Mexico Health Review 2022 by Mexico Business Publishing

2022

Introduction Digitalization was a futuristic promise for the health sector. Despite the highly complex and innovative nature of the industry, integrating digital solutions for everyday practices seemed like a decades-long promise. However, the past two years have successfully shortened this process thanks to the development of novel, responsible solutions. Nonetheless, the country still has historic burdens to address, such as the high incidence of chronic diseases and the lack of quality service coverage. Adopting a prevention-based system also remains one of the sector’s main objectives, actively pursued by all providers of the health chain. Trends for 2022 are clear and industry leaders need to set their strategies and goals accordingly. Focused on promoting well-being, companies in this sector are expected to become completely patient-centric. At the same time, meeting sustainability requirements, opening quality health access, moving toward a value-based model, strengthening publicprivate partnerships and empowering patients on their health journey with scientific data remain pillars for a successful sectoral transformation. For health delivery models to be patient-centric, providers need to take into account the spiritual, emotional, financial, social, mental and physical conditions of patients when discussing wellness or illness. For this integral approach, patients will need education, counseling, monitoring, diagnostics, insights, behavioral nudges, intervention and treatment management. Because of this, patient empowerment is fundamental and only a provider with the right tools can achieve that. Players in the Mexican health ecosystem are already making interesting proposals regarding these trends. Mexico Health Review shines a light on the industry’s efforts to achieve a universal, patient-oriented and digitalized health system. In its 2021/2022 edition, leaders highlight their journey in digitalization, growth and research, coupled with their efforts to promote solutions that ensure market success through accessibility.

Table of Contents

Introduction

State of the Industry

Research & Innovation

Medtech

Healthcare Environment

State of the Industry The state of the health industry for 2021/2022 remained stable, yet ambitious, filled with plans and opportunities to build a system able to respond to the current and emerging needs of the Mexican population. The sector faces numerous challenges in the form of budget restrictions, limited primary care and diagnostics, a pension deficit and the migration of medical professionals to the private sector. Despite these barriers, the industry needs to move toward new health delivery models, built around the patient rather than the provider. The federal budget for 2022 prioritizes health much more than in past years with an approved increase of MX$1.58 billion (US$77.5 million). Still, the country is yet to reach an ideal expenditure as budget increases remain lower than inflation, representing a challenge to achieving national health goals. Industry actors continue to pursue public-private collaboration to take health provision to another level.

State of the Industry

Analysis Strengthening Primary Healthcare in Mexico

Conference Highlights The Challenging Path Toward Integrated Healthcare

View From the Top Raúl Anaya | Director General of Certification | General Health Council

View From the Top Alec Lee | Director, Healthcare Research | FrontierView

View From the Top Marcos Pascual | Commercial Director | ANAFARMEX

View From the Top Gabriela Allard | President | AMD

View From the Top Jon Benjamin | Ambassador | British Embassy in Mexico

Analysis Environmental Risks and Their Impact on Health

Conference Highlights Public-Private Dialogue is Crucial to Guarantee Medical Supplies

View From the Top Luis Gutiérrez | Director General | INGER

View From the Top Misael Uribe | President | Médica Sur

Expert Contributor Alejandro Rossano | Director General | Grupo Médico Rossano

Expert Contributor Jorge Valdéz García | Dean | TecSalud

Expert Contributor Christian López Silva | Partner-Healthcare and Life Sciences | Baker McKenzie

Expert Contributor Sandra Sánchez Oldenhage | President | PharmaAdvice

Content Links

State of the Industry | 7

Strengthening Primary Healthcare in Mexico Primary healthcare (PHC) comprises most of the healthcare services people might receive in their lifetime. It is also the most inclusive, equitable, cost-effective and efficient approach to enhancing people’s physical and mental health, as well as their social well-being. As a result, PHC is being highly encouraged and strengthened in health systems globally. OECD shares that investing in primary care represents good value for money as it can help avoid costly admissions to hospitals, improving care coordination and health outcomes, particularly for the growing number of people with chronic diseases. Alongside prevention, PHC has been a highly touted approach to healthcare throughout the COVID-19 pandemic to create stronger health systems and move closer to universal health coverage. Spending on primary care services accounted for an average of 14 percent of all healthcare spending across OECD countries in 2016. This is equivalent to around US$500 per capita, when adjusted for differences in price levels across countries. General outpatient care for a range of acute or chronic conditions account for the largest share of spending. In Mexico and Australia alone, general outpatient care reached over 12 percent of total health spending. Mexico’s PHC Urgency Indicators Mexico reports an overweight and obesity incidence rate of over 70 percent, 32.5 percent for hypertension and 9.2 percent for diabetes. There is a low detection rate and inequality in access to health services due to a model that has proven to be inefficient and of poor quality. In terms of cancer, Mexico

MONTHLY PRIMARY HEALTHCARE VISITS IN MEXICO (million) 9 8 7 6 5 4 3 2 1

Source: FrontierView

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State of the Industry | 8

registers an ascending prevalence plus a lack of registration and information. Inequality in access and financial protection is also prevalent, as well as limited supply of services and personnel, coupled with a low detection rate. Unhealthy old age is common in the country. There is also inequality in healthcare access and financial protection, economic dependence and lack of primary care services for older adults. The country also sees a high prevalence of communicable infectious diseases, which are the leading cause of outpatient consultations. There is a high risk of complications and weak epidemiological surveillance, as well as poor control of antimicrobial resistance, insufficient control of main disease vectors, incomplete coverage of key biologics in the expanded scheme and infections associated with poorly managed treatments. Other urgent problems to address through PHC include sexual and reproductive health, due to poor sex education for teens and the high prevalence of sexually transmitted diseases; mental health, due to the high frequency of mental disorders, the increase in the main determinants of mental health problems (violence and addictions) and an increase in the frequency of suicide, and disabilities, due to the wide gaps in social and human rights. PHC Efforts in Mexico According to the National Public Health Institute (INSP), PHC services aimed at users in the public sector focus on community actions and on prevention, promotion and care services provided at health centers of the state’s health services, IMSS’ family medicine units, IMSS-Bienestar’s rural and urban medical units and the latter’s itinerant services provided by mobile medical units in collaboration with the Ministry of Health. The integration between primary care and public health is key to promoting greater efficiency and effectiveness for the benefit of the population. In the private sector, this integration is achieved through different initiatives and platforms. Health entrepreneur Jacobo Luchtan, CEO of Hello Doctor, a digital platform that links doctors and patients to widen healthcare availability, says that immediate access to an online doctor means fewer health insurance claims from routine primary care check-ups or visits to emergency rooms. The Mexican Hospital Consortium (CMH) is strengthening primary care by “making it more accessible to the general population,” says Javier Potes, Director General of CMH. “While many hospitals are not designed to provide primary care, we can initiate alliances to strengthen the facilities that already offer this service, such as pharmacies that have a pharmacy-adjacent medical office (PAMO).” Regarding mental health, technology has been a watershed in terms of PHC. Edilberto Peña de León, Director of the Nervous System Research Center (CISNE), says the pandemic has enabled technological changes necessary to provide care at earlier stages. “Teleconsultations were already used in psychiatry but they became more relevant as a result of the pandemic,” he says. While the private sector continues to innovate and strengthen PHC, the Ministry of Health has also defined a model of “Comprehensive Primary Healthcare” in its Sectoral Health Program 2019 – 2024. The program targets the incorporation of a new care model that Read the complete article More about this topic

might transform health centers and units, “particularly the first level of care: mobile units and small health centers with a varied number of offices and expanded health service centers (CSSA).”

Conference

Highlights State of the Industry | 9

he industry is moving toward new health delivery models, which are oriented around the patient rather than the provider. The transition toward integral, integrated healthcare in Mexico will be filled with challenges, which are outweighed by the benefits

to the economy and personal well-being, says Alexandro Arias, Partner - Life Sciences and Heathcare Leader for South Latin America, Deloitte. The current state of health delivery focuses primarily on physical health, with models oriented around the provider offering fragmented and analog experiences that have negative consequences for the patient and for the country’s economy, says Arias. “There are cost overruns when information is lost between doctors, in time between appointments and non-adherence to treatments, causing patients to decline, which will translate to a greater cost for the health system and the economy in general.” The future of health delivery models is patient-centric, taking into account the spiritual, emotional, financial, social, mental and physical conditions when discussing wellness or illness, says Arias. For this integral approach, “we must create a layer

The Challenging Path Toward Integrated Healthcare Alexandro Arias Partner - Life Sciences & Heath Care Leader S-Latam | Deloitte

around” patients that includes education, counseling, monitoring, diagnostics, insights, behavioral nudges, intervention and treatment. This layer can be built around workplaces, schools, hospitals, clinics, retail stores and community facilities, taking advantage of digital tools. “Monitoring and diagnostics are crucial for silent diseases. An early diagnosed disease is better treated and reduces system costs. As (Mexico’s) system is fractured, there is not enough information to treat patients. This is one of the greatest opportunities in the sector. With enough data, patients will be treated more efficiently, both in-person or virtually,” says Arias. Among the aspects taken into account to determine a patient’s well-being are mental and financial health, both of which were impacted by the pandemic. Lockdowns and grief impacted mental health, which has not been addressed with the importance it deserves, says Arias. In Mexico, over 50 percent of health expenditure comes from the public sector, 40.7 percent is paid out of pocket and 7.3 percent is paid by private insurers, reported MBN. Out-of-pocket expenditure increased during the pandemic due to people’s unwillingness to visit hospitals. “This situation impacts directly on the general economy. The money used for health expenses is replacing other spending,” says Arias. Integrated care is whole-person, team-based care that provides access to affordable, evidence-based care at a population level and across the care continuum, says Arias. With the patient at the center, there are four key areas where actors across diverse sectors converge. One of these key areas is the primary care team, which includes health generalists, social workers, nursing staff, pharmacists, nutritionists and health coaches. Then, the specialist care team includes all nonprimary care members involved in the patient’s healthcare, such as surgeons, endocrinologists or cardiologists. The other two key areas, says

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Arias, are social-community support and digital care tools, such as telehealth, remote patient monitoring or digital therapeutics and self-management tools.

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from the

Q: Mexico’s health expenditure is below the average of OECD countries. Considering the current situation, what are the country’s priorities according to this assigned budget? A: According to Health at a Glance, health spending represents 5.5 percent of GDP, which is among the lowest of the OECD countries. Health insurance coverage for vulnerable populations has improved but gaps persist. The coverage of a basic set of health services in Mexico is the lowest in the OECD at 89.3 percent. Outof-pocket expenses remain high, representing 41 percent of total health spending. Mexico’s health expenditure per capita is US$1,134, whereas the average of the OECD is US$3,806. Mexico’s health expenditure as a percentage of GDP is 5.5 percent, which is below the OECD average of 8.8 percent. The number of practicing physicians per 1,000 people is 2.4; the OECD average is 3.5. The number of practicing nurses per 1,000 people is 2.9; the OECD average is 8.8. The priorities in each administration are established in the Sectoral Health Program, which is derived from the National Development Plan. Among the priorities of the current program are to make health effective, universal and free to access; to continuously work to improve technical competence, medical quality, cultural relevance and non-discriminatory, dignified and humane

Raúl Anaya

treatment; to care for the capacity and quality of health personnel and infrastructure, especially in regions with high and very high marginalization; to carry out epidemiological surveillance; and to promote health and well-being.

Director General of Certification | General Health Council

Q: Is healthcare a national priority for Mexico? A: Mexico’s public health challenges are related to its demographic and epidemiological transition, which makes them a national

Health Is a National Priority: General Health Council

priority to improve the health and well-being of Mexicans. The country suffers from several chronic non-communicable diseases, such as cardiovascular, oncological and degenerative diseases. The country also faces diseases linked to poverty and misinformation, such as infectious diseases, although at a smaller rate. Other diseases are linked to unhealthy lifestyles and reproductive health, with teenage pregnancy being one of the most common problems. The priorities are to influence the social determinants of health and fight against the negative effects of the pandemic, with a human rights approach to ensure the well-being of the population and a preventive nature. This approach also addresses the needs of specific groups, such as migrants, Indigenous people and Afrodescendants, and supports sexual and cultural diversity. Health is and should always be a national priority since it is a Constitutional right. The state of health reflects the level of prevention, control or abatement of the risks that affect it. To make health an effective right, Mexico requires that all services and medicines are granted to the non-eligible population without

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detriment to quality. For that, a patient-centric model is required. It is also necessary to strengthen the quality-of-service provision in social security institutions, have competent human resources for the provision of services at all levels of care and a permanent and mandatory verification of quality levels.

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from the

Q: What does Mexico’s 2022 healthcare budget proposal say about the government’s priorities regarding healthcare? A: It is very clear that the government is attempting to prioritize the part of the population that historically has not been covered by social security, through INSABI and additional funds for IMSS Bienestar. It has also significantly increased the budget for the vaccination program. However, it is unclear to what end that budget will be directed, whether it is rolling out vaccinations, buying more vaccines or to fund the rest of the program. This is really important because the vaccination program in general has suffered during the pandemic and does require significant reinforcement to avoid population health consequences over the next couple of years. Q: How will the allocation of FONSABI funds impact patients in the public health sector? A: The first challenge is that it is unclear what will happen to these funds. From the information available, they were transferred to the general fund within the SSA. That does not necessarily mean they will not go to the same places they went before but it is uncertain. Over the last couple of years, we have seen a significant drop in the diagnosis and treatment of some patients who are covered by this fund, including the most famous case of adolescent cancer patients. There are other

Alec Lee

patients who suffer from rare diseases and who have high-cost treatments. They have also struggled to access treatment during the last couple of years, likely because of the disruption of this budget and unknowns regarding budget execution. If these

Director, Healthcare Research | FrontierView

trends continue, these patients are probably still going to face uncertainty and even miss out on receiving treatment. Q: What opportunities have telemedicine advances brought to the Mexican healthcare sector?

FrontierView Shares Healthcare Overview

A: What has probably been most impactful during the pandemic has been allowing people to have certain symptoms triaged by medical professionals through telemedicine. Many patients were easily treated with a simple prescription that could be picked up at a pharmacy, meaning they did not have to come into a hospital, which generated savings for the entire healthcare system. I think coming out of the pandemic, the question is whether or not Mexico can capitalize on the investment in infrastructure. This means access to the correct platforms to facilitate the various applications of telemedicine, creating a holistic patient pathway across therapy areas to really maximize the lessons from the pandemic and improve outcomes while decreasing cost in a post-pandemic era. This basically means maintaining telehealth access and doubling down on other applications of telehealth, such as patient monitoring, patient follow-up, physician-to-physician consultations and various other sub-applications that have been developed. Between the public and private sectors, the public sector has done a good job given the challenges it has faced. Obviously, there is a difference from institution to institution and since the private sector is more dynamic, it has more space to innovate. We’ve seen telehealth being applied to facilitate the creation of lower-cost

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private insurance plans to increase private hospital capacity. The dynamism of the private sector is not going to go anywhere. What this group needs to think about is how policy will limit or accelerate that continued innovation because telehealth has the opportunity to expand health access for the greater part of the population.

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from the

Q: Why did opening 3,000 pharmacies make sense when e-pharmacies are also experiencing exponential growth? A: In 2022, we expect a mass opening of traditional, independent pharmacies, which have been dominating the market since the start of the COVID-19 outbreak. Retail pharmacies have grown exponentially because they are considered an essential industry. As a result, large investors and investment funds are looking at this segment. Investors already present in the health industry are also betting on the pharmacy segment. Most of the new pharmacies, about 45 percent, will open in Mexico City and the surrounding metropolitan area. The remainder will open in Monterrey and Jalisco. There are also good opportunities in the southeast. The massive growth of the e-pharmacy segment is mostly a factor in the US, where major chain CVS Pharmacy will close about 10 percent of its retail stores in 2022. This is in response to its market structure and the needs of the US health system and delivery mechanisms, which are very different from those in Mexico. Mexico is not ready to move toward a complete e-pharmacy framework. Traditional pharmacies are well received by the Mexican market. Independent, small pharmacies build a relationship of trust with their clients. Most people in Mexico also prefer in-person contact when purchasing their medicines because it makes them

Marcos Pascual

feel safer. This does not mean we are not entering the digital market. ANAFARMEX’s affiliates are aware of the importance of e-prescriptions, which continue to grow alongside telemedicine. One of our objectives for 2022 is to begin using e-prescriptions

Commercial Director | ANAFARMEX

and to validate them across the network’s pharmacies. Q: How are pharmacy-adjacent medical offices disrupting demand as they bring more solutions to the table?

Pharmacies Offer Responsive Solutions: ANAFARMEX

A: ANAFARMEX has intensively worked on the formalization of pharmacy-adjacent medical offices (PAMO) and will continue to do so. Our network includes about 18,000 PAMOs with an average of two doctors per office, for a total of 36,000 doctors. Through these offices, we offer almost 400,000 appointments per day. Doctors at PAMOs are treating mild COVID-19 cases and directing complex cases to specialists. ANAFARMEX is working with Patrick Devlyn, President of the CCE Health Commission, to further train doctors working at PAMOs. Q: How have pharmacies continued to empower patients by providing them affordable products? A: Medicine prices are dependent on the country’s economy and local regulations. In terms of the economy, Mexico is facing 7.3 percent inflation, which will undoubtedly impact medicine prices. On the regulatory front, prices on medications are regulated by the authorities so it is unlikely that the private sector will increase them. However, there are still shortages of seasonal antibiotics, such

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as ceftriaxone, and OTCs like aderogyl. The reasons for the shortages are seasonal demand, which rises in the winter, and the ongoing supply chain disruptions caused by the pandemic. These shortages will affect the country as the number of omicron cases increases and the winter season continues.

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from the

Q: How does AMD support the fight against diabetes in Mexico? A: AMD continually generates content, courses and workshops to create health awareness. We also offer training and diploma courses on diabetes to primary doctors, who can then take what they learn to their communities to generate a positive impact. AMD’s goal is also to train patients and their families in the development of prevention skills. AMD recently developed a YouTube library anyone can consult to obtain reliable information regarding diabetes. We also conduct small, field inquiries and provide renography and teeth cleaning. While offering these services, we analyze the prevalence of people unknowingly living with diabetes and identify symptoms, if any. Q: What are the main difficulties to prevent diabetes within Mexico’s healthcare system? A: The main issue with the system is that coverage is not the same for everyone. The basic schedule of essential drugs you receive depends on what health system you are affiliated to. This is a fragmented system that does not provide the patient with a broad coverage of drugs to choose from when looking for the best treatment. Innovation and technology will provide better information and education to chronic patients, helping them avoid

Gabriela Allard

complications from the disease. However, access to innovative medicine and technology is limited in Mexico. Q: What role does technology play in allowing

President | AMD

diabetics to manage their disease? A: Technology is key. It is not possible to effectively manage diabetes without technology. Auto monitoring has advanced tremendously in recent years, from simple glucometers to

Diabetes: Managing a Chronic Disease Through Prevention

sophisticated equipment that connects to computers and smartphones to keep track of the patient’s blood sugar, sending the information directly to the doctor. This data allows physicians to offer the most personalized diagnoses and treatments. Innovation continues to boost prevention. For example, new devices, such as flashless monitoring or intelligent sensors, can measure glucose 300 times a day just by scanning the patient. Data is important in getting the best possible therapy that includes dose adjustments and precise monitoring. Innovative medicine is key. Today, we have state-of-the-art drugs and insulin whose effects last longer and are better than those administered in the 1970s. Q: How limited is access to the opportunities that technology and innovation offer? A: Unfortunately, access to coverage depends on the patient or the healthcare system’s budget. Diabetics need the widest coverage possible; it is their right. To ensure that happens, every hospital in Mexico must provide standardized coverage. Also, without access to innovative medicines and treatments, physicians are unable to

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recommend the best therapy for every patient, which could lead to future complications. On a cost-benefit basis, investing in early, quality treatments would be more efficient for the system. It is difficult to treat patients if we only have insulin from the 1970s on the basic list of essential medicines.

