Pedro I’s unit was transformed into a field hospital, says Unimed-BH

Unimed-BH President Samuel Flam announced on Thursday (30) that the outpatient hospital unit on Avenida Dom Pedro I, in the Planalto neighborhood, in the northern region of Belo Horizonte, was transformed into a hospital campaign against Covid-19. It has 120 beds, of which 20 must be ready by next Monday (4/5).

It is forecast that 200 new beds will be opened in the group’s network, which include ten beds in the Avenida do Contorno unit, ten beds in the ICU in the São Camilo Children’s Hospital, 40 beds in the infirmary and 20 CTI units in the Unimed hospital in Betim, in the metropolitan region.

Flam gave the statement during the Live time, daily live interview by Helenice Laguardia and Karlon Aredes on the portal’s digital channels Time (see the calendar at the end of this article).

Watch the full interview:

Since March 18, the same date of the decree that closed part of the trade in Belo Horizonte, Unimed-BH also adopts online consultations, which so far have reached 12,000. The municipality of BH uses the company’s platform for remote consultations through the public health network.

According to Flam, the company’s operating costs have increased: he says that the value of surgical masks, which cost R $ 0.90 before the pandemic, has increased to R $ 2.40, while his demand has multiplied six times. Reducing elective procedures, such as hernia surgeries, does not reduce costs, he says, since they have only been postponed.

Read the full interview:

Unimed-BH is the seventh largest operator in the country, with more than 1.2 million clients, and is installing 200 new beds in its own network. Where are they?

In the face of the pandemic, we expanded our own network. We expanded with ten new beds in the Avenida do Contorno hospital, ten ICU beds in the São Camilo children’s hospital, we reopened the Unimed hospital in the center of Betim, with 40 nursing beds and 20 CTI units, we opened another ten CTI beds at the Betim hospital and we transformed the ambulatory unit on Avenida Pedro I into a field hospital. In it, we have 120 beds, of which 20 will be operational on Monday 4. As necessary, we will expand. We have an almost daily analysis to see the need for expansion. This, in our own network, but we also have a network of partners, with almost all the hospitals in Belo Horizonte, and all of them reinforced the bed so that we can meet all demands.

Does the pandemic have any effect on Unimed’s costs? Is there any relief as there are no other demands being made in this period such as elective surgeries and consultations?

Right now, we have an absurd increase in supplies: the surgical mask went from R $ 0.09 to R $ 2.40, and consumption increased almost six times. Also, very little-used items are being heavily used and discarded, such as the N-95 mask, hats, overalls, and face shields. One of Unimed’s main guidelines is the protection of front-line personnel.

Regarding the reduction of procedures, we understand that elective procedures, such as surgery for knee prostheses or hernia, are not performed, they have only been postponed. They do not enter the account during the month, but in the account for a longer period of time, there will be a compensation.

On the other hand, Unimed-BH has a 53% market share. Can the number of clients decrease after the pandemic, with rising unemployment and a lack of income to pay for health plans?

With the assistance to the clients of Seguros Unimed, the exchange of Unimed in the interior and Central Nacional Unimed, this number rises to around 60%. There will be a great change in the national scenario, with the forecast of a fall in world GDP and in Brazil. Unlike in other crises, when Brazil had a contraction and the world was growing, this time, everyone should decrease, perhaps with the exception of India and China. With this decrease, we have reduced the number of jobs in numerous chains, such as aviation, the automotive industry, and tourism. We hope the recovery will be quick, but we already see that the jobs are directly affected.

How much can the impact be on the customer base this year and next?

We can use the 2015 crisis as a basis. At that time, Unimed lost around 5% of customers, which is equivalent to 70,000 customers. Companies fire employees, but sometimes stick to the plan and only decrease the number of customers. Our expectation is that there will be a loss, but we expect a faster recovery. The number of clients lost in 2014 and 2015 had already recovered and exceeded at the end of 2019.

A reader says to pay for a Unimed plan in Teófilo Otoni, but there is no ICU in the city’s Unimed hospital. What to do if necessary in this case?

