TuMédico

According to La República, a Colombian Newspaper (https://bit.ly/3tt9Q1l), in Colombia there are only about 1.5 general doctors for every 1,000 inhabitants. It means that to have an appointment with the government health system, patients must wait for at least 7 business days on average. This situation is even worse in rural areas in Colombia where 11 million people currently live. For these people, going to a medical consultation is a great challenge that makes them give up the appointment and to wait until the condition worsens. After the waiting period for the consultation, at least 2-3 hours of travel are required just to get to the doctor's office, not including additional waiting time at the clinic. In addition, these patients mostly live on their daily income, so for them, going to the doctor's appointment means that they would be losing a day or more of their income, which has a very negative impact on their family. This is the reason why people (1) who are living in rural areas (2) who have low/medium income (3) who are from indiginous background who usually apply for the previous two reasons are reluctant to go to the doctor, although most of them need regular care by a professional. 

Moreover, according to the World Bank Group report (https://bit.ly/3t8kuKC), the COVID-19 crisis plunged Colombians into recession in 2020 and exacerbated existing labor market weakness, resulting in an increase in monetary poverty upto 35.7%. Meanwhile, telemedicine has been a technology available mostly for high income patients, as was offered by premium insurance companies or required electronic payments to access. 47% of our population belongs to subsidized healthcare insurance and cannot access these necessary services. 

This situation does not only apply to Colombia, but to many other countries in Latin America. According to an article published by United Nations(https://bit.ly/3M6uoVU) , poverty and extreme poverty in Latin America reached levels in 2020 that had not been seen in the last 12 and 20 years, respectively, while the indices of inequality in the region worsened along with employment and labor participation rates, among women above all, due to the COVID-19 pandemic. Now, 326 million people fall into poverty in Latin America and do not have access to the healthcare system when they need it due to the above problems. Now, we are about to change that. 

We believe that medical consultation should be accessible, affordable, easy to use and a pleasant experience for all patients regardless of their level of income, who they are or where they are. That is why we launched TuMédico, a telemedicine service that provides immediate, affordable and high quality medical consultation to underserved communities. 

To make it accessible, we are providing our solution, TuMédico, through 1,309 pharmacies and small Mom and Pop´s shops all over Colombia (as in feb, 2022), covering every corner of the country. Patients can acquire the video telemedicine service of TuMédico in a pharmacy or a grocery shop nearby as easily as buying a bottle of water. Of course, we are managing the website where patients can acquire the service digitally in case they are able to and prefer to do so. 

The TuMédico service is very easy to use, there are 5 steps in the process:

(1) The patient or his/her family or relatives feel sick. Usually when this happens they go to the pharmacy. In the pharmacy, patients can acquire a consultation service of TuMédico for less than USD $6 to buy the medication or follow the treatment that they would really need after getting diagnosed with their health situation exactly by a doctor.. (2) Immediately, TuMédico team will receive the name and the contact number of the patient by the pharmacies or merchants. In less than 5 minutes, TuMédico will be contacting the patient through WhatsApp or call, the communication channels most preferred by our patients. (3) According to the patient's preference, we will schedule the consultation or carry it out immediately. (4) The patient will receive a link through the WhatsApp message, SMS and email  to realize the consultation. The consultation will be realized through high quality technology, Saludtools. All they have to do is simply click the link and video-talk to the doctor, without registering or downloading an app. (5) After the consultation, the patient will receive via email the medical record, prescription and examination recommendation if necessary. Patients can schedule another consultation with the same doctor without any problem. In addition, TuMédico will help them order medications if they need it.

The technology we are using throughout the process is Saludtools, our own SaaS platform for telemedicine consultation, agenda management, patient information, medical records, prescription and follow-up.

Due to its innovative approach to tackle the inequality in the healthcare system, TuMédico has been selected to be part of Innovation Inclusive Journey, Más Vida: Acelerando a Telesalud en Colombia by UNDP Colombia and Business Call to Action. (January to March 2022) Moreover, thanks to the TuMédico, the company Saludtools is chosen as one of the "los 100 innovadores de 2021” by Bloomberg and is also selected as one of the best 100 startups in Colombia by Forbes Colombia in 2020 and 2021. 