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from the

Q: What role will tech have in transforming the health sector? A: The UK is among the countries with major growth in the tech market, with a venture capital investment of £15 billion (US$20 billion) in 2020. Its strongest emerging trends are in education, health, climate and agricultural tech. Healthcare is an essential part of the UK’s identity. The UK has the third-largest market in the world for medtech, contributing £25.6 billion (US$35 billion) to the UK’s annual life sciences sector turnover of over £70 billion (US$95 billion). Around 80 percent of medtech companies are SMEs. The growing trends in medtech are internet of things (IoT) in healthcare, telemedicine, artificial intelligence and biotechnology. Mexico is a key country for the growing market of healthcare; its location is an excellent entry point into the region and to the US market. In addition, Mexico has one of the largest economies in Latin America, which makes it a very attractive destination for UK companies to invest and do business. Due to the importance of the country and our will to share knowledge, since 2019, we have organized workshops and training sessions between the National Institute for Health and Care Excellence (NICE) and its Mexican counterpart the National Center for Health Technology Excellence (CENETEC). During the last week of November and the initial weeks of December, three masterclasses were delivered to different countries in the region, Mexico included.

Jon Benjamin

Q: How could Mexico and the UK enhance health access through tech, innovation and alternative financing options? A: We have built a strong relationship with the Mexican Ministry

Ambassador | British Embassy in Mexico

of Health, looking for opportunities on bilateral cooperation. Memorandums of Understanding are a key element for these interactions and for future collaborations. We hope that our collaboration between NICE and CENETEC will strengthen the evaluation processes for the analysis and inclusion of new

Bilateral Efforts Strengthen Health, Sustainability, Development

technologies into the Mexican health system. Having an effective cost-analysis evaluation process allows the integration of technology and innovation into the health system. In addition to working with the public sector, promoting trade between both countries allows the exchange of knowledge and experiences in regard to technology. Q: What steps are you taking to pursue and promote green energy, sustainability and climate actions in Mexico? A: We have a strong collaboration with Mexico on climate. Through policy discussions and our cooperation programs, we are supporting Mexico’s efforts to transition to a low carbon economy. The UK and Mexico work together on a wide range of topics, from electric vehicles to green finance. We support initiatives in collaboration with the federal government but also collaborate with state governments and the private sector. Climate change is one of the greatest threats to public health by directly influencing health outcomes related to extreme weather events, heat stress, air and water quality, wildfires, food

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supply and safety and with vector distribution. Thus, there are great opportunities to build a climate resilient health system, guide a rapid transition into clean renewable energies, promote sustainable, heathy, urban systems and protect and restore nature and ecosystems.

State of the Industry | 15

Environmental Risks and Their Impact on Health For decades, concern has steadily increased over the impact from pollution on the population’s well-being, reflected in the development of several disabilities and even death. Despite calls for action, global awareness and effective initiatives to counter pollution are still lacking. More than 12 million people around the world die every year because they live or work in unhealthy environments, states WHO. Specifically, there are eight environmental factors that have a direct impact on health: chemical safety, air pollution, climate change and natural disasters, diseases caused by microbes, lack of access to healthcare, infrastructure issues, poor water quality and global environmental issues. Environmental risk factors greatly determine one of many health outcomes and will manifest in different stages of life. Targeting the most influential factors can help to understand how these can affect the human body and its development. The International Journal of Environmental Research and Public Health (IJERPH) marked air quality, water quality and access and climate change as the major environmental determinants of health. Environment-related health affectations can manifest differently. WHO’s study, “Preventing Disease Through Healthy Environments,” from 2016, breaks down environmental burden effects into infectious and parasitic diseases, neonatal and nutritional conditions and noncommunicable diseases. Environmental risks can also be a cause of unintentional injuries and intentional injuries. Despite the clear evidence and negative impact that environmental risks have on healthcare, Mexico’s actions to prevent negative outcomes seem to be failing. “In Mexico, air pollution represents the first environmental risk factor associated with premature mortality,” stated Beatriz Cárdenas, Expert from the Mexico World Resources Institute, during a webinar by Renovables X México. According to Cardenas, factors such as age and socioeconomic inequality alter the effects of environmental pollution, mainly affecting vulnerable populations such as children, pregnant women, the elderly and people with fewer economic resources. “This highlights the urgency to expand sustainable energy solutions around the world,” she says. At the same event, Roberto de la Maza, Professor, University of the Environment, shared that as a constitutional right, healthcare is to be guaranteed by the state. Thus, “the government must guarantee the improvement of quality of life, including the right to a healthy environment, a condition without which it is not possible to fully guarantee the right to health.” Cardenas and de la Maza agree that the energy reform promoted by President Andrés Manuel López Obrador will represent a setback in the levels of compliance with the citizen’s right to health. De la Maza explained that the reform will lead Mexico to greater consumption of fossil fuels, such as coal, natural gas and Read the complete article More about this topic

fuel oil, to generate electricity. “All these agents severely damage the health of the population, the environment and compromise the future of children in Mexico,” he says.

Conference

State of the Industry | 16

Highlights

Public-Private Dialogue is Crucial to Guarantee Medical Supplies Ana Riquelme Executive Director | AMID

Rafael Gual Director General | CANIFARMA

Karla Baez Ángeles Director of Access to Innovation | AMIIF

ublic medicine and medical device supply have been among the main issues for the health industry since the Acquisition Law was changed. A path to improve and guarantee treatment for patients will only be possible if the public and private sectors have

open dialogue and work together on planning, processes and monitoring, say industry experts. “Public-private collaboration is required to have conversations regarding inventory control and institutional strengthening. The pharmaceutical industry is a strong, important sector for the country and all actors involved in the value chain have the need to work with legal certainty,” says Karla Báez Ángeles, Director of Access to Innovation, AMIIF. The new Acquisition Law for medicines and medical devices involved a consolidated purchasing model that centralized operations through INSABI. The federal government removed distribution companies from the equation and, as a result, each public institution and state had to place its own orders. The complexity of this change led to a “technical assistance” agreement for the administration and management of projects and the acquisition of goods and services. Later, on July 31, 2021, INSABI and UNOPS signed a new agreement, called “Acquisition of medicines and healing materials,” which empowered the UN-backed organization to carry out the bidding procedures to supply medicines to the Mexican health system between 2021 and 2024. “The results (of the changes) have been frankly bad. The processes carried out by UNOPS have also not been positive. The lack of planning has led to shortages. Ninety-seven percent of allocations given by UNOPS were previously handled by companies established in the country,” says Rafael Gual, Director General, CANIFARMA. The main catalyst to work toward securing medicine supply is to collaborate as a sector with effective, permanent communication channels with the government, says Báez. “We need planning, clarity of processes, certainty of times and traceability to enable this monitoring of supplies reaching the end goal.” Ana Riquelme, Executive Director, AMID, agrees: “We are all in the same boat. Everyone is susceptible to becoming a patient

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and we must work together with the authorities to find solutions. If we do not achieve this in the next three years, we will continue experiencing problems.”

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Q: What are the most common trends you see affecting Mexico’s seniors? A: During the past 10 years, we have developed specific care programs for Mexico’s aging population, which was not receiving the attention it deserved. Under the current presidential administration, we are focusing on research and are launching a first-generation of master’s programs in geroscience, the study of how aging enables disease. For the past year, we have been building a system alongside INEGI to collect information pertaining to health, aging and dependency to have a clear registry of long-term care. We expect this information will be available for public use in October 2022, in time for the International Day of Older People. Q: How is the institute transforming the provision of healthcare services for seniors? A: When we started, we wanted to transform geriatrics. The National Institute of Geriatrics began this transformation 10 years ago, leading to the quadrupling of specialized centers and the incorporation of 10 times more geriatrics specialty residents. Thanks to this change, the institute now works with over 700 geriatricians across the country. We want to increase awareness of issues concerning aging among technology providers and public and private health providers, for which the typical client

Luis Gutiérrez

profile has changed as the primary client for healthcare services is now a senior. Q: Healthy aging is influenced by the early stages of

Director General | INGER

life. How is INGER enhancing healthy aging? A: In 2013, we became part of an international group convened by the World Health Organization and worked in what became the WHO’s first global report of health and aging in 2015. The

As Life Expectancy Increases, Geriatrics Must Improve

Integrated Care for the People (ICOPE) report coined the concept of intrinsic capacity. Building and sustaining that intrinsic capacity is key for maintaining health while aging. ICOPE is the primary tool to promptly identify risks and later intervene to preserve the intrinsic health of people. At a federal level, the concept has been incorporated into social security and we are working on the provision of health services in Mexico City and training doctors from Argentina, Chile and Costa Rica through the Pan-American Health Organization. Our priority is to develop strategies to care for the country’s elderly population, addressing their health concerns and dependency. We are increasingly interested in the modulation of the aging process. The past 100 years made it evident that aging processes have changed because life expectancy has doubled. Q: Does Mexico have the ideal conditions to support healthy physical and mental aging? A: We have a long way to go, unfortunately. The life expectancy increase stopped as a result of the pandemic but we are 2.3 to three years below the life expectancy in the US, despite the sharp

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difference in health investment. We cannot forget about the influence of economic and social determinants in the quality of aging, which play a 75 percent larger role in aging than genetics. The role of the environment in which one develops is fundamental in determining the quality of aging.

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from the

Q: How has tech revolutionized care in terms of physical and remote attention? A: There has been a push to incorporate technological services that bring the patient closer to the doctor. Therapeutic treatments have also advanced. We have invested in economic and human resources to help patients. Many hospitals and countries were not prepared for the COVID-19 crisis, which led to a large cost of life. But the pandemic also led many hospitals and doctors to look for solutions to communicate rapidly with patients. We invested in artificial intelligence, computer systems, databases and communication technology so Médica Sur’s services would be available 24/7 to address any issue. These investments were taken up by a number of hospitals, even from the EU and the US. Q: As a hospital-university, how are you integrating tech in education? A: University hospitals have an obligation to offer research and educational programs, besides providing medical care. At Médica Sur, we perform biomedical research and provide education. Médica Sur allied with UNAM 22 years ago to offer a series of post and pre-graduate programs for doctors. Every

Misael Uribe

year, between 100 and 190 medical students can take a master’s or Ph.D. program with us. This year, we published the “1,000 Research Cases by Medica

President | Médica Sur

Sur” book to celebrate 40 years since Médica Sur’s founding. During that time, we have graduated 3,500 doctors from our post-graduate program. We prioritize the patient’s well-being over business interests as we aspire to be the best hospital in Mexico.

Médica Sur Celebrates 40 Years of Helping Patients

Unfortunately, many doctors have passed away due to lack of resources and Médica Sur is working with UNAM to regulate this situation. The devotion and willingness to put their life on the line for their patients is what sets Mexican doctors apart. Q: Mental health continues to gain attention as the stigma surrounding it fades. How is Médica Sur approaching mental health for patients and employees? A: The pandemic had deep consequences for physical health and led to numerous deaths, which affected survivors and society. To many, the consequences were also very personal. COVID-19 can affect the brain directly, especially in cases of “long-COVID,” when symptoms continue for a year. Long-COVID causes continued brain cell death and leads to losses in memory and other cognitive problems. The country was not ready to handle the large number of COVID-19 cases and it did not have enough doctors to do so. The pandemic also led to other psychological complications.

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We have not finished understanding what will happen with the pandemic, how long it will last or when and if it will become endemic. Its pulmonary and cardiovascular long-term effects are still undetermined, as are potential disabilities caused by COVID-19.

issue engineering, genetic reorientation of nonhuman donors for transplantation purposes, xenotransplantation and regenerative medicine are steadily setting milestones in the field of replacing organs damaged by various diseases. It is estimated

that 10 percent of the world population is affected to some degree by kidney failure, where diabetes mellitus is the No. 1 cause. Attempts to adapt organs from different animal species to humans are not new and we can recall several precedents of high impact on society, such as “Dolly,” the cloned sheep, in 1997. On the other hand, genetic mapping and its codification determined a whole new era of knowledge of the human genome with the subsequent beneficial effect of putting at our disposal personalized medicine based on specific risks according to the genetic conformation of each individual. Less than a year after the FDA — in December 2020 — authorized

the first intentional genomic alteration in a group of domestic pigs

State of the Industry | 19

for both feeding potential and for therapeutic purposes, medicine

Humanized Organs: The New Hope in Transplants Alejandro Rossano Director General | Grupo Médico Rossano

witnessed the worldwide impact from the “humanized” pig kidney news that opened a plausible road toward transplants between porcine species and humans. Xenotransplants, from the Greek xenos, meaning foreign, are transplants of organs among different species, for instance between pigs and humans. The search for alternatives to increase the number of organs for transplantation also includes new strategies that involve decellularization and recellularization of organs. Ideally, with decellularization and recellularization, the possibility of rejection would be eliminated as well as the need to administer immunosuppressive drugs, whose function is to reduce the ability of the immune system to recognize a new organ as foreign and reject it. Recent advances in xenotransplantation, particularly those based on the research on pigs, could make it possible to carry out more testing. Considerable efforts have been made to improve efficiency and minimize risks. However, more studies are required before the benefits of xenotransplantation can be exploited. According to the Global Observatory on Donation and Transplantation, 100,097 kidney transplants were performed in 2019 around the world. A glance at the mapping of transplant surgery reveals that the distribution of this clinical practice is very uneven. In countries where economic resources suffice and technology is available, such surgeries are almost routine. On the other hand, in those countries where neither economic resources nor technology are plentiful, these transplants are scarce. In many other countries, this advanced surgical procedure remains out of reach. The truth is that 60 years have passed since the first successful kidney transplant and throughout these years, transplant surgery has evolved dramatically. What are the next steps in basic and clinical transplant research? What other animal species will

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be helpful for organ and tissue transplantation? What other humanized organs are suitable for transplantation? These and other questions are ahead of passionate and motivated transplant physicians, transplant surgeons, health companies, pharmaceutical industries and universities.

roviding the population with quality healthcare is a complex process that involves different actors but mainly proficient, skillful and highly specialized physicians. The goal of graduate medical education is to ensure that enough physicians-in-training

become competent to practice in their field of medicine. In Mexico, medical residency is defined as a set of academic, care, and research activities that are endorsed by universities and the surgical programs implemented by the clinical training sites. Each residency program must be registered with the National Medical Residence System of the Interinstitutional Commission for the Training of Human Resources in Health. Training in residency programs is highly competitive; it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills, attitudes, and interpersonal abilities. The goals of any residency program describe three needs: best care for the patient, social pertinence and accountability, and personal accomplishment. In this type

State of the Industry | 20

of training, learning takes place in the clinical settings that are

Medical Specialist Training: Challenges and Opportunities Jorge Valdéz García Dean | TecSalud

highly influenced by several changes to clinical care, such as the diminution of patients, cost optimization, and a reduction of the length of stay in hospitals. Medical specialties should adapt to those changes, and they would still have to reorient their efforts to prepare the physicians in their residency. In Mexico, the number of specialists is lower than the OECD average (178 versus 119 per 100,000 population). Regarding geographical distribution, 54.2 percent of specialists are concentrated in Mexico City, State of Mexico, Jalisco, and Nuevo Leon. Mexico City had the highest rate of medical specialists (505.7/100 000 population), followed by Nuevo Leon (185.3/100 000 population) and Jalisco (172/100 000 population). On average, there are 1.7 male per female specialist. Training programs are concentrated in a few cities; the cities with the highest concentration are Mexico City, Monterrey, and Guadalajara. After completing a three- to five-year training period, residents graduate with a university degree of medical specialist. To practice their specialty, graduates must obtain a professional license, which requires passing their specialty Board of Certification examination. This is a practical and theoretical examination. Of the total of 147,910 specialists; 69 percent had current specialty certification by the medical council of the respective specialty. With some specialties obtaining rates above 95 percent of valid certification, while others occupational with percentages below 20 percent. Excellence in clinical care demands quality medical education. This principle has prompted initiatives for evaluation and accreditation in Mexico’s residency programs. The National Council of Science and Technology has established an accreditation system for medical residencies: the List of the National Graduate Quality Program. According to the National Council of Science and Technology (CONACyT), 250 medical specialty programs were incorporated into the PNPC in 2021. The need for medical specialists is a hot topic of debate. Gaps in

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what is needed and what is offered are often highlighted. There is an inertial thinking to make decisions based on the force of custom, but it is imperative to ensure the strategic planning of human resources in health in Mexico, considering the needs of the population, the quality of the training and its pertinence.

e are facing an extreme situation in Mexico, where there is not a single provision that regulates emergency use authorizations (EUAs). The situation is now becoming critical because the federal government

has erratically but persistently argued that it is inherent to the emergency nature of such authorizations that a crucial restriction should exist. That is, that the products authorized this way can only be made available to the public sector. This has created a profound restriction or exclusion that did not exist before, arbitrarily excluding access to critical treatments in the private health sector. Undoubtedly, the pandemic, and the way it has been managed by this federal administration, has put a great deal of visibility on a discrete area of law: health law and health regulation. Unfortunately, this has occurred for the wrong reasons. Nevertheless, it is an opportunity to consolidate this area of law for the benefit of the country and its patients, which includes all of us.

State of the Industry | 21

Is dedicated regulation really necessary? Yes, it is. We can take

Mexico in Urgent Need of Emergency Use Regulation Christian López Silva Partner-Healthcare and Life Sciences | Baker McKenzie

one example from another jurisdiction that is very close to us geographically, historically and commercially. EUAs are regulated in the US through five different pieces of legislation: (i) the Federal Food Drug and Cosmetic Act (FDCA) of 1938, (ii) the Project BioShield Act of 2004, (iii) the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, (iv) the 21st Century Cures Act of 2016, and (v) the amendment of FDCA of 2017. Those legislative instruments address different aspects, including: (i) the type and extent of scientific evidence required for approval; (ii) the potential immunity for product liability claims filed by injured patients; (iii) the nature, scope and limits of the power to grant them, and (iv) its connection with or its transition toward full approval. In addition, the FDA issued further regulatory guidance for EUAs relating to COVID-19 vaccines. Even with dedicated regulation, it has been pointed out that the US system requires careful implementation to: (i) avoid undue political influence, (ii) strike the right balance between putting some people at greater risk in the hope of preventing a greater amount of suffering, and (iii) maintaining the trust of the general public in the health regulator. Thus, yes, we do need dedicated regulation. There are multiple issues to address and define. At the same time, while looking at that system, we could also ask the following: Is the aforementioned restriction an essential part of the US system? No, it is not. Also, if we think a bit more about this, the reality in which federal governments around the world have secured purchase agreements for COVID-19 vaccines much faster and more effectively than any other private entity is rather just a reflection of how governments can sometimes mobilize and leverage larger volumes and resources to achieve a result. However, that recent experience, relating only to vaccines, does not mean that by their very nature EUAs should contain a strong restriction to exclude products from the private health sector. For some, it may be rather surprising to find out that our legal

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regulatory framework simply does not have a type of approval that limits the commercialization exclusively to the public sector. However, as put forward here, what should really be the main surprise for all of us is that we are not yet urgently developing the required regulation.

or the past several decades, health systems, hospitals, private physician practices and insurance health plans have run in a consistent manner. However, the average patient has had to deal with confusing processes, unexpected costs and a limited number of services,

regardless of segment — public or private. Healthcare disruptors know there is more than one way to run a business in this sector, and as such, they have taken the opportunity to shake up and disrupt the segment, causing radical change and potentially resulting in new leaders in the field. New incumbents in the market from different sectors (retailers, technology, telecommunications, wellness, and others) are already searching for overlooked gaps in the value chain and creating innovative solutions to bridge those “holes,” potentially snatching billions of dollars of revenue from traditional healthcare/pharma companies. Companies such as Amazon, Apple, CVS and Samsung, are

State of the Industry | 22

already stirring up the life sciences industry and gaining

Healthcare Disruptors Beyond COVID-19 Sandra Sánchez Oldenhage President | PharmaAdvice

traction by challenging the status quo. These new players approach challenges and opportunities in unconventional ways. They are empowered by technological advancements and bring insights that are borrowed from other industries. So, what are they doing different? What can traditional health/pharma companies learn from them? First, they are playing a critical role in a broad-based transformation of healthcare by positioning themselves to fill the gaps created and neglected — for various reasons — by many healthcare incumbents. Filling gaps between consumer expectations and the current medical ecosystem provides many opportunities for new entrants to move in with fresh ideas and skills. One instance is offering transparent and authentic customer choices for customization. Another approach is by bringing more affordable and convenient care and/or treatment options, together with wellness and fitness, thus increasing their value proposition. Second, they develop strategic alliances, they build capabilities and business models that will allow current incumbents to transform the industry, hence shaking it up even further. They engage with key stakeholders and leverage their network, rather than going at it alone. Like Amazon, they believe that there is a way to make healthcare less confusing for everyone and as such are trying out unconventional business models. Organizations are partnering with nutritionists, gyms, technology leaders, and more, to create a new business of healthcare that considers a person’s total well-being, Quality of Life (QoL) and health journey. Third, their nimble innovation and product development cycles are the status quo for many of these entrants, whereas current pharma companies often take 10-plus years to develop and launch products. New entrants have a great opportunity to improve healthcare delivery, while partnering with researchers and manufacturers to develop and commercialize health

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treatments and solutions more effectively. They can help improve the development cycle, saving time and costs, and enhance the process by which products and services are designed to meet the needs and expectations of specific patient targets; expectations that are constantly changing and evolving more than ever.

