Morgan is turning the traditional model of community health upside down by caring for communities with chronic diseases as a whole rather than only those who are ill and enabling all community members to take charge of their own care. Morgan seeks to shift the chronic, degenerative disease healthcare paradigm to one focused on wellness rather than disease. Using a disruptive model that includes prevention campaigns and an innovative monitoring system, he is able to maintain community wellbeing and chronic, degenerative disease control for each individual community member. Morgan’s model allows for remote, continuous monitoring using telemedicine, health coaches, and mobile clinic units.
La nuova idea
Morgan is revolutionizing the health system by providing prevention services using telemedicine integrated by cellular phone technologies and mobile units for the detection, monitoring, and control of chronic diseases like diabetes, hypertension, obesity, and others. Such disease detection often falls outside the scope of traditional medical detection. Morgan’s system is innovative in three respects: it attends to chronic diseases by treating whole communities with a package of highly technological services, tracks its patients with brand-new software, and is changing the role of doctors to be that of telemedical health coaches.
Morgan’s organization, Previta, takes the health of communities as a whole into account as it packages diagnostic, monitoring, and treatment services for the benefit of the ill and at-risk members of a community. Meanwhile, Previta engages in educational activities targeted at the healthy members of a community in order to prevent them from becoming ill. This engagement with all members of a community, ill or not, signals a paradigm shift in community. This shift is enhanced by the package of highly technological and convenient services that Previta offers its patients. Previta employs different information technologies (ITs) to maintain constant communication with patients, telephone health coaches, and mobile unit technicians. This ensures constant monitoring and control of diseases, thus minimizing complications.
In order to track each patient, Morgan developed an electronic health software called e-healthtracker that contains all patient information including reports from their visits, relevant protocols, medical information, and monitoring alerts. This software allows for physicians, patients, and those seeking community health statistics to analyze a number of risk factors and health outcomes for any individual or community that Previta treats. This software also makes the Previta call centers, physician-staffed call centers where “health coaches” are always available to answer patient questions and give advice, possible.
This call center design has brought about a new breed of doctors that Previta employs, doctors who work as “health coaches.” These doctors work over the phone using Previta software and files to treat patients. Morgan promotes this design because it allows doctors to treat many patients, is low cost, and trains young doctors in how to operate in the new global trend towards electronic medical files.
Chronic diseases, particularly diabetes mellitus, have become one of the gravest public health concerns of our time due to their high prevalence, chronic complications with serious effects on patients’ quality of life, high economic cost for individuals and health systems, and correlation with cardiovascular problems. According to the World Health Organization (WHO), the number of diabetics will double between 2000 and 2030. Currently, there are 371 million diabetics in the world and it is estimated that the disease affects more than 540 million people worldwide. Mexico currently has the sixth highest adult diabetes prevalence in the world according to the International Diabetes Federation, with 12 million people affected. In 2030, it is expected that more than 30 million Mexicans will have diabetes. One of the principal causes of high non-communicable disease (NCD) prevalence in Mexico is obesity, which can be attributed to the low price and widespread availability of high calorie food and drink, large portion sizes, an increasingly sedentary lifestyle, and the constant promotion of unhealthy consumer products. Furthermore, it is estimated that 22.4 million adults 20 or older suffer from arterial hypertension. The total cost of diabetes in Mexico increased from 2,970 million pesos in 2004 to 8,836 million in 2010, an increase of more than 290% in just 7 years.
Mexico’s health system is focused on hospital treatment and largely dedicated to infectious diseases. Preventative medicine is almost nonexistent, especially for patients with risk factors for chronic diseases. Prevention can make the difference between life and death with regards to NCDs, but this is not yet commonly addressed by Mexican healthcare providers. The prevention of chronic diseases requires an educational process and significant lifestyle changes including diet modification, frequent health checkups, and long-term pharmaceuticals usage.
There are very few effective alternatives to early detection and constant monitoring in terms of chronic disease treatment. The few organizations that are dedicated to chronic diseases are normally focused on treating these diseases rather than preventing them, and thus function within the hospitalization system. There are almost no political movements in Mexico directed towards primary and secondary prevention. Instead, the services provided for chronic diseases tend to be hospitalization, surgery, dialysis, and intensive therapies to treat diabetes complications. Untreated diabetes costs 8 times as much to treat as constantly monitored and controlled diabetes. Unfortunately, the Mexican public health system leaves many affected by NCDs and their risk factors without detection or treatment.
