Primary Care, the Treatment of the Future
Mexico has a real need for primary care; however, access to health services is the indicator that has grown the most in INEGI surveys, which has helped to combat poverty and extreme poverty, said Secretary of Health José Narro on Thursday in his opening presentation at the third edition of Mexico Health Summit, held at the Sheraton Maria Isabel Hotel in Mexico City.
During his presentation, Narro reviewed the country’s achievements in health over the last decades, as well as the main challenges from the new health scenario facing the country: the rise in chronic noncommunicable diseases, one of the major threats in Mexico represented mainly by three pathologies: obesity, diabetes and cardiovascular diseases. He pointed out, however, that since 1980 communicable diseases have declined 85 percent.
Narro suggested that demographic changes will continue to have a profound impact on the country. “From 1950 to today, Mexico has multiplied its population by five. Today, we have 10 times more people over 65 years than in 1950,” he said. This means that in 2050, there will be 17.2 million people over 70 years old, which in turn will lead to challenges such as the appearance of chronic degenerative diseases. “Public policy needs to consider demographic changes and its impact on health,” he added.
According to Narro, Mexico faces several challenges. “We were late to diagnose the diabetes threat,” he acknowledged before offering some figures. “We have 130,000 annual deaths caused by cardiovascular disease and we have not been able to stop and prevent breast cancer,” he said. He defined geriatric health as “a growing threat,” since Mexico has few hospital beds and few certified specialists. “We have to advance in prevention and timely diagnosis,” Narro concluded.
The Patient Goes First: Using Big Data and Collaboration to Optimize Treatment
Massive quantities of data are generated on a daily basis by the many players in the health system including hospitals, private consultants and pharmacies. To move beyond the creation and collection of information and into the identification of key patterns to optimize primary care and treatment, Mexico faces the challenge of developing standardized systems and protocols for data management, panelists told the Mexico Health Summit 2017 at Hotel Sheraton Maria Isabel in Mexico City on Thursday.
Speaking during a panel titled The Patient Goes First: Using Big Data and Collaboration to Optimize Treatment, Peter Kroll, CEO of Everis, said “business intelligence is creating an evolution in healthcare. New technology allows us to analyze large amounts of information, operating systems and medical records. But we need to find ways to adequately use this data to quickly prevent epidemics and chronic diseases.”
There are, however, several bumps in the road toward leveraging Big Data in healthcare. The Mexican healthcare system, public and private, is spread among several institutions and lacks connectivity. “We need to make a bigger effort to synchronize this data that comes from several platforms. It would help facilitate decisión-making,” said Francisco Corpi, Latin North Director RSS and Mexico of Elsevier.
The moderator of the panel, Ignacio García-Téllez, Director of Health for KPMG, reiterated the scarce amount of resources that exist in the healthcare system and the role Big Data plays in its optimization. Added Antonio Carrasco, CEO of PLM: “Mexico spends a large amount of capital treating illnesses and diseases that could have been prevented at an early stage. By finding patterns in the population through data we can identify key areas that need to be addressed and improve the primary care patients are receiving.”
To achieve a higher level of optimization, the proper use and evaluation of data should be promoted. “Models and systems to treat chronic diseases and epidemics can be created through clinical research based on mass data. We need to invest in properly evaluating information,” said García-Téllez.
The human factor also plays a big role in making sure that information is being properly used. “If the people inputing the information do not know how to adequately use the system, the information becomes completely useless through the lack of accuracy,” said Corpi. “We have to think about the human factor and its interaction with the data-management ecosystem.”
Finding adequate ways to manage the use of data can equally help doctors avoid wasting time filtering the large amount of information available. “Doctors now have to wade through massive amounts of data and our job is to simplify a complex system,” said Corpi. “We aim to reduce treatment times from the moment a patient enters the hospital to the moment they leave.”
