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Athenahealth Amps Up Drive To Build Inpatient EMR

Posted on January 26, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

EMR vendor athenahealth has been driving forward for a while now to build a new hospital inpatient system and fight for the big-ticket customers in acute care. Given the intense competition for the acute care EMR dollar, I’m skeptical that athenahealth can wedge its way into the game. But so far, it looks like the vendor is going about things the right way.

athenahealth already offers the athenaOne suite, which includes an ambulatory EMR, revenue cycle management and patient engagement tools. But it seems the ambitious execs there have also decided to participate in the bare-knuckled fight for hospital bucks being duked out between Cerner, Epic, MEDITECH, McKesson and Allscripts. Considering the billions at stake, these acute care giants won’t be gentle. But as the following details suggest, athenahealth may just have enough going for it to slip into place.

Last year, athenahealth got the ball rolling when it struck a co-development deal with Boston-based Beth Israel Deaconess Medical Center to create a new inpatient system. The two organizations agreed to kick off the development work at Beth Israel’s 58-bed hospital, which is located in the nearby suburb of Needham, Mass.  The deal makes particular sense given that athena corporate is located in another Boston suburb, Watertown.

To supplement its development efforts, athenahealth also picked up small-hospital EMR vendor RazorInsights and Beth Israel’s home-built webOMR EMR. athena has replaced the RazorInsights EMR with a rebuilt version of its ambulatory athenaClinicals EMR, and integrated it with the RI hospital information system, plus several ancillary systems. This hybrid system is being sold to the small-hospital market.

athenahealth has begun converting webOMR into athenaNet in partnership with the small Needham branch of Beth Israel, working with clinicians and technical staffers to better understand the inpatient care environment.

That agreement alone might have gotten the job done, but athena didn’t stop there. Last week, the vendor announced that it would be partnering with the University of Toledo Medical Center to further speed the development of its inpatient EMR. The agreement clearly builds on the vendor’s prior relationship with the University of Toledo Physicians, which picked up the athenaOne suite in late 2014.

The deal with UTMC will do more than give athenahealth another testbed and development site. This agreement with the health system, which is dumping its McKesson Horizon system by 2018, gives athenahealth a real-life win in a substantial setting. What’s more, given that the medical center is being given the chance to build things to its liking, the new acute-care EMR is unlikely to cost as much over the long-term as, say, Epic support and maintenance.

I must admit that I still see athenahealth’s plans as fairly risky. While it has significant resources, the vendor can’t match those of its big competitors. What’s more, it could lose a great deal if it endangers its strong legacy base of ambulatory users. But if any of the established ambulatory HIT firms have a shot at the bigger deals, this one does. I’m eager to see how this turns out.

Healthcare IT Market Salary Survey

Posted on December 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For the past couple of years, we’ve helped support Greythorn’s efforts to survey the healthcare IT marketplace. The survey has always produced an interesting look into the salary, job satisfaction, and benefits packages that are being offered across the health care IT industry. We hope that readers of Hospital EMR and EHR will participate in their 2016 survey so they have the best data possible.

We get to see the challenge of healthcare IT job seekers every day on our Healthcare IT Central job board. One of the challenges we see people face over and over is the decision of whether to leave their current job or not. The data from the Greythorn health care IT market survey is one way to assess whether you should leave your current position for greener pastures or whether your current position is one of the greener pastures and you just didn’t realize it.

Plus, the survey looks at a lot of other areas of health care IT beyond just salary. For example, in the past couple years, the market survey showed us the major shift that was happening as EHR experts moved from being consultants to full time employees.

The survey is anonymous and takes 10 minutes to complete, covering questions of salary, benefits packages, career motivation, job satisfaction, and more. A free report based on this research will be published and share on Hospital EMR and EHR in a future post. I hope you’ll participate so the report reflects the best data possible.

Full Disclosure: Greythorn posts their healthcare IT jobs on Healthcare IT Central.

NYC Hospitals Face Massive Problems With Epic Install

Posted on August 24, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.

In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.

Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.

With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.

The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York PostHHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.

So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.

The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.

HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.

What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.

