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Healthcare BPO Thematic

The document discusses the significant growth potential of the US healthcare BPO market, projected to reach $6.1 trillion by 2028, with only 20% currently outsourced. It highlights key players Sagility and IKS, emphasizing their strengths in payer and provider segments, respectively, and outlines the driving factors for outsourcing in healthcare. The report recommends a long-term investment in these companies due to their strong market positions and anticipated growth rates in revenue and profitability.

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Healthcare BPO Thematic

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Healthcare BPO

23rd July 2025

HEADS AND TAILS OF US HEALTHCARE, LEVERAGING OUTSOURING
OPPORTUNITY
Particulars (₹ in Cr) Sagility IKS
US healthcare system, with a projected spend of $6.1trn by 2028 (up MCap 20,592 27,365
from ~$4.7trn in 2023), remains the world’s largest and most CMP 44 1,591
complex market. With over $200bn in core operational spend across Target Price 72 2,285
Payers and Providers and only ~20% currently outsourced, the Upside 63% 44%
opportunity for specialized healthcare BPO players is immense.
CAGR FY25-28E
Tailwinds such as rising administrative costs, aging demographics,
chronic disease prevalence and talent shortages are driving an Revenue 16% 20%
accelerating shift toward outsourcing. In this context, players like EBITDA 17% 26%
Sagility and IKS, with deep domain expertise, scalable delivery EBIT 22% 29%
models and long-standing client relationships are well-positioned to PAT 28% 32%
capture share and deliver long-term compounding growth in a
CAGR FY23-25
structurally underpenetrated market.
Revenue 15% 61%
IKS – A long-term bet on Platform led transformation EBITDA 12% 40%
IKS is a differentiated platform-led player in the provider segment, EBIT 47% 34%
enabling physicians to focus on care while it handles non-clinical PAT 94% 25%
operations across revenue cycle, documentation and value-based Average 3Y CFO/EBIT 89% 49%
care. With <1% market share in a $225bn+ TAM, IKS offers massive
Return Ratios (FY25)
headroom for growth. The company has delivered ~38% revenue
CAGR (FY20–25) and is expected to grow at ~20% CAGR over FY25– ROE 6% 27%
28E. PAT is expected to grow at ~32% CAGR over FY25-28E, supported RoCE 46% 62%
by margin recovery post-AQuity acquisition and deeper cross-sell. Valuation (FY28)
With high client stickiness (>95% recurring revenue) and a tech-first PE 18 24
DNA, we believe IKS is a long-term structural story. Currently it is
PEG 0.7 0.8
trading at PE multiple of ~24x FY28E EPS. We initiate with a BUY
EV/EBITDA 10 18
recommendation with a TP of ₹2,285, valuing the company at 35x PE
multiple on FY28E EPS. Source: ABML Research

Sagility – Steady execution, cash-rich model, attractive valuation

We are constructive on Sagility, a payer centric player, given its strong
execution track record, consistent revenue growth and high client
stickiness (top 5 clients have 17+ years of average tenure). Currently
serving 6 of the top 10 US insurers, with a growing mid-market
presence. The company has a robust M&A engine, demonstrated by
acquisitions like Devlin (payment integrity), BirchAI (GenAI) and
Research Team:-
Broadpath (mid-market segment). With ~89% average three years
CFO-to-EBITDA, Sagility runs a highly cash-generative model and Analysts
trades at PE multiple of ~18x FY28E EPS, making it a compelling value Vinit Agarwal
play in the BPM space. We see strong earnings visibility and margin [Link]@[Link]
accretion as digital adoption deepens and client concentration 022-6819 0517
moderates. We are expecting revenue/EBITDA/PAT growth of
~16%/17%/28% over FY25-28E. We initiate with a BUY Ninad Sarpotdar
recommendation with a TP of ₹72, valuing the company at 30x PE [Link]@[Link]
multiple on FY28E EPS. 022-6819 0538

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Healthcare BPO

Healthcare BPO Industry

This report focuses on the niche operations of healthcare BPO service providers (SAGILITY & IKS) within the highly mature and
complex US healthcare market. These firms have built strong competitive moats through deep domain expertise across
specialized service areas. We believe this differentiated business models hold significant long-term potential, well beyond what
current numbers may suggest. Today’s metrics represent only the beginning of a much larger opportunity. Our thesis
underscores the value these companies can unlock over time and we recommend a long-term investment horizon to fully realize
their growth and strategic value.

What makes US Healthcare complex and evolved?

Healthcare represents one of the most critical and complex segments of the US economy, accounting for 17.1% of nominal GDP
and totalling US$4.7trn (₹389.6trn) in 2023, according to the Centers for Medicare & Medicaid Services (CMS). This reflects a CAGR
of 5.0% from 2014 to 2023. Notably, healthcare spending peaked at 19.4% of GDP during the COVID-19 pandemic in 2020, reaching
US$4.1trn (₹346.0 trn).

Looking ahead, CMS projects healthcare expenditures to grow at a CAGR of 5.5%, reaching US$6.1trn (₹509.8trn) by 2028. US
continues to lead globally in per capita healthcare spending, which stood at ~US$14,570 (as of 2023 as per CMS data), making up
around 17.6% of the nation's GDP.

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Healthcare spend Per Capita (as per CY23)

Comparable Country Average $7,393

United States $13,432
Switzerland $9,688
Germany $8,441
Austria $7,811
Netherlands $7,737
Sweden $7,522
Belgium $7,380
France $7,136
Canada $7,013
Australia $6,931
United Kingdom $6,023
Japan $5,640
0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000
Source: Company, KFF, ABML research

The US healthcare market primarily consists of two key components related to financing and delivery of care:

1. Healthcare Payers: These are organizations that finance or reimburse the cost of medical services for insured individuals
through health insurance plans.

➢ Plan Type:
• Government/Public Plans: Funded by federal/state governments.
o Medicaid: For low-income groups; 78M+ enrolled (Dec 2023).
o CHIP: For children/pregnant women above Medicaid threshold; 7M+ enrolled.
o Medicare: For seniors and disabled; 66M+ enrolled, with Medicare Advantage growing fast (~33M).
o Others: TRICARE, Veterans Health Administration.
• Commercial Plans: Privately managed by insurance companies.
o Employer-sponsored: ~161M enrolled (2023).
o Health Insurance Exchange (HIX): 21M+ enrolled (2024).
o Medicare Supplement (Medigap): Covers Medicare out-of-pocket costs.

➢ By Carrier Type:
• National Carriers: Operate across states (e.g., UnitedHealthcare, CVS Health, Cigna).
• Regional Carriers: Localized plans (e.g., UPMC Health Plan, Florida Blue).
o BCBSA Plans: 33 independent community-based insurers.

2. Healthcare Providers: These include licensed individuals or institutions responsible for delivering healthcare services, such as
physicians, hospitals, clinics, laboratories and suppliers of medical equipment.

• Hospitals & Health Systems: Deliver a range of inpatient/outpatient services (e.g., Cleveland Clinic, Cedars-Sinai).
• Physician Groups & Clinics: Office-based care providers (e.g., IU Health, Cleveland Clinic).
• Others: Long-term care, home health, labs, dental and DMEs (e.g., DaVita, LabCorp).

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Accountable Care Organizations (ACOs): Collaborations of providers to improve quality and reduce costs under value-based
payment models.

Pharmacy Benefit Managers (PBMs): Manage prescription benefits between insurers, drug manufacturers and pharmacies.

Source: Company, ABML research

Why US healthcare? Unpacking the strategic rational

Key Trends Reshaping US Healthcare

1. Rising Life Expectancy: Advances in medical science, technology and living standards are driving longer lifespans,
increasing demand for specialized care and chronic disease management.
2. Aging Population: The 65+ demographic are projected to reach 26.7% of the population by 2025, significantly increasing
the burden on the healthcare system and accelerating the need for geriatric care.
3. Chronic Conditions on the Rise: About 70% of Americans live with at least one chronic disease, accounting for 75% of
healthcare costs. Over 164mn people are expected to be diagnosed with a chronic illness by 2025.
4. Expanded Insurance Coverage: Health insurance coverage is projected to grow from 86.3% in 2000 to 92.5% by 2025,
driving increased patient visits and healthcare utilization.
5. COVID-19 Disruptions: The pandemic strained the healthcare system, leading to care deferrals, extended hospital stays,
and emphasized the need for universal, affordable access.
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Healthcare BPO

6. Physician Burnout & Workforce Shortages: Increased demand and extended work hours have caused stress and
resignations, leading to projected shortages in critical healthcare roles by 2025.
7. Rising Costs: Per capita healthcare spending is expected to rise from $12,530 in 2020 to $20,425 by 2031, driven by high-
intensity care needs and systemic inefficiencies.
8. Shift to Home-Based Care: Accelerated by the pandemic, home care is gaining traction as a cost-effective and patient-
friendly model, projected to become a $272bn market by 2026.

US Payer market is the most mature market with more than 90% insurance penetration & the top 18 players controlling up to 70%
of the total market. The payers operational spend market in 2023 is calculated to around $200 bn of which ~22% is currently
outsourced which comes to ~$45 bn. This market is expected to grow at ~7% CAGR.

US Provider market on the other hand is highly fragmented market with around 900k physicians & rapidly consolidating. This
segment forms ~$1.5tn of the total healthcare spending. Of this, ~15% accounts for administrative expenses accounting to
~$225bn of which ~15.6% is currently outsourced summing up to $35bn. This market is expected to grow at a much higher CAGR
of ~16% driven by consolidation in the industry.

We have analysed Sagility and IKS as two prominent players operating within the expansive US healthcare landscape, with
Sagility focused on the payer side and IKS on the provider side. While Sagility does have a presence in the provider segment
through its Revenue cycle management (RCM) solutions, this segment currently contributes less than 10% to its overall
revenues. The company’s management has indicated that this contribution is unlikely to exceed 20% over the next 2–3 years,
as the provider segment is not a core strategic priority. That said, the provider market being more fragmented than the payer
space—offers relatively easier entry opportunities for players with strong capabilities and technology platforms.

The outsourcing imperative: What is fueling the shift?