Another issue that needs addressing is the lack of transparency and trust in the healthcare system and the way information is stored. According to Carrasco, studies show that Latin America and the Caribbean need to promote more trust in the storage of data. “Unfortunately other countries such as the UK and Australia have had cases where data was used for private and unethical matters and that has impacted the public’s perception. We need to increase trust in institutions.”
When it comes to the collection and use of data, pharmacies are leading the way. “Considering the large number of points of sale that pharmacies encompass, they have become a point of reference for the industry when it comes to using data in healthcare,” said Marcos Pascual, Commercial Director of ANFARMEX. He considers this to be an example of how the private sector often takes the initiative in incorporating new trends in the industry and optimizing services. ANFARMEX is working to create new standards for primary care and to boost the quality of attention through data generation and certification.
Overall, creating an interconnected ecosystem in the health industry is one of the biggest challenges the industry faces. “Data management is essential to reducing health risks in the country. Imagine if someone on vacation in Cancun has a sudden medical emergency and the hospitals and doctors in the area have no access to that person’s medical record,” said Kroll. These situations can put patients at great risk and can be resolved through a better exchange of data. He also emphasized the need for the private sector to share information because the lack of trust inhibits the creation of a single platform. “We can use data to greatly improve the efficiency, quality and prevention of chronic diseases but this is only possible through collaboration.”
Carrasco concluded by saying that Big Data is part of the fourth industrial revolution and it is impacting all industries, andnot only in Mexico. “We need to see the areas of opportunity that can arise from sharing information. Creating a medical record is irrelevant if the data is not being used to improve the care patients are receiving.”
Taking Mexico to the Top 10 in Clinical Research
Mexico has the potential to become a clinical research hub, but the sector requires professionalization in the system, a regulatory framework that is open to innovation and a commitment from industry players, said clinical research experts Arturo Rodríguez, CEO of ACROM, and Karen Hahn, Director of Clinical Operations at ICON, during a debate on the challenges and milestones for Mexico’s clinical research sector at Mexico Health Summit 2017 in Mexico City on Thursday.
The discussion at the Hotel Sheraton Maria Isabel and moderated by Sophie Murten, Journalist and Industry Analyst for Mexico Health Review, tackled the question of how industry players could work together to make Mexico a clinical research hub. Mexico contributes US$260 million to the global clinical research industry, according to Rodríguez. “The country only does 1 percent of the total research done in the world. Growing 1 percent more represents US$260 million more,” he said. “Mexico’s clinical research sector is between 19th and 22nd in the world. We are used to saying we are in the top three in Latin America but the plan is to take Mexico to the 10thplace globally.” The CEO of ACROM believes that to achieve this, Mexico should be looking at the standards of the leading countries.
Both panelists agreed that in addition to clearer rules, there needs to be a higher degree of professionalization among all players to create a better understanding and stronger cooperative relationship between the regulatory agencies and CROs. “In the research segment, we are used to working to punctual timeframes and with tools that guarantee efficacy. While the regulatory segment cannot always function in the same way. We have to understand the reason why this is the way it is to start getting involved with them and to drive the regulation to adapt to the research,” said Hahn. Added Rodríguez: “Sometimes public policy does not move at the same speed as the research. However, the regulations resulting from public policy are the mechanisms that allow the evolution of the system.”
Regulatory flexibility is also required, Rodríguez said, not in the law but in understanding and adapting to new technologies. The debate covered the importance of innovation and how clinical research can impact patients by providing new treatments. “We must look at the impact of research on patients and at its capacity to save lives,” said Hahn. She added that clinical research opens new markets and provides access to treatments that many patients need but cannot afford.
The two participants agreed that research represents a great opportunity for Mexico’s public healthcare sector. “Today in Mexico, public institutions conduct 20 percent of the research and the public sector does 80 percent. In countries where the sector is fully developed it is the other way around. We want to increase that 20 percent in the public sector to drive investment,” said Rodríguez. He mentioned that the government and CROs are moving forward in this area as ISSSTE has an agreement with COFEPRIS and CANIFARMA to start doing research at the institution, which could open access to millions of patients.
