We Fixed It. You're Welcome.

Aaron Wolpoff [0:14 - 1:20]: All right, here's how this works. In each episode, we pick a company we all know that has something going on right now. Then we put ourselves in charge and see if we can fix it. You'll be hearing from Melissa in Operations Channel, Gino on people and culture and me on marketing. My name's Aaron. As always, a quick disclaimer. We are going into this somewhat cold and nothing we say should be construed as legal advice, financial advice, or anything that would get us in trouble. These are our views and opinions. We're here to ask the kinds of questions everyone's thinking, have an engaging conversation and maybe come to some conclusions that we feel are worth exploring by the end. If We Fixed it. You're welcome. All trademarks, IP and brand elements discussed are property of their respective owners. Welcome back to We Fixed It. You're welcome. We're thrilled to have you here. We are your fearless fixers. You've got Melissa Chino and myself. And we've got a special guest on TODAY that we'll be introducing shortly. On our show, we set out to fix the world one company at a time. Each episode we have to prove ourselves all over again. So let's get into it. We've taken our vitamins for the occasion. We're amped up and ready. Melissa, tell us, what are we talking about today?

Melissa Eaton [1:20 - 2:07]: So like every week, we are not going to shy away from some tough topics and we're really excited to talk about healthcare in the US it's at a crossroads. Costs are soaring, access is uneven and it's very bureaucratic. Meanwhile, in Mexico and we're going to hear a little bit more from our guest. Private systems like Hospitales Mac deliver high quality care at a fraction of the cost. So today we're going to compare Kaiser Permanente's integrated model with Mexico's private healthcare system and ask what can we learn from Mexico's approach to affordable, efficient care? And what bumps have there been in the journey, Eduardo, and how can we reimagine health care for the future? So Erin, take it away. Please introduce our special guest.

Aaron Wolpoff [2:07 - 2:29]: Thank you, Melissa. I will. If we're going to take on the health care system in the US and maybe Canada too, we're going to need some help on this one. And I'm thrilled to introduce our special guest, Eduardo Verbon and Khoury. Eduardo is the esteemed co president of Hospitalis Mac, which is rapidly becoming the largest private hospital system throughout Mexico as we'll be hearing from him. So Eduardo, tell us a little bit about yourself.

Eduardo Verboonen Khoury [2:29 - 3:18]: Thank you, Aaron. Thank you, Melissa. It's a pleasure to be here today. Healthcare is one of the pressing issues today, not only for the US but for everywhere in the world. I will give you a bit of my background. I'm an engineer and I have two masters, one in public administration and the other in management. But I've been studying healthcare for a while. I took a certificate at Harvard of managing healthcare delivery. So I know a bit about the US system. Here at Hospitales Mac, we've spent years trying to refine a model that delivers high quality healthcare at a fraction of the cost. I'm really excited to discuss how our approach differs from that, from case of Permanente and other institutions in the US and the lessons that can be applied across borders because we have a lot to learn too.

Aaron Wolpoff [3:19 - 3:33]: Thank you, Eduardo. And we look forward to hearing from you about your approaches and what you see working and implications for the rest of us. Since we're going to talk about Kaiser 2 and bring them into the conversation, I will throw it back to Melissa. Give us a little bit of context about Kaiser Permanente.

