NMC CEO Michael Davis on growth post-scandal: Business Extra

It has been more than two years since NMC Health almost collapsed, after a more than $4 billion debt pile was uncovered and the company's founder and former joint chairman, BR Shetty, fled the UAE in one of the biggest corporate scandals in the country's history.

That history is receding as the new NMC Healthcare charts a different path, while maintaining its position as the biggest private healthcare provider in the UAE.

In March, a restructuring process was completed, a move that allowed 34 NMC companies to exit administration, a signal that jobs and cash flow have been saved. Before that, NMC's business rebounded in the first half of 2021 as revenue beat expectations despite pandemic headwinds.

Joining co-hosts Mustafa Alrawi and Kelsey Warner this week is Michael Davis, chief executive of NMC Healthcare, who has been at the helm since the saga began.

They discuss priorities of the brand new board of directors, retaining 12,000 employees amid corporate scandal, growth opportunities coming out of the pandemic and if NMC will become a listed company again.

Transcript has been edited for clarity.

Mustafa Alrawi 00:06

Welcome to the Business Extra podcast. I'm Mustafa Alrawi, The National’s Assistant Editor-in-Chief. With me is Kelsey Warner, The National’s Future Editor and co-host.

Hi Kelsey.

Kelsey Warner

Hey Mustafa.

MA

So today we're talking about NMC Health, the country's largest healthcare provider. With us to discuss this subject is the CEO of NMC Healthcare, Michael Davis. Thanks for being with us today.

Michael Davis

Thank you for having me.

MA

It's a very interesting time to have you with us in the podcast studio because in March NMC came out of administration, a two-year saga if you like. Thirty-four out of the 36 companies are now sort of free and clear. And you're running things.

It's still the biggest healthcare group in the UAE, which I find remarkable, given the last two years and despite all the challenges that have been going on outside of the hospitals in terms of legally and financially, and everything that's been going on since 2019, 2020, that it's still the leading player.

If I read from your LinkedIn account, if you don't mind, it says, “NMC Healthcare is the largest private healthcare company in the UAE. Over the last 46 years NMC has earned the trust of millions, thanks to its personalised care, genuine concern, its sincere commitment to the overall well-being of the communities it serves.”

I read this because I think people should remember, and I'm sure you know, that, although we were reporting all the time about the different aspects of what was happening, following the scandal and everything, you're still having to serve patients every day. And how does that happen when it is life or death sometimes, yet in the back of your mind, you're having to deal with all the things that are going on when it comes to restructuring and administration and all the noise. So it'd be interesting to hear about that, from your point of view. You're still running a hospital group. You know, your job isn't necessarily to come here and talk to me and Kelsey.

MD 02:05

It's fun to do that but you're right, it is our job is to take care of patients. And as you said, we're the largest private provider of healthcare in the UAE.

Just as a brief, I'll give you my elevator spiel: we operate across five strategic verticals. And I think people forget that about NMC Healthcare. We have 11 multi-specialty hospitals and clinics in the UAE and Oman. We also own a majority of the Fakih IVF programme, where we do almost 6,000 in vitro fertilisation cycles per year. We have the CosmeSurge clinics, where we have 21 cosmetic and aesthetic surgery clinics across the UAE and Oman. And we also own ProVita International Medical Centre, which does long term care, home care, and rehabilitation. About 50 per cent of our patients are adults and 50 per cent are children. We're most known probably for our multi-specialty hospitals. And those hospitals operate on a hub and spoke model where the multispecialty hospital operates as the hub. And then the day surgery centres and the medical centres are the spokes that feed those hospitals.

Last year, the group saw five and a half million patients. So everything that you said is correct in the midst of everything that occurred. Every single day, seven days a week, 24 hours a day, there's a clinician, a doctor, a nurse or a paramedical staff, in uniform with their stethoscope on caring for a patient. And we care for people across a very broad range of clinical issues, sometimes at their very worst. And sometimes at their very best whether it's trying to help a family to realise their dream of being a parent, [or] it's maybe someone going into CosmeSurge because they want to feel better about themselves or feel competitive. Or maybe it's someone in a very vulnerable state having a heart attack or a stroke or needing a [operation].

Myself and the leadership team over the last two years put a lot of emphasis on making sure that the people that were doing the work at the bedside and the people that were actually caring for patients were distanced from the issues that were occurring at the corporate office. That was what my job was, to somehow create a chasm between what we were dealing with, with the legal issues and the restructuring issues and the discovery of the fraud, with our 12,000 employees who were in the middle of the worst pandemic the world had seen in 100 years.

