How Vishal Bali is pushing for single-specialty hospitals

The executive chairman at Asia Healthcare Holdings is addressing a demand-supply gap by building a network of focused care hospitals across the country

Sep 04, 2025, 11:37 IST9 min

Vishal Bali; Photo by Hemant Mishra FOR FORBES INDIA

Vishal Bali breathes health care. That is all that he has done all his life.

Bali is not a doctor by training, unlike some of his contemporaries at India’s leading corporate hospitals. The 58-year-old was a former CEO of Wockhardt and Fortis, two of the largest multispecialty hospitals in India before building a host of single-specialty hospitals across the country.

Building Blocks

AHH started out in 2016, with a specific focus on investing in single-specialty hospitals.Bali, who began his career as a management trainee at Wockhardt Hospitals in 1991 and later became its CEO, was chosen to lead the venture. He had earlier served as CEO of Fortis after the Habil Khorakiwala-promoted Wockhardt sold 10 of its hospitals to Fortis Healthcare for Rs909 crore, in one of the largest health care deals in the country.

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After five years with Fortis Hospitals as its CEO, Bali quit Fortis by 2014 and set up Medwell Ventures, which ran Nightingales, a home health care services company across four large metros. Nightingales has since been sold. He had also joined TPG as an advisor, focusing on the private equity (PE) giant’s investments in the health care sector in India, and more specifically on young health care providers.

“When I came back from Singapore after Fortis, there was a massive demand-supply gap in health care in India. Either you could address it by continuing to build multi-specialty institutions or put it behind five or six single-specialty boxes in different cities,” Bali says. “That way, at least you can start filling up the demand-supply gap, not just in the large metros, but also in other cities.”

In May 2016, AHH bought a majority stake (68 percent) in Cancer Treatment Services International (CTSI), which operated a single 250-bed hospital in Hyderabad under the American Oncology Institute brand. CTSI operated the American Oncology Institute in Hyderabad and 10 multidisciplinary cancer centres across the Indian subcontinent.

AHH also inducted a new management team, including the onboarding of new CEOs and other executives. By 2019, the company had sold CTSI to New York-based Varian Medical Systems for $283 million (approximately `1,972 crore), marking one of the largest exits for TPG. It was, in many ways, an eye-opener for the health care industry, highlighting the potential for lucrative exits for PE firms.

In 2016, AHH took majority control of Bengaluru-based Rhea Healthcare with an investment of $33 million. Rhea was then operating three mother and childcare hospitals under the brand ‘Motherhood’ in Bengaluru, Chennai, and Hyderabad. Motherhood had three centres in Bengaluru then, of which two were operational. The company had an annual revenue of $5 million then. Today, there are 24 Motherhood hospitals.

The Motherhood acquisition was followed up with the purchase of the loss-making Nova IVF Fertility for $100 million. It was India’s second-largest network of IVF centres, running 19 outlets in 15 cities. Goldman Sachs was an investor. That number has since scaled to 95 centres.

By September 2023, AHH had acquired a majority stake in the Asian Institute of Nephrology and Urology for `600 crore through a mix of primary and secondary investments. This year, the company is projected to have revenues of over $225 million, up from $10 million in 2016.

AHH is now the only platform in India and Asia that operates multiple single-specialty hospitals under one umbrella.

A neonatal intensive care unit (NICU) at Motherhood Hospitals in Bengaluru. AHH operates 25 Motherhood Hospitals across 12 cities making it the largest network of NICU beds in India

Financial Advantage

India currently has 1.4 hospital beds per 1,000 people. There is also a shortage of skilled health workers—0.65 physicians and 1.3 nurses for every 1,000 people. India requires an additional 2.4 million beds to achieve the target of three beds per 1,000 people.

Then there is the financial advantage, particularly in the cost of deploying capital, which works out much cheaper in single-specialty hospitals. “Our enterprises are showing 25 to 30 percent return on capital employed [ROCE],” adds Bali. “Today, capital deployment is almost like 60:40, which is a big change.”

Under the single-specialty format, hospitals typically have 40 to 50 beds compared to between 250 and 300 beds at multi-specialty hospitals. This allows for low capital allocation and personalised care, prompting many to choose their services. AHH does not own real estate; it operates an asset-light model.

“Seventy-plus percent of health care services investments in the last decade have been in traditional single specialties like IVF, oncology and eyecare. Over 60 percent of total investments in emerging single specialties like dental, urology/nephrology, and skin and hair care have been made in the last two to three years, indicating significant investor interest in these specialties,” says Avendus Capital in its report.