Melissa Eaton [3:34 - 7:31]: So a lot of you know who Kaiser is and I wanted to share. They were founded in 1945. They pioneered integrated healthcare, combining insurance, hospitals and providers under one system. They're known for their focus on preventative care, electronic health records and coordinated care. But they're also criticized for high cost, limited geographic coverage, they're only in a few states, and very long wait times which as a patient none of us want. So why are we questioning this now? It's because of all the things that are happening in our environment and ecosystem with rising healthcare costs, inefficiencies in the US system and, and have led many to ask if this model is scalable or is it outdated or what are the alternatives out there. So that's one of the reasons why it's very timely that we have Eduardo here to talk about hospitalism. They are Mexico's private healthcare system, one of them, and have grown rapidly by focusing on those things that we seem to have some problems with around affordability and efficiency, offering care at sometimes 20 times lower cost than the US without hopefully compromising quality. I'm sure that's going to be a big topic for Eduardo for us to discuss. And again, why is this relevant now? I think it's because we're grappling with healthcare reform. I know Chino talked about that. They're also having that question there in Canada. So this should be a very interesting topic about which model and what also are the pitfalls of some of those models and how can we scale those across these very large, large areas? I also wanted to just talk a little bit. I don't want to spend too much time on this, but just to share what integrated health, what that means, because I think there might be some questions about that. It refers to this system where insurance, hospitals and providers all operate under one umbrella. So you don't have to go searching for those creating really for the customer and patient, a seam. And that's, here's what it really looks like in practice. That looks like coordinated care for a lot of you who might have a PPO or some other type of system. You have to have, you know, you have to get referred and then there takes a while before that referral actually happens. With Kaiser, it's all under one umbrella. They have a big focus on preventative care, which is wonderful and a very patient centered approach. Meaning everything is housed in a very tight geographical area. Right. So you can go to the doctor and see your doctor in the hospital setting and campus and the pharmacy is downstairs right now. We're not talking about the waiting for long in long lines, but I think for a lot of people the ability to have it all under one location has been very helpful. So that's one of the things I wanted to share about what Kaiser really, why we're choosing Kaiser is they have a very, they've kind of crafted this integrated health system and they've really done it well. But now as the future awaits us in healthcare, we really need to start thinking about whether that model is really going to take us to the place it needs to be. And it's like I said, it's only, you know, when you think about California, Colorado, only a few states that have Kaiser access is a huge issue. So I don't know who wants to kick it off. I mean, I know all of us have a lot of things that we probably want to share and I would be really interested in. Eduardo, what drove you to like start developing this model and really kick off. I mean this is, this is really exciting and interesting and I know you're passionate about this, so would love to hear what, why you chose to start hospitals, Mac, and how it's going.

Eduardo Verboonen Khoury [7:31 - 9:22]: Thank you, Melissa. I'd love to share that. I'm really passionate so if I speak too long, please interrupt me because I can go hours of talking to this. When our founder Miguel Curie started Hospitales Mac, he realized and we realized that there was a need of good healthcare, high quality healthcare at an affordable price. And we started in a small city in Mexico where you couldn't find a good hospital and a good price, so you had a really not so good hospitals and they were also charging you excessively. So he started on a mission to fix the city and to have a hospital in the city. And then a few years after we had the first hospital, we realized that it wasn't only our city, it was many cities around Mexico. So we started building more hospitals and more hospitals and more hospitals and buying some hospitals and fixing their operations. To be in our model, that is a high quality, low cost. We try to do it in a few ways. We don't like the status quo, so we are always looking for efficiencies. And I think in some regards we operate like a startup because we are very flexible, we are fast, we are agile, but we don't compromise quality. So we are very strict on quality and we maintain a high quality standard in our operations. It's been a ride. We are about to become in a few months, the largest hospital provider in Mexico. And we only started 17 years ago. So we are a fairly new company and I think we still have much to do and much to learn from other systems around the world.

Melissa Eaton [9:22 - 9:54]: So one of the things that really are, you know, I think we see this in our system and I don't know about this for you, Chino, but in our system, part of the cost is all of the regulatory, administrative, bureaucratic types of things. So is there a way that you're able to be innovative within the Mexican healthcare system? Do you not have some of the constraints that we do is that one of the reasons you're able to kind of drive efficiencies?

