Salauno: Eye care for all

80% of worldwide blindness cases are preventable; unfortunately, it is not the case for many in the developing world, where people can’t access healthcare.

Facing this alarming problem, salauno leverages economies of scale to reduce the costs of providing ophthalmological services. Through innovative schemes and technology, we aim to augment access to specialized care to low and middle-income populations. The use of technology enables scalable access to eyecare in resource-constrained environments. We thus aim to leverage technology to provide global access to healthcare. We developed an AI algorithm with Microsoft and FORUS to detect Diabetic Retinopathy, another algorithm to predict patient show-ups to augment our agenda occupancy, and incorporated telemedicine programs in our clinics. Our solution can reach higher volumes of underserved populations to restore their sight and change their lives by giving back their physical independence, their capability to work and partake in economic development in an inclusive society. 

In the world there are 1.3 billion people with some sort of visual impairment, causing them loss of economic and social independence. This is a public health, social and economic problem for many countries. 80% of blindness cases are preventable or reversible if treated timely. Unfortunately, the scarcity of medical specialists, education, financing, and geographical distribution limit access for many.

Greater Mexico City is the third most densely populated city in the world with over 22 million people, just after Tokyo and Delhi, and the most populated city in Latin America. Its rapid growth has generated uneven levels of development, isolating many communities within itself. It is estimated that 32.6 million Mexicans do not have access to medical services due to distance and geographic distribution and the lack of medical specialists (3.56 for every 100,000 habitants).

This reveals a system that has failed to meet the needs of the population in our cities worldwide. Therefore, salauno seeks to strengthen this system, focusing on those who have been underserved by traditional non-inclusive paradigms of healthcare, providing affordable services with the capacity to attend high volumes, and located strategically to reach unattended sectors of our city. 

Through our clinics, we primarily serve low-income populations who live in underdeveloped conditions in our cities. These people experience different barriers to access healthcare such as economic limitations, geographic distance, and lack of knowledge about their conditions. In Mexico, public health services are saturated, accentuated in densely populated cities, leaving many behind, and private institutions are above the financial possibilities of the majority. On the other hand, the swift and unplanned urbanization, has left many people isolated within extremely marginalized sectors of the city; this marginalization has also fostered high disadvantages in terms of education and information access. Salauno, works to develop innovative solutions that target these barriers and brings specialized healthcare to those in need of it.

We understand that in order to develop a comprehensive and effective solution we must listen to the people we are serving. To this end, all our processes are designed with our patient in mind, and some of our key performance indicators are directly related to the evaluations we constantly survey from our patients. This way, the important decisions we make about areas of improvement come from understanding our patients and what they need.

Through simple innovations in the way we built our business, we have been able to lower costs and provide affordable and high-quality services to low-income population and our hub and spoke model allow us to bring specialized healthcare services to underserved slums in the city with less intensive capital expenditure. Leveraging technology, we have been able to reach economies of scale to procure a model based on high volumes. In 8 years, we have been able to attend more than 343,972 patients, perform over 49,461 surgeries, and deliver around 40,000 pairs of lenses, all with prices below the market average.

We have become a complete ophthalmology service provider with a comprehensive offer of specialties, products and services, consolidating our presence across Greater Mexico City. Today, we have reached a point of maturation where we are ready to jump to massive screening volumes. In other to do this, we plan to incorporate different technologies such as artificial intelligence that can cut back costs and close the breach between people and specialized doctors.

We have developed different strategies to reach communities in need in efficient ways. One example is our Outreach Campaigns program through which we screen patients in remote and marginalized areas and other states, to detect possible eye conditions and refer only those who need specialized treatment or further evaluation. Other example is our Vision Guardians program which aims to build a strong network amongst primary care providers and specialized medical treatment. Through a mobile application and educational campaigns, we have given tools to primary care physicians to detect potential patients and refer them to our clinics for treatment if needed. Other important project is the development of AI algorithms to detect Diabetic retinopathy with the purpose of fixing a system flaw where there are not enough specialized doctors to attend the needs of the population. Capitalizing on the scarce human recourse we can allocate specialized evaluation in areas with little medical infrastructure. Lastly, we are begining to prove the benefits of telediagnosis models in some of our clinics located in the more marginalized areas of our city, to bring specialized healthcare to underserved communities.

