We Fixed It, You're Welcome - Cost-Effective Medicine: International Insights

Episode Date: March 4, 2025

In this episode of "We Fixed It, You're Welcome" the hosts tackle the complex issue of healthcare reform, comparing the integrated model of Kaiser Permanente with Mexico's private healthcare system. Guest Eduardo Verboonen Khoury, co-president of Hospitales Mac, shares insights on delivering high-quality care at lower costs through innovative practices and incentives. The discussion explores topics such as technology integration, billing efficiency, doctor accessibility, and preventive care. The panel debates whether elements of Mexico's private healthcare model could be applied to improve systems in the US and Canada, addressing challenges like wait times, cost transparency, and doctor shortages. While not claiming to have all the answers, the conversation highlights actionable insights for healthcare improvement across borders.Challenges in US Healthcare Discussion of soaring costs, uneven access, and bureaucracy in the US healthcare system. Comparison with Mexico's private systems like Hospitales Mac, offering quality care at lower costs. Hospitales Mac's Approach Eduardo explains the company's mission to provide high-quality, affordable healthcare. Focus on efficiency, flexibility, and maintaining high-quality standards. Innovative Cost-Saving Strategies Direct negotiations with suppliers and providers to reduce costs. In-house construction and real estate management for hospitals. Emphasis on repairing and refurbishing equipment instead of replacing. Technology Integration in Healthcare Use of AI in CAD labs to optimize procedures and reduce costs. Streamlined billing processes with insurance companies, reducing claim closure time. Doctor Incentives and Accessibility Implementation of a call role system for doctors to ensure quick access for patients. Building medical towers adjacent to hospitals for improved doctor accessibility. Preventive Care and Future Challenges Acknowledgment of the need to improve preventive care in Mexico. Discussion on scalability challenges for both Hospitales Mac and Kaiser Permanente. Comparison with US and Canadian Healthcare Systems Exploration of how Hospitales Mac's model could potentially address issues in US and Canadian healthcare. Discussion on the possibility of integrating private healthcare models with public systems. Key Takeaways and Future Outlook Emphasis on continuous improvement and innovation in healthcare delivery. Potential for cross-border learning and adaptation of successful healthcare strategies. __________________ Disclaimer: 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. Music by Milo W.Produced by Straight Forward Media Group See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info. Learn more about your ad choices. Visit megaphone.fm/adchoices

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 and Operations, Chino on people in 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 Fix 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? So, like every week, we're not going to shy away from some tough topics, and we're really excited to talk about health care in the U.S. 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 health care 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, Aaron, take it away. Please introduce our special guest. Thank you, Melissa.

I will. If we're going to take on the health care system in the U.S. and maybe Canada too, we're going to need some help on this one. And I'm thrilled to introduce our special guest, Eduardo Verbunen-Courri. Eduardo is the esteemed co-president of Hospitalist 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. 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 U.S., but for everywhere in 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. And here at Hospitalis Mac, we've spent years trying to refine a model that delivers high quality healthcare at a fraction of the cost. And I'm really excited to this. discuss how our approach defers from that from Casso Permanente and other institutions in the U.S. And the lessons that can be applied across borders, because we have a lot to learn too. Awesome. 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. So a lot of you know who Kaiser is, and I wanted to share, they were founded in 1945, they pioneered integrated health care, 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 costs, 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 health care costs and efficiencies in the U.S. system 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 Hospitalis Mock. They are Mexico's private health care system, one of them, and have gone 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 costs than the U.S. 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 health care 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 seamless experience. And 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 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 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 health care, we really need to start thinking about whether that model is really going to take us to the place it needs. debate. 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 I know you're passionate about this, so I would love to hear why you chose to start Hospitalis Mac and how it's going. Thank you, Melissa. I 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 Hospitalis Mac, he realized, and we realized that

there was a need of good health care, high-quality health care 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. And it's been a ride. We are about to become in a few months the largest hospital provided 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 like around the world. 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? 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 the hospital, with another company that is going to have to have some revenue and some margin,

we do it ourselves. And we take care of everything. If we see that the electrical system cables are going around a wall and they can go in another trajectory, 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 our approach to most of the things that we do. And one other thing 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 will. 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 city scanner breaks, instead of replacing it, we fix it. And 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 world because instead of giving all this trash away, and filling a space with trash, we fix it and then we make most of it.

Yep. It's like you're taking responsibility, like, as if it's your own house, right? Exactly. Exactly. 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 health care 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 U.S.

And so what I'm wondering from you is how did you get that initial buy-in? Because people need to trust you. Health care is not something that it's a product. It's our health. It's 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? It's a very interesting question, Chino.

And I think 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 your 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 Hospitalis Mac, the probability of having good healthcare and a good outcome is better than if they go to 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 health care, but complementing it. We have shorter wait times. I'm going to tell you story. I was a client in a hospital in the U.S. 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 fit until he gets his appointment. And he was two years old.

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 3 a.m. 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, don't have that need. And that needs translate to accessibility and the timing of care. So it's really interesting how the model differs and how could it be different if you have the right incentives in place? 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't have your own doctor from Kaiser, but, like, 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, right? 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 understand that there's, there's just a, there's, there's just a, There's just a sense that we need to figure out how to do this better 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 way. 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 has that helped you? Technology integration is really important for us.

We use it for many things. We streamline employee onboarding with technology. So we are faster and better transmitting the culture to our employees when they arrived for their first day out of the job. But we also use it for diagnostic, billing, and technology helps us reduce inefficiencies that often inflate costs. One way that we are using technology to reduce costs is with AI. We have it in our catlapse.