On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

Four Things You Should Know About Deloitte’s “Evergreen” EHR Program

Posted on February 20, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage.  Here’s some key points I took away from my chat with Morris:

  • Evergreen is a suite of services, not a product:  Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself.  It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.
  • Evergreen is only offered in tandem with an Epic purchase:  The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic.  Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.
  • Both onshore and offshore services are available through Evergreen:  One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work.  Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.
  • This is a new application services management offering for Deloitte:  While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract

Posted on January 12, 2015 I Written By

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?

Sutter Health Ready To Deploy HIE, But Can It Succeed?

Posted on June 30, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

Healthcare IT Job Corner

Posted on May 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re working in healthcare IT and haven’t checked out Healthcare IT Central, I encourage you to do so now. I acquired the site late last year and we’ve been growing it to be the leading source of health IT jobs and health IT professionals. Plus, if you’re looking for a health IT job or a better health IT job, it’s free for you to register and post your resume. Plus, you don’t even have to register to search through the healthcare IT jobs that companies like Dell and Beacon Partners and First Choice Professionals have posted. In fact, here’s a list of some of our top health IT job searches:

Along with a great health IT and EHR job board, Healthcare IT Central also has a resume database (close to 12,000 active health IT professional resumes) and a great health IT career blog.

On the healthcare IT career blog, we sometimes feature jobs like we did with this Wanted: Healthcare Consulting Senior Principal – Optimization. Plus, I’m sure many of you will love the Dear Cassie series we’re doing. In fact, if you have health IT career questions you’d like answer, let me know and I’ll work with Cassie to get you an answer.

Finding the right health IT professionals to work on your team is still one of the most important thing you can do in any organization. Plus, it’s a real challenge in this highly competitive market. Hopefully the resources above will help those searching for talent and those searching for health IT jobs.

Hospital EMR and EHR Recruiting

Posted on April 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Late last year, I acquired the healthcare IT career website Healthcare IT Central. Since bringing Healthcare IT Central into the Healthcare Scene family, I’ve dove head first into the healthcare IT Recruiting and career space. It’s been quite an adventure with a lot of great learning for me along the way.

What I’ve learned most is that there are some really amazing people working in healthcare IT and some really amazing companies that are trying their best to make healthcare better. There are a lot of screwed up things in healthcare, but the people are generally good people and a real pleasure to work with.

Health IT Job Seekers
If you’re in the job market and looking for a healthcare IT job, take a few minutes to register as a job seeker where you can upload your resume and apply for jobs at some of the top healthcare IT companies. Also, be sure to check out some of these popular job searches:

Of course, you can always do your own health IT job search using the criteria that matter for you. All of this is all free for the job seeker.

Health IT Employers
If you’re a health IT company or a hospital organization looking to hire qualified healthcare IT professionals, you can register and post your jobs as well. We just passed over 20,000 registered job seekers and are getting close to 11,000 active health IT focused resumes.

We also have other options available to employers like eNewsletter sponsorships (almost 16,000 email subscribers), webinars, and resume database access where you can search for specific candidates.

We’re working really hard to be an amazing health IT career resource for both job seekers and employers. If you have any feedback on the site and what we’re doing, we’d love to hear it on our contact us page.

Outsourcing Your Disaster Recovery Team

Posted on April 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I imagine most hospital CIOs are overwhelmed by the total number of systems and applications that they have to support. Hospital systems can have hundreds of applications that they’re required to support. Along with having to support the day to day operations of these systems, you also have to plan for business continuity and disaster recovery as well.

Every 6 months to a year, it seems we get a stark reminder of the need for good disaster recovery thanks to some devastating hurricane, earthquake, or other natural disaster. Plus, the stories of Hurricane Katrina and Super Storm Sandy and their impact at hospitals still ring in my ears and likely many other hospital CIOs.

Considering this background, I was intrigued by this Florida Hospital Case Study on Disaster Recovery. Obviously, Florida sits out there in a position that’s just waiting to be hit by a hurricane. So, good disaster recovery is a necessity for them.

What was most intriguing to me was that this hospital chose to use a managed recovery program from SunGard to make this a reality. While I don’t suggest outsourcing all of your disaster recovery (you need in house expertise deeply involved), I think it’s a great idea to work with a third party provider for your disaster recovery.