So it is something we're very proud of, we're proud to have come out of administration. We came out on March 25. It's a bit of a new rebirth for the organisation. But that's not the day that NMC was born. This is a company that's been around for over 40 years, that's grown and gained the trust of its constituents. And we're here today to talk about it and we're just really proud that we got to this point.

KW 04:58

So you just mentioned your 12,000 employees. It's going to be impossible to unpick the scandal from the pandemic and how much fallout there was from either one of those doing the accounting of the last two years.

Your revenue took a hit midyear last year, would you attribute it to the pandemic? And I'm just curious, can you reflect a little bit more on that? Just what have been the drawbacks in the last two years? Where have you lost out? What do you blame on the pandemic? And what do you blame on the scandal?

MD 05:26

Yeah, well, you know, pandemic wise, we've done 4 million PCR tests, and we've given about 150,000 vaccines. So we played a very integral role in the UAE’s response to the pandemic. I think that everyone, any of our competitors, even the government hospitals, would tell you that it was a struggle during the pandemic, that we incurred a lot of wage inflation because nurses and doctors were being almost, you know, people were being offered 5,000, 10,000 dirhams more per month to go next door. And, you know, it was just it was really, really, really difficult. I think what we really have lost out on mostly as our recruitment. Thank God our patients had been well cared for. And I think we've always put patient care first and foremost, and our mission to provide, you know, world class care at international benchmarks.

Remember also, NMC cares for a very broad socio-economic group. So if you look at our company, we have very different brands, the Fakeh IVF brand, for instance, cares for very, very many Emiratis as well as expats who are paying cash for their IVF treatment. If you look at our CosmeSurge brand, that's a lot of cash-type patients. But if you look at our multispecialty hospital brands, the NMC Specialty hospital brand cares for many, many people from the Indian subcontinent, other Arab countries, you know, there's a large, there's a wide variety of earners, and here, so we care for many different insurance cards, many different socio-economic levels. And we found that this business was really stress tested. It's got a very strong risk mitigation component to it because we were able to care for such a broad group of people. So I think if anything, we probably lost out more on recruitment. And that's one of our goals for 2022 is to try to replace some of the doctors and some of the nurses who maybe were not coming into the country because they were needed at their own country, or maybe people that were being sort of bouncing around because pay was there was such, you know, wage inflation that was occurring across the way. But mostly, you know, we're really proud of the clinical work that we were able to do over the last two years, and the role we played in the UAE’s response to the pandemic.

MA 07:45

I mean, you have an engagement with your patients, with your employees, you have a number of stakeholders. The legacy of BR Shetty, the founder, as you said, the company has been around for several decades, he was synonymous with it. And he was very high profile, spoke a lot actually, was in [this] studio, as well, at one point.

Before the scandal happened, and I know that the administration was a very important sort of watershed to kind of move on from the past. But at the same time, you couldn't, for example, just drop the name because of the patients, the patients particularly here in the UAE, understood what the NMC brand was. But at the same time holding on to that means that you've always got to carry that baggage around. From your point of view, how do you move past the past? I mean, I can see from the pandemic, that's great. Yes, you're looking at the learnings and you're saying this is what we need. But from the scandal? How do you not always have to discuss that for 20 seconds? In any meeting you go into?

KW 08:50

Mustafa’s question is just: are you going to rebrand?

MD 08:53

First, I'll answer that bluntly, no … At this point, there's no reason to rebrand. 60% of our patients are repeat customers. So 60% of the patients that come into NMC are patients that have come to us before. As it relates to Dr Shetty and the past you know, regardless of what occurred, we can't negate or even discount the legacy of the last 40 years. And I've been with the organisation in some capacity since 2015. And we underwent a very large capacity building and capability building exercise. Dr Shetty stepped aside as the CEO in 2016. So Dr Shetty hasn't been associated as the CEO. He was a shareholder like everyone else. Now that having been said he was the founder. What I do is my responsibility now is to make sure that our 12,000 employees have a sense of purpose, feel like they have worthwhile work, are working for an organisation that there can be proud of an organisation that's honest, open, transparent … that puts our patients and our employees and our other stakeholders first.

