The future of regional health care

Updated: Feb 6

Blue Continent finalizing GRMC acquisition; $400M bond sale in the offing



By Mar-Vic Cagurangan

Pending completion of Guam Regional Medical City’s acquisition, the hospital’s new owner has begun laying out strategic plans to transition the island’s private medical facility into a nonprofit entity that will be the heart of integrated health care for the region.


“What we are trying to do is create a facility that will really address the needs of a very large population,” said Dr. Gilbert Mudge, chairman of Blue Continent Healthcare Guam Medical City, a nonprofit group that has acquired GRMC’s assets from the Philippines’ Guam Healthcare Development Inc. (GHDI)

Gilbert Mudge

Mudge said the acquisition of GRMC was driven by the Biden administration’s move to restore Medicaid coverage for citizens of the freely associated states— Palau, Marshall Islands and the Federated States of Micronesia. “The Medicaid coverage will be available to about 680,000 people,” Mudge said.


While the Medicaid eligibility applies only to FAS citizens living on Guam and in other U.S. jurisdictions, Mudge said the plan is to expand GRMC’s medical service to FAS by linking up with their individual medical facilities to create a regional network. “The vision is to turn it into a medical hub,” he said.


As it embarks on its ambitious plans, the new leadership is shifting focus on primary care. “We hope to supplement the excellent services that are there with a change in focus and enhanced programs to address primary care as well as those programs that address specialty care,” Mudge said.


The new GRMC plans to beef up specialty medicine on Guam, particularly oncology, cardiology, bone marrow surgery and pulmonary diseases. “I look forward to being able to talk to the leadership of Guam Memorial Hospital about how we can work together to accomplish all of these. It has to be done in what we call a public-private partnership,” said Mudge, a senior advisor at Albright Stone Bridge Group.


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He said Blue Continent will establish an institutional relationship with one of the most renowned academic medical centers located on the West Coast to leverage resources and telehealth to bridge care gaps throughout the many islands of Micronesia.


“If we think about what the future of health care is going to be in Micronesia, it will be heavily reliant on digital medicine and artificial intelligence as a way of providing care to many remote islands,” Mudge said.


He said adopting the digital protocols will eliminate the need for off-island patients to travel to Guam and facilitate expeditious treatment. “That is the vision that we hope to bring to this new project,” Mudge said. “We believe that a lot of digital infrastructures can be brought to these islands very quickly. I do know they have microwave capabilities.”


The 136-bed acute care hospital opened in July 2015 and became the first private hospital on Guam. Before GRMC opened, the government-run Guam Memorial Hospital was the only hospital that served the civilian population. Most patients traveled off-shore to seek medical treatments that were not available at GMH. The U.S. Naval Hospital caters only to service members.


Mudge said transitioning GRMC from being a Philippine-owned facility to a U.S. institution with a nonprofit status is imperative to reach its expansion goal and execute other plans that were hampered by its current status.


GHDI will continue to manage the hospital with its existing staff so as not to disrupt its operations, Mudge said.


The Blue Continent’s acquisition of GRMC has stirred confusion and skepticism due to the intricacy of the funding mechanism and the transfer process, which has yet to be finalized.


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The Blue Continent has raised $200 million to purchase the property from GHDI. An additional $400 million will be raised through a bond that will be floated this month.


The bond will be issued by the Public Finance Authority, a Wisconsin-based nonprofit entity that issues tax-exempt and taxable conduit bonds for public and private entities nationwide.


“So, as previously stated, the Guam Economic Development Authority is not the issuer. It is absolutely a private bond financing. In fact, the issuer of the bond is the same issuer I used for a bond financing I did for a client,” said Peter Sgro, president and chairman of International Group Inc.

Peter Sgro

Sgro was the president and chairman of the Guam Healthcare and Hospital Development Foundation that launched the GRMC project.


“There are numerous entities like the Public Finance Authority that essentially act solely as issuers of bonds. They receive an issuer’s fee to be the issuer of private bonds. It’s a purely private bond financing in this case,” Sgro explained.


“This is a complex and strategic two-prong refinancing that will create significant benefits not just for GHDI, but as a by-product, will also bring significant healthcare advancements for the people of Guam and the region,” he added.


Mudge said as a nonprofit entity, Blue Continent will be able to reinvest money right back into the health care system. “It is very important because a not-for-profit entity has the ability to be much more responsive to community needs.”


Currently, GRMC enjoys tax breaks under GEDA’s qualifying certificate program. Once it fully transitions to a nonprofit entity, GRMC will assume a tax-exempt status.



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