By Jennifer Prestigiacomo and John Degaspari
In the rapidly changing healthcare IT landscape, the top IT vendors are the enablers that provide the largest percentage of crucial tools that will allow hospitals and physician groups to meet the challenges of healthcare reform. Their solutions are the virtual gears that will transform the healthcare environment. To be sure, the largest vendors will play a big hand in how healthcare evolves.
Yet for every large vendor, there are dozens of smaller companies with products that provide important solutions, while offering a tantalizing glimpse into a world of new possibilities. What follows is a sampling of six vendors that have established themselves as technology leaders with innovative solutions on a variety of fronts, from a virtual tool to interact with patients, to e-prescribing, mobile chronic disease management, and accountable care solutions. They are definitely worth keeping on your radar screens.
Boston-based American Well has solved the conundrum of how to deliver care to patients without actually seeing them, a problem that call centers and nurse lines have historically addressed. Since 2006, American Well has been contracting its technology, which allows patients to make online consultations with a physician, health plans, and other partners. American Well now can count one-third of all U.S. managed care companies as its clients, including heavyweights like Blue Cross and Blue Shield of Minnesota (Eagan, Minn.) and WellPoint (Indianapolis, Ind.).
“When you look at the reform [movement], and other trends like accountable care organizations, they all drill down to the fact that access to care is becoming more and more difficult. It just takes too long, and it costs too much to see a doctor,” says Ido Schoenberg, M.D., American Well's chairman and CEO.
Schoenberg notes that American Well's strategy isn't strictly about signing up one health plan after another, but rather engaging in a variety of types of tactical partnerships, releasing new products, and positioning its offering to be a tool for accountable care organizations. “Our platform is a good way to glue together and unite [the organizations] under a new brand, and basically they can all enroll in the system and provide service to the population they are focusing on,” he adds.
Blue Cross and Blue Shield of Minnesota (Blue Cross) was the first continental U.S. customer to use American Well's technology platform to roll out its Online Care Anywhere pilot in November 2009. Blue Cross employs two models, a fee per use model of $45 for a 13-minute online consultation, or an employer group sliding scale pricing that starts at $50 per month for small companies, according to Sig Muller, vice president, business development at Blue Cross. Mueller says that according to customer surveys since implementation, Online Care Anywhere has prevented 86 percent of customers from going to an urgent care center and has saved 71 percent of customers at least an hour in time. Schoenberg adds that overall more females than males use the service, with a wide age range, including the senior population. He says mothers especially like to use the service for themselves and their children.
In April 2010, American Well partnered with Rite Aid Corp., Camp Hill, Pa., to provide online consultations with Rite Aid pharmacists and from private consultation rooms in select Rite Aid pharmacies. Schoenberg says he's now engaging much larger organizations, such as governments, that could use the American Well platform as a “backbone” care solution for their countries. The company in April released Online Care For Providers, a telehealth solution that allows providers to provide live consultations with patients using the Web or phone and automatically captures a complete record of each encounter, which may be imported into EMRs, supporting clinical documentation standards and continuity of care.
“We really took note of other efficiencies of the marketplace that were achieved outside of healthcare, and we said, ‘how can we bring it in,’ and it is really complicated,” says Schoenberg. “There are issues with security and scalability and privacy and continuity. We knew it wasn't going to be easy, but we knew it was going to be worthwhile.”
At a time when hospitals are being asked to do more with less, and are facing extra scrutiny under the Medicare reimbursement system, it's never been more important to have control over the revenue cycle. This is especially true of providers pursuing the development of the accountable care model.
Craneware, Inc., Atlanta, has set its focus on revenue integrity-helping providers bill for everything for which they are entitled, and to bill correctly, according to CEO Keith Nielson. The company draws a distinction between revenue cycle management and revenue integrity, which is focused on three main areas: optimizing reimbursement, increasing operational efficiency, and minimizing compliance risk.
