CEMS INTERNSHIP REPORT

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Maria Teresa Sande Lemos da Cunha e Sá 
 
Americas Serviços Médicos – United HealthGroup 
Internship Report 
Americas Medical City 
 
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Contents 
Company Overview ................................................................................................................... 2 
Narrative ................................................................................................................................... 2 
Evaluation .................................................................................................................................. 6 
Conclusion ................................................................................................................................. 6 
Annex 1 ...................................................................................................................................... 7 
Annex 2 ...................................................................................................................................... 8 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Company Overview 
 
During July and August 2017, I was given the outstanding opportunity of working at Americas 
Medical City, in Rio de Janeiro, Brazil. The medical complex is composed of two high quality 
hospitals – Hospital Samaritano and Hospital Vitoria - with a total of 494 beds, 16 surgery rooms 
and 11 Day-Hospital beds. Both hospitals are fully equipped with state-of-the-art technology, 
enjoy a complete and multidisciplinary team of medical professionals and luxurious facilities. 
Additionally, there is an outpatient center with 252 spaces dived into medical offices, clinics and 
convenience stores. 
Americas Medical City initiated its operations in 2015 and it has been growing impressively ever 
since. A training center designed for minimally invasive and robotic surgeries was recently 
inaugurated. Furthermore, by the end of 2017 the “city’s” pediatric services are expected to 
move to a different, better equipped space. This will allow this service’s expansion and an 
improved capacity of answering to patients’ needs and address the overwhelming demand that 
the group has been facing as of late. 
Americas Medical City (AMC) is part of Americas Serviços Médicos network, composed of 22 
hospitals. Their commitment is to offer the best in health care, focusing on high performance 
and process innovation, seeking the best experience for their clients and contributing to the 
development of the Brazilian medical-hospital sector. 
Americas Serviços Médicos belongs to UnitedHealth Group. UHG is healthcare company 
headquartered in the United States and a leader worldwide in improving the healthcare system 
and helping people live healthier lives. UHG offers a wide range of products and services through 
two business platforms: UnitedHealthcare, which provides coverage and healthcare services, 
and Optum, which offers integrated health and wellness solutions based on data and 
technology. In 2012 UHG acquired a majority ownership in Amil Participações S.A., Brazil’s 
largest health care company. 
In 2016 UnitedHealth Group Brazil was established and it is divided in to three main pillars: 
• Americas Serviços Médicos – hospitals and specialty centers; 
• Amil – Health and dental plans; 
• Optum – Technology applied to healthcare. 
 
Narrative 
 
My first week was spent doing a recognition of the complex and the different departments such 
as Finance, Billing and Quality, amongst others. This period was very important to further my 
knowledge of healthcare management and to experience the differences between the 
Portuguese and Brazilian systems. My previous experience in the healthcare industry, an 
internship in CUF Descobertas Hospital (José de Mello Saúde Group) in Lisbon, Portugal shed a 
more interesting light on my first week in AMC. 
One of the major differences between Portugal and Brazil’s healthcare system is the billing 
methodology. In Portugal, insurance companies pay a fixed amount based on the patient’s 
Diagnosis Related Group (DRG). However, in Brazil, the method in play is fee for service, that is, 
 
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each item of the procedure is paid separately, meaning that payment is dependent on quantity 
rather than on quality. 
Additionally, during my first week, I learned about how to properly evaluate a business with 
tools such as Net Promoter Score (NPS), which measures the customer experience and predicts 
business growth. 
 
Specialty Centers Project 
In my second week, I was assigned a challenging yet deeply interesting project, which was to 
develop a model that could measure the performance of specialty centers, using as a pilot the 
trauma center. Specialty centers consist of teams of highly skilled experts that deliver the best 
outcomes for their patients and are often involved in research and innovation to advance the 
field. 
In both Vitória and Samaritano Hospitals there has been a lot of effort put into structuring these 
centers and their implementation started as of late. Therefore, there was a need for a well-
thought model that measured and compared results. 
The first phase of the model development was research. I studied the new paths of healthcare 
management such as value-based medicine and outcome measurement. My research led me to 
the conclusion that is extremely important to take the first steps towards value-based medicine, 
as it is important to develop an operations chain that places the well-being of clients at its center. 
Therefore, I decided that the model I was going to create should have a great focus on outcome 
assessment. 
The model is divided in two main segments. First, the overall results related to target volumes 
and revenues for inpatient, outpatient and emergency services. Secondly clinical, financial and 
process KPIs are analyzed. The KPI list employed in this project is described below: 
CLINICAL 
• % of patients with adverse effects 
• Mortality rate within 30days of surgery 
• Re-operation rate within 30 days of surgery 
• % of patients that are happy with the results 
• Staff to patient ratio 
FINANCIAL 
• Average cost per patient 
• Average cost per surgery 
• Average revenue per patient 
• Operating Margin 
• % Glosas (Specific to Brazil’s healthcare system) 1 
 
1Glosas: the term refers to the non-payment by health plans of care, medication, materials or fees 
charged by companies providing services (hospitals, clinics, laboratories, among others). Medical glosas 
can have damaging effects on the companies’ financials. 
 
 
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PROCESS 
• % new patients 
• Average number of visits per patient 
• % cancelled surgeries 
• %cancelled appointments 
• Nº of surgeons 
• Nº of beds dedicated to the center 
• Average waiting time for surgeries 
Additionally, I suggested segmenting the patients by age and insurance company as to better 
understand the market and to be able to understand demand and structure the service and 
marketing. 
 
