“Adaptation alone does not fix it,” says Central National Unimed | Economics

Sophia Bernardes

The ANS approved an increase of up to 15.5%

Luiz Paulo Tostes Coimbra Central Nacional Unimed (CNU), CEO of Unimed’s national health plan operator, says that the digital change brought about by the pandemic will transform the way health plan companies operate.

CNU joined a São Paulo start-up center in search of innovative solutions. Emphasizes the importance of good management. It is trading shares in companies in the supplier network, which allows it to verticalize operations, gain scale and reduce costs. And the CNU is evaluating cooperation with funds that could pave the way for Amil.

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What has changed in the health field with the pandemic?

The pandemic accelerated mergers and acquisitions, but especially changes in health plan operations. If digital was already growing significantly, it exploded and became very important. The operation of health plans will change significantly in the coming years as there is a worldwide trend towards disarticulation.

There is mediation between the customer and the service provider by the operator, administrator, broker. Technology will facilitate this interaction and reduce mediation a bit. CNU’s main business is the operation of health plans for large companies and entities, and it is aware of these changes.

If mediation is not good, can it be left out?

We need to make this flow very simple and reduce the flow of that cost because the customer had a very large loss of revenue. And people’s ability to pay is eroding. We need to provide more access to quality health care and be closer to the people. And the path is technology. There are many start-ups interested in healthcare. We have an innovation cell, called Trunk, which has been working with this approach.

Does CNU buy startups?

We are on our way. In late April, we began a partnership with an initial unit in São Paulo, the State Innovation Center. And we talked about an initial incentive fund. It is a capital fund that would allow the financing of new more mature companies.

Is basic health care key to reducing costs?

This issue was sold as a magic solution in a country with no primary care physician training. We train more specialists. Primary care, general practitioners, should be more comprehensive medicine, but linked to this evolution with secondary care. Primary care, if done in a holistic way, will fix 80% of things.

But there are no professionals for that. Another point is the fee for the service payment model (which pays for the service provided). We’ve been wrong for 20 years, but we haven’t found a way. Some are being traced, but we have not been able to change the way we pay for the disease, not the health.

We need to find a way, the healthier we are, the better the pay will be for professionals.

And how to do it then?

We don’t just cut costs to reduce costs. Let’s reduce the waste. There are protocols all over the world, evidence-based medicine. It is not valid to go to the doctor and requires 50 tests, which is very common. Related to this are the rewards.

So we have to end up with waste, have protocols. CT and MRI cannot be performed on all emergency responders. In the end, the important thing is that the client was well cared for, had a correct diagnosis, recovered. At CNU, Seguros Unimed had one specialization and Central Nacional another.

We brought the two groups together and set up a company called Integra Unimed, which has been working since January to bring together the best practices for each other, in terms of networking, audits, programs that can interact with the network. waste reduction. By 2022, there is a plan to reduce costs by around R $ 600 million. It’s always a difficult debate, one that has to bring in profits, because there is currently no money to pay for all that waste. We need to be aware of this so that the market can be balanced.

Is it the same with individual plans?

We are a corporate corporation and we have a number of corporate entities based on membership. And a small part of our individual portfolio. These are the portfolios we had to take on, especially with the loss of São Paulo, Unimed Paulistana and Unimed São Paulo.

We do not sell plans to individuals. It’s a small, old wallet with 13,500 customers, which leads to a wild annual loss. Last year it was R $ 100 million.

Is the problem a readjustment?

The readjustment does not cover. When we took these portfolios, at one time, there was pressure to practice prices below what was calculated. Sharing has already started to be low, and readjustments are not enough to cover the cost of people who use it more.

We are running a program to give more attention to these people. It does not serve to reduce costs, care needs to be improved so that there are fewer patients. Even in business plans, readjustment alone does not solve the problem. Management is required.

I took charge of the CNU on March 30 last year. We ended the first four months of the year with a negative result of R $ 78 million. It took a lot of work to reduce costs by R $ 515 million (costs total R $ 7 billion) and close the year with a positive result of more than R $ 50 million.

Individual plans will have a record reduction of 15.5% …

The ANS readjustment regulates individual plans. CNU sells corporate contracts, the adjustments to which are established based on the business relationship between the contracting company and the operator. The individual redistribution follows the ANS formula, a legal provision, and forms part of the losses.

The index, in its second year, reflects the effects of the pandemic, so it should be examined in conjunction with an 8.19% drop in enrollment in 2021. In practice, individual plans will have a 6% annual correction for two years. The weight (utilization rate) of plans and the ratio of claims (utilization rate) should be taken into account, according to FenaSaude, which rose from 76.2% to 86.2% in 2020.

Are you planning on shopping?

We are growing very organically. Last year, we grew by 14.2% in the portfolio. But we don’t have much room for growth with purchases like the ones that have been made. Often, listed companies pay a value that is much higher than the market value of another company. We started talking to a vertical operator within the country, and our valuation was worth R $ 50 million. A listed company offered R $ 150 million, which is worth its share of the stock market, which is worth it. So we came out of this competition. I don’t think they make money covering that price difference.

Would you consider buying Amil?

According to. We discussed the options with funds and banks, we were ready to talk. What is important to support the National Power Plant? Our management ability. We have already approached the funds so that they can make the investment and we, the management. It’s an opportunity.

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