Factors driving outsourcing

Trends Driving Payers Providers IKS Health Sagility Positioning

Outsourcing Positioning

Medical Loss Ratio Compel payers to N.A. Limited focus on Strong payer DNA; deep in
(MLR) Cap (≤20%) outsource admin payers. claims operations,
operations to stay under member services,
cost ceiling analytics

Clinical labor UM nurses, triage, care Nurse shortages, Strong in provider- Offshore nurse-staffed
shortages coordinators coding staff, clinical side clinical ops, support, both payer and
RCM nursing, coding provider sides
benches

ICD-11 transition Coding rules, risk of non- Huge increase in Deep expertise in Tech-enabled CAC tools,
compliance coding complexity CAC, certified scale play on both sides
and denials coders, denial
resolution

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Trends Driving Payers Providers IKS Health Sagility Positioning

Outsourcing Positioning

Denial management UM appeals, Denials growing, Strength in RCM playbook across

& AR pressure authorization backlog especially complex overturning clinical patient access to
MA plans denials (60%+ collections
success)
Regulatory churn Documentation, Compliance on Provider-focused Scalable workflows for
(CMS, Medicaid eligibility pricing transparency, audit handling & CMS-triggered volumes
redetermination) redeterminations, MA audit readiness clinical (e.g., Medicaid
risk adjustment documentation redeterminations)

Value-based care Risk stratification, HEDIS, Outcome-linked Deep in care-gap HCC/Risk-adjustment

shift population health reimbursements, closure, provider support, PHM programs
care quality audits analytics

Patient/member Omnichannel contact Scheduling, portal Digital front-door Scaled omnichannel

digital expectations center, premium billing interaction, billing tools, provider CRM voice/chat ops for payers
clarity expertise

Cybersecurity & HIPAA, CMS data rules, Same across provider Proprietary Enterprise-grade secure
compliance needs HITRUST EMRs and patient platforms with delivery infra with
data HITRUST/ISO HITRUST
security

Credentialing & Directory accuracy, — Co-developed Strong data operations

provider data provider network “Provider capability
management integrity Forward™” platform

How administrative costs are driving US healthcare spending

➢ US spends significantly more on healthcare than other large, wealthy OECD countries but has worse health outcomes.
While much attention is given to high prescription drug costs and insurer profits, administrative costs are a major driver
of this spending gap.
➢ In 2021, US spent $925 per person on health administration, compared to an average of $245 in comparable countries
— a difference of $680 per person, accounting for 12% of the total spending gap. Administrative costs in the US include
the overhead of private insurers, as well as costs related to government health programs like Medicare and Medicaid but
exclude provider administrative costs.
➢ From 2013 to 2021, administrative spending was responsible for 7% of the total growth in US healthcare spending, more
than double its contribution to growth in peer countries (3%).
➢ Despite spending more, administrative complexity in the US often results in inefficiencies. Patients experience delays in
care, higher out-of-pocket costs and dissatisfaction, while providers face burdensome billing systems and complex
insurance requirements.

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➢ While lowering drug prices (as targeted by the Inflation Reduction Act) may help, reducing excessive administrative
overhead is critical for achieving cost efficiency and better outcomes in the US healthcare system.

Per Capita healthcare spend break up

Comparable Average (Total:

$6,514 per capita)

U.S. (Total: $12,197 per capita)

2,000

4,000

6,000

8,000

10,000

12,000

14,000
Inpatient & outpatient care Long-term care
Preventive care Prescription drugs and medical goods
Administration Other

Source: Company, KFF, ABML research

Domain expertise differentiates Sagility & IKS from other business models

The US healthcare service providers have 4 different categorizations: -

Categories Specialises in Companies

Healthcare Specialists Focus exclusively on healthcare, offering CorroHealth, Sagility, Shearwater
deep domain and process expertise Health, Omega Healthcare
across payer and provider segments
Broad-based IT & Business Services Offer IT and business process services Accenture, Cognizant, EXL
Firms across industries, including healthcare.
Provide services like claims ops, RCM
and provider engagement
Product-Focused Companies Deliver healthcare-specific products like Optum, Cotiviti, FinThrive, Epic Systems
EHRs, analytics, and health information
systems, often via licensing or bundled
service partnerships
Broad-based CX Firms Focus on front-end patient/member ResultsCX
experience (e.g., call centers, digital
channels)

Unlike generic IT service providers that typically offer standalone solutions and leave clients to realize the benefits independently,
firms like Sagility take a more embedded, operations-first approach. Rather than presenting generalized technologies like GenAI

Aditya Birla Money Ltd. Registered Office:

and expecting clients to define use cases, it already manages core operations for its clients. This allows it to pilot, validate and scale
innovations such as automation and AI directly within existing workflows, ensuring solutions are practical, healthcare-specific and
deliver immediate, measurable value.

IKS, while often perceived as a product-focused company, has strategically evolved by integrating its capabilities into a unified
platform. Through offerings like performance underwriting and strategic investments, it embeds itself deeply within client
operations. This approach reflects its commitment to being an integrated, value-driven partner, setting it apart from conventional
service providers.

Regulatory changes & its impact

1. Expiration of premium tax credits may impact the payer’s market

What are Premium Tax Credits?

Premium tax credits were created under the Affordable Care Act (ACA) to help lower-income individuals and families afford health
insurance purchased through the Marketplace. These credits reduce monthly premium costs based on income. Originally, they
were available to those earning between 100% and 400% of the federal poverty level (FPL).

More recently, the American Rescue Plan Act introduced enhanced premium tax credits that increased the amount of these tax
credits and also expanded eligibility to households with an annual income over 400% of the federal poverty limit ($103,280 for a
family of three signing up for coverage in 2025), capping their out-of-pocket premiums for a benchmark plan at 8.5% of income.
Since the introduction of the enhanced premium tax credits, enrollment in the ACA Marketplaces has soared, more than doubling
from 11.4mn people in 2020 to 24.3mn people in 2025. The enhanced premium tax credits were originally set to expire at the end
of 2022 but were then extended as part of the Inflation Reduction Act.

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What is the impact?

➢ Net premiums (what individuals pay) may increase by over 75% on average.
➢ Gross premiums are expected to rise as healthier individuals drop coverage due to higher net costs. The CBO estimates
benchmark silver premiums will be 7.9% higher, as the risk pool becomes sicker and more people lose coverage.
➢ 23 insurers across DC, Oregon, Vermont and Washington have already built this expected increase into their 2026 rate
filings.
➢ As premiums rise, younger and healthier individuals are more likely to drop out, leaving a sicker and costlier insured
population, further pushing premiums upward.

Why this matters?

The ACA Marketplaces have seen historic enrollment levels since the introduction of enhanced premium tax credits—growing
from 11.4mn enrollees in 2020 to over 24mn in 2025. Much of this growth has been attributed to the improved affordability
resulting from the expanded subsidies.

If the credits expire:

• Millions may face financial barriers to maintaining coverage.
• Uninsured rates are expected to rise, particularly among middle-income individuals who were previously ineligible for
standard tax credits.
• The overall risk pool may deteriorate, placing financial strain on insurers and further driving up premium rates.

2. Trump policy changes

➢ Massive Medicaid spending cuts

• Congress passed the One Big Beautiful Bill (OBBB) in July 2025, which includes ~$1.0–1.2tn in Medicaid reductions
over ten years.
• These cuts encompass caps on federal matching funds, provider tax adjustments and restrictions on state-directed
payments.

➢ Medicaid work requirements & documentation

• Able-bodied Medicaid recipients aged 19–64 must now work, volunteer, or train for at least 80 hours monthly,
beginning in late 2026
• States are required to verify eligibility every six months, doubling previous requirements.
• These administrative rules are projected to result in millions losing coverage between 7.8mn (CBO) and up to 12mn.

➢ Provider Tax and Funding Changes

• The bill significantly reduces provider taxes from up to 6% of Medicaid funding to 3.5% and places stricter limits on
state-directed payments.
• These changes affect hospital funding models and may reduce reimbursements, particularly in Medicaid-expansion
states.

➢ Impact on Rural Hospitals

• The bill establishes a $50bn Rural Health Transformation Fund, yet rural hospitals still face an estimated $50.4bn in
federal funding losses over ten years.
• Over 300 rural hospitals risk closure in the immediate term, with over 700 at risk nationally.
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Healthcare BPO

Potential Industry Impacts

1. Insurer Retrenchment: Medicaid funding cuts and rising administrative burdens may prompt insurers to exit less
profitable markets or reduce expansion efforts, as seen in UnitedHealthcare and Centene discussions.

2. Operational Strain on State Medicaid Programs: States must upgrade systems to handle complex biannual eligibility
checks and documentation, which may overwhelm under-resourced Medicaid agencies.

3. Rural Healthcare Collapse Risk: With significant funding losses and ongoing financial pressures, many rural hospitals may
face staffing cuts, reduced services, or closure, particularly in states dependent on Medicaid revenue.

4. Administrative Outsourcing Demand: The increased complexity in Medicaid administration could drive demand for
outsourced eligibility verification, documentation and workflow automation, representing growth opportunities for
third-party vendors.

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ICEBERG OF OPPORTUNITY, SURFING THE CONSOLIDATION WAVE

Over the last 18 years, IKS has built a highly recurring, sticky business model CMP (₹) 1,591
with 95%+ recurring revenue and low client attrition. Its top 5 and top 10 Target (₹) 2,285
clients have an average relationship of 8+ and 6+ years, respectively. As of Upside /Downside (%) 44%
March 2025, IKS has a 12,661 strong workforce, including ~475 technologists
and ~2,294 clinically trained staff, powering its scalable, tech-enabled care High/Low (₹) 2,190/ 1,226
enablement platform. IKS’s integrated platform is designed to capture value
as the market moves toward scale, efficiency and bundled care delivery. We Market cap (Cr) 27,365
expect the revenues/ EBITDA/ PAT to grow at a CAGR of ~20%/ 26%/ 32%
between FY25-28. We initiate coverage with a TP of ₹2,285/ share valuing No. of shares (Cr) 17.2
the company at 35x FY28 EPS implying 44% upside.

Shift to physician led, patient-centric care Shareholding (%)

As the US pivots from hospital-centric to physician-led models, care
Dec-24 Mar-25
enablement becomes critical. IKS is positioned at the center of this shift,
enabling physicians to reclaim up to 30-50% of their time and optimize the Promoters 63.72 63.72
$225bn they spend on non-clinical work out of which only ~$30bn is FIIs 5.48 5.38
outsourced today. With outsourced care enablement growing at ~12% CAGR
over FY25-28, outpacing the overall growth of ~8%, IKS is well-positioned to DIls 4.45 4.02
capture a large share of this expanding market and outgrow industry averages. Public & Others 26.37 26.87
IKS is actively co-developing 2–3 new features with clients at any given time,
especially in emerging areas like value-based care and physician workflows,
unlocking incremental TAM beyond the current $225bn opportunity. Financial & Valuations
Y/E Mar (₹ cr) FY26E FY27E FY28E
Platform led growth driving strong financial performance
Over the five-year from FY20-25, IKS achieved a strong revenue CAGR of ~38%, Revenue 3,296 3,880 4,554
driven by a combination of organic growth and strategic inorganic acquisitions. EBITDA 977 1,242 1,555
The company has consistently focused on expanding its feature offerings and EBITDA Margin (%) 30% 32% 34%
has evolved from selling individual features to providing bundled platform
offering, categorized as clinical and administrative bundles. These bundles PAT 651 871 1,124
encompass all 16 features across revenue optimization, clinical support and P/E (x) 43 32 24
value-based care, tailored to customer needs. This transition to a platform-
ROE (%) 27% 26% 25%
based model has enabled broad-based, secular growth across client segments.
EBITDA also grew at a healthy ~37% CAGR during the same period, closely
tracking revenue growth. While the acquisition of AQuity led to a temporary
dilution in margins, from standalone levels of 35%+ to below 30% post- IKS Nifty
acquisition. The company expects margins to recover to above 30% in the 150
coming years, supported by deeper cross-sell opportunities and ongoing
integration benefits. 100

Client stickiness and new client onboard 50

IKS boasts over 95% recurring revenue and enjoys exceptionally low client
0
attrition, reflecting the critical, embedded nature of its offerings. Its top 5 and
Jan-25

May-25
Mar-25

Jun-25

Jun-25
Dec-24

Feb-25

Apr-25

top 10 clients have average relationships of 8+ and 6+ years, respectively,

underlining deep trust and satisfaction. Post the AQuity acquisition, IKS’s
enterprise client base expanded to over 850 customers (rationalized to ~700
in FY25), including ~450 large enterprises employing ~150,000 physicians,
nearly 18% of the total US physician base, offering a robust and sticky cross-
sell opportunity. Recent marquee wins further reinforce IKS’s growth
momentum; 1) Palomar Health: 15-year, full-platform deal with $16.5M
guaranteed upside and gain-share model; strengthens margin visibility and
client stickiness, 2) Radiology Partners: Building VRA platform with 25–30%
productivity boost; potential $600–700M value unlock; future JV planned and
3) Western Washington Medical Group: RCM-led entry with rapid platform
expansion; showcases cross-sell potential in large physician groups.