Eduardo Verboonen Khoury [9:55 - 12:21]: I think so, yes, we do have a lot of regulations and government oversight like in any other country, but we are able to do direct negotiations. So we deal directly with suppliers, we avoid dealing with the layers or intermediaries, and we also deal directly with our providers. We get better pricing and better revenue cycle and we pass all those savings to our patients so we can keep our costs for the patients low. We also do a lot of our buildings and we have a real estate company and a construction company. So we look for efficiencies there too. Instead of having to build a hospital with another company that is going to have to have some, some revenue and some margin, we do it ourselves and we take care of everything. If, if we see that the electrical systems, cables are going around a wall and they can go in another trajectory, we, we, we do it in order to save every penny that we save, it's a penny that we don't need to charge the patients. So that's, that's our approach to most of the things that we do. And one other thing that I, that I think differs a lot from the American system is that we fix things in the USA and I'm sure in Canada as well, a lot of things tend to be discarded and replaced. So if a bed, a hospital bed is broken, it will be discarded and somebody will buy another bed. And we have a team of people that refurbishes them. So if the wheel gets broken, we will fix the wheel and over time we will fix the bed. So instead of the bed having a five year lifelong time, we have them for 10 years. And if our CT scanner breaks, instead of replacing it, we fix it. A lot of things that are little things but add up a lot on the costs we do it. So it's even sustainable for the, for the world because instead of giving all this trash away and filling a space with trash, we fix it and then we, we, we make most of it.

Melissa Eaton [12:21 - 12:26]: Yep. It's like you're taking responsibility like as if it's your own house, right?

Eduardo Verboonen Khoury [12:26 - 12:28]: Like, exactly, exactly.

Melissa Eaton [12:28 - 12:30]: Wouldn't do that. Yeah, exactly.

Chino Nnadi [12:30 - 13:11]: I'm curious too, because I know you've been around for 17 years, which seems like a lot, but it isn't a lot when you look at kind of old antiquated healthcare systems. Again, I'm the resident Canadian, which is why I'm wearing my red flannel today. You know, it's a slight, well, completely different model to the US and so what I'm wondering from you is how did you get that initial buy in? Because people need to trust you. Healthcare is not something that, it's a product. It's, it's our health, literally life and death. And so how were you able to kind of build that trust not only with the people, but with governments to allow you to have the space to run your own shop?

Eduardo Verboonen Khoury [13:11 - 15:57]: It's a very interesting question, Chino, and I think it comes, the answer comes from different points of view. Here in Mexico, the doctors are independent professionals, so they are not employees of the hospital. The hospitals have to care to the doctors and the doctors will bring their patients to the hospitals. So what we do is we build safe facilities, really technically well equipped, with high tech and every standard of care so the doctor can feel safe operating in our hospitals. And when we have the doctor's trust, then the patients will come with the doctors. So that's one of the ways and the other is that the patients know the outcomes. So they know that if they go to hospitales, Mac, their probability of having good healthcare and a good outcome is better than if they go to a different one. And that's the way you build trust with patients and doctors and what you were talking about, the government. It's very interesting. Here in Mexico, we have a public system that is overwhelmed, as all the public systems are in the world. And this private sector of hospitals is not about replacing public healthcare, but complementing it. We have shorter wait times. I'm going to tell you a story. I was a client in a hospital in the US and we were there and my son broke his feet and we took him to the ER and we got an appointment for somebody to see his fit a week later. And it was horrible because they told us, tell your son not to move his feet until he gets his appointment. And he was two years old. Two years old. So it was horrible. Here in Mexico, in the private sector, if it was three in the morning, orthopedic pediatric doctor would have come to the ER to see my kid. So it's really different because being professional, independent doctors, they are maximizing their income too. So they want to see patients. So it doesn't matter if it's 3am they want to get a new client. And the model in other parts of the world where, where doctors are part of the payroll, they don't have that urge or don't have that need. And that need translate to accessibility and the timing of care. It's really interesting how the model differs. How could it be different if you have the right incentives in place?

Melissa Eaton [15:58 - 17:16]: Right. I mean, that's interesting that you said that because I think that's one of the things that is different with our models. Right. So like, Kaiser is like, it's kind of, you go there and you see whatever doctor is available to you, you can have your own doctor from Kaiser. But like in, in the scenario you just presented, which was the er, they have their ER doctors, right? So for us, that definitely that accountability and you know, what you're saying about, like, I want to, you know, have more patients. So I'm going to be available, right? And I'm going to bring them to someplace I feel safe. It's a very different take on it. And I think that's definitely something that, you know, when we talk about these long wait times, I mean, I think the ER is just in the United States is known horrendously for that. I mean, I laugh. Eduardo. I had my son Broke his nose and I don't even remember. And we took him to the top hospital in San Francisco, and we were there for at least eight hours. And by the time he had eaten all the Doritos and everything out of the vending machine and there was blood all over us and all the stuff he started, you know, pushing his nose and just saying, mommy, I want to go home.

