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 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 in regards to 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 techniques was that a whole lot of occasions behavioral well being was extra of a value middle than it was a service line. Loads of huge 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, a whole lot of these teams began to outsource a whole lot 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 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 techniques and also you go into behavioral well being, you notice none of that knowledge got here with me. So in case you’re speaking about whole-person care, that is one thing that must be addressed.
Tran: We have been at Epic and acquired to see a whole lot of the challenges that individuals skilled by way of integrating with behavioral well being. We’re properly conscious of well being techniques which can be utilizing fully separate digital well being information 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 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 techniques that have been on the market. We thought we’ve got 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: Once you take a look at the potential buyer base, is it principally smaller practices versus departments of massive well being techniques or massive psychological well being practices?
Vogel: The overwhelming majority are smaller. There’s a whole lot of consolidation taking place, however predominantly you are speaking about smaller teams. There are a whole 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: Once you seemed 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 whole lot of completely different EMRs which can be doing very particular issues properly. 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 a whole lot of M&A exercise taking place within the behavioral well being house. That is occurring each on the observe aspect and in addition on the EMR aspect. So that you’re seeing this large 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 great instance of an organization that was doing the best 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 mentioned, ‘Hey, there’s all of this actually good information, there’s this actually sturdy group buyer base that may assist us actually create a purpose-built answer.’ So we’ve got buyer advisory boards, we’ve got focus teams, we do a whole lot of consumer 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 she or he mentioned they’ve been utilizing the system virtually 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 got a chance to consider how we actually make this scale. How can we make this interoperable? How can 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 a whole lot 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 chance to enhance?
Tran: Sure, it is also one among our interoperability performs. We combine with a pair completely different applied sciences to guarantee that folks have, for instance, a built-in clearing home. They’ve the chance to essentially see some extra real-time knowledge 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 wanted to know rev cycle tremendous properly due to the entire panorama modifications which can be taking place in behavioral well being particularly.
Vogel: These practices are realizing that the payers are shifting the purpose line on a regular basis, and the laws change, and if you do not have automation in-built, 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 simply receives a commission. Properly, the issue is that the reimbursement is not important sufficient to have the ability to rent all these folks to do this work. Loads of these teams wish to add suppliers, but when you do not have a know-how that means that you can preserve the executive overhead low, it is virtually 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’s a whole lot of completely different AI tooling on the market. And admittedly, in behavioral well being, there’s a whole lot of nervousness round AI instruments. So in our present buyer base, for instance, solely 14% of individuals mentioned they have been completely comfy with the concept of AI. However although there are completely different consolation ranges, there are completely 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 group to assist create these AI instruments, each from a income cycle perspective and in addition from a medical perspective. There are people who find themselves utilizing ChatGPT as a web based 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 protected 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 properly.