And I really feel like there was a period of time probably two years ago where those people that were associated with the business before were very much at the forefront. But a lot of water is crossed under the bridge over the last two years. And I think that, for better or for worse, you know, my job, though, has never been to be the judge and the jury. I tell people that all the time. My job was never to to blame or to point fingers at any the previous leadership. My job, which is always to ensure the stability and the continuity of the organisation. And as the CEO, there were periods of time early on in this process, where the only thing I could do is just get up and try to do whatever the next most important thing in front of me was, whatever that might would be. That's what I had to do. And I've continued to do that throughout this process.

KW 10:59

In thinking about moving on, and moving ahead and finding growth in a company that had just a massive debt pile, what are you looking to in terms of just growth segments? So Dubai last week disclosed 630,000 medical tourists, the UAE seems like they're on just kind of new footing coming out of the pandemic in terms of reputation, and quality of healthcare, which might surprise some people who may have even just gone elsewhere outside of the UAE for medical care in the past. Coming out of the pandemic now as the destination medical care, but it also had a really tech-savvy approach to the pandemic and accelerated a lot of things in terms of telemedicine, remote care, all sorts of different aspects. So, what are you excited about? Where will growth come from? Is it tech heavy? Is it patient-centric? Is it personalised care? What are the things that you're thinking about?

MD 11:53

And the answer is yes, it's all of those things. I can tell you that the UAE healthcare sector is expected to grow at seven and a half per cent CAGR until 2025. And be a … a $40 billion industry by 2025. We've done a lot of those things that you talked about.

I mean, for us, one of our big focuses and big shifts is to bring in more subspecialty doctors, particularly their patients that went abroad previously, we've got collaboration agreements with Boston Children's Hospital in the US, where we're actually bringing subspecialty paediatricians here and bringing that level of expertise here. Also, we're really excited about our home dialysis service. We found during the pandemic that people who particularly patients that were encumbered or patients that were critically ill, that were going into the hospital, people became afraid to come into the hospital. So we brought in an entirely new service line where we now do dialysis in the home. We have over 100 patients getting home dialysis now through our long term care service. I think part of it is just looking at our existing hospitals like our NMC Royal Hospital in Dubai investment Park and our NMC specialty and Amada in Dubai, those hospitals are bursting at the seams, those catchment areas have grown exponentially over the last five years. So we're adding additional beds there as well.

You know the story for us, we basically at this point, the company has three very, very important goals, the first is always going to be patient care, because we are a healthcare company. The second is ensuring that we have a good strong governance structure. And that we've got a governance structure that allows me and the leadership team to run the business, but also to ensure that nothing that had occurred previously would occur again. And then lastly, its growth. And that growth could be organic or inorganic, but looking at continuing to get our market share to take care of greater swathes of the population.

MA 13:50

Am I right in understanding that the ownership of the company now is largely in the hands of the creditors? That ADCB for example, is over a third ownership in the company?

MD

That's correct. Yes.

MA

And how does that, when you talk about governance, how does that work?

MD 14:09

At this point, we did what's called a deed of company arrangements. And it's sort of a modified debt for equity swap. So the creditors own a percentage of the company commensurate with the amount of debt that they held, and our largest shareholder is ADCB. And I have to say, it's, it's really important for people to understand that the support that NMC received from ADCB did literally save the company. There was a period of time where if our creditors had not stepped up and loaned me and the company money that NMC would not exist today.

And so we have a board of directors, the board of directors are representatives of the largest shareholders. ADCB has three of those seats. We have now a very robust board, a board that's really interested in driving the organisation forward, very focused on governance. But also, thankfully, a board that recognises that the last two years has been very difficult for me and for the team. And they recognise and have given a lot of grace to us for the work that we've done to put the company where it is today. So the board was just formed March 25. We're having our third board meeting next week. We're working very closely with the board. But yes, ADCB is our majority shareholder. And they've been extremely supportive and integral really, to our success at this point.

MA 15:28

I mean, your interests are aligned, you want to grow the company, you want to be more profitable. They want the same thing for whatever it might mean [to] exit down the line.

MD

Correct.

MA

So it's quite novel in some ways to have a board like this, which is a board of technocrats and experts in business essentially.

MD 15:48

You know, it's interesting because we do have a healthcare expert on the board as well. I've been in the business for over 30 years. But we do have a board that is heavily leaning toward financial restructuring and legal.