As can be noted, technology enabled solutions are at the core of our strategy to reach people in need, as efficiently as possible, to face the challenges of cities with healthcare systems that traditionally have left significant portions of the population unattended.  

Traditional means of providing healthcare haven’t been enough resulting in millions of underserved people in cities around the world due to economic constraints, misinformation, and lack of access. salauno tackles each one of these barriers through innovative models and programs and the constant incorporation of new technologies to the field of healthcare, defying the status quo in the Mexican healthcare system.

There are two lines of innovation within our business: Innovation in the model and innovation in technology-enabled solutions.

The first one is incorporated in the salauno’s core, proposing an extremely innovative model that differentiates from any other healthcare provider in the country. It incorporates operational efficiency, high volume capacity, an integral offer of eyecare services, and an intersectoral collaborative approach.

As for the second one, our technology driven innovations have enabled us to further foster economies of scale benefits, providing high-quality healthcare services to massive volumes of people. These innovations include our Electronic Medical Record, a telediagnosis program, Artificial Intelligence, and mobile applications aiding medical referral networks.

These innovations pose a very different way of attending the medical needs of the populations, with the potential of catalyzing true change in the ecosystem. 

saluno adapts different technologies to make operations more efficient and reach numbers that match up the need for healthcare services. We developed an electronical medical record (EMR) to make our medical operations more efficient, a telediagnosis model to remotely diagnose patients, and an AI algorithm with the potential of reaching massive screening capacities. We have also incorporated the use of our in house developed mobile application, through which primary care physicians can refer patients with potential eye conditions; in order to expand our network of primary care physicians and close the breach between the average citizen and specialized healthcare. Naturally we are heavy users of technology regarding cutting edge medical equipment. In fact, we just begun the process to acquire 3D Heads Up technology to enable doctors to perform surgeries with greater visualization of the procedure and thus a greater efficiency.

These technologies have the potential to revolutionize the ophthalmology field in Mexico where the doctor-patient ratio is 3.6 to 100,000 and eventually leverage on this platform to launch new lines of attention and catalyze change in other medical specialties to foster healthier communities in all human dimensions.

We believe that the flaws of the healthcare in our cities can be effectively tackled through the use of new technologies, and the incorporation of existing technology to the field of healthcare.

We are progressively eradicating avoidable blindness by generating awareness and granting access to diagnose and treatment to unattended population.

With operational efficiency, applied technologies, a hub-and-spoke model and innovative initiatives, we are able to provide accessible (geographically and financially) specialized medical care to vulnerable people. The outcomes are a more inclusive healthcare system in our city, and healthier people who has been underserved for a long time. We are a volume based model which by reaching more people is increasing the cost effectiveness of healthcare access. According to the WHO “interventions that reach more people are always more cost-effective than those than reach fewer”.

Trough operational efficiency, we are able to lower costs and offer services to a greater number of people. This opens the doors for people in vulnerable economic conditions to access to our services. With our hub and spoke model we are able to augment our geographical coverage with less capital and bring specialized healthcare to areas of the city with little medical infrastructure. The use of technology enables us to make strategic decisions based on facts rather than simple intuition, through our Business Intelligence area we create performance indicators to enhance operational efficiency and attend more patients. Technology also enables us to allocate doctors in marginalized communities to close the breach between the average citizen and specialized medical care. Lastly, through innovative initiatives such as our Outreach campaigns or our mobile app referral system, we actively reach patients in need localized in urban and peri-urban communities.

Since our foundation in 2011 we have been able to serve 343,872 patients, perform more than 49,461 surgeries, and delivered more than 28,771 pairs of glasses. Thanks to a successful round of capital early this year we are accomplishing our expansion plans which include the opening of 12 new clinics this year -of which we have already opened 3. With this growth and our average rate of patients per month of almost 8,800, we project to reach 105,495 new patients by the end of 2019. If we keep up with this growth rate, we project to serve over 800,000 people by the end of 2023.

Our ultimate goal is to eradicate avoidable blindness in our country and replicate our model in other counties and cities with similar contexts. We plan to build a solid platform that can eventually support new lines of attention such as women´s and reproductive health and others; with the purpose of developing stronger healthcare systems, allowing every citizen and human to be healthy and thrive as an individual and as a member of society. Our tangible goals for this year are 1.- Open 12 new clinics, 2.- Add near 800 primary care physicians to our referral network, 3.- Grow our Outreach campaigns by 30%, 4.-Consolidate our program for financing patients in the lowest-income sectors (through an inhouse microcredit program), and 5.- Establish a telemedicine program in all of our B type clinics. Within the next five years, our goal is to cover cities in other states within Mexican territory, expanding our network across Mexican territory and potential begin to explore the possibilities of opening new lines of attention and also replicating our model in other countries in Latin America. 