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The Upcoming Challenges in the Healthcare Industry Fernando Becerril Orta Senior Partner | Becerril, Coca & Becerril

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Research & Innovation One of the biggest trends for the health sector is the transition toward a valuebased model, which is expected to drive equity in access and to put the patient at the center of the health system. Providers are betting on disease management and remote monitoring to have complete insight on the patient’s lifestyle and care toward their condition. Yet again, tech is the trusted ally for these companies to boost their already life-changing innovations and to achieve the desired outcomes. Mexico is considered one of the Top 5 Latin American countries with the best conditions to integrate and promote personalized medicine, according to the Latin American Personalized Medicine Index. How are leading companies in the sector taking advantage of this fact? Experts share their plans and the potential of personalized, precision medicine to reduce the incidence of chronic diseases. Other innovations are also addressed along with the prospects for improved care related to rare diseases.

Research & Innovation

Analysis Tech, Pharma on Chronic Disease Management

View From the Top Miguel Angelo Ricchiuti | Operations and Supply Chain Director Mexico and Latam | Apotex Mauricio Rodríguez | Commercial Director | Apotex

View From the Top Marlene Llópiz | CEO | CRO Mexicana

View From the Top José Celaya | Medical Director | Bristol Myers Squibb México

View From the Top Alfredo Román | Director of the Fertility Unit | Merck Group México

View From the Top Sonia Pérez | Executive Director | UDIBI-IPN

Analysis Tech-Based Solutions for Patient-Centric Care

Conference Highlights Innovation, Collaboration Are Crucial for Healthy Aging

Expert Contributor David Salas | Manufacturing Operations Director | Atramat

View From the Top Ramón Mier | Commercial Director | Vitalmex

View From the Top Vanessa Ballarte | Executive Director, Corporate Strategy and Digital Health for Latin America | Omron Healthcare

Expert Contributor César Marrón | Director General | Cardinal Health

View From the Top Luis Valdés | General Manager | Sarstedt México

Content Links

POPULATION WITH CHRONIC DISEASES IN MEXICO

Mexico’s high prevalence of chronic diseases is an ongoing issue that requires measures beyond medications. To address this health and economic burden, experts suggest technology as a support to improve health outcomes and reduce mortality and expenditure. Mexico’s urgency for chronic disease management (CDM) is based on the high prevalence of chronic diseases and poor health habits of the population. The country’s population pyramid shows that 75 percent of adults are under 55 years of age while, at the same time, millions of people at risk of developing a chronic disease are among the economically active population, according to the study, “Mexico and the Challenge of Chronic Non-Communicable Diseases,” by José Barba Evia. Barba highlights obesity, diabetes, dyslipidemias, arterial hypertension, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and chronic kidney disease as the most urgent diseases to be managed by proper programs that address

13% Diabetes

12.2% Renal Insufficiency

31.5% Arterial hypertension

unhealthy lifestyles and ensure proper treatment attachment. One of the latest national efforts to manage chronic diseases, specifically obesity, diabetes and overweight in Mexico, began in 2013 with the National Strategy for Prevention and Control of Overweight, Obesity and Diabetes.

PRIVATE EXPENDITURE ON MEXICO’S MOST COMMON CHRONIC DISEASES (US$)

Mexico’s strategy to address obesity, overweight and diabetes, however, has not delivered as expected, according to Deputy

Private Public

Minister of Health Hugo López-Gatell. “(The strategy) had 8,868

20,000

15,000

implementation problems, the government did not have a technical program for health promotion in all states or performance and impact indicators. There was also a lack of inputs for detection, such as test strips for metabolic control of people with diabetes, among others.”

Arterial hypertension

Despite being restructured under the current presidential administration, CDM programs have failed to include novel innovations that could ensure the strategy has a greater impact. It was not until September 2021 that the government announced the

4,364

National Digital Strategy 2021-2024 to change this panorama. But it is not unusual to see traditional CDM programs fail, according to

691

5,000

1,776

9,091

10,000

598

Research & Innovation | 27

Tech, Pharma on Chronic Disease Management

Diabetes

the Tony Blair Institute for Global Change. Renal Insufficiency

While, systemically, Mexico waits to integrate technology into Source: INEGI, MBN, PLoS One

a national strategy, the private sector is already developing programs to address some of Mexico’s health burdens. “Sanofi is developing AI applications for devices that people use all the time: wearables. In Mexico, we have just presented a new application, ‘Delivering Patient Health,’ which collects information from patients with diabetes or hypertension to facilitate monitoring their treatments from their mobile devices,” says Fernando Sampaio, Country Lead and General Manager, Sanofi Mexico and Sanofi Pasteur. According to Sampaio, Sanofi has a broad medicine portfolio for patients with Type 1 and 2 diabetes, which is currently complemented by the use of monitoring Read the complete article More about this topic

technologies to track glucose levels, alert the patient and their doctor of necessary adjustments and ensure adherence to the personalized treatment.

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from the

Q: How does the company ensure continuous supply and operations? MAR: While COVID-19 limited in-person contact, it forced us to increase our outreach to clients to prepare for shifts in demand, supply and priorities. Over the past year, COVID-19 waves caused demand to fluctuate wildly. Ensuring the availability of products is fundamental. We tried to anticipate negotiations with international suppliers and invested in inventories to be prepared. Last year, COFEPRIS, once again, authorized our Good Manufacturing Practices (GMP) that give certainty to our customers in supply continuity and our Quality System.

Miguel Angelo Ricchiuti

MR: There were variations in demand for many products for varying reasons, some directly due to COVID-19 and others due to supply failures. Sometimes we had increases in demand that were

Operations and Supply Chain Director Mexico and Latam | Apotex

completely atypical so we had to have enough inventory, even an excess in many cases. Increments in demand for us have been sometimes a result of a failure to supply other laboratories, which allowed us to reach out to patients in a more effective way. Q: What are the main benefits for Apotex as an API manufacturer? MAR: APIs have been key to our development and growth. We have API plants in Mexico and in Canada that supply primarily to our manufacturing sites, which allows us to react faster to market changes. Our vertical integration gives us two main advantages: being the first to develop the APIs and cost benefits from the start. Without vertical integration and close communication, it would be more difficult to ensure availability of affordable products. We have seen an increase in demand of over-the-counter (OTC) and public sector products. By integrating API manufacturing

Mauricio Rodríguez Commercial Director | Apotex

and refurbishment, we gained an edge to become government suppliers for affordable products as some current tenders imply a challenge in the fast availability and additional volumes. Q: Apotex is also betting on biosimilars. How will your supply chain transform to manufacture these products? MAR: Our Apobiologix division creates biosimilars and we

Apotex Mexico Continues Focus on Meeting Demand

now have three in the market: Grastofil (figlastrim), Lapelga (pegfilgastrim) and Bambevi (bevacizumab). We are a little bit behind in Mexico and Latin America in the development and approval of biosimilars as we are more aligned to the FDA. There is also a wide gap between the US and EU’s biosimilar approval process. While we do not expect to produce biosimilars in our Mexican plant, we will integrate the local supply chain with biosimilars developed and produced in Canada. Q: How has Apotex used technology to transform its supply chain and how has this benefited the company? MAR: Apotex is launching a digital transformation and a “smart factory.” Our SAP system is integrated into the whole chain: commercial, finance, production, operation and warehousing

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systems. On the production side, we are investing in new areas to improve employee communication and to make production more automated, all of which we will launch next year. We will be able to control all parameters of manufacturing directly at the machines. Through these investments, we will be at the forefront of technology.

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from the

Q: What makes Mexico an attractive country to conduct medical trials? A: International trials depend on several factors, including short setup times to get studies up and running. After all, time is money. Mexico should not be considered as rescue country when a pharmaceutical firm requires patients with specific criteria to partake in a trial. Mexico should be a first choice worldwide from the start of any trial to actively be included from the get go and in parallel with other countries. Mexico is an excellent place to carry out clinical trials for certain therapeutic indications, such as cancer, obesity, diabetes, heart problems and infectious diseases. The country has always been at the forefront and is again gaining ground in clinical trials worldwide. For a number of years, the clinical research arena had turned towards Asia, now returning to Latin America. Q: How can Mexico become a key player in medical research? A: Pharmaceutical companies have a pipeline of products being developed for several diseases and are always competing to bring new medicines to market. Mexico’s epidemiological profile includes a wide range of diseases of interest to pharmaceutical companies. The country is an adequate commercial partner for pharma firms to further explore their markets in Latin America.

Marlene Llópiz

Nowadays, biotechnological firms should view Mexico as an outstanding marketplace for strategic business transactions. From a commercial standpoint, the purpose of clinical research

CEO | CRO Mexicana

is to market medicines to a population requiring treatment. With a population of over 130 million people of all ages, pharmaceutical companies are keen to launch the medicines that Mexico’s population needs and requires. We have a wide range of pharmaceutical companies in Mexico, making the country an

Mexico Is Fertile Ground for Clinical Research

excellent destination for clinical research. It has patients, wellprepared researchers, sites, CROs and pharmaceutical companies to propel clinical research and bring novel treatments for patients. Q: What part of the population is more involved in clinical trials? Do women have lower participation, for example? A: It depends on what the clinical study is about. Each clinical trial requires patients with specific ailments, of different ages, sex, with certain characteristics. For instance, seniors are not commonly involved in clinical trials because most of them have co-morbidities that limit their participation. It is also difficult to find a large population over 60 years old who does not take any medication, which also automatically may exclude them from trials. Every clinical trial has a set of criteria for including or excluding patients. The more ill a patient is and the more co-morbidities he/she has, the higher the likelihood they will be excluded from a clinical trial. We seldom see geriatric trials per se. Trials are directed at diseases and therapeutic indications. If a patient meets the criteria, he/she is asked to take part in a trial. Women often participate in clinical trials depending on the

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trials´ requirements. Male patients have a greater propensity to certain diseases, which is why on occasions they participate more meeting the required criteria. Women participate specifically in trials on ovarian and breast cancer, in addition to trials on diabetes and other illnesses.

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from the

Q: Immunotherapy and cellular therapy have been positively disruptive for Mexico’s health system. What is behind these types of innovations for BMS? A: Immunotherapies are divided into four main lines: action on immune checkpoints, effects on cytokines, immunity through cellular therapies and anti-cancer vaccines. The company is strongly committed to fighting cancer, so studying the immune system has been pivotal. Through our studies, we learned of the immunoediting process and how our immune system attacks unknown cells. In some patients, the immunoediting process gets overwhelmed, allowing the development of tumorous cells due to lymphocyte inactivation. Tumors will then generate an entire system and quantity of cells unable to be identified by the immune system, creating a tumor load that develops into a visible tumor that can later spread cells to other parts of the body. Our studies have found ways to generate a response that only attacks those unknown cells when lymphocyte is reactivated, otherwise the tumor would further develop. It is an honor to note that immunotherapy recently in 2021 celebrated 10 years of being introduced to Mexico and was the result of research funded by Bristol Myers Squibb in partnership with Dr. James P. Allison, Executive Director of the MD Anderson Cancer Immunotherapy Platform at Center of the

José Celaya

University of Texas, United States and Dr. Tasuku Honjo, of the University of Kyoto, Japan. BMS is also developing cell therapies for hemato-oncological

Medical Director | Bristol Myers Squibb México

diseases. This therapy, called transferred immunity, extracts lymphocytes from the patient and changes DNA by adding protein information that will allow the lymphocytes to identify and fight cancerous cells. Transferred immunity is usually the last option for patients who have tried other immunotherapies

Immunotherapy: Future of Healthcare

but for the pharmaceutical industry and who has no other options, it is the future. Q: What is the future of personalized oncology and what efforts is BMS making to better understand the biology of cancer? A: Personalized medicine goes hand in hand with precision medicine. In the past, therapies would be generalized for all types of patients. BMS focuses on treating the individual because diseases do not present or evolve equally in everyone, and each patient can react differently to generic therapies. BMS is trying to identify patient groups for whom therapies have a better chance of working and increasing their years of life without affecting their quality of life. By using biomarkers, genetic studies or mutation detection, BMS is able to identify if a therapy will work for a particular patient as a first-, second- or third-line treatment. Precision medicine allows us to determine the how and when of therapies, depending on the patient and conditions. It must be remembered that precision medicine is not only the detection of genetic mutations or understanding the psychosocial

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context of a person within their environment, but also refers to an early and timely diagnosis because, otherwise, we may lose the opportunity to offer a therapy that could have had a better response or efficacy and since the patient was late, he is no longer going to get the benefits that he would have had.

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from the

Q: How is Merck’s novel ovarian stimulation treatment for infertility making a difference? A: Infertility is defined as the absence of a pregnancy after 12 months or more of regular unprotected sexual intercourse. It is a common condition experienced by between 50-80 million people globally. It can be caused by numerous reasons, equally divided between men and women. In Mexico, there are at least 2.6 million cases of infertility and 180,000 new diagnoses are added every year. Merck offers women a portfolio of products that help them overcome infertility. We recently introduced to the market an ovarian stimulation treatment: a pen-shaped device that is safe and comfortable to use, leading to easier application and higher adherence to treatment. This innovative mechanism is a short-term hormonal treatment that can be applied by the patient herself. She selects the amount of medicine to be administered without the need to prepare it beforehand. Hormonally stimulating the number of ovules released in each menstrual cycle allows for a higher percentage of successful pregnancies by having more than one embryo available during the assisted reproduction process. These embryos can be used in the current cycle or preserved or cryopreserved for a later treatment.

Alfredo Román

Q: How does this device complement your portfolio of assisted reproduction treatments? A: This launch completes our portfolio of pen-shaped devices,

Director of the Fertility Unit | Merck Group México

an area in which Merck is a leader. With this product, we can cover all stages in the assisted reproduction process and provide individualized treatment according to the needs of each patient. Our pen-shaped devices make it easier for patients to adhere to treatment, which is a global issue for any pharmaceutical company.

Merck Launches Pen-Shaped Device for Fertility Treatments

In fertility, adherence becomes even more challenging because almost every solution in the market consists of products for intramuscular application, which are harder to apply. Merck’s novel treatment gives patients a convenient application device to make it easier for the patient to use the treatment. The pen-shaped device is a complement to a hormonal product that was already in the Mexican market; it aims to improve clinical results by offering a better, easier way to apply the medication. Different assisted reproduction treatments can stimulate either partner but the female system is more likely to benefit from treatment. As a result, Merck has created different treatments for infertility that support women, even after they become pregnant. Q: How will Merck introduce this device to the Mexican market? A: Mexico has over 100 assisted reproduction centers, in which we try to be present. Merck works alongside medical professionals to introduce our treatments and to listen to their feedback. Besides developing specialized treatments, Merck constantly works to inform and sensitize the Mexican population to the importance of treating infertility in a timely manner. Merck has operated for over

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350 years and has been in Mexico for over 90 years. We invest over €2.6 billion (US$3.02 billion) in annual R&D to develop solutions for patients, including fertility treatments, which allows us to develop highly innovative products that improve to patient’s lives and contribute to science and technology.

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from the

Q: How are you working to shape regulation in Mexico and what is your perception of the changes in COFEPRIS commissioners? A: Global regulations are based on regulatory science that needs to be in line with scientific advances. In the last 10 years, Mexico had started establishing a scientific base within COFEPRIS through the creation of committees composed of experts in the industry, and there was a great deal of growth. Clinically, each new committee imprints its influence by addressing the problems presented to the commission. Today, there have been changes focused on battling corruption, which from my point of view has not always been proven. However, those changes sacrificed scientific advancements. Mexico was already certified by the WHO for vaccines but there was a change in public health policies and COFEPRIS started to be directed by doctors rather than economists, who have a deeper regulatory knowledge. There have been advancements at INNOVAPRIS and EDUCAPRIS, but I think it is still a commission that is closed off to the industry. Regulatory administrations work with the industry. They understand the role of the commission in ensuring the safety of the population but also accompany the industry as it is a benefit for medical access. Still, we need a commission that is more willing to accompany Mexican developments from their earliest stages. Q: What role does UDIBI play in helping Mexican

Sonia Pérez

developments enter the market? A: We manufacture proteins and we support developers. To start seeing market results and having more 100 percent Mexican

Executive Director | UDIBI-IPN

products in the market, you need to push development and overcome that Death Valley of having no venture capital in Mexico. There is no venture capital investment, much less for doctors who are neither business savvy nor trained to deliver results based on venture capital commitments. The risk and the preparation that

Fostering a Culture of Mexican Scientific Innovation

you need for this is different. UDIBI must continue supporting this effort but we must also foster a different Mexican scientific culture. There has to be a differentiated selection of innovation. UDIBI must also grow to offer more services. Each university should have their own UDIBI because there are limitless technological opportunities for development. But there must also be an increased investment. This is the only way to achieve an economy based on science; there has to be a cycle of innovation. Globally, investment in science was overwhelming and scientific advancements in the last two years have equaled the advancements made in the previous decade. In Mexico, we also had support that we did not have before. For example, AMEXCID gave us more support, which allowed UDIBI to double in size, but this was more the exception than the rule. There was not an increased investment in science because of the pandemic. There was a realignment in how that budget was organized. There were funds to buy vaccines and for hospitals but not a substantial increase for science and technology. Q: How is tech being integrated in the education and training of scientists in Mexico?

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A: It is not as fast as the world is evolving. Machine learning, data science, metaverses and other advances are creating a generational challenge. We will have to catch up but technology is advancing much faster than our country is adapting it.

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Tech-Based Solutions for Patient-Centric Care Aging and growing disease rates put pressure on health budgets. Patient-centric care models aim to be the perfect alternative for health systems to offer more tailored solutions to patients with one or multiple diseases. To adopt these, however, health providers need to change their traditional approach. After the first waves of the pandemic, hospitals, medical devices and pharmaceutical companies realized that they were “largely focused on the immediate crisis,” says Sandra SánchezOldenhage, President, PharmaAdvice Consulting. “The priority was to ensure that the delivery of high-quality patient care kept going and, for pharmaceutical companies, to maintain the supply of critical drugs to prevent potential drug shortages in the future.” The insufficiency of this approach has been a catalyst for companies to finally commit to a patient-centric commercial model. This can be defined as care that is respectful of and responsive to individual patient preferences, needs and values. This approach considers education and support for patients to make decisions and actively participate in their own care. According to Mercury Healthcare (MH), for patient-centric providers, tools and data play a major role. “Patient-centric practices know the only person around for 100 percent of an individual’s care and appointments is the patient.” A combination of cloud, cybersecurity, social media, analytics and mobile technologies is helping providers launch valuable, disruptive products to the market. For patients with diabetes, for example, “devices that connect to computers and smartphones to keep track of blood sugar, sending the information directly to the doctor, allows physicians to offer the most personalized diagnoses and treatments,” says Gabriela Allard, President, Mexican Association of Diabetes (AMD). Cloud solutions are playing a major role in facilitating the use of this data. “Data presents the greatest opportunity in the medical and life sciences industry by providing deeper insights and distributing them to the right people so they make better decisions in real time,” says Esteban Lopez, Market Lead for Healthcare and Life Sciences, Google Cloud Americas. Nevertheless, for cloud-based solutions to work at their full potential, they need to adhere to the highest levels of security, compliance and respect for user privacy. Medical professionals can also benefit from digital solutions as these can support their diagnoses, while helping to identify a variety of indicators that might be impacting the patient’s disease, such as mental health issues, treatment adherence and socio-economic risks. For this analysis, data transfer and interconnection are crucial. “By enabling the storage and computation of massive data sets, healthcare organizations can easily store, integrate and analyze vast amounts of data,” says López. He adds that the Harris Poll shows that 86 percent of Read the complete article More about this topic

clinicians say that greater data interoperability will significantly reduce the time required for diagnosis and help improve patient outcomes by 95 percent.