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INVENTURUS KNOWLEDGE SOLUTIONS LTD.

About Inventurus Knowledge Solutions Ltd. (IKS)

IKS was established in 2006 with headquarter in Mumbai, it is a technology-enabled healthcare solutions provider and offer a care
enablement platform assisting physician enterprises in the US, addressing financial, clinical, and operational needs. With delivery
centers across the US, India, Canada and Australia, IKS Health supports healthcare providers in delivering quality care, improving
population health and transitioning to value-based care while optimizing revenue and reducing costs.

As of March 2025, IKS Ltd serves ~700 healthcare organizations, including health systems, academic medical centers, medical
groups and ancillary healthcare providers. Notable clients include Mass General Brigham Inc., Texas Health Care PLLC, and The GI
Alliance Management.

With a global workforce of over 12,661 employees, including 2,294 clinically trained professionals, IKS is positioned as a trusted
partner for healthcare organizations navigating the shift towards efficient, value-based care.

Source: Company, ABML research

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Why IKS is uniquely positioned in a fragmented market

IKS Health has built a truly differentiated position in the healthcare enablement ecosystem through its tech-led, human-in-the-
loop care enablement platform. Unlike most players that offer isolated solutions, IKS has developed the only platform globally
that delegates and solves the full spectrum of physician-support chores with 16 services identified across the clinical, operational
and administrative gamut.

Over the past 18 years, IKS has combined proprietary technology with a deep pool of global human capital to create a vertically
integrated solution that enables physicians to focus on care delivery while offloading non-core, repetitive and compliance-driven
tasks which helps physicians saves 30-50% of their time, which can be redirected toward seeing more patients.

In contrast, many other companies in the space are point-solution vendors, focusing on solving one or two problems or at most,
four to five without offering a holistic view. While these solutions might be “best-in-class” in isolation, they place the burden of
integration, orchestration and value realization on the physician enterprise. This fragmented approach creates friction, inefficiency
and incremental cost for buyers who are now beginning to recognize that platform solutions drive better outcomes than stitching
together a patchwork of tools.

As market maturity progresses, buyer behaviour is shifting from fragmented point solutions to integrated platform offerings.
IKS is strategically positioned to benefit from this evolution, already serving early adopters who embrace this new model. While
competitive intensity is expected to rise, often backed by capital-rich new entrants, most of these players remain limited in scope
and depth. IKS stands out by offering a comprehensive, scalable and operationally embedded platform that not only addresses
today’s inefficiencies but is also designed to evolve with the future of physician enablement. IKS is not just another vendor, it is a
strategic partner delivering end-to-end enablement and proven execution, making it uniquely positioned in an increasingly
crowded and fragmented marketplace.

IKS - Service Offerings

Business Operation Description Key Offerings

Revenue Cycle Solutions to optimize financial health of healthcare - Patient Access Solutions
Management organizations across the care journey. - Denials Management
- Billing and Collections
- Contract Administration
Coding Accurate medical coding for precise documentation, - Medical Coding for diagnoses and
compliant billing and efficient operations. treatments
Scribing and Medical Services that reduce administrative burden and improve - Virtual Scribing
Transcription clinical documentation. - Medical Transcription
Clinical Services Offerings to optimize patient care, manage chronic - Referral Management
conditions, and improve operational performance. - Clinical Chart Review
- Utilization Management
- Medico-legal Document Preparation
- Medication Renewal
Value-Based Care Comprehensive services to support success in value-based - HCC (Hierarchical Condition
Solutions healthcare models. Category) Coding
- Population Health Management
- Provider Workflow Optimization
(e.g., Clinical Chart Reviews)

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Source: Company, ABML research

Investment Thesis

Large addressable market with headroom for growth

IKS Health operates in the physician segment of the US healthcare market, a $1.5trn industry consisting of 900k physicians
which serves as the fulcrum of care delivery in the broader $5trn US healthcare system. This segment is undergoing rapid
consolidation, driven by the need for better payer negotiations, improved access to expensive resources and more effective
management of regulatory and administrative complexities.

As physician enterprises mature, they are increasingly focusing on their core mission, delivering patient care while outsourcing
non-core administrative "chores". These chore tasks ranging from clinical documentation to revenue cycle functions which
represent nearly 15% of physician revenue, translating to a $225bn total addressable market (TAM). Factors like increasing
elderly population, surging chronic illness, matured insurance market, etc will drive this growth. US has the highest per capita
healthcare spend at ~$14,570 and accounts to about 17.6% of US GDP as per CMS data.

Distrubution of US Physician Practice by Ownership

100% 7% 8%
11% 10% 11% 11% 5%
6% 7% 7% 8% 9% 10% 12%
80% 4% 5% 7%
23% 26% 25% 27% 31% 31%
60% 35%
60% 57% 56%
40% 54% 49% 47% 42%
20%
0%
2012 2014 2016 2018 2020 2022 2024

Private Practice Hospital Owned Private Equity Owned Direct Hospital Employee Other

Source: Company, AMA 2024, ABML research

Aditya Birla Money Ltd. Registered Office:

IKS TAM is set to grow beyond the current $225bn as new features and task clusters are continuously co-developed with clients.
Currently, 2–3 such features are in active development, particularly within the evolving value-based care space, shifting from risk
and quality optimization to total cost of care management. Emerging areas like care coordination, transition of care, risk
stratification and asynchronous order entry are expanding the platform’s relevance. With 3–4 new features expected over the
next 24–36 months, IKS is well-positioned to unlock incremental market opportunities and capture a larger share of this growing
market. Currently, the outsourced market accounts for ~$35 bn implying an outsourcing penetration of ~15.6%. We expect this
piece of the market to grow at a ~12% CAGR to reach $55 bn by FY28 driven by ~120 bps of increased penetration in outsourcing
& unlocking new services areas.

IKS TAM Projections ($ bn)

350 16.8% 17.0%
300 55
49 16.5%
250 44
200 35 16.0%
16.2%
150 15.5%
100 15.6% 15.6%
15.0%
50
0 14.5%
2025 2026 2027 2028

TAM ($ bn) Outsourced ($ bn) Penetration

Source: Company, CMS, ABML research

Currently, IKS has a market share of < 1% which shows the scope & opportunity of growth in the industry driven by digital
transformation in healthcare. As the only player in the industry to provide end-to-end integrated technology solutions, IKS is
uniquely positioned to capitalise on this opportunity. This creates multiple advantages and value proposition as scale unlocks
efficiencies, it also supports the land & expand strategy of the company as the additional cost of deploying incremental solution
is lower for both IKS and its client. Additionally, with each new service added, clients benefit from greater synergies and cost
optimization, making IKS an increasingly strategic partner. Most importantly, clients prefer working with a single, trusted partner
who can meet a broader scope of their needs, driving stickiness and long-term value creation.

Aditya Birla Money Ltd. Registered Office:

Source: Company, ABML research

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Scope of Digital Transformation in Healthcare:

Stage Challenges Digital Innovations Key Technologies

1. Patient Pre-Visit - Manual registration and lack of - Online appointment portals and RPA, AI/ML, Blockchain,
streamlined operations automated reminders Cloud, Analytics
- Inaccurate or inconsistent - RPA for registration, insurance
patient demographics verification, and pre-authorization
- Physician shortages leading to - Blockchain for secure consent and
long queues authorization
- Appointment no-shows and
cancellations
2. Diagnostics & - Delays in diagnosis impacting - AI for triaging and diagnosis AI, Cloud, Analytics,
Treatment outcomes - Real-time surgical tracking and RPA, IoT
- Fragmented EHRs and poor sensors
patient retention - Teleconsult via cloud platforms
- Data privacy concerns in - RPA for discharges and lab order
telehealth processing
- Long OR turnover time - Clinical decision support integrated
with EHRs
3. Administration & - Equipment mismanagement - AI for revenue cycle automation AI, Analytics, RPA,
Management and asset theft (billing, coding, reconciliation) Blockchain
- Declining reimbursement rates - Blockchain for data security and
(RVUs) audit trails
- Rising cyber threats and data - Analytics for workforce planning
breaches and patient load forecasting
- Complex transition to ICD-11 - ICD-11 codification tools
- High administrative burden on
staff
4. Post-Treatment - Prescription and medication - E-prescribing and smart packaging AI, IoT, Cloud,
Follow-up errors - Wearables and IoT-based Wearables
- Missing or incorrect medication monitoring- Personalized rehab plans
history using AI
- Risks during care transitions - LTACH/SNF planning and
- Remote monitoring challenges coordination
(battery life, data security) - Medication adherence tools like
mobile apps and ingestible sensors

In addition to its existing offerings, IKS is actively developing new solutions to enhance its technology platform and support a
broader range of clinical and administrative functions. Key developments in the product roadmap include:

Product/Tool Description Key Benefits

IKS CLAIM Suite of predictive models for identifying revenue Improves cash flow, reduces
leakage before claim submission. Forecasts denial uncompensated care, lowers operating
likelihood, payment probability, and timing. costs.

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Daily Huddle Summary Tool for providers to review daily schedules with Optimizes visit flow, enhances care delivery,
insights on clinical and administrative aspects of improves physician efficiency.
patient visits.

Pre-emptive Order Algorithm-driven system that generates relevant Reduces administrative tasks, improves visit
Entry medical orders before patient appointments. quality, minimizes care delays.

Medication Pre-visit outreach to verify and update patient Ensures medication accuracy, reduces
Reconciliation medications. clinical burden and staffing costs.

Medication Adherence Multi-channel tools to monitor and support patient Enhances patient outcomes, reduces
Tools adherence to prescribed regimens. preventable complications.

Utilization Solution for providers with delegated risk to monitor Controls clinical costs, supports evidence-
Management and ensure appropriate care delivery. based care.

Care Coordination & Tools for managing care transitions and chronic Improves care continuity, boosts patient
Chronic Care diseases with improved patient engagement. outcomes, and enhances
Management financial/operational performance.

Autonomous Coding AI/ML-powered system to automate clinical coding Increases speed, improves accuracy, reduces
with little to no human intervention. documentation costs.