Chino Nnadi [17:17 - 17:17]: Right?

Melissa Eaton [17:17 - 18:14]: Like, I mean, and we just left. And I don't know if I got charged. I don't know. I mean, we had signed in, but, like, we just left because it was just ridiculous, right? So I. I understand that there's, there's just a. There's just a sense that we need to figure out how to do this better and, and also figure out how to meet the needs of the people where they. Where they. Where they are. So I really appreciate that. Can you talk a little bit about technology? Because being 17 years old means that you were part of the technology wave. And like I said, like, one of the things that there's a lot of talk about here is that there's these cost codes right for care, and if you have the wrong cost code assigned, your claim will be denied by your health insurance company. So how have you worked technology into your operations and how's that helped you?

Eduardo Verboonen Khoury [18:15 - 20:55]: Technology integration is really important for us. We use it for many things. For. We streamline employee onboarding with technology so we are faster and better transmitting the culture to our employees when they arrive for their first day at the job. But we also use it for diagnostic billing. And technology help us reduce inefficiencies that often inflate costs. One way that we are using technology to reduce cost is with AI. We have it in our CAD labs. So the CAD labs machine, when they're doing a procedure with a procedure with a patient, will recommend the doctor a lower dose of the pharmaceutical or a lower dose of radiation. And that saves cost but also gets better outcomes with the patients. But also with technology, we've been able to close the gap with the billing with the insurance companies here in Mexico. They represent a small fraction of all the population in Mexico. Only less than 9% of people in Mexico have private insurance. And with technology, what we've done is get closer to them. So when we have a patient that is being discharged in our hospitals, we preemptively send all the information back and forth. And we, we work with our counterpart in the insurance companies to review the. To review all the billing process. So when it's time to. For the discharge, almost all the Billing process is closed. Maybe the patient have to wait a couple of hours to finalize the little steps that are missing or they. Or the paperwork for the last few days or the last few hours. Sorry, but our claims are closing 35 days. So we get paid 35 days after the patient left. So that's really quick. And that helps us with capital, that helps us with interest that we would have paid to the bank. So our cost of capital is less than in other parts of the world where the claims can wait six or seven months. We deal with international insurance companies from the US From Japan, from many places. And some of those claims can take a year. So the cost of capital is really, really high. And in Mexico, with technology, we close that gap to make it quicker. So the claims process is smooth. It takes hours.

Melissa Eaton [20:55 - 22:48]: Yeah, that's very interesting. Chino and Aaron, I used to do some consulting for the COO of a health of a hospital here in Colorado. And one of the things I had to look at was billing. And at this, this is a very large hospital here. I won't name them. The billing was over 50% of the bills were wrong, right. So that meant that the bills were wrong getting sent to insurance, then insurance was denying or whatever they were doing. And then. And your model is very interesting because the patient doesn't see it, it goes through insurance and then they see it when it gets denied and the insurance company comes back and says, oh, sorry, we're not going to pay for your appendix being taken out. And it's like, what? That was an emergency procedure, right? And it's because maybe a code was wrong or something was wrong. And so I love the idea of being, trying to close that gap from a technology perspective. I know running large operations that you need to automate as much as you can because all the errors from the human touch is just huge. And I know that right now when you go in the hospital, like everything is on a barcode, right? Like they just, you know, everything, which is great. But I think that I love the idea of having the patient actually know when they're getting checked out, right. And being let go, that, hey, this is what we have so far and this is what we're going to charge your insurance. And this is what you, you may hear back from them. And so that seems to me to be a very different way of looking at things. I mean, I think that's one of the reasons why people like Kaiser. So Kaiser's model is really, you pay into it and then you can go use Kaiser. And it's very. Because it's all integrated. It's a much simpler billing system system. Right.