Conference

Research & Innovation | 34

Highlights

Innovation, Collaboration Are Crucial for Healthy Aging Cristobal Thompson Executive Director | AMIIF

Luis Miguel Gutiérrez Robledo Director General | National Geriatrics Institute

Vanessa Ballarte Executive Director Corporate Strategy and Digital Health for Latin America | Omron Health Care

Cynthia Ramírez Communications Director | AMIIF

iverse factors, including science and technology, have allowed people to live longer. In fact, the global population is aging at an accelerated pace, with over 1 billion people now aged 60 years and older. While this presents considerable

financial challenges for economies across the world, it also opens opportunities for several actors, including those in the healthcare sector, agree industry experts. “We saw a large evolution in the last 20 years. Living longer carries enormous financial challenges for countries. For example, by 2025, pensions will represent 6.4 percent of Mexico’s GDP. In addition, staying healthy and improving quality of life are important challenges, which in turn present the opportunity for the health industry to collaborate and offer solutions,” says Cristobal Thompson, Executive Director, AMIIF. In Mexico, between 1990 and 2020, the 60-year and older population went from 5 million to 15.1 million, now making up 12 percent of the total population, according to INEGI. Twenty percent of those over 60 years old are not affiliated to any healthcare institution. Seniors are common targets of stigmatization and discrimination, says Luis Miguel Gutiérrez, Director General, National Geriatrics Institute. But healthy and independent seniors contribute to the well-being of families and communities. “The fact that old age is coming increasingly later offers opportunities. In Mexico, less than 5 percent of those aged 60 years or older fully rely on their families (for care and economic support),” adds Gutiérrez. The private sector is contributing to healthy aging. “In Japan, similarly to Mexico, one out of every three people suffer arterial hypertension. Omron created the first home blood pressure monitor, aiming to reach zero cardiovascular events,” says Vanessa Ballarte, Executive Director of Corporate Strategy and Digital Health for Latin America, Omron Healthcare. Japanesebased medical devices company Omron specializes in blood pressure monitors, nebulizers, electrotherapy TENS2 devices and other innovative products and services. Working toward healthy aging requires the participation of the public sector, civil society, academia and the private sector. However, care for seniors is still framed around chronic disease management rather than the person, says Gutiérrez. “Seniors

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are usually excluded from clinical trials due to their complexity but they still are part of the real world. Clinical trials are an important area of opportunity.”

any people are talking about things we need to change due to the pandemic but there are others that we not only need to keep but actually reinforce. Can you imagine what is needed to keep manufacturing operations working while almost

everybody is working from home? While home office can be a reality for some companies, there are others that cannot take advantage of this option. This is the case of manufacturing in the healthcare industry. If you need to transform incoming materials into a finished good, you need to be where the required installation and equipment are located. In regular operations, we need to work hard to keep our people not just focused but motivated in terms of what they are doing every day. When things get difficult and uncertain, this becomes an even bigger challenge. In my experience, this is when leaders need to be not only empathetic but resilient. When leaders in the organization exhibit resilience, others are able to replicate it and the whole

Research & Innovation | 35

operation becomes resilient.

Resilient Manufacturing Reinforces Reliability, Service, Purpose David Salas Manufacturing Operations Director | Atramat

Manufacturing in the pharma and medical devices sector requires high levels of concentration to ensure people’s safety, regulatory compliance, the right quality standard and the service level customers expect. The best way to ensure this happens is through motivated people who strongly believe in the purpose of their job, enabling a reliable operation. However, when disruptions threaten our safety and we feel uncertain, there is an impact on people’s self-confidence. Despite adversities, we need to ensure that manufacturing remains reliable. First, we need to accept and recognize that we all are vulnerable. By acknowledging this, an automatic self-defense instinct arises; we protect ourselves. We also can learn from our experiences with adversity, which provides the lessons needed to overcome every time we face a new challenge. A demanding individual effort is required to move forward no matter what is threatening us or when we experience setbacks. The skill to successfully start over is resilience. Without it, we will continue but with hesitation around each action and decision we take. The CCL (Center for Creative Leadership) recommends eight steps to enhance resilient leadership: 1. Develop a broad network of personal and professional relationships 2. Socialization 3. Regular exercise 4. Seven to eight hours of sleep at night 5. Mindfulness 6. Embrace new perspectives 7. Savoring emotions 8. Practicing gratitude

In manufacturing, good service to our customers is a consequence of the degree of reliability we can achieve but this is not possible if people do not overcome adversity. We can work with people who have deep knowledge and experience in their Read the complete article More about this person More about this company

field but if they are not resilient, their abilities will not be 100 percent present in their job. This is why we need to develop high levels of resilience in our organizations. People who are able to overcome will always make a difference, delivering the promised service to customers and patients.

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from the

Q: How does Vitalmex contribute to the Mexican healthcare system? A: Vitalmex is constantly evolving to improve and offer the best health services in Mexico, both for the public and private sectors. Our main goal is to support institutions and healthcare professionals in every aspect of their work, from supplies and equipment to technology and expert personnel, allowing them to focus on what they do best: taking care of patients. The articulated services offered by Vitalmex must be configurable, adaptable and flexible for patients and healthcare professionals. We must understand the needs of both parties to ensure our solutions work optimally. Vitalmex focuses on finding efficiencies in the clinical-surgical, administrative-operational, technological and financial segments. Q: How do those efficiencies translate into benefits for healthcare institutions? A: When a patient is being treated at either a public or private institution, medical care is highly expensive. Vitalmex’s services accelerate recovery times while keeping everyone involved safe. We offer integral solutions that incorporate equipment, surgical instruments, supplies and human resources.

Ramón Mier

In addition, Vitalmex emphasizes continuing education. We have a very robust medical continuing education program to boost our services. If healthcare professionals are not trained to use the technology and tools we offer, they will not be able to take

Commercial Director | Vitalmex

full advantage of our articulated services. Q: How does Vitalmex help in the prevention of nosocomial infections?

Integral Solutions Vital to Boosting Hospital Productivity

A: Nosocomial infections can be contracted from several fronts: through the air when there is poor management of positive and negative pressures within a hospital; from water contamination; personal contact; or through poorly sterilized surgical instruments. Our high-level disinfection service covers three main steps: vaporization, nebulization and validation of prior processes. Vitalmex conducts an initial study to understand the contamination in the surgical room or other hospital areas. Once our processes are completed, we confirm that everything is within the parameters established to carry out any procedure. Q: How does Vitalmex’s help hospitals develop agile surgical cycles? A: Vitalmex has a business line focused on facilitating complete, agile surgical cycles. These cycles not only include the operating room but also the patient, the Sterilization and Equipment Center (CEYE) service and the recovery process, all of which may cause bottlenecks. Recovery processes must be safe and agile to avoid those bottlenecks.

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We also help clients by taking control of CEYEs. When surgical instruments arrive, we check that the delivery is complete and wash and classify the instruments in steam, plasma or ethylene oxide autoclaves to sterilize them.

VIEW TOP Research & Innovation | 37

from the

Q: What technologies will keep Omron at the forefront of the health sector’s digital transformation? A: We are pushing two technologies. One has to do with connectivity because as online ecosystems grow through mobile devices, our consumers want to monitor their health on their phone or through an app. We are working to launch a portfolio of connected products, including not only pressure monitoring devices but also thermometers, nebulizers and so on. Additionally, we are expanding our technology to cover chronic conditions beyond hypertension, including cardiovascular or cerebrovascular problems, which can result from hypertension. This will include the ECG, which a client can use at home to get an ECG measurement. Most people cannot read the data from an ECG but our technology will alert you to consult a doctor if necessary. The doctor can then decide how to treat the information. Additionally, nebulization is expanding our portfolio for asthma-prevention. We are launching products that will allow parents to monitor asthma attacks in young children who may not know what is happening. This technology will inform the parent of the attack the child is experiencing so they can get medication. We also have products for pain control, including an expansion into the sports arena through a product called TENS. It is used by soccer professionals when they experience knee pain but anyone can access it. Q: Why is tech the perfect ally for the “Going for Zero” initiative?

Vanessa Ballarte

A: The “Going for Zero” program is aimed at eliminating heart attacks and strokes. It is focused on three pillars: Initially,

Executive Director, Corporate Strategy and Digital Health for Latin America | Omron Healthcare

preventing a patient from developing a chronic condition before they develop hypertension or obesity. The second level is control of chronic conditions. And the third is avoiding a second occurrence after a primary event. In Mexico, in particular, we are focused on prevention and we are working to introduce plans for controlling conditions remotely. In the future, as we introduce new

Omron Bets on Remote Monitoring

products, we will be able to enter the third level, finally “going for zero.” Q: How are preventive programs promoted in a Mexican system that is more corrective than preventive? A: The Omron Academy is a program that works directly with doctors in Mexico and Latin America to ensure they can communicate to patients the importance of home monitoring. One of a patient’s biggest influences is the doctor. With that in mind, five or six years ago, we founded an education and awareness program for doctors. It was created in Europe with a focus on hypertension and comorbidities, obesity and diabetes, including pregnant diabetics. The goal was to make doctors aware of the benefits of digital home monitoring for the tracking of diseases. We are now promoting this program with some innovations, such as the implementation of digital monitoring where the patient simply connects through their phone and the data is automatically sent to the doctor’s computer in real time, allowing the doctor to monitor that data without a consultation. We make this technology accessible by ensuring our devices are

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available in the most important pharmaceutical chains across Latin America as well as in supermarkets and certain retailers. We also have relationships with public and private institutions and provide workshops for the general public, especially regarding prevention.

he future will require leaders who are global citizens and able to work in a multicultural environment, who value talent and intellectual property and who embrace the need for constant digital transformation.

Future leaders will need to be innovative, collaborative and adaptive. They will also need to be both strategic and agile (“stragility”) to build tomorrow’s talent. The future of leadership is diverse and anchored in what I like to refer to as Executive Leadership Presence, which I believe embodies inclusive leadership.

Leaders increasingly will face challenges that have no solutions. Of course, they will have to make decisions anyway. For the next 10 years, leaders must be positive change agents in the midst of chaos, creating the future. Globalization and the significant changes taking place in the

Research & Innovation | 38

workforce will also influence leadership. Uncertainty and

Leadership in the Future César Marrón Director General | Cardinal Health

complexity will be around their decisions from now on — and confusion will remain part of the mix. The next 10 years will be exceptionally volatile, with many makeor-break decisions to be made. To survive, lead and create the future, experts say that leaders must build and apply 10 future leadership skills: 1. Maker instinct: The ability to exploit your inner drive to build and grow things, as well as connect with others in the making. How can you draw out your inner maker instinct and apply it to your leadership? Future leaders — working with others — will need both a can-do and a can-make spirit. 2. Clarity: The ability to see through messes and contradictions to a future that others can’t yet see. How can you communicate with clarity in confusing times, so you’re simple without being simplistic? 3. Dilemma flipping: The ability to turn dilemmas into advantages and opportunities. How can you improve your skills at dilemma flipping so that you succeed with challenges that can’t be solved and won’t go away? 4. Immersive learning ability: The ability to immerse yourself in unfamiliar environments and to learn from them in a first-person way. Do you have what it takes to learn by immersing yourself in new physical and virtual worlds that will take you out of your comfort zone? 5. Empathy: The ability to see things from nature’s point of view — to understand, respect, and learn from nature’s patterns. Can you learn from nature and use that wisdom to inform your leadership? 6. Constructive depolarizing: The ability to bring people from divergent cultures toward constructive engagement. How can you calm and improve tense situations where people cannot agree? 7. Quiet transparency: The ability to be open and authentic about what matters without being overly self-promoting. How do you lead so that you inspire credibility and trust? 8. Rapid prototyping: The ability to create quick, early versions of innovations, with the expectation that later success will require early failures. How can you do rapid prototyping that allows you to fail early, fail often, and fail cheaply — while learning along the way?

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9. Smart mob organizing: The ability to create, engage with, and nurture purposeful business or social change networks through intelligent use of electronic or other media. How can you organize smart mobs using a range of media, choosing the best medium for each communication challenge? 10. Commons creating: The ability to seed, nurture, and grow shared assets that can benefit other players. How can you create settings within which both cooperation and competition may occur?

VIEW TOP Research & Innovation | 39

from the

Q: What added value does SARSTEDT offer to the Mexican health industry? A: SARSTEDT’s core business is clinical diagnostic. In the pre-analytical phase, we offer a unique dual system for blood collection that combines the aspiration technique and the vacuum technique, enabling users to safely and efficiently take samples. Before the traditional vacuum blood collection system was implemented, blood samples were obtained via syringes, with the advantage of a gentle technique – aspiration - but they are limited usage since they lack of chemical preparation and are not suitable for modern automated analyzers thus blood samples need to be transferred to a prepared vacuum tube to be analyzed, this common practice may cause hemolysis in the sample. The vacuum tube solves this problem. However, vacuum technique is not suitable for every patient. This method puts some pediatric, geriatric and those suffering from certain specific pathologies at risk because their veins are so delicate that may collapse. In such cases, syringes and other open techniques, such as capillary blood sampling, are used but they compromise the sample, the patient and the user. SARSTEDT’s unique system eliminates these risks. Our solutions make the entire process more efficient and eliminate

Luis Valdés

the need to waste samples, which saves time and money. Our cost-benefit solution optimizes the blood-taking process and provides savings for laboratories and hospitals. A successful pre-analytical phase makes the entire process more efficient

General Manager | Sarstedt México

and avoids double expenditures. Q: What is SARSTEDT’s product portfolio regarding COVID-19 detection?

Innovation Offers Unique Value in Pre-Analytical Processes

A: Our products were in high demand during the pandemic, including our PCR plates, pipette filter tips, transportation tubes, cryotubes and swabs. These product families significantly increased the company’s profile during the past two years. The brand is now well-known in the industry and other stakeholders have begun to understand how we can help them. Q: How will SARSTEDT translate its higher profile into a greater market penetration of its dual blood-collection system? A: This is the biggest challenge for SARSTEDT in Mexico. Our dual system is unique in the world. Our products are generally designed for six types of clients: hospitals, clinical laboratories, blood banks, veterinary, industry and research institutes. Of those, four are potential clients for our dual blood-collection system, mainly hospitals and labs. Nowadays, patients are more aware about the importance of sanitary protocols and their own care about blood management. These concerns made us create a dual and 100 percent disposable system to fulfill their expectations and provide an

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integral solution. SARSTEDT will compete through training. We do not compete on price or substitution but by offering real solutions that provide efficiency and savings.

The Significance of Innovation Alejandro Luna Partner | Olivares

Value, Impact of Patient Blood Management 02/17/2022

Innovative, Itinerant Articulated Services for Heart Surgeries 02/17/2022

Personalized Medicine: A Growing Opportunity 02/17/2022

Genomics Is Taking Diagnostics to the Next Level 02/17/2022

Technology to Manage Chronic Diseases 02/16/2022

Patient’s Role in Health Outcomes 11/08/2021

MRNA-Technology HIV Vaccine Tests Have Begun 01/28/2022

Cost Should Not Be the Only Focus of Healthcare: Ultragenyx Nicolás Linares Executive Director and General Manager | Ultragenyx Pharmaceutical

Chronic Pain Recognized by Ministry of Health 12/15/2021

Medtech Medtech has grabbed the industry spotlight, with digitalization becoming a reality despite the obstacles. Medtech aims to be a support system for patients and providers, creating local solutions that target both the specific and general needs of the population. This segment is forecast to continue growing as investors realize the potential profitability of advanced solutions. While most funds come from foreign investors, medtech providers and entrepreneurs are hopeful that the country will soon acknowledge the longterm benefits of local innovation. Experts in this sector have two major goals for 2022: having a clear regulatory framework to operate under and boost investment and establishing a healthtech ecosystem that interconnects all providers in the health chain.

Medtech 44

Analysis Building a Local Healthtech Ecosystem

Conference Highlights Redefining Tech Skills for Health Talent

View From the Top Oscar De la Garza | CEO and Founder | MEDPACOM

Expert Contributor Javier Cardona | CEO | 1DOC3

Expert Contributor Adrián Alcántara | Director General | Doctoralia Mexico

View From the Top Carina Reverter | CEO and Partner | Meeting Doctors Latam

View From the Top Christian Rivera | CEO | Smart Doctor Javier Sánchez Serrano | Business Developer | Smart Doctor

Analysis Tech Needed to Democratize Health Access, Promote Prevention

View From the Top Guillermo Pepe | CEO | Mamotest

Conference Highlights Technology to Strengthen, Democratize Primary Care

View From the Top Amiel Rosales | CEO and Co-Founder | Nubix Arturo Jain | CTO and Co-Founder | Nubix

View From the Top Cristina Raunich | CMO | Terapify

View From the Top Ricardo Moguel | Founder and CEO | Clivi

View From the Top Cristina Campero | CEO | PROSPERiA Alejandro Noriega | CTO | PROSPERiA Abelardo Vidaurreta | COO | PROSPERiA

Expert Contributor Gustavo Rodríguez Leal | Founder and CEO | nutriADN

Content Links

Medtech | 44

Building a Local Healthtech Ecosystem MEXICO’S HEALTH MARKET VALUE (US$ million)

As the digital transformation permeates the health sector, creating a complete healthtech ecosystem has become a priority

257.03

2017

for industry providers. Healthtech has proven to be a bridge for

221.85

care provision and as local companies further develop solutions,

302.78 325.72

2018

405.36

2019

512.16

2020

supports the transformation of an organization-centered

603.22

755.59

2022

In essence, a healthtech ecosystem is infrastructure that

511.1

638.91

2021

purpose of this system is to deliver multidisciplinary and

500

and skills through devices, procedures, systems, medicines and vaccines that solve numerous health problems and improve the

852.96

1,000

1,500

Digital fitness and well-being

quality of life of the population. Apart from being a booster to Mexico’s health system, it also has a large influence on the

906.8

1,215.16

2026

Healthtech is present in the application of organized knowledge

801

1,108.71

2025

collaborative health services that overall transform the system.

745.56

994.85

2024

healthcare model into a patient-centered model. The main

679.33

876.82

2023

results show more precise outcomes.

415.21

2,000

2,500

country’s economic development, as local tech development is a pivotal indicator of national development.

E-health In the private sector, startups have been agile to come up with

Source: Statista

innovative solutions much quicker than established companies with more stakeholders who may take longer to approve new

Despite these projections, only

projects. Startups are also able to specialize in ultra-specific areas, unlike established companies that may not be able to

dedicate time or personnel to specific issues. Startups are among the leading actors creating a healthtech environment

of startups in Mexico are dedicated to providing health and technology services

globally and in Mexico. By studying health-related habits, preventive health and wellness, and pairing these with new lifestyle technologies, entrepreneurs are promoting greater access to healthcare. Development of local tech has materialized in states such as Jalisco, which is known as the Mexican Silicon Valley due to its bet on entrepreneurship, tech and innovation. “The state has built strong innovation capabilities in many sectors thanks to its great universities and academic programs in engineering, medicine and many other specialties,” says Georgina García, President, Jalisco’s Medical Cluster. Local universities have comprehensive healthcare-focused programs, such as a bachelor’s degree in biomedical engineering and others in complementary areas like industrial engineering and marketing, García says. The state also has a CONACYT center and a CINVESTAV center with research focused on IoT and biotechnology, supporting many activities within the cluster. “This concentration of knowledge brings interesting opportunities to the medical industry and has allowed the state to develop its Una Salud por Jalisco (Health for Jalisco) program, which follows WHO’s recommendations on creating a transversal model for healthcare,” according to García. Investment in innovation and tech has boosted Jalisco’s economic development, placing it among the Top 5 states based on GDP. Jalisco is No. 2 on the list of innovative states, Read the complete article More about this topic

which, according to its government, has contributed to its competitiveness in terms of income and public spending to support orderly urban development.

