sustainability goals.

Sustainable Growth

Our commitment to sustainability and clinical excellence is closely connected, reflecting our holistic approach to responsible healthcare.

On the environmental front, our initiatives are designed to reduce our ecological footprint by implementing innovative and responsible practices. This year we prioritised environmental responsibility and sustainability in our operations. We focussed on minimising our carbon footprint through achieving greater energy efficiency, waste reduction and management, installing renewable energy solutions, and conserving and rejuvenating natural resources.

Our hospitals have achieved ISO 14001:2015 accreditation, demonstrating our dedication to efficient resource utilisation. We are transitioning to clean energy by installing solar-powered systems and partnering with renewable energy providers like Avaada Solar and Sunarka Energy. We have notably sourced 23.81 Lakh kWh of renewable electricity this year.

We have implemented energy-efficient measures like Electronically Commutated Fans and Variable Frequency Drives in our high-usage areas. Our new buildings meet the Indian Green Building Council's rigorous standards, earning us the prestigious Gold Standard certification and IGBC certification for several facilities, including Patparganj, Mohali, and Vaishali.

We acknowledge the critical role of effective waste management in safeguarding both human health and the environment. Responsible waste management is a cornerstone of our sustainability commitment. Our certified waste collection partners ensure biomedical waste is transported and disposed of with utmost care in accordance with the Biomedical Waste Management Rules 2016. We have adopted alternative technologies for processing of organic waste. This allows us to repurpose the resulting compost, for use in our landscaping efforts. Our waste intensity based on occupied bed per day in FY 2023-24 was 0.003 MT per bed which is ~20% lower than the previous year, demonstrating our consistent commitment to balancing healthcare with environmental stewardship.

In our efforts to revive water bodies and recharge ground water, we constructed a pond in village Rajpura, Kharkhauda, in Meerut district. For this initiative, we partnered with IIT Delhi who helped us with the technical knowhow related to recharging of ground water aquifers.

More Beds, More Care, More Hope

The year under review marked our foray into 2 new cities, namely Nagpur and Lucknow, adding ~750 beds to our existing bed capacity with further expansion potential in the future. We successfully completed the acquisition of two leading healthcare institutions-Alexis Hospital in Nagpur and Sahara Hospital in Lucknow, which have now been renamed as Max Super Speciality Hospitals and fully integrated with the Max network of hospitals. Max Hospital, Dwarka, a 303 bed state of the art facility commenced operations in mid-June, 2024. The addition of these hospitals to our network is a significant milestone in our journey to expand access to quality healthcare services. The strategic location of these hospitals will enable us to serve a wider patient base, not only from these respective cities but also from neighbouring geographies.

Brownfield and greenfield capacity expansion projects at our sites in Gurugram, Saket (New Delhi), Mumbai, Mohali, Lucknow, and Nagpur are continuing apace and we expect the augmented capacities to be functional in the next 18-24 months.

As part of our ongoing commitment to growth, we are also actively exploring opportunities for expansion in various cities across the country.

Clinical Excellence and Patient Safety

In tandem with the efforts to ensure sustainability and growth, we continued to focus on clinical excellence, prioritise patient safety and delivering an exceptional patient experience above everything else.

Our commitment to clinical excellence is supported by state-of-the-art medical technologies, the expertise of multidisciplinary medical teams, and data-driven quality and monitoring platforms that enhance patient outcomes, setting us apart from the rest.

We have undertaken many ambitious goals, including enhancing clinical outcome measures through innovative technologies, such as, MaxCel, our digital platform that empowers healthcare professionals to monitor and benchmark clinical outcomes against standardised protocols and evidence-based national and global publications. This integrated clinical dashboard strengthens quality care delivery and patient safety.

We pay highest attention to patient safety and well-being. Patient safety systems are embedded in all our clinical processes and IT systems, thereby raising appropriate alerts, helping clinicians carefully consider their decisions. Multiple checks help minimise clinical errors and improve patient safety. We ardently believe in listening to our patients and are committed to provide an environment where the voices of patients and their attendants are heard and addressed promptly. By leveraging advanced communication technology and best practices in customer service, we ensure that feedback is not just collected but also analysed and acted upon in real time.