Having a good understanding of revenue integrity is crucial to the successful execution of ACOs, Nielson says. “It's all about the quality of the data and understanding the data. Better clinical data at various stages, and collecting the data correctly the first time around, means you have less cost and overhead from re-treating patients and readmitting patients,” he says.
Craneware's strength lies in providing actionable data for hospitals to improve on the financial side, and tying those improvements back to clinical care, Nielson says. “Our strength has always been like being almost like the glue between the various different computer systems that you have in the hospital.” In his view, the rapid change taking place in the hospital business model under healthcare reform has resulted in investments in clinical systems, while investments in financial systems have lagged.
Since introducing its first automated chargemaster solution 12 years ago, Craneware has expanded its solutions in revenue cycle, strategic pricing, and supply management. Recent additions include Supplies ChargeLink, a solution introduced last year that is designed to help hospitals better manage reimbursements for chargeable supplies, by maintaining a link between the item master and supplies in the chargemaster.
Last December Craneware launched the Value-Based Pricing Analyzer, a solution that automates the price modeling process, allowing hospitals to assess the potential impact of changes such as revenue shortfalls, and making sure that their pricing is transparent and defensible. Nielson says the Pricing Analyzer was developed as a direct request from customers. “It allows them to very quickly and rapidly model their expected reimbursement in the very rapidly changing landscape of healthcare reform and rules and regulations,” he says. The solution moves through demographic data and uses data from previous experience to create what-if scenarios.
In February, Craneware added three new products through its acquisition of Claim Trust Inc., a provider of software as a service (SaaS) revenue cycle solutions that has allowed Craneware to broaden its offerings in areas of health management, payment variance and audit management, according to Nielson. In the area of RAC audits, the software manages the recovery of the contractors' audit and gives the hospital a tool to appeal any denials that come through as well, Nielson says. He adds that RAC audits will be an important area for the company in the foreseeable future. Another potential growth area for the company is to work with hospitals that are looking to outsource certain areas of their financial operations, by providing a baseline to make sure the hospital is getting the return that is expected, he says.
The Rockville, Md.-based DrFirst originally made its mark in e-prescribing, and continues to be a vendor to watch, both in terms of product development, as well as its business model and the way it positions itself with its vendor partners. The company has taken a two-prong marketing approach: by making its solutions available to physicians as well as EMR vendor partners that have used its solutions as the back-end e-prescribing component in their systems.
“Our position is, physicians should be connected and able to pass information freely back and forth,” says DrFirst's President, Cameron Deemer. “We plan to take a very broad-based low-cost approach to this.” The company has an expanding product line, as well as a customer base that ranges from small practices and physician groups to large hospitals. Its product development strategy has been to fill gaps in the product offerings of other EMR vendors. Its solutions are SaaS-based, offering a flexible platform so that solutions can be configured for variously sized practices, Deemer says.
DrFirst has created a technology platform that allows other vendors to incorporate its solutions easily into their applications, Deemer says. As of March, the company counted 160 EMR vendors as its partners that use DrFirst as their back-end e-prescribing technology. The vendor relationship serves as a modular approach for physicians to move gradually into a full-blown EMR system. When a physician customer is ready, DrFirst can help facilitate the move to any of its partners, Deemer says.
The company's e-prescribing solution, Rcopia, continues to see strong demand, which is largely driven by the Medicare Improvement for Patients and Providers Act (MIPPA) requirements, according to Deemer. Nonetheless, the company has expanded beyond the boundaries of its original product with solutions that are geared to helping physicians make a successful transition to meaningful use. E-prescribing is required of every software vendor to attain certification, Deemer notes.
Last year the company added Rcopia Meaningful Use, a certified modular EHR that is combined with a patient registry (provided by WellCentive, Atlanta). “With this product the physician can meet all 25 Stage 1 meaningful use criteria, core items plus menu items,” Deemer says. He describes the product as a low-cost approach to acquiring an EMR, allowing the physician to understand the benefits of meaningful use and to begin to modify his workflow.
