In 2012, the Barrington, Ill.-based GE Healthcare and Microsoft Corp. (Redmond, Wash.) announced the launch of a joint healthcare IT venture, Caradigm, which would focus on developing and marketing a technology platform and collaborative clinical applications focused on enabling better population health management. Combining Microsoft’s capabilities in building platforms with GE Healthcare’s experience in clinical workflow solutions, the new joint venture aimed to help healthcare organizations use real-time, system-wide intelligence to improve healthcare quality and the patient experience.
Five years ago, when Caradigm launched, population health management was an emerging area on the healthcare provider side. Fast forward five years, the need for big data in healthcare IT has fueled explosive growth for population health and data analytics technology solutions, and the population health management market, in particular, is rapidly maturing and evolving.
“The population health market today is crowded with a lot of different vendors and a lot of different solutions,” Mark Allphin, research director, value-based care, at the Orem, Utah-based KLAS Research, says. “Part of the challenge that providers have dealt with the last few years really is around figuring out what piece of the population health pie they want to swallow. When you mention population health to a provider they could be thinking of it in terms of three or four different things. And, with each specific aspect of population health, there is yet another list of vendors, who are willing, able and ready to help. As you look at the market, it has created a big push for many different vendors to enter the space to help meet some of these different needs.”
Five-year-old Caradigm, which is based in Bellevue, Washington, is carving out its own niche within the market with an end-to-end enterprise approach to population health, and with a focus on the hospital and integrated delivery network market. In April 2016, Microsoft sold its 50 percent stake in Caradigm to GE Healthcare, and later that same month, Caradigm named Neal Singh as CEO. Singh, who previously served as the company’s chief technology officer, replaced Michael Simpson, who led Caradigm for four years.
According to Singh, Caradigm maintains a steadfast focus on population health, even as it expands its solutions offerings to meet healthcare providers’ evolving needs. “In fact, I can go back to our first HIMSS, in 2013, when we had our independent booth, and we have not changed our main banner since then—it said population health back then and it says population health now and that continues to be our focus.” Further, Singh says Caradigm’s population health enterprise solution, from its core inception, was designed as a “real-time data analytics platform to provide analytics, care coordination and workflow applications all around a single foundation of a unified platform.”
Singh continues, “What differentiates us from many other players in the industry is, first, what started out in Microsoft as a real-time, scalable data platform, that’s the key to our foundation in terms of being able to get data across multiple entities and organizations, including clinical, claims and financial data, and doing it at scale, and now we’re getting into social data. And then we have an integrated suite of applications that are sitting on top of that platform, a unified set of applications for doing either risk stratification to identify your population of patients at risk, care coordination to manage the patients, quality improvement to measure and manage quality, and then utilization and financial analytics to understand your cost drivers and bring them under control.”
Caradigm’s 200-plus customers include Greenville Health System, Billings Clinic and Virtua, and other large integrated delivery networks (IDNs), accountable care organizations (ACOs), academic medical centers, government facilities and community hospitals. Caradigm solutions are operating in more than 1,500 hospitals worldwide, connect to over 500 customer systems and to data for more than 175 million patients. In addition, its identity and access management solutions are employed daily by over 1.2 million users.
Scaling up Population Health
The population health management vendor market is fast-evolving and very competitive, as the large electronic health record (EHR) vendors are expanding their capabilities for population health and data analytics. As hospitals and health systems move forward into population health initiatives, it’s natural for executive leaders to look at their EHR vendors, KLAS’ Allphin says, largely because of the workflow functionalities.
“Caradigm is an interesting solution as one of the vendors that have come into the market from an EMR-agnostic perspective,” Allphin says. “A lot of these organizations oftentimes are looking for a flexible platform that can work in an environment filled with diversity, where there are all different types of EHRs and EMRs and different systems, and that’s where Caradigm looks very attractive to some of these providers. And, thus far, that’s the market they seem to be serving the best at this moment.”
Caradigm is able to support IDNs and CINs because its suite of enterprise solutions was designed to handle complex data aggregation requirements and leverage that data to drive workflow efficiencies necessary to scale population health initiatives.
Singh says Caradigm’s platform can work with 400-plus systems, including clinical, claims and financial systems. “And now with social data and behavioral data that we’re getting into, we have this unique ability, which was incubated in Microsoft and we’ve taken that in our DNA and grown that, so that even with clinical data across multiple EMRs, what differentiates us is that we have the ability of bringing that together in a real-time basis.”
Essentially, Caradigm offers an end-to-end enterprise approach, Singh says, with a single unified platform across all of its applications. “A lot of the players in the space, they say they have an end-to-end approach, or a suite of applications for population health, what they really mean is that they have built add-ons that are plugging in or they have acquired a bunch of companies and technologies that they bundle together from a marketing perspective,” he says. “Why this is important is because when you have a suite of applications built on a unified platform, from a customer perspective, these applications can have workflow that can seamlessly go across applications, they have a unified interface, and a unified customer experience. More importantly, because you have a single unified platform, you can incrementally add applications without having to worry about deploying brand new platforms for each of the applications that you have.”
