AGENDA

THE ACHIEVER

WEEK OF THURSDAY, MARCH 10, 2011 WWW.MIAMITODAYNEWS.COM

MIAMI TODAY$3.00

Photo by Maxine Usdan

ATTORNEYS PROBE TRANSFER OF TAX FUNDS AT JACKSON … 2

AREA BIDS FOR 2,300-BED IMMIGRATION DETENTION SITE … 3

GUSMAN AT CROSSROADS: EITHER A TRUST OR CURTAINS … 3

VIEWPOINT: COUNTY HALL REFORM STARTS WITH MAYOR … 6

$190 MILLION LAND AT HERALD NOW WORTH $116 MILLION …7

MILLION-SQUARE-FOOT LOGISTICS HUB A KEY TO TRADE … 10

JUST 600 DIRECT JOBS IN PORT DREDGING, STUDY STATES …10

CHARRETTE EYES BISCAYNE BOULEVARD PARKING LOSS … 23

Lenders return to condo market,but cash remains the king, pg. 13

Albert SantaloBuilding CareCloud quickly to handle medical records

The profile is on Page 4

BANKING & FINANCE

Accounting changes could remakecommercial lease structure, pg. 14

Legislatorscraft routeto reforms

As flights added, air passengers soar 7% this year

BY ZACHARY S. FAGENSON

Miami-Dade residents maysoon get a nearly direct path toalter the county’s charterthrough Tallahassee.

State Rep. Carlos Lopez-Cantera and Sen. Rene Garcia,both Miami Republicans, filed ajoint resolution to allow charterchanges through a special lawthat would have to be approvedby the local legislative delegation,then put to Miami-Dade voters.

But first, the bill would have tobe approved by the legislaturebefore being put on a statewideballot, according to Sen. Garcia.

The legislation would supple-ment, not replace, currentmodes of charter change.

“If you want to change thecharter, this is another vehicle,”he said.

The bill would retain all of theexisting Miami-Dade CountyHome Rule Charter and wouldkeep all officeholders in placeuntil the end of their present term.

“This came about years agowhen I first was in the House.[There was a] similar piece oflegislation and it was defeatedstatewide. We are now just tryingto bring it back,” Sen. Garcia said.It’s been “changed a little bit,where before I don’t think it hadto go before the Dade delegation.”

The bill comes as many pointto charter reform as the nextlogical step if a March 15 electionrecalls Mayor Carlos Alvarez.

Billion auto dealer NormanBraman has floated his “Cov-enant with the People of Miami-Dade County” charter changepackage in public as well asprivately with some mayoralhopefuls. The genesis can betraced to the 2007 charter re-view committee and its Chair,attorney Victor Diaz.

At the same time, Commis-sion Chair Joe Martinez hascharter amendments waiting inthe wings to increase commis-sion salaries and create an in-spector general independent ofthe commission.

BY ASHLEY D. TORRES

A Miami International Airport passengerboom boosted aloft in 2010 by 30 addi-tional American Airlines flights, new inter-national routes and airport improvementsjust keeps rising.

More visitors keep coming in 2011, evenas American, Delta and various foreignairlines line up new flights. However, ris-ing gas prices could burst the expandingpassenger bubble.

Total air passengers here hit an all-timehigh in 2010, climbing 5.35% year over yearto 35.7 million from 33.9 million in 2009.

The rising numbers continue into 2011,with traveler arrivals climbing 4.7% yearover year in January to 1.586 million from1.515 million in January 2010.

Even that is speeding up. Passenger num-bers from Jan. 1 to March 7 rose 7%, saidJosé Abreu, Miami-Dade aviation director,smashing previous forecasts that travelernumbers would remain flat in 2010 andpick up only 2% in 2011.

With 98% of Miami-Dade visitors arriv-ing by air and 75% flying American Air-lines, said William D. Talbert III, the Greater

Miami Convention & Visitors Bureau’s CEO,increasing flights mean more travelers.

American Airlines has been a primarycontributor to the traveler rise, with 30 newdaily flights in 2010.

“Some people,” Mr. Abreu said, “buildnew airports to get 30 new flights.”

New international routes, such asTransaero’s twice-weekly service to Mos-cow Domodedovo Airport and airberlin’sNovember commencement of four weeklyflights to Berlin, added to the passenger rise.

It is “really a testament to the strength ofthe [Miami] brand,” Mr. Talbert said, “thatthese airlines are adding service.”

Nonetheless, there are concerns that risinggas prices could stall increases in airporttravelers as, Mr. Abreu said, the airline modelcan’t handle oil prices above $100 per barrel.

