Latest / Becker’s Healthcare Podcast / Neil Machhar on Scaling High-Touch Primary Care for Medicare Advantage

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Neil Machhar on Scaling High-Touch Primary Care for Medicare Advantage · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Hello, everyone. Welcome to Becker's Healthcare podcast. I'm
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  - Scott King. Thrilled to be joined by a
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  - very special guest, Neil Machar, chief executive officer
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  - over at Greenbrook
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  - Medical. Neil, how are you doing? Thanks so
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  - much for joining us.
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  - Doing great. Yeah. Thanks for having me, Scott.
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  - Of course. We have a lot of kind
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  - of big topics to get to. Obviously, I
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  - wanna ask you about a lot of trends
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  - going on in health care. But before we
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  - do that, I was wondering, Neil, if you
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  - could please just tell us a little about
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  - your, career journey in health care.
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  - Yeah. No. Absolutely.
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  - Well, Scott, appreciate you having me here. I've
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  - I've listened to Becker's almost every day for
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  - the last five years or so. So exciting
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  - to be here and share about our work.
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  - My name is Neil Machar, as you said,
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  - cofounder and CEO of a business called Greenbrook
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  - Medical. I'll, you know, spend most of my
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  - career in health care as a consultant at
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  - McKinsey,
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  - as an investor,
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  - in private equity in Boston at a firm
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  - called Berkshire Partners,
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  - and then as an executive of a venture
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  - backed care coordination software business called Patient Paying,
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  - all before starting Greenbrook. And,
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  - and just to share you know, I know
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  - we're gonna talk about a bunch of things,
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  - but just to share a little bit about
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  - Greenbrook Medical, you know, we
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  - we exist primarily for two reasons. You know,
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  - one is to improve the health and well-being
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  - of seniors by providing them a special healthcare
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  - experience.
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  - And two is by doing so
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  - to help health systems
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  - make Medicare Advantage financially viable.
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  - So what it is that we do is
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  - we deliver a very high touch
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  - concierge like primary care experience to patients with
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  - Medicare Advantage plans. And everything that we do
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  - is built around the idea that seniors deserve
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  - a lot of time and attention from their
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  - primary care physician. And when they get that,
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  - when they get to have a real
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  - trusted relationship with a PCP who
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  - knows them,
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  - understands them,
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  - is accessible to them, and can guide them
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  - through their health care journeys, then good things
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  - happen. Access improves,
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  - outcomes improve,
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  - and their cost of care ultimately goes down.
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  - And so we've built
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  - our entire operation to accomplish that. And to
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  - pay for that model,
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  - we don't charge our patients. We instead
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  - have risk agreements with the MA plans that
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  - we partner with in order to participate in
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  - the cost savings that we create.
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  - So right now, we're currently doing that all
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  - in Tampa, Florida in a joint venture with
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  - Tampa General Hospital. We've got four locations today,
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  - and we're expanding rapidly. We have plans to
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  - open six more locations here in the next
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  - twelve months.
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  - Thanks so much for sharing that background and
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  - further, Neil, about your career journey and everything
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  - Green Book, medical
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  - is up to.
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  - Love hearing the, the growth there and and
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  - also how you're trying to keep the cost
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  - of care down for patients.
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  - The the first question I have for you,
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  - I was wondering if you could please give
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  - us, like, just kind of a quick state
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  - of the union. Like, what what has gone
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  - well this year
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  - for for you and Green Brook Green Brook
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  - Medical, and what are you focused on for
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  - the rest of 2026?
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  - Yeah.
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  - This this year has been,
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  - an inflection point, I'd say, for our business.
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  - I I started the company five years ago
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  - with my brother, Raj. He's our chief medical
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  - officer. And just as a brief history to
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  - give you some context to where we are
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  - today,
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  - you when we first started the company, our
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  - job was to prove that we had a
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  - clinical model and a business model that works,
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  - that delivered on all those promises I just
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  - said, and that could sustain also all the
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  - headwinds
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  - happening in the Medicare Advantage program today.
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  - And so we've spent the first three years
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  - of the business from 2021
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  - to 2024,
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  - proving that to ourselves. And once we did,
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  - you know, the next job was to prove
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  - that we could do that in partnership with
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  - a leading health system. I mean, the way
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  - that we think about the world,
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  - we've got a great experience for patients, and
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  - we have a
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  - a special model.