So the catlapse machine, when they're doing a procedure with a patient, will recommend the doctor a lower dose of the, the pharmaceutical or a lower dose of aviation. 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 work with our counterpart in the insurance companies to review all the billing process. So when it's time for the discharge, almost all the billing process is closed. Maybe the patient have to wait a couple of hours to finalize the the little steps that are missing 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 U.S., 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 process of the claims process is smooth. It takes hours. 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 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 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, right? 99.5% of our patients pay the deductible and co-pay before leaving the hospital. So they know for sure what's going to cost them. Wow. Wow.

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, so I'm sure I've shared who's 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 as an emergency is what that's going to cost me. So it's a completely different thinking, like the co-pay 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 billings, right? Like, 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 U.S. angle as a Canadian. I have to kind of put my hand up too because I'm like 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 being able to kind of fix or answer and solve some of those challenges? I think it's a lot 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 ER. 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 good there, the next time we don't call them. So 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 doctor quick. Because when you are in the ER, what you want 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 teeth. And you are, like, really 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 are, they don't have to have the money resets. 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 when 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. It's the internal medicine, the endocrinologist, everybody is going to be trying to work together as a team to get you text. And that's a problem that many places in the world have. You go to the cardiologists, 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're dying or you have something really wrong going on with you, there's no model to incentivize preventive care in Mexico. And that's something that we need to

learned from from the U.S. and from Canada, I'm sure. Yeah, it's also interesting to kind of touching on this because we're talking about incentive. And I want to talk about it 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 I was there, it was very integrated. We have 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 big. 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, Aaron, 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 U.S. because 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? 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 U.S., I think about, I had a physician, a general practitioner years ago that said, I'm introducing this new model. It's called concierge health care. And I said, oh, what's that? And he said, well, it's basically, and the way he explained it was, it's great for everybody, but it's basically a pay for access. So when you talk about doctor available at three in the morning, they're available to, you

know, to add a, at a premium price point. And they, you can put a brand on that. You can call it, you know, Dr. Plus or velvet rope doctor. any concierge, anything you want that's not trademarked. But is a brand enough to, you know, shift the mindset that this premium exclusivity kind of aspect is a good model to go with for privatized care? Because I don't think, at least here in the U.S., there's not a limit, a ceiling, 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 I'm curious too, 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 where they don't want to do that? They want to go to you. 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, they work alone with our help in our hospitals by being credentialized and having the best record, and all the competences 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 being honest. If you're going to overcharge, nobody's going to come. So we said suggested rights, and those suggested rights ended up being the rate. Because 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 3 in the morning from an orthopedics surgeon would be around $80. US. And a consultation maybe during 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 when it's not, when they are 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 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 that's another way of of getting access to the patients and and having the doctors being happy with us so as a marketing perspective is it's kind of tricky but I think it can it can work with the right incentives 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, you know, how do you get that, you know, 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 KPI. 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 is 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 for 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 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. Well, in order, I want to ask you, so this is, 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?

it's so process driven or regimented or whatever the critique is, does it have to be done in parallel? 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're 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 the hospitals, but it's only like 10% of our income with the government hospitals that they surrogate for us. Like, hey, we are overcapacity. 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 is his premium going to go? Like, if what he already paid to, for the public sector is going to go to the public sector or 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. Right. And when you give that possibility to the system, then you'll find efficiencies and then you'll find a lot of things that nobody thought about it so far. So if you give the control to the patients, whether he wants to get health care, I think that

will change lives for the better. I would agree with what you're sharing, Edwater, 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, or human errors that we can help hopefully mobilize. a team so there's less focused on the admin and more on kind of the help and the 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 US 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 that you know anywhere near as much you don't even think about the cost. However, the weight times are a little longer. And, you know, again, going back to Pfizer, the fact that they do focus on preventative care. And 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, you know, addressing the symptoms and not the cause and with more preventative care. So can your company be the blend and the Mexican, U.S., North American answer to all of health care's problems is my

is my question. And I do actually believe in what you're doing. And I'm curious to see how that can work in, you know, a government kind of funded and focused area and also blending that in with a place like U.S. Thank you. Thank you, Chino. I wouldn't dare say we're 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 U.S. and Canada, and even Mexico, could learn a lot from us, but we can still learn a lot from the way the healthcare is running Canada or Caser 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 or 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. We took on the health care system that's not bad for a day's work.

We looked at what's going on with privatized health care in Mexico. and Eduardo, what you're working to accomplish with Hospitalis Mac. And I do have to ask the question that everyone is, did we fix it? If we took some of the ideas we came up with, the model of private health care that's being created in Mexico, could we implement that improve health care here in the U.S. 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? 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 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'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. How about you, Chia? As the resident Canadian who is terrified of the U.S. healthcare system and the costs associated, I think, Eduardo, that is, it can be such a big solution. It would, for me as a visitor, I would feel more confident knowing that I'm not stuck with a $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 U.S. system, but also the Canadian ones. 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. And what are last words? Could your model work in the U.S. and also in Canada? 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-center 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. We'll take it. Thanks again for tuning in to We Fix 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? They can go to LinkedIn. I'm Eduardo Verboni and Kuri and it's Eduardo VK in my address. 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 at we fixeditpod.com forward slash 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. This podcast is produced by Straightforward Media Group, all rights reserved. If you'd like to learn more about how a podcast can help your company establish authority and generate leads,

please email us at Eric at straightforwardmg.com or go to straightforwardmg.com for more information.