According to Bloomberg, Tuesday’s NewYork Mercantile Exchange crude oil futurewas $104.45 per barrel.

Despite these concerns, additional flightsfrom Miami are to begin in coming months.

American is to add more flights to Balti-more, Los Angeles and Madrid in April

followed by increased service to St. Tho-mas and St. Croix in June.

American Eagle, American’s regionalaffiliate, is also to increase flights in Aprillinking to La Romana (Casa de Campo),Dominican Republic, to fives times a week.

Delta Air Lines is to commence fourdaily Jacksonville roundtrips, one daily toLondon and five daily to Orlando andTampa on March 26. Delta, according tothe Official Airline Guide, is also to relo-cate to Miami its daily Los Angeles servicefrom Fort Lauderdale Hollywood Interna-tional Airport.

For foreign air providers, Iberia Air-lines is to begin three weekly nonstopBarcelona flights on March 29. Servicelinking to Amsterdam is to begin March 21on KLM Airlines with four weekly non-stop flights and on Arkefly beginning June24. TAP Portugal is also to start flights toLisbon Portela Airport.

Airport officials say improvements alsocontributed to increasing passenger num-bers, such as construction of the MiamiIntermodal Center, which features therental car center, MIA Mover and MiamiCentral Station.

REASON TO LEAVE: After deferring theitem at a previous meeting, Miami commission-ers are to vote today (3/10) on a proposed one-month early retirement incentive expected tosave $6 million in salary expenses this fiscalyear. Those electing to leave the city’s De-ferred Retirement Option Program (DROP) earlyfrom March 15-April 15 would pay the samehealth care contribution as active employeesfor up to seven years after retiring.

MEGA-YACHT MARINA VOTE: State officials are to vote on grantinga state waiver to Flagstone Property Group for its planned Watson Islanddevelopment April 5, Madeline Valdes, City of Miami director of publicfacilities, wrote in an e-mail. Because the project sits on an island givento Miami by the state in 1949 for public use, any commercial developmentrequires state approval. If approved by the state, city commissioners areto then vote on the project again April 14, she said.BINGO!: In a bid to bring 400 jobs to Miami-Dade, the county commis-sion last week supported the state’s push to allow bingo at state-gambling facilities. According to county documents, if approved by thestate, the games could create about 100 jobs per facility, four of whichare within county boundaries.TOURISM FIGURES: Miami-Dade hotel occupancy dropped 0.8% inJanuary to 74.5% from 75.1% in January 2010, according to Smith TravelResearch’s Trend Report. January’s average daily rate rose 4% to $171.51compared to January 2010’s $164.88.OVERNIGHT VISITORS: Total Miami-Dade overnight visitors roseyear over year 5.6% in 2010 to 12.6 million visitors from 11.9 million in 2009.Domestic overnight visitors also climbed in 2010 to 6.5 million visitorscompared to 6.2 million in 2009, a 4.7% year over year rise. Internationalovernight visitors spiked 6.6% in 2010 to 6.1 million visitors over 5.7million in 2009.RIDE TRANSIT: The American Public Transportation Association rankedMiami 16th in the country for transit savings with $9,781 saved annually and$815 saved per month, when factoring in local gas prices, the purchase ofmonthly public transportation passes and local monthly unreserved parkingrates. Miami is just under the average transit-use savings of $9,904 annuallyand roughly $825 per month, which is the highest savings in two years. NewYork’s public transportation system ranked first with an annual savings of$14,376 and monthly savings of $1,198.

Census data key to change, pg. 8Few who run visit Braman, pg. 8

Brazil our first billion-dollar visitor hub, pg. 3

PROFILE WEEK OF THURSDAY, MARCH 10, 20114 MIAMI TODAY

Photo by Maxine Usdan

The AchieverAlbert Santalo

President/CEOCareCloud5200 Blue Lagoon Drive, Suite 900Miami 33136(305) 265-4200asantalo@carecloud.comAge: 43Born: BaltimoreEducation: University of Miami(bachelor’s, computer engineering),Florida International University(master’s).Personal Philosophy: “Aim big and try tochange the world. To do that you haveto deal with risk. That’s something Istruggled with earlier on in my career butI’ve come to embrace. It’s amazing howlucky you can get if you work hard.”

Albert Santalo expects health care providers in 30 states...CareCloud President and CEO Albert

Santalo is quickly on his way to becom-ing a serial entrepreneur.