Building capabilities with strategic acquisitions & partnerships-

(A). Aquity acquisition unlocked inpatient capabilities, added basket of clients creating opportunity for cross-sell
IKS acquired Aquity Holdings on October 27, 2023. Aquity is a well-established provider of technology-enabled clinical
documentation, medical coding and revenue integrity solutions. This acquisition significantly enhances IKS capability to serve the
inpatient care segment and provides access to Aquity’s extensive inpatient customer base of over 804 healthcare clients as of
March 31, 2024.

Strategic benefits of the Acquisition

Cross-Selling Opportunities: The acquisition has enabled IKS to unlock cross-selling potential by gaining access to Aquity’s large
and established outpatient client base of 450+ enterprise-level clients out of a total 804. In parallel, IKS is also introducing Aquity’s
documentation and coding services to its own customer network, creating reciprocal revenue opportunities and deepening client
engagement across both platforms. As part of its strategic focus on profitability, IKS is actively rationalizing its client portfolio,
phasing out smaller, non-profitable accounts. Consequently, the total client base has reduced from ~850 to ~700 as of March
2025, with expectations to stabilize at 600–650 clients. Full integration benefits are expected to become evident by FY27, offering
a clearer picture of scale-driven efficiency and revenue synergy.

Expansion into Inpatient Care: With Aquity’s deep expertise in inpatient clinical documentation, medical coding and medico-legal
documentation, IKS is now well-positioned to:

• Deliver inpatient Revenue Cycle Management (RCM) solutions.

• Develop clinical staffing solutions tailored to inpatient needs.
• Enhance patient intake and discharge processes, including managing transitions of care more effectively.

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Holistic Care Enablement: This move allows IKS to provide comprehensive, end-to-end solutions across the care continuum,
making it a more strategic partner to health systems. Improved outpatient access, when combined with seamless inpatient service
delivery, enhances care coordination and unlocks greater revenue potential for integrated provider organizations.

Platform Modernization and Global Delivery Optimization:

IKS intends to modernize Aquity’s delivery operations by transforming its platform into a technology-led, human-enabled model.
It also plans to optimize resource allocation by blending US-based and India-based talent, aligning with IKS’s proven global delivery
approach. This will improve operational efficiency, reduce costs and maintain a competitive edge in a cost-sensitive industry. This
strategy reflects from margin accretion for the Aquity’s business from ~10% to ~23%.

Cross selling Opportunity & Ability of IKS

1400 49 49 50
1200 49

1000 48
47
800
45 46
600
45
400 44
200 43
0 42
FY22 FY23 FY24
Revenue (clients availing 1 solution) Revenue (clients availing 2-4 solutions)

Revenue (clients availing 4+ solutions) No. of Clients (IKS)

Source: Company, ABML research

The above chart provides confidence for the cross-selling strategy of IKS where, despite client addition, the company has been
able to maintain & increase the revenue share of clients availing 4+ solutions. In FY24, ~48% revenue came from this category,
up 400 bps. Addition of 450+ enterprise level clientele of Aquity amplifies this opportunity.

(B). Strategic investment in WWMG MSO LLC to accelerate adoption of platform via proof of efficiencies & builing long-term
relationships with customers & co-ownership of benefits derived
Evolving the IKS Engagement Model (IKS 3.0)
To accelerate platform adoption and deepen value creation, IKS has introduced three distinct client engagement models:

1. Strategic Joint Ventures with Leading Provider Aggregators

For top-tier provider groups in specific specialties, IKS may consider JV-style partnerships. In return for full platform adoption, IKS
co-develops specialty-specific versions of the platform and leverages client success as proof points for the broader market. Thus,
these JVs will act as a proof of concept and drive deeper penetration into remainder of that particular specialty industry.

2. Performance Underwriting - Palomar deal – A new benchmark in strategic partnership

IKS offers underwritten performance models, where it assumes partial financial risk and shares upside beyond predefined
thresholds. This aligns incentives and allows IKS to participate in the outcomes it helps deliver. Like the Palomar deal is a highly
strategic, 15-year contract with no exit for convenience, a significant departure from the typical 4–5year industry norm. What
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10th Floor, R-Tech Park, Nirlon Knowledge Park, Off W.E. Highway, Indian Rayon Compound, Veraval,
Goregaon, Mumbai – 400 063 Gujarat – 362 266
+91 22 6225 7600 CIN: L65993GJ1995PLC064810
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INVENTURUS KNOWLEDGE SOLUTIONS LTD.

sets this apart is Palomar’s full adoption of IKS’s 16-feature Care Enablement Platform from day one, unlocking deep operational
and financial transformation.

In a first-of-its-kind value-sharing structure, IKS has advanced $16.5mn upfront, with the first tranche of economic value created
flowing entirely to IKS, followed by a tiered 50-50 and then higher-share benefit to Palomar. The total value expected to be
created is projected to be many multiples of the $16.5mn, enabling rapid payback and significant margin expansion over time.
This deal reflects strong client conviction, deep platform integration and the potential to drive non-linear value creation beyond
traditional margins.

3. Equity Investments in Provider Aggregators

In select cases, IKS may invest directly in the growth of provider aggregators using its platform. This creates a perpetual, symbiotic
relationship, allowing IKS to benefit both from its core implementation business and from the value created in the provider group
itself.

Source: Company, ABML research

Investment in WWMG (Washington)

• Partnership Overview: IKS has formed a strategic relationship with Western Washington Medical Group (WWMG), a
~$100mn revenue physician group near Seattle with ~100 physicians and associated providers.
• Structure: A new management services organization (MSO) has been created, co-owned by IKS (48%) and WWMG
physician-shareholders (52%).
• Investment: IKS has committed $17mn at a pre-money valuation of $18.4mn.
• MSO Role: The MSO is responsible for all non-clinical operations, including front and back-office support, admin functions
(e.g., payroll, finance) and clinical support infrastructure (e.g., nurses, MAs). WWMG retains ownership of physician care
delivery.

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• Revenue Split: ~63% of the group's total revenue flows to the MSO to manage operational costs and platform services,
while ~37% supports physician compensation.
• Strategic Intent: The investment capital is entirely directed towards growth initiatives—not physician liquidity events, as
is common in private equity transactions.
• Timeframe: The structure was developed over 6–12 months in close collaboration with WWMG physicians.

Source: Company, ABML research

Marquee clientele with huge headroom for growth. Strong brand value & ‘land & expand’ approach results in customer
stickiness
IKS’s top 10 clients have $100M+ ACV potential, with the largest exceeding $300M, supporting land-and-expand growth. As of
FY25, the top 10 clients contribute to ~$108mn out of the total ~$1.2bn opportunity in the top 10 clients itself.

Reducing client concentration

3,000 68% 80%
67%
70%
2,500
60%
2,000 44% 50%
35%
1,500 40%
30%
1,000
20%
500
45 49 852 700 10%
0 0%
FY22 FY23 FY24 FY25

Revenue from top 10 Revenue from Non-top 10 Consolidated No. of Clients

Growth % % of top 10

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Headroom from Top 10 clients ($ mn) Increase in Headroom for non-top 10 clients
3000 100
108
90
2500
80

70
2000
60

1500 50

40
1000
30

20
500
9 10
7
0 1 3 0
FY22 FY23 FY24 FY25
1092
Revenue from top 10 Revenue from Non-top 10
Consolidated No. of Clients Average Revenue of top 10
Potential Top 10 Top 10 contribution FY25 Average Revenue of Others

Source: Company, ABML research

Aquity’s acquisition has been an inflection point for de-risking due to reduced concentration of revenues from top-10 clients from
68% in FY22 to 35% in FY25 while maintaining the growth in terms of absolute revenues from these clients. The average revenues
from the top-10 clients grew at a ~21% CAGR during FY22-FY25. The non top-10 client average revenues per clients stood at ~₹9cr
which dipped to ~₹1cr post Aquity acquisition due to addition of many small size & non-revenue generating clientele. With the
curtailment efforts and cross-selling strategies, the average realisations have improved to ~₹3cr & we expect this growth to be
faster and quicker than the top-10 basket. This is justified with the management expectation of 80%+ of the overall growth derived
from existing customer expansion.

IKS has been able to successfully deploy its “Land & Expand” strategy & hosts marquee clients. Its brand value reflects through
98%+ revenues being derived from repeat clients consistently for last three financial years. For each new client engagement, IKS
adopts a tailored approach—beginning with a deep understanding of the client’s specific needs, such as revenue optimization or
clinical documentation. Based on these initial priorities, IKS delivers targeted solutions that address immediate challenges.

Over time, IKS strategically expands its presence within the client organization by identifying opportunities to cross-sell and up-
sell additional services from its broader provider enablement platform. This expansion approach is particularly effective with large
enterprise clients that have a wider geographic footprint, larger employee base and higher net worth or annual revenues.

IKS’s pivot from selling individual features to offering integrated clinical and administrative bundles has significantly increased
client stickiness. With nine features in the clinical bundle and seven in the administrative bundle, clients typically adopt one
bundle and then expand usage by selectively adding from the other, driving deep platform integration. This approach not only
enhances value delivery but also creates high switching costs and long-term engagement, reinforcing IKS’s position as a strategic
partner rather than a point-solution vendor.

Key customer wins recently strengthening platform adoption

• Palomar Health ($1bn health system): Signed a 15-year full-platform deal covering revenue optimization, clinical support
and value-based care. IKS has guaranteed $16.5mn in upfront value with a gain-share model beyond, creating strong margin
upside and long-term stickiness.

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• Radiology Partners ($3.5B revenue, 3,000+ radiologists): Strategic partnership to build a Virtual Radiology Assistant (VRA)
platform. The model can improve productivity by 25–30%, with potential $600–700mn annual value creation. Deal expected
to evolve into a JV for wider market deployment.
• Western Washington Medical Group: Initial engagement on revenue cycle management, with rapid expansion into other IKS
platform features, reinforcing cross-sell opportunity in large independent medical groups.
Revenue trends show client stickiness IKS Client Aeging (years)
8.6
1400 70% 9 8.0
1200 66% 60%
8
63%
6.3 6.5
60% 7
1000 50%
6
800 40% 5 6.0 6.2
40%
5.6
600 37% 30% 4 4.7
34%
3
400 20%
2
200 10%
1
0 0% 0
FY22 FY23 FY24
FY22 FY23 FY24 FY25
Revenue from clients for 5+ years Revenue from clients for <5 years

% from clients for 5+ years % from clients for <5 years

Aeging of top-5 Aeging of top-10

Source: Company, ABML research

Leveraging GenAI for scalable innovation and efficiency

IKS is actively embedding GenAI across 7–8 key use cases within its 16-feature platform, including solutions like Scribble Now.
GenAI is significantly improving productivity and automation, delivering 20–35% efficiency gains and up to 70–85% in areas like
clinical documentation. Building on this success, IKS is now progressing toward Agentic AI, where autonomous agents understand
and execute tasks independently marking the next frontier in automation. To accelerate this journey, IKS is launching a GenAI
Center of Excellence in the US, reinforcing its commitment to innovation, product enhancement and scalable business growth.

Aditya Birla Money Ltd. Registered Office:

IKS has embedded GenAI across its platform, driving significant advances in automation and efficiency. From Scribble Now—its
ambient listening and transcription tool—to autonomous medical coding and patient credential clearance (prior authorization),
GenAI is enabling faster, scalable and more accurate solutions. It has enhanced denial prediction and prevention in revenue cycle
management and even nudged patient behaviour to improve both clinical and financial outcomes. This shift from human-led to
tech-led execution is accelerating implementation timelines, improving scalability, and expanding margins.

