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There’s an elephant in the room

7 octubre, 2022 • By

The pandemic has been a global tragedy from which we should have learned. However, that is not the impression that the public has, given the current situation in hospitals and primary care centres. That is why it is more necessary than ever to take brave and efficient decisions, in order to guarantee the sustainability of healthcare in the medium to long term.

Before Covid, there was already pressure regarding the evolution of the costs due to the ageing of the population, the increase in chronicity and the incorporation of technology and scarcity of professionals. Now, as a result of the pandemic, we also have to add the challenge of facing the longest waiting lists in history, significant diagnostic delays, which are already putting the lives of many patients in danger, and primary healthcare that is completely overwhelmed by the lack of organisation and historical neglect, in spite of the fact that it is the key to the health and well-being of the public.

In my opinion, there are three keys to successfully dealing with the challenges of the healthcare sector in the medium to long term. Firstly, we have to invest more in human resources, and faced with a general lack of professionals in Spain, we need to better organise workforces for the future, starting with university places and Resident Medical Interns. In addition, we have to introduce flexibility and incentives, which allow for the implementation of a modern human resource policy.

Secondly, we must assume that technology is essential for both the present and future of healthcare, that telemedicine is here to stay, and that applications and devices that monitor patients remotely are of growing importance. The healthcare of the future requires us to take care of the citizen when they are healthy and heal them as soon as possible when they are sick.

Lastly, it is crucial to commit to improving the management of social healthcare systems, both public and private, and to strengthening the collaboration between both. This is because the public system needs the private. The role that healthcare organisations, such as the Ribera healthcare group, are playing with agreements with public administration and insurance providers, is key in order to make high quality and efficient healthcare available to public and private funders. The response to Covid would have been impossible without the collaboration of both,  even though some are still insisting on challenging views, as shown with the draft of the Law regarding Equity, Universality and Cohesion of the National Health System (NHS). There are those who do not want to see the elephant in the room.


The Michael Neidorff Room

22 septiembre, 2022 • By

It may seem surprising, but the truth is that this is the first blog that I have written in 2022. We have experienced very intense months at the Ribera healthcare group since practically the start of the year. Together with the challenges of the healthcare sector and the effects on the Covid pandemic, which are still being felt this year in our hospitals, we have also had the passing away of Michael Neidorff, the Chairman and CEO of Centene Corporation, the main Ribera shareholder, on 7th April. A few months earlier, he had announced his retirement due to his poor health.

For that reason, during the months before and after this sad event, I preferred to be prudent, since Michael Neidorff has been and always will be part of Ribera, both emotionally and professionally, due to his humanity, charisma, strength, foresight and support in all of the projects and moments that we have shared. And, in my opinion, he saw the same values and spirit in Ribera that he always transmitted to his own company.

Michael Neidorff was not only the Chairman and CEO of Centene Corporation, but also the founder of the company, who started with a turnover of 40 million dollars and left the company with one of 130,000 million, positioning it as one of the 25 most important companies in the United States.

His social vision of healthcare, his work capacity and leadership, the social projects that he spearheaded and his personal involvement in the commitment to quality healthcare for all (Medicaid, Medicare) are an inspiration for those of us who dedicate our lives to health prevention and taking care of the population. He always sought balance between management, the unique nature of each aspect such as the healthcare of the population and the commitment and involvement of the professionals. He placed value on and prioritized the humanistic side that those who dedicate themselves to healthcare should have, our public service vocation, social commitment and passion for this sector.

Michael was a visionary who understood, visualized and knew how to convey the keys to the healthcare of the next decade better than anyone which, as I pointed out earlier, will always be a reference for me. I have felt the loss greatly and I would like to take advantage of this first blog entry of the year to send his wife and son a hug and a message: Michael Neidorf will always be with us, and his work and legend will live on as an example of healthcare, both within and outside the United States.

In the group’s central offices, all of the rooms have the name of important figures in medicine, from Ramón y Cajal to Marie Curie or Severo Ochoa, and we have decided to name the Ribera Board Meeting room with the name of this great man, Michael Neidorff, because we know that his philosophy and vision regarding healthcare, as well as his memory, will forever inspire us.