Eduardo Verboonen Khoury [22:48 - 22:59]: But 99.5% of our patients pay the deductible and co pay before leaving the hospital. So they, they know for sure what's going to cost them.

Melissa Eaton [23:00 - 23:01]: Wow. Wow.

Chino Nnadi [23:01 - 24:55]: It's. It's interesting for me because you know, when I've had to go to the ER for many reasons I've never had to think about, like the fact that you have to think about a barcode and that's kind of how you go into the hospital is completely bizarre to me. You know, I had a family member, as I'm sure I've shared, who was quite ill and you know, they had great care. Again, I would say in Canada, like anywhere, like yes, healthcare systems are overwhelmed right now. But you know, as a patient you're not thinking about, you know, the appendix that I need to be removed. Is it an emergency as what that's going to cost me. So it's a completely different thinking like the copay and all of that. Like yes. And you know, often people do actually have supplementary health care because you know, as much as everyone thinks it's completely free, it's not. There are things but it's at a completely different cost. Similar to, I'm sure what, you know, the cost of your company, Eduardo. But I'm curious to get your take, Eduardo, because that's not Canada's problem necessarily. It's not okay. The, the billings. Right. Like is. I do agree technology is important there for me as a patient where I don't have to worry about that. I'm worried about the care and I'm worried about kind of how soon I can get in. Right. We're overwhelmed with wait times. So I would love to understand because I think this conversation is interesting. We're talking about it from a US angle. As a Canadian, I have to kind of put my hand up too because I'm against. Our experience is completely different. And I would curious to see how your company can blend the two. Like the worst parts of both of us. How has your company been able to kind of fix or answer and solve some of those challenges?

Eduardo Verboonen Khoury [24:55 - 28:39]: I think it's a lot of about incentives and having the right incentives and good incentives, not perversive incentives. And you have to think a lot of what are you trying to achieve with those incentives before getting them to applied or getting them to work. What we did for fixing access to specialty doctors was to build a call role for the doctors and give them specific times they have 30 minutes to get to the hospital if somebody needs to see them in the error. If they are not going to be able to come in 30 minutes, they have to tell us and we have to call the next one. Because if they say we're going to be there and they are not there the next time we don't call them. That's one way that we fix the access and the timely of access to have it quick and to get the patient in front of the specialty Dr. Quick. Because when you are in the ER, what you want is, is quick and a fast resolution to whatever you are feeling because it's an emergency, you are not there saying, hey, I need to fix one of my. One of my feet. And you are like really in an emergency. So that's one approach that we took and the other approach that we've taken is to work with the providers, with the insurance providers to really transmit to the population of patients that we are high quality and they're going to be able to close their claims quickly and they don't have to have the money reserves that they should have if their claim is not closed. So they could put their capital to work faster. And with the doctors, we gave them a really good incentive of having good outcomes because we oversee the outcomes of the doctors. If they have good outcomes, then we call them for our patients and their incentive to have more patients as well. And then we build teams and we start building teams of gynecologists so they can work as a team and then they can refer to the neurosurgeon if they need. So what we build these communities of doctors that can work together for the benefit of the patient. So in our hospitals, it's not like a silo. It's not only the neurosurgeon that is going to look after you is the internal medicine, the endocrinologist. Everybody is going to be trying to work together as a team to get you fixed. And that's a problem that many places in the world have. You go to the cardiologist, they give you one thing and then it messes with your brain. And then you go to the neurologist and then it gives you another thing and then it messes with your liver. And then they are not working together as a team. And we incentivize working together as a team. And I think that's been really great. One of the things that I have to say that we're lacking is one of the things that Kaiser Permanente does very well, that is preventive care in Mexico people are fixing the issue when it happens. We are not doing enough to have preventive care there. So you go to the hospital when you really feel like you are dying or you have something really wrong going on with you. There is no model to incentivize preventive care in Mexico. And that's something that we need to learn from the US and from Canada, I'm sure.