The experts also agreed on the importance of certainty in the sector to potentialize its improvement. “We need certainty in the regulatory timeframe, in the commitment of the researchers and in the compromise made by patients,” said Hahn.
CNS Issues Created by an Aging Population
In a discussion on Mexico’s ability to meet the increasing challenge of Central Nervous System (CNS) disorders in the elderly, panelists at Mexico Health Summit 2017, held at the Hotel Sheraton Maria Isabel in Mexico City on Thursday, said the country needs to prepare specialists and promote education.
Moderator José María Ostos, Associate Partner at McKinsey, opened the discussion to experts on CNS disorders Marco Antonio Navarrete, Subdirector of Health Services for PEMEX, Miguel Castillo, Health Consultant at Corporation Macs, Luis Gutiérrez, Director General of the National Institution of Geriatrics of the National Institutes of Health, and Vanessa López, Neurology PVU Head LATINA of UCB.
“The challenge is to create a strategy to have healthy, active elderly people that are a part of society,” said López, adding that Mexico needs to prepare specialists to care for this population and to promote continuous education among doctors, especially as there may be new medicines that were not around when they were originally trained, as also noted by Castillo. Gutiérrez highlighted the additional need to increase prevention and recognize risk factors such as chronic- degenerative diseases. “Geriatrics is only one chapter in a medical school textbook,” noted Navarrete, adding that not many doctors want to specialize in geriatrics due to low renumeration. In terms of prevention, optimizing resources is the key. Panelists focused on the inefficient use of tertiary level hospitals and primary care. “Hospitals are being used for purposes they were not meant for,” said Gutiérrez, while Castillo added that, “electronic patient records are vital for managing who should be cared for and where.”
The panelists also agreed the need to educate the general population. “We need more prevention and education of the population in general on how to care for the elderly, as hospitals cannot do this,” Navarette said. When later asked about the patient’s role, panelists emphasized that many risk factors can be controlled and that technology can help, such as application on cellphones that help diagnose the risk of developing a certain disease or condition.
The high amount of out-of- pocket spending was in focus in the second half of the debate, as Gutiérrez explained that the nonpaid work of those looking after family members with a CNS condition amounted to 22 percent of Mexico’s health GDP, compared to 19 percent from the hospital sector.
When Ostos asked about other countries with high levels of elderly population that Mexico could learn from, panelists spoke of Japan, Vietnam and Spain, where care is operated by the private sector but funded by the public sector. López spoke of models closer to home such as Argentina or Chile, which operates a public-private system that could be a source of inspiration.
“The active life expectancy of Mexicans is only three years less than overall life expectancy,” said Gutiérrez. He added that physical activity and nutrition are key to staying healthy in later years “Much will depend on the role the patient plays. There are diseases that depend 90 percent on how patients care for themselves. Patients play an important role in Parkinson’s for example, which changes as the disease advances,” López said.
Innovations including the use of Big Data also have a significant role to play when dealing with CNS disorders. “There are devices that can predict an epilepsy crisis up to four hours beforehand,” said López, adding that Big Data can be used for treatment and that generally, the industry is moving toward personalized medicine. “We need to digitalize information and Big Data is the second part of the solution,” said Navarrete.
Mexico’s Health and Pharma Indicators
When it comes to its health industry, Mexico is at a crossroads between technological advances, its aging population, the rise of expensive chronic diseases and the need for public institutions to quickly respond to this context. “Health insurance covers only 4 percent of major medical expenses policies in Mexico. This means that families have to pay the rest out of pocket, which can be a challenge for a large segment of the population,” Xavier Valdez, General Manager Mexico and Central America of QuintilesIMS, told Mexico Health Summit 2017 on Thursday. “The country’s healthcare system needs to coordinate itself better to properly address these types of issues.”
