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Max Healthcare Institute Edelweiss Wealth Research Max Healthcare Institute Praveen Sahay Research Analyst [email protected] Date: May 3, 2021 Max Healthcare Institute A sustainable growth story Max Healthcare Institute Ltd. (MHI) is one of India’s leading hospital chains with 16 facilities Praveen Sahay and ~3,400 beds. MHI was formed after the merger of Max Healthcare and Radiant (effective Research Analyst 1st Jun’20). The company’s major shareholders are Kayak Investments – an affiliate of KKR [email protected] (~49%) and Mr. Abhay Soi – MHI’s CMD (22%). Besides the core hospital business, MHI has also launched two related businesses that are run as separate business units (SBUs) – Max@Home (providing preventive and pre/post-hospitalization care at home) and MaxLab (offering diagnostics services). We believe MHI meets all our key investment considerations – it has a CMP: INR 227 superior case mix, brand power, quality of care, cost efficiencies and presence in premium Rating: Tactical BUY markets. We recommend a ‘Tactical BUY’ on the stock with a target price of INR293/share. Target Price: INR 293 Presence in premium markets with superior case mix leading to higher ARPOB Upside: 29% MHI is focused on the premium markets in India, namely Delhi NCR and Mumbai. The two metros deliver the highest average revenue per occupied bed (ARPOB) and are the most profitable markets in the country (72% of MHI’s beds are in Delhi NCR) due to high (a) demand-supply mismatch, (b) per capita income and (c) insurance penetration. MHI enjoys higher ARPOB compared to peers largely due to higher share of operational beds in metros/northern urban areas and a superior case mix. Moreover, MHI has the largest bone marrow transplant (BTM) Bloomberg: MAXHEALTH:IN programme in Asia and the largest Oncology programme in North India. Thus, MHI is further 52-week expected to generate higher ARPOBs on account of such complex treatments. 97 / 239 range (INR): Long-term structural cost-savings programme to boost margins further MHI’s focus on cost-saving initiatives and strategic capital management activities helped it to Share in issue (cr): 97 achieve operational efficiency and stable earnings. The company’s operating matrix too has M cap (INR cr): 21,145 improved QoQ – it recorded record-high quarterly EBITDA margin in Q3FY21, mainly due to its long-term structural cost savings programme. Thus, we believe MHI is geared up to achieve Promoter 75.25 industry-leading margins by FY23E, which coupled with higher growth would give management Holding (%) an opportunity to unlock synergies. Expansion plan to help MHI sustain leadership position in premium markets Hospital availability in India is weak compared to the global average. Therefore, private hospital chains in India are more focused on increasing their reach and garnering volumes (patients) in the country. MHI has the means to execute brownfield capacity expansion in premium locations of South Delhi and Mumbai with minimal capex. This is a unique opportunity for MHI to expand capacity in the country without compromising its RoCE. Outlook and valuation; Recommend Tactical BUY with 29% upside potential MHI’s new management has successfully addressed challenges that were earlier plaguing the company like high debt and bloated costs. Under the leadership of Chairman, Mr. Abhay Soi, (who has skin in the game with ~22% stake in MHI), the company has witnessed a spectacular turnaround. In less than two years, MHI’s EBITDA margin has crossed the 23% mark (for many years, it was languishing in single digits). Further, management is also focused on cost rationalisation, efficient utilisation of facilities, lighter balance sheet and expansion in existing geographies. We believe MHI deserves superior valuations because of its presence in premium markets and excellent business mix compared to peers. The stock is a ‘Tactical BUY’ with a target price of INR293/share (we have considered an average of DCF and EV/EBITDA to arrive at our blended target price). Year to March (INR Cr) FY19 FY20 FY21E FY22E FY23E Revenue 2,671 4,026 3,718 4,429 5,314 YoY growth (%) 2.0 50.7 (7.7) 19.1 20.0 EBITDA 224 587 629 879 1,108 EBITDA margin (%) 8.4 14.6 16.9 19.8 20.8 Profit after tax 224 151 -5 443 702 YoY growth (%) 0.9 (13.4) 26.9 80.0 58.5 EPS (INR) 4.2 3.6 2.7 4.6 7.3 ROACE (%) 13.3 14.9 8.3 9.9 13.0 P/E (x) 54.4 62.9 83.4 49.5 31.2 Date: May 03, 2021 EV/EBITDA (x) 56.2 22.0 35.6 26.7 20.9 Edelweiss Wealth Research 1 Max Healthcare Institute Index Table of Contents Page No. Structure ..................................................................................................................................................................... 