Q
Right. So, why the focus on ACOs? Why not other aspects or other health institutions?
No, I think we’re doing all of the above, HITC. That’s the point I want to highlight, that Medicare shared savings program a la ACO is not the only quality and risk program that we’ve achieved success in. We have many customers doing Bridges to Excellence as one of the other programs. We have many customers doing commercial insurance plans where they’re getting into this.
We have a large network in Minnesota that is doing Blue Cross/Blue Shield Minnesota children’s initiatives, which is clearly not Medicare. So these are board highlighted ACOs where we are leading in terms of both market share and functionality, but that same functionality has been used for other programs, including pediatrics. We are getting into
orthopedics and Ob/Gyn also, so it’s diverse to handle not just primary care, it’s also got the flexibility of dealing with other payer programs.
Q
Right. OK. Back to talking a little bit about the population health management aspects: We talked about how important it is to engage the physician, but part of the piece of the PMH pie is certainly patient engagement. So obviously, how does your technology gear staff to engage with the patient, because that is a key piece of the puzzle here?
I don’t know if you read that press release, but if you didn’t, I’ll send it your way. Two years ago we decided to invest a substantive amount of money. We had set $25 million at that time. We have since added to that investment where we would hire people, we would have eClinicalWorks resources start a new subsidiary with exclusive focus on
building software technology for patients to use. It’s called healow, Health and Online Wellness.
As part of an initiative of the last two years, we came up with a healow app which has been extremely successful. Their patients download it, they get access to their own records, they can talk to doctors, they can enter their own vital signs and all. We have since then launched
Healow.com in Dallas, and we’re going to go nationwide soon, which allows patients to find new doctors for care if they have not been able to find one yet. It’s a platform to find resources. When you do that, you automatically get access to your healthcare if you go visit that doctor because you get your electronic health records converted to you in a PHR form.
We are now launching in the summer Telemedicine. We are going to come out with integrations for Fitbit and other wearables. I have a whole division in the company with significant resources both in terms of money and people that are heavily focused on building technology that we want patients to use when they are at home, and find ways to engage doctors by either doing real time visits like telemedicine or get notified with text messaging/voice messaging reminders, or being able to find healthcare services when they’re looking for new ones.
Q
Right. I think it would be interesting for our provider readers to get a little of your insight on what is it that the patients are looking for when it comes to connecting with a health institution or with any matter of their own health on a device? What has the conversation largely wrapped around itself there?
I think we can share more. The most common thing we are seeing right now is that there’s a generation of patients that like smart phones and smart phone apps. There’s a generation that prefers to be notified with voice and text and reminders, and there’s a generation that likes voicemail still, a phone call right into their home. I think it’s different modalities based on different people and different needs. I think the best way we’ve done it, is we’ve allowed a patient to make the modality or pick the modality that they like most and have their provider engage them using that capability.
Q
Right. Now, with population health management, a lot of our aging population, that plays into it, especially with disease prevention. They may not, well, there are plenty of tech-savvy people that are in the aging population, but how do you address that challenge?
It’s not easy. I think that’s why you will find the use of care coordinators, care managers: people that will engage patients when they’re at home. I think technology will facilitate who they need to call, who they need to talk to, and what they need to overcome in terms of their barriers or goals that they’ve had. But you might not just have technology do it. It’ll be technology plus human intervention, but it will still not require an everyday visit into the office. You could do that with a patient still being at home.
Q
Right. That brings me to the question of: how much or how important is the human element here? Like you said, you talk to doctors on a daily basis that still say, “You don’t understand our needs.” I think the flip side of that is, sometimes people rely, maybe, on the technology too much without perhaps thinking of the mastery of the technology, or how to fully integrate the technology into their practices. What’s your thought on that?
I think technology will facilitate and assist. The technology will not displace the use of the healthcare professional being the quarterback of care. I just think that if you’re in a paper-based system, the healthcare provider will not be able to do it, because they
won’t even know who to reach out to, when is the next follow-up that they should make, and can I leverage technology to do it, or also do it on an exception basis.
For example, you tell a patient to give us their weight, and they give you their weight profile regularly, and only when they gain weight and they’ve been diagnosed with congestive heart failure, you might find the need to call them. So instead of calling them 10 times, you might call them once and counsel them and work with them. Technology will play a role, but it will never be at the expense of not having a healthcare quarterback. I’d go as far as to say that there’s a reason why Microsoft HealthVault and Google Health failed, and that’s because there was no doctor behind those patient engagement platforms. If there is a healthcare provider like this, in on our case behind healow, you will have patients using that platform.