We are trying to improve medical care, medical consultation for everyone, but especially in our target population in Colombia in the following way:

1. People who do not have easy access to the health system in Colombia, such as people in rural areas or small towns where most ethnic minorities live and people with disabilities. This accounts for an approximate 23.5M patients just in Colombia. 

2. People with low/medium income, people who find it difficult to leave their job for a day to go to the doctor's office. 

3. People who require an important (but not urgent) medical consultation or who prefer not to wait at least 7 business days to speak to a doctor.

4. People who do not have access to the health system in Colombia such as travelers, immigrants, people who cannot afford it and others.

In addition, we have been executing various projects to serve a specific target population as following: 

1. With the Red Cross Colombia, from February to July 2021, we have been helping COVID patients in hospitalization and emergency. It was an interconsultation service between Internists from TuMédico and general doctors from the Red Cross.

2. Since July 2021, with Allianz (German insurance company), we have provided a tele orientation service to take care of the mental health of all Colombians. We started this project to raise awareness about the importance of mental health in Colombia as well as to take care of people's mental health. For example, with 5 issues that most Colombians were suffering from during the pandemic: anxiety, insomnia, depression, grief management and domestic violence... Now, we are adding one more topic to the project to take care of children's mental health as they have been going through all the unexpected changes due to COVID. Therefore, through this project, we are trying to impact all people in Colombia, from children to adults.

3. From December 2020 to January 2021, we helped those who were affected by the hurricane in San Andrés by providing telemedicine service at no cost. During the passage of the hurricane, the only hospital in the Sand Andres region was destroyed, so with the collaboration of Bansat (Internet provider) and La Defensa Civil Colombia (government officials), we have been treating patients in that region from mental care to physical care.

4. With Bavaria (AB Inbev), the largest beverage company in Colombia, we have been helping small entrepreneurs or Mom and Pop’s business owners take care of their health and that of their family without leaving their shops closed. With Taxia, we have been providing our solution to taxi drivers and with Liftit, to cargo trucks drivers.

To make healthcare accessible, affordable, easy to use and a pleasant experience to patients especially in underserved communities, our solution is trying our best as following:

1. Make it accessible: Patients can buy the teleconsultation service through pharmacies or Mom and Pop´s stores next to their house with the same ease with which they buy a bottle of water.

2. Make it affordable: Our solution is the virtual medical consultation that does not require an acquisition of a physical office space. Therefore, we can provide the service with an economic value to our patients and it makes us highly scalable. 

3. Make it easy to use: We constantly communicate with our patients to improve our customer journey with no pain points. (There is a more detailed explanation on improving the customer journey in question #16.)

4. Make it a pleasant experience for patients: with TuMédico's own medical team specially trained to attend patients through Telemedicine consultation and with our service team with a "patient obsession" mentality.

The co-founder and the Head of Division of TuMédico is Lucy Jun, focusing on general business management, business development and innovation of the solution, TuMédico. She joined the company, Saludtools to add a new fresh point of view and she founded the solution, TuMédico, to attack the inequality of the healthcare system in Colombia and to provide a great medical consultation experience that all people deserve. Based on her international experience, such as working in sales/marketing at a big corporate, Seoul, in business development at an NGO, Washington DC, and in marketing and business development at a small business, Barcelona after her MBA at ESADE business school, she has maximized her deep understanding of innovation and strategy. She constantly challenges the situation and the service to improve the customer journey, maximize the social impact and also make the business scalable and sustainable.

The Chief Medical Officer of TuMédico is Doctor Natalia Malaver, leading the team of 14 general doctors and 4 specialist doctors (1 gynecologist, 2 Internist, 1 Pediatrics) as in feb, 2022. Doctor Natalia Malaver is Nephrologist (MD), Internal Medicine Physician (MD) and Public Health specialist (MPH) with 20  years of experience in Medical Care, Clinical Research, and Clinical Unit Management working for healthcare providers, medical clinics, and Schools of Medicine as: Scientific Manager at Unimedin (1998 - 2012), Nephrology Physician at Fresenius Medical Care (2011), Renal Therapy Service (RTS) Units Director at Baxter (1999 - 2011), Clinical Research Center Director at Country Medical Clinic (2004 - 2011), Nephrology, Internal Medicine & ICU Physician (1995 - 2012), Faculty Professor at PUJ, CMNSR, and UPTC Schools of Medicine (1996 - 2012), Nephrology Lecturer at Colombian Congress of Nephrology & Hypertension (2001-2011), BOD member at Colombian Society of Nephrologists (2008 - 2010) and Nephrology Advisor & Colombia Liaison at DaVita Dialysis (2014 to present) and of course the CMO for TuMédico from the beginning. She has been selected as one of the TopDoctors in Colombia in 2017, 2020 and 2021. (The Introduction of Dr. Natalia Malaver in TopDoctor: https://bit.ly/3BQ5Tr0) 

