Narayana Hrudayalaya is a healthcare provider built on a single, stubborn idea: that world-class heart surgery and cancer care should not depend on a patient’s wealth. Founded in 2000 by cardiac surgeon Dr. Devi Prasad Shetty, it has grown from a cardiac centre in Bengaluru into a network of 55 facilities across India, the Cayman Islands, and the United Kingdom, all chasing the same goal of affordable, high-volume, quality-driven care. The recurring approach is to treat the cost of care as the enemy - driving it down through scale, standardisation, and in-house technology - so that prices can stay low without sacrificing outcomes, a discipline that now extends from its flagship hospitals into health insurance and digital platforms. # Business segments Four engines at different stages - a multi-specialty Indian hospital network that is the group’s heart, an international hospital-and-insurance platform in the Caribbean, a newly acquired UK hospital chain, and an integrated care experiment combining clinics with health insurance - each built on the clinical reputation and cost-conscious DNA of the one before. ## 1. India hospitals and heart centres: the core engine delivering affordable tertiary care at scale **A network of 20 owned and operated hospitals and heart centres runs on a high-volume, low-cost model where cardiac surgery success rates beat global benchmarks and prices undercut competitors, funded mostly by domestic walk-in and insured patients.** - **Cardiac care is the anchor** - the Bangalore cardiac hospital alone performs more than 2,250 surgeries and 5,500 cath lab procedures every quarter, including over 150 minimally invasive heart surgeries using incisions of roughly 1 to 1.5 inches, and its bypass surgery success rate exceeds 99%, better than the Society of Thoracic Surgeons benchmark of under 98%. - **Cost control, not price hikes, drives the model** - doctors and nurses together account for 28% of operating revenue and consumables 23%, while the average effective cost per operational bed is INR 7.5 million, a figure kept low by building or leasing rather than acquiring expensive real estate. - **Pricing is structured for predictability** - most treatments are sold as fixed packages for standard clinical pathways, with open billing reserved only for unpredictable cases, and the company tracks average revenue per patient rather than per bed because it considers that metric harder to manipulate. - **Specialties now extend far beyond the heart** - oncology contributes 15% of India hospital revenue, supported by over 200 oncologists and one of Asia’s few end-to-end CAR-T cell therapy centres, while renal sciences has performed more than 7,000 transplants and gastro sciences over 350 liver transplants to date. - **Quality is measured obsessively** - the group monitors more than 500 KPIs, conducts over 250 mock drills a year, and has driven near-miss reporting up by 400% through staff training, with a standardised mortality ratio of 0.52% against a 1% benchmark. ## 2. Cayman Islands operations: a Caribbean hospital-and-insurance platform serving local patients **A wholly owned subsidiary runs two hospitals and a licensed health insurance company in the Cayman Islands, having pivoted from a failed US medical-tourism model to building deep relationships with domestic patients who previously flew to America for treatment.** - **A deliberate pivot to local demand** - the business spent its first 10 years chasing international patients from the US, then refocused on domestic Cayman residents, adding obstetrics, paediatrics, neonatal care, and a trauma centre to become the community’s comprehensive provider. - **Insurance is integrated into the hospital** - the subsidiary owns Cayman Integrated Healthcare Limited, which holds an insurer certificate and generated US$41.8 million in gross earned revenue in FY26, creating a closed loop where the same entity manages both care delivery and coverage. - **A bridge into the Bahamas** - a 4.01% stake in Doctors Hospital Health System, the largest private healthcare provider in the Bahamas with two hospitals and over 15 clinics, was acquired to enable clinical collaboration and feed referrals for advanced tertiary care back to the Cayman facilities. ## 3. United Kingdom operations: a newly acquired network of surgical and diagnostic centres **Acquired in November 2025 through a step-down subsidiary, this chain of 13 facilities - including seven hospitals, three surgical centres, and two urgent treatment centres - gives the group a foothold in the UK’s publicly funded healthcare market.** - **Bought, not built** - the entire platform was acquired for £188.78 million in cash, bringing 330 beds and roughly 2,500 staff, of whom about 1,300 are doctors and clinical professionals, with a pre-acquisition turnover of approximately £250 million. - **An Opco/Propco structure separates property from operations** - a dedicated property subsidiary was incorporated in March 2026 to hold UK hospital infrastructure, keeping the operating company asset-light and the infrastructure captive within the group. - **Early performance shows a stabilising margin** - in its first full quarter post-acquisition, the UK business delivered a net EBITDA margin of 10.5% after absorbing losses from new centres, with hospital-level profit before interest and acquisition amortisation turning positive. ## 4. Integrated care and health insurance: an experiment in aligning care and coverage **A wholly owned subsidiary combines neighbourhood clinics with proprietary health insurance products, testing a managed-care model where keeping patients healthy is financially rewarded rather than penalised.** - **Clinics feed the insurance, insurance feeds the clinics** - 11 clinic locations recorded 581,000 patient transactions in FY26, while the insurance arm covered roughly 4,000 lives in Bengaluru and Mysore under the “Arya” plan, which includes home delivery of medicines at no extra transport cost. - **The insurance model is deliberately lean** - because it relies less on distributor commissions than traditional insurers, the business needs fewer enrolled lives to break even, and underwriting is guided by a mathematical risk model that should improve as the pool grows. - **Clinics are being folded back into the parent** - a demerger approved in 2026 transfers the clinical services undertaking into Narayana Hrudayalaya Ltd, leaving the subsidiary to focus exclusively on the digital-first preventive health platform “Narayana Aarogyam”. # ATHMA: the in-house digital backbone **A cloud-based hospital information system, built entirely in-house, runs every group facility on a single software instance - and it is now being sold to external labs and hospitals as a SaaS product.** - **One system, every facility** - ATHMA powers the Hospital Information System and Lab Information System across all India and Cayman hospitals, with the lab module alone processing over 24,000 samples a day and delivering 70% of results within two hours. - **Patient-facing apps drive volume** - the NH Care App has crossed 3.8 million installs and accounts for over a third of outpatient appointments, while self-help kiosks now process more than ₹40 crore in monthly payments across the network. - **AI is moving from research to the bedside** - a machine-learning risk prediction model for bypass surgery, trained on the group’s own patient data, has been accepted for publication, and a real-time ICU risk model is under development. # Group structure and partners **The listed parent controls a federation of Indian and international subsidiaries, with the founder family holding 63.3% and distinct leadership teams running the India, Cayman, and UK operations.** - **India subsidiaries are being simplified** - Meridian Medical Research & Hospital Ltd, which operates two Kolkata hospitals, is being amalgamated into the listed parent, while a new northern India subsidiary was incorporated in January 2026 to give that region dedicated focus. - **Clinical partnerships extend capabilities** - a joint venture with 2070 Health and W Health Ventures will build a network of chemotherapy centres across India, while Immuneel’s CAR-T manufacturing facility sits physically on the group’s Bengaluru campus, making advanced cell therapy available under one roof.