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  - But we wanted to use that not to
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  - disrupt
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  - the health systems, but rather to support them.
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  - You know, the the health systems we view
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  - play a huge role in our communities as
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  - social safety nets in the backbones of our
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  - healthcare system.
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  - So we were lucky enough to have a
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  - great health system in our backyard
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  - in Tampa General Hospital that is led by,
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  - I'm sure, a
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  - very inspiring and innovative CEO, John Kouras, and
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  - he's built an amazing team around him with
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  - folks like Adam Smith, the chief ambulatory care
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  - officer there.
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  - And we got together and we saw an
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  - opportunity. So we launched that joint venture in
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  - 2024.
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  - So the past two years
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  - have really been our prove it period with
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  - TGH,
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  - and that's gone well. And so this year,
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  - we've committed to expanding the partnership
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  - much more meaningfully, hence the plan to, you
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  - know, open six additional locations here in the
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  - next twelve months.
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  - So, you know, for the rest of the
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  - year, I'd say we're very focused on building
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  - the capabilities that we'll need to support that
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  - scale between,
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  - you know, people, new process to install new
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  - tools and technology.
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  - And so we're doing a lot of hiring
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  - right now. So, honestly, hiring and onboarding well,
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  - that that's gonna be the main focus for
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  - the rest of the year.
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  - You mentioned headwinds.
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  - Just curious what you think is the biggest
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  - headwind
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  - that you're keeping an eye on and preparing
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  - for and why.
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  - Yeah. You know, I think,
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  - I think anyone who operates in the world
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  - of Medicare Advantage
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  - is paying close attention to what CMS does
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  - with rates
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  - and risk adjustment changes. It's sort of no
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  - surprise CMS has been
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  - tightening the belt on Medicare Advantage for the
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  - last few years, specifically on the risk adjustment
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  - model. And that's created a lot of pressure
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  - on
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  - MA plans and risk providers, especially those who
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  - are,
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  - say, overly dependent on risk adjustment.
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  - And so we're we're paying close attention to
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  - that, but I'd say maybe with a a
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  - different perspective than a lot of fellow travelers
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  - in our space. You know, Greenberg,
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  - we're cheering CMS on here. You know, first
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  - as
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  - a citizen and a taxpayer,
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  - I think it's probably just the right thing
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  - to do for the country. You know, the
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  - Medicare Advantage program has grown a lot and
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  - it's
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  - serving a lot of constituents very well. But,
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  - you know, it's a huge program with a
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  - lot of spending and I think it was
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  - probably necessary to rationalize spending in an area
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  - that frankly ran maybe a little too hot
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  - for a bit.
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  - And so as a citizen and taxpayers, we're
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  - celebrating that. But also
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  - in our business, we're celebrating it too because
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  - this rationalization
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  - is good for us. Our
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  - business is very focused on
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  - improving outcomes for patients and reducing
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  - costs as a result.
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  - And because we are quite good at that,
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  - you know, we're we're much less dependent
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  - on risk adjustment alone than many of our
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  - peers. And so
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  - the more CMS stays on the brake pedal
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  - there,
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  - I'd say the better off we are on
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  - a relative basis. So, you know, we're paying
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  - close attention to
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  - all the risk adjustment model changes and the
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  - reimbursement headwinds in Medicare Advantage. But,
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  - on balance,
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  - we're we're
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  - pleased with where we are, and we think
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  - they actually are are benefiting our business here.
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  - What do you think is Greenbrook's best opportunity
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  - to grow in the next two to three
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  - years?
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  - Our our main focus
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  - right now is expanding our partnership with TGH.
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  - You know, we're really proud of what we
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  - built so far and the impact that we're
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  - having in our four locations. But, you know,
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  - we've we've got a lot of room to
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  - run here. There are a lot more
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  - seniors across the Tampa Bay region who deserve
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  - the experience we're providing. So, we're going to
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  - close that gap. We're very focused on that.