First, there are so many systems that it’s great to have a third party hold you accountable for all of your systems. Second, a third party can ensure that you do proper and regular disaster recovery testing of your systems. Third, they can provide an outside perspective that can improve your internal approach to disaster recovery.

Many of the above items can be done in house as well, but we all know that there’s a certain level of accountability that comes from having paid someone to hold you accountable. Otherwise, it’s really easy for one of your staff who’s being pulled in a hundred different directions to let your disaster recovery program slip through the cracks.

Interview with Dana Sellers: Encore Pay for Perfomance (P4P) Managed Services

Posted on February 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is an interview with Dana Sellers, CEO of Encore Health Resources about their new Pay for Performance Managed Services offering which they’ll be sharing at HIMSS 2014.
Dana Sellers
Tell us your vision for how your new P4P Managed Services will work.
Our vision is to help our clients manage performance and data components against payer contracts to maximize quality, obtain incentives, and avoid penalties. Our offering uses a combination of Encore subject-matter experts (SMEs), software tools, and methodologies that we’ve already tested and proven in large healthcare systems. P4P Managed Services lifts the burden of meeting these value-based demands off our clients’ shoulders and into Encore’s hands. As part of this innovative offering, we also share risks and rewards via multi-year partnerships. We work with clients to ensure that they have the trusted data they need to support performance improvement and obtain incentives.

Our service begins with the P4P Value-driven Roadmap, which identifies the dollars and associated measures at stake in clients’ at-risk, value-based contracts — including projections for the next few years. As input for the roadmap, we perform a data assessment of a client’s EHR and other source systems to determine if they are capturing the right data for the targeted measures. The roadmap defines the multi-year data and process program required to obtain the desired incentives.

Next, we establish this required program along with data governance, technology, and data tools. We also build the value components of the program, including EHR remediation, workflow redesign, change management, data profiling, ETL, and dashboards required to monitor performance.

Once the program foundation is established, the value-management cycle begins. Encore monitors each client’s performance, providing insight through performance analysis and suggesting needed performance improvements to meet all targeted incentives and enhance the quality of care. Also, as new contracts emerge, we work with clients to incorporate new eMeasures into the program.

By creating trusted, transparent data, Encore helps health systems transform and meet new payment-model requirements by using eMeasures to adhere to evidence-based standards. The result is better patient care and an improved bottom line. We provide the consulting expertise, unique methodologies, and our own, in-house developed software tools to help our clients succeed — as we’ve proven by our results in helping other large clients accelerate their achievements through eMeasures.

Why did you choose to offer a service like this?
We know EHR data! Our methodologies and software tools are built around EHR data and eMeasures.

Encore was founded to provide consulting services with a focus on analytics fueled by clinical data. In the broad spectrum of consulting services that we provide – from HIT and clinical advisory to implementation, go-live services, and analytics — our focus is trained on identifying and gathering the data that our clients need to improve healthcare and operational performance. Therefore, our P4P Managed Services offering is a natural extension of our mission. At-risk contracts require the ability to track eMeasures, which has been an Encore strength – and differentiator — since our founding five years ago.

Our vision for P4P Managed Services is also supported by our clients – especially CIOs and CFOs. They have told us that they need assistance with all aspects of data capture, analytics, and performance improvement. When we lift that burden from our clients’ shoulders, it frees them to focus on other critical issues, such as cost reduction, while we leverage our unique expertise and proven experience to manage the value side of the equation.

Which P4P programs do you see Encore supporting?
We support measures — quality measures that go back to incentives. These include Medicare, Medicaid, commercial P4P/Fee-for-Value type contracts, IQR, PQRS, ACO, ACAs, ACCs, NQF/CQMs, PCMH, PCQUS, clinically integrated networks, and the like.

Our methodology and tools tie the eMeasures directly to workflow, so we know how to change each client’s workflow to get better results. Our knowledge bases include over 350 eMeasures.

How much of this offering is technical and how much of it is services.
This is an important question. Encore is first and foremost a services company – a services company that is strongly differentiated by unmatched, in-house-developed software solutions that are uniquely designed to support the services we provide. So our new offering is precisely that: services supported by innovative technology and processes on a flexible, as-needed basis.