Conference

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Highlights

Redefining Tech Skills for Health Talent Jorge Valdez Dean of the Medicine and Health Sciences Faculty | TecSalud

Sonia Pérez Executive Director | UDIBI-IPN

Igor Renan da Costa Latam Account Executive | Docusign

Jorge Zita Regional Sales Manager GHE | CrowdStrike

Nidia Garza Vice President Talent Management | MMM Holdings

hile technology is already used daily in healthcare, increasing its penetration could further benefit the profession and the patient, say health experts. But despite its great promise, most health professionals feel

insufficiently trained to deal with the digital revolution, according to a survey by the EU Health Parliament. “We need to acknowledge that tech must be integrated into medical education and first train educators to pass on that information,” says Jorge Valdez, Dean of the Medicine and Health Sciences Faculty (TecSalud), Tecnológico de Monterrey. Education could benefit the profession but training should be continuous throughout the medical professional’s entire career. Training should also be practical and hands-on to directly benefit the patient. “The industry must be aware that with this training, there are different levels of required skills,” says Sonia Mayra Pérez, Executive Director, UDIBI-IPN. Tech is highly dynamic, thus, staying up-to-date on specialized competencies in health is a demanding job. “As care providers and educators, we must consider the basic, specific and superior levels of competences we are going to learn and teach and to whom we must teach them. Once this is defined, updating the knowledge becomes the challenge.” Tech can be the ultimate solution to many of the problems faced by health and life sciences professionals because it is an ally in diagnosis, management and growth. “Automation in the health sector is reflected in greater productivity and time management, which is easy to measure because projects in this sector always have a certain level of urgency and a direct impact on people’s lives,” says Igor Renan da Costa, Latin America Account Executive, Docusign. The benefits of the digital transformation are undeniable but so are its risks as it continues to expand. “Many companies and institutions work on-site, accustomed to their IT department protecting their internal information. But as working processes become remote and more data is generated, users become more exposed,” says Jorge Zita, Regional Sales Manager for GHE, CrowdStrike. Misused data can lead to an in-house mistake or a cyberattack, according to Nidia Garza, Vice President for Talent Management,

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MMM Holdings. “It is important to inform professionals of these dangers to make sure they are aware of what a poor understanding of tech can cause,” Garza says.

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from the

Q: What is MEDPACOM’s differentiator versus other telemedicine services in the market? A: MEDPACOM formalizes the doctor-patient digital interaction. Our core business is centered around empowering health professionals to generate income through virtual consultations. Advice or recommendations provided through a traditional digital communication app often turn the medical practice into a hobby, which devaluates the doctor’s knowledge and experience. Q: In MEDPACOM’s view, what is a professional telemedicine service in terms of quality of care? A: Three factors determine a professional telemedicine practice. The first is the proximity of the relationship between the doctor and patient because there might be health complications that need to be handled in person. Second is the trust built with the doctor. The final factor is the confidentiality of the private information shared during the appointment. This is one of the reasons why telemedicine has not escalated: when a telemedicine platform pairs a random patient with a random doctor, it is basically breaking these three factors. MEDPACOM has found that the most effective way to build a sustainable telemedicine practice is by first creating the

Oscar De la Garza

doctor-patient relationship in person and then continuing this relationship online. At MEDPACOM, doctors determine the fees for their services. We view technology as a support tool, which has driven us to create a friendly platform that facilitates

CEO and Founder | MEDPACOM

management processes. This means doctors spend less time filing in patient records and have more time for their patients. Medical professionals were recognized during COVID-19 and we want to provide them with the best tools we can. We

Digital Channel Fosters Closer Doctor-Patient Relationship

created MEDPACOM’s medical council to guide us through the development of this platform. Our business model is very transparent: 90 percent of the company’s income is given to the doctors using the platform and the remaining 10 percent is used to continue growing. Q: What is your approach to hospitals and clinics? A: We are developing MEDPACOM Institutional exclusively as a communication channel between health facilities and their doctors. The channels will be divided by specialty and MEDPACOM would be the digital platform where patients can enter their electronic clinical record (ECR) and receive digital consultations. We will also include the ERC, which will soon be validated in most pharmacies in Mexico. MEDPACOM developers do not have access to ECRs and we comply with all national and international norms regarding the management of sensitive data. We are also supported by Amazon Web Services (AWS). Q: What role does MEDPACOM want to play in the growth of the Mexican health system?

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A: We want to support IMSS and the public healthcare institutions in the same way pharmacy-adjacent medical offices (PAMO) do: by helping them look after a large number of patients. We are first approaching Nuevo Leon’s government and later we will approach institutions in other states.

fter COVID-19, safety, well-being, and health regulations are part of our present and future. Even if we want to return to “normality,” ensuring comprehensive health services to employees will bring long-lasting benefits. That is not just about

complying with the laws of each country regarding the obligations that apply; it is about understanding and creating a plan of action that allows employees to live more peacefully and happily in a productive and responsible role as a worker but that holistically supports them in the other areas of their lives. But why does corporate health contribute effectively to business? Because well-cared-for employees are more productive employees. Increased work productivity is perhaps the most important point of all. Another benefit is the prevention and reduction of absenteeism, a major concern of business leaders. There would be less time off to visit the doctor, fewer staff absences due to sickness and a more compact workforce able to work at its best. All this boils down to considerable cost savings.

Medtech | 47

What can companies and business leaders do?

Prioritizing the Health of Your Associates Is Great Business Javier Cardona CEO | 1DOC3

Generate Flexible Spaces We are not talking about a big, beautiful place; we are talking about a workspace that understands the needs of each employee. Flexible work is a term used to describe a company that has different and accessible locations, remote schemes and staggered or partial schedules. In this case, flexible working not only benefits employees who find a different way of working much more relaxed, it is also beneficial for companies, which can optimize expenses by saving on office costs and everything else involved in having an office. Investing in Health Taking care of our employees and their families is fundamental to establishing long-lasting and useful relationships. Motivating and promoting healthy actions and activities can improve the working environment of any company. There are different options to cover the health needs of our employees and if COVID-19 left us with anything, it was the opportunity to find in digitalization timely solutions that contribute to and support the achievement of these health goals. Why not think about telemedicine platforms that help companies to centralize their health needs? According to figures from 1DOC3, the consultations allow the identification of situations where timely intervention is possible and where companies can benefit. Some of these situations are: + Affected emotional well-being: anxiety and depression (27 percent) + Potential occupational health and/or disability situations (12 percent) + Risks associated with chronic diseases (5 percent) + Other (11 percent)

Providing these types of benefits and tools is giving employees the importance they deserve, and in my experience, they will give it back through responsibility, productivity, leadership and love for the company. Adapting to these new demands will be the biggest challenge for employers in 2022. Health is inherent Read the complete article More about this person More about this company

in all aspects of everyone’s life and the workplace is no stranger to this situation. Companies that want to be leaders in their profession will have to think about, motivate and implement actions in which health and well-being are at the forefront, regardless of the sector in which they operate.

n Mexico, like in many other countries, there has been an accelerated transformation in the health sector to overcome “technological gaps” and provide patients with the care they deserve. From my perspective, the health sector faces three challenges in the wake of the coronavirus pandemic.

Health Sector Digitalization In Latin America, according to data from CEPAL, evidence began to amass that highlights the importance of digital technologies to counteract isolation, spread prophylactic measures and facilitate the operation of economic systems. The relative success in the control of COVID-19 in some countries within the region was explained by the use of mobile apps and information systems supported on digital technologies. The challenge is to achieve the democratization of health services through technology and to provide the entire population with equal access to health services. Technology Adoption According to the 17th Study on Internet Users Habits in Mexico,

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carried out by the MX Internet Association (AIMX), by 2020, there

The Challenges for the Health Sector in Mexico Adrián Alcántara Director General | Doctoralia Mexico

were 84.1 million web users in the country, which represents 72 percent of the population ages six and older. During the last year, as a result of the lockdown, the number of web users had the largest growth rate observed in the last five years. As to the number of digital-based patients, they also experienced major growth. At a webinar on digital perspectives organized by Doctoralia in October of last year, Adrian Olaya, Senior Manager, Comscore Latam, not only pointed out this increase, but also the growth in the age ranges of digital patients: those between ages 45 and 56 experienced major growth, while those between 55 and 64 were in the 12 to 20 percent range. This shows that the lockdown challenged patients of all ages to focus their habits on digitization, increasing their internet searches on health topics, online drug purchasing, and communicating with professionals through channels other than one-on-one, such as social networks, health platforms and apps, which is leading to greater trust in virtual communications between doctors and patients. In fact, health professionals also had to evolve in their digital habits and, according to the First Study on Digital Habits of the Medical Community in Mexico, held by the AIMX in 2021, the penetration of doctors connected to the internet in our country is 84 percent. Limited Online Reach Due to the growing number of digital patients, people offering health services had to speed up their response time and enable their technologies to attend to the population requiring support, not only for COVID-19, but for other treatments as well. This brought forward online consultations and an endless number of digital tools; nevertheless, the gap in internet coverage must be breached so 100 percent of the population can access the service, and with it, remote healthcare. According to the National Institute of Statistics and Geography (INEGI), in 2020, the urban population using the internet was 78.3 percent, while in rural zones, it was only 50.4 percent,

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which evinces the need to expand the coverage. An effort is required, not only from the private sector but also from the public sector, to breach these gaps and offer the entire population the opportunity to receive medical attention. Digitalization offers great opportunities to achieve this goal.

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from the

Q: Why was MeetingDoctors conceived as a B2B solution only? A: MeetingDoctors provides telemedicine services that our clients can offer to their customers under their branding. We launched our operations in Spain in 2017 when we saw an opportunity in the insurance sector to create an alternate channel for teleconsultations through chat or video call. This was an optimal tool for companies that already had a large pool of clients but did not have the technology to offer telemedicine. We create our own technology and do not rely on third parties. Our technology stands out because we bet on a model of immediate response. We have over 7 million end clients connected to our service and we are committed to responding to a chat or video call in less than two minutes. We cover over 10 medical specialties. Our services require a robust and user-friendly technology and service, which is by provided by well-trained, highly-qualified doctors on our payroll. We have a global chain with a strong base in Spain but we adapt to each country’s regulations. For the provision of electronic prescriptions or medical diagnostics, many regulations require the doctors to be local. We have approximately 300 doctors globally and 25-30 in Mexico. We also offer prevention services, such as nutrition, psychology,

Carina Reverter

personal trainers and others, which can be managed by a professional from any country. Q: How does Meeting Doctors manage patients

CEO and Partner | Meeting Doctors Latam

who require in-person treatment? A: We build programs depending on what the client is looking for. Insurance companies often have alliances with medical networks for in-person visits and with pharmacies for

Platform Tackles Mexico’s Lack of Insurance

prescriptions. Our job is to build the patient’s journey to the in-person consultation, leveraging technology and people. Q: What has been the reception to your services in Mexico? A: The reception has been positive. We came across some particularities of Mexican culture that made telemedicine all the more important. For example, insurance penetration is remarkably low in the country, with only 7 percent of the population having medical insurance. This contrasts with the EU, Asia, the US and even other Latin American countries. The COVID-19 pandemic further strained public health services. This was an opportunity for companies that wanted to offer their employees a way to access medical services but could not afford medical insurance. Our services might not cover 100 percent of health needs but they cater to 70 percent of the needs of most companies. Q: How are you expanding your services in the country? A: We are committed to Mexico and will offer different

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services to insurance and private companies for their employees and or their clients. The public sector has been slow in providing primary care so Mexico’s population stands to benefit from telemedicine. Telemedicine can even reduce the need for in-person visits in many cases.

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Q: What differentiates Smart Doctor from other health platforms in Latin America? CR: The primary difference of Smart Doctor is its vision. The Mexican health sector is highly fragmented. We created Smart Doctor to address this problem. Smart Doctor is an ecosystem focused on health and well-being that addresses common matters such as mental health and nutrition but also chronic illnesses, such as obesity, hypertension and thyroid diseases. We are gradually providing coverage for all diseases to truly be a single system that provides everything, up to pharmacies and laboratories. We want to be an end-to-end solution.

Christian Rivera

Q: What key elements make Smart Doctor a professional telemedicine platform? CR: Healthtech startups must have a medical professional onboard.

CEO | Smart Doctor

As a medical professional, I have observed that many Healthtech services have not adapted to their needs. Also, medical education does not include a single course on digital health. For many doctors, it seems like a language they do not speak. Smart Doctor is completely different. It was built by doctors and developers and later shared with 10 medical professionals, then with 50, then with 100. It was then opened to doctors from the public and private sectors. The reason doctors are attracted to the platform is because it was created by them and for them. Q: What alliances have been key for Smart Doctor to offer a professional, functional medtech service? CR: We are an omnipresent, on-screen medical support that provides constant help. Of those who visit an ER, 90-95 percent do not face an actual emergency; they only want a quick service.

Javier Sánchez Serrano

However, they are creating congestion in a system built for those who truly need emergency care. The health sector is inefficient because there is no middle responder to diagnose the severity of the problem. Smart Doctor is targeting that middle market

Business Developer | Smart Doctor

between hospital care and self-medication. Q: Smart Doctor allows physicians and patients to chat before

Smart Doctor Provides Immediate Medical Attention

a medical consultation. How is the chat kept professional? CR: Medically, professionals previously only had the option to communicate through WhatsApp, which is not very professional. There was a great deal of confusion over whether those communications were consultations or not and if medical professionals should charge for them. Smart Doctor has a chat app where doctors can analyze a problem and determine if the patient can wait for a visit or must go to the ER. In non-emergencies, it also allows doctors to decide when to respond. If they are not in office, they can choose not to respond immediately. But if there is an emergency, they can choose to respond. JS: From the point of view of a patient, whenever they do not feel well, they would usually go to a hospital and look for a specialist. With Smart Doctor, they can find a variety of

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specialists. Patients write to them and the doctor determines whether they can help or point them to the ER. If they cannot redirect a patient, the latter can contact customer service, which will survey the medical team and find the correct specialist. One of the main issues for users is that they do not know where to start, so the platform helps them figure that out.

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Tech Needed to Democratize Health Access, Promote Prevention INSURTECH’S CAPITAL RAISING (US$ million)

Prior to the pandemic, healthtech was a vision for the future.

Today, it is present in diagnosis, treatment, management and

has helped to establish a preventive health culture. Still, many

6 5

2014

“Tech adoption within the healthcare sector has historically been slower in Mexico because doctors and other entities in the sector take their time adapting to emerging changes,” says Roberto Aguilera, Health Sciences and Wellness Consulting Partner, EY Latin America North. However, according to an EY international survey, industry players are now prioritizing future investment and incorporation of

4 0

barriers are preventing a full technification of the sector.

technology into their practices.

innovation. Technology has democratized health access and

2015

Raised capital

2016

2017

—

2018

2019

2020

2021

Total rounds

Pharmaceutical companies are leading the way in tech integration. “We are convinced that technology facilitates business. Adapting to changes, opportunities, trends, requirements, regulations and controls is easier using technology,” says Fernando Gamallo, CIO, Sanfer. Tech offers greater control of raw materials and of what, when and how the company is producing to prevent any shortages and

always be responsive to the patient’s needs. “Without even changing manufacturing processes, technology does influence

entrepreneur companies identified working in Mexico

the way our plants work. In the warehouse, automation helps to administer orders, clients and our over 2,000 SKUs,” says Gamallo.

From these,

In terms of innovation, tech leads to sustainable R&D models

86%

that impact costs. “Research costs have increased together with the complexity of new developments. Incorporating

were founded in Mexico

information tools and data analysis is essential to reduce development times as we have greater access to information and better internal communication, which leads to cost reductions,” says Florencia Davel, General Manager for Latin

1,271

America, Bristol Myers Squibb.

direct employments generated

While its impact is clear, there are still areas of opportunity to ensure that tech will remain a standard practice in health. A study by Global Health Intelligence found that even though telemedicine saw significant growth, just 3 percent of the

Source: Endeavor

hospitals in Mexico offer this service as part of their portfolio. For experts like Arturo Jain, CTO and co-Founder, Nubix, interoperability and cooperation among all actors is essential to standardize tech use as it would allow all companies to offer better service. “An interconnected system would register the patient’s journey through a health service so every actor can be aware of their state.” Training and education of medical professionals in these new tools in also fundamental for widespread technology adoption. These professionals must be ready to implement such technologies to boost operational efficiency and improve Read the complete article More about this topic

patient outcomes and experiences, says Jorge Valdez, Dean of the Medicine and Health Sciences School (TecSalud), Tecnológico de Monterrey.

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from the

Q: Why is Mamotest an ideal solution for Mexico’s and Latin America’s social and economic reality regarding healthcare? A: Breast cancer’s impact is linked to the lack of early diagnostic opportunities, especially in Latin America, due to shortages of mammographs and outdated technology used to perform a screening. Moreover, access to specialists is also lacking as they mainly work in urban areas. There is also limited awareness on the subject. With this in mind, Mamotest was developed 10 years ago as a telemedicine-based solution that uses remote stateof-the-art mammographs to enhance access to a proper, timely diagnosis. This solution does not depend on an in-person visit; it virtually reaches out to specialists to obtain a professional diagnosis. Mamotest can be used by anyone no matter where they live, whether in the capital or a rural community. Through this solution, women in both locations receive the same quality results from a recognized specialist. Mamotest increases access to care — 70-80 percent of women who have used it were unable to receive an in-person diagnosis. The solution also provides top-quality service, delivering results within the first four hours after the mammography. We have already diagnosed 500,000 women in Argentina, allowing us to obtain investment from Merck Sharp & Dohme (MSD), their first direct investment in Latin America. We will use this investment to expand to Mexico.

Guillermo Pepe

Q: Mamotest’s goals include venturing into Mexico between 2020 and 2025. How did your regional success propel this plan and how is the expansion going?

CEO | Mamotest

A: Mexico’s health system is fairly different from Argentina’s. However, the Mexican market is larger because we are able to work directly with patients, while in Argentina we have to work through an insurance company. In Mexico, we are planning

Regional Telemammography Solution Meets Social, Health Needs

to expand through pharmacy chains, local governments and individual diagnostic centers. For example, Mamotest allied with Fundación IMSS in October 2021 to spread awareness. We hope to replicate these efforts in 2022 to reach a wider audience and save more lives. During our physical expansion, we have recognized that to save the patient, it is necessary to go beyond diagnosis and offer treatment to those who need it. With MSD’s investment, we have started developing our Bolder platform, which will manage the patient’s follow-ups. Bolder will allow patients to store the data from the different follow-up studies and treatments on their journey to a full recovery from breast cancer. The real-time data generated by Bolder will be used to improve treatment, accessibility and care for women. It will also be used to create a database of the disease that can later be used to create novel solutions and provide the appropriate care and resources for treating breast cancer. We expect to collect data from a variety of indicators, such as mental health impact, treatment adherence and socio-economic trends that might influence outcomes. This data will be protected and anonymized. Bolder

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is possible thanks to our work with German company Vara, their expertise on artificial intelligence, used by the German health system, and Mamotest’s know-how are added to the continuous monitoring of the patient through Bolder to offer the best diagnostic experience.

