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EF: If 2020 was the year of diagnostics and 2021 the year of vaccines, what do you think will be the key healthcare talking points for 2022? 

EC: The last few years have been a challenging experience for all health systems, health insurance entities, and governments. In Colombia, we use thirty-year-old legislation; the insurance model is either public or private or sometimes mixed. The new government administration wants to introduce important changes to the health system, which I will go into later. We have faced challenges in the last two to three years, for which the system was unprepared. We were all caught unprepared for Covid and the pandemic at a global level and have had difficulties adjusting to the new reality. At Colmedica, we were already working on digitalizing procedures. We took advantage of telemedicine to guarantee patient access to medical consults. At the height of the pandemic, 50 to 60% of consultations were made virtually through telemedicine. That figure has changed; currently, 8 to 10% of consultations are done through telemedicine, and 90% are face-to-face, but telemedicine is here to stay, mainly for control consults. In administrative and health service access, Colmedica and other clinical centres under my management have been using information technologies procedures to facilitate access to services for patients. Appointments can be made via Apps, the web, or a call centre; payments, results, and medical forms are all available on platforms that have simplified patients' life.  

Colmedica has thirty-two medical centres in Colombia; sixteen are in Bogota because it is where we have most affiliates, and we have venues in eleven other cities. We have been working on a digitalized operation and administration for a few years. I had been doing most of my committee meetings virtually for quality, safety, medical records, infections, audits, bio-security, etc., so we did not suffer the change too badly with the pandemic. Similarly, we also had started doing training, induction, continuous, and process training virtually, so even if it was a challenge to migrate to doing everything digitally, it was doable. The change went hand in hand with investments to guarantee the medical centre's safety, air circulation, ventilation, separation of areas, signalization, temperature control, etc. We managed to adapt without too much pain, supporting our professionals, and ensuring the doctors that had to come in had the necessary safety measures. For dentists, for example, who had difficulties seeing patients, we created supportive strategies. We calculated an average of their earnings, and based on that; we gave them an interest-free loan to be paid back when they started earning again. When the vaccine came out, we made further investments in physical structures, personnel hiring, and vaccination centres, vaccinating our people first as they were more exposed to the virus. This year vaccination is decreasing, and we are in a more pre-pandemic scenario. But, we have taken many lessons from that period in matters of safety, personal hygiene, social distancing, and face masks that have remained in the people's consciousness to take better care of themselves. We did a very good job taking care of our people and patients, increasing the scope of home care for medical consultations, Covid testing, laboratory tests, and monitoring patients. We grew our car fleet, doctors, and therapists adapting to the new environment, learning as we went.   

EF: With the increase in teleconsultations, how do you see the future of your medical centres and hospitals? Do you plan to keep evolving your physical footprint?  

EC: Virtual healthcare will work well for chronic patient medical controls, particularly for certain pathologies that allow access to services. Technology will enable us to control and monitor patients remotely through already-developed platforms. The pandemic only accelerated the improvement, implementation, and use of remote care for diabetics, hypertension, and obese patients. We had developed an App pre-pandemic which we polished and used to control, monitor, and generate alerts; we will continue to focus on improving in this area. Telemedicine can breach the gaps in cities where we don't have medical centres. We have high-income service users that travel internationally, whom we serve long-distance, as they have their medical records in their App. They can access them to show a doctor in another country, which is a huge advantage. There are still issues to be worked on; there are many different platforms to visualize imaging -not all compatible- and we are working with technology providers to overcome this barrier. Unfortunately, private interests are involved, and imaging providers prefer to have control of their images, technology, and software. It is their way of securing their customers to their systems, but a wider view is needed to benefit the patient. Similarly, a doctor should have access to patient clinical records in the hands of other healthcare companies. It is not a simple issue; legislation in Colombia is trying to guarantee the interoperability of medical records, but implementing such a rule will be complex due to the technological infrastructure investment required. Topics like the cloud, blockchain, etc., are complicated, as all health institutions must agree. We have a long way to go before it becomes a reality in Colombia and worldwide. But, it would guarantee continuity and integrality in clinical management, avoiding waste in health matters –no-repeat exams for labs, x-rays, and MRIs that have already been done at another institution. Security issues also delay this initiative as data must be exceedingly well-protected, issues that the government and MedTech companies must overcome.  

EF: Many local and multinational companies are established in Colombia, including Colmedica of Empresas Banmedica, originally from Chile, creating a health hub for the region. Why is Colombia such an attractive market for healthcare? 

