Read the Conversation
Meeting highlights:
- Data is foundational for healthcare transformation: Latin America's inability to shift from reactive to proactive, value-based care stems from a lack of usable patient data, especially in ambulatory care, where 70% of information is lost due to paper-based systems.
- Current political reforms are straining the sector: Colombia's healthcare system is in a liquidity crisis, especially affecting mid-tier providers. Political changes are worsening conditions, pushing more services to the private and out-of-pocket sphere.
- Saludtools offers an integrated digital solution: Focused on small practices, Saludtools combines scheduling, records, billing, and telemedicine in one platform. With 7,000 active users, it operates in Colombia and across LATAM and aims to expand through strategic acquisitions.
- Regulatory shifts will drive software adoption: New interoperability laws in countries like Colombia, Chile, and Uruguay are making electronic records effectively mandatory. Camilo anticipates a five-to-sixfold market growth in Latin America over the next few years, similar to the U.S. post-HiTech Act.
- AI and patient empowerment will reshape healthcare: The rise of AI presents a major opportunity for platforms with data. As healthcare becomes more privatized, patients will take a more active role, and companies must be ready to deliver streamlined, patient-centric care experiences.
EF: What inspired you to start Saludtools? Where did you identify the gap in the market?
CN: One of the biggest challenges we face in Latin America is that we haven’t been able to change the healthcare model. We’re still mostly focused on reactive care. We haven’t successfully shifted, at least not yet, to a proactive care model where we try to anticipate issues and reward providers based on outcomes rather than just actions.
A major reason we haven’t made that shift is the lack of reliable data and patient information. This is especially true in ambulatory care, particularly among small providers and independent practices. Only about 30% of encounters in this setting are even recorded. And of those, just 30% produce data that’s usable for the industry. The other 70% gets lost, written down on paper, in a notebook, or maybe entered into an Excel sheet that ends up being useless. From the outset, our mission has been to help address this by providing the industry with a means to capture meaningful data and transform it into actionable insights for informed decision-making, as well as to support providers in delivering proactive care.
EF: How do you see this year from your perspective? What challenges and opportunities are you dealing with right now?
CN: The healthcare industry in Colombia is currently experiencing a challenging period. Significant political change has occurred, primarily due to contending political views within the healthcare industry. The sector is presently undergoing a liquidity crisis as a result of this impasse. If the healthcare system were a pyramid, the big hospitals and providers would be at the top. In the middle, you have small to mid-sized ambulatory care clinics. And at the base, there are independent practices run by individual doctors who also provide ambulatory care.
Many of these clinics are struggling with cash flow. A significant number aren't receiving payments, and some are even going out of business. Meanwhile, the top of the pyramid is becoming stronger, while independent practices at the base are also growing, mainly due to patients’ limited access to care. More doctors are transitioning to private practice, resulting in an increase in out-of-pocket expenses for patients.
What we’re witnessing is a collision between political agendas and the way the industry normally operates. It’s placing a significant financial strain on a substantial segment of providers, and these are the ones that employ a considerable number of doctors. Looking ahead, I don’t see this changing anytime in the next year. As far as we can tell, there is no real effort or incentive at a government level to address the issue right now.
EF: Could you tell us a bit about the Saludtools platform, its newer portfolio features, and how the different features of the platform complement each other to create an all-in-one solution for operation?
CN: When running a small practice or clinic, several essential tasks must be managed to keep it running smoothly, including scheduling appointments, maintaining accurate medical records, processing prescriptions, handling invoicing and billing, and collecting payments. What we’ve done is combine all of that into a single software platform designed specifically for this niche of the market. We don’t target big clinics. We focus on independent and small practices. We offer everything they need in one place. So, if you’re a doctor, regardless of your specialty, or whether you’re a psychologist or a nutritionist, you’ll find everything you need to manage your practice with Saludtools.
Right now, we have 8.000 active users on the platform each month. In Colombia, we’re either number one or number two in our category based on the install base in Colombia, not among large hospitals but within our niche. We’re a team of approximately 40 people from four different Latin American countries, serving clients not only in Colombia but also in Ecuador, Peru, Mexico, and the Dominican Republic.
EF: How does technology, such as telemedicine, help address health equity and bridge access gaps? Colombia is a large, geographically diverse country with a significant rural population. Is that an area you have also identified as an opportunity to make a difference?
CN: We’ve been working in telemedicine for over 15 years, and honestly, it’s one of the areas we should be focusing on more than we currently are. Our country faces significant challenges in terms of geography, accessibility, and infrastructure. Making healthcare services available to people in remote areas should be a priority, especially for the public healthcare system. There are regions where the only way in or out is by water, and it can take two to three days in a small canoe to reach them. Typically, patients wait until things are really bad before requesting an air extraction, which is extremely expensive. Our goal is to bring technology to these areas and make it accessible and useful for people who currently have no other options.
