Global economics and the opportunity to share healthcare knowledge with other governments and organizations led Pendulum HealthCare Development Corporation to seek out new and expanded relationships for our products and services.


Puerto Rico

In early 2006 Pendulum HealthCare Development Corporation and DeMarco & Associates supported the efforts of a core group of physician and hospital leadership to build Puerto Rico’s first provider sponsored Medicare Advantage health plan. While the US federal rules applied to eligible Medicare enrollees, the Commonwealth developed its own ASIS plan for Medicaid making this a very different set of rules and regulations than anything in the USA. The island had a limited number of HMOs but MA plans were growing with over 70% of the population participating in the Medicare Advantage CMP plan or Special needs plan as dual eligibility. Insurers split up the island disrupting delivery system relationships. Providers felt a large island wide organization of physicians and hospitals could help unify care delivery and grow to the Virgin Islands and surrounding Caribbean locations, making Puerto Rico a Mecca for medical care, equivalent in capability and quality to Miami.

Costa Rica

Shortly thereafter Costa Rica entered into CAFTA agreements with the U.S. which offered broader trading opportunities but also limited the use of monopolies by governments and industries to encourage competitive trading. The INS covers the entire population of Costa Rica with a basic health plan. As a single payer insurance plan, it represented the only source of income for hospital and physicians. In breaking this insurance monopoly, physicians became concerned that insurance companies would begin to split up the delivery systems and disrupt the continuity of care. When physicians in Puerto Rico were contacted they said that Pendulum HealthCare Development Corporation could help. Thus, Pendulum HealthCare Development Corporation received a call to visit with various government and ministry directors as well as employers and brokers. We continue to work through the evolving government leadership and are positioned to create a technological link between providers and payers and to assist in the transition of an Accountable Care like structure using local and international care standards.


Panama intrigued us due to its rapid economic growth and strategic location between North and South America. In visiting with health ministers, employers and insurance company representatives, we saw excellent potential for technology applications to establish links between practices many of which were interested in informatics as a means to improve the quality of care and attract global dollars from medical tourism. We also recommended a public health component to act as an early warning system for infectious disease and a direct linkage between physicians and employers to improve both safety and outcomes of care. Finally, it became apparent that the basic value of informatics would be improved by opening a series of workshops affiliated with local medical schools to teach informatics and their application in improving care.

Mr. DeMarco and Pendulum HealthCare Development Corporation Caribbean Group lead development Consultant Osvaldo Ramirez MBA JD pictured here at the Panama Canal.



Pendulum HealthCare Development Corporation was invited by the Health Ministry of Turkey to participate in the first international summit on Pay for Performance. Over 1,000 attendees from the surrounding area of the Mediterranean and Black Sea attended to better understand how different countries could best use the Pay for Performance process to improve care within their countries. Representatives from the World Bank and the European Union also attended to see what they could do to somehow unite countries via data systems and use of same or similar metrics. We continue to await Turkey’s inclusion as a EU country enabling both funding and agreements with the west on topics of patient privacy and reporting against international standards.


Pendulum HealthCare Development Corporation is participating as advisor on health care transactions with Overseas Bridges , a business transaction and communications company in Northern Illinois. We have been asked to assist in bringing Chinese health care executives to America for training, develop insurance alternatives for seniors and create a medical products exchange for the Chinese Government.

Overseas Bridges