Key Strategic Pillars of IKS

Strategic Pillar What It Means Execution Status (FY25)

1. AI-native Evolve from human-led processes to Scribble Now (GPT-4-based), autonomous coding for key
Platform GenAI-powered, autonomous tech specialties, EVE for prior auth, denial prediction models –
Transformation solutions enhancing scale, speed & margins.
2. AQuity Consolidate and optimize AQuity’s Integrated teams and brand, reduced client base from 850+ to
Acquisition operations, costs, clients and tech ~700, initiated margin improvement, began cross-sell into 450+
Integration capabilities enterprise clients.
3. Leadership in Be top 3 in each of the 16 product Strengthened feature-specific leadership; gained analyst
Platform features via capability depth and recognition (e.g., KLAS, Black Book); building complete,
Features analyst validation competitive platform.
4. Segmented Tailored go-to-market: land & expand Executing differentiated strategies across large, mid, and PE-
Growth in large health systems, platform-led backed health systems; two of three segments moving to full-
Strategy for mid/PE platform adoption.
5. Shift to Move from tool provider to Building capabilities to own outcomes; early deployments
Outcome accountable partner delivering launched where IKS is responsible for measurable results, not just
Ownership financial/clinical outcomes tech deployment.

Financial Performance
The revenues for the company have grown at ~38% CAGR from FY20-25 from ₹529 cr to ₹2,264 cr Going forward, we expect the
growth to normalise slightly at ~20% CAGR to reach ₹4,554 cr in FY28. While during FY20-23 the EBITDA margins grew by 800 bps
to ~38% in FY23 dropping back down to ~29% in FY24 & FY25 on account of acquisition of Aquity which had onshore employees
and inefficient clientele. Now with IKS’s strategic efforts of offshoring & client curtailment, we see the integration bearing fruits
and the margins to improve from here onwards. We expect the margins to grow by ~400-500 bps between FY25-28. This will drive
the EBITDA growth at ~26% CAGR.

Revenue Trend EBITDA Trend

5,000 100% 2000 60%
4,000 80% 50%
1500
3,000 60% 40%
1000 30%
2,000 40%
20%
1,000 20% 500
10%
- 0% 0 0%
2020

2021

2022

2023

2024

2025

2026E

2027E

2028E
FY26E
FY20

FY21

FY22

FY23

FY24

FY25

FY27E

FY28E

Revenue Growth (%) EBITDA EBITDA Growth

Source: Company, ABML research

Aditya Birla Money Ltd. Registered Office:

Further, we expect the cash conversion ratio to improve to 70%+ over the forecast period resulting in reduction of the
debt which was drawn for financing the Aquity acquisition.

CFO/EBITDA (%) Debt/Equity(X)

90% 1800 1.2
1.0
80% 1600
70% 1400 1
60% 1200
0.8
50% 1000
40% 800
0.6 0.4
30% 600
20% 400 0.4
10% 200 0.2
0% 0 0.2
0.0
2022 2023 2024 2025 2026E 2027E 2028E 0.0 0.0 0.0
0
CFO EBITDA CFO/EBITDA (%) 2022 2023 2024 2025 2026E 2027E 2028E

Source: Company, ABML research

In terms of efficiencies, we expect the working capital cycle to remain stable at ~60 days. While, on the employees’ front, the
revenue growth is expected to outpace employee growth due to implementation of AI. This will result in sharp improvement in
the revenue per employee indicating efficiencies.

Revenue Per Employee ('000) Working Capital (Days)

18000 3000
70
16000
2500
14000 60
12000 2000
50
10000
1500
8000 40
6000 1000
30
4000
500
2000 20
0 0
2022 2023 2024 2025 2026E 2027E 2028E 10

No. of Employees Revenue per EE 0

2022 2023 2024 2025 2026E 2027E 2028E

Source: Company, ABML research

Risks:

Regulatory Risk

The company operates in a highly regulated US healthcare market and is subject to various laws and regulations related to data
protection & HIPAA Act. Any non-compliance of these can adversely affect the company’s reputation & business in the US. Further,

Aditya Birla Money Ltd. Registered Office:

any change in regulation or laws may hamper the outsourcing growth or affect the profitability of the company in case of additional
compliance requirements. Any changes in the healthcare regulations may affect the industry as a whole slowing down the growth
of the industry.

Competition Risk

The company faces competition from the local players and many other companies offering point solutions. Currently, the company
is the only player with integrated end-to-end solutions, however, with rapid consolidation happening in the industry, competition
can get intense with more and more players adding capabilities via acquisitions. Further, players like Sagility, which have limited
presence in providers market but big presence in payer market can find it easier to penetrate the fragmented provider market &
leverage the business synergies.

Execution Risk

The company has made several acquisitions & till date has been successfully able to integrate its operations. However, with new
strategic changes in business models like the Palomar & WWMG deal, the company is exposed to execution risks in context of
these contracts & investments. Any failure to deliver the promised performances may result in huge financial losses & dent on
reputation.

Outlook:

We believe IKS holds immense long-term potential in the US based provider’s market. The strategic initiatives by the company
to improve client relationship longevity along with expansions through acquisitions on client’s front & capabilities further
cements its position in the market. Marquee promoters, superior margins & the only company having such an integrated end-
to-end offering are some qualitative factors that justifies valuation premium. We initiate coverage with a “BUY”
recommendation with a TP of ₹2,285 indicating 44% upside from the CMP, implying 35x FY28 PE.

Financial Snapshot:

Profit & Loss Account 2020A 2021A 2022A 2023A 2024A 2025A 2026E 2027E 2028E
Revenue 529 553 764 1,031 1,818 2,664 3,296 3,880 4,554
Cost of goods sold (COGS) 18 15 - - 1 1 - - -
Gross Profit 511 538 764 1,031 1,817 2,663 3,296 3,880 4,554
Salaries and Benefits 280 294 373 492 962 1,495 1,726 1,939 2,179
Other SG&A 70 39 93 148 335 399 593 698 820
EBIDTA 161 204 297 391 520 770 977 1,242 1,555
EBITDA Margins (%) 30% 37% 39% 38% 29% 29% 30% 32% 34%
Depreciation & Amortization 41 30 23 25 59 113 122 136 150
EBIT 120 174 274 367 462 657 854 1,106 1,405
Interest Expenses 7 8 6 5 60 90 63 36 16
Other Income 32 16 21 29 40 39 43 47 52
Profit Before Tax 145 183 288 390 442 606 834 1,117 1,441
Taxes 7 17 36 54 71 120 184 246 317
Profit After Tax 137 165 253 336 370 486 651 871 1,124

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Balance Sheet 2020A 2021A 2022A 2023A 2024A 2025A 2026E 2027E 2028E
Assets
Current Assets
Cash& Bank 122 224 347 523 332 192 500 1,042 1,972
Account Receivables 75 75 96 161 362 532 632 723 848
Inventory - - - - 1 - - - -
Short-term loans and advances 5 1 2 6 17 - - - -
Other current assets 32 45 16 9 34 60 60 60 60
Currents Investments - - - - 152 - - - -
Non-current assets
Property, Plant & Equipment 98 87 75 57 155 125 135 132 117
Goodwill - - - - 1,168 1,197 1,197 1,197 1,197
Other Intangibles - - 1 1 508 469 416 362 307
Financial assets 16 23 42 44 109 260 260 260 260
Other non-current assets 39 70 132 93 13 72 72 72 72
Total Assets 386 524 710 893 2,851 2,906 3,272 3,848 4,834

Liabilities
Current Liabilities
Account Payable 13 7 10 22 68 76 90 96 112
Other Current Liability 68 52 73 93 341 199 199 199 199
Non-Current Liabilities
Debt - - - - 1,193 755 455 155 0
other Non-Current Liabilities 22 9 -19 -50 92 86 86 87 87
Total Liabilities 103 68 63 65 1,694 1,116 831 537 398
Shareholder's Equity
Equity Capital 8 8 17 17 17 17 17 17 17
Retained Earnings (reserve & surplus) 275 449 630 812 1,141 1,773 2,423 3,294 4,418
Shareholder's Equity 283 457 647 829 1,158 1,790 2,440 3,311 4,435
Total Liabilities & Shareholder's Equity 386 524 711 894 2,852 2,906 3,272 3,848 4,834

Cash Flow Statement 2020A 2021A 2022A 2023A 2024A 2025A 2026E 2027E 2028E
Operating Cash flow
Net Earnings 117 153 224 284 348 490 651 871 1,124
Plus: depreciation & Amortization 41 30 23 25 59 113 122 136 150
Plus/less adjustment for non-operating
6 -8 5 12 29 86 20 -11 -36
items
Plus/less adjustment for operating
-0 -1 -20 -33 -226 -371 -86 -85 -109
Assets & Liabilities
Cash Flow from Operations 163 175 233 288 210 318 707 911 1,129

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kInvesting Cash Flow

Sale of property, plant and equipment -12 -7 -11 -8 -33 -42 -80 -80 -80
Purchase & Sale of investments -72 -164 -83 -171 268 325 - - -
Dividend received - - - - -1,412 -64 - - -
Interest received 4 5 11 24 35 26 43 47 52
Cash from Investing -80 -166 -82 -156 -1,141 245 -37 -33 -28

Financing Cash flow

Issuance (repayment) of debt - - - - 1,000 -328 -300 -300 -155
Issuance (repayment) of preferential
1 1 4 -98 3 44 - - -
shares NCI
Dividend paid -19 -19 -44 - -165 - - - -
Interest paid -7 -7 -6 -14 -41 -84 -63 -36 -16
Other Financial Activities -15 -11 -12 -40 -16 -21 - - -
Cash from Financing -41 -37 -59 -152 780 -389 -363 -336 -171

Source: Company, ABML research

Note: Data presented is for financial year April to March

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SINGULAR FOCUS WITH DEEP EXPERTISE