As a highly innovative solution, we definitely face the challenge of defying the status quo and what it entails. Also the way Mexico City grew, and the lack of planification, built a city with many disadvantage communities. In this regard we have identified the following challenges, to fulfilling our mission: 1.- Scarce medical professional who don´t suffice to attend all the population 2.- Complex geographical situation 3. Lack of knowledge within the communities 4. Changes in political and private agendas, 5.- apprehension from traditional actors, particularly in the medical community.

1.- In Mexico the ophthalmologist-patient ratio is 3.6 to 100,000. For this reason, we invest heavily in technology so patients can be screened faster. With our operational efficiency model, adding our telemedicine program and our AI algorithm, we aim to face the lack of medical specialist leveraging technology.

2.- Mexico City is one of the biggest cities in the world. Unplanned urbanization and great distances make it difficult to reach communities in the periphery. To overcome this, we developed a hub-and-spoke model that allows us to cover greater areas cost-effectively. Also, through our Outreach Campaigns we can still further our reach.

3.- Sometimes patients won’t get treatment because they don´t understand the risks or severity of their condition, often they don´t even know they have one. To overcome this, we have developed educational campaigns and processes within our activities, to take the time to educate people on ophthalmological healthcare and the importance of periodical medical evaluation.

4.- In the past we have experienced cuts of patients’ flow, derived from changes in public policy. Thus, we have experience in pivoting and maintaining our operations, independently of political agendas, today we are more proactive in reaching out to patients. 5.- We are different from traditional healthcare providers and have experienced some apprehension from the medical community since we have disrupted tradition. Over the years, we have proven that our model works well, and the medical community is accepting new technics in healthcare services, and more doctors want to work with us.

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Today we have 343 employees between medical staff and corporate staff.

salauno’s team is comprised by experienced professionals in the field of scalable healthcare and entrepreneurship and gathers the experience and knowledge from various backgrounds and fields. This gives our team a holistic overview of the challenges that healthcare faces and the experience to implement a solution that works.

Carlos and Javier, salauno Co-Founders and Co-CEO ́s, are young, energetic and experienced entrepreneurs committed to making a difference through a profitable and scalable model. In 2012, the duo was named “Entrepreneurs of the Year” by CNN Expansión magazine, “Global Shapers” by the World Economic Forum. They were also recognized with the National Entrepreneur of the year award in 2014 which is granted by the Mexican president and by the Schwab Foundation (World Economic Forum) in 2015 as Social Entrepreneurs of the Year.

We also have a proven record of execution capability, with a strong multidisciplinary team. Our key team members are Marcelo Samano, our operations director with a strong background in health business. Dr Fernando Macouzet, retina specialist and renown researcher, our Medical director. Edgar Guerra our IT director with track experience technological developments. Eva Martinez our Marketing director, who has deep experience growing networks. Monica Rodriguez experienced in corporate finance in diverse retail companies, our CFO. Andrea Portilla our human resources director who holds Master’s in human resources direction by the University of Catalunya. Additionally, our board is comprised by experts in health policy, impact investment, and social entrepreneurship.

Throughout different projects, we have teamed up with other stakeholders to exponentiate our impact and catalyze change in the Mexican healthcare system. salauno has worked with public health institutions like IMSS (biggest social security institution) and DIF (the national institution for family development and welfare), with public-private partnerships. In the case of IMSS to detect Diabetic Retinopathy in specific communities, and in the case of DIF providing optic evaluations and delivering glasses to 15,000 beneficiaries and establishing clinics in unutilized facilities.

We also work with private organizations like BEST performing diagnosis and awareness campaigns leveraging on their installed capacity and primary care doctors’ network. Also, we have been greatly benefited by philanthropic organizations like Cinepolis Foundation who subsidizes more than a 1,000 surgeries per year, Pfizer Foundation who helped us developing a network of primary care physicians, The World Diabetes Foundation who helped us to strengthen our outreach campaign program, L’Occitane Foundation, the Sovereign Order of Malta and others, who see in salauno a safe and effective way of deploying their capital recourses and perceiving a social benefit in return.

