As chief executive officer of Genevive, Amanda Tufano leads a mission-driven healthcare company created to meet the complex care needs of Minnesota’s geriatric population and improve lives and health outcomes. Genevive has a team of more than 115 physicians, nurse practitioners, nurses, and social workers deployed throughout the Twin Cities and greater Minnesota.
Amanda joined the organization as director of business operations in 2012 and has also served as the organization’s treasurer and chief operating officer. She thoroughly enjoys growing the business and building a network among other small businesses that support healthcare. She is credentialed with the Medical Group Management Association (MGMA) as a Certified Medical Practice Executive (CMPE).
While I believe it is helpful to learn from other industries, I think it is even more critical to understand our own industry better. There are so many facets of the industry that touch older adults: payers, healthcare systems, facilities, transitional care units, acute care, home-based services, device providers, and so on. These tend to operate in silos because, to this point, there hasn’t been any incentive for them to collaborate. That adds significant complexity to what is already a complicated care environment. If we can find a way to talk across these silos, I think we can do much more to improve care and quality of life for older Americans.
I would flip this question and start by emphasizing that value-based care is not necessarily the right approach for every organization or scenario. For some, it may make sense to retain a fee-for-service model. An organization needs to start with its mission, vision, and values: Who are we, and how do we create value for patients?
Where a value-based care model does make sense, I think the most challenging part of the shift is laying the right groundwork in the right order. Three key things must be in place for it to be successful: value-driven business operations, clinical operations that reflect a value orientation, and value-based contracts. Think of it as a three-legged stool: If one leg is missing or too short, it will not support the weight. Many organizations spend a lot of time addressing business operations and contracts but not enough on transforming clinical operations.
Our owners and our practice bring different experiences to the table: Allina and PHS lend hospital and health system perspectives while Genevive offers medical practice and care management perspectives. It is a great combination for rethinking how our seniors receive care. How can we ease the transition into a facility? How will they receive hospital, specialty, or acute care? How can we deliver best-in-class campus care? As the geriatrician quarterback, how can we work with families through the transition? How can we evolve our processes to create a different and better experience? I really enjoy being part of a new level of collaboration that really isn’t happening elsewhere – here in Minnesota or nationally.
In the present environment, aligning payment with our care model continues to be a key challenge. It is hard to get new and innovative payment reform that enables what we want to accomplish as a clinical organization. Rapid technology evolution, of course, is also a challenge. It is difficult to keep pace.
The looming challenge, though – and it is a big one – is what many are calling the “silver tsunami.” Every day, 10,000 people turn 65, and that will continue for another 10 years. We haven’t yet hit the tipping point in this wave, so we really don’t know what the future healthcare requirements look like for this population. We’ve never had this many older adults before.
Because we haven’t felt the impact, the healthcare ecosystem is not prepared for it. We already have a shortage of geriatrics providers, and there is not enough supply in the medical school pipeline. We also lack infrastructure. For example, most hospitals don’t have geriatric wings. Ten years ago, the average stay in a nursing home was five years. Today, it is 12 to 18 months. There are so many questions: Where will this population live? Who will care for them? How will our provider system accommodate them? Do they have enough money to pay for necessary care? If they are at home, how will they get transportation when they need care?
Organizations need to be thinking about this. Bricks and mortar may not be the right answer. I believe that appropriate care in the home will be a key part of the future model, but that raises additional challenges. For example, current reimbursement systems are not well aligned with in-home care models. They reimburse care providers for visits but not for the potentially significant “windshield” time in the car between visits.
One key theme is the need to treat geriatrics as a specialty that requires unique infrastructure to serve unique needs. We are doing a relatively good job of advancing operational and strategic approaches for the population at large, with innovations such as virtual care helping to drive better access and experience. But these aren’t serving seniors effectively.
We need to rethink how we deliver care for those later in life and invest in new ways — in all facets of care. We need research on medications and how they react in older bodies. We need systems that work with, rather than around, the provider. Think of it a little like pediatrics, where the pediatrician is the point person and coordinator for everything. And we need to allow people to buy care management services directly from provider organizations.
From a professional standpoint, I enjoy the fact that we have a very strong healthcare community. Healthcare is a priority here, and the strong advocacy makes it easier to work outside the box and seek to become a disruptor.
Personally, I’ve developed a passion for broomball, which I discovered after moving here from Texas. I now play both indoors and outdoors and am proud to be part the Minnesota women’s traveling broomball team.
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