After these events and changes in Centene’s management, there was, as we all know, a re-definition of its strategy and projects. Today the Ribera group no longer belongs to Centene. We have grown and learned a lot together, but we are beginning a new stage. At the end of July the purchasing of the American insurer’s shares by Vivalto was made public.  They are the 3rd leading private healthcare group in France with which we share our values, vision and mission, as well as the obvious close geographical location. We are starting a new journey, with a lot of experience and the knowledge of our more than 7,000 professionals in the group, as well as great excitement and a lot of projects in which the role of these professionals is going to be even more important in this post-pandemic era.

If you follow this blog, you will definitely have seen the importance that we always give to the role of the professionals in our organization. Clinical leadership has always been key in our responsible health model, but, without a doubt, it has also been one of the keys in terms of successsfully overcoming the hardest moments of this pandemic, together with foresight, flexibility in management and the ability to adapt quickly. Furthermore, if you know Ribera’s new shareholder, Vivalto Santé, you will know that part of his equity is in the hands of professionals connected to the project. That is the level of importance that our new shareholder gives to their role. This is the spirit. And with so many shared values, principles and priorities, I know that we are going to do great things together. 

And I’ll finish here. We are starting a new chapter to which are passionately looking ahead, involving significant challenges, both as a nation and a sector. In the next blog entries I will try to continue to present my analysis and vision regarding the trends and challenges that await us. I will just say that, with work, enthusiasm and commitment, I am sure that we will progress with the Ribera group’s great responsible health project.


32 years working for close, sustainable and innovative healthcare

26 noviembre, 2021 • By

In this blog I would like to share some words of thanks for the New Medical Economics award which I received on 15th, November, in Madrid, for the work carried out during my career. 

Firstly, I would like to thank this renowned medium of digital communication, edited by Health Economics S.L. and managed by Doctor José María Martínez García, economist and Doctor of Medicine, for this acknowledgement of my experience in the health sector. However, in addition, I also want to dedicate it to all those people that in these 32 years have joined me in working for responsible, excellent, sustainable and transformative healthcare. I have learned from all of them and together we have shared challenges and proposals, worries and achievements. In my speech infront of a packed audience which gathered at the Jiménez Díaz Foundation, I wanted to give a special mention to the Communication, Marketing and Corporate Social Responsibility Manager, Angélica Alarcón, who has accompanied me for the majority of this journey.

I am passionate about the health sector. I have been working towards closer, more human, sustainable and innovative healthcare for 32 years and all of those adjectives are shared by those of us that met on Monday at the NME awards. This connection, invisible but real, is largely what motivates us to continue working, each of us from our own organization, on building the healthcare of tomorrow, today. 

And we need to think about the immediate future now. This is because we are going to face big challenges in the next few years and we should look for what unites us and that which allows us to give the response that the citizens deserve. Above all, in order to guarantee them an integrated, universal socio-healthcare, without waiting lists, which integrates the different levels of care – from Primary Healthcare to care homes for the elderly – and permanently establish this new digital culture, something which is a pending matter, so that our healthcare is a global benchmark due to its quality. 

At Ribera Group we have dedicated our work to helping to build a strong public system, from our innovative and sustainable model, with responsibility, institutional loyalty and the confidence that good health results and patient and professional satisfaction give us, after more than 20 years managing hospitals and health departments. 

I am sure that we will go from strength to strength on this path that we began  on many years ago and, between us, we will manage to secure the pillars of a single form of healthcare, one that is transformative and universal, without anyone taking ownership of it.

Thank you to those who have accompanied me in these 32 years of professional career and mutual learning. My hope is that life allows me to keep working and providing my knowledge and experience in the sector in order to continue transforming healthcare and preparing it for the immediate future. 


A responsible health model for a better world

15 noviembre, 2021 • By

Let me share with you all my article published in the spanish digital newspaper El Español on 11th November 2021 about Sustainable Development Goals

Leaving the world in a better way than what we found it, thinking about the future with strong foundations in terms of well-being and designing tomorrow with sustainability, efficiency and solidarity as criteria. This should be the objective of citizens, companies, organizations and institutions. And in order to do that, the roadmap set out by the 2030 Agenda is key as well as committing, without hesitation, to the Sustainable Development Goals (SDG) that, with the tragedy of Covid, are becoming even more important. Each one in their area of activity, on a small, medium or large scale. The important thing is to unite so that the foundations of this welfare society, which we are fortunate to experience as citizens in the first world, are extended to every corner of the globe and are sustainable over time. 

