Collaborating for more comprehensive, patient-centered care


Overweight couple walking

In 2009, Cesar Guevara Perez and Miguel Forero Botero, two Colombian physicians specializing in bariatric surgery, founded the Multidisciplinary Support Group for Obesity Management (Grammo), one of the leading clinics in comprehensive, multidisciplinary management of patients living with obesity in Bogota.

“Grammo is an ambulatory clinic that provides outpatient services and performs surgical procedures for obese patients. The focus is on individuals with a body mass index (BMI) above 40; a BMI above 35 with comorbidities; and, in some cases, patients with a BMI above 30, within Level 1 Obesity, who also have diabetes,” explained Dr. Guevara Perez, one of the directors at Grammo and former president of the Colombian Association for Obesity and Bariatric Surgery.


In the last nine years, Grammo has performed approximately 1,800 surgeries of this kind. Surgeon Miguel Forero Botero, also a director at Grammo, added that they carefully monitor all treatment outcomes. At 6, 12, and 24 months, they measure variables such as:

  • Excess weight and BMI percentages
  • Fat volume reduction
  • Resolution of comorbidities (diabetes, hypertension, hyperlipidemia)
  • Hospital readmissions

Grammo Clinic's efforts to measure results were the reason Sura, one of the top three insurance companies in the Colombian healthcare system, chose Grammo to implement the value-based healthcare (VBHC) model that Medtronic had implemented at other internationally renowned medical institutions.

Unlike the fee-for-service model, VBHC places the concept of “value” on center stage. The key is to measure outcomes and pay according to results obtained.

“We partner with Medtronic because we agree on this approach,” highlighted Dr. Forero Botero. “At Grammo, we believe that surgery should be the last resort for obesity. We are convinced that treating patients comprehensively is critical — holding their interest with a program using several specialists (doctors, nutritionists, psychologists) focused on retraining patients to lose weight and change habits; reserving surgery for specific cases, while providing comprehensive pre- and post-surgical support.”

The key is to measure outcomes and pay according to results obtained.


Today, professionals at clinics like Grammo charge fees for every ambulatory or surgical service they provide. “In this case, you also need to take into account fees from surgeons, anesthesiologists, operating room, surgical instruments, medication, patient therapy during a hospital stay, and follow-up medical fees for a year after the surgery,” added Forero Botero. And these fees are paid regardless of results obtained. In the future, as patient results improve without increasing expenses, those fees could be higher.

Initial results from this alliance will become visible within approximately two years, through a rigorous outcome analysis of 50 patients undergoing bariatric surgery. In the medium term, Grammo wants to make VBHC a business model that can also be applied to the nonsurgical care of overweight or obese patients. “We want to decrease morbimortality rates and promote education among families, in order to expand our work and help control obesity,” says Guevara Perez.

According to the last National Nutritional Health Survey in Colombia, 56% of adults are overweight and 1,200,000 people are morbidly obese.1 With this in mind, the alliance between Medtronic and Grammo promises to have significant impact on the Colombian health system and its patients.

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Instituto Colombiano de Bienestar Familiar. Encuesta Nacional de la Situación Nutricional de Colombia (ENSIN 2015). Bogotá: ICBF; 2016