TuMedico started as an experiment from Saludtools back in 2020 and the CEO and the founder of Saludtools is Camilo Naranjo, a healthtech entrepreneur. He has been working in the healthtech industry for 16 years, serving as an eHealth consultant for the Colombian Ministry of Communications at USAID, Solutions Manager - eHealth at Orange, VP of eHealth at Salud Vida EPS SA, where he was able to launch and operate several Healthtech projects for large underserved communities of 2 million patients (our same target population today). After that, he founded the company, Saludtools, in 2014. Through his diverse experience in the healthcare industry, he has developed the platform Saludtools where doctors can realize telemedicine consultations and manage their appointment schedule, patients´ information and all the relevant documents such as clinical history, prescriptions etc. The most important value for him is constant learning and growth. As a startup that aims to solve the problem in the health sector, his daily goal is to experiment ideas and learn from the results quickly and make them better than yesterday.

Victor Diaz is a business manager with proactive communication and impeccable relationship building skills with in-depth knowledge of Saludtools technology. Through this, he is in charge of managing alliances with local pharmacies and small businesses. He regularly visits all points of sale to understand market situations and the reaction of potential patients in various regions in Colombia. 

In the team there are 4 more members, Patricia Roman, administration manager, Nataly Rodriguez, commercial assistant, Cristian Buelvas, administrative assistant and Angie Camacho, marketing/design assistant. They are helping those responsible for the area to make the workflow agile and efficient. 

TuMédico is a relatively young solution that started in 2020. Over 2 years, we have tested the solution and researched the target population, proved the needs of the solution, improved the service and the business model to make it scalable and sustainable. Therefore,  we have witnessed that the solution can bring the impact to our target population and make a valuable contribution to various communities. However, we have been struggling to make the solution next level. These are the questions we ask ourselves every day:

(1) How can we maximize the impact with our solution? And how exactly can we measure the impact? 

(2) What are the characteristics of our target population that we do not understand? How can we find and investigate those missing parts?

(3) How can we gain the trust of our potential patients? How can we convince conservative and traditional patients in Colombia and in Latin America to convince them that we have a better option for them?

(4) What are the patient pain points that we are missing in the customer journey? Or, what are the points that we can improve in terms of customer experience?

(5) How can we minimize CAC and maximize retention rate?

(6) We understand that our business model has a high level of scalability, however, how can we make our operation more scalable?

Based on the conversation with Nicolás Acosta and his team, from Dondoctor and Sexperto (MIT Solver 2018), we have learned that the Solve program would provide an opportunity to analyze our solution from different perspectives and receive invaluable inspiration through other Solver peers. Moreover, we would be learning how we could develop and improve our solution to have greater impact through mentoring systems, training and strategic advice from experts who have really been in our shoes. We believe that this would be a perfect opportunity for TuMédico to redesign and execute the strategy to make an impact on all the communities in Latin America. This is exactly what we urgently need right now for our solution and this is why we absolutely desire to be a part of the Solve Program 2022.  

There are 5 points which make the solution TuMédico innovative like following: 

1. Accessibility: 47% of our population in Colombia do not have a premium insurance subscription and they have to rely on the general one that does not offer virtual services and waiting times are of at least 7 business days on average for a basic medical consultation. Even though there are many telemedicine services available on the internet, however, the internet penetration rate in Colombia is only 65% according to Our World in Data (Individuals using the Internet (% of population) by 2019) compared to the rate in the South Korea 97%, UK 93%, US 89%, EU 86% and OECD members 83%. It signifies that the low-income population and population in the rural areas or small villages do not have easy access to the internet to find any information about telemedicine service. That is why we started the alliance with the 3 largest pharmacy chains in Colombia, Copservir, Coopidrogas and Droxi, local pharmacies and local Mom and Pop´s stores so that we can reach people who need a medical consultation. We are the ONLY telemedicine service in Colombia that provides the service through these channels and covers almost every corner of Colombia with 1,309 points of sale (as in feb, 2022). We are doing our best to make the service accessible to everyone regardless of their income, who they are and where they are, making the process as easy as buying a bottle of water at the pharmacy or grocery store next door.