Chino Nnadi [28:39 - 29:55]: Yeah. It's also interesting too kind of touching on this because we're talking about incentive. And I want to talk about a little bit from like a brand perspective, Aaron too, to get your perspective here, because in Canada we do have like, if you're at a hospital, again, the family member was there. It was very integrated. We had the best of the best of the best person taking care of my family member where everybody was talking again, didn't have to worry about the cost. If we did, I probably would be bankrupt. But that was there. However, again, that over. They're just over capacity at this point. And so my curiosity for you, Eduardo, and you, Erin, is like from a brand perspective to incentivize doctors because there's only so many doctors in hospitals for us. Right. How are you able to pull people over to your company to work there? Because our trouble is we don't have enough. There's a doctor shortage in Canada. A lot of people are going to the US because it's, it's more profit. Right. You can do the same thing, work half the time and make 10 times the amount of money. So how are you getting the best incentivizing to stay there? And then from a brand perspective, how are you pulling people over?

Aaron Wolpoff [29:55 - 31:18]: Yeah, and I'm curious about that too because from, you know, you talk about a brand perspective and when I think about privatized health care here, at least here in the US I think about, I had a physician, a general practitioner years ago that said, I'm introducing this new model, it's called concierge Healthcare. And I said, oh, what's that? And he said, well, it's, it's basically. And the way he explained it was it's great for everybody, but it's basically a pay, pay for access. So when you talk about doctor available at three in the morning, they're, they're available to, you know, to add up at a premium price point. And they, you can put a brand on that. You can call it, you know, doc, doctor plus or velvet rope doctor or any concierge, anything you want that's not trademarked. But, but is, is a brand enough to, you know, shift the mindset that this, this premium exclusivity kind of aspect is, is a good model to go with for privatized care. Because I don't think, at least here in the, in the US there's not, there's not a limit, a ceiling if, if, if a physician's private practice, you know, there's no one around them saying, yes, but bring your rates down. Right? They want to maximize their rates and all those things. So that's, I'm curious too. You know, they can call it anything they want from a brand perspective and put nice branding around it and making it appealing. But why does your system work when they don't want to do that? They want to go to you.

Eduardo Verboonen Khoury [31:18 - 33:43]: That's a really interesting question. And it made me think. I'm going to give you one of the examples that we've tried to achieve, or the things we tried to achieve. We realized if the doctors were able to set any price they wanted for their consultation and three in the morning, then nobody will really want to go to the ER because they wouldn't know what to expect. The billing, what would the billing be? And what we did is even though they are independent professionals and they work alone with our help in our hospitals by being credentialized and having the best record and all the competencies that they need to operate or to be doctors in their specialty, what we try to do by a marketing standpoint is getting together with them and talking to them and tell them and, and being honest, like if you're going to overcharge, nobody's going to come. So we set suggested rates, and those suggested rate ended up being the rate because everyone, every one of the doctors wanted to be in the game and they didn't want to be the one that stepped out of line. So a consultation at three in the morning from an orthopedics surgeon would be around $80 US and a consultation maybe at 2 in the afternoon would be $60. So there's a premium, but it's a very small premium that they charge when access is tougher than when it's not, when they arrive in the hospitals. Because in the model that we build, we build medical towers with medical offices adjacent to the hospital so they can just walk from their office to their, to the ER or to the operating room. And the access for the doctors is really easy. So we incentivize them being in the hospital. That's another way of getting access to the patients and having the doctors being happy with us. So as a marketing perspective is it's kind of tricky, but I think it can work with the right incentives.

