Miami-Based Accountable Care Organization Wins CMS Approval To Take On Downside Risk

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 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 2019. 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 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…

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