Read the Conversation
EF: What attracted you to the in-home care market? Why did you choose this sector to start your business?
MR: I come from a family of doctors, and thus, I was drawn to the healthcare sector. I went directly into an entrepreneurial training program after I graduated from college. It was a venture capital firm that had an incubator, and that's where my co-founder and I started looking at different ideas in the healthcare market. We came up with the idea of purchasing different types of publicity in hospital waiting rooms to empower patients to have a better lifestyle and make better decisions.
We quickly learned that our idea was capital intensive, and it would be hard to maintain something like this because the big funders are normally companies in the industry that might have different incentives than us and thus create conflicts of interest in the sponsored messages. We started different workshops, and that's when we gravitated towards home care. After several ideas, we decided to explore the home health industry in the form of an “Uber for nurses.” We learned that in more developed countries, hospital care is shifting towards a home-based model, presenting fewer risks, better care plans, and better patient outcomes.
We discovered that contrary to what is happening in the home care industry in other countries, in Mexico, home care is more focused on long-term relationships where live-in caregivers and nurses stay with a patient for 12 to 24-hour shifts for months or even years. This unique situation developed as a combination of demographic and geographic factors, essentially meaning that the nurses and the people who could afford home care services live in completely separate parts of Mexico City, and it simply isn’t feasible to ask a nurse to travel six hours round-trip for a short shift. Our value proposition and how we planned to involve ourselves in those relationships became something like being mediators between the two parties, adding value to both sides by providing care at a lower cost and paying higher salaries to our nurses.
Our main focus when we started was elder care. We were more focused on patients with Alzheimer's, dementia, and Parkinson's. We also discovered that one of the problems with the industry is that it's not regulated. Nothing is being done in terms of compliance and training in Mexico, unlike the United States, which has a National Caregiver Association that keeps a record of caregivers and their qualifications.
Due to the lack of regulation, caregivers in the home care market have a bad reputation because there is no standard of care quality. The sector is also informal in an economic sense because people are paying for this out-of-pocket. People end up having to choose a cheaper option, which may be a caregiver whom they have heard about through the grapevine, as opposed to from a company.
People preferred to hire a person who they found through a recommendation so that they could pay less than hiring from a company. That is when we started shifting our focus toward outpatient care, post-hospitalized patients, and specialized elder care because the degree of care these patients need is much greater, as is the opportunity cost of someone having to re-enter the hospital. It is also different from the payer's perspective, so we shifted our focus to more specific care, using more registered or auxiliary nurses with educational qualifications.
EF: In addition to vetting your professionals, is there anything else that you do when looking for the best employees?
MR: Recruitment is a long process, and in Mexico, it has its complexities. Nursing in Mexico is mostly a low-income job, and nurses have a limited career path. The number of nurses in Mexico with master's degrees or post-graduate education is minimal. People who study nursing normally come from low-income families and live in the suburbs.
Mexico also has a disparity in the quality of education. You can have a registered nurse who has a degree but knows less than a caregiver who has cared for an elderly person for ten years. This poses a big problem since nursing is a low-income job. Considering it plays a support role in the healthcare system, the nursing industry doesn’t have the importance or power that it has in other countries, where nurses have different categories and are empowered by the system.
Our recruitment process has been streamlined and combines digital aspects with in-house training and vetting. Initial applications are received digitally and are then vetted in terms of demographics and educational background. Those who pass this stage undertake a theoretical test regardless of the role they are applying for. Following this, candidates go through a competency exam and an interview with a psychologist, and finally, they go through a practical exam where they are asked structured questions related to the work they will be doing.
Once hired, we help our employees formalize their affairs by having them pay taxes, register with SAT, and do invoices. As nursing is a low-income job where people are used to getting paid cash in order to avoid taxes, this has been one of our biggest achievements to date. We have formalized more than 3,000 nurses over the years.
EF: What separates Atend from the alternatives? Why would somebody choose home care instead of a hospital?
MR: There has been a shift towards homecare companies for care services. All companies that offer that service say the same things when it comes to what they can deliver. I think what separates us from the rest, besides our robust vetting process, are two things: First, we don't spend anything on marketing since our strategy is based on referrals, which means a trust factor is involved. We are a company that will be referred to you by a doctor, a friend, a family member, or a hospital.
The second differentiator is our business model and how we sell our services. When you are selling the same thing as someone else, the way you sell it makes a huge difference. There's a lot of informal competition - different types of companies that are not well-established – but Atend employs an onboarding plan for the families of our patients because we understand that when you are faced with the situation of having to leave the hospital and hire a nurse, the entire process can be intimidating and unclear. Our onboarding plan enables us to set realistic expectations and educate our clients and patients about their path of self-care. We will never promise something we cannot fulfill, and we will always be very straightforward about what to expect from the service and what we can deliver. Our users are our patients, but our clients are mostly their family members, and our value proposition is to mediate these complicated situations and keep everyone’s best interests in mind.