Our bilingual resources at all patient touch-points enhance accessibility and comprehension.

Our holistic approach to nurturing health continues to set a benchmark. At Max Healthcare, we remain dedicated and committed to clinical quality, deployment of innovative medical technologies and cutting-edge treatment techniques, enabling us to help thousands of patients get world-class medical care.

Latest Medical Technologies to the Fore

Investments in the latest medical technologies help us retain the cutting edge. These investments not only bode well for the future but also empower us to achieve superior outcomes and help drive sustainable growth and create value for all stakeholders.

Among our 24 robotic surgical systems are the Da Vinci Surgical Robot Systems, which enable minimally invasive procedures with extraordinary precision, and the Versius Surgical Robot, which assists in minimal access surgery with 3D vision and ergonomic instrument control. We also have the Mako Total Knee Application for robotic-arm assisted joint replacement surgery, ensuring precise surgery, minimal blood loss, and faster recovery.

Additionally, our hospitals employ AI-enabled robotic systems for joint replacement, Excelsius GPS for spine surgery, and the StealthStation^TM S8 navigation system for stereotactic surgery. We also use the Radixact X9 TomoTherapy System for cancer treatment and TruBeam STx LINAC system for a range of treatment techniques.

We introduced the advanced CAR-T therapy for advanced and difficult to treat cancers this year. This state-of-the art technology is now available in several of our hospitals in Delhi and Mumbai and has helped us successfully treat cancer patients with stubborn tumours.

Our imaging technologies include the Artis Zee Cath Lab system, intraoperative portable CT scanners and Bi-Plane technology for minimally invasive procedures. We also offer HIPEC treatment for advanced abdominal cancers and SPECT-CT systems for anatomical and functional imaging.

Furthermore, our hospitals are equipped with the Azurion 5 platform for interventional procedures, Artis ZEE Siemens Cath Lab and MAGNETOM Lumina for MRI scans. We also have Symbia Evo Excel Dual head Gamma Camera for high-resolution SPECT imaging.

Enhancing Patient Experiences through Digitisation

Our key digital initiatives are transforming healthcare by making it more accessible, efficient and patient-centric. We have introduced apps for doctors and patients, enabling self-patient registration and integrating a global payment solution, making healthcare more accessible to all and from anywhere. With improved access and functionality, these platforms offer seamless downloads and timely updates, ensuring users stay well informed and connected at all times. Additionally, we have also launched digital in-patient services, streamlined diagnostic testing processes, and implemented a data lake, virtual consult back-office solution, appointment management system, and nursing duty roster software, all aimed at optimising the overall healthcare experience.

We have introduced an integrated appointment booking system on our website, allowing patients to schedule appointments with clinicians effortlessly. Additionally, we launched health calculators, available on our website, to empower individuals to take charge of their health and monitor vitals, such as,

BMI and ovulation, along with other key health metrics. These user-friendly tools, grounded in the latest medical guidelines, support proactive health management and preventive care.

By harnessing advanced digital technologies, we have enhanced patient experiences, empowered informed decision-making and created a new era of accessibility. Our user-friendly WhatsApp chatbot has streamlined appointment scheduling and video consultations, expanding access to quality healthcare services. Our digitisation efforts align with our environmental stewardship, transitioning patient interactions to digital platforms, reducing paper and resource consumption and fostering better engagement.

The digital transformation journey is a journey of continuous improvements. We are also very excited about the work presently underway and I am sure in the days ahead, we will be taking even greater strides in this area.

Community and CSR Initiatives

We are passionately dedicated to uplifting the communities we serve through a wide array of impactful Corporate Social Responsibility (CSR) initiatives. We focus on education, skill development and nutritional support to build stronger communities. One of our notable initiatives is the Max Medical Scholarship Programme, which fully funds medical education for students from economically disadvantaged households each year. This year, we also provided skills training to promote sustainable livelihoods to 1,700 undertrials in Tihar Jail, which will help them gain employment once released from incarceration and reintegrate with society.

In the field of medical education, we distributed 2,000 copies of an acclaimed textbook on Critical Care Medicine to libraries and clinicians.