But that having been said, they're all very quick learners, and they're very interested in understanding the intricacies of a healthcare company. And frankly, they've been really good about leaving the running of the company to the experts. But it's been really challenging for me, because I've enjoyed the questions that I've been asked, and I've enjoyed the different perspective or about the business. And, you know, it's, you think about the saying of you can't see the forest for the trees, but I've literally lived and breathed this company since February of 2020. And to now take a step back and have other people view it through a different lens, maybe there are areas that I had not seen.

I, admittedly, and I've said this to the chairman, I'm not someone who really likes my homework checked. So it's been a little bit of a struggle, you know, in some areas, but at the same time, when you sort of release some of that and say, listen, let's just take a step back and see, let's focus on what's important for the organisation and go from that perspective.

KW 16:56

And NMC’s new chairman is Kevin Taylor, who is ADCB’s treasurer.

MD

Correct.

KW

So I'm curious from you, a little more insight into what have you learned from this new board of directors? And what are they learning from you? What are the things that you're teaching them about the biggest misconceptions about running a healthcare company this century?

17:15

… We can't reduce NMC to a 45-minute podcast, right? It's a very complicated business and all across the UAE. As I said earlier, today we'll see thousands of patients and across five strategic verticals, operations and management, cosmetics and aesthetics, in vitro fertilisation, long term care, multispecialty, hospitals and clinics. A broad swathe. It's not a tabletop exercise, it's a living, breathing business with a lot of pressure points, I always say, you know, just make the analogy sort of flippantly, you know, we're not, we don't sell frozen yoghurt, no shade to Pinkberry, because we all love Pinkberry, but we're dealing with people's lives.

I think what has been interesting for the board is many of the people that were creditors, who have been so supportive, know NMC from a spreadsheet. And they understood that we played a great role in the pandemic. And they understood that we saw a broad swathe of patients, that now they actually see what we're doing, they've gone out to the facilities, they've met some of the clinicians, they've met the employees, and it's a new world for them, you know, they've met patients improve at our long-term care business. So for them to come in and see actually what we're doing, it's been very eye opening for them. And for me to go back and look at it from the lens of someone who's made an investment, almost lost that investment. But it's now put, kind of doubled down and said, We believe in you, we believe in the company. And we're gonna give you what it takes to make the company successful. That's been very interesting. For me, it's been really nice for me to see, and to interact with the people that essentially saved the business. There's no other way to say it.

MA 18:56

And we talked a little bit about the future and growth. But you know, now it seems most sectors are looking at how they can utilise, you know, AI, other advanced technologies, and is the kind of almost unique structure that you have as a healthcare player compared to your competitors. Does that make it more challenging to to begin these new areas and to kind of take more risks when it comes to capex and other and other decisions?

MD 19:22

Yeah, I think one would think that, but we're putting a lot of effort and a lot of energy right now and what is the next stage of growth for us? And whether it is, you know, looking at big data and looking at all the data points that we currently collect, looking at areas where we can better serve our patients, our new creditors and our new board are really interested in that and there's not been any hesitation.

Even during the last two years of the pandemic and to administration. We were able to I mean, we we we have the brand new MRI machine at our NMC Royal Hospital in Sharjah. It's the only MRI of its type in the Northern Emirates but we've invested in the business because it's important. It's important for our patients and it's important for our employees to see that the business is thriving. But financially, you know, coming out of the last two years, we are an honest, open, transparent organisation. So financially stable, we've been stress tested, you know, to the max. And I think that there's probably no safer investment than NMC at this point, because really, we were able to rip the band-aid off and sort of begin to build a company that we all want it to work for in the first place.

MA 20:35

Do you think you'll move towards another listing at some point?

MD 20:39

You know, I think it's too early to say that. I think it's not a secret. It's not proprietary information that the financial institutions would not want to hang on to this for 10 years. But I think what comforts me is that the financial institutions are willing to hang on to this business as long as it takes to realise its value. And if that's three to five years, so be it.

But you know, having delisted from the London Stock Exchange in April, and that was a very difficult and painful journey. That's not you know, right now, my focus is on continued growth, emerging from the pandemic, retaining our staff, hiring new doctors, and, you know, whatever the future holds, we'll sort of uncover and discover that together. But it's not something that's on the forefront of our mind now.

MA 21:29

Michael Davis, thanks so much for being with us.

MD 21:31

I appreciate it. Thank you both.

Transcript has been edited for clarity.

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