2. Medication Delivery: TuMédico's medical consultation service is integrated with the Pharmacy Saludtools medication module. This allows a patient to acquire the medications prescribed by their doctor without having to leave their home and at an excellent price. The patient does not have to register, search for medications, step on a pharmacy or download an application, just with a single click, they can receive their medications through the service integration between TuMédico and Pharmacy Saludtools. Thanks to our partnerships with the largest pharmacy chain in Colombia, Copservir (la rebaja droguerías, 977 sales points), we can not only offer the medication delivery service but also provide a 10% special discount on their medications to our patients, given that our target population is living in the underserved communities. 

3. Constant improvement of the customer journey: we constantly learn from our patients. We do constant interviews with them to know what are the pain points of the customer and how to improve our customer journey. Here are three points that we have achieved.

   1. No sign up, no verification code: TuMédico used to have a registration process and a verification code for the purchase of the service. However, our patients expressed that these processes were not easy to follow. Therefore, we completely removed these parts. For the sign up, we receive the basic information of the patients and our service team registers them in our system and we confirm the sales with the pharmacies directly and automatically, without putting our patients to work. 

   2. No downloads: TuMédico used to have an app only for the video consultation. However, based on our research, we have found that 70% of our patients have difficulty in downloading an application due to a low internet connection or mobile device problem and it delays the consultation at least 13 minutes. Therefore, we completely eliminated the application even though it was a huge amount of investment in the beginning of prototyping the solution. Now, patients will receive a WhatsApp message, SMS and email right before the consultation with the link and all they have to do is click on the link and talk to our doctor to consult their health problem. 

4. Service that would make patients comfortable, great customer experience: 

   1. Own team of doctors: TuMédico has its own team of doctors. Our doctors, in addition to having all the suitability and credentials to practice their specialties, are trained in Telemedicine and patient care, which guarantees our excellent customer service. The medical team is headed by Dr. Natalia Malaver, a nephrologist and internist at the Javeriana University. Since it is a team of doctors of TuMédico, in case one patient wants to continue his/her follow up with a specific doctor again, it is possible without any problem. 

   2. No chatbot: As one of the characteristics of the local customer, Colombians prefer and like to speak with the service team in a direct and personal way, not through a chat bot. For example, senior citizens and people from rural areas who are not familiar with the service would like to ask questions through calls to make sure that the service would work for them. We understand the situation given that TuMédico is a new and innovative service for Colombia, therefore, we postponed the plan to use a chatbot in terms of customer service to make our patients feel more comfortable. Rather, we created a customer service guide so that our service team can answer questions without any delay.

   3. In extreme cases: If patients do not have an internet connection, TuMédico can provide the service through their home phone only with their consent. If patients do not have email or access to email, we also send all post-consultation documentation (medical history, prescription, test recommendations, certificates...) via WhatsApp only with their consent. 

5. Proprietary technology, Saludtools: TuMédico offers the patient a simple, friendly but very robust technology that guarantees 100% confidential and secure communication.

Impact goal for the next year

1. Expanding the market to one of Latin America countries where there is ineuqliaty situation in healthcare system and where Saludtools already has a presence in (for example, Peru or Mexico) to cover more people who are in need of medical consultation service. 