In some non-timed units that cannot provide care of a certain complexity, patients are referred to closer units that provide this care. Unimeds operates in an exchange system, all supporting each other, centralizing the greatest complexities of the metropolitan region of Belo Horizonte, in association with its hospitals.

You spoke about the increase in Unimed-BH costs. What effect will this have on the plan’s price adjustments in the future?

The National Health Agency (ANS) determines the future readjustment of individual and family contracts. The contracts of large companies are a direct negotiation, so they have another model. The agency has a calculation methodology based on consumption. But I think that, at this moment, it will have some difficulty in fixing prices, firstly, the increase in operator costs and, secondly, a certain impoverishment of the population. This will produce additional complexity for the agency to determine cost models.

But do you think there may be a freeze on the price of the plan?

Unlike an airline, which is stationary and puts the plane on the ground, without spending fuel and with vacations for employees, Unimed-BH is in flight. It is important to note that there is a cost to the PPE and the actions Unimed is taking to guarantee its clients the best assistance, in addition to all innovative processes, such as online consultation (remembering that office waiting rooms are the focus of contagion in respiratory epidemics).

Online inquiries here to stay? What is the demand?

We can divide them into two main fronts. The first is the Covid-19 specific online query. It was implemented to provide guidance and open a preferential flow for those who have symptoms, and it reached some 12,000 clients. We have around 100 doctors working on this, and they reassure people when their symptoms don’t match Covd-19. On the other hand, if the person has symptoms compatible with the disease, they are referred to hospitals. When the procedure is inconclusive, we place this patient on telemonitoring. We have already had a large number of people who entered and some of them have already been fired. Today, we have around 600 people in telemonitoring and, from the beginning, there have been almost 9 thousand clients in this situation.

Another modality, which was approved by the Ministry of Health and is being implemented by the Federal Council of Medicine (CFM), is normal online consultation, with specialists. We understand that it is a complementary procedure, since that patient already has his doctor and wants to receive some orientation or show evidence. We have to wait for the process after the pandemic. We will follow the guidelines of the ministry and CFM to be in the current legislation. We also understand that face-to-face consultation establishes a relationship of trust and proximity between the doctor and the patient. We cannot forget that, and I think it is an important factor for therapeutic success.

Unimed-BH recruited more than 300 people. Is there any forecast of opening more vacancies?

Publications are always on our website. With these 200 new beds, we hired 350 new professionals. If more beds need to be opened, we will make new hires. Every time we open a bed, we open the hiring of new professionals even before the bed is ready, because we train people. One of the fundamental points of our training is how to dress. It may seem like you just need to put on and put on the PPE, but there must be a lot of care and training to put on and take off this material. Our primary purpose is to prevent contamination of front-line staff, because without them, respirators, beds and care don’t work. We were unable to train staff overnight. It is not just buying the respirator, it is necessary to have people who know how to use it. It is important to have the physical material, but the presence of doctors and nurses is what will guarantee the success of the action against Covid-19.

A reader asks if, at Unimeds across the country, people are dying, as the press shows.

Brazil is vast and each place has a pollution model. The places where there are airports and are crucial centers for the transit of people are the most affected. Manaus, for example, has an international airport and the entire surrounding region goes to the city, as well as to São Paulo and Rio de Janeiro. Belo Horizonte International Airport does not have the same volume of flights as Guarulhos (in São Paulo). We are also an inland region, with less traffic at our airport and we had very early isolation and information measures for the population. On February 3, Unimed was activating the crisis committee. We worked with the government to provide Unimed’s online consultation system and collect the numbers and see what studies were important.

Are you in favor of social isolation?

I think we should determine social isolation over time. That is, at each moment, we will have a model. The model that worked a month ago will not be the one that will work in three months. We started with horizontal isolation and fortunately the metropolitan region has had a very small number of cases. These numbers are certainly the result of the work done, with people who remain isolated at home.