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  - But in the back of our minds, if
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  - we take a step back,
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  - we're also starting to realize
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  - that TGH is not the only health system
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  - that's grappling with
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  - the challenges of an aging population
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  - and a growing Medicare Advantage program. We're
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  - still in the middle of the silver tsunami
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  - here. And in our view,
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  - despite a lot of negative rhetoric around the
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  - MA program today, it seems like it's here
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  - to stay. So I think as we look
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  - across the landscape,
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  - it seems like more and more health systems
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  - are experiencing this challenge. And we think that
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  - they are gonna have to find a way
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  - to make
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  - this whole setup more sustainable.
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  - And so
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  - you know, at some point, we'd love to
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  - take the learnings from what we've built here
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  - with TGH and share them with others and
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  - and be a part of that solution.
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  - But we are,
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  - right now, very focused on expanding our our
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  - partnership with TGH.
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  - Speaking of of sharing things you've learned, you
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  - know, I I love to talk with health
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  - care leaders on this podcast about about leadership
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  - and and the journey of leadership. Just curious
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  - if you can share, who do you admire
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  - as a leader? It could be any industry.
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  - It doesn't have to be health care.
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  - Who who do you admire and why?
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  - Yeah.
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  - We probably spend hours on just this topic
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  - alone and just
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  - listing people. But I you know, I'd say
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  - that
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  - the few that come to mind and the
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  - ones that have inspired us in the way
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  - that we've built the company the most are
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  - it's probably a category of leaders I would
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  - describe as folks who have built really
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  - big, impactful
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  - organizations
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  - in service industries like the ones that we
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  - operate in.
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  - So I'm thinking of folks like
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  - Ken Langone at the Home Depot and Howard
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  - Schultz from Starbucks and
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  - Danny Meyer from the Union Square Hospitality Group.
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  - I mean, these are folks who have built
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  - real winning cultures
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  - in service industries.
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  - And, I'd say the one through line between
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  - all of them is,
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  - you know, if you if you
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  - read and digest everything that they put out
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  - there, they all seem to make it clear
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  - that the number one stakeholder in their business
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  - is their team, it's their employees. And so
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  - we've taken
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  - a lot of inspiration from that, and we've
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  - embodied that concept in the way that we've
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  - built Greenbrook, where we
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  - we think about ourselves as very team first,
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  - patients second, not because we don't care about
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  - our patients. You know, it's our mission to
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  - improve
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  - their health and well-being. It's why we get
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  - out of bed in the morning
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  - is to take care of them. But we
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  - also recognize that we can't take care of
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  - our patients without first taking care of each
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  - other and our team. And so we are
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  - very, very focused,
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  - say inspired by those folks.
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  - We're very focused on making Greenbrook the absolute
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  - best place to work. And then we think
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  - the
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  - experience we deliver for our patients and the
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  - results we deliver for our partners is just
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  - a a byproduct of that.
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  - Sticking with leadership, do you recall any advice
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  - you got from any leaders that kinda shaped
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  - the way that that you lead?
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  - Yeah. I mean, I I have been really
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  - fortunate. I
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  - was served as chief of staff
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  - to a guy named Jay Desai, who's the
• 11:34
  - founder and CEO of a company called PatientPing
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  - and has remained a close friend and mentor.
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  - And I like, every day,
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  - there are
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  - words and sentences of his that just flash
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  - through my brain as we're going through the
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  - daily challenges of building Greenbrook today.
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  - You know, one that's just standing out right
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  - now as you ask the question is
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  - organizations
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  - reflect the values of the leaders
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  - of the organization.
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  - And so, you know, as we think about
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  - building the team,
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  - we spend a lot of time
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  - as we think of people joining Greenbrook Medical
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  - on focusing on values alignment.
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  - Because our philosophy is
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  - we can teach people the skills and the
• 12:16
  - competencies, but it's really hard to change someone's
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  - values. And so,
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  - we we focus a lot on that on
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  - the selection process.
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  - Yeah. I think it's a great reminder to
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  - kinda make sure you're instilling those values that
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  - are important to you as a leader.
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  - Neil, thanks so much for coming on and
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  - joining us on the podcast. It was great
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  - hearing about everything Greenbrook is up to, and
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  - we're looking forward to working with you as
• 12:38
  - the CEO, CFO roundtable.
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  - Awesome. Thanks, Scott. Appreciate the time.