In the picture above it is possible to observe part of the dashboard, the output of the model, 
that displays the information regarding a specific center of excellence analyzed. 
 
Weekly Meetings Project 
Every Wednesday the key leadership of AMC gets together to discuss and evaluate the 
performance of the hospital’s main sectors. Currently, the meeting’s focus is mainly on numbers 
and their weekly evolution which, after a while, can become 
rather repetitive and even tedious. Consequently, I was asked 
to suggest some changes as to revamp the meetings,encouraging debate and strategic planning. 
Firstly, I thought that I should involve the participants in the 
changes so I designed a questionnaire and asked everyone 
that attended the meeting to fill it. Subsequently, I gathered 
the resulted and analyze them as to take into account the 
attendees’ thoughts and ideas. 
On the left it can be seen the questionnaire and below the 
main results. 
 
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Secondly, I decided to use the Surgical Center as a pilot and to re-structure the excel model 
behind the meetings. Currently, each unit works on a different excel file per week, which 
accounts to 52 separate files a year. Ten years from now, or even three, it will be somewhat 
highly inefficient to have that many files. Hence, one of my suggestions was to completely 
modify the structure of the model used and compile the information in one single excel file that 
performs the analysis by day, week, month and year. 
Furthermore, I linked the excel information to the PPT presentation so that the process would 
become more effective and automatized. Also, I furthered some analysis with the aim of forming 
a more strategical path. Some of these changes and results I worked on can be observed in 
Annex 1. 
One other important characteristic of these meetings is the visual feature of the presentations. 
Not only there are different designs and layouts spread out across the several units and their 
corresponding slides, but also the latter are very polluted, making the presentation grim and 
considerably hard to read. For that reason, I completely reshaped the presentation and 
proposed a transversal format for all the units with cleaner slides resulting in an overall more 
appealing presentation. 
Moreover, I tried to lead the meetings towards a more strategic oriented debate with result 
interpretation, weekly feedback, and interaction amongst every co-worker. Hence, I designed 
the presentation as to include in the beginning a summary of the week with the highs and lows 
and a short description of what lies ahead, the main challenges to come. Likewise, in the end of 
each segment presentation, the leader should specify the goal for the next week and the steps 
his team will take to achieve it. The point is to share the successes and the failures so that the 
group as a whole can improve its care delivering services and skyrocket the hospital’s 
performance and clients’ satisfaction. 
Part of my suggestions can be seen in Annex 2. 
Finally, I also made some practical suggestions such as having the presenters use a microphone 
as well as giving the audience time for Q&A. 
In conclusion, these were the two main projects I was responsible for in my time here. Also, I 
had the outstanding opportunity of getting to know and working with an extremely experienced 
Statement
Concordo 
Plenamente 
Concordo Neutro Discordo 
Discordo 
Fortemente
Estou satisfeito 
com a duração 
da reunião.
3% 41% 22% 34% 0%
Estou satisfeito 
com o aspeto 
visual da 
apresentação.
0% 44% 16% 38% 3%
Os membros 
participam 
livremente, 
proporcionando 
um debate 
interessante.
28% 38% 19% 16% 0%
As discussões 
são 
profissionais e 
todas as 
opiniões 
consideradas.
22% 53% 16% 9% 0%
Entendo todos 
os tópicos 
abordados na 
reunião.
22% 59% 9% 9% 0%
A informação é 
relevante e 
contribui para o 
meu trabalho.
16% 72% 9% 3% 0%
No final da 
reunião os 
projetos futuros 
ficam definidos 
e cada um sabe 
o que tem de 
fazer individual 
e 
coletivamente.
3% 34% 28% 34% 0%
Observo 
progressos ao 
longo da 
semana.
3% 28% 47% 22% 0%
 
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and caring team and to attend meetings and conferences. The most important thing I take from 
this experience is the in-depth knowledge of hospital management practices that will be very 
useful as it is my ambition to work in this area. 
 
Evaluation 
 
It has been an overwhelming experience and highly rewarding one. Throughout these couple of 
months, I had to deal with the many challenges of working in a much larger country with an 
organizational culture completely different from Portugal. Also, I worked in a medical complex 
of envious dimension and structure, with advanced technology and, most importantly, in a 
company going through an interesting adaptation period. 
I learned a great deal from experiencing first hand business meetings, presentations and great 
professionals at work. Nonetheless what I found the most valuable take-away from this 
experience was the people. At Americas Medical City, everyone is treated the same and there 
are no inappropriate questions nor does the will to teach ever cease. I learned something new 
from the entire team, from the CEO and medical director, from doctors, nurses and technicians 
to administrative staff. Each one of them contributed to the wonderful time I spent in Brazil. 
 
Conclusion 
 
In conclusion, I had a fantastic experience. I feel extremely fortunate to have had the 
opportunity of doing my internship at Americas Medical City in Rio de Janeiro, Brazil. 
I return home with a lot more baggage regarding hospital management, work ethics and people 
skills. My learning process was incredibly and I believe it will prove itself extremely helpful in my 
future endeavors. 
 
 
 
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Annex 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Annex 2 
 
 CURRENT FORMAT MY SUGGESTION