For the first time, we have the opportunity to commit to some good objectives for both the planet and for humanity, with inclusive, impartial and depoliticized language, which unites and does not discriminate, and which attracts due to the strength of its message. In my opinion, it is important that it goes beyond political ideals and personal interests. 

Ribera has been a pioneer for quite some time in the development of a responsible health model, with the aim of improving the well-being of the population, adding value by combining innovation and humanization, whilst, at the same time, contributing to the sustainability of the healthcare systems. For that reason, when the 2030 Agenda appeared, its integration into our day-to-day operations was immediate and natural. This is because our vocation is to transform the way of managing health, and although we are in line with the SDGs in general, our focus in on number 3 which refers to health and well-being. 

Technology and human resources are essential for this responsible health model that we apply and that we are working hard to expand, beyond the nine hospitals and 60 primary care centers that we manage in five Spanish regions. Both are key in that they allow us to provide all patients with access to personalized, preventative, predictive and participatory healthcare. We make sure that they feel they are at the center, actively participating in their care, and provide them with the technology and the support that they need, as well as facilities and equipment adapted to people with functional diversity. Equality, universality, fairness and responsibility. All of them applied to health. 

Furthermore, thanks to our commitment to research and co-innovation, we develop tools, applications and predictive models every day, such as that which, as of more than a year ago, allows us to predict which Covid patients may end up in the ICU, the telemonitoring of chronic illnesses, telerehabilitation or a virtual carer which, thanks to voice technology and artificial intelligence, “understands” patients, sends their vital signs to a healthcare professional almost immediately and is capable of handling thousands of patients in a few hours. 

We must always keep moving forward and commit to initiatives that seek to make what still seems a utopia in a world that is becoming more and more skeptical, a reality, little by little. And I genuinely think that Ribera forms part of that group of brave people that work and reinvent themselves everyday to create a better world, in our case, even greater, faster, more humanized and socially responsible healthcare. Therefore, for example, we recently joined the One Health strategy, which promotes a global vision of health all over the world. Covid and the global pandemic that it has caused should make governments and health organizations aware of the importance of approaching the health and well-being of the population from a holistic point of view, since the health, economic, social and cultural constraints greatly influence the organization and planning of healthcare resources in both prevention and caring for the population. 

No government should make decisions that affect the health and well-being of the population based on, for example, a political agenda built on confrontation, without valuing results and objective data. Yet, unfortunately, some political leaders are following a prehistoric agenda, and are still committed to 50 year old management models, serving a society that, quite simply, does not exist anymore.

And how can we guarantee a healthy life and promote well-being and health for the citizens of today at the Ribera group? With a strong and firm commitment to prevention and education for the health of the population, for all ages and stages of life, from the youngest, to pregnant women and the elderly, making medicine personalized, responding to the challenges of this new society. Covid has resulted in everything being a challenge in this area, as it has forced us to contemplate other kinds of actions, different from those organized before the pandemic started, where face-to-face workshops predominated. In March, 2020, everything changed, first due to the lockdown and later because of the social distancing needed which is still recommended today. That led us, during the first lockdown, and thanks to the involvement and initiative of our professionals, to launch our Cuídate en casa (look after yourself at home) program, which included videos with advice about health, exercise, healthy eating and online mindfulness, relaxation and rehabilitation workshops. It was so well received that it led us to record a second edition, with new videos for every type of patient, which can be seen on our YouTube channel. 

With each of our actions today, we are defining how we want the world to be tomorrow. Are you on board?


The Ribera Salud doctrine

19 julio, 2021 • By

Last Thursday we were informed about the Supreme Court’s (SC) ruling number 952/2021’s regarding reversions and the adherence to the 2012 Budgetary Stability Organic Law and that the fact that it, without a doubt, affects the case started by the Valencian regional government for the internalization of the management of the University hospital of Torrevieja.

But allow me to share my thoughts on the aim of this case, because I think that it is so important that it goes beyond the specific examples of La Ribera Hospital, that of Torrevieja or the healthcare concessions. It marks a before and an after in the Spanish economic system and in the concessional model in any sector, and creates what, from now on, we are going to call “the Ribera Salud doctrine”.