3 Focus Charts .............................................................................................................................................................. 4 I. Presence in premium markets with superior case mix leading to higher ARPOB .................................................... 7 II. Long-term structural cost-savings programme to boost margins further ............................................................... 13 III. Expansion plan to help MHI sustain leadership position in premium markets ...................................................... 16 IV. Rising insurance penetration in India to drive utilisation for hospitals ................................................................. 22 V. Growing medical tourism in India to boost volumes for quality-focused players like MHI .................................... 25 VI. Focused on investing and scaling MaxLab and Max@Home for future growth .................................................... 29 VII. GoI’s healthcare initiatives creating new markets for hospital chains.................................................................. 31 Outlook and valuation ................................................................................................................................................. 33 Risks ............................................................................................................................................................................. 36 Company Description .................................................................................................................................................. 37 Management Profile .................................................................................................................................................... 38 Timeline ....................................................................................................................................................................... 40 Financial Analysis ......................................................................................................................................................... 41 Financials ..................................................................................................................................................................... 47 Annexure ..................................................................................................................................................................... 50 Edelweiss Wealth Research 2 Max Healthcare Institute Structure Over FY20-23E, MHI is expected to clock ~10% revenue CAGR, led by (a) expansion in operational beds, (b) consistently high ARPOB, and (c) increased focus on other segments such as diagnostics. Further, the company should deliver 23.5% EBITDA CAGR along with margin expansion of ~620bps due to healthy revenue growth, cost saving measures and operational efficiency. PAT CAGR is expected at ~67% with healthy RoCE of ~13%. MHI operates in India’s most premium MHI is focused on cost-saving initiatives The availability of brownfield markets (Mumbai and NCR), which deliver and strategic capital management capacity expansion in premium superior ARPOB in the country due to high activities, which has led to operational locations of South Delhi and (a) demand-supply mismatch, (b) per efficiencies and stable earnings. MHI is Mumbai with minimal capex, capita income, and (c) insurance expected to achieve industry leading provides MHI with a unique penetration. MHI enjoys higher ARPOB as margins by FY23, which coupled with opportunity to expand capacity compared to peers mainly due to (a) higher higher growth would give management without compromising its RoCE. share of operational beds in premium an opportunity to unlock synergies. markets and (b) superior case mix. (INR cr) FY20 FY21E FY22E FY23E FY20 FY21E FY22E FY23E FY23E CMP/Target Revenue 4,026 3,718 4,429 5,314 RoCE (%) 14.9 8.3 9.9 13.0 EV/EBITDA 25.6x 293 Debt-to- EBITDA 587 629 879 1,108 0.3 0.4 0.4 0.3 Equity ratio EBITDA margin (%) 14.6 16.9 19.8 20.8 PAT margin (%) 3.7 -0.1 10.0 13.2 At target price, FY23E EV/EBITDA is At CMP, FY23E EV/EBITDA is 21x FY23E RoCE of 13% 25.6x The stock is a ‘Tactical BUY’ with a target price of INR293/share. Upside of 29% Edelweiss Wealth Research 3 Max Healthcare Institute Focus Charts Story in a Nutshell Exhibit 1: Bed density per 10,000 people across countries Exhibit 2: Premium market expanding with rising urban population India 14 Malaysia 19 Brazil 21 Thailand 21 Global Median: 29 Beds 40% United Kingdom 25 35% 31% 33% 26% 28% Vietnam 26 23% 18% 20% United States of America 29 China 43 Russian Federation 81 1960 1970 1980 1990 2000 2010 2015 2020P 2030P 0 20 40 60 80 100 Share of urban population (%) Exhibit 3 (A): Low density of
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