During the event at the Hotel Sheraton Maria Isabel in Mexico City, Valdéz said that Latin America is one of the largest emerging regions with significant growth potential in the industry. “Mexico is the second-biggest market in the region after Brazil, representing a total value of US$11-12 billion dollars. The industry is being impacted by the rise of cancer, heart disease and chronic diseases that diminish the population’s quality of life.” To take advantage of the sector’s potential, the country needs to change its healthcare model to optimize collaboration between the public and private sectors. A possible area of opportunity could be data management, as the public sector has little capacity to collect information, Valdéz said.
In 2017, the health budget per capita in IMSS was MX$3,000, PEMEX was at MX$17,381, and Seguro Popular at MX$1,203. “We need to analyze the costs and the number of people using these services to integrate the system more efficiently. The country has yet to adapt its healthcare system to the demographic context it encompasses.”
Along with optimizing budgets, Valdéz emphasized the need to increase Mexico’s participation in clinical trials. “In 2016, worldwide investment in clinical trials was US$162.9 billion. Of this share, Latin America invested a total of US$6.2 billion while Mexico only invested US$199.4 million.”
While public institutions need to work on updating an outdated system, QuintileIMS has found that the main companies showing growth in the pharmaceutical sector are regional and national companies. Multinational companies are not growing as quickly in the country because their products are pricier and are directed more toward institutions. He predicts a rise in generic products in the short term as many patents around the world are set to expire. “Non-original products benefit the country because they allow more Mexicans to have access to medication and to continue their treatments.”
Valdéz urged the health industry in Mexico to work together to improve data management and to increase collaboration with insurance companies. “Only 8-9 million people in the country have access to private health insurance. Creating a better alliance between insurance companies and public and private healthcare models can create more efficient preventive strategies.”
Fighting Anti-Microbial Resistance
Greater patient awareness and stricter control of antibiotic prescriptions are among the keys to fighting anti-microbial resistance (AMR) in Mexico, according to panelists discussing the topic at Mexico Health Summit 2017 on Thursday at the Hotel Sheraton Maria Isabel in Mexico City.
The panel consisted of moderator Gerry Eijkemans, Mexico Representative of the WHO/PAHO; Rafael Gual, Director General of CANIFARMA; Maarten Pouw, Director General of DSM Sinochem Pharmaceuticals Mexico; Juan Pablo Solís, Vice President and General Manager Mexico, Central America and the Caribbean of Becton Dickinson; and Rocío Alatorre, Commissioner of Risk Assessment & Management at COFEPRIS.
“A study performed by the Antimicrobial Review and KPMG shows that there will be 10 million deaths per year globally in 2050,” said Pouw, explaining that antibiotics in the environment also reach the food chain. “Bacteria have no borders and can reach the whole world in two years,” he added.
Alatorre explained that Mexico has established a national plan to combat antimicrobial resistance that involves multiple sectors. “It would be interesting to see if there is a certain legislation needed that we have not yet developed. If the industry can spot gaps in regulation, we will happily review it,” she said.
The general feeling that this is not the sole responsibility of one sector was summed up by Solís: “This is a multifactorial problem, it is not something that can be solved alone. We must work as a team.” He said that medical devices could play an important role in helping identify and diagnose AMR. “If we do not take the appropriate precautions, we could be a vehicle for infection.”
Panelists lamented the general population’s attitude toward antibiotics, requesting them when not needed and not finishing prescription courses. “90 percent of ear infections are caused by a virus, yet doctors prescribe antibiotics,” said Pouw. Alatorre added that part of the problem is the lack of awareness in people’s consumption of antibiotics.
Industry professionals are also part of the problem. “Often, pharmacies and doctors in pharmacies prescribe antibiotics without testing,” said Gual, advocating more thorough antibiograms before a prescription is written. Solís pointed out that this is an area in which medical devices could be of use. He added that devices in general now also have better security to help prevent the spread of infection. “Devices have evolved to have presentations that contain active or passive security, such as caps on needles after use. This reduces infections in professionals and patients,” said Solís.