CMP (₹) 44
Sagility is a US healthcare-focused BPM (Business Process Management)
company with over 24 years of operational experience, formed through a
Target (₹) 72
carve-out from HGS in 2022. Despite being a relatively new brand, it brings a Upside /Downside (%) 63%
legacy of deep domain expertise, serving 75 client groups (including
High/Low (₹) 56/ 27
Brodpath clients). It serves 6 of the top 10 US Payers, 3 of the top 6 PBMs,
and multiple large Providers like IDNs, labs, DME, and radiology firms. Market cap (Cr) 20,592
All operations are underpinned by strong investments in technology and
transformation, delivered across five global geographies—US (onshore),
No. of shares (Cr) 468
Jamaica & Colombia (nearshore) and India & Philippines (offshore). Sagility’s
39,409-strong workforce as of March’25, including 2,000+ clinicians, is led by
a tenured leadership team and a board with deep healthcare expertise. Shareholding (%)
Longstanding client relationships, with top 5 clients averaging 17 years— Dec-24 Mar-25 June-25
underscore the company’s commitment to quality and continuity. We expect
the revenues/ EBITDA/ PAT to grow at a CAGR of ~16%/ 17%/ 28% between Promoters 82.4 82.4 67.4
FY25-28. We initiate coverage with a TP of ₹72/ share valuing the company FIIs 3.8 3.4 6.0
at 30x FY28 EPS implying 63% upside.
DIls 7.2 7.5 14.1
Massive market, untapped potential Public & Others 6.6 6.7 12.5
US healthcare is a massive and growing $4.7trn industry in 2023, accounting
for over 17% of GDP, projected to reach 18% by 2028. With per capita spend
of ~$14,570, the US leads globally, creating a vast addressable market for
Financial & Valuations
operational outsourcing. Sagility operates within a $200bn core operations Y/E Mar (₹ cr) FY26E FY27E FY28E
market (Payers + Providers), of which only ~20% is currently outsourced, a Revenue (₹) 6,785 7,706 8,668
$45bn opportunity. As outsourcing penetration deepens, especially in mid-
market payers and end-to-end offerings, Sagility is well-positioned to expand EBITDA 1,595 1,820 2,088
its market share. With long-tenured client relationships, a focused go-to- EBITDA Margin (%) 23.5% 23.6% 24.1%
market strategy and a strong second-half revenue boost from open enrolment,
PAT 767 935 1,121
Sagility is poised for sustained growth in a structurally underpenetrated and
high-potential market. P/E (x) 27 22 18
ROE (%) 8% 9% 10%
M&A, a catalyst for capacity expansion and market access
Sagility’s focused M&A strategy has proven effective in enhancing domain
capabilities, accelerating GenAI integration and broadening its client base
Sagility Nifty
particularly in the underpenetrated mid-market segment. Recent acquisitions
like Devlin consulting (payment integrity), BirchAI (GenAI-driven automation) 200
and BroadPath (mid-market client access and remote work tech) have
150
significantly bolstered Sagility’s service portfolio, reduced client concentration
and unlocked new growth levers. These strategic moves not only deepen 100
Sagility’s value proposition across payer and provider segments but also 50
position it to capture white space opportunities in a ~$200bn market with low 0
outsourcing penetration, driving both top-line growth and margin expansion.
Feb-25

Apr-25
Nov-24
Dec-24
Dec-24

Jul-25
Jan-25

Mar-25
Mar-25

May-25
May-25
Jun-25

Hard to win, harder to replace

Winning new clients in US healthcare operations specially on the payer side is
inherently challenging due to the critical nature of services and the need for
deep domain expertise. Clients are extremely cautious in offshoring decisions,
as they’re entrusting partners with business-critical, day-to-day operations.
This makes operational capability and healthcare know-how key
differentiators, creating a significant barrier to entry for new players. Ramp-
up timelines vary 2–3 months for smaller deals and 4–6 months for larger
engagements—driven by hiring and intensive training cycles. While RFP led
wins can close in 3–4 months, relationship-driven deals may take 6–8 months,
further underscoring the importance of trust and proven execution in breaking
into this space.
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Page No: 29
SAGILITY INDIA LTD.

About Sagility Ltd. (Sagility)

Sagility is a technology-enabled, pure-play healthcare business process outsourcing (BPO) provider focused exclusively on the US
healthcare market. Originally part of the Hinduja group, the business was acquired by Baring Private Equity Asia in January 2022
for $1.2bn, through a leveraged buyout. The company delivers from multiple geographies, US is the onshore geography and
offshore spanning India, Philippines, Jamaica and Colombia. Despite being a relatively new standalone entity, Sagility builds on
over 25 years of operational experience. It delivers a wide range of services to US payers (insurance companies), providers
(hospitals and clinics) and pharmacy benefit managers (PBMs), across functions such as benefits administration, clinical services
and revenue cycle management. With a global delivery footprint across five countries and long-standing client relationships—
some exceeding 18 years—Sagility is positioned as a strategic partner driving efficiency and innovation across the healthcare
value chain.

Business offerings

Source: Company, ABML research

Segment Service Category Key Offerings

Payer Claims • Intake, Indexing & Imaging: document handling, recognition, validation,
Services Management extraction
• Adjudication: first-pass claims, provider correspondence, pre-payment coding,
third-party liability reviews
• Post-Adjudication: adjustments, member communication, retrospective
reviews, pricing, SIU reviews, fraud detection
• Grievances & Appeals: triage, resolution, compliance
Payment Integrity • Pre-Pay Audit & Validation
• Post-Pay Audit & Validation
Clinical • Chronic & Complex Case Management: whole-person care, predictive
Management analytics, discharge planning
• Utilization Management: prior authorizations, concurrent reviews, clinical
decisioning engine, URAC-accredited

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Segment Service Category Key Offerings

• Population Health Management: Aging-in-Place platform, frailty risk

prediction, caregiver engagement, 24x7 nurse helpline
Other Payer • Provider Data & Credentialing: onboarding, licensing, verification via Provider
Services Forward™
• Member Enrollment: onboarding for group & government plans, ID card
generation
• Plan Building & Premium Billing: plan design, billing, reconciliation, refunds
• PBM Services: member/provider engagement, authorization support,
pharmacy plan design
Provider Patient • Appointment scheduling
Services Engagement • Billing & collections
• Communication support
Claims & Coding • Prospective coding
• Medical record analysis
• Claim editing
Revenue • A/R follow-up
Management • Denials resolution
• Claim submission (electronic/hard copy)
• Clearinghouse rejection handling
• Underpayment reviews
• Refund processing
Denials • Clinical and coding denial analysis
Management • Appeal preparation
• ~60% success rate leveraging analytics and certified coders/nurses
DME & Lab • Order intake and triage
Services • Prior authorization - Billing, denials, A/R support
• Patient engagement
• Debt reduction & productivity enhancement through automation

Service Delivery Model

Sagility operates a multi-shore delivery model with services provided from 31 locations across five countries: the US, Colombia,
Jamaica, India and Philippines. All client contracts are executed through Sagility’s US subsidiaries. Services are delivered by
employees in India and those employed by Sagility’s subsidiaries.

Revenue Model

Sagility generates revenue from providing services to Payer and Provider clients, using three primary commercial models:

• Time-Based: Billing is based on hourly or monthly rates for employee time (FTE).
• Transaction-Based: Revenue is tied to transaction volume (e.g., number of claims processed).
• Outcome-Based: Fees depend on measurable results, such as collections or recovery of overpayments, etc.

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Investment Thesis

Operating in complex US healthcare space with huge market opportunity

The US healthcare industry is massive, with a total spend of ~$4.7trn in 2023, accounting for over 17% of GDP which is expected
to rise to 18% by 2028. With per capita spending of ~$14,570 in 2023, the US tops global healthcare expenditure, nearly 50%
higher than the next country. Within this, the core operational spend across Payers and Providers stands at ~$200bn in CY23 and
is projected to reach $259bn by 2028. Key drivers include an aging population, rising chronic conditions, ongoing staffing shortages
and regulatory complexity, all of which are pushing healthcare enterprises to outsource more non-core functions.

In 2023, the outsourcing penetration in healthcare operations stood at 21.5–23.5%, translating to an outsourced spend of ~$45bn.
This market is expected to grow at a CAGR over CY23-28 of 8.7%, with Provider outsourcing accelerating faster (12.5% CAGR) than
the Payer segment (7.0% CAGR). Within this space, Sagility’s market share is below 2% currently despite growing higher than the
industry growth over the years. We believe there is still a huge headroom for growth given the size of the industry, Sagility’s
expertise in the domain and long-standing relationship with the top 5 clients.

US Payer's operational spend market

300 29%
28% 28%
250
27% 27%
200 26% 26%
25% 25%
150
24% 24%
100 23% 23%
22%
50
21%
0 20%
2023A 2024A 2025A 2026E 2027E 2028E

Healthcare Operational Spend Payer's Share

Outsourced Market Outsourcing %

Source: Company, ABML research

Outsourcing in the US healthcare sector is gaining momentum as clients face rising cost pressures and look to offload non-core
functions traditionally managed in-house. These financial constraints are accelerating the shift toward third-party service
providers like Sagility, who not only offer cost-effective delivery from the outset but also bring operational efficiencies over time.
Such dynamics are prompting more active discussions with existing clients, as organizations increasingly prioritize scalable,
efficient solutions to manage ongoing budget challenges.

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Niche business with deep domain expertise creates moat

As a specialist healthcare service provider, Sagility brings over two decades of experience supporting both Payers and Providers.
With a team of 2,000+ healthcare-trained professionals (across nursing, medical coding, pharmacy, therapy and more) and
mandatory healthcare training for all employees, Sagility ensures its workforce is well-equipped to handle industry-specific
challenges.

Key Advantages of Sagility’s Domain Expertise

• Medical Appropriateness: Assessing whether care is medically necessary

• Risk Prediction: Leveraging data to anticipate high-risk cases
• Claims Optimization: Reducing rework, provider abrasion, and high interest payouts
• Customer Effort Reduction: Enhancing member experience through benefit navigation
• Automation & Intelligence: Deploying RPA, AI and predictive models to prioritize work and streamline processes
• End-to-End Insight: Deep understanding of both Payer administrative and Provider revenue cycle workflows
• Tech-Contextualization: Applying automation tools (RPA, Gen AI, analytics) in a healthcare-specific context
• Sticky Relationships: Offering non-discretionary, domain-rich services that create long-term client partnerships

Entry barriers created by domain expertise

Winning a new client in the healthcare BPO space is challenging due to high entry barriers driven by the need for proven domain
expertise. Clients are outsourcing critical day-to-day operations and cannot afford operational disruptions, making them cautious
and selective. The decision to offshore, despite its cost advantages, involves risk, especially in regulated environments like
healthcare. As a result:

• Operational credibility and domain capability are must.

• Sales cycles vary: If responding to an RFP for incremental services, it can take 3–4 months; if building a new relationship,
it may take 6–8 months.
• Ramp-up speed depends on deal size: Small deals may scale in 2–3 months; large deals (300–400 FTEs) may take 4–6
months, depending on hiring and training cycles—especially for non-clinical roles that require US healthcare training.

Leveraging M&A for building capabilities & market penetration

Sagility views mergers and acquisitions (M&A) as a strategic lever to build capabilities, expand its client base—especially in the
mid-market segment and accelerate growth. Its M&A approach focuses on two primary areas:

1. Capability-Driven Acquisitions
o Targeting companies that bring deep domain expertise or technology differentiation, such as AI or payment
integrity tools.
o Goal: Enhance Sagility’s offerings in areas like GenAI, clinical operations and claims management.

2. Client Base Expansion Acquisitions

o Focused on acquiring firms with an established mid-market client base.
o Goal: Reduce dependence on top clients and tap into “white space”— the mid and small market segments,
where outsourcing penetration remains very low.

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Sagility aims to reduce revenue concentration from its top 5 clients (currently ~80%) to 60–65% over the next 2–3 years through
these strategic acquisitions.