The company's latest addition is an e-prescribing solution for controlled substances, the outgrowth of a pilot program with the Massachusetts Department of Health. The solution, EPCS Gold, has been available to its vendor partners since March, and the company is making it available to physicians this month.
Future plans include the development of a clinical data exchange platform that will allow secure messaging “based on the company's core competency around security and privacy,” Deemer says, adding that the service will be available this month or next month. He adds that while this and other company initiatives are centered on Continuity of Care Records and Continuity of Care Documents, the company is also trying to broaden the types of information that are able to be exchanged, to better mesh with physician workflows.
In February, DrFirst acquired AdherenceRX, a supplier of behavioral health coaching and medication adherence solutions, which Deemer says will form the basis of DrFirst's new Patient Innovation division. The platform will be around clinical systems that are relevant to patients, including evidence-based solutions, medication e-reminders, patient education, incentives and caregiver support, according to the company. Deemer adds that the division will “give partner vendors access to pharmaceutical companies and the programs that would be beneficial to everyone in the process.”
It's a half-serious story that Epocrates was founded in 1998 because Richard Fiedotin, M.D., then a student at Stanford, had difficulty remembering all the prescription drugs he was studying, and he ended up partnering on a product with business student Jeff Tangney, who was really digging his PalmPilot at the time. This collaboration, after a slight detour to left field (an early business plan included renting out mobile devices for patrons to order food and keep track of players' stats in baseball stadiums), did indeed lead to the creation of Epocrates (San Mateo, Calif.), the clinical support reference tool that more than 300,000, or 45 percent, of U.S. physicians use.
Epocrates CEO Rose Crane says that what has given Epocrates its leading edge is that it has always been a forward-thinking company. “We were an app before apps were apps,” she says. “I'm talking like 2000. We were so far ahead of our time, and as a result of that, we built a really iconic brand.”
Tagney adds that Epocrates' appeal is that its products have always been tailored to the clinician audience. “Doctors are mobile professionals,” he says. “They don't usually have a desk, and if they do, they don't spend much time sitting behind it. So you need something that can move with them.”
Epocrates' business model is based on monetizing its network by selling products to pharmaceutical companies. “They use our network to market through as they get less and less opportunity with the reps to get into physician offices; and 70 percent of doctors use a smartphone, so we have become their channel.” The company derives 60 percent of its revenue from pharmaceutical companies, and the other 40 percent split evenly between subscriptions and their market research arm.
Beyond its core subscription/pharmaceutical monetization platform, Epocrates looks to deepen its relationship with doctors by releasing its EHR with practice manager partner NewSoft (Atlanta) in late Q2 or early Q3, targeting it to small practices with 10 doctors or fewer.
Crane finds the small practice market attractive as it's the largest segment of the physician market. “The vast amount of doctors is spread across the United States and can't consolidate, and they trust and know us,” she says. “They are also very difficult to get at from an acquisition cost for any of the other players.” And with the EHR's SaaS model, the monthly subscription of $300, plus a modest startup fee, will be affordable to those smaller organizations with equally small budgets, Crane says.
Tagney has since left Epocrates to start up the secure text messaging service Doximity. He says Epocrates has come a long way from being one of the first apps offered via the Apple App Store to going public this year in February, when the company raised $86 million in its IPO.
With roots in revenue cycle management, MedeAnalytics, Emeryville, Calif., has expanded the scope of its solutions to encompass both the payer and the provider sides of healthcare, as those worlds come together through value-based purchasing and population management. CEO Michael Gallagher uses the term performance management to describe the company's focus on analytics, driven around financial, operational, and clinical solutions. Its approach positions the company as a resource for providers and payers moving toward the accountable care model.
“We feel that our value is in broad performance management in the healthcare sector,” which includes hospitals, physician groups, and insurance companies. In the future, he would like to expand the scope of clients to include self-insured employers as well, he says. Gallagher notes that each of those verticals, whether payer or provider, is characterized by a data landscape of disparate systems. “They need someone to come in and bring that information together, and make it actionable.” That is a task that MedeAnalytics provides through analytics as well as workflow and document management solutions, he says.
