By Bernie Cahiles-Magkilat
Health issue can be a very serious affair. Other than the financial and emotional burdens attached to it, literal access to healthcare can also be very challenging. Thus, bringing medical care to remote areas is one task a former medical representative envisions to provide to Filipinos.
Jylberd I. Nabor, who has seen the challenges faced by dialysis patients, has sought to bring dialysis centers closer to these patients at very affordable rates. He put up Nephromed Asia Dialysis Center with the mission to be the dialysis center of choice for quality and affordable treatments in the Philippines and Asia Pacific.
Jylberd’s foray into the dialysis center business was an offshoot of his retrenchment from Swiss pharmaceutical giant Roche in 2015. His last position was national sales manager.
“I am so lucky,” says Jylberd of his work with Roche that he did not even feel sad of his retrenchment because of the generous tax-free package. There were 20 people retrenched and he was still young at 38 years old.
The retrenchment program was generous enough to fund a business close to his heart: free-standing dialysis center.
Jylberd was armed with 17 years of experience in the pharmaceutical industry concentrating on nephrology market and dealing with kidney doctors. That gave him the idea of a business that is at the same helping those in need. He has seen the big challenge nationwide among patients not just with their medicines before and during dialysis. There are also issues on medicines for kidney transplant patients.
Jylberd himself has witnessed how kidney failures affected his family as both his parents succumbed to diabetes. He was orphaned at the age of 14 when he was only in second year high school with the passing of their dad. Their mom followed three years after.
Both parents were diabetic, a disease that runs in the family. Jylberd spent his schools in Pasay supported by his older brother.
So, when the retrenchment opportunity came, he was more than glad to start his own business.
“I was retrenched in 2015 by Roche Philippines and the package was good enough so with the help of classmate/friends we set up dialysis centers,” says Jylberd, who also sought the help of his older brother. They also brought in some nephrologist doctors to lend their expertise.
He called it mere guts when they decided to put up the business, which entails a sizeable investment, but his business proposition is data-driven.
According to Jylberd, 30 percent of diabetic patients end up needing dialysis. Another data Jylberd cited is that of 10 dialysis patients, three are diabetic.
But their business model is geared for the poor patients located in the remote areas. These patients have a hard time going to dialysis centers, which are normally located in hospitals. It was only lately that some privately-owned and stand-alone dialysis centers were established.
Thus, the birth of Nephromed Asia Dialysis Center. Investments are not small, each machine costs P800,000 with the lowest at P650,000. The minimum for one dialysis center is 13 stations to achieve an economy of scale and to ensure faster recovery on investments. A center also requires a staff of between 15-18 people.
At present, Nephromed has six company owned dialysis centers and two are still under construction. Each of their centers has 13-18 machines depending on the space.
At first, they were engaged largely in setting up dialysis centers for individual investors. But since, they have the expertise when it comes to the economics of this kind of business, they decided to put up their own dialysis centers.
Nephromed’s first dialysis center was established in July 2016 in Taguig as their pilot project. It has 14 stations with investment of P12 million. They expect a return on investment sooner. The second facility is in Bicol.
Each center is operated by people with experience in the dialysis treatment for the past 25 years. A center has three doctors including a nephrologist, a surgeon and a radiologist and 3 non-doctors.
Now, they have dialysis centers in Nueva Ecija, Sta. Rosa in Laguna, Ibaan, Batangas, two in Silang, Cavite and now in General Trias, Cavite. Its Nueva Ecija branch has already expanded to 18 stations. They even operate now a 40-bed hospital in Silang.
To fulfill its mission of providing quality dialysis to kidney patients they have to expand quickly. To do this, Jylberd has thought of franchising.
With the help of Francorp Philippines, the franchise authority in the country, the Nephromed franchise scheme was crafted. Nephromed’s franchising program was launched only in March this year during the Franchise Asia event of the Philippine Franchising Association.
Nephromed now offers franchise packages from P14 million to P18 million turn-key. The franchise fee is P750,000. Most of the interested franchises are doctors and businessmen.
“When we talked with Francorp we became more confident because our market is the Class C and D patients. Those patients that go to the hospital are rich patients, but we are free-standing and we cater to patients outside of hospital premises,” says Jylberd.
“We are able to change the game,” says Jylberd. Their rate is so low that a patient could only shell out P200 cash per treatment as the bulk of P2,600 is paid for by the government through PhilHealth.
But still, some patients cannot afford to go to hospitals and other dialysis centers because these are far from their homes. With Nephromed’s free-standing dialysis centers in the provinces and rates way below what the hospital charges, patients can now afford to get treatment.
“The highest upfront cash a patient pays to us is between P200 to P300 per treatment, but other hospitals charge between P600 to P1,200 per session as they have to maintain a certain mark-up,” says Jylberd.
According to Jylberd, they can offer a lot cheaper rate because they are able to get good rates with the consumables as they can get volume orders. They are also able to arrange for better price for the dialysis machines because they can place order because they are a chain.
“So, we get better rates for our machines and stuff making us very competitive,” adds Jylberd.