Conference

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Highlights

Technology to Strengthen, Democratize Primary Care Mario Aguillón | AIM Co–Founder | Board Member Zenda.la

Guillermo Pepe CEO | Mamotest

Andrés González-Silén Executive Chairman and Co-Founder | Asistensi

Arturo Sánchez CEO | Sofía

Eduardo Medeiros Co-Founder and CEO | Welbe Care

Carina Reverter CEO | Meeting Doctors

echnology has played an important role as an enabler and paradigm-shifter in multiple industries. Although the Mexican health sector is far from reaching its full technological potential due to a variety of barriers, technology will break paradigms and democratize the

primary healthcare (PHC) and insurance culture in the country, say industry experts. “The low penetration of medical insurance in Mexico is astonishing. Technology offers great advantages regarding PHC, both for patients and for healthcare providers. Patients save time and do not need to be exposed, while healthcare providers have a more efficient model, which takes advantage of technologies such as telemedicine,” says Carina Reverter, CEO, Meeting Doctors. “Access to PHC is the foundation for good healthcare. Combining PHC with insurance, which could cover long-term diseases, is key. Prevention and timely detection of serious diseases allow us to subsidize the cost of providing PHC. This combination links the financial incentive with people being healthier,” says Arturo Sánchez, CEO, Sofía. Technology focused on improving PHC has also penetrated the Mexican B2B market, with companies such as Welbe Care offering a comprehensive well-being ecosystem that integrates artificial intelligence and human contact to ensure the physical and mental health of employees. “Twenty-one million of the 29 million Mexican employees only have access to public health. We aim to increase access and raise the quality of healthcare,” says Eduardo Medeiros, Co-Founder and CEO, Welbe Care. But technology itself may not be enough to boost PHC in Mexico, says Mario Aguillón, Board Member, AIM, and Co-Founder, Zenda.la. “The question here is what do we need for our solutions to be adapted and adopted to Mexicans’ lifestyles.” The way to foster PHC is through incentives, says Andrés GonzálezSilén, Executive Chairman and Co-Founder, Asistensi. “Medical emergencies usually cause a health and financial disaster when they happen. Through technology, we can offer telemedicine and home healthcare, besides other services,” he says. “Technology is an enhancer of democratization, not only to healthcare access but to quality services. It allows us to become more efficient and to lower costs. We seek the demonetization

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of services, such as mammograms, which would reach millions of women if they are available at a very low cost,” says Guillermo Pepe, CEO, Mamotest.

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from the

Q: How does Nubix develop its technological solutions? AR: Every solution we add to the platform is developed in-house following the client’s feedback after they have experienced Nubix. We adapt to each client because we understand that everyone works differently. Nubix’s goal is to facilitate early diagnosis and avoid health complications. AJ: We are looking forward to introducing novel, foreign technologies in Mexico to add to Nubix’s capabilities. Nubix operates with radiology tests but behind this solution, there is a complete suite of products that we seek to complement with teleradiology, schedule management and more. We also want to

Amiel Rosales

contribute to AI in radiology. Q: Apart from your growth in capital cities, how has Nubix expanded in rural areas?

CEO and Co-Founder | Nubix AJ: We are achieving our planned expansion in Mexico, which motivates us to continue approaching all remote areas of the country. We are present in over half of Oaxaca, beyond its capital and large cities. We still depend on digital imaging equipment but we do not require the state-of-the-art equipment that is centralized in major urban areas. We are also well aware of the network limitations in remote areas so we deliver results via text message, which can be easily accessed by doctors at any health center. AR: Outside Mexico, we are already partnering with third parties in LATAM. This is a natural market for us but we first want to fully understand those regions so our solution is as responsive there as it has been in Mexico. Q: How do you educate doctors to use your

Arturo Jain

tech and how open are they to adopt it? AJ: Nubix was designed to be intuitive and easy to use and understand by both doctors and patients. We allocated the

CTO and Co-Founder | Nubix

majority of our resources to understanding what patients, doctors, insurers and laboratories needed from the platform. As a result, we added a QR code in every result that contains the patient’s record to verify it is the right information.

Timely Radiology Diagnosis Powered by Nubix

AR: We are also in constant communication with the doctors who work with Nubix. They give us their feedback to improve the platform’s functionalities. We provide training for doctors when we add something new to the platform or when they join Nubix but they are able to operate the platform on their own after a few minutes. Q: How did the pandemic influence the use of Nubix? AR: The pandemic propelled the use of tech and of our platform. Accelerated digitalization standardized the use of tech for healthcare to the point where we see digital prescriptions becoming more common and accepted. The same happened with radiology results. Doctors and patients have begun to ask for

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digital results because they are more convenient. AJ: We surveyed 10,000 doctors and patients in the radiology field to evaluate their tech acceptance. The results showed that 90 percent of patients and 81 percent of doctors welcomed digital results.

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from the

Q: What is the added value that Terapify offers to those seeking psychological attention? A: Terapify offers a variety of psychological treatments. It considers what each patient needs and the way they want to approach their therapist. We are aware that some people might need guidance when selecting the type of therapy that is best for them. We help them find the most suitable choice. Others already know the method they prefer. Terapify provides a simple test to help patients understand what is best for them. It explains the types of psychological approaches they can choose from and helps them select their preferred method and therapist. Patients are also able to test whether they feel comfortable with the method and the therapist they chose and make changes if necessary. We were aware that therapy remained a taboo for some so our goal was to make the therapy experience easy to access and as enjoyable as possible. Finding help needs to be fast, affordable and efficient, and the internet and technology enabled Terapify to provide exactly that. We also share educational content to create awareness of the importance of mental health so people are more comfortable to ask for help. Q: With the growing focus on mental health in the workplace, how attractive has your service been as a corporate benefit?

Cristina Raunich

A: NOM-035, which has been active since 2019, asks companies to integrate tools to identify, analyze and prevent psychosocial risk factors in the workplace. As such, companies are required

CMO | Terapify

to promote a favorable corporate environment, independent of their size. The corporation is responsible for identifying such risks and promoting a safe working environment. The NOM made companies recognize their weak spots and their areas of opportunity. To address them, they have integrated emotional

A Mental Health Support System With No Barriers

support for their employees. During the past few years, we have been exposed to an earthquake and a pandemic that led to stress, anxiety and grief if a loved one was lost. While not everyone manages these issues in the same way, companies need to offer resources equally. Terapify is available to those who need it. Our services will adapt to the company’s requirements. To date, we are working with over 10 companies that have chosen online therapy as a benefit for their employees. Q: How has Terapify performed during the pandemic? A: Terapify was created after the September 2017 earthquake, after the company’s founders recognized that numerous therapists were offering their services on social media, and numerous patients required those services. Terapify’s founders gathered all of them into a single platform, which later became a hub that offers diverse approaches and a trained staff for online medical services. During the pandemic, we grew five times and we continue to see

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double-digit growth every month in our individual and corporate services. As an online service, we are present in different states in Mexico and abroad. We have large demand from Germany, the US, Colombia and Peru, driving us to integrate professionals from other countries.

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from the

Q: What is Clivi’s role in the health system and how is its business model innovative and disruptive? A: Diabetes is the second-leading cause of death in Mexico and the main root of those deaths is that many patients do not manage the disease properly, leading to serious complications that affect their quality of life and put their lives at risk. Diabetes also impacts the lives of the patients’ families. As 12.8 million Mexicans have diabetes, a large percentage of the population sees their life affected by the disease. Studies also estimate that there are 12 million diabetics who have not been diagnosed. Together, both groups represent almost 20 percent of the Mexican population. This can help explain the impact of COVID-19 in the country because four out of every 10 people who died due to COVID-19 had diabetes and five out of 10 had hypertension. Chronic disease management involves a traditional program offered in an in-person specialized clinic. This has some issues. First, it is a private service that not everyone can afford and these clinics are usually found only in cities. Second, there are only 1,400 endocrinologists in Mexico, so even if they were distributed throughout the country and patients had the resources to pay for their services, there would not be enough professionals to meet demand. Tech offers a solution for this problem.

Ricardo Moguel

We wanted Clivi to be an alternative to Mexico’s national health strategy to manage chronic diseases. Clivi is a low-cost alternative to treat and manage chronic diseases through a multidisciplinary team that follows international standards. Our

Founder and CEO | Clivi

role in Mexico is of a tech-based, tertiary care supplier providing an integral approach to disease management. We are a fully digital service and are able to reach every person who uses the internet and suffers from a chronic disease. In the near future, we will look into establishing a hybrid service, in which patients have

Digitalization Creates Accessible Chronic Disease Management

first contact at clinics. Q: How do you ensure professionalism while using regular communications services like WhatsApp? A: Tech is not a trend in healthcare; it is a solution that helps providers reach more people. Telehealth has democratized health access in areas where there is not a single endocrinologist. Just in 2021, multinational health companies invested US$44 billion in tech. Governments, such as those in Colombia and Brazil, officially recognized tech as an important tool for healthcare. We decided to use WhatsApp because it has a high number of users in Mexico and became the most used channel to stay in contact with others during the pandemic. Had we developed a new service, we would have had more barriers to use and engagement that would have made it harder for people with chronic diseases. To have a faster impact, we chose to use Mexico’s most common communication channel. Q: In terms of investment, how has the company funded its operations and what are its investment plans?

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A: We initially used our own capital to fund Clivi but we had a first investment round from Silicon Valley. This seed investment will be used to quickly grow our operations. To continue growing, we will seek another investment round this year.

VIEW TOP from the

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Cost-Effective Diagnostic Solutions for Smart Health Systems Cristina Campero

Q: What factors do your algorithms consider to deliver results? AN: PROSPERiA develops tools to identify individuals with

CEO | PROSPERiA

undiagnosed diabetes, high vulnerability to the disease, and already diagnosed patients at risk of developing related complications. Once we identify a patient at risk, we can connect them with specialists to promptly prevent and/or treat their disease. The first step is carried out by an AI-based risk calculator, in which people answer questions related to their habits, height and weight, socioeconomic status and background of chronic disease prevalence, among other variables. With this information, our AI algorithms calculate a score that determines if the individual is at low, middle or high risk of having the disease. For instance, the platform calculates the risk of having diabetes, hypertension or sight-related complications. The goal of the calculator is to offer the patient timely referrals to adequate healthcare attention

Alejandro Noriega

before they present serious complications, such as loss of vision, which has the highest incidence for diabetic patients in Mexico. Q: Retinia is another of PROSPERiA AI solutions.

CTO | PROSPERiA

How does this tool support your calculator? AN: Healthcare providers use Retinia to analyze retinas’ images captured with a specialized fundus camera. Retinia analyzes these images, detects damage caused by diabetes and generates a recommendation regarding visiting an ophthalmologist to initiate treatment, or repeating the exam in the following 6 to 12 months. If PROSPERiA’s calculator indicates that a person has an eyesightrelated risk, it recommends the patient to have a retina examen to prevent diseases such as diabetic retinopathy. CC: Mexico does not have a regulation for tools like Retinia. In the US, it is categorized as software as a medical device, but a similar categorization is not available in Mexico. Retinia is not a typical medical device because it works independently from a physical

Abelardo Vidaurreta

medical instrument and does not deliver a diagnosis; it helps ophthalmologists to effectively identify an eye problem caused by diabetes. Retinia and PROSPERiA’s added value is the ability to target the population in need of specialized attention, allowing

COO | PROSPERiA

them to take early action to prevent loss of vision. We would like to see clear regulation for novel technologies like Retinia. Mexico has a very uncertain framework for technology in healthcare, so entrepreneurs are operating without clear local guidelines and only based on good-practice manuals generated

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by international organizations. This could be changed by opening the market to startup innovation and encouraging the adoption of these innovations.

cience continues to contribute to the progress of medicine, a clear example of which is that the world’s life expectancy has been increasing as knowledge advances. We no longer only need a medicine for treating prevalent diseases; we

also need a method of detecting diseases to which we are susceptible and a way to prevent them. Various studies have linked the factors related to diseases among workers that result in work absenteeism. In particular, a study carried out in Bogotá, Colombia, included information from 214 employees to determine the prevalence of risk factors related to cardiovascular diseases. The study’s results showed that the prevalence of absenteeism from work broke down as follows (where one respondent could select multiple afflictions): 13 percent was due to smoking, 35 percent to alcohol consumption, 40 percent to a sedentary lifestyle, 54 percent were workers who had high total cholesterol and 44 percent were overweight or obese.

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There is a need to highlight the importance of taking

Nutrigenetic Testing in the Workplace Gustavo Rodríguez Leal Founder and CEO | nutriADN

preventive measures that can help reduce cardiovascular risk factors in workers, as well as to help reduce the impact of morbidity and mortality from chronic diseases. The improvement of health in the working population will also be achieved and it is emphasized that wellness programs within a company reduce expenses related to medical services and labor absenteeism. Although the findings of this study and others like it present an interesting analysis of work absenteeism, they do not delve into the great impact of a very important risk factor: genetics. Knowing our nutrigenetic profile allows us to identify the variations contained in our genetic material, which affect our ability to metabolize the nutrients obtained in our diet or supplements and the diseases that they could influence. The above makes possible the development of strategies for the treatment and prevention of certain diseases. The benefits of using nutrigenetic tests in health and wellness programs are prevention and risk management, savings in medical expenses by preventing health problems beforehand or detecting them in the early stages, reduction of work absenteeism and improved performance in work activities. According to the results of a survey mentioned by Fordham (2016), 29 percent of the people surveyed answered that if they were aware that they had an inherited genetic variant related to the development of a disease, they would be willing to make changes in their lifestyle and 28 percent would be more careful with the medical monitoring of their health. The use of genetic tests allows us, through a preventive approach to medicine, to reduce suffering from serious illnesses that imply losses for companies due to medical expenses, work absenteeism and rotation of personnel. On the other hand, an investment in nutrigenetic tests and advice that guides workers to get to know their unique necessities and

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improve their nutrition, sleeping and physical activity habits represents, in comparison, a lower expense and, in addition, offers well-being to the individuals who make up the company. Companies can also generate the awakening of people’s interest in the care and monitoring of their health.

Next-Level Care Solutions Powered by Tech Esteban López Market Lead Healthcare and Life Sciences | Google Cloud Americas

Cloud Infrastructure for Every Health Provider Igor Fermin Principal Adviser Healthcare and Life Sciences | Google Cloud Latam

The Digital Transformation in Healthcare Mario Muniz General Manager North Latam | IQVIA

Pragmatec: Connecting the Healthcare Ecosystem Víctor Sánchez CEO | Pragmatec

Navigating Frustration Amid a Global Crisis Diego Muradás Co-Founder and CEO | Zenda.la

How to Launch a Tech Startup Ulises Vázquez CEO | Mureni

Big Data to Drive Healthcare 3.0 02/17/2022

Medical Devices Enhance Treatment Adherence 12/06/2021

WHO Publishes Ethics Guidelines for AI in Healthcare 10/27/2021

How Can Telemedicine Boost Productivity? 11/26/2021

Healthcare Environment Mexico’s historic health burdens represent a barrier for innovative solutions to succeed. However, providers have turned this around and created approach models that will boost prevention and well-being. Given the current challenges of low insurance penetration and low adherence to treatment, innovative leaders have developed insurtech and techbased products to promote a health culture that allows other solutions to permeate. Medicine access has also been strongly challenged since 2019, after the pandemic and the restructuring of the national purchasing scheme. Still, pharmacies and logistic companies have responded and created a solid provision base that is resilient to challenges and supported by local providers. In this environment, publicprivate collaboration is key to democratizing healthcare. In this chapter, tradition meets innovation as industry stakeholders highlight disruptive changes amid a slow but sustainable adoption of novel solutions.

Healthcare Environment

Analysis Tech-Based Approach Necessary to Tackle Health Prevention

Conference Highlights Digital Health Regulation in Mexico: Hits, Opportunities

View From the Top Juan Manuel Cáceres | CEO | Aidicare

View From the Top Luis Fernández | Co-Founder and CEO | TINC CMMS

View From the Top Esteban López | Market Lead Healthcare and Life Sciences | Google Cloud Americas

View From the Top Mario Aguillón | Co-Founder, Treasurer | Zenda.la, Insurtech Association Mexico

View From the Top Arturo Sánchez | CEO | Sofía

Analysis Mexican Health Chain Securing Drug-Supply Access

View From the Top Eduardo Medeiros | Co-Founder and CEO | Welbe Care

View From the Top Víctor Medina | President | HL7 México

View From the Top Praxedis Sánchez | HIS Business Manager | Dedalus Latinoamérica

View From the Top Ignacio Merino | Director General | Farmacia París

View From the Top Rodolfo Camargo | Director General | El Crisol

View From the Top Liliana Castillo | Head of Life Sciences and Chemicals Sales DGF Mexico | DHL

Expert Contributor Deyanira Chiñas | Commercial Director | T5DC

Content Links

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Tech-Based Approach Necessary to Tackle Health Prevention The transformation of the Mexican healthcare system has been focused on the objective of reducing the incidence of the largest burden on the system: chronic diseases. Through tech and new prevention methods, the country is finally materializing this goal, experts say. The Specialized Medical Units for Chronic Diseases (UNEME EC) established at public hospitals and clinics were the result of these efforts, focused on providing patients with an integral approach to chronic disease prevention involving detection, education and treatment. These units follow a “modular medical-architectural program” and offer multiple outpatient services properly organized and scheduled to scale the level of care to regional demand, with particular emphasis on illnesses with a so-called “catastrophic expenditure.” The initial goal of the UNEME ECs was to help reduce saturation rates and operating costs at hospitals, offering patients comprehensive care and personalized follow-up from medical, nursing, nutritional, psychological and social work staff. These efforts, however, have not delivered to the expected level. “Programs like UNEME EC were not enough to revert increases in the prevalence of NCD and its associated costs, which calls for additional prevention programs, regulations and policies,” reports Health Promotion International. Furthermore, according to a study by the Ministry of Health, most patients at UNEME ECs were only under integral treatment for five months. After that, they stopped attending their appointments. While strong government leadership is essential to reducing the risk and burden of chronic diseases (through policies and programs that create a healthy environment and improve access to care), effective intersectoral collaboration aimed at prevention and control of chronic diseases is just as fundamental. Mexican health leaders and entrepreneurs from the private sector have actively promoted programs on healthy habits, disease prevention and general information on health topics. Technology has become a common denominator in all these efforts. The use of new technologies makes the patient feel engaged in the prevention of various types of diseases, explains The Healthcare Insights. This has led to a number of applications for smartphones and computers that help people better control fundamental aspects of prevention, such as diet and physical activity. Insurtech Sofía, for example, offers easy access to healthcare through an accessible plan that includes preventive care, video consultations with specialists and coverage of medical expenses, all through an app. “Access to primary healthcare (PHC) is the foundation for good healthcare. Combining PHC with insurance, which could cover long-term diseases, is key. Prevention and timely detection of serious diseases allow us to subsidize the cost of providing PHC. Read the complete article More about this topic

This combination links the financial incentive with people being healthier and is exactly what we have built with Sofía,” says Arturo Sánchez, CEO, Sofía.

Conference

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Highlights

Digital Health Regulation in Mexico: Hits, Opportunities Juan Luis Serrano Partner- Life Sciences | Sánchez Devanny

exico has an urgent need for regulation in the healthcare sector after the pandemic exacerbated digitalization and the adoption of new technological innovations. “Digihealth is in a unique position as it combines tech and healthcare to give Mexican

citizens access to health services and digital technologies,” says Juan Luis Serrano Leets, Partner-Life Sciences, Sánchez Devanny. However, despite the significant impact it has on companies, doctors and patients, regulation is lacking.

Andrea Arozamena

Because digihealth merges health and information, its regulation

Healthcare Linkage Leader | GS1

must not only focus on health regulation but also on information

Christian López-Silva Partner, Head of Pharmaceuticals and Life Sciences | Backer Mckenzie

technologies to avoid skipping important steps such as technological neutrality, says Christian López-Silva, Partner and Head of Pharmaceuticals and Life Sciences, Baker Mckenzie.