Q
Interesting. With that in mind, can you talk to me a little bit about what are some of the challenges that come with instituting that population health management, and what are the takeaways, the lessons learned in working with those providers that you have learned to help them do that?
There is a significant amount of change in moving fromfee-for-service to fee-for-value. There’s a significant change of mindset in terms of understanding how you might end up actually not making the same amount of revenue if you don’t achieve your goals, and how do you collectively have each provider get into that mindset? That’s the hard part. That’s the counseling part of getting together. What we have found easy or easier is finding the cost saving while attaining better quality goals, because there have been significant savings that can be accomplished.
I have a number of ACOs that have talked about readmission to hospitals dropping somewhere between 12-17% after they put the technology in, and after they started proactively managing patients that were being discharged. There have been reductions in duplicate labs being ordered, because lab results were available once and they could all see it.
There were many lessons learned by stratifying patients that were high-risk versus low-risk, focusing more attention to the high-risk patients and addressing them proactively which resulted in lower admits to inpatient settings.
That’s not the hard part, because once you get to see the scorecards, physicians, like any, are very competitive. They get to do it, they get to change. It’s the initial step of moving in that direction which is the harder part, and that’s an area that I think we will have to continue to work towards that physician networks need to come together to attain better quality outcomes, and they’ll have better cost savings as well.
Q
Right. So, if you’re sitting down across from a hesitant physician or provider organization, what do you say to them to try to get them on board?
I think the best way to do it is to have them talk to another physician that has done it, and ask them the lessons learned, and see the benefits they got, and also understand that is inevitable, that that’s where we need to go. The sooner we start that discussion, the better it is. It is going to take hard work, but I think we are building enough of a reference base where we can have one customer help the other go through it.
Q
Right. And I understand that is how eClinicalWorks has had their success, that it has its own social media group where physicians were suggesting the product, but it wasn’t actually an eClinicalWorks site. Am I correct on that?
That is correct. It has always been that model: un-moderated, uncensored view to your customers with the overview where they can talk to others. For every one that might walk away because they see our weaknesses, nine accept it and embrace it and move forward because they know more than they ever did. That’s pretty much how we run the company. Our salespeople are our customers.
Q
Right. Another unique thing is that you haven’t changed your price point. Why is that? What’s the thought process behind that?
We are able to run a very profitable company at the price point by just getting more customers to go with us. Plus, we are a cloud-based solution, so we have a lot of recurring revenue stream. We don’t have to raise prices to survive, so we won’t raise it, because the goal is not to just make more money. The goal is to find a way to improve healthcare, for which we need more doctors to use technology, which means if I can make it more affordable, I will. I will tell you that every one of my customers will tell me, “You’re still trying to charge me too much,” but we haven’t changed the price over the last 14 years.
Q
So, what is the thought process as you develop your products, especially when you were developing your population health management solution?
I think our philosophy has been very straightforward. You try to get your customers to get an affordable product at a price point that they will probably find acceptable. Keep it consistent. Don’t go back to them and raise it after they buy the product. Find a way to build efficiency in your own business models. I think it’s worked for us the last 15 years. I think it’s going to work for us another 15 years.
Q
We’ve talked about the technology and we’ve talked about the human element already, but I also know that in your own organization, you’re known for your leadership skills, so there’s something I want to ask about. How much does eClinicalWorks get involved to offer that helping hand to put the organizational structure in place to make that transition from fee-for-service to practicing population health management? I would imagine that’s a really important part of it, and I didn’t know if you guys offer a hand in that in any way.
I think that’s a great question. We’ve so far gone to the point where an organization has decided to be a fee-for-value, and we provide them a lot of consulting and a lot of help on what they should do after, in terms of both technology and how to leverage it, and what changes to bring in at all. There’s a step before this too, which is proactive consulting and management services on how to get there. We’ve not been in that space as a company. We have actually helped our customers. There are some that actually manage multiple ACOs. There are some that have actually gone ahead and built clinical integration companies to help. We’re right now working that through a partner program. The question remains open: Will we ever get into the upstream process as well? I am not sure about that at this moment in time.