The Mexican public health sector also suffers from a logistical overload that compromises patient treatment and services. Public health clinics are saturated with patients. It takes a great deal of time for patients to go to a clinic for even a simple evaluation or diagnostic exam both because of the clinic distance from patients’ homes and the long wait times to be seen by overloaded doctors. Most people, therefore, only go to clinics for emergencies or intense pain. The public health system does not have the capacity or desire to be a continual monitoring system. Meanwhile, the private system is too expensive for the majority of Mexicans, especially for continuous monitoring of a chronic disease. The logistical problems in the public health system are compounded by a lack of communication between different health centers. Significantly, Mexican patients are not given copies of their diagnosis or treatment plans, which make changing doctors or treatment centers extremely difficult. There are no decentralized systems to effectively identify risk factors or help doctors make rapid, cost-effective decisions for patients with chronic diseases. On a separate note, electronic medical records have not yet been introduced in Mexican medical schools. Previta thus seeks to address both these issues with its “health coach” system.
There are also many Mexican doctors who find themselves unemployed or with unfulfilling jobs as medical consultants in corner store pharmacies. These doctors are often general practitioners who could not find a job due to the medical establishment’s emphasis on specialists like cardiologists and endocrinologists.
Morgan has developed a model for remote, continuous monitoring using telemedicine, health coaches, and mobile clinic units. His strategy is based in information and health communications technologies (CHCT) that offer a viable alternative in terms of providing health care options to vulnerable groups. This system was built with consideration for the high concentration of patients at high risk for chronic diseases in urban and semi-urban areas.
Previta’s model is three-pronged. The first element is a multidisciplinary group of specialists form a medical team, consisting of a psychologist, endocrinologist, ophthalmologist, cardiologist, nutritionist, and a general practice physician. The second component is the health coaches: a group of doctors that provide general medical attention, including information distribution and protocol design. This group is responsible for patient training and is the primary contact between Previta and the patient. Health coaches attend to patients by telephone and follow each patient in order to help him/her manage his/her health. Lastly, the mobile medicine units specialize in chronic disease attention. These units have technicians who do a basic physical exam, educate patients about their health, identify treatment goals, design follow-up plans, and create patient action plans personalized to each patient’s lifestyle. These technicians also identify barriers to regimen adherence, and they therefore promote family inclusion and proper pharmaceutical treatment as well as clinic attendance.
Previta offers its services in mobile units that travel to the urban and semi-urban zones that are notoriously deficient in healthcare provision. Previta’s initial contact with a community is in the form of a health fair in the town center. This fair is held in partnership with the local government and is meant to maximize the number of people that Previta reaches out to in the community. It is important that community members be beneficiaries of “Seguro Popular,” Mexico’s public social security provider, because it is through this program that Previta is able to treat them for free. If a patient is not a “Seguro Popular” beneficiary, Previta charges small fees for its services. Upon first contact with the patient, Previta staff creates a personalized patient file in e-healthtracker, takes a blood sample, records the patient’s weight and blood pressure, and does a comprehensive check-up. If the patient is at risk for disease, the doctor creates a monitoring plan for them. This plan is then carried out with the help of monthly calls from Previta health coaches, trimestral physical medical visits, and email or SMS mobile phone monitoring. There are also 4 annual visits to every community in which Previta works in order to update the Previta system’s information. This is a bilateral communication system that allows patients to communicate with the health coaches about medical advice and concerns. With the support and monitoring of the health coaches, the patients learn to improve their lifestyles with exercise and good nutrition.
One basic tool that Previta developed is the e-healthtracker. This medical records software contains digital files of each patient’s analysis results, monitoring plan, performance indicators, and much more. The software is used by doctors and advisors to create comprehensive progress reports, set goals, collate information collected during patient visits, and organize all follow-up monitoring by phone or email. The patient can also use this software to look at her health plan online, solicit health advice, do online self-assessments, look at a summary of the test results, and access alerts and notifications for self-monitoring. This software can also be used by doctors who are not familiar with a particular case so that they can see all the studies done on the patient and be able to make informed decisions.