Victor Sánchez

“Regulatory concerns are increasingly prominent considering

CEO | Pragmatec

that digital health is expected to grow 10 percent in the next

Fabiola Fajardo

five years in Mexico,” says Víctor Sánchez, CEO, Pragmatec. This

Strategic Consultant | Alitea

Gabriela Lerma Contract Sales and Medical Solutions BU Director | IQVIA

phenomenon is creating new ways of providing healthcare that were previously unheard of. Under these circumstances, regulation will impact not only the final user but also doctors who trust that the technologies have passed regulations and companies that invest in the health sector. Regulation is key because digihealth is here to stay, says Fabiola Fajardo, Strategic Consultant, Alitea. However, it needs to be regulated. “Digihealth will impact companies by affecting the interoperability between the public and private sector, reimbursement capacity with insurance companies and the impact perceived by investors. For doctors, it will mean a temporary workload increase with long-term benefits and increasing demand at decentralized clinical practices,” says Fajardo. Digihealth must be regulated to guarantee its quality and efficiency, adds Andrea Arozamena, Healthcare Linkage Leader, GS1. “Not having a clear regulation opens the door to products without assurance and security, but the regulation process should flow in the same direction as the operation,” says Arozamena. This technology brings numerous benefits to the sector, such as empowerment and increased accessibility geographically, says Gabriela Lerma Valencia, Contract Sales and Medical Solutions BU Director, IQVIA. However, it is necessary for patients and doctors to have guarantees regarding the use of their data. It is

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also necessary to have a regulation that ensures all players are well informed regarding regulated markets, telemedicine, prescriptions and digital file management, among other areas.

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from the

Q: What has been Aidicare’s most significant achievement in the last year? A: We have invested greatly in remote patient monitoring to complement our professional telemedicine services. For example, we added Omron’s interconnected medical devices, which allow doctors to remotely listen to a patient’s heartbeat in real time. To implement these changes, Aidicare has worked alongside recognized doctors from Mexico’s leading hospitals, such as Medica Sur and ABC. Using their feedback, we created a solution that allows doctors to reach new patients and comfortably provide follow-ups. The new components have also helped us add more specialists to our platform because they feel more comfortable having real-time devices that support their remote practice. Patients can be monitored remotely using disease-specific devices. For example, the kit for diabetic patients includes a glucometer, a blood pressure monitor, a scale and a tablet. Patients can rent those smart devices or use their own. The information from the smart devices is collected by a tablet and shared with the doctor, giving the latter a complete real-time record of the patient’s health. Patients are expected to input data pertaining to their daily habits, including medicine intake, exercise, nutrition and sleeping patterns. This data is used to generate algorithms to suggest changes that will improve the patient’s life quality. The platform can be used to monitor several different

Juan Manuel Cáceres

diseases and standardizes the data so it is easier for the system to have a cohesive nomenclature. With COVID-19 patients, our services made a difference on bed

CEO | Aidicare

utilization because doctors were able to tell when a patient needed to come to the hospital or could remain home. Q: How has Aidicare created an interconnected ecosystem that seamlessly links your services and those of external providers?

Remote Monitoring Services Supported with Real-Time Information

A: COVID-19 greatly accelerated interconnectivity. For example, the services we now provide with Omron were impossible five years ago. Beyond interconnecting medical devices, we can also use WhatsApp to send reminders or answer questions. We offered these services in the US and it is encouraging to see them in Mexico. We also developed the Health Late with Amazon Web Services (AWS), which identifies health and behavioral trends based on patients’ algorithms and habits and makes personalized recommendations. Using AI, we are able to accompany each patient on their health journey. Q: As a tech service hosting data, how do you ensure data is used safely and ethically? A: We are compliant with the US Health Insurance Portability and Accountability Act (HIPAA) to ensure patient data is protected. We work with recognized health institutions and doctors specialized in tech to ensure we use AI responsibly and provide bias-free diagnostics and recommendations.

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We are also working with professionals at MIT to develop a targeted, ethical innovation that truly improves health systems. Innovation is competitive these days but we should not forget functionality and ethics.

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Q: How did the COVID-19 pandemic impacted TINC as a hospital management company? A: The pandemic significantly impacted some of hospitals’ strongest business units, such as programed surgeries. This affected patient flows for private hospitals, which are our main clients. Most people thought that hospitals benefited from the pandemic but we noticed that some went nearly bankrupt as a result of COVID-19. Low-income flows for hospitals affected their providers, including us. TINC is part of hospitals’ continuous improvement areas, which were not a priority during the crisis. Our income was affected by the situation, but we found a way to remain relevant during a situation that required cooperation from all players in the sector. Taking a risk, we shifted our business model and developed a new platform called TINC LTE, which was provided to hospitals for free. This platform gives hospitals inventory control of their assets. The platform allows hospitals to experience the benefits of our platform and improve their performance through a standardized inventory of their medical equipment. This allowed us to reach over 800 hospitals in 11 countries and we are currently managing around US$370 million and nearly 32,000 assets registered on

Luis Fernández

the platform. As the pandemic stabilized, hospitals recovered and began to invest in infrastructure and improvement. By the end of

Co-Founder and CEO | TINC CMMS

November, we began to see results from our free platform. The hospitals that had been using it wanted to learn what more could the platform do for them and their equipment. The hospitals that began as free users became our clients.

Hospital Management Systems Needed to Support Key Investments

Q: What were the most concerning findings from TINC LTE in terms of usable equipment for care facilities? A: We found that the lack of a standard nomenclature is a problem for hospitals. Mexico urgently needs to adopt a nomenclature for medical devices to improve the overall capacity of health systems. Without it, we are unlikely to succeed on creating a strategy for sanitary crisis in the future. Moreover, we partnered with the Mexican Consortium of Private Hospitals (CMH) to study their hospitals nomenclature and standardize it to the Global Medical Device Nomenclature (GMDN). This one of the most important documents for clinical engineering nationally. The document will support the CMH in its technology acquisition planning and allow it to detect opportunities to improve its equipment. Through this work we also proved that by having a clear idea of the technology assets a hospital had, we are able to know if the facility complies with NOM-016 of hospital infrastructure. In addition, we made this information easy to access to each facility to facilitate decision making.

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During this work, we realized that the importance of clinical engineers inside hospitals grew. After the COVID-19 crisis, the importance of maintenance and correct functioning of medical devices was recognized as vital to treat, diagnose or guide patients, which is what clinical engineers do for hospitals.

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Q: What is Google Cloud’s long-term vision of digital healthcare and how are its solutions part of this future? A: Since the COVID-19 pandemic, many industries have seen their digital transformation processes accelerate. The health sector was no exception. Many changes previously seen as futuristic are now a reality. A survey of 300 doctors conducted by Google with the support of The Harris Poll found that 45 percent believed that the pandemic accelerated the pace of technology adoption at their workplace. Three out of five doctors mentioned that the pandemic forced their organization to make technology upgrades that would normally have taken years. Google Workspace tools fit together to meet the new needs of the sector. They help care coordination teams to collaborate and stay connected and doctors to follow up on patients through video calls. AI Documents make operations much more efficient by automating data capture and providing a comprehensive understanding of fax documents, PDFs and paper files, converting paper content into digital data. The interoperability of data and information is becoming increasingly popular. Solutions, such as Google Cloud’s API Healthcare, allow the upload of patient data in FHIR, HL7 v2 and DICOM standards and digitize workflows that were previously on

Esteban López

paper. Data and analytics tools like BigQuery are being used to provide a complete picture of patient data and key operational metrics for providers, turning data into actionable insights.

Market Lead Healthcare and Life Sciences | Google Cloud Americas

Technologies such as AI play a key role in the transformation of the sector. In this sense, solutions, such as Contact Center AI, through chatbots, make it possible to provide patients with the information they need, thus relieving pressure on healthcare contact centers.

Next-Level Care Solutions Powered by Tech

Q: How do Google Cloud services help advance ValueBased Healthcare (VBHC) models in the Americas? A: Our solutions do not replicate the VBHC model. The goal of Google Cloud for Healthcare is a reflection of Google’s overall mission, which is to organize the world’s information and make it universally accessible and useful. Applying this mission to healthcare means employing open standards to help enable data sharing and interactive collaboration while providing a secure platform. Ultimately, we hope that better data flow will inspire new discoveries with AI and machine learning, leading to insights that improve patient outcomes. At Google Cloud, we collaborate with customers to offer customized solutions that address their most complex challenges, such as operating with interoperability for the benefit of patients. Enabling the next level of interoperability is possible through the Healthcare Data Engine, an end-to-end solution that takes a heavy load off healthcare IT teams. The sheer volume of this data presents the greatest opportunity in the medical and life sciences industry by providing deeper

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insights and distributing them to the right people so they make better decisions in real time, adhering to the highest levels of security, compliance and respect for user privacy. We support healthcare organizations as their need for interoperability at scale grows.

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Q: How does Zenda.la fit into Mexico’s insurance system? A: We wanted to change traditional insurance. Insurance penetration is 2.4 percent in Mexico, which is very low compared to other OECD countries. We believe that this has been caused by the industry’s offer of complex, expensive products that are hard to scale to the general public. Traditional insurance distribution depends on insurance agents, which also limits the reach of the products. Moreover, the value of an insurance product is perceived only when an accident occurs, associating it with a bad experience. We wanted to offer a product that would respond in the best possible way to a person’s needs, leading to a friendly, free insurance product that can scale as much as the user wants. Free insurance coverage is possible for Zenda.la because we reduce costs by going digital and by not having a broker. Our business model would not be possible if we expected the same commissions that insurance agents receive. Free plans are also covered by the payments from premium plans. We can offer a better portfolio with solutions that truly adapt to our customers’ needs. It is similar to Spotify’s subscription model, in which some users choose to pay for the premium plan while others stay on the free plan. Q: Mexico’s traditional insurance penetration is significantly low. How could your business model change this panorama?

Mario Aguillón

A: Our main strategy is to offer a free product, which is different from a free trial. This is attractive to the general public and follows our aggressive growth plan. Zenda.la is also consolidating alliances to reach more users. For example, we work with fintechs

Co-Founder, Treasurer | Zenda.la, Insurtech Association Mexico

and other tech companies that believe in digitization. Working with us, these companies will not necessarily increase their expenses because they can use our free subscription. We are actively looking for strategic allies.

Premium-Free Insurance to Democratize Health

Q: How is the company able to cover chronic diseases, such as diabetes and cancer? A: We have a partnership with Swiss Re Group, the largest reinsurer in the world, which co-designed this product with Zenda.la. The alliance addresses financial health inclusion regardless of the patient’s condition. Insurance products are based on risks, not on certainties. To make a claim for a chronic disease in traditional products, the patient would have had to be insured for at least two years before diagnosis. At Zenda.la, this period was shortened to three months. Zenda.la has a dynamic coverage for critical illnesses: the first three months are not covered, the next three months are covered up to MX$9,200 (US$449.66), the next three up to MX$18,000 (US$879.76), then the next three up to MX$26,400 (US$1290.32) and so on until reaching the limit of the patient’s coverage. Our maximum is MX$240,000 (US$11,730.20). Q: What alliances have made your product possible? A: Our alliance with Swiss Re to co-design or product, we

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work with Prevem Seguros in order to have the operational capabilities that allows us to offer end-to-end digital processes, also we have an alliance with Salud Digna, which also aims to democratize health. This partnership allows us to offer blood tests that analyze 30 different indicators.

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Q: Sofía’s goal is to improve the way millions of people care for their health. How does the company use tech to achieve that? A: Traditional insurance companies usually require in-person contact. Gradually, several industries are migrating to a fully or mostly online operation but the health sector has been slow to adopt technology, missing out on the improvement it can provide. It allows doctors and people to better use their time during appointments and can take over the administrative processes for scheduling, payment and prescribing. On a larger scale and done constantly, this leads to the overall improvement of the system. At Sofía, we wanted to bring technology to the health care sector. Sofía uses tech not only to make interactions easier but to promote health and prevention through the same platform. With the creation of a proprietary system capable of integrating medical operations, insurance operations, etc, we want to be the only thing people need to take care of their health. Q: How does Sofía’s value offer differ depending on generational needs and lifestyles? A: Sofía offers a complete insurance plan that covers both minor and major expenses. Besides that, we also cover and focus on

Arturo Sánchez

preventive care, which is one of our main differentiators. This fresh approach to health is attractive to new generations that tend to be more aware and mindful about their health and daily habits. That is why we cover from a simple flu to a major

CEO | Sofía

incident: the major benefit of having Sofía is that you can use it at any time. Nonetheless, we offer our services to all generations; our product is suitable for everyone.

An Insurance Service for New Generational Needs

Q: What alliances have helped the company grow and establish itself? A: Our most valuable alliance is with the doctors that form our medical group: SofíaMed. They have propelled the use of Sofía; they are fundamental to our services. We do select doctors carefully to ensure they meet the required specialties and certifications. They have to be open to use technology to provide a better service. To date, Sofía has doctors in over 90 specialties and we are constantly increasing this network to enrich our offer. Hospitals are also important allies. In Mexico City, for example, we allied with Grupo San Angel Inn, which has six hospitals and a short-stay clinic. Laboratories have also been essential partners because they complement our services. Of course, we are certified by the main financial and health institutions in Mexico such as: The National Insurance and Bond Commission (CNSF), CONDUSEF and the Ministry of Health (SS), at the end of the day, these institutions give us the

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credibility of a serious and committed company. Sofía is constantly looking for more partners because we want to create an entire ecosystem of health built through partnerships that can provide services through our platform.

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Mexican Health Chain Securing Drug-Supply Access Supply shortages, poor infrastructure, long wait times and high out-of-pocket expenditures have all compromised health access in Mexico. Private sector experts are now trying to fight these problems by granting the population access to healthcare at a cost-effective rate, using innovation and technology as cornerstones in their strategy. Since 2019, Mexico has seen dozens of protests, hundreds of appeals and over 550 complaints to the CNDH (National Commission for Human Rights) due to medicine shortages going back to 2019. By Oct. 1, 2021, INSABI had only delivered 9.5 percent of all the drugs requested by states, with the entities with the lowest percentage of drugs delivered being Mexico City with 0.3 percent of its orders fulfilled, Campeche with 1.7 percent, Coahuila with 2.2 percent, Sinaloa with 3.6 percent and Chiapas with 3.9 percent. Beyond preventing proper treatment follow-up, the situation has increased out-of-pocket expenditure. According to Rafael Maciel, President, AMEGI, the use of generics in the public sector decreased by 22 percent in units and by 8.5 percent in value as a result of new acquisition processes, which caused many implementation challenges and led to further shortages. The decrease was mostly seen at IMSS, where 30 percent of the units it required were missing. “The shortages drove patients to seek medications in the private market. The majority of the missing drugs were for cancer or other high-impact diseases,” says Maciel. In terms of logistics, distributors have worked hand in hand with laboratories to ensure the best distribution practices for drugs and medical equipment. In this process, big data has expedited the optimization of routes for logistics companies worldwide. Many logistics partners of medical companies are using logtech developments to provide better services. Effective manufacturing and logistics execution is not completely dependent on the private sector, however. Public and private sectors play complementary roles throughout the entire health chain to supply medications and medical supplies. “Regulators also play a key role in ensuring access to medications. In the case of generics, authorities need to work faster so generic drugs can reach the population on time,” says Américo García, Vice President and General Manager for Latin America, Apotex. By accelerating this process, regulators will further promote a framework that will propel quick access to new medications and supplies, he says. Efforts from both sectors are required to end public medicine shortages. “We all share the same end goal, which is to deliver medical supplies to the patient,” says Karla Báez Ángeles, Director of Access to Innovation, AMIIF. These efforts, according Read the complete article More about this topic

to Rafael Gual, Director General, CANIFARMA, need also go to the production of pharmaceutical chemicals in Mexico to avoid depending on Asian production chains.

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Q: How does Welbe Care address both employees’ health needs and regulatory compliance? A: Mexico’s highly fragmented health system has led private services to focus on out-of-pocket expenditures, major medical expenses coverage or doctors working at pharmacy-adjacent medical offices (PAMO). There are few options for minor medical expenses and the coverage is often limited, so patients end up with large bills. Moreover, none of these options are used for prevention, which can be seen in the high percentage of work handled by occupational doctors in comparison to other specialties. Occupational doctors are often the first choice for the 21 million

Eduardo Medeiros

workers in Mexico and their families but they only visit them once they are sick. These workers rarely have insurance coverage because Mexican healthcare is often corrective instead of preventive. These circumstances motivated Welbe Care to offer a

Co-Founder and CEO | Welbe Care

solution through our occupational health software, which simplifies doctors’ schedules, payments, follow-ups and prescriptions. Q: What information does Wellbe Care collect and how does it benefit employees and companies? A: This solution was designed for Mexican workers. Welbe Care software has a dashboard that, once the records of the workers are uploaded, human resources managers can visualize them and be aware of the general health of the company. To protect employee data, all information is anonymized. Visualizing this data allows insurance companies and doctors to create personalized services for each worker in the company. Additionally, Welbe Care subscription can be extended to five family members or friends of the employee and there is no age limit. To enhance the quality of our services, we work with external service providers,

Marcus Paiva Co-Founder | Welbe Care

such as telemedicine. Patients’ records are not shared with other providers aside from doctors and the information is always encrypted. Welbe Care’s dashboard for human resources managers generates graphs to measure the reduction of absences, improvement of general health and other indicators, depending on the workers and the company. Welbe Care is focused on prevention so it provides

Health, Productivity Boosted Through Employment Benefits Read the complete article More about Eduardo Medeiros More about Marcus Paiva More about this company

telemedicine services 24/7 complemented with a chat service and additional laboratory benefits. For in-person care, Welbe Care has a network of partners that users can access as part of their benefits package. Regardless of the channel they use, their information is uploaded to the platform to create a complete picture of their health. Q: How does Welbe Care foster user and doctor engagement? A:Reception among doctors has been positive because they struggle with management and data storage, so engagement from this side has been natural. To promote user engagement, our onboarding process for every new client explains the benefits of the platform. MP: We are a tech company; we use tech to create personalized benefits that fit the user’s clinical profile. For example, if a doctor prescribes a certain medicine, we are able to use our network to offer the user a pharmacy discount for that medicine. We are seeking partnerships with gyms and sport centers to incorporate their services into Welbe Care.

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Q: How has HL7 evolved to respond to the changing times? A: HL7 is the name of an interoperability standards protocol created roughly 40 years ago. Over time, it evolved to take into account the need for interoperability and quick communication between applications and web platforms. Fast Healthcare Interoperability Resources (FHIR) connects applications moving quickly in the network that need simple, transparent and efficient communication in a web platform. The FIHR protocol is an API that enables the connection between two or more applications in a simple way, using resources that establish what, how and in what language the apps communicate the information. Q: How successful has Mexico been in adapting these protocols? A: The last regulatory reference regarding interoperability and information exchange is NOM-024 issued in 2012. This means that Mexico is almost 10 years behind in regulation. NOM-024 is not fully compulsory as it does not establish the enforcement of interoperability standards. However, the norm mentions the use of standards such as HL7 and names a few others. If companies want to comply with the rules, they must use these standards. Theoretically, companies would need to certify under NOM-024 to use a health information system in Mexico but companies could still get the certification even without using HL7 or another standard

Víctor Medina

protocol. The Department of Health Information (DGIS) from the Ministry of Health is in charge of these certifications. However, given the growing volume of new systems in the country following the acceleration of digitalization due to the pandemic, DGIS is over

President | HL7 México

one year behind in answering certification applications. Q: What triggered HL7’s arrival to Mexico? A: HL7 began operating in August 2021, after the birth of the

Mexico’s Path to Interoperability Standards

HealthTech México association in September 2020. This association brings together a large number of software developers, vendors and academic organizations that started working together to help Mexico have a clear mission, vision and regulations that allow a true interoperable digital health ecosystem that includes e-prescriptions, telemedicine, drug codes and electronic medical records. Within HealthTech, we offer continuous education in digital health for health institutions. One of HealthTech’s commissions works on interoperability and helped bring the HL7 chapter to Mexico. Through HealthTech, we work with the support of many companies experienced in communication with the government and big hospital consortiums. Q: What is necessary to improve regulations regarding this technology? A: An updated norm would support the sector. However, given the speed at which digitalization is moving in the health industry versus the speed of regulators, it is clear that there will never be enough norms. Regulations have to become very dynamic to keep up. For instance, a norm regarding HL7 FHIR could be issued today but

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a better option could be available shortly thereafter. Regulation has to update continuously as new technology emerges. Mexico needs a standardization mechanism to keep up to date with the large amount of innovation emerging and the fast speed at which medtech is moving forward.