Melissa Eaton [33:43 - 36:54]: I love this because actually, Eduardo, this applies to businesses in general. Right. So what Aaron was bringing up is really like, you don't want to be left out. Like how do you get that kind of viral activity going around how good you are. And I think that what's really interesting is what you shared is something that we haven't definitely in the United States and businesses done as good a job of which is holding your professional, high level professional. So we're talking about the MDs to high level expectations and KPIs. So what you said originally when you said if you're not there in 30 minutes, we're going to the next person and we're going to remember that. Right. So you didn't meet the expectation and that was. And that's okay because you, you chose to prioritize your work somewhere else. But I love that, you know, because I know that this is something that Chino, we talk about so frequently. It's about the workforce, engagement of the workforce, how to grow the workforce and build talent and how to, you know, especially in healthcare, it's around trust for the patients and good outcomes. And so this talk about incentives is just really interesting to me because I think you're using it as you incentivize them. But actually at the same time it's not just incentives. Right. It's not like a bonus. It's actually like we're going to pay you for what you actually should be doing. And we're setting an expectation of what that should look like. Right. And so this is really something that Kaiser can learn from too because their model is a little more, you know, we have everything in one place. And to your point, like maybe we only have two ER doctors and they have a very busy er. Right. But that's just the way that they've kind of scheduled around that. And so the pain gets pushed back to the patient and for them to be able to grow, I mean, you've brought up some amazing things that I think Kaiser needs to think about, like the accessibility, like how you started in one city and then realized that that model needed to be transferred elsewhere. And Kaiser, the same thing. They've been very successful in the states that they are in, but they need to think about that accessibility in other places and especially in places that don't have the choices. Right. And to your point where you said we didn't have great access to good health care and I love the idea of having, you know, the medical offices built next to the hospital so that you don't, you don't have that delay in time. So I love what you've shared, Eduardo, because I feel like it's been really helpful for us when we're thinking about those models. I mean, I don't think we can solve everything all at once, but I know that like, you know, technology integration, you know, is key. You know, scalability is going to be the challenge for both you as well as Kaiser.

Aaron Wolpoff [36:54 - 37:14]: Well, Inorda, I want to ask you, so this is, you're, you're doing this parallel to the government system and could this be done inside the system? Could these types of, this mindset, these types of changes? Or does it have to be, is it so, you know, process driven or regimented or whatever the critique is, does it have to be done in parallel?

Eduardo Verboonen Khoury [37:15 - 38:19]: I think it can be done together. I don't think that the government systems have the flexibility to implement a lot of the things that we are doing because it's a robust machine. There's a lot of things going on, but I think it can be done together by having the public sector sending patients out to the private hospitals at a better rate. We actually work with our hospitals, but it's only like 10% of our income with the government hospitals that they surrogate for us, like, hey, we are over capacity with these procedures, please do it for us. I think it can be a much broader approach and if you can give the patient the ability to choose who is going to pay for it, like where is, where's, where is his premium going to go. Like if what he already paid for the public sector is going to go to public sector, private sector, then you'll have incentives to make the government more efficient because if they don't, they will lose every one of the patients.

Melissa Eaton [38:19 - 38:19]: Right.

Eduardo Verboonen Khoury [38:20 - 38:40]: And when you give that possibility to the system, then you'll find efficiencies and then you'll find a lot of things that never that nobody thought about it so far. So if you give the control to the patients, whether he wants to get healthcare, I think that will change lives for the, for the better.

Chino Nnadi [38:41 - 40:19]: I would agree with what you're sharing, Eduardo, and I think Canada, you know, to Aaron's point, that would be truly the only way because we do have a healthcare system that is very government run. Our trouble is overcapacity, shortage of doctors. And I think your company answers a lot of that with this incentivizing, you know, getting up to speed on technology for the little errors that, you know, are human errors that we can hope helpfully mobilize the team. So there's less focused on the admin and more on kind of the, the help and the, and the, and the care. And I'm curious to see if, you know, your company is the fix kind of in two different worlds where it's like the U.S. you know, I'm terrified to break an arm there because I know that would cost me an arm and a leg. Where in Canada won't cost you, you know, anywhere near as much. You don't even think about the cost. However, the wait times are a little longer and you know, again, going back to Kaiser, the fact that they do focus on preventative care, I know you said that's something that you want to continue to focus on because I think that is also a huge thing. We're often addressing the symptoms and not the cause and with more preventative care. So can your company be the blend and the Mexican, us, North American answer to all of healthcare's problems is my question. And I do actually believe in what you're doing and I'm curious to see how that can work in a government kind of funded and focused area and also blending that in with a place like us.

