The Auna Way: A Platform for High-complexity Care in 3 Countries in Latin America

Introduction: We believe that by focusing so passionately slash obsessively with high complexity, which as everybody knows represents a disproportionate amount of healthcare spend in the world with a smaller number of cases, actually no, we believe that we can stand it. The challenge of standardizing that is much, much easier than General Healthcare. The fewer diseases, fewer protocols, fewer practices, and that's what we try to do.

Welcome to The Quest for Excellence, a dynamic IFC webisode series dedicated to exploring the evolving landscape of healthcare performance. Each episode dives into best practices, innovative solutions, and inspiring stories from professionals striving to deliver exceptional care. Join us as we uncover pathways to excellence and share insights that empower healthcare organizations to achieve their highest potential.

Charles Dalton: So today we're going to be talking to AUNA, who are going to tell us about what they've been doing in Peru, Colombia and Mexico and the journey that they've taken — to get some really good insights on how they look at the business, how they operate the business and how they look at performance measurements. So it'd be great if you could introduce yourself and just give us a little bit of a background on AUNA and what AUNA does.

Jesus Zamora: So we are a platform of healthcare in Peru, in Colombia and Mexico, we call it, we manage it as a regional platform. Very much focused on granting access to families for high quality healthcare services specifically related to high complexity diseases — cancer, cardiovascular, trauma and orthopedics and neurosciences.

Charles Dalton: So I think it would be really good if you could just give us an insight on your strategy, the business model and the sort of the building blocks that you look at.

Jesus Zamora: So AUNA is a model that is mature in Peru, gaining some level of maturity in Colombia and starting in Mexico. So if we were to take a snapshot of the different countries and different cities, you would find different levels of where we've taken the AUNA way. The AUNA way is our North Star — it doesn't mean that all the clinical sites and the practices that we have reached that North Star yet, but that sort of guides us there.

It's important that I say that because I want to make sure that when assessing AUNA, what's really interesting is scaling. One of the key things is that we are of course a healthcare company with a great clinical practice. What we try to strive to be more and more so is a company of processes. We're more in engineering with a back office that's really strong in processes in which we standardize for the benefit of all the countries and all the sites and all our patients and all our staff.

We standardize procedures and processes in those typical 3 dimensions of healthcare — the patient journey, the medical practice, the clinical act, and of course the unit economics of all those little steps, all those little engagements that create the delivery of our services. We try to make sure that there are processes that allow us to scale. Some of the words that we love are predictability — in healthcare there's very little predictability. We try to make sure that there's more and more predictability in those three dimensions: patient journey, clinical practice and of course financial returns.

We believe that by focusing so passionately slash obsessively with high complexity — which as everybody knows represents a disproportionate amount of healthcare spend in the world with a smaller number of cases — we believe that the challenge of standardizing that is much, much easier than General Healthcare. The fewer diseases, fewer protocols, fewer practices — that's what we try to do. That allows us to increase scale, diminish cost and not only improve our margins, but more importantly produce new financial products that are accessible and affordable to families.

Our nature within AUNA has this need to be integrated in 2 dimensions. Vertically integrated — because our healthcare plans are integrated into our healthcare services. Someone buys a policy from us or we take on a large contract with the population for a large insurer, and we make sure that all the delivery of the services is within our network. We make sure that all our policies have an access point that is affordable, with no deductible, no co-payment, and includes a lot of prevention. We're really obsessed about prevention, especially in oncology where it makes such a big difference in survival rates.

That conquering of that service offering is critical because it allows us again to standardize and to have the best cost. And then horizontal integration — making sure that we are a healthcare company, not a disease care company. Being committed to keeping our policyholders: #1 healthy, #2 preventing diseases, #3 detecting them early, and #4 treating diseases. That horizontal integration means being in that space of health and disease in different channels — digital, outpatient centers, hospitals, and of course being at home throughout that space.

Charles Dalton: At a time where there's less money available, we have fiscal constraints, we have payers and patients all looking for more value out of every dollar spent. The way you're approaching the business model and backward integrating into the payer side — I'm assuming the end objective is better coordinated care with hopefully better outcomes and also offering better value. So the patient is in the middle and is getting the right coordinated care around them.

Jesus Zamora: Coordination works well when you have this obsessive nature on making sure that there are processes and standardization behind everything. It's not only that we have great teams of physicians and nurses that work in large medical committees and tumor boards and orthopedic boards regionally — there's a lot of coordination there. It's also the fact that behind that there's a protocol that they devised together and that they change together.

Charles Dalton: How do you develop what I would call a performance-focused team approach which allows you to effectively manage clinical services and operational services? And how do you embed the right incentivization or accountability into the structures to enable you to effectively manage performance in the way AUNA wants performance to be managed?

Jesus Zamora: I think there are various things and I'm going to go through a series of attributes of our culture. I think we're humble. Very warm and engaged. We talk about the privilege of serving others, so that aligns a lot of the people. We're very ambitious — we're always questioning if we could go further, faster, better, and that's the culture of the whole team. Teamwork is basic. Individual results are secondary to team results.

Our responsibility as leaders is to push the team to their limits. I don't know what the limits are at the beginning, and I keep on pushing — and that's something we continue to see. We measure more and more — recently more and more — what the objectives of all the teams are and how we have a strategy that starts at the board level and cascades all the way down with different interpretations of the objectives. Everybody knows what we're doing. I spend a lot of time — almost every other week — communicating to our 60,000 employees and collaborators what we're doing, why we're doing it, and why it fits so importantly into that objective.

