George M. Rapier III became a gerontologist because he liked old people. And he became an entrepreneur, somewhat inadvertently, because he thought there was a better way to take care of them.
WellMed doc receives exec award
After almost 20 years, his better way seems to be paying off for everyone. The medical management company he founded, WellMed Medical Management, takes care of one in five seniors in its San Antonio headquarters, and a total of more than 83,000 patients through 24 clinics in Texas and five in Florida. About 35,000 of its patients come through the managed-care option Medicare Advantage.
WellMed provides extras such as free transportation to appointments to help patients show up consistently, free flu vaccinations, and help with medication copayments and deductibles that have increased WellMed patients’ prescription fill rates to more than 90% from 17%.
More than 12,000 WellMed patients wear bracelets or carry key fobs with a USB device that lets providers access their electronic health records. WellMed patients with chronic conditions, such as diabetes or congestive heart failure, have health coaches who contact them regularly and make sure they’re getting the care they need to stay as healthy as possible through a disease-management subsidiary called HealthRight.
WellMed took in more than half a billion dollars in revenue last year. While the company is privately held and doesn’t release profit figures, its revenue has more than doubled in the past three years.
For his central role in creating a company that takes better care of patients and makes money doing it, Rapier is the recipient of sister publication Modern Physician’s Physician Entrepreneur of the Year award for 2009. He was chosen from a field of 37 nominees in the second annual competition.
Rapier, 56, saw his entrepreneurial opportunity in 1990 when the HMO PacifiCare (now part of UnitedHealth Group) came to his previous practice, the multispecialty group Diagnostic Clinic of San Antonio, with a proposal to expand the amount of primary care in the metropolitan area. PacifiCare was willing to put up the money for the expansion. The practice wasn’t interested, but Rapier himself (who was at the time the practice’s president) certainly was. “It sounded like a no-brainer to me, so off we went,” he says. The resulting joint venture opened Trinity Medical Group, specializing in primary care for seniors.
That first clinic grew, fueled by a model for primary care that wasn’t built on volume. WellMed prefers to operate on the basis of capitation and delegation: that is, it receives a fixed sum from the insurer for the care of each patient, has sole responsibility for figuring out how best to spend it, gets to keep what’s left over, and thus benefits directly from keeping its patients as healthy as possible. Its 60 employed physicians and 20 physician assistants are paid a base salary plus a bonus based partly on profitability, and partly on hitting specific quality targets that vary from year to year. WellMed also contracts with about 150 primary-care physicians.
Recruiting physicians has been one of the relatively easy parts, because patient loads are at a civilized level. “We’ve never focused on high volume,” Rapier says. “That’s not the way we do business. Most primary-care docs have to see 35 to 40 patients a day to make a decent living. We’ve operated under capitated risk arrangements since day one, and have put more focus on managing patients than on volume. Those are mutually exclusive.”
Rapier bought out PacifiCare’s interest in the business as soon as he was able to, and changed the company’s name to WellMed Medical Management. He grew it relatively slowly, keeping its clinics within the borders of Texas until last year, when WellMed expanded into Florida. WellMed also operates Physicians Health Choice, a Medicare Advantage health plan that’s offered in parts of four states.
As part of his mission to promote preventive care, Rapier gives back to the San Antonio community, both through a personal charity—the Blake, Kymberly and George Rapier Charitable Trust—and through the WellMed Charitable Foundation. “George is quite a hero in this community, and WellMed has set high standards for what a medical group should do,” says Fernando Guerra, San Antonio’s director of health for the past 22 years.
Rapier quit seeing patients about six years ago because the company demanded his full attention, but he misses them. “I just like old people—I like dealing with them,” he says. “They grew up in a different time, went through the Depression and World War II. Most of them are so appreciative of what you do for them and really respect it.”
Elizabeth Gardner, a former Modern Healthcare reporter, is a freelance writer living in Riverside, Ill. She can be reached at [email protected]
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