Amanda Tufano, Former CEO Genevive

May 24, 2024 | Interview

Read the transcript below:

Thank you so much for taking the time to chat with us. We appreciate your willingness to share your wisdom and experience. Let’s start with a bit of your background and experience.

Thanks for the opportunity. I’ve been at a geriatric care management medical practice for the last eleven and a half years, leaving as CEO after serving in that role for six and a half years. We’re based in Minnesota, and the company was called Genevieve. I left that job in May. Genevieve was the largest facility-based geriatric practice in Minnesota, with the majority of our revenue coming from value-based care contracts. I have extensive experience in high-base care negotiations, Medicare contracting, and dealing with complex patient populations, both in facilities and in home-based primary care. I’m excited to be here, so thanks.

Awesome, thanks so much. Let’s dive right in with the first question. We’ve spoken to quite a few leaders in the risk-bearing space. One CEO mentioned that in value-based care, about one-third of the chief executive role is contracting. She even said, “always be contracting,” which I find hilarious. Your reputation in contracting precedes you. Someone said you were risk contracting before it was even a thing. Given that, what’s one of the hardest things about contracting to get right, and how have you found ways to mitigate pitfalls in that area?

That’s a good one. I think the first hardest thing is getting the deal done right: aligning on a shared vision, milestones, and goals. This can take anywhere from a few months to over a year, which can be frustrating. You’re designing a partnership where everyone wins, and navigating that can be challenging. However, after a decade in value-based care contracting, I’ve found that maintaining the contract and the relationship is more challenging. Things change, and both sides have to adapt. It’s a bit like a marriage—you need to continually invest in the relationship to keep it strong. Building a strong foundation and understanding how each party adapts to change is crucial for long-term alignment.

Wow, that’s amazing wisdom, not just for contracting but for relationships in general. Any additional thoughts on this topic?

The dating portion—building the infrastructure—is critical. If you build it on a shaky foundation, it doesn’t matter how much work you put in. This involves understanding the other party’s drivers, pain points, and goals. For example, Genevieve became a partial owner in an MSSP, and we spent 12 to 15 months working on the operating agreement. Early on, when things start to fall apart, that foundation is crucial. Some contracts didn’t work because they were built on the wrong assumptions, so it’s essential to invest time and attention in the early stages. But the long-term maintenance is where the real challenge lies.

We know Genevieve has flourished under your leadership. What are some performance metrics or improvements you accomplished at Genevieve?

The early years at Genevieve were about organizing—figuring out what goes where, who does what, and what works well. This constant process of iteration took a lot of thought, time, partnership, and investment in people. Later, it was about optimizing—using data intelligently, creating structures and systems to support our goals, and becoming more efficient. Implementing electronic systems like EHR, practice management, and data analytics with HIE connections was crucial. Over time, as the world got smarter with data, we had to continually connect to that and extract meaningful data to drive results. This allowed us to create key performance indicators and scorecards, which were essential for driving performance.

How did you organize and operationalize your data infrastructure and team at Genevieve?

We had to do it across the board—for clinical systems, support systems, back office, IT, etc. It required continuous rethinking. Early lessons included underestimating the human interaction needed with technology. For instance, we initially thought one FTE would suffice, but it ended up requiring three. We needed better data to drive results, but it often required more manpower than anticipated. We also focused on diversifying our value-based care contracts, which was crucial for expanding our market share and creating new markets. Our most successful contracts were risk-based ones, and optimizing these holdings was key to our growth and ability to scale.

That diversification must have added significant weight to the importance of getting contract relationships right.

Absolutely. In value-based care contracting, the responsibility often lies with the CEO because it affects every aspect of operations. It doesn’t have to be the CEO, but it must be clearly understood by the C-suite because it touches every component of the organization.

Looking forward, what does the future hold for high-needs groups and home-based primary care? What needs to change?

The future is wide open for high-needs groups and home-based primary care. This space includes geriatrics, behavioral health, oncology, nephrology, cardiology—any expensive healthcare areas outside of primary care. Home-based primary care needs to continue evolving to lower costs, incorporating telehealth, remote patient monitoring, community health workers, and self-guided supports for patients and caregivers. Stratification of patients based on needs will also be crucial, providing different levels of support as needed. The focus will be on being nimble, partnering more, keeping fewer closed doors, and improving access to technology and ideas.

Let’s close with one question we ask all our participants. What question would you have for our high-needs, risk-bearing community?

Where am I wrong? What did I get wrong? Where is the opportunity for me to learn and grow? And how can I help? Today’s environment requires leaders to be curious and relentless. We must keep asking ourselves how to prepare leaders and clinicians for this new environment.

If you had to characterize the new environment in a few snippets, what would you say?

The new environment is characterized by new ways of working, driven by the next generation, particularly Gen Z. Every new generation pushes us to innovate, think differently, and work smarter. Healthcare is being asked to adapt to what our customers need, where they need care, and who provides it. Our systems have been relatively fixed, but now we have the opportunity to be leaders in innovation, meeting customers where they are. We need adaptable, unflappable leaders who focus on people and customers first, and we’ll succeed. The future is exciting with more opportunities for innovation and growth.

Thank you so much for sharing your insights with us.

Thanks for having me.