Salauno’s model, provides affordable ophthalmological health services to low-income segments. Our model is based on optimizing resources to ensure low costs, affordable prices and high-quality services. We optimize the use of “high skilled” resources —doctors, leveraging on more abundant human recourses, and the use of technologies. Doctors can focus almost 100% of their time in surgeries and become extremely efficient as they eliminate administration and basic medical tasks that are performed by other skilled professionals, such as optometrists, nurses and administrative staff: today, our surgeons perform five times more surgeries that the average ophthalmologist in Mexico.

Our innovative business model based on operating efficiency, high patient volume and cross-subsidies, enables us to provide superior quality eye care to populations living in vulnerable situations and marginalized communities. Doctor & nurse education and career programs, and a multisectoral approach -partnering with public, private & non-for-profit institutions- fuse a value chain that breaks paradigms to transform the Mexican health system. Furthermore, through patient centered care and Lean production principles, salauno provides holistic eye care at UK and US standards, transforming people’s lives and generating social and economic impact. Furthermore, avoiding the quality/cost conundrum has been one of salauno's greatest successes. Using innovative IT platforms, monitoring systems, checklists, processes and algorithms salauno ensures standardization. Efficiencies enable doctors to progressively improve their clinical outcome measures, making salauno a quality reference in Mexico.

We have a blended financing approach, in which our day to day operations are self-sustained by our revenue, and for growth and innovation we actively seek financing in equity and in grants. The operating model has proven to be profitable which has attracted institutional investors and lenders. We are also an innovation driven venture which is constantly ideating disruptive solutions and has operational capacity to implement these, this has attracted philanthropic organizations seeking to foster innovation and operating programs to serve vulnerable populations.

Our model was recently mentioned by the Health and Philanthropy Netfwd Policy Note by the OECD with the subtitle “Blended financing to spur innovation”. Financial sustainability and viability is key for us because it is the only way we can sustain our operations and keep providing specialized healthcare to people. The success of our solution can be noted on our annual revenue, which is consistently growing and is certainly able to sustain our operations. Nonetheless, at this point of our journey we are betting big on our expansion plans and thus need further financing to materialize our plans. We have successfully raised three rounds of equity and have teamed up with prominent shareholders such as the IFC. On the other hand, we have raised over 1 million dollars in grants that have allowed us to innovate further and develop some of our best projects and programs.

As aforementioned, two challenging barriers we have to tackle are lack of medical professionals and challenging geographical situations. We believe that with the use of technology, we can capitalize the skills of specialized doctors and bring them closer to people in need. For this reason, we believe that MIT solve could help us through allowing partnerships with experts who can help us develop better technological solutions in this regard. It is important for us to develop partnerships with other actors around the world. We believe that collaboration is the only sure way to tackle the most pressing problems humanity faces today. For this reason, we believe that solve could help us as a platform to know and be known by other innovators, other healthcare providers with exiting projects, people with ideas that might help our solution, tech savvy people eager to share what they know with others, experts in health, in marketing, in fundraising in development projects who could offer us mentoring, possible organizations seeking to donate money for health causes, etc. Every chance we have to tell the world we are here, and this is what we are doing and this is why it is important, might signify a step closer to accomplishing our mission. We are also interested in applying for the AI prize to be able to advance our AI operations and implement our existing algorithm to screen patients. 

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We developed an AI algorithm along with Microsoft and Forus (ophthalmological equipment providers) to detect diabetic retinopathy through image evaluation. Even though we already use AI to some extent in our solution, like in our smart agenda booking that predicts no shows from patients (based on age, distance, day of the week, time, weather, etc), we want to apply this technology in an integral approach that includes both operational and medical aspects of our solution. Being part of the AI Innovations Prize would be catalytic for us, propelling technological innovation to improve health of citizens globally. We have designed the roadmap to build the aforementioned approach, considering the use of AI in all the patient journey and all we are waiting for is the financial means to implement it. This project consists in using AI to optimize the full patient journey by improving triage, capacity utilization, patient workflows, diagnostics, and pricing and financing. This enables scalable access to timely and efficient eyecare in resource-constrained environments (scarce doctors, lack of economic capacities, geographic dispersion, etc.) which is exacerbated in densely populated and poorly planned urban areas. Our model seeks Our data-driven, scalable solution will be able to reach higher volumes of underserved populations and better change their quality of life.

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