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Slide Notes
Medical evacuation is a highly under-served market in India. As medical care has evolved in India, most advancements in technology are available only in Tier-1 cities, while the disposable incomes have seen the biggest rise in Tier-2 & Tier-3 cities. An average medivac for a patient in Guwahati is approx. Rs.10Lakh, which is no longer unaffordable considering the life saving nature of the business. In a strong family ecosystem that India is built around, money for education and healthcare is always provided for, irrespective of the emergency. Today most people plan for medical policies that have at least 50Lakh of coverage.
Fly Iris Medical Evacuation
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PRESENTATION OUTLINE
FLY IRIS MEDIVAC
SAVING LIVES
Medical evacuation is a highly under-served market in India. As medical care has evolved in India, most advancements in technology are available only in Tier-1 cities, while the disposable incomes have seen the biggest rise in Tier-2 & Tier-3 cities. An average medivac for a patient in Guwahati is approx. Rs.10Lakh, which is no longer unaffordable considering the life saving nature of the business. In a strong family ecosystem that India is built around, money for education and healthcare is always provided for, irrespective of the emergency. Today most people plan for medical policies that have at least 50Lakh of coverage.
Photo by Michael C
CRITICALLY ILL PATIENTS
- Ventilator dependent
- Pre-mature infants
- No airline connectivity
- Contagious/Sterile Patients
- Time bound medical care
- Embargo/Disturbed area
- Disability concerns
critically ill patients decisions are always taken by the family, no family member wants to be seen as having not tried something which could have saved a life. Giving up is not an option. As hospitals reel under pressure of profitability, they haven’t expanded as well into the Tier-2 and Tier-3 cities and still bank upon referrals to move patients from interiors to metros. On an average a ground ambulance meets most needs, however, there are always critical patients who cannot take that journey and need to be mobilised. This is where medical evacuations come into play. It is imperative to note here that we are NOT doctors, we are ambulance operators.
Photo by COD Newsroom
SAVING LIVES
BRINGING HOPE TO TIER-2/3 CITIES
Until recently, there didn’t exist an option for a critically ill patient to get world class medical care. The medical evacuation business has since changed this scenario. As affordability in Tier-2 & Tier-3 cities increases, while connectivity hasn’t, this is a life saver. For example, a mine owner in the interiors of Jharkhand has the money, but does not have access to the facility. A patriarch falling ill commands immediate attention to be shifted to the best medical care possible. An expo owner in Budgam has the capitalisation but not the terrain to travel 18hrs to Delhi.
Photo by List [trade break - catching up]
DRIVING INVESTOR VALUE
- Tie up with key doctors in this business.
- Patients family calls doctor.
- Insurers call doctor.
- Business aggregator : Doctor
Calls always come to a doctor for evacuation. The doctor has tie-ups with insurance companies, ambulances, local hospitals (where the patient is) and para-medics. The doctor uses the medivac operator to co-ordinate this.
Photo by Jeremy Brooks
THE MATH @ 1 AIRCRAFT
One aircraft and one set of crew cannot be used more than 100hrs in a month (regulatory as well as practically) which caps the amount that can be earned from one aircraft at this. The calculation of revenue is done from patient entry to patient exit (which is about a 10% increase in the actual flying hours). The costs are incurred purely for the flying hours, but the revenue is calculated differently. In addition, the ambulance services are exempt from GST.
COSTS 100HRS 1 AIRCRAFT
Fuel remains the single largest cost. Also, due to dynamic pricing the medivac is priced on a case to case basis making it immune to price fluctuations caused by ATF price changes. What is 85,000/hr on one day can become 80,000/hr if ATF comes down or can go up to 120,000/hr depending on ATF and availability. Right now the market is going through a supply-demand mismatch where the demand is higher than supply, hence the prices are artificially higher than what is normally taken, we have averaged the number at the lower half of the spectrum assuming running average of fuel prices over a 6month period.
Salaries : This includes only OPS salaries for P1, P2, Saftey Pilot & AME.