EC: There are various reasons; Colombia has a clear economic openness to foreign investment, and it welcomes investment from abroad. It is an open free market economy; healthcare is not 100% regulated by the public health sector. The government encourages private businesses to securely and transparently enter the Colombian market. They create companies, employment, and revenue for the country, with the added advantage of the devaluation of the Colombian peso. If their capital is USD investing in Colombia means investing less USD, making the proposition even more attractive. 

EF: How do you assess the current political uncertainty issues, and how does Colmedica plan to adapt? 

EC: We must be patient and wait for the new government announcements on this matter. The government has suggested some important changes, but some political sectors try not to make substantial changes. Some changes are necessary, but a total change in public health is not welcomed. There are successful public healthcare models in different countries, but they are generally high-income countries, and the level of corruption is also a definer. Corruption is one of the reasons that they want to change things here. I believe that a few black sheep do not ruin our entire system and that we should improve control of legislation, regulation, and monitoring to avoid corruption. Changing the whole system doesn't necessarily mean corruption will be weeded out. Thirty years ago, when public health was centralized, the corruption and waste of public resources were enormous, and the system's quality was bad, which was why the whole country agreed that the system had to change. Currently, 97 or 98% of the population have coverage in health, arguably not all at the same level, but there is coverage. Switching to a public system doesn't mean we will guarantee the same access we have today. In a scenario where the government controls all the suppliers and pricing in a decentralized way, each state managing its region has its complications. Politicians will also be involved, and unfortunately, with so many stakeholders, politicians, regional and national authorities could amount to even more inefficiency, waste, and corruption. The loss of resources allocated to health will damage the population's health. I know some EPSs have not done a good job –quite a few have closed down, and others have been intervened- but they are not all bad. It is naïve to think that changing the whole system will mean the elimination of corruption.  

To prepare adequately, we must first know what the changes are. Colmedica offers prepaid medicine; if the new proposition is as we believe it will be, there will be room for alternative quality health plans for service and access for many more people who currently have prepaid medicine plans. At the moment, the EPSs of the basic health plan are so good that the Colombian population doesn't consider it necessary to pay for a health plan because the state offers very good health for free. Of Colombia's 50 million population, only 1.5 million people pay for health, and maybe another million pay for complementary plans. Prepaid medicine will play a big role in offering a viable alternative. From a service provider's view, we believe we must continue to improve and grow in medical centres, something we are already doing, to offer more attention and services. We must invest more in services as our customers will always want better quality in health. If the health reform affects the present level of public health, we will be a good alternative even for people not insured with us. The plan is to become more robust and offer more and better services to be considered a good alternative for voluntary health plans. We must grow stronger and improve technology, access, and quality. Currently, our outpatient centres are certified and standardized under ISO 9001 Standard Content -a quality management certification. At Colmedica, quality and safety come first. As part of our group, we have an EPS (Alien Salud), which works well within the limitations existing in the EPSs.  

EF: Pre-pandemic collaboration and partnerships between companies were uncommon, but this has changed. Could you elaborate on how Colmedica collaborates with other companies and what can be achieved by working together? 

EC: It is a complex subject, as companies can have private interests that impede making alliances. Each company wants to win, and by partnering, they may gain less but can potentiate the business. We have made alliances with multinationals that invest and are established in Colombia. For example, Synlab is a Spanish multinational with a very big net of laboratories that have come to Colombia. We have made a successful alliance with them working within our medical centres; they offer us quality and good pricing for a high work volume. Partnerships also exist between companies and technological multinationals, Siemens, and GE, which provide us with equipment and are prepared to consider the devalued peso, making agreements, allowing us to work on and grow. It is a win-win for all sides and health benefits. Healthcare requires a joint effort. 

EF: What achievements are you most proud of after 18 years of working in Colmedica? 

EC: I am proud of the growth in infrastructure and quality within a transparent health system. We have grown and developed by listening to our patients, the insurance companies, and the government responsible for the entire health system. I have listened to all the system players and stakeholders and built up the organization by allying with excellent professionals, recognizing their worth and the value all the personnel brings to Colmedica. When I started 18 years ago, there was only one medical centre with a staff of twenty people; today, we have thirty-two centres across the country and employ 1800 people. We are working to replicate our good experience in Peru, Chile, and Brazil in the Latam region. The model we offer benefits patients and insurance companies, which grow in members because of the excellence and high quality of our outpatient services. Our suppliers (technology, medical equipment, infrastructure) also benefit, and we have 1800 employees with their families that are proud to be part of the organization. We have also benefited financially and are a good example of what can be done in health. Our high quality and work ethics with all stakeholders make the business successful. Successful financially, in quality, and in service. We are not the biggest, but we work transparently and innovatively, always looking to change and adapt when necessary.  

October 2022