Xavier Urtubey is the CEO of AccuHealth, a Chilean telehealth company focused on improving continuity of chronic-disease care for patients. Working with hospitals, long-term care facilities and rehabilitation centers, AccuHealth’s medical team remotely monitors vital signs of chronically ill patients 24 hours a day. AccuHealth is currently expanding to Colombia, and has plans to roll out services in Mexico. Urtubey also recently concluded a term as chairman of the Latin American & Caribbean Chapter of the American Telemedicine Association (ATALACC).
Tell us about AccuHealth.
We do mobile health, which has components of deep learning, telehealth, telemonitoring and data analytics. We are involved in the entire value chain in telehealth. At the end of the day, we are not trying to replace the medical team that treats the patient, but rather serve as an extension in areas where the team doesn’t tend to be with the patient. Our service exists as part of a continuum of care, filling what is currently a gap.
We call what we do “telehealth,” and we distinguish it from “telemedicine.” We say telemedicine is a relationship through a digital platform between two health professionals, whether it’s a doctor, a specialist, a nurse or a technician. In telehealth, on one end is a health professional and on the other end is the patient, the family of the patient, or a caregiver.
What distinguishes your approach?
We are a company that measures everything. Any change or any element that is introduced to the service, whether it is a way to approach a patient, or training a doctor in a hospital, we measure. For example, when we launched in Chile, we used a third-party technology that came with a woman’s voice. In Chile, we tried the woman’s voice and measured our results, and then after a while, we had the idea of trying a man’s voice. Interestingly, we found that patient adherence increased with the man’s voice. We believe that this is a cultural issue here in Chile, so this might not be a useful finding in another country like the U.K. But we measured it, we saw the impact it had, and since we could really correlate this impact with this specific change, we went about adapting our platform in Chile.
How far along are your services?
We began operating in Chile with pilot programs, the first of which was in January 2011. It ran for a year and half before we began to operate commercially. In June 2012, we had our first paying patients, who were within the public sector, and then just a few weeks later in July, we had our first patients from the private sector. At this time we have seven contracts in the public and private sectors. Since the first contract, including the pilots, we have monitored approximately 12,000 patients. Right now we are monitoring about 4,000 people per month.
What is your caseload like?
We work primarily with chronic-care management. The high volume of chronic illness is a big problem in the world in general, and in Chile in particular, so it’s a significant portion of our work that is growing quickly. These chronic cases also require a dual approach in our services. On the one hand, it’s high-tech, where we combine biometric sensors and intelligent questionnaires with predictive algorithms. On the other hand, it’s very high-touch, meaning there is a team that is totally dedicated to accompanying patients and better anticipating the problems that they might face. The objective there is to resolve these problems with the patient and their support network before they necessitate a visit to the emergency room.
We have a goal within our core business to try and provide greater healthcare access to people with fewer resources. In Chile, this is not really an issue with rural versus urban dwellers, because there are many people with low incomes in urban areas who have just as hard a time getting access to quality medical treatments as those in rural areas. We do have a mission to serve low-income patients, but that doesn’t mean we don’t also have high-income patients. We have a good mix of patients that ultimately works to ensure the sustainability of the company. In 2016, between 35 and 40 percent of the population we monitored each month were people from the bottom of the socioeconomic pyramid. But the majority of the people with low income were not from rural areas.
How has your business model developed over time?
By the end of 2012, the Superintendence of Health, a regulatory agency in Chile, took an interest in our work. They proposed an agreement for a year-long study, during which we had access to an anonymous database of 2.4 million people’s health records. Those records enabled us to better understand our biggest group of patients, patients with chronic diseases like diabetes, hypertension, cardiac insufficiency and respiratory insufficiency. We had no access to any confidential information, but thanks to this work with the regulator, we could work with anonymous data to strengthen our data mining models.
The study findings enabled AccuHealth to make various correlations that strengthened our data mining platform, which we have been developing for the past eight years. We could understand and correlate our actions from a clinical and metabolic standpoint, and then determine that they would have consequences in this or that category of health. In turn, we could predict that these categories may or may not have financial implications for 1) the principal payer or the insurer; 2) the patient; or 3) the patient’s employer, or the patients themselves if they are self-employed.
This is what allowed us to have a very clear idea as to what could be the implications in direct and indirect financial terms of the different healthcare services. Instead of charging an upfront fee for our service, we could charge afterwards with a clear idea of what it would cost. I could go to the insurer and say, “I won’t charge you anything without demonstrating performance.” Because I had this kind of information, not just from the data from the superintendence, but because of how we worked the correlations with the data of AccuHealth patients.
With that, we were able to convince our board and our investors that we should make significant changes to our pricing model and go to a system where we charge based on how much we save the insurer after care is delivered. This was an important change because generally in Chile, healthcare is paid for by private insurers, called ISAPRES, and these payers are often hesitant to forgo payment in advance based on a promise that they will end up saving money. The study gave us the information we needed to establish a significant bond of trust between us and the payer and set up this new payment system. This enabled us to bill in a way that is called a “saving-share.” I don’t know any other company in telehealth that has done it this way. Most use a straightforward fee-for-service model.
Who are your clients, and how do you deliver savings?
We aim to mirror how the payment system customarily works in the regions we do business. In general, this is a combination of the insurer and the patient. Often the cost is solely covered by the insurance, and the patient doesn’t pay anything. We also contract directly with hospitals, where they pay according to the services we provide.
For the payer, our service depends on the quality of the database. That can mean savings between 35 and 55 percent. But the real savings come from having fewer unplanned medical visits. Patients have more planned visits but fewer unplanned visits, which are much more expensive. And that is true everywhere in the world, including Chile.
What makes Latin America a good market for this approach?
Latin America has focused more on traditional solutions and not innovative ones, and this is a problem. Governments and organizations are more worried about building high-complexity hospitals and not as interested in creating access to health services wherever the patient may be. What’s happening now is that the number of chronic illnesses is so great, and the weight of these chronic diseases on hospital resources is growing so quickly, that there aren’t enough hospital beds.
This is what is happening in Chile, and in many other countries in the region. We just opened a branch in Colombia. We think we’ll have Colombian patients by the end of the third quarter in one or two cities- we're looking at Bogotá, Medellin and Cali. We’re forming our team in Bogotá, recruiting nurses, and already working with three potential clients. The principal objective is to quickly see if what happened in Chile can be reproduced in Colombia and, if so, what are the adaptations we must make. We don’t think we need to do unpaid pilots in Colombia. Instead we will work directly with partners to get the programs started, and then work to customize the service, both in the high-tech and in high-touch aspects I mentioned before. And we are planning on entering Mexico shortly. There’s a very significant population with chronic illnesses in Mexico as well.
Do regulatory or other challenges impact your choice of markets?
The regulatory environments are different in Chile, Colombia and Mexico, but we didn’t choose Chile because it would be easier from a regulatory perspective. Today, the barriers are elsewhere. It could be hard to enter a market because of a certain level of corruption, for instance. We are not interested in countries where corruption is too prevalent.
— Catherine Elton
Catherine Elton is a freelance journalist and business writer based in Lima, Peru.