Increasing Value When Negotiating With Payers



Value-based care expert Joe Caruncho, CEO of Genuine Health Group, was featured in a Medical Economics piece entitled “Increasing Value When Negotiating With Payers.”

In it, Mr. Caruncho describes how physicians can partner with health plans to meet shared goals, and how these doctors can plan a transition to value-based care. Keep reading below.

Increasingly, payers are adopting a take it or leave it approach in contracts with physicians in the value-based marketplace, putting physicians in a tough spot. What can physicians do to show their value and increase their power in negotiations?

Experts say physicians will have to get creative, by partnering with health plans to achieve common goals, and finding ways to grow market share—and leverage.

“It helps if you can position yourself as a partner versus a vendor,” says Joe Caruncho, JD, CEO of Genuine Health Group in Miami, Fla., a management company that helps physicians make the transition to value-based care.

Becoming a partner

Caruncho says that physicians can achieve that partner status and increase their value by figuring out what the health plan’s strategic initiatives and focus are, and by offering to help the health plan achieve some goals in exchange for a better rate or shared profits.

“These days they’re competing on quality measures,” Caruncho says. “It’s not about [which payer] can provide the cost for the cheapest, it’s about who can increase their four-and-a-half-star plan in the market and get the best reputation. That’s how they compete for membership.”

Then, he says, the physician and the payer can work together to share in either cost savings or added revenues that result because the physician helped the plan increase its ratings, and as a result, its physicians may be getting more money from Medicare and/or more patients.


Keep reading on Medical Economics.

Joe Caruncho has earned a national reputation for his pioneering work in advancing value-based care and helping physicians transition to this new model of care delivery. Prior to serving as CEO of Genuine Health Group, Joe co-founded Preferred Care Partners, a Medicare Advantage plan, which he and his partners sold to United Healthcare. As Preferred’s chief executive, he helped grow membership to 55,000 and generate sales in excess of $750 million.

For more than a dozen years, he practiced corporate healthcare law, representing physicians, hospital systems, health care delivery networks, ancillary providers and health plans.


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