Read the Conversation
EF: As a medical professional, if you were a doctor’s instrument or tool, which would you be and why?
RC: At this moment, I believe the most valuable tool a doctor has is their cell phone equipped with the latest AI technology, like the newest version of ChatGPT. I am deeply engaged in studying and implementing AI in every way possible. The rapid developments in AI provide us with new tools and capabilities weekly, enhancing our daily lives and healthcare work.
I am trying to get all the employees in the building where I work to incorporate AI into their workflows because it significantly boosts efficiency. For example, I recently received a proposal from a cardiology clinic. They provided a straightforward offer, quoting a specific amount in reais for all the exams to be included in the price of the ambulatorial appointment. I used ChatGPT to help construct a business plan based on that information. It pulled all the local pricing data, and within a few minutes, I had a comprehensive business plan with a break-even point. In the past, this process would have taken at least half a day, involving gathering information, sending emails to retrieve numbers, and then constructing the business plan before making a decision.
EF: What attracted you to MedSênior as a company and what mission did you give yourself in this new role?
RF: In my previous role as CEO at a very recognized private hospital, I was deeply concerned about the direction of the private health sector in Brazil. Since the pandemic, we have seen a significant increase in direct costs for materials and drugs, and prices have not returned to pre-pandemic levels. What worried me most was the massive financial losses faced by healthcare insurers. In 2022, health insurance operators in Brazil faced a significant operational loss of BRL 11.5 billion, the worst result since the beginning of the historical series in 2001 as published at Setor Saúde. This loss was mainly attributed to high costs and financial difficulties encountered by the sector during and after the Covid-19 pandemic. In 2023, The operational loss of health operators fell to BRL 5.9 billion in 2022. While a few insurers have managed to achieve good results, they did so by passing on the increased costs to their clients.
The origins of waste in healthcare are multifactorial, with various actors simultaneously contributing to the issue. Financial incentives geared towards increased usage certainly do not help. However, a fundamental aspect of the discussion that is often overlooked—because it is difficult to address—is the involvement of doctors in the financing problem. Today, this crucial actor is trained to use the best available technical evidence to make the best decisions. The problem with this approach is that the evidence is often heavily biased by the sponsors of the studies, and doctors do not have a pharmacoeconomic evaluation of what they are proposing, often leading to marginal benefits.
For instance, studies have shown that pharmaceutical companies fund a significant portion of clinical research, which can lead to favorable outcomes for their products. A systematic review published in the British Medical Journal (BMJ) found that industry-sponsored studies were more likely to report positive results compared to non-industry-sponsored studies. This bias can skew the decision-making process, resulting in the prescription of expensive treatments with limited additional benefits.
Furthermore, health plan beneficiaries need to be aware of this reality to understand that misuse ultimately results in higher premiums. For example, a study in the Journal of the American Medical Association (JAMA) highlighted that high-cost drugs did not always correlate with substantial clinical benefits, emphasizing the need for more cost-effective healthcare practices.
In summary, addressing the issue of waste in healthcare requires a multifaceted approach involving doctors, patients, and the financial structures that incentivize excessive use. Educating all stakeholders about the economic implications of medical decisions is crucial to mitigate the long-term financial impact on the healthcare system.
In 2020, I made a contract with MedSênior in my previous role and I began to understand that their approach was different. I analyzed a cohort of patients from MedSênior over a period and compared them with other patients. Those under MedSênior's care had shorter hospital stays, fewer hospital-acquired conditions, and incurred less expenses overall.
Our model is based on a holistic approach where every patient, exclusively aged 49 and older, is stratified according to their state of health and recommended a specific care path by geriatricians. In every city where MedSênior operates, they have built small units focused on primary care, where geriatricians consult with these patients. In those offices, the patients can participate in group activities with the main objective of promoting health. It is not just about preventing disease; it's about promoting health. The focus is on patients' muscular strength, sleep quality, and sociability. Mental health, a significant issue in this population, is also a key focus. This comprehensive approach ensures that emergency services in hospitals used by MedSênior patients are utilized more efficiently.
MedSênior's performance metrics are significantly better than others in the industry, making it one with good results compared with other insurance providers in Brazil. Since I have been involved with the company, I have come to understand some of its key strategies. MedSênior thoroughly studies the market to identify the next target area, considering both the epidemiology of older adults and their income levels to ensure they can afford the plan. They are also careful to avoid regions where the healthcare providers are insufficient, especially in terms of quality.
