A Clinical Algorithm: Thomaz Srougi MPP'04 Reboots Healthcare

Thomaz Srougi MPP’04, MBA’04, grew up with a special perspective on a huge problem in Brazil: healthcare.

Srougi’s father and brother are both doctors, so he saw firsthand how broken the country’s healthcare system really is. It takes someone an average of 400 days to receive care through Brazil’s public healthcare system. Private healthcare is accessed through insurance, which many Brazilians can’t afford to purchase. But even among the 25 percent of Brazilians who can afford private insurance, two-thirds express dissatisfaction with their offerings.

“I decided to tackle this and try to reboot the care model,” Srougi said.

From this ambitious goal was born Dr Consulta, a health risk management system structured over a network of medical centers. His first clinic opened in the biggest slum in São Paolo in 2011, and since then, he has opened 50 clinics across São Paolo, as well as clinics in two other states in Brazil. Over the past seven years, Dr Consulta has served one million patients.

Created through innovation, with little regard for the status quo, Dr Consulta is different from the public and private healthcare available in Brazil.

First, Dr Consulta does not work with any insurance companies. Patients pay out of pocket, either with cash or credit, simplifying the system and ensuring the patients and doctors are at the center of healthcare rather than insurance companies and administrators.

But how does Srougi keep the healthcare affordable? Dr Consulta uses algorithms that guide doctors in the care they provide.

 “The problem with the old fee for service system is that if the doctor prescribes more medication or more exams than necessary, patients won’t know that, and doctors and companies make more money because they have overprescribed,” Srougi said. “They’re abusing the system! So, we thought, let’s make sure no one can prescribe more than necessary. But how do you do that? You have to work with medical protocols — a clinical algorithm.”

Under this system, every time a doctor sees a patient, Dr Consulta’s electronic health records system gives parameters on what the doctor should do. Every time a doctor adheres to the protocol, she is paid more. Every time she prescribes more or less than the protocol, she is paid less.

“In healthcare, the fee for service model doesn’t work,” Srougi said. “But we have tweaked it, and this is working beautifully. We’re preventing abuses and waste, and our medical outcomes are actually higher.

“This is a core value that I took from Harris,” Srougi continued. “In public policy, people are creative. What works is aligning incentives. That’s probably the most valuable and impactful lesson that I took from Harris.”

Harris is expanding its programming in the healthcare space, and has just rolled out a brand new degree program: a Double Executive Masters in Health Policy with the London School of Economics. The degree was created to prepare health professionals to lead and direct programs and policies in the private, public and government sectors.

The degree is intended for international mid-career health professionals looking to transition to leadership roles.

“Our program allows participants to continue working full-time while pursuing the degree, and to interact with peers from across the globe,” said professor Elias Mossialos, head of the Department of Health Policy and the London School of Economics. “Students will transform their international leadership skills through the first transatlantic partnership of two leading global universities."

“The mission is to really help create a new generation of leaders in health that can think globally, that can tackle the basic issues that are leading to the crises we’re in today – which are that we aren’t preventing illness, we don’t learn from each other, we’re bankrupting entire systems, etc.,” said Joseph Antoun, Senior Fellow and co-director at the Center for Health Policy, who played a major role in getting the double executive master’s degree up and running.

Antoun said Dr Consulta is an innovative model, making healthcare affordable for people who had no access before. According to Antoun, Latin America has been innovating in the healthcare space, from Dr Consulta to other countries which sustain the industry financially by selling data to entities like the Ministry of Health, market researchers, and pharmaceutical companies, rather than charging patients.

“It’s hugely popular now in Mexico, Chile and other countries,” Antoun said. “Some are trying to do the same thing in the U.S. now. It’d be interesting to introduce them [to Srougi].”

Srougi said he plans to continue expanding Dr Consulta, with hopes to take the model to other countries someday. He said he would tell future changemakers in healthcare that the key to success is keeping people as the priority.

“There’s always a tradeoff, and there’s never enough information, but decisions need to be made fast, and that implies we have to take risks,” he said. “It’s hard to make the right programs, to write the correct policy, because we never have enough information.”

But Srougi is focused: 

“As long as we do what’s right for people, as long as you prioritize people, everything works out. That’s what was done here: We prioritized patients and doctors.”