The company, which offers social net-working-style practice management soft-ware, traces its seeds back to only Janu-ary 2009. It secured $2.3 million frominvestors, according to TechCrunch, andtook its product to market last March.The company now has 70 employees in anew office in the Blue Lagoon area, with200 physician clients and 500 ancillarycare providers spread across 10 states.

Mr. Santalo expects health care pro-viders in 30 states to soon be using theCareCloud system.

Trained in computer engineering, he’sworked mostly on the business side ofhealth care technology. Prior toCareCloud, Mr. Santalo in 2001 helpedfound Avisena, which provided revenuemanagement software to health care pro-viders. Though he exited the company in2008, he saw opportunities in the sectorand was eager to jump back in.

“Our business targets ambulatoryhealth care, which is physician prac-tices of all shapes and sizes,” he said.“That’s a very fragmented and verywasteful segment of health care. Esti-mates put it between 25% to 50% waste.”

CareCloud, he continued, helps prac-tices get rid of that waste by taking careof the back-office functions and lettingdoctors focus on their patients.

Mr. Santalo discussed how CareCloudwas started, and where it’s headed, inits new office with Miami Today staffwriter Zachary S. Fagenson.

Q: Can you tell us a little bit aboutCareCloud and what it offers?

A: CareCloud is a health care infor-mation technology company, built at atime when consumer and business mindsare able to wrap their heads around thetype of solutions we deliver.

Some incredible consumer site solu-tions have been developed on the Internetand enterprise solutions have lagged abit. We’re bringing the best of con-sumer-side thinking to enterprise-classsolutions within health care.

Our business targets ambulatory healthcare, which is physician practices of allshapes and sizes, and that’s a veryfragmented and very wasteful segmentof health care. Estimates put it between25% to 50% waste, so we’re all feelingthat in our pocket books, [in] risinghealth care [and] insurance premiums.

There are 50 million uninsured, whichis now being addressed by Obamacare.If that money can be recaptured andutilized to provide health care to morepeople, lower our insurance premiums,or at least keep them stable, there’s a bigsocietal benefit.

Our solutions are about leveraging theInternet so that we can access andconnect all physician practices. [We’re]leveraging concepts like social network-ing to facilitate that.

Then [we’re] delivering robust busi-ness software applications to streamlinethese processes so that doctors don’thave to worry about running their busi-ness. They get paid for servicing patientsand can focus on the clinical side of thebusiness, which is what’s important.

Q: What are the price points of the

software?A: Traditionally doctors have to pur-

chase software, purchase hardware, runtheir own technology shop within theirbusiness. Most of these businesses arepretty small. We facilitate the comput-ing infrastructure as a utility – in es-sence cloud computing.

Just like you would plug into theelectrical grid and pay for what you use,you [can] do the same thing with ourcomputing solutions. All you need arebasic desktop PCs, iPads, iPhones, anycomputing device that can talk on theInternet. We take care of all the heavylifting related to the server infrastruc-ture, connectivity and software applica-tions. There’s nothing that’s installed inthe doctor’s office.

Q: How does that work? Is it on asliding scale based on use?

A: Yes. The typical doctor will paysomething like $500 per month and have all

their key transactions included in that price– full utilization of the software, full con-nectivity to their patients. If they leverageour back office, they can have more hu-man resources thrown into the mix. Theycan pay a percentage of collections.

Q: Who are some of the clients, andwhere are the located?

A: We launched the product in Marchof last year and we’ve been bringingclients online ever since. Our clients arein about 22 medical specialties. Theyrange in size from solo practitioners tolarge multi-specialty groups.

They’re in about 10 states, more con-centrated in Florida, because that’s theway our sales efforts have gone. I an-ticipate that by the end of the year we’llbe in no less than 30 states.

Q: Do you know where the cloudcomputing servers are located?

A: Absolutely. We have a partnershipwith Terremark. They’ve been support-ive of the genesis of the company ingeneral. We’ve had absolutely zero out-ages leveraging Terremark.

Q: What segment of the industry doyou focus on?

A: Something like 50% of the marketis five doctors or less; 80% is 10 doc-tors or less. We, more than anything,target that segment.

However, our solutions work well fora small doctor, a solo practitioner and alarge practice. The system and the busi-ness model work well whether it’s asmall or large client.

Q: Your company is relatively young.How did you get started?

A: The company was started in Janu-ary of 2009. I was finishing up thebusiness plan and started taking theinvestment offering around town, look-ing to raise a couple million dollars inangel money. [We] ended that roundoversubscribed by about 40%, whichwas pretty good because that was theGreat Depression of our time. We wereable to oversubscribe our first round ofinvestment.