This prevented the spread of Covid-19, but also that of other viruses. When evaluating the number of people who went to the emergency room, we see that other common viruses of that time were also reduced, such as influenza and H1N1 cases. The suspension of classes, the contagion among the children, who end up taking the virus inside the house, has been drastically reduced. Unimed services are fully open for emergencies, all Unimed emergency rooms and associated hospitals have separate doors for patients with suspected Covid-19. Urgent surgical demands, like appendicitis, are being met.

There was a reduction in motor vehicle and motorcycle accidents, in addition to sports accidents, such as people who break their legs while playing soccer. Not only in Unimed hospitals, but in public hospitals, there is a great reduction.

Do you argue that horizontal insulation should be done in the current way for how long?

Sometimes we charge a date: for example, until midnight on day 1, no one can go outside, but at 1 am on day 2, everyone can. I am going to make a comparison with a patient who has a heart attack: he goes to the ICU and, when the condition stabilizes, he goes to the infirmary, then he goes home, with restrictions to return to his usual work. They then release him to exercise and go for a walk and ask him when he can play ball again. I think we have to think of a more medical and biological model that reduces our risk of contamination. This opening will probably be done gradually, respecting older people and people with risk factors. We saw what happened around the world, first in China, then in Iran and Italy, Spain and the United States. We had dramatic reports from some doctors.

A reader says that he needs to do physical therapy sessions, but they have been canceled. Is there a way to reverse this?

We have to see your case. If there is an urgent need, the service will be provided. All services are open, respecting the guidelines given for elective cases that can be postponed.

Many hospitals say they are on the verge of bankruptcy and want to negotiate, with health plans, a three to four month transfer of part of the estimated income they would have if they were working normally. That’s possible?

This is not only possible, it was already done when we called the hospitals to speak. When Unimed saw the situation, he immediately called the hospitals and said that he would guarantee them, for four months, 70% of their average income. It is the same reasoning for elective surgery: it is only being postponed. We are also doing this for cooperative doctors. To the best of my knowledge, Unimed was the only operator in the country who anticipated and spoke to hospitals to ensure that they will remain open, serving patients with the utmost care, attention, and compliance with EPP requirements. When we saw (the demand for hospitals) in the press, it had been 45 days since we spoke to our hospitals, predicting what would happen next.

You mentioned that emergency investments are being made because of Covid-19. Are Unimed-BH’s investment plans maintained for the coming years?

All the strategic planning that Unimed and any company in the country made for the year 2020 could not predict a pandemic with this virulence. At this time, we are considering a shorter period, doing everything necessary to guarantee the best service. After that, new strategic planning will have to be done based on new data, new numbers, and new growth and expansion forecasts. After the pandemic, we will have a new normal, and it will take a little time to understand it and establish a long-term investment program.

A reader asks if pregnant women who work in hospitals are at risk.

There is no report on Covid-19 regarding events during pregnancy, but overall we have removed people with risk factors from the care of patients with the disease.

The municipality of BH is using the online consultation platform in the municipal health system. Can Unimed-BH extend this service to other cities?

Unimed makes the program available to all who want it. It has a very clear objective. When a dengue patient goes to an emergency room, there is no risk of contagion to a patient close to him, even if they are hugged, because there is no person-to-person transmission. In the case of respiratory pandemics, the reasoning is completely different, since each person can infect another. We have seen that in other epidemics, including very high mortality from either Sars, Mers, or the onset of H1N1 flu, control is different. When the patient has a fever or discomfort, he goes to an emergency room. When the patient is referred for the coronavirus-specific online consultation, he has a separate front door, he already knows where he is going, and therefore he is sure that if he does not have Covid-19, there is no risk of acquiring it. in hospital And if you have the disease, do not transmit it.

A reader says that most Belo Horizonte City Council employees joined the Unimed-BH plan cards and the cards are due in August. Is there a forecast for contract renewal, in case the pandemic spreads?

I think there is no reason to understand that this association with the Belo Horizonte City Council cannot continue, especially at this time of pandemic.

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