Long MX: Aircraft engines need to be overhauled every 3600hrs (for the PT6A-135) this cost has to be accrued even though it is spent once in 3yrs.
Line MX: Regular line maintenance is paid for propellor and engine consumables and other regular issues.
Fixed: This cost included office expenses and support staffff salaries and subscriptions.
Insurance: the hull value is typically insured at 1% to 4% of the value. This is a variable cost that can be worked on in detail later. The impact on the overall profitability is under 1%.
Salaries : This includes only OPS salaries for P1, P2, Saftey Pilot & AME.
Long MX: Aircraft engines need to be overhauled every 3600hrs (for the PT6A-135) this cost has to be accrued even though it is spent once in 3yrs.
Line MX: Regular line maintenance is paid for propellor and engine consumables and other regular issues.
Fixed: This cost included office expenses and support staffff salaries and subscriptions.
Insurance: the hull value is typically insured at 1% to 4% of the value. This is a variable cost that can be worked on in detail later. The impact on the overall profitability is under 1%.
THE MATH @ 2 AIRCRAFT
Since we are maximised in hours in 1 aircraft the profitability that can be earned is also constrained by the size of the fleet (explains the logic that large fleet operators such as Emirates, Indigo, etc. make more money than small fleet operators who find it tough to break even as fixed costs can be a killer). It is imperative to expand the fleet size to address and capture the market demand before other players can land up.
TEAM
- Doctor + 200 Ground ambulances (can reach within 100mi of any point on map)
- Ex-IAF Pilots (An32 + Avro) (Fearless, Familiar, Fast, Frugal, Fulfil)
- MX : Textron OE-partner (Minimal downtime)
- Ops: Ex-ADC to CAS + NAV (Ability to access routes and airports like no-one else)
- Weather : SkyMet + Frmr. IAF Met Officer (Anywhere, Anytime, Always)
- Advisors: Ex-DO Air India + Former Jt. Sec. MoCA (Regulatory advisory)
Team - Make or Break
Ex-IAF pilots bring a unique mix of terrain familiarity, which allows them to go anywhere in India and have been there before in addition to knowing the need and requirement.
Tie-up with the OE of the aircraft is like having the car serviced at the manufacturer service station.
Ops: Not always do things happen as per plan (more so when dealing with critically ill patients), increasing ATC watch, keeping airport open beyond permissible hours, etc.), plus his background as a navigator means routes are better planned for minimal fuel burn. Military airports access for medivac is easier and FIC/ADC numbers are always accurate.
Weather: with the changing patterns, this is a critical role. We can forecast at 11pm prior night of the fog intensity in the valley in Leh, Most operators rely on daybreak
Ex-IAF pilots bring a unique mix of terrain familiarity, which allows them to go anywhere in India and have been there before in addition to knowing the need and requirement.
Tie-up with the OE of the aircraft is like having the car serviced at the manufacturer service station.
Ops: Not always do things happen as per plan (more so when dealing with critically ill patients), increasing ATC watch, keeping airport open beyond permissible hours, etc.), plus his background as a navigator means routes are better planned for minimal fuel burn. Military airports access for medivac is easier and FIC/ADC numbers are always accurate.
Weather: with the changing patterns, this is a critical role. We can forecast at 11pm prior night of the fog intensity in the valley in Leh, Most operators rely on daybreak
Photo by jsgraphicdesign
SALIENT POINTS
- Revenue is calculated at 10%+ actuals
- 11 months of Ops, 1month of MX
- Asset identified from TXTAV
- 30% below market prices
- Dynamic pricing : Fuel mitigation
- Billing: Base to Base (Round)
- Innovative salary structure
- Lease : Chailease + AirLease options
- Building organ transplant transport capability.
All billing is base to base, i.e. if patient is in Patna & needs to be dropped in Calcutta, the billing is Delhi - Patna - Calcutta - Delhi. All incidentals are paid for by the renter.
One of the biggest challenges was to convince the pilots to do 4-sectors or 2 round trips in a day. By modification of incentives and balancing the base salary, we can better utilise the pilots in a 24hr block compared to other GA operators.
