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Lynn Fosse, Senior Editor
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Genuine Health Group
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Meieli Sawyer, The Weinbach Group
Interview conducted by:
Lynn Fosse, Senior Editor
Published – January 24, 2022
CEOCFO: Mr. Caruncho, what is the overall vision behind Genuine Health Group?
Mr. Caruncho: I will take you back to my prior project of which Genuine was sort of an outgrowth. In 2002, I founded a company called Preferred Care Partners, which was a Medicare Advantage plan; a health insurance company for seniors who qualify for Medicare. It grew statewide throughout Florida, and then in 2012, UnitedHealthcare, who wanted to strengthen its position in the South Florida market, acquired us.
When I thought of the vision for Genuine Health, it was partially an outgrowth of things that I wished I’d had in our toolbox at Preferred Care Partners, but that I did not have because we were the insurance company, so we were one step removed from the patient. At the same time, there was a huge shift in Medicare and the healthcare industry. The healthcare industry follows what Medicare does, and Medicare was quickly changing the way doctors are paid from the system called “fee-
The HMOs like my former company needed to get into this new value-
CEOCFO: What are some of the challenges in changing the mindset of doctors?
Mr. Caruncho: I actually talk about that all the time. We just had a dinner meeting for one of our physician groups with about 35 physicians. I referred them back to the first time I talked to them about value-
Now, all of a sudden, they are responsible for 100% of the healthcare dollars, but they also can share in the savings of managing that 100%. If they do it correctly, the upside really dwarfs any incremental income that they would get by billing a little more for this or that. It is about convincing them to take their eye off the 15% and put their eyes on the 100%, and then working together to ensure high-
CEOCFO: Would you give us an example of how that would play out today?
Mr. Caruncho: Physicians frequently refer diagnostics. If you need an MRI, you will frequently go to the hospital they are affiliated with. In a lot of cases, they are in the medical office building next door, so it appears very convenient. Doing that MRI at that hospital setting might cost four or five times more than doing it across the street or two blocks away at an independent diagnostic center. Many of the independent centers have concierge check-
CEOCFO: Ultimately doctors are paid for the quality of care and the result. How does a doctor go from ordering a test because the patient has coverage to “is this really necessary for the overall outcome”?
Mr. Caruncho: It is part of the same paradigm. A lot of times, the physician does the MRI instead of something more cost-
I mentioned analytics before… it is how we show them in understandable terms what is at stake. We are stewards of this money that Medicare pays from all our tax dollars, so on an idealistic basis, we should do it just based on that. However, also from a financial business standpoint, it requires you to engage with the patient more. Many doctors have been trained to engage more frequently in things that will translate into fees paid to them by Medicare (or the insurance company), and to shy away from the other decisions that did not traditionally impact them financially.
We are up to about 300 primary care physicians that are part of our network, and we meet with each of them once a month. We require it, or we do not affiliate them, because, without the engagement, the formula does not work. Once we engage them, we show them the analytics. They share in the savings which we call Genuine Rewards. We say to the doctors, if you engage and do these things, we will share the resulting upside with you. You engage them with the information, but you also align them with incentives. That way, they know what is financially beneficial also provides better outcomes. It’s a real win-
CEOCFO: Would you tell us about the acquisition of PreventiMed and what that adds to Genuine Health?
Mr. Caruncho: I self-
Finally, I mentioned plugging a gap. The physician leadership there is outstanding, particularly Dr. Charles Yanes. He is someone I am very impressed with because he took the lead initially on developing the company. I view him as becoming an integral part of our leadership team as we develop. In the industry, we call it peer-
CEOCFO: How do you show results and what has changed in your approach over time; what have you learned?
Mr. Caruncho: One of the things that has changed dramatically in the last few years is technology. That has allowed us to engage the physicians and provide that information in a way that was not even imaginable in 2012. You can slice and dice data and do predictive modeling, and a lot of the things were not available then. But what I also learned is that there were some physicians who wanted a paper chart, and there were others that wanted access to our actual database. So, we don’t impose our new “toys” on our physicians. We make it available but meet them where they are.
Our hope is that over time, we gradually move them along the spectrum with more technical options and tools. We have a one-
CEOCFO: What is the competitive landscape? Why engage with Genuine Health Group?
Mr. Caruncho: There are a lot of groups that are purportedly doing what we are doing. We think we are different in a couple of important ways. One is that we are kind of a hybrid of a traditional risk provider, and the front-
So, we combine a traditional “MSO,” or Management Services Organization, with the physician-
The second factor: we were the first to do this in our market. Usually, these “MSOs” have focused on the Medicare Advantage for seniors that chose to get their Medicare benefits through an HMO insurance company. However, part of the value-
One other thing that makes us unique is that, when you read about a lot of these competitors, their way of engaging the doctors is to buy them. They have to acquire them, which is expensive and a capital-
Genuine Health Group | Joe Caruncho | Accountable Care Organizations Miami | Value Based Care Organizations Miami | Joe Caruncho of Genuine Health Group Discusses Value-
“We think of ourselves as a single point of contact, a one-