The coronavirus pandemic drove the emergence and growth of Brazilian health techs: there are already 542 this year, an increase of 118% compared to 2018, according to data from the latest Distrito Healthtech Report. The authorization of telemedicine in Brazil, made by law due to the pandemic and still lacking specific regulation by the Federal Council of Medicine, collaborated and greatly for the segment. “COVID-19 accelerated the digital service process irreversibly”, as the Brazilian health tech Alice’s doctor, Cesar Ferreira, told LABS.
The startup was launched in June this year, in the middle of the pandemic, with an infusion of $ 16 million from the founders André Florence and Matheus Moraes (former financial director and president of the ride-sharing app 99), and Guilherme Azevedo (co-founder of another health-tech startup Dr. Consulta), in addition to the Latin American funds Kaszek, Canary and Maya Capital, after 15 months incubated.
Alice, which has 80 people on the team and plans to hire 20 more by the end of the year, offers the first health plan of a health tech registered with the National Supplementary Health Agency (ANS, in the acronym in Portuguese) in Brazil and has the mission of making people healthier through technology.
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The idea is to use technology to do “coordinated care”, that is, the patient’s health data is concentrated in Alice’s app, integrated with an individual health plan. In this way, the operations of hospitals, doctors, and the health team are integrated within the app. When entering the plan, the user goes through an “immersion” with one of Alice’s doctors.
“In immersion, we understand who the person is and what his or her health goals are. We start to build the person’s health history and when the user has a cold, for example, he or she get in touch again and we already have this prior information “, explains Ferreira, who has been Alice’s doctor for nine months now.
“If I were to ask myself where are my exams. Where are the referrals that I have already done? When was the last surgery that I did? Who are the doctors who saw me and know me, well, we usually don’t know how to answer these questions”, adds Ricardo Lázaro (Jack), Alice’s CTO. This is because, according to him, in Brazil, the world of medicine does not have interoperability as a goal.
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What the startup proposes is a tech solution with this consolidated medical information, in addition to the accredited private health care network, which health plans traditionally offer. Alice has partnerships with laboratories and hospitals, such as Fleury and Oswaldo Cruz, in the city of São Paulo.
Lazáro stresses that Alice’s goal is not to reduce costs, but that the reduction in costs is a natural consequence of the patient becoming less ill.
How does Alice’s app work?
Ferreira explains how Alice’s application works based on a recent use case. A user came into contact with him because of abdominal pain. “As it was a different pain, we transformed the contact into a videoconference between the user, a doctor, and a nurse. As I have the user’s history, I saw that she had had this pain before, about three times. I requested some exams and scheduled a face-to-face consultation,” he explains.
The results of the exams, when ready, will be available in the application. “Suppose that the ultrasound we requested had shown some change (in the patient’s abdomen). In this case, I would get in touch with our network of specialists, because she would probably have to undergo surgery, and would already be admitted to our accredited Oswaldo Cruz network. The continuity (of care) would also be through the application, to observe the postoperative period,” he says.
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Alice does not disclose its current number of members. The company adopts a remuneration based on the number of services delivered to users. “At Oswaldo Cruz, for example, we have a remuneration model that is closed by packages. Under the contract with the hospital, we pay for the surgery with a closed logic that is not the fee-for-service logic. People will monitor the evolution of our users to see the evolution of their quality of life or health outcome, to evolve towards a remuneration proportional to the health outcome delivered to the person”, explains Ferreira.
A new model centered on primary care, on a family doctor, and also a new model of remuneration, which leaves behind the logic of the volume of procedures – the so-called fee-for-service mentioned by Ferreira, or open account, prevalent today in Brazil – it is an old discussion among health care specialists in the country. The general idea, as already explained by Alice’s team, is to value the final result of the service.
Inspired by health systems such as the United Kingdom, for example, the adoption of a model based on the concept of primary care would imply the monitoring of beneficiaries of health plans by a specialist in the area, that is, by a family doctor. The user would not pass for a specialist without the indication of that professional for that.
At the same time, that same family doctor would no longer be paid for the volume of consultations, tests and procedures he requests, but according to the health behavior of the patients treated by him. If Alice’s experience, together with its partner health institutions and services, works, it can not only make the startup grow, but also make it an example to be followed by the sector in the country.