Add, Don't Take Away

Alejandro Fernandez has no family background in healthcare. He took a job at the front desk of a doctor's office in the early 1990s to help pay his way through college in Miami, working medical records before picking up billing, coding, and revenue cycle management along the way. Over three decades he grew physician groups from a handful of doctors into far larger organizations, including a run of almost thirty acquisitions at Gastro Health, the gastroenterology group he helped build from eighteen doctors to roughly one hundred fifty providers before his own exit through a private equity sale; the group has since grown into one of the largest GI organizations in the US. He is now CEO of Synergy Orthopedic Specialists in San Diego.

Fernandez's argument is that healthcare tackles its problems in the wrong order. Most conversations start with technology. He starts with access, pointing to narrow networks, coverage gaps, and a payment model that compensates single encounters rather than an ongoing relationship of care. He illustrates the pricing mismatch bluntly: a plumber can charge several hundred dollars for a house call and a lawyer bills seven hundred to twelve hundred dollars an hour, while a physician with a decade or more of training charges a few hundred dollars for a visit. Only once access is addressed does he turn to empathy, and his answer to what clinicians should have taken off their plate is the opposite of what is expected: nothing. He would rather add empathy into the front desk and the wider operation, because that is where a patient first feels whether they are being treated as a customer with two hundred other providers to choose from, or as a number.

Technology comes last in his hierarchy, though he is clear it is still necessary, because healthcare margins are under constant downward pressure: Medicare is proposing cuts of roughly three percent generally and closer to twelve percent for joint replacement specifically, which on a practice running fifty to sixty percent overhead can mean close to a thirty percent cut to physician take-home pay. He points to a concrete win: an AI tool built with GE that sped up MRI processing enough to lift daily scan volume from around twelve or thirteen to seventeen or eighteen, adding capacity without a new machine or a new building. Asked how he separates AI substance from AI hype after thirty years of buying and adopting healthcare technology, he compares today's vendor promises to implementing electronic medical records fifteen to twenty years ago: the 'that feature is coming in our next release' pattern is identical, the vendors are not lying, software has simply gotten dramatically faster.