Alvaro Montealegre: How I patched up American healthcare

Nicaraguan exile Alvaro Montealegre won the confidence of his patients at his Texas clinic by offering better levels of customer care. Building on success, he set up Almori to offer administration services to the medical firms he soon won over. Now, Montealegre spies further growth opportunities for Almori.

Years spent working for a Texas-based health insurer prompted Alvaro Montealegre an exile from the Nicaraguan Sandinista revolution to buy a medical clinic in America. "Health-care providers were too focused on the insurance companies. Because we paid the bills, we were their priority. Not the patients." The healthcare crisis that dogged Bill Clinton's presidency gave Montealegre his opportunity. In 1996, with its owners looking for a way out, he was able to buy his first clinic.

"My idea was that instead of looking to maximise the cash I could get from insurers I would try to offer great patient care and pick up more clients." Convinced, for example, that most hip fractures are caused by bad eyesight, Montealegre offered free glasses to his patients. "They cost me very little but my patients loved it." His timing proved spot on as health spending picked up. He soon bought another clinic and then a pharmacy. With more clients and scale, he set up a special customer care team to manage the treatment of patients. "Many treatments were not successful because people forgot to take their pills or didn't understand the instructions. By spending small amounts of money on customer care we were able to prevent big bills later on." This in turn gave him expertise in the growing field of health management services.

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James McKeigue

James graduated from Keele University with a BA (Hons) in English literature and history, and has a certificate in journalism from the NCTJ. James has worked as a freelance journalist in various Latin American countries.He also had a spell at ITV, as welll as wring for Television Business International and covering the European equity markets for the Forbes.com London bureau. James has travelled extensively in emerging markets, reporting for international energy magazines such as Oil and Gas Investor, and institutional publications such as the Commonwealth Business Environment Report. He is currently the managing editor of LatAm INVESTOR, the UK's only Latin American finance magazine.