Key Acquisitions

1. Devlin Consulting Inc. (DCI) acquisition – Strengthening payment integrity

Sagility completed the acquisition of Devlin Consulting Inc. (DCI) in April 2023. DCI is a 28-year-old company specializing in payment
integrity (PI) services for US healthcare payers. Its proprietary “Contract Central” platform serves as a secondary adjudication
engine, enabling identification of overpayments and effective claims reprocessing. Through this acquisition, Sagility significantly
enhanced its precision PI offerings, adding strength in both pre-payment cost avoidance and post-payment recovery services. The
acquisition expanded Sagility’s reach into regional and national health plans, opening up new opportunities and reinforcing its
positioning as a comprehensive PI solutions partner.

2. Sagility supercharges GenAI capabilities with BirchAI acquisition

In March 2024, Sagility acquired BirchAI, a healthcare technology firm known for its cloud-based Generative AI (GenAI) capabilities.
BirchAI offers real-time customer support automation powered by domain-specific natural language processing (NLP) models. Key
features include speech-to-text conversion, call summarization, classification and trend detection, which improve engagement
outcomes for members and providers. The acquisition strengthens Sagility’s AI Center of Excellence and adds advanced capabilities
in fraud, waste & abuse (FWA) detection, clinical reviews and decision support. This move allows Sagility to more deeply integrate
GenAI into its operations, enhancing both cost efficiency and client transformation efforts.

Source: Company, ABML research

3. Sagility taps mid-market with BroadPath acquisition

Later in 2024, Sagility acquired BroadPath Healthcare Solutions, a Tucson-based healthcare services company focused on payer
and provider operations, especially in the mid-market space. This acquisition supports Sagility’s strategic goal to diversify its client
base beyond large enterprise clients by gaining access to over 30 mid-market customers, many of whom had not previously

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outsourced. BroadPath brought new capabilities in member acquisition and enrollment services, particularly in Medicare and
Medicaid segments, enriching Sagility’s service portfolio.

BroadPath also contributed Bhive, a proprietary remote-work platform built pre-COVID that enhances employee engagement and
operational metrics in a virtual setup. Bhive is being integrated across Sagility’s delivery geographies and merged with its GenAI
stack to boost efficiency. The acquisition, funded entirely through internal cash was EPS accretive from the date of acquisition and
added 1,600 employees to Sagility’s workforce. Expected synergies include cross-sell opportunities, SG&A rationalization and
vendor consolidation, which are projected to enhance margins by 50–70bps over the next 2–3 years to ~24.2% by FY28E. The
acquisition also increased Sagility’s presence among the top 10 US payers and introduced a high-performing client-facing team
into its operations.

Below are the capabilities and the strategic value or synergies derived from Sagility’s recent acquisitions:

Acquisition Key Capabilities Strategic Value / Synergies

Devlin Consulting Inc. • “Contract Central” platform: • Strengthens Sagility’s PI offerings

(DCI) (Acquired: Apr secondary adjudication engine • Expands access to national & regional plans
2023) • Pre-pay cost avoidance & post- • Enhances claims accuracy and
pay recovery overpayment detection
BirchAI (Acquired: Mar • Speech-to-text NLP engine for • Enhances Sagility’s AI Center of Excellence
2024) healthcare • Boosts Member & Provider engagement
• Call classification, summarization, • Supports fraud, waste & abuse detection,
trend analysis clinical reviews, decision support
• Real-time support automation • Drives operational cost efficiency
BroadPath Healthcare • 30+ mid-market clients • Adds mid-market client base (diversifies
Solutions (Acquired: • Member acquisition revenue)
2024) (Medicare/Medicaid), enrolment • Expands top-payer relationships (6 of top
services 10) - Enables cross-sell of Sagility’s full
• Bhive: employee engagement & portfolio
remote operations platform • EPS accretive from the date of acquisition
• Operational synergies via SG&A, vendor
consolidation and shared services
• Seasonality impact via open enrollment
cycles

Deep client partnerships driving growth through cross-sell and upsell opportunities

Sagility has built deep, long-standing relationships with leading US healthcare Payers and Providers. As of March 2025, the
company served 6 of the top 10 US payers by enrolment (1 added from Broadpath acquisition), 3 of the top 6 pharmacy benefits
managers (PBMs) by claims volume and one of the largest hospital networks by revenue. Its top five client groups had an average
relationship tenure of ~18 years as of March 2025, reflecting high client stickiness and satisfaction. An important thing to note
here is that the payer market is consolidated (top 18 hold 70% share), unlike the fragmented provider market.

Sagility follows a land-and-expand strategy, typically beginning client engagements with a specific service such as claims processing
and gradually expanding across the healthcare value chain, including areas like enrolment and utilization management. Sagility
focuses on large clients who generally have 7–8 active scopes of work (SOWs), each managed by different decision-makers,
fostering strong, multi-layered relationships. Notably, the company has maintained its client base without any attrition due to
performance-related issues, underscoring its consistent delivery and operational excellence.

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Source: Company, ABML research

It also continues to onboard new clients while broadening services to existing ones, adding 38 (30 from Broadpath acquisition)
gross new clients in FY25. The number of active SOWs with its top five client groups increased from 337 in March 2022 to 358 by
June 2024. High service quality is maintained through robust SLAs, with a compliance rate of over 95% consistently across periods.

Total clients & additions Client profiles

80 40 60
38
70 35
60 30 40
50 25
40 20 20
30 15
13
20 10
7 0
10 5
2022 2023 2024 2025
0 0 0
2022 2023 2024 2025 Clients >$20 mn Clients $5-$20 mn
Total Clients Gross Additions Clients $1mn-$5 mn Clients <$1 mn

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Client concentration

2025

2024

2023

0% 20% 40% 60% 80% 100%

Top 10 clients Top 5 clients Top 3 clients

Source: Company, ABML research

The acquisition of BroadPath has proven to be a significant strategic milestone for Sagility, particularly in expanding its client
footprint within the mid-market segment. This move has opened up substantial opportunities for cross-selling and up-selling
Sagility’s broader portfolio of healthcare services to a diverse base of over 30 new clients. Furthermore, BroadPath’s established
capabilities in member acquisition—especially within the Medicare and Medicaid segments—add a valuable dimension to
Sagility’s offerings.

In addition to client synergies, the acquisition positions Sagility to benefit from ongoing consolidation trends within the healthcare
services industry. The company anticipates that these strategic advantages, combined with operational efficiencies, integration of
proprietary platforms like Bhive and cost rationalization—will contribute to an estimated 600–700bps acceleration in top-line
growth over the next two years.

Offshore scale, leveraging technology

Sagility has progressively evolved into a technology-driven healthcare BPO provider by developing and integrating a
comprehensive suite of proprietary platforms and digital solutions. The company strategically leverages automation, artificial
intelligence (AI), machine learning (ML), natural language processing (NLP) and generative AI (GenAI) across both front-office and
back-office functions to drive operational efficiency, cost savings and better client outcomes. Their proprietary tools support core
Payer and Provider operations, ranging from revenue cycle management to clinical decision-making and customer engagement.

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Source: Company, ABML research

Category Tool / Platform Description

Automation Robotic Process Used since 2015 to automate rule-based back-office processes like claims
Automation (RPA) management and provider data validation, helping reduce costs and improve
speed.

AI / Predictive Predictive Models Models built for overpayment prediction, claim error propensity and collection
Analytics optimization.

Natural Language STT + NLP / NLU Used for speech-to-text transcription, call intent identification, quality audits,
Tech and interactive analytics for engagement services.

Document Document Extracts and classifies data from structured/unstructured sources using OCR
Processing Processing Engine and NLP. Helps identify misrouted documents, duplicates, urgent cases and
routes them for appropriate action.

Clinical AI Nurse Assist Tool to summarize and annotate clinical documents, improving review speed
and accuracy. Assists in prior authorizations and clinical decision support.

Member Member Enables care coordinators and nurses to interact with members, track
Engagement Engagement progress on programs and deliver targeted interventions.
Platform

Provider Services Provider Forward™ Platform for provider data management and credentialing. Includes self-
service web portals for providers and workflow engines for Sagility teams.

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Category Tool / Platform Description

Speech Analytics Speech Analytics Includes real-time call summarization, sentiment analysis, call deflection and
Suite next-best action recommendations.

Claims Adjudication Contract Central (via Detects overpayment by reprocessing claims using payer contracts and
DCI) compliance rules.

Enrolment Enrolment & Plan Automates end-to-end Member enrolment, quote generation, ID creation and
Automation Building Automation benefits plan design using third-party tools.

Revenue Cycle End-to-End RCM Manages provider claims, eligibility, order processing and payment collections.
Management (RCM) Platform Predicts claim collectability using ML and AI tools.

Proprietary Bhive (via Virtual engagement and monitoring platform to enhance work-from-home
Collaboration Tool BroadPath) operations, employee productivity and training in remote setups.

How is Sagility embracing GenAI and its business impact

Sagility has strategically integrated Generative AI (GenAI) to enhance both client-facing and internal operations. Its application
spans front office functions, such as automating member and provider interactions and real-time call summarization and back-
office processes, including grievance and appeals, letter generation and fraud, waste, and abuse (FWA) detection. GenAI has
significantly transformed clinical workflows, especially in summarizing and classifying medical records to support faster and more
accurate decisions by nurses and coders. Internally, Sagility also uses GenAI to streamline hiring, training and onboarding,
accelerating productivity and time-to-proficiency. The company’s AI Center of Excellence drives the development, deployment
and governance of these innovations, supported by the acquisition of BirchAI, which added domain-specific speech-to-text and
LLM capabilities to Sagility’s GenAI toolkit.

While full-scale automation of healthcare interactions remains constrained due to the complexity and fragmentation of systems,
GenAI is proving to be a powerful enabler of operational efficiency at Sagility. The company doesn't frame its impact merely in
terms of reducing contact center workload, but rather in terms of end-to-end process enhancement.

Take, for example, the claims management workflow. When a Provider receives a partial payment, it often triggers an
interaction—either a phone call, a chat, or a written appeal. While not all such interactions can be fully automated, Sagility has
already helped clients reduce the volume of these touchpoints by creating direct gateways between Payers and Providers,
rerouting or eliminating unnecessary interactions.

Where GenAI plays a transformative role is in the automation of high-frequency, repeatable elements of the interaction lifecycle.
The company is actively running pilots with clients to identify call drivers that are amenable to automation and early indications
suggest that up to 15–20% of interactions can be automated.

Beyond full automation, the real value lies in augmenting human productivity. GenAI is being leveraged for:

• Knowledge retrieval: Helping associates quickly access context-specific information across disparate systems.
• Real-time summarization: Reducing documentation time by auto-generating interaction summaries.
• Decision support: Assisting associates in making more informed responses during live interactions.

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These improvements, while not eliminating the need for human intervention, significantly reduce the cognitive load and manual
effort, allowing associates to focus on higher-value tasks. The result is a material improvement in efficiency, faster turnaround
times and better client outcomes, all without compromising service quality in a highly regulated and complex industry. In essence,
while GenAI won’t fully replace human engagement, it is reshaping how work is done, driving both scalability and sustainability
across Sagility’s service lines.

Financials performance

Historically, after getting its independent identity, if we compare for full reported years, Sagility has grown its topline at a 15%
CAGR over FY23-25. We expect the growth to remain stable subject to new inorganic acquisitions like Broadpath. We model in
16% revenue CAGR over FY25-28 fueled by robust relationship with the existing clients and strong performance of sales and
marketing teams to win new logos. Also, with Broadpath acquisition, there is an incremental opportunity with the focus on small
and mid-market payer segment, where Sagility can provide end-to end offerings.