Telemedicine was previously heavily restricted by regulations, but that changed after the pandemic. The new rules have helped the technology grow. What we’re building doesn’t require special hardware or complicated equipment. Sometimes, people need a basic consultation with a doctor who can help make sense of their symptoms and guide them on the next steps. Such basic access is still lacking in many places.
That said, telemedicine is only one part of what we do, not the whole picture. We have a much deeper reach with our medical records software. Telemedicine isn’t yet the preferred option for most patients or doctors, which makes sense, but it’s growing quickly. It’s not at pandemic levels anymore, but it’s moving in the right direction. The primary focus now is on providing doctors with an integrated way to care for patients. It’s not about choosing between telemedicine and in-person care. It’s about combining both. Sometimes, they need to see a patient face-to-face; at other times, they can conduct the assessment remotely. What matters is having a single platform that makes it simple to do both. Doctors need an integrated solution.
EF: What was the strategic decision behind acquiring NetMedik in 2023? Looking at the bigger picture, where do you see growth opportunities, in terms of both organic and inorganic growth?
CN: We acquired NetMedik because we believed expanding our user base would help us grow faster through organic channels. This business relies heavily on referrals. When you do good work with a doctor, they tend to recommend you to their colleagues. That's the kind of growth we're aiming for. It turned out to be a solid move. We bought the company using our resources. The entire operation was financed internally, and it proved to be a smart financial and strategic decision. It enabled us to establish a strong presence in a region where we hadn't previously had a presence. After the acquisition, we became one of the leading companies in that area.
Another key outcome was our connection with one of Colombia's largest insurance companies, Sura. Now, doctors who work with or provide services to Sura can share and access information through Saludtools. That kind of interoperability adds real value. So yes, it was an expensive decision, but looking back a few years later, we can confidently say it was the right one. We're actively seeking additional companies to acquire, following the same model, not only in Colombia but also in Peru and Ecuador. The goal is to build a unified platform and continue growing.
EF: How do you identify market opportunities in the LATAM region? Are you navigating diverse market dynamics and regulations across different markets? How do you assess that?
CN: That's tricky because, in Latin America, software solutions aren't mandatory. A good example is invoicing software. If electronic invoices weren't required, most people wouldn't use invoicing software at all. It's a task most would avoid if they could. However, once electronic invoicing became mandatory, the software became necessary, which is why it has experienced significant growth in the region.
We're seeing a similar phenomenon occur in healthcare. Governments have made only limited efforts in terms of data and interoperability. Some have tried to create a single national electronic health record, but these attempts have not been successful. Now, instead of trying to build a single unified system, governments are pushing for data interoperability. That means that every time a patient sees a doctor and information is recorded, the data needs to be synced with national healthcare repositories. And the only way to do that is through software. Although software isn't officially mandatory, it's becoming required in practice. We're seeing this in Colombia and Chile. These countries have begun implementing laws that promote interoperability. Uruguay has already implemented theirs. Mexico is still lagging, but we expect to see broader adoption over the next five to six years.
That's why we're betting on this market. It is expected to grow five to six times over the next five to seven years, similar to what happened in the U.S. after the passage of the HITECH Act in 2009. Before that, adoption rates for small practices were around 25 to 30%. Following the law's implementation, adoption rates rose to approximately 90% within a few years. The pattern is clear, depending on the country; these markets tend to grow four to six times once regulation starts pushing things forward.
EF: When building a company from scratch, it’s important to instill a culture and purpose from the beginning. Could you tell us more about that?
CN: Finding talent is always hard. As a founder, it's one of the things you must continually do. Currently, it's becoming increasingly interesting and challenging because AI is transforming everything, and these changes are happening rapidly. In healthcare, that's unusual. This is an industry where change typically takes years, but now we're starting to see real shifts, and they're coming quickly. Over the next two to three years, the way we deliver care will look different. When we think about talent in our company, we're not just looking for specific skill sets; we're also looking for individuals who embody the company's values. We're looking for individuals who understand where things are headed and how the future of care might unfold.
We'll not keep going to the doctor the way we do today. It doesn't make sense, especially in a region like ours, where we may have only two or three doctors per thousand people. That's not a scalable or efficient way to deliver care. However, we now have technology that can change that.
When we're hiring, especially at the C-suite level, we're focused on finding individuals who can grasp that. People often ask, 'What are the things that won't change?' One of those is that people will still get sick, which is not going away. When you're sick, you'll still need treatment. But everything in between is up for change. How you seek care, where you get it, how you understand what's happening to you, and how empowered you are as a patient, all of that's going to shift. That's the mindset we're looking for in talent, and it's not easy to find. Especially in this industry, it's rare to come across people who genuinely think that way.
EF: Why is a dollar better invested in health than somewhere else?