Since MedSênior’s plan is not vertically integrated, it relies on local providers for specialized and complex care, especially hospital admissions. Local directors, including myself, are all doctors and are expected to engage with both patients and healthcare providers, including clinics, diagnostic centers, doctors and hospitals. The goal is to create pre-agreed, high-quality protocols to avoid the usual conflicts between providers and insurers, where disagreements often lead to non-payment for services rendered. MedSênior avoids this by maintaining close relationships with providers, ensuring that services are agreed upon in advance and are patient-centered, efficient, and fast.
The approach so far has proven successful. MedSênior has grown from 30,000 to 180,000 lives covered in just 10 years. This growth is expected to continue rapidly, with ambitions to reach one million clients by 2030. This goal seems entirely achievable given the market size and opportunities all around Brasil which offers promising prospects for MedSênior. The region around Campinas also demonstrates incredible economic vitality, with high employment and significant industrial presence.
MedSênior is poised to lead the future of medicine in Brazil, especially for the elderly, by integrating comprehensive, patient-centered care with efficient healthcare delivery systems.
EF: There is a term used to describe the way MedSênior innovates; what does the term “Agetech” mean?
RF: Agetech encompasses various initiatives aimed at improving the lives of older adults through technology. It is important to note that innovation, however, doesn't always mean complex technology. It also involves understanding and respecting the capacity of the elderly to engage with technology. The key is to find the best way to facilitate this engagement. For example, our concierges in MedSênior units are often in their 60s. When they explain how to use our mobile application to other seniors, they can communicate in a relatable language, fostering empathy and understanding. This connection allows for more effective learning compared to a younger person trying to explain the same technology. Different generations have varying ways of processing information, and we must consider this when designing and implementing technology solutions for elderly care.
We also recognize a significant opportunity to improve health outcomes for our patients through data. When we combine different variables, the power of our algorithms allows us to predict future health trends. However, our work goes beyond just data analysis. We are also focusing on workflow integration and addressing the multitude of systems we currently use.
Marcus Vinicius Leitao, our head of innovation and a critical care physician like me, shares a deep interest in AI. We have discussed extensively how AI can be utilized for automation. Our main objective is to leverage AI for predictive analysis, utilizing the extensive data we have on our large patient population, both while they are hospitalized and at home.
EF: Do you have any advice for people who want to succeed in a new company?
RF: One of the biggest mistakes you can make in a leadership role is trying to impose the culture of your previous institution onto your new position. Instead, you need to understand your new environment and adapt yourself to it, using your strengths to enhance the organization's capabilities. This mindset should be seen as an opportunity for both the company and you—to bring new perspectives and learn new ways of doing things while recognizing that your weaknesses are opportunities for personal growth.
Onboarding can be a slow process, where you listen a lot, understand the existing processes, and only suggest changes when you have the insight to add real value, and even then, it should be done non-intrusively. In leadership, especially at the executive level, it is not about fixing everything. It is not even about coaching people. Leadership today is more about creating paths for your team to achieve their best and find their own successes. My experience in previous roles has shown me the value of this approach, and I have been learning and improving my way of working, for example, creating positive habits in aspects of communication. I start my emails by suggesting they be read when the recipient is rested and feels no pressure to respond. By fostering a culture of thoughtful communication and understanding, we create a more productive and positive work environment.
EF: Why is $1 invested in Brazilian healthcare worth more than in other markets?
RF: The Brazilian market is vast and continues to grow each year, and there is still much to be done in terms of efficiency, presenting significant opportunities for those in the market. The changing dynamics, especially the narrow margins we discussed, are part of an ongoing disruption in Brazil's private healthcare sector. This disruption is setting the stage for a more efficient, profitable, and patient-centered model.
Post-disruption, these attributes will make investment opportunities in the sector highly attractive. Additionally, a significant part of Brazil, particularly regions away from the coast, remains undersaturated. This half of Brazil represents a substantial potential for transformation and expansion within the private healthcare sector.
EF: Do you have a final message for our readers?
RF: As we navigate the rapidly evolving landscape of healthcare, it’s imperative to remain focused on innovation, efficiency, and patient-centered care. At MedSênior, we are committed to integrating advanced technologies, such as AI, to streamline our processes and enhance the quality of care for our patients. Our holistic approach ensures that every patient receives tailored services that promote overall health and well-being, particularly for our elderly population.
The challenges faced by the healthcare sector in Brazil, from rising costs to inefficiencies, demand a multifaceted strategy involving all stakeholders—providers, payers, and patients. By fostering a culture of continuous improvement and leveraging data-driven insights, we can address these challenges effectively.
I encourage everyone in the healthcare industry to embrace the potential of technology and innovation. By doing so, we can create a more sustainable and efficient healthcare system that benefits all. Investing in the Brazilian healthcare market presents unique opportunities for growth and improvement, and I am confident that together, we can drive meaningful change.