We then ramped up the team andstarted developing a software. We wereto develop that first release of the soft-ware in record time and go to market inMarch of 2010 with the first implemen-tations. We’ve been perfecting things

ever since.Q: What was it like to shop the idea

for angel funding?A: It was a shotgun as opposed to a

rifle. It was putting it in front of a lot ofdifferent investors, starting with thepeople that were close to me and wouldintroduce me.

In that initial round of capital it took 150to 200 meetings to get it all together. It allcomes down to hard work. If someonesays no, you go to the next person.

A lot of real estate money evaporatedduring that time, but in general peopleunderstood that health care and technol-ogy was a great space to be in. If youhad a seasoned entrepreneur behind theidea that knew how to execute, then itwas probably a good investment.

Q: Was the software CareCloud of-fers developed in house or did you workwith software developers?

A: It was developed in house. We haveabout 24 people dedicated to softwaredevelopment and we have a small groupthat works in India. It was designed,managed and developed here in Miami.

Q: What was your career like leadingup to this?

A: I’ve always been in the technologyfield, on the business side, beginning asa software developer. Even today I’mthe designer and lead architect of thesoftware itself.

I’ve worked in a lot of industries, bothas a technologist and a managementconsultant. In the late ’90s I worked atThe Hackett Group, formerlyAnswerthink, where I did a lot of man-agement consulting with large compa-nies in all aspects of technology.

In 2001 I got the courage to branch outon my own and become an entrepreneurand started a company called Avisena.

It’s interesting because this is mysecond time starting a company in eco-nomic downturn. In 2001 we were ableto launch that platform, raise both angeland venture capital and successfullybuild that company to the point where Iexited in 2008.

Having experience in health care ITand knowing the opportunities that werein this space, I decided to jump backinto health care technology and startCareCloud as soon as I could.

Q: Describe your average day.A: It’s plate spinning at its best. It’s

a bit of everything. It’s product devel-opment, to which I try to dedicate one,two days a week. I can articulate avision, get involved in architecture, butthe execution is left up to some verysolid folks.

It’s talking to the investment commu-nity, whether that be the angel commu-nity or more institutional investors andbankers. It’s business development.[It’s] working with our sales groups,where I have excellent leadership to helpwith new clients.

Q: What are your short-term goals?A: We’re looking to broaden our prod-

uct. We want to have all of those com-ponents in the marketplace within thenext few months, igniting the sales en-gine. We’ve been selling from the begin-ning, but we want to prove initial as-sumptions from the business plan. Westrive to be a high-growth company.

CareCloud President and CEO Albert Santalo got investor funding only two years agoand now has 70 employees taking care of 200 physician clients’ back-office functions.

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PROFILEWEEK OF THURSDAY, MARCH 10, 2011 MIAMI TODAY 5

...to soon be using his year-old CareCloud technology systemOur end goal is to have health care

instantiated in our systems so that wecan eliminate the inefficiencies that ex-ist between these players.

Q: What are your long-term goals?A: Although we are building out the

sales capabilities and will always lever-age those sales to grow a platform, weenvision that there’s a network effectthat comes into play [when] people arepromoting the system. That’s going totake hold sometime next year.

We envision becoming a platformcompany. Medical device companiesand people we don’t service directly canbuild apps on top of the CareCloudecosystem and deliver those to doctorsand patients five times cheaper, fivestimes faster, with five times less risk.[They’ll have] immediate distributionchannels for those apps built in.

Q: Would CareCloud need to ap-prove company applications, as Applehas done through its app store?A: They would, and not for the same

reasons that Apple does it. Apple does it[to] make sure the quality is there andthat people aren’t putting the wrongkind of apps on their platform.

For us, there’s no way around thatbecause of the nature of the data. We’redealing with personal health informa-tion, so we have to be careful aboutwhat type of apps live on our system.

Q: You recently moved into an officenear the airport. What gave you theconfidence to pull the trigger on a lease?A: We were in some borrowed office

space from a friend in Kendall and quicklyoutgrew that. The moment we had enoughcapital we felt like we needed a biggeroffice. Our No. 1 priority is our people,and we wanted them in place that wascomfortable and worthy of their time.

We love the Blue Lagoon area andHewlett Packer subleased some high-quality space for an affordable price. Weended up signing a permanent lease here.

Q: How many employees do you have?A: We have about 70 employees. We’re

servicing close to 200 physicians andabout 500 ancillary care providers. We’re

in 10 states and capturing one or twoadditional states a month. We’ve beenaccelerating that, so every new statecomes online faster.