The use of the e-healthtracker system is essential to the “health coach” doctoring system that Previta employs. General practitioners who function as health coaches contact patients over the phone and use their electronic files to advise, diagnose, and treat these patients. This is a totally new model for health practitioner training that serves to cut costs, maximize patient ability to contact their physician, and trains doctors in an electronic medical records system. Mexican doctors suffer from high rates of unemployment because the system only values those doctors who have more than ten years of specialized experience and studies. The market for doctors is thus saturated, and leads many medical professionals to work as general practitioners in corner pharmacies. Morgan is thus creating a new source of employment for doctors and allowing them to use their training to maintain patient wellness. The current healthcare paradigm is logistically unsustainable, so Previta’s system is training and inspiring a new generation of doctors to challenge the prevailing norms in the Mexican healthcare system.
Previta charges the government a fee per group of diseases treated. The government institution then assigns Previta a patient population to treat. For example, if the government assigns Previta a group of 100 diabetes patients, the government will pay Previta a fixed annual amount per patient. Previta will then provide the patient with a package of services including trimestral medical evaluation using mobile medical units, laboratory analysis and specialized medical tests like retinography, medication disbursal, and remote monitoring services using call center health coaches. Previta also provides SMS reminders to aid patients in adhering to their medical regimens, a 24-hour on-call physician to attend to patient concerns, and an electronic clinic that tracks patient biomarkers. Previta uses all of these services and the data they produce to compile a trimestral statistical report for the government. The report includes an analysis of patient performance as compared to patient biomarkers (glucose, cholesterol, blood pressure) and a sketch of further intervention plans. The patients who receive Previta services do not pay extra fees.
In the future, Previta intends to work with the government on a pay-for-performance basis. This would mean that Previta would receive a bonus if a patient improves and would not be paid if the patient does not improve. Previta’s model is affordable because it prevents hospitalization and unnecessary health expenditures. Previta is transforming the pay-for-service paradigm and allows for human development by helping people with few resources to invest in their needs rather than their disease.
Morgan has been totally dedicated to prevention for 9 years. In 2004, his team consisted of two people. Now, Morgan heads a team of 190 staff members, all of whom are dedicated to different prevention programs under the Previta umbrella organization, and with an average income of 12,000 pesos per month. Currently, Previta is consolidating and growing, creating alliances with different industries that complement their services both commercially and medically. Previta is currently working with the Joslin Diabetes Center, an international education organization, and with Harvard University to apply international best practices in medical attention. In the future, Previta plans to work with international health organizations. To date, Previta has seen more than 200,000 patients. In the future, with this prevention and patient monitoring system, Previta aims to diminish the number of complications and deaths associated with chronic degenerative deceives and reduce more than 15% of the total health costs of the populations it serves. Morgan hopes to see 3 million patients in the next 3 years and seeks to be a major employer for the training of doctors who are interested in general medicine. In February 2014, Previta will pilot a program called “Train of Health” in partnership with a large train company. This program will entail a mobile train clinic that will travel between five communities and function much as Previta’s other specialized mobile clinics. Morgan also aims to provide remote monitoring services to other Hispanic populations in the world, starting with the United States.
Morgan comes from a family of entrepreneurs. His parents were very hardworking people who ran different projects and businesses throughout their lives, thus teaching Morgan that he could always reach his goals if he put in enough work and creativity.
Morgan received in Master’s in Public Health at the INSP (Instituto Nacional de Salud Pública, México) and was trained as a surgeon at UAEM (Universidad Autónoma del Estado de Morelos). He worked for a gym company called Sportsworld from 2003 until 2004 as a medical analyst and designer of health programs. He also acted as the medical manager of Lasertech in 2003, where he conducted medical research and led conferences.
In 2004, due to a number of his family members falling ill to preventable and chronic diseases like cancer, Morgan realized that the medical field in Mexico directs its attention towards disease rather than prevention. It is for this reason that Morgan decided to dedicate himself to decreasing the avoidable suffering brought on by preventable chronic diseases.
Morgan analyzed the prevention system in Mexico and realized that the traditional means of prevention were not working because Mexicans would not request prevention or detection exams from their health providers of their own accord. Morgan asked himself, “If people do not go to health clinics, why not go look for them in their houses, with their families and communities?” It was this idea that led to Morgan’s business model focused on early detection, prevention, monitoring and treatment of chronic diseases using telemedicine technology that reaches millions of people. Morgan and Previta are thus able to prevent millions of people from losing years of their lives to easily preventable diseases and their life savings to avoidable medical costs.