What does the cost structure look like for this service?
As described earlier, the P4P Managed Services cost structure is based upon a roadmap we define with each client to quantify the value-based, at-risk dollars and the client’s capabilities to manage the quality-performance components of their at-risk contracts. Contract details, therefore, will vary with each client’s situation. The bottom line is that Encore is willing to manage our P4P Managed Services contracts while working with clients to define a risk-sharing arrangement that incents everyone to achieve.

Why would an organization choose to outsource the P4P to Encore as opposed to doing it in-house?
The process of managing performance against eMeasures across a health system is complex, and many clients have not put together a disciplined approach to performance improvement. Further, many of our clients are telling us that they simply do not have the full complement of expertise, resources, technology, and program-management disciplines available to move fast enough against a dizzying array of government and commercial at-risk contracts. But we do, and we – especially our skilled eMeasures experts — have a track record that proves it.

Also, an increasing number of health systems are recognizing that they’ll have to enter a world of eMeasures that is growing every year. With P4P Managed Services, we bring the expertise, skills, tools, and methodology that can take this eMeasure world and our clients under our wing. Our new service provides clients the breathing room to focus on multiple fronts simultaneously – and not leave any dollars on the table as a result.

A third reason for choosing our new offering is because it’s a cost-conscious solution. We eliminate the need for clients to hire more architects, eMeasures specialists, analysts, and report builders.

Finally, P4P Managed Services can preserve endangered species. That is, we supplement our clients’ existing IT department with some of the hardest resources to find: clinicians and operational SMEs with an understanding of data; eMeasures experts; and, technical SMEs with an understanding of the clinical and the operational worlds.

How much accountability is Encore taking on with these P4P Managed Services? Where do you draw the line?
Our new offering is a full life-cycle solution that we approach as a partnership. We nail down the amount of accountability – the risk that we’re able to share – on a case-by-case basis through the roadmap. Depending upon what we learn, we then determine the degree of accountability that both we and our clients can share to incent the highest levels of achievement.

Is there some risk on Encore’s part that the client will fall short on what they need to accomplish for Encore to provide the P4P services? Encore can’t go in and do the documentation for the doctor.
This is precisely what our new service is in place to define. As with every engagement, we use a thorough, careful assessment process to ascertain the nature of the challenges involved. With P4P Managed Services, that means understanding:
• The incentives involved
• The risk involved if our clients can’t achieve optimal revenue reimbursement – say with Medicare and Medicaid contracts
• The risk involved for Encore if those contractual incentives are not earned
Bottom line: we both win, or we both lose. With P4P managed services, we are convinced that we can define on a case-by-case basis the mix of Encore services, solutions, and client resources that Encore will manage to produce a win or multiple wins for both sides.

This feels similar to revenue cycle management (RCM) applied to P4P programs. Can you apply some of the RCM learnings to this type of offering?
Yes, similarities do exist between RCM and the management of quality performance components of at-risk contracts. The way we see it, RCM has been responsible for collecting patient data and getting claims ready for a long time. It remains fairly unchanged and encompasses the management of people, processes, and technology across health systems to improve revenue collection. By tying eMeasures to clinical rather than latent claims data, performance issues can be corrected within a few days. That is because the use of EHR data literally “moves the needle” in real time. Beyond claims data, we use EHR clinical data to affect change that meets the required quality measures thresholds.

At present, there is an increased focus on traditional cost monitoring, which informs RCM. This typically happens at the service line and department level; not at the episode-of-care level. Although direct, indirect, fixed, and ad-hoc costs are certainly important and are included, value-based cost control and reduction efforts must focus on the clinical processes, just like the quality performance components. Both will require tracking the costs and quality across the entire continuum of care, constantly analyzing performance and applying adjustments. And the revenue cycle is a significant piece of this. So the discipline and techniques needed for RCM can certainly inform a health system’s approach to fee-for-value focused management.

Do you see this as the start of offering even more Managed Services offerings?
Yes. We are now working on another offering – it’s in the packaging stages – around Meta-Data Management. Stay tuned for more details later this year.