Charles Dalton: What you're telling me is that you have that cultural commonality across countries but with that cultural oversight. Yeah?

Jesus Zamora: It is. But I'm even more ambitious — culture, we believe, is a structural element of a community that is aligned. What we're trying to build is a community of health — and it's not doctors and nurses and administrators only. It's patients and families and suppliers and neighbors. We are building communities of health in which we take care of each other. We're very obsessed about health, not disease care. So many things that we know can be avoided with a healthy lifestyle, in terms of longevity and quality of life. So we're always promoting this idea that the real platform is a community — engaging with the community, catalyzing a community, and of course fostering the right behavioral standards and values that we want in that community.

Charles Dalton: How do you ensure standard approaches to quality and ethics? Because you're operating in three different countries, each with its own nuances. What are the fundamentals for you from a quality and ethics perspective, because that can directly and indirectly impact performance?

Jesus Zamora: There's a level of things that are non-negotiable — quality, patient safety — non-negotiable. There's no leniency or tolerance of anything. And then there are cultural standards that are different in each country and each city. First of all, we make sure that we have a culture of openness and open discussion. There's a level of community accountability because you will be exposed to your best practice and to your worst practice.

In Peru, today over 80% of our doctors or employees have a contractual model that aligns them — they adhere to our protocols and they produce our protocols. It wasn't like that 15 years ago. It was very similar to Mexico, where today we have maybe 10% of our physicians in a contract model. So it takes time. It's not something Peruvian — it's something that AUNA has produced over time.

Charles Dalton: What's your view on the digitization of healthcare? How are you embracing it and evaluating it? Because there's a lot of opportunity for digital and AI, a lot of potential, but also a lot of hype. How does an organization like AUNA balance that hype versus reality to improve performance?

Jesus Zamora: For many years we'll have the benefit of efficiencies of technology applied, which will reduce the cost of delivering services and make it more accessible. Today our digital practices are about making it easier for the patient and the family on that journey — more information, ease of getting appointments, information that you can share with AI platforms to get more knowledge about your situation. Empowering the patient with information and data and analysis is critical.

Charles Dalton: How do you put in place the right governance structures?

Jesus Zamora: Since we started, we've always had an oversized board of independents. That is our ethos — how we operate. I want to make sure that I'm found wrong by someone that can tell me, "Hey, you are wrong." That saves me. And I think that's the culture we have — we're OK with being found wrong. In certain meetings I always like to say, "Let's imagine we have a patient here. Let's make her listen to this conversation and how she feels about this decision." That governance with an openness to put the different parties in the same discussion is critical.

Charles Dalton: What are the critical things for you at a board level, and what are you holding your managers accountable for when measuring and managing performance?

Jesus Zamora: At least two additional performance metrics matter to us because our model is one of vertical integration. It's very difficult and costly to start with a very high penetration of revenues related to insurance plans because they grow at different stages. You inaugurate a new hospital, spend $100 million on it, it takes another four years to break even. You're growing your healthcare plan slowly, gradually every month and every year, so they don't coincide — you have steps against gradual growth. What's important for us is to make sure that healthcare plans which grant access grow consistently and penetrate our hospital services.

Charles Dalton: I'm assuming behind all of this you need active collection and utilization of data. That seems to be a big challenge in some markets because data sits in silos. I'm assuming data plays a huge role in how you manage performance, but also how you grow and evolve the business.

Jesus Zamora: Some of the countries are a little more advanced — ERP systems that are standard, digital platforms. Others we have a collection of new hospitals and older hospitals that we bought with legacy systems. Putting all that data together takes some time. In Mexico, for example, where we bought hospitals a little more than three years ago, we're right now in the huge implementation of the ERP system. It's very traumatic, but it will bring Mexico to the level of our digital offering in Peru. Technology and data — data use, data mining — also has a big cultural aspect.

One of the things where we're a very formidable player is oncology in the region. We have something like 60,000 active patients in oncology — a big number with great practices. That information — say, of a woman with breast cancer — and the ability to show her that we treated 150,000 of those same types of breast cancer at the same stage — that data is so rich and so important. We're getting there to say, "Listen, what we've done with exactly the same diagnosis — knowing that you're a different person — is this. These are the outcomes. This was the experience. This was the cost. This is our best experience and we want to show it to you."

Charles Dalton: So where will be the next mountain for you to climb as you continue on your North Star journey and the quest for excellence?

Jesus Zamora: There are two distinct mountains that we see from afar. One, no doubt about it, is insurance. Private insurance penetration in Peru is 6% of the population — the rest have a Social Security system or a national healthcare system that is lacking. In Mexico, less than 10% of Mexicans have private insurance — most people wait months for an appointment or surgery. That's a huge problem. It's a tragedy.

I think there's an opportunity to start delivering our services in a B2G model. We as privates have a very clear objective of standardization, predictability of the patient experience, predictability of the medical outcome, predictability of the cost. I see ourselves delivering services more and more to the government. I empathize with the government — it's really difficult and complex to deliver services to so many people in so many ways. But I think we can make that a little easier as privates, delivering a sliver of what they can delegate — at a better cost basis, with a better experience and a better outcome. I see the B2G opportunity as the next mountain.

Charles Dalton: Thank you so much, Jesus. This has been excellent. I've really enjoyed this. Thank you enough.

Jesus Zamora: Thank you. Thank you very much.