And what does this doctine, that has set the standard with the Supreme Court’s ruling, consist of? I have summarized it for you into some key points which are included in the Supreme Court judges’ document.

  1. The Ribera doctrine has managed to set a limit regarding economic populism in Spain. From now on, governments cannot make arbitrary decisions without opening an administrative record which includes the strict economic and budgetary impact and is backed up with data. With this ruling, we have made sure that in the future decisions of an ideological nature are not made, without explaining and justifying the economic implications of that decision to citizens, as well as how their internalization proposal will affect the quality of services, in a transparent way.
  2. This Supreme Court ruling voids the previous ruling from the Valencian Community’s High Court of Justice (TSJCV), which stated that a government could make unilateral decisions, without any type of study or analysis of the impact of these decisions. With the Supreme Court case, this ruling is now void, something very extraordinary in the Spanish legal system and very very significant for the concessional sector in general.
  3. And I’d like to add something else. The Supreme Court’s ruling states that PRIOR to making a decision and PRIOR to any communication regarding the internalization of a service (the end of a concession), the administration has to compile a comprehensive and substantiated file, which includes the evaluation of the economic and budgetary impact of this decision. BEFORE MAKING A DECISION.

From my point of view, it’s a historic ruling, which marks a before and after in terms of the guarantees of a democratic state, opting for the legal safety of concessionaire companies and guaranteeing the strictness and seriousness of the government when making decisions that affect any public service that citizens receive.

I feel proud for having taken this issue to the Supreme Court and for having managed to void the ruling of the Valencian High Court, which endorsed arbitrariness in governmental decision making, when it affects a public service. It has always seemed bad judgement to us at Ribera and now the Supreme Court has shown that we are right by voiding it.

Today Spain is a safer country, from a legal point of view, and a limit has been set regarding economic populism. And I am happy to have contributed to a stricter, more serious and more objective scenario than that which existed previously. In my opinion, it is not acceptable that a decision on the scale of the reversion of the administrative concession is justified by appealing to a government agreement, whether it be the Botánic agreement or any other, and regardless of which parties form it. Governing for all citizens is a responsibility which should be carried out with seriousness, objectivity and strict criteria and, above all, by justifying decisions with reports and data, decisions that affect so many families and, in this case, thousands of patients and healthcare professionals. What is more, this is during a pandemic and healthcare crisis.

Furthermore, we are asking for European funds to get out of a very severe crisis and it is not logical or reasonable to ask Europe for funds on the one hand and on the other hand to ignore the saving, in the case of Torrevieja hospital, for example, estimated by the region’s Court of Auditors to be 45 million euros.

I also want to place value on the social contribution of the Ribera group. We don’t want medals, but one thing is for sure, thanks to this ruling, that we have taken to the highest body within our judiciary, we have prevented other companies that manage public services from going through what we went through. The concept of company freedom, institutional loyalty between administration and a concession, respect and legal safety is essential, and even more so in a country in which public private collaboration is a reality in many sectors. And I’m talking about infrastructure, energy, water, care homes, education, MOTs and, of course, healthcare, since healthcare agreements exist in many Spanish regions.

I’m aware that we have been like David facing Goliath in this legal battle and, for that reason, I feel especially happy that the whole organization has defended affected patients and professionals, as well as our providers, subcontracted services, collaborators and, ultimately, all those who believe and appreciate that loyal, sincere and quality collaboration is also in the citizens’ interests. We have, I reiterate, simply defended the safeguards of the rule of law.

Lastly, I want to say that we trust that the contribution of the “Ribera Salud doctrine” to a great nation such as Spain allows us, and future generations, to enjoy a freer and safer country to invest in, create employment, generate opportunities and offer quality services to citizens. A country in which the ideology doesn’t put limits on freedom, in which attitudes and decisions that attack sectors such as subsidized schools, care homes, pharmacies or the healthcare sector disappear.

We trust, and we have never stopped trusting, in goodwill, dialogue and loyalty to find the best solution together with the administration, and to keep guaranteeing a responsible health model and the best public healthcare service for patients in the areas that we manage.

This is, and always has been, our vocation.