Pursuing our environmental goal of water neutrality, we constructed a pond in village Rajpura, Kharkhauda, Meerut district, which benefits agriculture and recharges groundwater.

We also prioritised nutritional support, contributing to the Government of India's Nikshay Mitra scheme to provide vital nutritional support to TB patients.

Additionally, we organised regular cancer screening programmes, comprehensive health assessments for school students, and health camps in collaboration with NGOs in communities neighbouring our hospitals. We celebrated International Yoga Day with Yoga Camps and emphasised overall wellness through free health check-ups and doctor talks.

At the Max Cancer Congress 2023, we united over 2,000 individuals in the fight against cancer, presenting dynamic debates, informative sessions, and empowering student-focused initiatives. Our "Dil Ki Baat" initiatives promoted heart health awareness through fun activities like Zumba, Yoga and cycling.

In the year under review, we conducted free treatment of ~3.51 Lakh patient episodes across our Network.

Transforming Healthcare through Research and Academic Initiatives

At Max Healthcare, the Office of Research (OOR) supports and guides our diverse research initiatives, promoting thought leadership. In 2023, we published our inaugural journal, "The Max Medical Journal", which marked Max Healthcare's foray into the world of clinical academics with its own international standard publication.

We forged new international partnerships with the Royal College of Obstetrics & Gynaecology (RCOG) in the United Kingdom and introduced the Advanced Trauma Life Support Course, accredited by the American College of Surgeons and conducted under the Indian Society of Acute and Trauma Care.

Our research and academic partnerships with esteemed institutions such as Imperial College, London, Deakin University, and Ashoka University continued to grow with more areas of collaboration being identified. Currently, we are actively engaged in research on type 2 diabetes, cardiovascular disease, cancer and molecular genomics, and antimicrobial resistance, with a focus on improving global health outcomes.

The year saw our researchers publishing numerous papers in internationally recognised medical journals. In total, ~400 academic papers by our clinicians were published last year.

Max@Home and Max Lab

We have expanded Max@Home services to include services like Palliative Care, Holter and Ambulatory Blood Pressure monitoring. Our online care plans and 24/7 patient remote monitoring system ensure personalised care for our patients. Max@Home services are now available in 12 cities.

At Max Lab, we continued our journey of growth and expansion throughout the year. Max Lab services are now available in 41 cities through 1,100+ collection centres, pick-up points in doctor's clinic and hospitals. Max Lab now offer a comprehensive menu of over 2,500 tests across multiple specialities. Additionally, our genomics and molecular lab significantly enhances our capabilities in molecular testing and advancing our engagement in biomolecular and genetic research through collaborations with national and international research institutes.

Financial Highlights

The results of the last fiscal year (FY 2023-24) has been a testament to both our strength and our strategic foresight, marked by significant growth in both revenue and profit. Our network gross revenue and operating EBITDA have both demonstrated impressive year-on-year increase of 16% and 17%, respectively, standing at H 7,215 Crore and H 1,907 Crore, respectively. In a remarkable achievement, our key operating and financial metrics, including ARPOB, EBITDA margins, and EBITDA/ bed touched all-time highs and remain best in the industry.

This stellar growth can be attributed to the hospitals doing more higher-end quaternary work, deployment of the latest medical technology across the network, higher occupancies, and better average revenue per occupied bed days.

Up and Beyond

As I reflect on the past year, I am delighted to note that our organisation delivered world-class healthcare to countless people. Our pursuit of improving healthcare access and opportunities for our patients has yielded remarkable results, positioning us for sustained growth. Building on our healthy financial performance, we plan to significantly increase our bed capacity over the next five years, ensuring greater access to quality care for those in need. Our capital-light initiatives, such as Max Lab and Max@Home enable us to extend our services into our patients' homes, ensuring their convenience and comfort. With compassion and dedication, we strive to reach more people and make a qualitative difference to their lives.

I am greatly humbled by what we have achieved so far and am equally excited about what lies ahead.

I would like to express my sincere gratitude to all our stakeholders for their continued support and faith. Together, we will continue to work towards a stronger and sustainable future for all.