Pouw pointed out that there have been no new classes of antibiotics developed since 1987. “It is easier to protect what we have,” he said. Eijkemans asked what incentives could be put in place to encourage the production of new antibiotics, and Alatorre commented that antibiotics research is no longer a priority for many, but that the government could put incentives in place.
The environment was a final cause for concern. “We need to establish a maximum level of antibiotics in animals destined for meat,” said Alatorre, speaking of synergies between sectors and adding that an integral vision between animal, human and environmental health was key and that Mexico was a leader in Latin America.
Gual explained that waste from pharmaceutical facilities is strictly controlled. “Nothing is overlooked and many times water is recycled and reused. The water the industry throws away is probably cleaner that the water it receives. Antibiotic plants are separate and have many more controls than standard plants,” he said. Added Pouw: “No government establishes maximum limits of antibiotics in waste.” He called for more control globally. “Companies that sell antibiotics in Mexico should certify their waste. The technology is available and is not expensive.”
Solis suggested that as measurement of AMR advances, plans to combat it become more effective. “What is not measured cannot be improved,” he said. “We must be capable of producing a list of the main bacteria that are producing resistance.” COFEPRIS’ Alatorre hinted at an upcoming NOM that would regulate the use of silver to clean water instead of chlorine, which should help with AMR.
From Quantity to Quality: Assuring Access to State-of-the-Art Services
A high percentage of the population in Mexico has access to healthcare through public institutions such as IMSS and Seguro Popular but the system has yet to guarantee universal access to state-of-the-art care or to offer an integrated package of services, both preventive and curative, told Mexico Health Summit 2017 on Thursday. Germán Fajardo, Dean of the School of Medicine at UNAM, opened and moderated the panel, The Challenges in Accessing Healthcare, by emphasizing the need to eliminate the wide array of barriers between patients and doctors in Mexico.
During the discussion at Hotel Sheraton Maria Isabel in Mexico City, Paulino Decanini, Director General go SisNova, explained that access to modern healthcare continues to be a privileged service for the few. “The public healthcare system was created in 1943 when the main problems in Mexico were diarrhea and maternity-related issues, among others. We recently experienced an explosion of information that has widened our knowledge of the industry but the system has yet to adapt itself to this new context.” He urged the industry to focus on more than just quantitative data and to focus on quality to measure true access to healthcare. “We have one of the lowest rankings in terms of healthcare in the OECD as 50 percent of healthcare costs in the country comes out of pocket.”
Fajardo added that public healthcare suffers from fragmentation as access to services depends on employment status. “This can become a nightmare for a patient as every time they change institutions a new record needs to be created when transitioning throughout IMSS, Seguro Popular and private health insurance.”
Aside from the responsibility that governmental institutions encompass, Paul Doulton, Founder and Managing Partner of Oriundo, urged leaders of the industry to take into consideration the responsibility of the patient as well. “Universal healthcare can create a dependence on the system. A smoker can feel assured by the fact that someone else is going to pay for the consequences of their behavior. We need to think about creating more consciousness among patients and changing habits through incentives.”
Patient education is also of importance as a high percentage of the population is dying from preventable diseases and illnesses. “An estimated 70 percent of the causes of mortality among the lower socioeconomic branch of the Mexican population are preventable, such as diabetes,” said Decanini.
Bureaucratic filters in approval processes and certifications are additional obstacles between the health industry and patients. “New medical treatments have to go through several filters before entering the country and additional filters are required for them to enter each institution such as IMSS,” said Fajardo. “Sometimes thousands of days can pass between the time a medical treatment enters the country and the patient has access to the medicine. We need to create methods that can shorten the process.”
A new perspective was added to the conversation by Omar Viveros, Director of Health at Willis Towers Watson, who compared access to healthcare in urban and rural areas. “Bureaucratic filters are equally slowing down the construction of clinics and hospitals in the country. Smaller towns could have greater access to services if the approval process was simplified.”