We anticipate that we’ll create thisyear something along the lines of 50new jobs.

Q: When working with companies inother states, how do you find a balancebetween meeting in person or meetingvia video conference or telephone?A: More and more you can do the

Cisco, WebEx type of engagement.We’ve built those capabilities directlyinto our system.

We’ll come out, but it costs money.There’s a lot of wasted time, so why nothave them here, doing work on behalf ofthe customers, rather then sending themall over the place? We’re trying to pro-mote a high-touch, high-tech service.

Q: How does CareCloud help clientscapitalize on health care reform efforts?A: We’ve started the development of

our system at a time where we canleverage some great technologies. A lotof what we built strikes to the heart ofhealth care reform – things like ac-countable care organizations or the pa-tient-centered medical home are modelsthat we enable in our system.

We treat the patient rather than as acustomer of the practice, as an indi-vidual. That individual can have multiplecustomer relationships with multiplepractices in our system, and because ofthat we can identify and analyze theentire life cycle of treatment, whichstrikes to the heart of outcomes-basedaccountable care organizations or pa-tient center medical homes.

In these new models health care pro-viders begin to assume risk and operatemore like an insurance company.

The systems that are out there arecompletely deficient in this area. It’sanother area where we can help themmanage risk profiles, drive better qual-ity outcomes and lower cost of caredirectly through our system.

We’re well-positioned for health carereform and, because we’re on the

Internet, the accessibility and the abilityto capture entire populations of patientsis much more viable.

Q: Will health care providers experi-ence any risks associated with becom-ing more transparent?A: Health care providers get paid for

a population of patients, whether theysee them once or 10 times. The onceversus 10 drives our cost. [We’re] man-aging that cost, making sure the patientpopulation is profitable, having the bestoutcomes and ensuring the financial live-lihood of the provider organization.

Today providers get paid for service,so the more they do the more they getpaid. Under an accountable care organi-zation it switches, so it’s utilizationbased.

Q: Are there any federal grant pro-grams available to support theCareCloud mission?A: There is on the clinical side, elec-

tronic records.Beginning this year each physician can

secure up to $64,000 of stimulus money,paid over a number of years. They haveto demonstrate meaningful use of elec-tronic medical record systems.

Most physicians will qualify for lessfor $44,000. It depends on how muchMedicare versus Medicaid they have.It’s not direct stimulus dollars that af-fect us, but it affects our clients in theprocurement of our system.

Q: In preparation for upcominghealth care reform, many practiceshave been merging. Has this had anyeffect on CareCloud?A: We’ve absolutely seen that. We’ve

also seen hospitals acquiring physicianpractices. The transactions are easy, butthe implementations are difficult. Someof it is the complexity of the corporatestructure and how those contracts withthe insurance companies work.

We can handle these groups that areheavy into acquisitions. We can handletheir divestitures. Most systems that areout there, 90% of them, do not do this well.

Where [a large merger] normallywould have to spend seven figures to

get this infrastructure built, they can,with us, pay a little bit of money toactivate each physician. [They] thenpay as they go in a variable cost struc-ture and utilize that money in a way thatgenerates revenue.

Q: You mentioned that there arefederal dollars for practices that try toconvert to electronic health care records.Is that whole process going well?A: There is progress being made.

There’s been significant rise in adoptionon behalf of the doctors of these sys-tems. The systems are needed, but thereare still a lot of systems that inhibit thedoctors’ work flow as opposed to en-hance it.

The doctor is the revenue generator ina lot of these practices, so if they workless, [if] they see less patients, theymake less money. Usability issues arethings that we address well. Our de-signs are centered around the end user,and that’s why we enabled devices likethe iPad to make the user experiencerich.

Q: If I take a trip out West this falland break my arm, is the infrastruc-ture yet in place that would allow adoctor to pull my records and treat me?A: We’re not there. Across state

boundaries [it’s] even worse. The gov-ernment has been promoting regionalhealth exchanges, which I don’t neces-sarily think is a way to go. It should bea federal infrastructure. We’re trying tomake it so that it is ubiquitous andtransparent.

Q: Are you involved with anynonprofits?A: I work with Florida International

University. I’m on the dean’s council ofthe business school there. I workedwith the center for entrepreneurshipthere. I’m passionate about workingwith the schools that I’ve been to topromote entrepreneurship.

Aside from that we stay involved whenthere’s charity runs or bike rides orthings we can do as a group.

With four kids at home, work andtraveling, I try to focus on family.