While there is a long line of potential franchises, Jylberd, however, noted of the need to pace their expansion. They want to limit to eight this year.
There are lots of factors to consider like location and having a well-trained medical team. “It is not easy especially in finding a good location. But even if they have already a space, there are still certain things to consider,” he adds.
“As a free-standing dialysis center, we have to have a physician on duty and one nurse to four patients. Those serious cases we have to refer them back to the hospital,” says Jylberd.
Already, several groups are lining up for franchising opportunity. Inquiries are not only from nephrologists but other medical doctors. Some are as young as 26 years old and non-doctors. One inquiry comes from a food franchise business.
True to its mission, Nephromed has turned down inquiries whose interest are mainly driven by profit.
“We have to filter them because they are going to destroy the market by focusing on profit. They are going to raise the rates and put in machines that do not meet our standards, that’s greed,” says Jylberd.
Nephromed is expected to sign its first franchise this month for Northern Luzon. They are a group of doctors. Already, this new franchise is looking at its second branch in Mindanao. “We have 3 inquiries in Davao, 2 in Cagayan de Oro and in Nueva Viscaya,” says Jylberd.
The ROI for Nephromed is between 3 to 3.5 years with average of 28 patients a day or 84 patients in a week. But a break even can happen earlier. One center even registered a break-even in 3-4 months.
Even as the business opportunity looks bright, Jylberd was worried of the increased number of Filipinos afflicted by diabetes.
There has been a 12 percent increase in diabetes incidence among Filipinos. Of new dialysis patients, the number of those with diabetes has also increased.
Aside from the dialysis facility, Nephromed is making sure they are investing to make their facility always above standard. They are investing in Green Dialysis. For instance, they have waste management and water technology system called reverse osmosis to avoid causing chills on patients.
“We also segregate all wastes and make sure we exceed the required standards,” he adds.
They are also practicing green dialysis where they create a system to use excess water. They are also using solar power to make their operations more environment friendly.
They also invest in people to keep their staff despite the lure of bigger pay from Saudi Arabia, which offers P50,000 a month salary to Filipino nurses.
“We invest in people development with no lock up period,” he adds.
“I am letting them go because I am glad for them. I don’t hold them back even if I have shared everything I’ve learned with them. That is my number one advocacy as a leader,” adds Jylberd, who encourages his people to speak up to be heard.
As a salesman, Jylberd is heavy into training. “I love training people and training is my core competency,” he adds noting that training people is his passion although it is difficult to train people. The best way to make his people learn is to teach them so they won’t fall into the same mistakes he once encountered before.
Most of all, he has inculcated a culture of service attitude for all of his staff up to the medical team because they have to look after the welfare of patients. He is of the opinion that if they cannot uphold this attitude and implement it properly then they have no one to serve and they should be out of business.
But because of their service attitude, they continue to receive an outpouring of gratitude from their patients.
“They would add me on Facebook as friend and send me private messages to express their gratitude,” he adds of these simple but genuine joys.
From time to time, Nephromed conducts promo of “no cash out” dialysis sessions just to encourage patients to come to the center. “When we announced the promo, the patients were crying. We are changing the game,” he adds.
Jylberg is the son of a pure Chinaman, but they did not belong to the rich Chinese. “I grew up in Tondo with my brother,” says Jylberd as they were orphaned while he was still 14 years old.
He used to live with his big brother Jimmy, who is into garment factory since 1985 with factories in Caloocan and Bulacan employing 600 people. Jylberd finished business administration major in marketing from Letran University in Intramuros.
Life then was hard so he needed to work extra to augment his money that at one point he became a taxi driver. The hardships in life were also good motivation to pursue his dreams.
After college, he was drawn into the pharmaceutical sector because of the good offer of free car and gas.
“But what is most fulfilling is that my relatives with no medical exposure often consulted ME about their medical condition and who to go to. So, it feels good that I was of help and my brother was very supportive of me,” says Jylberd, who now lives in Sta. Rosa, Laguna with his wife and two kids, a girl and a boy.
In business, he learned that the best way to succeed is to have focus because competition is stiff.
“We have a patient-centric approach,” he says. This approach has enabled them to bring down the cost of their treatment down to the barest minimum.
“Others do not understand that most patients do not have money to even pay for their commute. So, we sort of subsidize the cost just so they can come and complete their treatment. You have to be compassionate because we are extending life to these poor patients,” he adds.
“We just have to be persevering,” he adds.
Among the local business icons who Jylberd looks up to is John Gokongwei. Based on what he has read, the patriarch of one of the country’s biggest conglomerates has a heart. In terms of taking risks, he likes the guts of businessman Injap Sia.
A family man, Jylberd said his kids are his “stress-buster.” He holds weekends sacred as these are devoted to family.
“I am not really rich, but who I am now and what I have are all the fruits of hardwork. But most of all, these are provisions from God because he is the giver,” says Jylberd, a Christian by religious affiliation.
His family gives back through tights. “Me and my wife are taught to give tight so blessings will pour out,” he adds.
But even as he enjoys a very comfortable life now, Jylberd said he has not changed a bit.
“There is no reason to change. God is good, I was just blessed, really,” he concludes.