2. Establishing the first government partnership to cover more people in rural areas in Colombia 

3. Attending 20.000 patients total (currently, 7,059 patients are attended as in feb, 2022)

4. NPS > 85%, satisfaction 9,5/10

Impact goal for the next 5 years

1. Expanding the market to at least 3 or 4 of Latin America countries where there are ineuqliaty situations in healthcare system and where Saludtools already has a presence in (for example, Peru Mexico, Ecuador, Argentina or  Venezuela) to cover more people who are in need of medical consultation service

2. Attending at least 120.000 patients total 

3. Making the business sustainable so that the solution can provide the service with more economic value to our patients 

4. NPS > 87%, satisfaction 9,7/10 every year

5. Achieving the official local autorizaciones to operate as a medical clinic. 

# of people who are in our reach based on the markets that the solution is available

• # of target population who are in our reach 

• # of patients attended by the solution

• NPS and satisfaction

Starting with a problem, inequality of the healthcare system in Colombia, we began to build a service model to meet the needs of patients and make healthcare more accessible, affordable, timely and user-friendly for all. Whoever patients are, wherever they are and whenever they are, we need to cover the needs of patients that the current health system is not covering.

        Activities: 

1. Main activity: Providing the virtual medical consultation 

2. Target population:  (1) People who do not have easy access to the health system in Colombia, such as people in rural areas or small towns where most ethnic minorities live and people with disabilities. This accounts for an approximate 23.5M patients just in Colombia. (2) People with low/medium income, people who find it difficult to leave their job for a day to go to the doctor's office. (3) People who require an important (but not urgent) medical consultation or who prefer not to wait at least 7 business days to speak to a doctor. (4) People who do not have access to the health system in Colombia such as travelers, immigrants, people who cannot afford it and others.

3. Sales channel expansion: New partnerships with (1)Mom and Pop´s stores, Chiper (2) Pharmacy chains, Copservir (La rebaja droguería), Coopidrogas, droxi and (3) independent pharmacies and creating online web page, https://www.tumedico.com.co/

4. Marketing activities: (1) to general public: radio, social media activities (Live, posts, videos), distribution of explication and promotion materials of the service (2) to pharmacies: introduction session to sales forces of pharmacies, special commission, regular calls, mystery shopper visits and distribution of explication and promotion materials of the service

Outputs

1. Proving the needs of the solution in target population and the interest of pharmacies

2. Proving the business model works and improving the business operation

3. Improving the customer journey and customer experience 

4. Raising the awareness of video medical consultation and also the brand, TuMédico

Short-term outcomes

1. Reaching more than 300 municipalities in Colombia

2. Attending 7,059 patients 

3. NPS: 88% and satisfaction 9,6/10

4. Established the concrete business model which can be scalable and sustainable

Long-term outcomes

1. Establishing partnerships with government organizations to expand the customer reach in Colombia

2. Expanding the market from Colombia to at least 9 countries in Latin America

3. Attending more than 2,000,000 patients

TuMédico connects patients with medical consultation service through Saludtools, technology that is 100% confidential, reliable and in accordance with all the regulations that regulate this matter in the country. All our medical services have the authorizations before the REPS, Secretaries of Health and other applicable entities, as well as the authorizations indicated by the regulations: Resolution 2654 of 2019 and Resolution 3100 of 2019.

Since TuMedico came from an experiment done in 2020 from Saludtools (www.saludtools.com) one of the strong points of TuMedico is its technology. Our platform (Saludtools) is currently used by 7.040 healthcare providers in Latam in 2 million medical encounters so far. We use Saludtools technology for scheduling, medical record taking, telemedicine and document management. Since we are essentially the same company we use the software for free and allow us to grow in technology with expending valuable resources in this aspect and at the same time we have a compliant, high performance tool for our own use.If you want to see a full description of Saludtools security and tech stack, you can find it here (spanish): 

https://bit.ly/3t8WvLh

During the recent couple of years, especially from the pandemic, the company started to grow exponentially not only in terms of business but also in human resources. Therefore, we are now establishing the goal to make the company more diverse, equitable and inclusive and our current approach is following: 

1. TuMédico provides equal and fair opportunity to all candidates and all employees. We consider qualified applicants for employements without regard to race, age, color, religion, national origin, marital status, disability, gender, sexual orientacion, gender identity/expression or any other legally protected factor. 

2. TuMédico provides the benefit program to all members, focusing on personal growth, job stability, emotional stability and benefits that allow the members to grow with the organization and at the same time have quality of life for their activities outside the office/home. This program is specifically designed based on the work from home culture due to the fact that 100% of our employees currently work from home since the pandemic. Therefore, its objective is to help team members have all the possible benefits of creating their work environment at home with all the necessary tools. Moreover, to make sure that team members can keep their close relationship with each other and to overcome any limit or restriction of working from home, TuMédico is organizing a constant virtual meeting about new employees introduction and any personal news to celebrate together (birthdays, weddings and/or new members of their family…). 