EBITDA has grown at a 12% CAGR during FY23-25, we expect this to grow at a 17% CAGR over FY25-28 primarily due to unlocking
of synergies & operational efficiencies (both tech-led initiatives and process improvements). However, the PAT will grow at a much
higher rate at 28% CAGR due to lower interest cost burdens from simultaneous repayment of loans from strong cashflow
generation & reduction in amortization of intangibles.

Revenue Growth EBITDA & EBITDA margin

2,500 25%
10,000 25%
2,000 24%
8,000 20% 23%
6,000 15% 1,500 22%
4,000 10% 1,000 21%
20%
2,000 5% 500 19%
0 0% 0 18%
2022A

2023A

2024A

2025A

2026E

2027E

2028E
2022A

2023A

2024A

2025A

2026E

2027E

2028E

Revenue Growth % EBITDA EBITDA Margin

PAT Growth CFO/EBITDA

1,200 150% 2500 100%
1,000 2000 80%
800 60%
100% 1500
600 40%
1000
400 20%
50% 500
200 0%
0 0 -20%
2022A

2023A

2024A

2025A

2026E

2027E

2028E

2022A

2023A

2024A

2025A

2026E

2027E

2028E

-200 0% -500 -40%

PAT %Growth CFO EBITDA CFO/EBITDA

Source: Company, ABML research

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Risks

Exposure to US Healthcare industry slowdown

Sagility’s exclusive reliance on the US healthcare market makes it vulnerable to industry-wide challenges. Factors such as reduced
government spending during economic downturns or lower demand for non-essential services may adversely impact its growth
trajectory.

Outsourcing reluctance among healthcare enterprises

Despite growing adoption of outsourcing, concerns around data privacy, regulatory compliance, or a strategic shift toward
insourcing may lead to increased resistance among healthcare organizations. Any regulatory changes restricting outsourcing could
further constrain Sagility’s growth opportunities.

Challenges in talent acquisition, retention and up-skilling

With ongoing talent shortages in the US healthcare industry, Sagility may face difficulties in retaining skilled professionals, bridging
skill gaps, and optimizing workforce utilization. Rising attrition and elevated hiring and training costs could pressure margins and
hinder scalability.

Technology disruption risk

Rapid technological advancements in healthcare processes may redefine efficiency benchmarks. Sagility’s inability to develop or
implement cutting-edge, integrated solutions that deliver higher productivity could weaken its competitive position.

Rising competitive pressure from potential new entrants

The threat of new players entering the market with disruptive business models or innovative, client-aligned solutions may intensify
competitive dynamics. While no major entrants have emerged yet, future competition could challenge Sagility’s market share and
differentiation.

Outlook:

Sagility has established itself as a specialised leader in the US healthcare payer’s market. It operates in a highly consolidated
and mature market having deep relationships with 6 of the top 10 client. This markets, due to its consolidation & required
specialization is very difficult to enter for a new or broader IT based player. Sagility has 20+ years of experience & has huge
headroom to expand its market share. The company is also strategically targeting mid-tier markets with Broadpath acquisition
creating cross-selling opportunities. We initiate coverage with a “BUY” recommendation with a TP of ₹72 per share indicating
66% upside from the CMP, implying 30x FY28 PE.

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Financial Snapshot:

Profit & Loss Account 2022A 2023A 2024A 2025A 2026A 2027A 2028E
Revenue 923 4,218 4,754 5,570 6,785 7,706 8,668
Salaries and Benefits 506 2,494 2,938 3,499 4,213 4,815 5,419
Other SG&A 228 697 728 773 977 1,071 1,162
EBIDTA 190 1,027 1,088 1,298 1,595 1,820 2,088
EBITDA Margins (%) 20.5% 24.4% 22.9% 23.3% 23.5% 23.6% 24.1%
Depreciation & Amortization 147 644 689 467 517 548 596
EBIT 42 383 399 831 1,078 1,272 1,492
Interest Expenses 65 215 185 127 112 87 64
Other Income 21 18 28 56 62 68 75
Profit Before Tax -2 186 242 760 1,028 1,253 1,502
Taxes 3 42 13 221 261 318 382
Profit After Tax -5 144 228 539 767 935 1,121

Balance Sheet 2022A 2023A 2024A 2025A 2026E 2027E 2028E

Assets
Current Assets
Cash & Bank deposits 374 585 344 344 1,050 1,647 2,823
Account Receivables 926 1,069 1,181 1,267 1,487 1,689 1,900
Short-term loans and advances 39 71 100 - - - -
other current assets 68 69 94 210 210 210 210
Non-current assets
Property, Plant & Equipment 265 295 383 370 357 312 235
RoU asset 553 529 567 552 378 203 211
Goodwill 5,218 5,460 5,710 6,039 6,039 6,039 6,039
Other Intangibles 2,585 2,322 2,008 2,036 1,857 1,678 1,501
Financial assets 38 115 132 99 99 99 99
Other non-current assets 20 14 10 - - - -
Total Assets 10,085 10,529 10,529 10,917 11,477 11,877 13,017

Liabilities
Current Liabilities
Account Payable 115 213 259 214 242 274 309
Other Current Liability 770 843 944 626 626 626 626
Non-Current Liabilities
Debt 4,184 2,324 1,914 817 582 15 0
Other Non-Current Liabilities 989 942 969 925 925 925 925
Total Liabilities 6,058 4,322 4,086 2,581 2,374 1,840 1,859
Shareholder's Equity

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Equity Capital 8,617 8,617 4,285 4,679 4,679 4,679 4,679

Retained Earnings (reserve & surplus) -4,590 -2,410 2,158 3,657 4,424 5,358 6,479
Shareholder's Equity 4,027 6,207 6,443 8,336 9,103 10,038 11,158
Non-controlling Interest (Minority Interest) - - - - - - -
Total Liabilities & Shareholder's Equity 10,085 10,529 10,529 10,917 11,477 11,877 13,018

Cash Flow Statement 2022A 2023A 2024A 2025A 2026E 2027E 2028E
Operating Cash flow
Net Earnings -11 16 115 587 767 935 1,121
Plus: depreciation & Amortization 147 644 689 467 517 548 596
Plus/less adjustment for non-operating items 50 267 180 231 50 19 -11
Plus/less adjustment for operating Assets & Liabilities -218 -70 -11 -71 -192 -169 -177
Cash Flow from Operations -32 857 973 1,214 1,141 1,332 1,529

Investing Cash Flow

sale of property, plant and equipment -7 -141 -182 -122 - - -
Purchase & Sale of investments -7,716 -16 -301 -483 -150 -150 -350
Interest received 0 1 2 16 62 68 75
Rent received 9 28 12 -375 - - -
Cash from Investing -7,714 -129 -469 -964 -88 -82 -275

Financing Cash flow

Issuance (repayment) of debt 4,161 -196 -428 1 -235 -567 -15
Issuance (repayment) of preferential shares NCI 1,921 - - - - - -
Interest paid -10 -246 -190 -132 -112 -87 -64
Other Financial Activities 2,045 -103 -134 -125 - - -
Cash from Financing 8,116 -545 -751 -256 -347 -654 -79
Source: Company, ABML research
Note: Data presented is for financial year April to March

Aditya Birla Money Ltd. Registered Office:

Disclaimer:

We, Vinit Agarwal and Ninad Sarpotdar, hereby certify that all the views expressed in this research report reflect our personal views about any or all of the subject issuer
or securities. This report has been prepared by the Research Team of Aditya Birla Money Limited, hereinafter referred to as ABML. Further, we Vinit Agarwal and Ninad
Sarpotdar, have not served / do not serve as an officer, director or employee of the companies mentioned in the report. Further, we Vinit Agarwal and Ninad Sarpotdar
have not been engaged in market making activity in the Subject Company. AI tools were not used for research services.
Aditya Birla Money Limited (ABML) is in the business of offering stock broking and depository services in securities through its various affiliations with Stock Exchanges and
Depositories. It offers Portfolio Management Services to HNI and Corporate investors. ABM also caters to investments in Mutual Funds through it digital platform to diversify
asset allocation.
This document is not for public distribution and is meant solely for the personal information of the authorized recipient. No part of the information must be altered,
transmitted, copied, distributed or reproduced in any form to any other person. Persons into whose possession this document may come are required to observe these
restrictions. This document is for general information purposes only and does not constitute an investment advice or an offer to sell or solicitation of an offer to buy / sell
any security and is not intended for distribution in countries where distribution of such material is subject to any licensing, registration or other legal requirements.
The information, opinion, views contained in this document are as per prevailing conditions and are of the date of appearing on this material only and are subject to change.
No reliance may be placed for any purpose whatsoever on the information contained in this document or on its completeness. Neither ABML, its group companies, its
directors, associates, employees nor any person connected with it accepts any liability or loss arising from the use of this document. The views and opinions expressed herein
by the author in the document are his own and do not reflect the views of Aditya Birla Money Limited or any of its associate or group companies. The information set out
herein may be subject to updating, completion, revision, verification and amendment and such information may change materially. Past performance is no guarantee and
does not indicate or guide to future performance.
Nothing in this document is intended to constitute legal, tax or investment advice, or an opinion regarding the appropriateness of any investment, or a solicitation of any
type. The contents in this document are intended for general information purposes only. This document or information mentioned therefore should not form the basis of
and should not be relied upon in connection with making any investment. The investment may not be suited to all the categories of investors. The recipients should therefore
obtain your own professional, legal, tax and financial advice and assessment of their risk profile and financial condition before considering any decision.
ABML, its associate and group companies, its directors, associates, employees from time to time may have various interests/ positions in any of the securities of the Company
(ies) mentioned therein or be engaged in any other transactions involving such securities or otherwise in other securities of the companies / organization mentioned in the
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Research Analysts or their relatives do not own 1% or more of the equity securities of the Company mentioned in the report as of the last day of the month preceding the
publication of the research report.
ABML may have issued other reports that are inconsistent with and reach different conclusion from the information presented in this report. Neither the Research Analysts
nor ABML have been engaged in market making activity for the companies mentioned in the report.
We submit that no material disciplinary action has been taken on ABML by any Regulatory Authority impacting Equity Research Analysis activities during the past 1 year.
In the last 12 months period ending on the last day of the month immediately preceding the date of publication of this research report Research Analysts, ABML or any of its
associates
(i) have not received any compensation from the Subject Company
(ii) may have managed or co-managed public offering of securities from subject company of this research report, or
(iii) may have received compensation for investment banking or merchant banking or brokerage services from subject company of this research report, or
(iv) may have received compensation for products or services other than investment banking or merchant banking or brokerage services as applicable from the subject
company of this research report or
(v) the Subject Company may have been a client of ABML or its associates during twelve months preceding the date of distribution of the research report.
ABML and it's associates have not received any compensation or other benefits from the subject company or third party in connection with the research report. Accordingly,
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The company follows employee trading policy which regulates the trading activities of the research analyst. The company policy do not restrict the compensation of research
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