Eduardo Verboonen Khoury [40:20 - 41:24]: Thank you. Thank you, Chino. I wouldn't dare say we are the fix because we have a lot to learn. We're a young company, but I think there are insights to learn from different models. So I think the US and Canada and even Mexico could learn a lot from us, but we can still learn a lot from the way the healthcare is run in Canada or queso permanente. It's not a one size fits all. There's a lot of changes. There's the staffing problem. In Mexico, we have a better rate of nurses than theirs in the U.S. we have many, many more doctors coming out every year of medicine school than in other parts of the world. So I think it's not one size fits all, but it's how we put it together to find what's better and to never stop improving and innovating and learning. Because when you think you fix it, it's probably when you are going to realize in a few years that you didn't. You have to keep on going.

Aaron Wolpoff [41:25 - 42:01]: We took on the healthcare system. That's not bad for a day's work. We looked at what's going on with privatized healthcare in Mexico and Eduardo, what you're working to accomplish with hospitalis Mac and I do have to ask the question to everyone is, did we fix it? If we took some of the ideas, we came up with the model of private healthcare that's being created in Mexico. Could we implement that, improve healthcare here in the US and also in Canada? Is there a pathway to affordable private health care here? Could that be a reality? And can the solutions that we've discussed coexist with Kaiser and the other options that exist now? So I'll ask each of you, Melissa, what do you think?

Melissa Eaton [42:01 - 42:51]: I do think that that's something that could be a really important path forward for the United States. I know that Kaiser does a great job around convenience, continuity, proactive care, telehealth, you know, all of those things that we, we talked about. But I think from an innovation standpoint and from where the patients come from, just from a cost perspective, we need to really explore all options. And I think, Eduardo, you've really shared something that's really going to be something that I think a lot of our listeners, as well as all of us as panelists, will have to think a lot about because it's been really exciting and I, I'm feeling your passion coming through and I love that that's something that you've shared with. So thank you very much. And I do think that this is something that we should consider.

Aaron Wolpoff [42:51 - 42:52]: How about you, Tina?

Chino Nnadi [42:52 - 43:33]: As the resident Canadian who is terrified of the US Healthcare system and the costs associated, I think, Edward, that is, it can be such a big solution and it would for me as a visitor, I would feel more confident knowing that I'm not stuck with $100,000 bill because I broke my arm. And I think from the Canadian perspective, if there's a way for partnerships to improve and if the goal is to make things better, to have better care for patients, I do think there's a lot of solutions that you've brought that can fix not only the US system, but also the Canadian one. So I don't think you have all the answers, but I do think you can fix a lot of the challenges both countries are facing.

Aaron Wolpoff [43:33 - 43:38]: Eduardo, last words. Could your model work in the US and also in Canada?

Eduardo Verboonen Khoury [43:39 - 44:18]: I think the Canada and the U.S. can take a lot of inspirations from our cost saving strategies. The way we do, the transparency in pricing and the patient centered approach that we have with the doctors. I think those are really actionable insights that they can do. But at the same time, I think we can learn a lot of improving our model by integrating the long term outcomes and the preventive care of the patients. So I think we didn't fix it entirely, but we really found actionable insights in both sides of the borders.

Aaron Wolpoff [44:18 - 44:29]: Well, we'll take it. Thanks again for tuning in to We Fixed it. You're welcome, Eduardo. It was a pleasure talking with you and having you on. If our listeners want to find out more about you, where can they go?

Eduardo Verboonen Khoury [44:30 - 44:37]: They can go to LinkedIn. I'm Eduardo Verbonen Curie, and it's Eduardo VK my address.

Aaron Wolpoff [44:37 - 45:00]: Very good. Thank you. Well, keep doing what you're doing and we hope to see you again. To our listeners, we want to know what you want to hear from us, so make sure to fill out our survey@wefixeditpod.com survey and there's a prize pack for one lucky winner. We've got more great stuff coming up for you. In the meantime, stay healthy and we'll see you next time.