Miami-based accountable care organization wins CMS approval to take on downside risk

Updated: Jan 3


Genuine Health Group, the enterprise co-founded by healthcare entrepreneurs Joe Caruncho and Dr. Orlando Lopez-Fernandez, wrapped up its first year of operations with a major win. Its recently acquired accountable care organization, PremierMD ACO, was approved to operate as a Track One-Plus (“Track 1+”) ACO. The distinction means the physician ACO now qualifies as an advanced alternative payment model and makes its participating physicians eligible to earn up to a five percent bonus payment starting in 2020. In addition, as an advanced alternative payment model, its participating physicians are exempt from burdensome reporting required by the merit incentive-based payment system (MIPS), which is part of the Medicare Access and CHIP Reauthorization ACT (MACRA).

Genuine Health purchased PremierMD ACO, which included mostly-Broward physicians, in June of last year. Since that time, Genuine has recruited a number of new physicians from Miami-Dade, Palm Beach, and is in talks with doctors in other states who may also join.

Caruncho and Lopez-Fernandez started Genuine Health to capitalize on new health delivery models, like ACOs, that incentivize “value-based” care. By leveraging their experience delivering high-quality, low-cost medical care at the Medicare Advantage plan they ran, Preferred Care Partners, and by using advanced analytics, the company will be able to earn more revenue for keeping patients healthier. The ACO earns half of the amount it saves Medicare for the care its doctors deliver to patients. However, the financial upside requires the organization to assume some downside risk. So, in the event its costs for delivering care are more than Medicare benchmarks, it must reimburse a portion of the overage.

“From the time we acquired PremierMD, we intended to transition our Miami ACO to an alternative advanced payment model,” said Joe Caruncho, president and CEO of Genuine Health Group. “The Track 1+ model brings significant benefits to our participating physicians, and is an appealing first step as we wade into taking on greater financial risk for the care of Medicare beneficiaries assigned to our ACO.”

Nationally, few ACOs – only about 5 percent – have opted to take on downside risk as a tradeoff for increased upside potential. Part of the hesitation is that these ACOs must demonstrate to the Centers for Medicare and Medicaid Services (CMS) that they have capital on hand to pay losses if they miss performance targets. In addition, these organizations need to invest in data analytics tools, hire clinical staff and care coordinators, and make other operational changes to ensure quality outcomes.

“The team at Genuine Health came to the table with the technology and experience to make sure our next phase epitomizes the concept of ‘value-based’ care,” said Dr. Victor Toledano, the president and founder of PremierACO. “With our team of doctors and their leadership and resources, we will be a national model for how to deliver better healthcare at a lower cost.”

For more information on Genuine Health Group, Miami Accountable Care Organizations, or to schedule an interview with Joe Caruncho, please contact Meieli Sawyer at 305-668-0070 or msawyer@weinbachgroup.com.


111 views

Recent Posts

See All

806 South Douglas Road

Suite 700

Coral Gables, FL 33134

  • Facebook - GHG
  • LinkedIn - GHG
  • Twitter - GHG
Send Us a Message

© 2020 Genuine Health Group