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 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 in regards to the market alternative they noticed within the behavioral well being EHR area.
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 loads of occasions behavioral well being was extra of a value heart than it was a service line. Lots of large 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, loads of these teams began to outsource loads of behavioral well being as a result of it did not reimburse effectively sufficient for them to have the ability to proceed providing it. From our vantage level, we considered what’s occurring to these sufferers once they’re leaving the partitions of a bigger well being system, and I can let you know 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 have been at Epic and bought to see loads of the challenges that folks skilled when it comes to integrating with behavioral well being. We’re effectively conscious of well being programs which might 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 possibility. 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 got the uncommon alternative and a number of the expertise having labored straight with suppliers, in addition to with an EMR to impact change within the behavioral well being area.
HCI: If you take a look at the potential buyer base, is it largely smaller practices versus departments of massive well being programs or giant psychological well being practices?
Vogel: The overwhelming majority are smaller. There’s loads of consolidation occurring, however predominantly you are speaking about smaller teams. There are loads of group practices which might be 10 or 15 or 20 suppliers with an aspiration to develop, and that is the dimensions group that that we’re primarily concentrating on.
HCI: If 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 loads of totally different EMRs which might be doing very particular issues effectively. And there are some that began 30 years in the past which might be smaller and have a core set of shoppers. And there was loads of M&A exercise occurring within the behavioral well being area. That is occurring each on the apply facet and in addition on the EMR facet. So that you’re seeing this large panorama shift occurring. Lots 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 very good instance of an organization that was doing the precise issues from a consumer 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 answer.’ So we’ve got buyer advisory boards, we’ve got focus teams, we do loads 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 she or he 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 when it comes to information to the legacy system, she’s capable of see it transition ahead — issues that matter essentially the most to the clinicians. However now, like Melissa mentioned, we’ve got a possibility to consider how we actually make this scale. How will we make this interoperable? How will 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 loads 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 difficulty that these suppliers grapple with or the place you noticed a possibility to enhance?
Tran: Sure, it is also considered one of our interoperability performs. We combine with a pair totally different applied sciences to ensure that folks have, for example, 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 considering by way of issues like credentialing. We knew that we would have liked to know rev cycle tremendous effectively due to all the panorama modifications which might be occurring 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 arduous to scale with out including a bunch of administrative overhead, with out including extra folks to chase in any case 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 try this work. Lots of these teams need to add suppliers, but when you do not have a expertise that lets you maintain the executive overhead low, it is nearly unattainable.
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 loads of totally different AI tooling on the market. And albeit, in behavioral well being, there’s loads 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 thought of AI. However despite the fact that there are totally different consolation ranges, there are totally different elements that we’d like to have the ability to ensure that we’re capable of 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 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 area. It seems like one thing that they’ll use, and it is clinically validated, which I feel is one thing that is comforting to the sufferers as effectively.