Revenue cycle, which is where the company started in the 1990s, has grown in complexity over time, and MedeAnalytics has kept pace through its solutions, according to Gallagher. On the back end, the company has expanded to helping providers evaluate their self-paid portfolios, as well as solutions for Medicare compliance and revenue integrity audits. On the front end, solutions include Patient Access Intelligence, a workflow solution that helps hospitals ensure that hospitals have the correct demographic, insurance and income level information on admitted patients.
The next step, Gallagher says, is to tie the financial information to the clinical experience-particularly around Medicare, which accounts for a fairly sizeable part of a provider's business. The company's Clinical Performance Manager solution is designed to help providers evaluate service lines to ensure that patients are getting high quality care and also cost effective care, Gallagher says.
On the payer side, MedeAnalytics's Claims Processing solution has been used by San Francisco-based Blue Shield of California and roughly 100 California hospitals under a program known as the Partnership for Operational Excellence and Transparency (POET), designed to reduce the number of claims denials. “We eliminate, or dramatically reduce denials, appeals, and overturned processes by helping them do root cause analysis; and that has strong return on investment for both the payer and the provider,” Gallagher says.
Gallagher notes that significant movement has taken place in ACO initiatives, both the commercial and Medicare models. Last December the company launched an Accountable Care Solution for providers and payer organizations. It includes technology components that are common to both commercial and Medicare ACOs, including data aggregation, clinical data exchange, performance management and role-based security. In February, the company went a step further, issuing an ACO Technology Framework, as a starting point for a technology infrastructure needed to run an effective ACO.
Future plans including expanding the company's ACO capabilities as well as its Clinical Performance Manager solution. It is also developing an ICD-10 solution, to help providers make the transition from ICD-9, according to Gallagher.
Founder and CEO Ryan Sysko says that the Baltimore, Md.-based WellDoc was founded as his sister, endocrinologist Suzanne Sysko Clough, M.D., became increasingly disillusioned with diabetes management, despite her and her colleagues' best efforts. Both Syskos noticed that diabetes was such a burden on patients and when coupled with outside stressors, patients couldn't devote enough time to managing their disease; and teaching self-care was like teaching patients a foreign language.
“The really big ‘aha’ moment for her [Sysko Clough] was that every patient who was coming into her clinic in downtown Baltimore in late 2004 was coming in with a cell phone,” Sysko says. “Here was this incredibly ubiquitous technology that patients were taking with them everywhere. It was a real ‘aha’ moment that said, ‘here's this device that if we could put actual clinical applications on that device would help patients self manage, and extend my clinical voice to patients.”
Fran Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.), says that WellDoc is one of her favorite chronic management tools. Since “diabetes is a whole lifestyle change, it's the meds you take, the constant checking of the blood-glucose levels, your diet changes,” she says; WellDoc makes the record-keeping aspect of disease management much simpler than using a paper diary.
After cobbling together some money in 2005 from Johnson and Johnson and Nokia to fund a clinical study, WellDoc received results that showed patients dramatically improve their disease management by using a smartphone. The company also invested in a clinical trial to convince health plans that its technology could produce verified outcomes. “From the beginning we always recognized we had to build the evidence for our system, and we invested millions of dollars at a time when we were a very small company to do a randomized controlled trial with the BlueCross BlueShield plan of Maryland [CareFirst] and the University of Maryland,” Sysko says. He also adds that the FDA cleared WellDoc in August 2010, which speaks to the rigor of the system.
The future looks bright for WellDoc, as it recently partnered with ATandT For Health, the Atlanta-based ATandT's healthcare practice, to provide its DiabetesManager to employees of Health Care Service Corp. (HCSC), the country's largest customer-owned health insurer which operates Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, to help manage diabetes in real time and connect patients to care providers. The company also seeks to diversify and develop applications to manage other areas like oncology, respiratory, and mental health.
Healthcare Informatics 2011 June;28(6):56-61