CN: This industry is poised for rapid change. It’s one of the sectors that will be most affected by AI and by the political shifts happening in the region. With that in mind, there are numerous opportunities for companies focused on enhancing the patient journey. We’re already seeing this play out in the U.S., as evidenced by recent acquisitions by Amazon and others. These companies are making significant investments in patient experience and its future evolution. Latin America tends to lag behind these trends, but the shift will eventually arrive here as well.
In my experience, I observed a similar phenomenon years ago with digital radiology. That shift wasn’t just about hardware and infrastructure. It also altered how patients navigated the system. And the companies that focused on improving that journey saw strong returns. What’s coming next will be ten times bigger. As an investor, I’m very interested in how all of this will unfold and how these political and technological changes will shape the industry over the next few years. I’d probably take a cautious approach in the next 6 to 12 months, but after that, I think things will get very interesting.
In other sectors, such as banking, education, and retail, there is a growing emphasis on the customer journey, and it’s becoming a real trend. I believe healthcare will naturally follow the same path. Just think about what’s happening: all these changes are pushing the private side of healthcare to grow in Latin America. In countries like Colombia, where out-of-pocket expenses used to be around 15%, that will no longer be the case.
Now, that shift is both good and bad. It’s bad because people will face more financial pressure when it comes to their health. But the upside is that the patient is being put back in the client seat. For a long time, patients have been passively told where to go, which doctor to see, and what medicine to take because the system handled the payments and made all the decisions.
But now, whether patients are paying directly or through private insurance, which often feels like the same thing, they’re back in the driver’s seat. They’re making decisions again. That means the patient journey becomes important once more, perhaps even more so than it has ever been. So we’re seeing a lot of space and opportunity for innovation in that area. Take Mexico, for example. There has been a boom in specialised private clinics focused on women’s health, men’s health, pregnancy, and more, all with a sharp focus on the patient experience. That’s a positive outcome of this model. However, it comes at a cost: patients are devoting a larger portion of their income to healthcare. That also creates room for new insurance models.
Mexico is ahead in this regard. Approximately 49% of healthcare spending in the country is out-of-pocket, compared to 15% in Colombia and 30% in Brazil. So, they have more experience with this setup. They’ve developed low-cost insurance options and a stronger private healthcare sector. I think there’s a lot we can learn from their experience because our countries are likely heading in the same direction over the next few years.
EF: Now that you have been on this journey with Saludtools for 10-11 years now, what advice would you give somebody launching a health startup in Latin America that you can reflect on?
CN: The remarkable thing about healthcare is that it's full of big, urgent problems each one an opportunity to make a meaningful impact. For an entrepreneur, that's a dream: challenges that affect millions of lives, backed by significant funding, especially in today's landscape. It's an exciting space to be in.
The challenge, though, is the financial model. It’s hard to make money solving these problems. Typically, you must rely on government funding or ask patients to pay more, both of which have significant drawbacks. This is a crucial challenge when starting a healthcare venture: determining how to make it profitable. We’ve seen big companies fail because of this. Telemedicine, for example, hasn’t grown as quickly, largely because hospitals can’t generate additional revenue from it. It’s more expensive, riskier, and difficult to monetize.
My advice is this: don’t spend too much time just searching for the perfect problem. That might sound counterintuitive, but you’ll find problems everywhere. Once you start working on one, you’ll discover a hundred more, and that’s a good thing because it keeps you passionate. What you need to focus on is building a sustainable business. Think beyond a few rounds of funding, loans, or grants. Consider how you’re going to make a company that can last for decades, maybe even 100 years. That’s the real challenge.
EF: What are you most excited about at Saludtools right now?
CN: I’m excited about the changes AI is bringing to our system. I believe companies like ours will be in an exceptional position over the next five years, as we have access to valuable data and insights. We can even act as healthcare providers indirectly, and that’s a huge opportunity we didn’t have just two years ago. Back then, companies like ours were mostly just a nice front end to a database, a good-looking webpage to retrieve and create information. However, with AI, the opportunity is massive because the way care is delivered is about to undergo a dramatic change. If we do things right and stay alert, we’ll have a huge chance to be part of this new way of delivering care. That’s exciting, and it’s something we didn’t have two years ago.
EF: What is your final message or challenge to the sector?
CN: Our dream from day one has been data. We have to understand that without data, a sustainable healthcare model is impossible. No matter how much you invest or where you invest, if you don’t have patient information to guide decisions, there’s no way to build a lasting system.
This problem is particularly severe in ambulatory care settings. Most of the investment in data management goes to large hospitals, while ambulatory care facilities receive little to no funding. My challenge is clear: without ambulatory care, we lack the necessary data. And without that data, we can’t build the value-based care model that Latin America desperately needs.
Another message is to hold on. We’ve faced serious challenges over the past two years, and they are likely to worsen over the next 8 to 12 months. But it will get better. We must continue to push because healthcare is bigger than politics. It’s here to stay. We need to outlast the politicians. We have to keep moving forward.