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Q: What makes your health and diagnostics solution unique for care providers and patients? A: Dedalus was born in Italy as a provider of tech and software for the industry, primarily for hospitals. Our expansion started throughout the EU but we are now present in over 40 countries around the world. We are in 6,300 hospitals and 5,300 laboratories and we work with 6,500 professionals, making us the leading digital health solutions company in the EU and one of the largest in the world. Dedalus main differentiator is our vast and pioneering expertise in the industry, which coupled with our quality solutions and close contact with clients put us top of mind as health companies begin their digital transition. While our solutions primarily targeted hospitals at first, Dedalus was created with a vision to interconnect different areas of the health ecosystem by interacting with different industry players to facilitate communication through tech. Dedalus’ value proposition is its consultancy capacity. We offer over 200 solutions for different clients in the health supply chain. We approach each client and work with them to offer and adapt the right solution to their practice. Instead of imposing tech, we want to adapt tech to their existing capabilities. We have found that this is the most effective and respectful way to begin a digital

Praxedis Sánchez

transformation, otherwise clients end up not using the tools out of ignorance of the solution or because it does not meet their needs. Q: The company’s success in the EU has been

HIS Business Manager | Dedalus Latinoamérica

significant. How are you replicating that success in Latin America, particularly in Mexico? A: We have an ambitious expansion plan. After our successful growth in the EU, we began strengthening our solutions portfolio

Personalized Advice for Tailored Software Solutions

by acquiring other companies, allowing us to enter markets such as Mexico. We have a robust portfolio of solutions, ranging from those that increase efficiency within a company, be it a hospital, clinic or laboratory, to interconnecting an entire health system. In Latin America, we have begun an approach to the latter in Panama as its government wants an interconnected health sector that can react and collaborate to the benefit of the population. Around the world, Dedalus has over 40 regional projects of this type, so we are very enthusiastic to bring them to Latin America. Q: What healthtech trends are emerging and how is Dedalus responding to them? A: Telemedicine is a trend that is growing globally, so we have developed services that adapt to the patient’s home. Mexico needs functional telemedicine platforms because it has a shortage of specialists and nurses to be able to attend remote areas patients. Telemedicine is the right tool to reduce that gap, this is the main reason why telemedicine is such an important technology at the region. Additionally, we are using the data we collect from the countries

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we work in to identify health trends. In the past, obtaining the budget to do this was challenging but as the benefits of data analytics have become more obvious, we have been able to exploit that. To secure safe data-sharing and use, we have obtained the HL7 certification.

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Q: How did Farmacia Paris remain competitive despite the closures resulting from the pandemic? A: The main factor is the brand’s prestige, which truly resulted in very positive support from our clients and from the commercial partners we have had for years. That close relationship, borne out of working with a great deal of transparency and honesty, meant that they understood when we told them that this was our situation. Q: In 2020, you discussed your plans for an e-commerce platform. How is this project unfolding? A: We did not open the page on that project for the same reasons; the moment was too complex given the pandemic. Sending products to the whole city would have been very expensive, which would have also undermined Farmacia Paris’s goal and reputation to always offer better prices. For anyone receiving that product, it would have been better to buy it at the closest pharmacy. We have plans to return to the project, however. We already have a catalog of 1,500 products, which is what we are going to start with. We have the website ready, we have created the catalog and we hope to launch it next year. Nevertheless, it will be a gradual undertaking because Paris’ overall catalog has more than 35,000 products.

Ignacio Merino

Q: You have also said that the industry is moving toward a customer-experience model. How is Farmacia Paris responding to this trend?

Director General | Farmacia París

A: In terms of discount cards, the pandemic stopped the whole process and the trend has changed a great deal. I think that the tendency of cards will no longer be attractive in the market. It is now more about reaching the client in a different way, with a different value proposal, which is what we are

‘City of Health’ Coming to Mexico City

working on. Q: Which significant alliances, other than Devlyn and LMP, has Farmacias Paris consolidated? A: Dentalia is one of our clients. We have four clinics that are already operating inside the installations of the pharmacy and we are trying to diversify the business. We are working to create what is called the “City of Health.” It is a building where we already have Devlyn, Dentalia and LMP and we are looking at clinics that specialize in orthopedics and treatments for tobacco and alcohol addictions. For me, the most important area, which I believe will be very strong in the next couple of years, is psychology. The pandemic changed many things in people. There are families where only one person survived or parents who lost children. It is extremely sad. As a result, there is a need for specialized support. We need to start building that City of Health to offer something different. There is also a space for restaurants

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serving traditional Mexican food. I think all of this will happen next year. We are looking at strategic alliances with other companies that offer health services so that this can be a onestop shop, offering everything from the selling of products to health services.

VIEW TOP Healthcare Environment | 75

from the

Q: El Crisol started the construction of its CEDIS in Queretaro. What impact do you expect from this development? A: The CEDIS was a strategic investment that offered better services for our clients. We are convinced that having a readily available, smart and diverse inventory is a competitive advantage for El Crisol, especially considering the supply chain disruption caused by the pandemic. This disruption boosted demand for our solutions, which had already been growing in the last three years. The pandemic provided confirmation that this was a good investment. The CEDIS provides the client with a quicker, better and more complete offer than before. Q: How is El Crisol integrating technology into its internal operations and distribution processes? A: We use SAP as a base for our operations, which helps us control the entire operation in real time. There is also Abaya design software to control calls and software for last-mile logistics, among others. We plan on implementing an important conversion to reinforce the structure of our software for the real-time control of inventory through bar-codes, which will be connected to our SAP. That new distribution center will revolutionize how we treat clients and introduce new technology. Q: How have the vaccination campaigns and growth of generics

Rodolfo Camargo

and OTC industries reflected on demand for your products? A: More than 95 percent of pharmaceuticals in Mexico have a commercial relationship with El Crisol. Manufacturers count on El

Director General | El Crisol

Crisol as a supplier, in particular because controlling quality, from the raw materials to the finished product, requires one of the tools that we sell. There are shortages in the pharmaceutical industry of phosphates, iodides, formaldehyde and others but we continue to have stock and have been able to offer the industry immediate

El Crisol Celebrates 60 Years by Looking Forward and Inward

delivery or alternatives. This has prevented delays or pauses in production and additional losses. Q: How has El Crisol planned its supply to meet local demand? A: When the shortage began, we asked for more products than usual. As a result, we have preference when products arrive. Previously, there was a clear plan for medicinal supply. Nowadays, the mistakes the government is making in supplying medicine through the UNOPS office are harming the pharmaceutical industry and supply chain. At the end of the day, the support we can provide is to supply the materials that companies need and that is how we are helping them. Q: What advantages does Mexico have to produce products domestically? A: The COVID-19 crisis has reminded us that the country has the capabilities to manufacture its own inputs for health. In the last couple of years, we have seen a shift in manufacturing from Asia to Mexico. More brands are betting on our country. That transnational push is making many companies realize the importance of having

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local manufacturing, which bolsters competitiveness and improves delivery times for distribution. The crisis related to shortages and logistics complications is going to make many companies look at Mexico as a manufacturing center that is highly competitive. It has a qualified workforce and an advantageous geographical location.

VIEW TOP Healthcare Environment | 76

from the

Q: DHL has delivered more than 2 billion COVID-19 vaccines to more than 175 countries. How was this accomplished? A: It was a very big challenge because we were not prepared for a pandemic. But when we started to receive information about the virus, we started an in-depth investigation into what our role could be regarding the vaccine. We were guided by McKinsey, which has been helping us to approach the situation realistically. Vaccines can take from two to 10 years to launch but these were launched in one year. We wanted to be prepared because we are leaders in the pharmaceutical sector. We have special packaging for the necessary transportation from everywhere to anywhere. In the end, we proved that we could do it. We are transporting vaccines in ultra-freezing packaging that eliminates any variation in temperature. DHL was the primary freight forwarder for transporting the first COVID-19 vaccines from Russia to the world. Q: How does DHL’s Good Distribution Practice (GDP) network of certified life sciences stations and industry-specific IT system, Life Track, impact your logistics services? A: One of our pillars is digitalization and technology. LifeTrack is a platform where our customers can monitor all the information related to their shipments. Through a mobile device, they

Liliana Castillo

can monitor, for example, the temperature control on their shipments. Another innovative service is LifeConEx for transporting

Head of Life Sciences and Chemicals Sales DGF Mexico | DHL

temperature-sensitive products. It helps our customers with tracking and follows GDPs. But it is not only for tracking or locating a shipment. It helps customers to see where their shipment is and how it is being handled. It uses advanced technology, a smart sensor, temperature monitoring, GPS

How DHL Delivered 2 Billion Vaccines

location information and so on. It covers security, temperature control, mapping and solutions for tracing your shipment with a proper SOP, following the GDPs for your shipment. Q: How does DHL manage a global supply chain with the differing regulatory environments in the countries it is in? A: We do not have a direct deal with entities; we are the partner of laboratories. If COFEPRIS demands a certain temperature or a certain practice for distribution, we accompany our clients and ensure successful audits. We prepare all of the health requirements, temperature control and good distribution practices for our clients, which they can deliver to health entities. Q: What will happen in terms of distribution after COVID-19 becomes an endemic? A: The situation is similar to the flu and we have accompanied our clients through this process as we did through the process with influenza. When influenza started, it was exactly the same: a number of laboratories started to invest in finding a vaccine.

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Now, influenza is endemic but that does not mean that only one laboratory has retained the patent for the influenza vaccine. Rather, during these 10 years, more firms have continued to invest in handling or producing the influenza vaccine. It became an opportunity for the industry.

leaning has always represented a big challenge in the pharma industry. Regrettable events that have led to the loss of human lives have forced us to remember that avoiding cross contamination by every means is always a necessity in the industry.

It is an absolute that no risk of any type can be allowed because, instead of solving health issues, we would be generating events that can cost lives. Regulatory agencies expect manufacturers to develop and validate an integral and complete general cleaning program. In fact, the cleaning process is considered a critical system within the industry, which is why the risk of contamination, residue carryover from products, and any type of crosscontamination must be monitored, controlled and minimized to safeguard the security of patients and the quality of the product. The existing regulations in several countries are aligned with general principles that arise from the basis that all pharmaceutical products must be safe, effective and free from adulteration from

Healthcare Environment | 77

other components or pollutants. The guides and regulations of

The Importance and Impact of The Cleaning Process Deyanira Chiñas Commercial Director | T5DC

reference used have been developed by countries and advanced international organizations, such as: CHP&FBI from Canada, EMA, FDA, the International Conference of Harmonization (ICH), Pharmaceutical Inspection Cooperation/Scheme (PIC/S) and WHO. Likewise, there are existing pharmaceutical documents and guides developed by experts within the pharma industry, such as APIC, ASME, BPE, ASTM (several), ISO 13408, ISPE and PDA. The most important aspect that the manufacturers of medications need to establish is the limits of residue acceptance, and the criteria must be defined based on the type of substance. If the residue comes from highly dangerous compounds, meaning compounds with a low daily exposure acceptance (ADE), for example =<10 mcg/day, a specific analytical method must be used to quantify the residue (HPLC) and to establish the maximum allowed carryover (MAC). The best examples are psychotropics and oncological medications. In the case of non-hazardous compounds, these refer to compounds with an ADE >= 100 mg/day; in these cases, the PDE corresponds to a dose of a substance that is unlikely to cause any adverse effects to a person unless that individual is exposed every day of his life to the these doses. In the case of a substance that is going to be cleaned in the manufacturing equipment, then it is possible to consider the use of non-specific analytical methods to be used for residue quantification, as is the case of the Total Organic Carbon (TOC), and thus establish a safety limit. Frequently, the actors in the pharma industry ask, what are the references that indicate that a non-specific analytical method could be used to determine the residue? The most important issue is to develop the scientific rationale that supports the decisions made to use non-specific analytical methods. We have shared in different forums our successful experiences running correlation tests, where an active substance is quantified by HPLC and TOC in parallel; if the results demonstrate that similar

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results are obtained with both analytical methods, with statistical support — evaluated by experts in pharmaceutical statistics — then they already have in hand the necessary “scientific rationale” required to demonstrate before any regulatory agency and justify the use of non-specific analytical methods for cleaning validation.

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Acronyms 3PLs

Third Party Logistics

CPTPP

Comprehensive and Progressive Trans-Pacific Partnership Agreement

ACROM

Clinical Research Organization Alliance of Mexico

AMELAF

Mexican Association of Pharmaceutical Laboratories

CRO

Clinical Research Organization

DCGI

Drugs Controller General of India

AMID

Mexican Association of Innovative Industries of Medical Devices

DRP

Direct From Patient

AMIIF

Mexican Association of Pharmaceutical Research Industries

DTP

Direct to Patient

ECDC

European Centre for Disease Prevention and Control

AMIS

Mexican Association of Insurance Institutes

EMA

European Medicines Agency

ANADIM

National Association of Drug Distributors

EMR

Electronic Medical Record

ANAFAM

National Association of Drug Manufacturers

ENSANUT

National Survey of Health and Nutrition

ANTAD

National Association of Supermarket and Department Stores

European Union

FDA

Food and Drug Administration

AOLM

Mexico’s Association of Logistics Operators

FIFARMA

Latin American Federation of the Pharmaceutical Industry

API

Active Pharmaceutical Ingredient

FPGC

Protection Fund Against Catastrophic Expenditures

AWS

Amazon Web Services

FTA

Free-Trade Agreement

CANACINTRA

National Chamber of the Transformation Industry

GMP

Good Manufacturing Practices

CANIFARMA

HIV

Human Immunodeficiency Virus

National Chamber of the Pharmaceutical Industry

ICU

Intensive Care Unit

CBD

Cannabidiol

IFPMA

CDC

US Centers for Disease Control and Prevention

International Federation of Pharmaceutical Manufacturers & Associations

CEDIS

Distribution Center

IMMEX

The Manufacturing Industry, Maquiladora and Export Services

CEPI

Coalition for Innovation in Epidemic Preparedness

IMPI

Mexican Institute of Industrial Property

CESSA

Health Centers With Extended Services

IMSS

Mexican Institute of Social Security

CEYE

Sterilization and Equipment Centers

INCIDE

Innovation and Science for Business Development

CFM

Mexican Pharmaceutical Council

INCMNSZ

CIMA

The Chinese International Machinery Association

The National Institute of Medical Sciences and Nutrition Salvador Zubirán

CINVESTAV

Center for Research and Advanced Studies of the National Polytechnic Institute

INDRE

Epidemiologic Diagnostics and Reference Institute

INEGI

National Institute of Statistic and Geography

INSABI

Health Institute for Welfare

Intellectual Property

CNS

Central Nervous System

COFECE

Federal Commission of Economic Competition

COFEPRIS

Federal Commission for Protection Against Sanitary Risks

ISSSTE

Institute of Safety and Social Services for Federal Workers

CONACYT

National Council for Science and Technology

JCI

Joint Commission International

Acronyms LAASSP

The Public Sector Acquisitions, Leases and Services Law

SCT

Ministry of Communications and Transportation

LEI

Laboratorios de Especialidades Inmunológicas

SEDENA

Ministry of National Defense

M&A

SEDESA

Ministry of Health of Mexico City

Merger and Acquisition

MBN

SEMAR

Ministry of the Navy

Mexico Business News

NAFTA

North American Free Trade Agreement

SINGREM

National System of Medicines and Bottle Residue Management

NCD

SME

Small-Medium Enterprise

Non-Communicable Disease

NOM

SMEO

Mexican Society of Oncology

Mexican Official Norms

NSF

SSA

Ministry of Health

National Safety in Food

OECD

Tetanus and Diphtheria

Organization for Economic Cooperation and Development

TMS

OMC

Transportation Management System

The Office for Medical Cannabis

Operating Room

UNAM

National Autonomous University of Mexico

OTC

Over the Counter

UNEMES

Medical Specialties Units

PAHO

Pan-American Health Organization

UNICEF

United Nations Children’s Fund

PAMO

Pharmacy-Adjacent Medical Offices

UNOPS

PCR

The United Nations Office for Project Services

Polymerase Chain Reaction

PEMEX

Petróleos Mexicanos

USMCA

United States-MexicoCanada Agreement

PHEIC

Public Health Emergency of International Concern

VAT

Value Added Tax

PPP

WHO

World Health Organization

Public-Private Partnership

PROSEC

Sector Promotion Programs

WIPO

World Intellectual Property Organization

RGA

Reinsurance Group of America

WMS

Warehouse Management System

Prescription Drugs

Advertising Index Sarstedt 1

T5DC

UK Gov

Vitalmex

Apotex

42 61

Index 62, 76

1DOC3 51

DHL

ACROM 79

Doctoralia

Aidicare 62, 65

ECDC 79

Amazon

El Crisol

Amazon Web Services AMD

6, 13, 33

43, 48

62, 75

EMA

EMR

AMELAF 79

Farmacia Paris 74

AMID

FDA 79

AMIIF

FIFARMA

AMIS

79 11

FronterView

ANADIM

General Health Council 6, 10

33, 59, 62, 67

ANAFAM 79

Google Cloud

ANAFARMEX 6, 12

Grupo Médico Rossano

ANTAD

HL7

AOLM 79

26, 35

Atramat AWS

22, 64

CANIFARMA

26, 38

CDC 79

CFM

IMPI

IMSS

79 79

INDRE

INGER

6, 17

INSABI 79

Cardinal Health

CESSA

INCMNSZ

Backer Mckenzie BMS

62, 67, 72, 73

IFPMA

26, 28, 70

Apotex

ISSSTE 79 LAASSP LEI

Mamotest

43, 52, 53

Medpacom

Clivi 43, 56

Médica Sur

6, 18

COFEPRIS

MeetingDoctors

CINVESTAV

CONACYT 79 CRO Mexicana DEDALUS 76

Merck 26, 29

26, 31, 52

Ministry of Health

Ministry of Health of Mexico City

Index 59

Nubix

SMEO

NutriADN 63 Omron

26, 34, 37, 65

Sofía

53, 62, 63, 69

T5DC

24, 42, 62, 77, 78

PAHO 80

TecSalud

PEMEX

Terapify

80 6, 22, 33

PharmaAdvice Prosperia

TINC UDIBI

6, 20, 45, 51 43, 55

62, 66 26, 32, 45

Reinsurance Group of America 80

UK Embassy

RGA

UNAM

Sarstedt 26, 39

USMCA 80

SCT

Vitalmex

26, 36

SEDENA 80

Welbe Care

SEDESA

WHO

SEMAR 80 Smart Doctors

World Health Organization 80 54

Zenda.la

53, 59, 62, 68

Photo Credits Cover

EnvatoElements

1DOC3

Siemens

Doctoralia Mexico

Deloitte

Meeting Doctors Latam

General Health Council

Smart Doctor

FrontierView

Smart Doctor

ANAFARMEX

Mamotest

AMD

MBE

British Embassy in Mexico

Nubix

MBE

Nubix

Médica Sur

Terapify

Grupo Médico Rossano

Clivi

TecSalud

PROSPERiA

Baker McKenzie

PROSPERiA

PharmaAdvice

nutriADN

Grupo Rossano

Philips

T5DC

Eolis

Apotex

MBE

Apotex

Aidicare

CRO Mexicana

TINC CMMS

Bristol Myers Squibb México

Google Cloud Americas

Merck Group México

Zenda.la

UDIBI-IPN

Sofía

MBP

Welbe Care

Atramat

Welbe Care

Vitalmex

HL7 México

Omron Healthcare

Dedalus Latinoamérica

Cardinal Health

Farmacia París

Sarstedt México

El Crisol

Novo Nordisk

DHL

Happins

T5DC

MBP

T5DC

MEDPACOM

Credits Journalist & Industry Analyst: Miriam Bello Editor: Alicia Arizpe Senior Editor: Mario Di Simine Managing Editor: Alejandro Salas Publication Coordinator: Alejandra Yick Content Partnership Coordinator: Alexa Villarruel Content Partnership Coordinator: Miguel García Content Marketing Coordinator: Christopher Reyes Junior Graphic Designer: Paulina Quiroz Junior Graphic Designer: Valeria Villanueva Graphic Designer: Marcela Muñoz Senior Graphic Designer: Mónica López Design Director: Marcos González Web Development: Omar Sánchez Collaborator: Antonio Gozain Collaborator: Alfonso Núñez Director General: Jeroen Posma

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Mexico Health Review 2022

Articles inside

Introduction