AHH takes ownership of the hospitals before scaling them up and selling them, thus finding an exit for investors. When it sold CTSI, the valuation was six times its revenue, which, says Bali, sparked keen interest in the single-specialty hospital business.

The single-specialty hospital segment is expected to have a market capitalisation of $18 billion by FY30, up from approximately $4 billion in 2025. AHH, too, is expected to go for an initial public offering (IPO). “I think going public is a milestone,” Bali says.

India’s hospital segment has been witnessing significant consolidation over the past few years, largely driven by IPO-bound Manipal Health, which is backed by Temasek and TPG Capital. Manipal, which acquired Maharashtra-based Sahyadri Hospitals in July, is attempting to expand its nationwide presence. Over the last five years, Manipal has been on a buying spree, acquiring hospitals such as Columbia Asia, Vikram Hospital and AMRI Hospitals in Kolkata. The recent deal with Sahyadri has made it the largest hospital network in the country, with over 12,000 beds.

Similarly, last year, publicly listed Aster DM Healthcare catapulted itself into the second-largest health care provider in terms of beds after a merger with US PE giant Blackstone-backed Quality Care India Ltd. Together, they have 10,300 beds, compared to approximately 10,100 at Apollo Hospitals.

“The acquisition opportunities have more or less finished because all the networks have been acquired,” Bali says. “So, when you look at the industry today compared to five years ago, you can’t buy growth anymore. You’ll need to build on this growth from here. Within the multi-specialty side, that would mean long gestation periods. But our boxes are smaller, which means it’s easier for us to grow.”

The spate of success has meant that hospitals are approaching AHH for acquisitions, compared to earlier, when Bali and his team had to be on the lookout for potential ventures to acquire. “If I were to go back nine years, we were not the favourites to do business with. But today, everybody knows what AHH has demonstrated. Options are coming our way.”

The Opportunity

The path ahead seems lucrative for Bali and AHH.

Within the single-specialty sector, categories such as dialysis and skin care are expected to grow annually at 17 percent over five years, followed closely by the likes of IVF. Organised markets in specialties such as mother and child, IVF, eyecare, and oncology have scaled substantially to between Rs3,500 crore and Rs5,000 crore.

Areas such as oncology, urology, eyecare, and mother and childcare clock revenues between Rs30 crore and Rs60 crore, once established, with Ebitda margins between 20 percent and 30 percent. It has also meant that single-specialty players are now actively scouting for acquisitions. “Single-specialty hospitals will continue to gain market share from multi-specialty hospitals and standalone doctor practices driven by branded consumer play, customised patient experience, higher accessibility, and faster technology adoption,” the Avendus report says.

It also helps that in many of the specialties, penetration remains abysmally low, with even lower public intervention. Take IVF, for instance. India has the world’s largest number of women in the 25 to 44 age group, with decreasing fertility rates. From about 194,000 IVF cycles in 2019, the number has grown to 320,000 in 2025. It is expected to grow to 550,000 by 2028. Within this, Indira IVF, which has filed for an IPO, corners 35 percent of the market.

Similarly, in the kidney care segment, the market is expected to double from Rs5,400 crore to Rs10,800 crore by 2028, largely due to India’s growing geriatric population and a rise in lifestyle diseases, primarily led by diabetes. “Diabetes creates a channel for many of the specialties,” Bali adds. “Because a lot of diabetic patients end up getting into neuro issues, urology issues, and those related to endocrinology that affect women’s health.”

India is often referred to as the diabetes capital of the world, accounting for 17 percent of the global diabetes patients, which means the opportunity, especially in single-specialty care, remains substantial.

“Depending on the capex per centre across specialties, at a mature centre level, it [single-specialty hospitals] can have ROCE in the range of 30 percent,” Avendus reckons. “Some of the specialties, such as IVF, operate at a higher mature centre level ROCE of 100 percent-plus compared to oncology, where it can be 15 percent-plus.”

For now, AHH wants to emulate its success and focus on tier 2 and 3 cities, where demand has been steadily growing and unit economics are working in its favour. “There’s a myth that tier 2 cities don’t deliver great unit economics… our businesses are showing that they do as a metro city would,” Bali says. That means, by the looks of it, Bali and his team are only getting started.

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Manu Balachandran

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