3. Currently, TuMédico is a woman-led team: the leader is Lucy Jun, originally from South Korea, worked in Korea, US, Spain and now in Colombia. Additionally, the leadership team of the Saludtools consists of 11 members: 4 nationalities (Colombia, Venezuela, Argentina and Korea), 55% of women, covering sales, marketing, product, technology, customer onboarding, customer service, human resources and more.

The business model is quite simple. Revenues are primarily marketed through three channels: (1) local pharmacies and local Mom and Pop´s stores (2) corporate alliances, and (3) the website. There is no subscription model, so patients can buy their medical consultation when they need it. The service is by video medical consultation, but in the event that patients cannot carry out the video consultation due to a problem with their cell phone or the Internet, in this case we also try to provide the service through a call (cell phone or landline) with their consent. The cost side has three parts, too: (1) Medical Costs (workforce) (2) the commission for pharmacies or businesses, and (3) the cost of administration and marketing.

We have 4 parties involved in the business model: (1) Saludtools, technology provider. Since it is our proprietary technology, there is no cost to use the tool. Our best interest is to provide the best healthcare experience with safe, high quality and friendly technology. (2) local pharmacies and local Mom and Pop´s shops. Their main interest is to provide the telemedicine service to their clients and by doing so earn the sales commission. Additionally, in the case of pharmacies, the sale of medicines based on the prescription after consultation is another of the interests. (3) Corporate (alliances): provide the telemedicine service to its indirect collaborator (not official employees) whom company benefit programs do not cover, to take care of their health. (4) Patients: their needs are to receive medical attention to take care of their health or that of their family rapidly without having to spend a lot of time traveling to the doctor's office or waiting in the office or without experiencing any inequality in the healthcare system. They prefer to receive good service: the doctor listening to their concerns, problems, symptoms and solving them together with empathy. 

As a reference of common revenue models (https://learn.marsdd.com/article/social-enterprise-business-models/), TuMédico is closely applied to Low income client business model and Fee for service model. With the B2C part, we have created the service distribution system, diversifying the sales channel by partnering various pharmacy chains in Colombia, and also have an advantage in production cost due to the virtual consultation model. TuMédico achieves a gross margin of 25% according to this channel distribution. The service is now rentable in terms of gross margin. We are currently working on the marketing costs and operating efficiencies to be financially sustainable. Currently, the marketing costs are the big part of our expenses due to the early phase of the product life cycle. 

With the B2B part, we have been providing the service of TuMédico through various alliances, such as Red Cross cundinamarca Colombia, Hocol, Castrol, Bavaría (AB InBev) and more. We provide the service to their patients or employees or collaborators. 

To become financially sustainable, TuMédico should be focusing on the maximization of the revenue. To maximize the revenue, TuMédico needs more service sales through B2C and B2B. In order to achieve this, we are trying to establish a close relationship with all the pharmacies by calls, visits, mystery shopper activities, training about the service to new sales forces and co-marketing projects. Moreover, we are doing an investigation for service contracts with government organizations. Secondly, it is needed to have more B2B partnerships which could guarantee more revenue. In terms of cost, the cost optimization in the marketing cost such as printed advertisement, digital ads and participation of marketing events. 

In 2020,  we were prototyping the solution TuMédico through various experiments with potential partners, listening to the potential customers and clients, improving the customer journey, establishing the business/financial model and operation, designing strategies for business development and marketing and expanding the network to find growth opportunities. Based on this, the year 2021 was the time when TuMédico started to achieve financial sustainability. TuMédico started to sell the service through 1.000 point of sales in Colombia through partnerships with the two largest pharmacy chains in Colombia and achieved the sales through various alliances with corporations such as the Red Cross, Allianz, IGS and much more. Therefore, TuMédico achieved a 1392% increase in the number of consultation sales in 2021 YOY.

Moreover, we have won the Novartis´ Challenge, Reto Innovation Que Late (innovation challenge that beats) in 2021, receiving the prize of USD $ 30.000 for the service development and the 3 months of mentoring program.