A crew of Epic alumni based mostly in Madison, Wis., is launching an organization known as ProsperityEHR constructed round a cloud-based digital well being document designed to assist behavioral well being organizations streamline operations and enhance affected person care. CEO Melissa Tran and Chief Income Workplace Jesse Vogel spoke with Healthcare Innovation concerning the market alternative they noticed within the behavioral well being EHR house.
Healthcare Innovation: I used to be to listen to your story, since you have been each Epic alums. What are some issues about your expertise there that led you to see this chance?
Vogel: What we noticed working with bigger well being programs was that quite a lot of occasions behavioral well being was extra of a value heart than it was a service line. A variety of large medical teams would supply behavioral well being providers, however it shrunk over time. I used to be at Epic from about 2003 till 2014 and in that point, quite a lot of these teams began to outsource quite a lot of behavioral well being as a result of it did not reimburse nicely sufficient for them to have the ability to proceed providing it. From our vantage level, we considered what’s taking place to these sufferers once they’re leaving the partitions of a bigger well being system, and I can let you know this — the info is not going with them. As a affected person or member of the family, as you allow the digital well being document tremendous freeway of the bigger well being programs and also you go into behavioral well being, you understand none of that information got here with me. So when you’re speaking about whole-person care, that is one thing that must be addressed.
Tran: We have been at Epic and obtained to see quite a lot of the challenges that folks skilled by way of integrating with behavioral well being. We’re nicely conscious of well being programs which can be utilizing utterly separate digital well being data or paper for his or her behavioral healthcare, and that is very separate from the Epics, the Cerners, the athenahealths. It was not unusual for us to go speak to somebody like an ER doctor who would say, ‘Gosh, if we simply had some data from a behavioral well being perspective, we would not have needed to put that particular person in restraints.’
So we noticed a chance. We noticed how a lot there was a necessity for integration and interoperability. We noticed what labored and did not work from an enormous EHR perspective, and we additionally noticed simply what number of disparate programs that have been on the market. We thought we’ve the uncommon alternative and a number of the expertise having labored immediately with suppliers, in addition to with an EMR to impact change within the behavioral well being house.
HCI: Whenever you have a look at the potential buyer base, is it largely smaller practices versus departments of massive well being programs or massive psychological well being practices?
Vogel: The overwhelming majority are smaller. There’s quite a lot of consolidation taking place, however predominantly you are speaking about smaller teams. There are quite a lot of group practices which can be 10 or 15 or 20 suppliers with an aspiration to develop, and that is the scale group that that we’re primarily focusing on.
HCI: Whenever you regarded on the present behavioral healthcare EHR market, what did you see? Are there a few gamers who dominate that, or is there an enormous array of small EHR choices?
Tran: There are quite a lot of totally different EMRs which can be doing very particular issues nicely. And there are some that began 30 years in the past which can be smaller and have a core set of consumers. And there was quite a lot of M&A exercise taking place within the behavioral well being house. That is occurring each on the apply facet and in addition on the EMR facet. So that you’re seeing this big panorama shift taking place. Most of the suppliers are needing an improve to fulfill a number of the compliance and interoperability wants.
HCI: Did you guys do an acquisition of an organization that already existed to be the baseline of what you began from?
Tran: We did. We acquired an organization known as TheraManager in August 2022. I affectionately name it our geriatric startup as a result of we’re beginning with a 30-year-old firm. They’re a great instance of an organization that was doing the correct issues from a person base standpoint, however additionally they knew that they wanted to alter. They knew interoperability was not their robust go well with, and it wanted to be. So we acquired the corporate in 2022. We got here in and we mentioned, ‘Hey, there’s all of this actually good information, there’s this actually robust neighborhood buyer base that may assist us actually create a purpose-built resolution.’ So we’ve buyer advisory boards, we’ve focus teams, we do quite a lot of person analysis, and from there, we have actually labored to launch this new product.
Vogel: The digital well being document that was first launched as part of the corporate’s founding was a behavioral health-specific EHR again within the early ‘90s, earlier than there was actually something on the market like that, and it was designed by a psychologist. I used to be not too long ago speaking to 1 buyer and he or she mentioned they’ve been utilizing the system nearly because it began. Now we’re migrating them to the brand new platform. She’s super-excited about the truth that the issues that they contributed by way of information to the legacy system, she’s in a position to see it transition ahead — issues that matter probably the most to the clinicians. However now, like Melissa mentioned, we’ve a chance to consider how we actually make this scale. How will we make this interoperable? How will we weave in issues like compliance and usefulness and productiveness and all of the issues that we all know matter?
HCI: Did you get any enterprise investments to construct the brand new platform?
Tran: We bootstrapped with quite a lot of angel investments. Jesse and I and others on the crew have this very private connection to psychological well being and behavioral well being. All people is aware of somebody who has been impacted.
HCI: I perceive you’ve paid fairly a little bit of consideration to income cycle. Is that a problem that these suppliers grapple with or the place you noticed a chance to enhance?
Tran: Sure, it is also one among our interoperability performs. We combine with a pair totally different applied sciences to guarantee that individuals have, for example, a built-in clearing home. They’ve the chance to essentially see some extra real-time information by way of denials and eligibility. We additionally take into consideration the truth that lots of people in behavioral well being want some assist by way of pondering by way of issues like credentialing. We knew that we would have liked to know rev cycle tremendous nicely due to all the panorama adjustments which can be taking place in behavioral well being particularly.
Vogel: These practices are realizing that the payers are transferring the aim line on a regular basis, and the rules change, and if you do not have automation in-built, it is actually laborious to scale with out including a bunch of administrative overhead, with out including extra individuals to chase in any case of these issues, so that you simply receives a commission. Nicely, the issue is that the reimbursement is not vital sufficient to have the ability to rent all these individuals to do this work. A variety of these teams need to add suppliers, but when you do not have a expertise that means that you can preserve the executive overhead low, it is nearly not possible.
HCI: I noticed your EHR as having an AI-ready structure. What does that time period imply to you?
Tran: We all know there’s quite a lot of totally different AI tooling on the market. And albeit, in behavioral well being, there’s quite a lot of nervousness round AI instruments. So in our present buyer base, for example, solely 14% of individuals mentioned they have been completely comfy with the concept of AI. However although there are totally different consolation ranges, there are totally different elements that we want to have the ability to guarantee that we’re in a position to combine with — issues like ambient documentation instruments.
One other space is working with our neighborhood to assist create these AI instruments, each from a income cycle perspective and in addition from a scientific perspective. There are people who find themselves utilizing ChatGPT as an internet therapist, proper? The most effective factor we will do, from an AI-ready structure standpoint is begin on that journey with suppliers, to develop these instruments with them so it appears like a secure house. It appears like one thing that they’ll use, and it is clinically validated, which I believe is one thing that is comforting to the sufferers as nicely.
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