A staff of Epic alumni based mostly in Madison, Wis., is launching an organization referred to as ProsperityEHR constructed round a cloud-based digital well being file 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 had 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 a number of instances behavioral well being was extra of a price heart than it was a service line. Lots of massive medical teams would supply behavioral well being companies, but it surely shrunk over time. I used to be at Epic from about 2003 till 2014 and in that point, a number of these teams began to outsource a number of behavioral well being as a result of it did not reimburse properly sufficient for them to have the ability to proceed providing it. From our vantage level, we thought of what’s taking place to these sufferers once they’re leaving the partitions of a bigger well being system, and I can inform you this — the information is not going with them. As a affected person or member of the family, as you allow the digital well being file 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 if you happen to’re speaking about whole-person care, that is one thing that must be addressed.
Tran: We had been at Epic and obtained to see a number of the challenges that folks skilled when it comes to integrating with behavioral well being. We’re properly conscious of well being programs which might be utilizing fully 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 info from a behavioral well being perspective, we would not have needed to put that particular person in restraints.’
So we noticed a possibility. We noticed how a lot there was a necessity for integration and interoperability. We noticed what labored and did not work from a giant EHR perspective, and we additionally noticed simply what number of disparate programs that had been on the market. We thought now we have the uncommon alternative and a number of the expertise having labored instantly with suppliers, in addition to with an EMR to impact change within the behavioral well being house.
HCI: If you take 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 may be a number of consolidation taking place, however predominantly you are speaking about smaller teams. There are a number of group practices which might 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: If you appeared 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 a number of completely different EMRs which might be doing very particular issues properly. And there are some that began 30 years in the past which might be smaller and have a core set of consumers. And there was a number of M&A exercise taking place within the behavioral well being house. That is occurring each on the apply facet and likewise on the EMR facet. So that you’re seeing this big panorama shift taking place. Most of the suppliers are needing an improve to satisfy 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 referred to 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 very good instance of an organization that was doing the precise issues from a consumer base standpoint, however in addition they knew that they wanted to vary. They knew interoperability was not their sturdy swimsuit, and it wanted to be. So we acquired the corporate in 2022. We got here in and we stated, ‘Hey, there’s all of this actually good data, there’s this actually sturdy group buyer base that may assist us actually create a purpose-built answer.’ So now we have buyer advisory boards, now we have focus teams, we do a number of consumer analysis, and from there, we have actually labored to launch this new product.
Vogel: The digital well being file 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 lately speaking to at least one buyer and he or she stated 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 when it comes to data 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 stated, now we have a possibility to consider how we actually make this scale. How can we make this interoperable? How can we weave in issues like compliance and value 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 a number of angel investments. Jesse and I and others on the staff 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 difficulty that these suppliers grapple with or the place you noticed a possibility to enhance?
Tran: Sure, it is also one among our interoperability performs. We combine with a pair completely different applied sciences to make it possible for folks have, for instance, a built-in clearing home. They’ve the chance to essentially see some extra real-time information when it comes to denials and eligibility. We additionally take into consideration the truth that lots of people in behavioral well being want some assist when it comes to pondering by issues like credentialing. We knew that we would have liked to know rev cycle tremendous properly due to the entire panorama adjustments which might be taking place in behavioral well being particularly.
Vogel: These practices are realizing that the payers are transferring the objective line on a regular basis, and the laws change, and if you do not have automation inbuilt, it is actually exhausting to scale with out including a bunch of administrative overhead, with out including extra folks to chase in spite of everything of these issues, so that you just receives a commission. Effectively, the issue is that the reimbursement is not important sufficient to have the ability to rent all these folks to do this work. Lots of these teams wish to add suppliers, but when you do not have a know-how that lets you maintain the executive overhead low, it is nearly inconceivable.
HCI: I noticed your EHR as having an AI-ready structure. What does that time period imply to you?
Tran: We all know there may be a number of completely different AI tooling on the market. And albeit, in behavioral well being, there’s a number of nervousness round AI instruments. So in our present buyer base, for instance, solely 14% of individuals stated they had been completely comfy with the concept of AI. However regardless that there are completely different consolation ranges, there are completely different elements that we’d like to have the ability to make it possible for we’re in a position to combine with — issues like ambient documentation instruments.
One other space is working with our group to assist create these AI instruments, each from a income cycle perspective and likewise from a medical perspective. There are people who find themselves utilizing ChatGPT as a web based therapist, proper? The most effective factor we are able to do, from an AI-ready structure standpoint is begin on that journey with suppliers, to develop these instruments with them so it seems like a protected house. It seems like one thing that they will use, and it is clinically validated, which I feel is one thing that is comforting to the sufferers as properly.