Innovative solutions from the private sector are helping close gaps between patients and doctors such as the incorporation of medical consultations in pharmacies, with so-called Docs-in-a-Box, stated Doulton. “Pharmaceutical doctors were regarded with hesitation at first but it has had surprisingly great results. For many, medical consultations in pharmacies are their first contact with a trained practitioner and an estimated 20 percent of patients go directly to doctors in the pharmacy. It helps alleviate the oversaturated healthcare system and reduces costs for the public sector”
Pharmaceutical doctors are only a short-term solution, countered Fajardo, because the services do not contemplate a wide array of indicators such as blood pressure. “The industry needs to find ways of offering a more integrated healthcare service to patients through pharmacies. We need to take advantage of its accessibility to the public and connect it to long-term care providers.”
Understanding the Value of Data in Healthcare
The healthcare industry is undergoing a major transformation through the use of Big Data, Marcos Martínez, CTO of Fligoo, said at Mexico Health Summit 2017 in Mexico City on Thursday. The representative from the Argentinian data company addressed the main trends of Big Data in healthcare during his presentation, Zero to Data at the Sheraton María Isabel Hotel.
“A goal of the modern healthcare system is to provide a great service through technology by improving quality, reducing cost and providing support for modified payment structures,” he said. Martínez said there are two factors driving healthcare companies to start looking for services in data management: the need for technical expertise and the lack of security in information administration. “One of the big obstacles of entering Big Data is finding companies that comply with the security requirements,” Martínez added.
According to Fligoo, data can also boost investments in healthcare. Spending on healthcare IoT could reach US$120 billion in four years. Martínez said this expenditure will be oriented to smarter monitoring devices, medicine intake control systems and to obtain lower cost of services to improve care. The investment, he said, is worth the savings. He also highlighted the role information could play in fighting fraud. “Big data and analytics can be a game changer for healthcare fraud,” he said, adding it had the capacity to reduce fraud, waste and abuse. The meaningful use of health information technology also allows the elaboration of predictive analytics to improve outcomes, which then impacts income and savings.
Martínez explained how understanding that the patient is executing a life outside the hospital is important to identify patterns and risk conditions. This is possible through real-time monitoring. “Having a complete vision of the patient is essential for care.”
AI: The Smart Decision in Healthcare
Artificial Intelligence (AI) can help doctors amplify their expertise and offer solutions, according to Martha González, Director of Watson Health for IBM Mexico at Mexico Health Summit 2017 on Thursday at the Hotel Sheraton Maria Isabel in Mexico City.
“We need to take advantage of all the knowledge that is produced,” said González, explaining that IBM develops AI with the intention of amplifying the world of professionals and their expertise. “AI is not a substitute for human expertise,” she said.
One of the main challenges that González noted in providing healthcare is that half of treatments offered to patients for the first time are wrong. She explained that doctors would need to study 29 hours per day to be completely up-to-date on the latest treatments in their field. “They are missing around 80 percent of the knowledge generated daily.”
Although a great deal of information is generated on a daily basis, it must be used effectively. González explained that the same amount of information is generated by using a tracker to exercise once than in the entire life of someone from a previous generation. “We need to transform data into intelligence and make smarter decisions,” she said.
González said that cognitive learning enables AI to make use of natural language and that it is constantly learning, capable of ingesting information, identifying the aim of a conversation and proposing a solution. “People interacting with AI need no technical expertise, only the expertise on the required topic,” she added.
She also discussed Watson Oncology, launched in 2011, which is an AI system based on physicians’ knowledge. Since its foundation, Watson Oncology has read over 600,000 articles, 28,000 patient files, at a speed of 15 million pages per second. “The system offers doctors a treatment recommendation based on the patient’s characteristics. This solution does not replace the doctor. It also suggests a solution that should not be given, and it can show the doctor the evidence and reasons why it made those conclusions.”
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