The result of all of the vetting of our professionals reflects the type of care we deliver. It is not always perfect – nothing ever is, but we have always managed to resolve conflicts conveniently for our patients and their families. We focus on the patient's well-being, and having them at the center is our top priority. We work to identify the needs and wants of the patient, and we do not have to force anything on anybody.
EF: Are you planning on attracting more investment to grow your company? If yes, how are you pitching the investors?
MR: That is a good question and is something we have spent years looking at. Uber for nurses sounds attractive, and with that name alone, one could build a business model that justifies a presence all over Latin America. However, I’m a firm believer that if you raise money, you should have a sustainable business model that allows for scalability and profitability. We started the company in a similar way to many others, with an entrepreneurial fund, focusing on growth and traction. Still, I do not think playing the valuation game is responsible. Focusing too much on how much you are worth and how much you are going to be worth in the future is a recipe for how to make a big snowball that only has your own interests at the center. That is not what I want Atend to become.
We have been very responsible with partnerships and collaborations, and we have not looked for financing because the type of care business we do is difficult to grow. If you have 1,000 patients, you need 4,000 qualified, honest nurses who want to work in home care and not in a hospital. We are looking for different ways to grow our market share without sacrificing the quality of care and the safety of our patients and their families. For example, we are exploring, among other things, working with or acquiring other home care companies with the intent of expanding to other cities. This business is based on recurrence, i.e., the patient needing care for an extended period of time. For that to happen, there has to be effective management of long-term relationships, which is a challenge in this business.
COVID was an interesting time for us. Almost 60 percent of our patients declined our services due to the risk of exposure they may have faced from having a caregiver enter their home. My partner and I were ready to close up shop, but a miraculous email came through asking us to help with infusions. We were able to develop a home infusion model, which was something quite innovative in Mexico. We worked with two pharmaceutical companies to deliver infusions of enzymatic replacement for pediatric patients, and others focused on cancer, multiple sclerosis, and arthritis. COVID opened a new avenue for us, and we realized nursing could be used to fulfill a specific need at a specified period of time, which was in-home infusion therapy, later transforming into our last-mile care infrastructure.
In our journey to create a more scalable business model, we are currently developing a "last mile care model." "Last Mile" is a term we borrowed from the telecommunications industry and typically refers to the final stage of healthcare delivery, where healthcare services or interventions are provided directly to the patient. In the context of healthcare, what we want is to improve access, increase convenience, and enhance the healthcare outcome. We are trying to build an infrastructure that has a mobile workforce and a solid technology base in terms of logistics to enable all stakeholders to connect to our infrastructure so that we can help companies incorporate at-home interactions into their care models.
For example, we work with pharmaceutical companies for blood tests, chemotherapies, infusions, and other types of medications that they want to administer through their patient support programs. We work with doctors who want to enhance their reach and monetize medical consultation. Instead of having them go to the hospital, we have them use our infrastructure to deliver the care.
This is not a pivot; it is another business avenue. We are incorporating diagnostics, primary care, specialty care, vaccinations, and many other things into our infrastructure so that stakeholders who want to implement their patient-facing at-home strategies can use our infrastructure to do so. This makes sense from a scalability point of view, and we are definitely going to look for more investment to develop these plans further.
There are three main trends that we have identified that support our business model. There are demographic trends, such as aging populations, that point to an opportunity in the future for increased expansion of our services. There are also economic trends that point to positive growth in the system. There is power in having homecare integrated into the healthcare system in a manner similar to the US and Europe, not only to provide care more efficiently but also as a means for prevention. These trends highlight the importance of home care services in meeting the evolving healthcare needs of individuals and prompting a more patient-centric approach to care delivery.
EF: Healthcare companies are pushing for digital solutions. What is your digital footprint?
MR: Our first model, for long-term care, is completely digital and is what we use to manage our own team. We have nurses on the platform who can log in and see the patients available to them and the level of care required. It works almost like a matchmaking service. In the last mile care model, we are building two digital models. The first is internal and focuses on logistics, which is essential in a large city like Mexico City. This model can be used to coordinate and assign resources where needed in order to have a way to connect our stakeholders and give them real-time updates. The second model is more patient-facing, so we are looking at how we can personalize our interactions with patients to draw out useful insights to provide our stakeholders to implement the best possible in-home care. We are looking to integrate home care in a sustainable and scalable way using technology to impact various areas: efficient resource utilization, collaboration and care continuity, improved patient outcomes, enhanced monitoring, disease management, and data-driven decision-making.
EF: At the end of 2025, what achievements do you think you will be celebrating?
MR: When I started Atend, one of my main goals was to empower nurses by creating a safe environment where they can develop and improve their services and their careers. Nurses make a lot of sacrifices, and I hope to look back and be proud that I built something that would allow these professionals to thrive, be economically independent, and grow in their careers. I also hope that home care will be integrated into the national healthcare system to deal with society's upcoming health challenges.