Examining an option at LIBOR + 1% lease rates.
By working directly with the OE, we have been able to source deals which are at least 30% lower than market prices, in fact if we just traded the asset, we can make a 30% margin.
As organ database and digitisation of medical records starts to happen, organ transplant will become a huge opportunity.
One of the biggest challenges was to convince the pilots to do 4-sectors or 2 round trips in a day. By modification of incentives and balancing the base salary, we can better utilise the pilots in a 24hr block compared to other GA operators.
Examining an option at LIBOR + 1% lease rates.
By working directly with the OE, we have been able to source deals which are at least 30% lower than market prices, in fact if we just traded the asset, we can make a 30% margin.
As organ database and digitisation of medical records starts to happen, organ transplant will become a huge opportunity.
Photo by psiaki
COMPETITION
- Existing : Air Charter Services. Bogged down by 3 crashes, under regulator scrutiny. Speculation : May exit turboprop biz. Pilatus fleet up for sale.
- Existing: VSR Ventures. Focused on Jet expansion. Of 2 B200s only one for medivac. In the ‘meaty’ int’l (Kathmandu, Kabul, Dhaka, Dubai, etc.) business.
- New : Tie-up with doctors. High entry cost. Sourcing aircraft at right price. Pilots. Right set of Ops personnel (Fuel is 55% of costs).
Historically, this business has been run either by family or by politically funded companies making this business very challenging for the doctors to work with. In addition with the onset of elections, aircrafts get blocked for campaigning, results and now, transporting MLAs to resorts. Doctors who have a fixed contract with the end-users end up burning their earnings just to stay in the business.
At some stage, it will become imperative to expand into international medical evacuation markets as they are highly lucrative and generate far greater profit, but also require a higher certification level and more investment in training for the pilots and maintenance records.
At some stage, it will become imperative to expand into international medical evacuation markets as they are highly lucrative and generate far greater profit, but also require a higher certification level and more investment in training for the pilots and maintenance records.
Photo by Ryan Somma
RISKS
- Weather : Changing weather patterns making flying increasingly unpredictable.
- Airlines: Raising P1 salaries.
- Elasticity: One aircraft cannot fly more than 100hrs in a month. Must expand fleet.
- FBO Costs: GA being seen as luxury travel vs. life savers. Lobby hard to exempt Ambulances from FBO costs.
From April’19 till October’19 37–days have been adverse weather across India (from cyclones to fog) preventing flying at lower levels. This increases costs and reduces utilization.
Indigo recently increased their salaries for captains and the desire to fly a bigger jet takes pilots away quicker even though medivac operation pays them higher, the diminishing delta in salaries is a concern.
FBO Costs: Most airports are revamping General Aviation terminals and imposing higher costs on the passengers using them. This can be as much as Rs.50,000/- in some cities purely as “lounge” and “access” charges. A patient does not need this, but is still imposed with this. It is expected that once operational, we will lobby for exemption of these charges for medivac operations.
Indigo recently increased their salaries for captains and the desire to fly a bigger jet takes pilots away quicker even though medivac operation pays them higher, the diminishing delta in salaries is a concern.
FBO Costs: Most airports are revamping General Aviation terminals and imposing higher costs on the passengers using them. This can be as much as Rs.50,000/- in some cities purely as “lounge” and “access” charges. A patient does not need this, but is still imposed with this. It is expected that once operational, we will lobby for exemption of these charges for medivac operations.
Photo by Lubo Minar
ASK
- INR 3Cr. in Jan’20
- INR 6Cr. in Jul’20
What amount of money, or what other kind of help would be helpful to you in advancing your project? How can people contact you afterwards to offer help?
THANK YOU
ARVIND CHANDRASEKAR (ARVINDC@FLYI.IN)
What are the next steps you need to take? What are the key things you need to do to advance the project in the coming weeks and months? What is your timeline for moving forward? What does the roadmap for your project look like? What are your goals for the upcoming period?
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