Singh says another foundational element of Caradigm’s approach to data analytics and population health is its focus on driving time-to value for customers. St. Luke’s University Health Network (SLUHN) a regional, integrated network providing services at six hospitals in Pennsylvania’s Lehigh Valley area, worked with Caradigm to deploy care management tools to support the health system’s participation in the Bundled Payments for Care Coordination (BPCI) program. SLUHN is one of the largest BPCI participants in the country, having signed up for 44 of 48 available episode bundles, and the health system needed tools for care coordination that would span both inpatient and outpatient settings, as well as combine its claims data with clinical data from its Epic EHR system. According to Chad Brisendine, CIO of SLUHN, Caradigm’s care coordination tools enable multi-disciplinary care teams to share information and streamline workflows as patients move from acute to post-acute settings.
“Through our partnership with Caradigm, our teams are already seeing benefits that include quicker turnaround times to initiate patient care, improved transitions of care workflows and enhanced sharing of clinical and claims data from inpatient and outpatient systems,” Brisendine said in a statement when the partnership was announced last fall.
Addressing Health Systems’ Evolving Needs
Even for experienced healthcare provider organizations, who are rapidly adding and changing payer agreements, population health management is an evolution, many healthcare industry leaders say. An important source of confidence comes from technology solution vendors who are responsive to customer needs and readily adapt to the latest requirements.
Singh acknowledges that in the five years since Caradigm launched, the pace of change in the healthcare industry has rapidly accelerated. “Providers are facing the challenges of scaling their programs to more locations and to include more patients, to provide additional services as well as employee education strategies and training to address more data sources that come in. We’re seeing that expand, and go across multiple states, as with large clinical integrated networks, super CINs as they are called, and large ACOs, and mergers and acquisitions coming into play, so we’re seeing that evolution also occurring at the same time.”
He says the company has made it a top priority to serve customers’ evolving needs by expanding its solutions portfolio. Shawna Cooper, director of program management at Caradigm, adds that the company’s solutions have been designed to be “configurable and future-proof” to keep pace with the accelerating pace of change in the healthcare industry.
To this point, just in the past six months, Caradigm has rolled out solutions and functionalities specifically targeted to help healthcare organizations with risk stratification as well as to facilitate two key value-based care programs—bundled payments and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The company expanded its quality measure library and user-built lists and workflows to help organizations analyze performance on measures for both tracks of the Quality Payment Program: the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs).
“Essentially, the way that we’ve designed the solutions is to make sure that as these regulatory needs come in, and MACRA is an example of a regulatory need, and also bundled payments, which is on the federal register as well as on the commercial side of the house, to be configurable and future-proof,” Singh says. “As an example, in the case of MACRA, there are a set of quality measures that you have to measure in terms of managing gaps in care. So, we have, as part of our suite of applications for quality improvement, and as MACRA came out with their requirements, we were able to rapidly configure those measures. The same thing in the case of bundled payments, where you are managing the entire floor of bundled payment patients, from soup to nuts, we built that capability into the system. And, more importantly, as bundled payments vary, the workflows vary. We were able to configure those workflows based on what the needs of customers are, and in many cases, the customers can self-configure them.”
For risk stratification, Caradigm developed an application that aggregates data from multiple EHRs in real time, creates segmented patient lists using clinical indicators, identifies patient that meet defined criteria and then integrates with Caradigm’s care management solution to streamline patient enrollment into care management programs.
Cooper says the vision is that the tool will incorporate a “multi-factor holistic view of a patients’ risk, including social determinants, behavioral indicators and financial indicators.” She adds, “We believe that combining a broad range of data to be used in risk stratification activities really will provide additional insights for providers, and enabling population health analytics to better identify patients who can most benefit from support.” She also notes that identifying patients who are the top spenders or have the highest predictive risk “is the easy part.” “What’s harder to see is the risk-mover, to see those people that seem like that are just getting a little bit worse over time. We want to catch them before they get into that top level category and that really is the goal of risk stratification. You’re not just dealing with the top level, you’re dealing with people that you can really affect change on.”
Looking at the population health management solutions vendor market broadly, Liam Bouchier, senior advisor at the Chicago-based healthcare IT consulting firm Impact Advisors, sees a trend of ongoing consolidation and he expects that consolidation to continue. “A lot of the vendors that were emerging a number of years ago are starting to be acquired, have already been acquired, or are creating partnerships with other vendors to deliver solutions,” he says, noting in particular the acquisitions of Phytel and Explorys by IBM and Evolent Health’s purchase of Valence Health. “I think the market is going in the same direction as the EMR market went; over the last 10 years we’ve seen a movement toward a single vendor strategy and a single integrated system with the likes of Cerner leading the market. And you certainly see the same thing with the population health space.”
Singh acknowledges that the population health management vendor market is becoming increasingly crowded as EHR vendors continue to evolve and focus on population health. “I think it reinforces our strategy that population health is the direction the healthcare industry has to move towards. And we said that five years ago, and we continue to say that. I think that’s where we see EMRs following our lead,” and he adds. “We see ourselves as not in competition with EMRs, we actually see ourselves as being an extension of the whole ecosystem that meets our provider customers’ needs.”
When asked what they are most excited about regarding Caradigm’s work right now, Cooper replies, “I’m really excited to see us continue to be part of the evolution of the healthcare landscape.”
Singh says, “We are focused as a company on innovating and delivering what we would call rapid time-to-value for our customers, and as a simply as possible, so they can positively impact more patients’ lives and scale population health effectively and efficiently. I feel so invigorated and excited about coming here, working with our employees, our customers and the industry to really change the game over healthcare and population health management.”