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Pushing Hard: Epic’s UGM’22

by John Moore | September 02, 2022

This being the first full-on UGM since the pandemic (yes, there was a UGM last year, albeit thinly attended) it was a crowded affair with some 12,000 or so attendees. Looking back over our notes one thing is clear; despite all the turmoil in the health IT market, especially among acute care EHR vendors, Epic continues to push forward, aggressively.

Coming into Epic I was beginning to wonder what, if anything, was truly new and exciting happening in health IT. Since starting Chilmark Research, there has been a never ending series of “big” initiatives. First, it was the HITECH Act/EHR adoption. Then the buzz of HIEs, followed by the misused term PHM, then VBC. And maybe we can stretch it now to omnichannel care, dominated by telehealth, in response to the pandemic lockdown. An now we have the used and abused term of consumerism in healthcare.

I see very little that is truly new. Rather, it is more the repurposing and/or rebranding of existing solutions. Epic’s CRM, Cheers is a perfect example of such.

UGM’22 Rocked My Boat

While some aspects of Epic’s progress were lackluster (aforementioned Cheers) or downright puzzling – you mean MyChart does not already have two-way texting capabilities – that does not mean Epic is slipping into a stupor now that it has an unassailable dominant share of the US acute care market. Rather, Epic is using that dominance to capitalize on two major themes: Provider-Payer Convergence and Real World Data/Real World Evidence (RWD/RWE).  

As we mentioned in our HIMSS’22 post, Epic has made significant headway in onboarding clients to Cosmos. Today, Cosmos has over a 162M patients lives and may exceed 200M before yearend. Cosmos is now one of the largest clinical data repositories in the world. But what is even more impressive is what Cosmos can do beyond simply supporting researchers and life science companies.

Epic has built two distinct clinician-facing products that leverage Cosmos: Best Care and Look Alikes. With Best Care, a physician can automatically search for patients similar to the one in the exam room with them to identify clinical pathways (therapeutics) and their relative success in treating a wide range of conditions. This is really cool to see in action and gives one a vision into the future of personalized medicine. Currently, Best Care is at a couple of Beta sites and may reach general availability (GA) by end of year.

Look-Alikes is somewhat similar to Best Care but for rare diseases. Rather than identifying specific clinical pathways, Look-Alikes lets a physician find another physician who may have more experience with such a disease. The physician can then request a call and if willing, the more experienced physician can provide treatment guidance. Look-Alikes will go GA in November 2022

Convergence is Alive and Well

A number of years ago, we came up with the concept of Convergence and actually hosted our one and only conference dedicated to the topic. Convergence is a conceptual model for providers and payers to come together to improve the patient experience.

The healthcare system today is loaded with administrative waste, some estimate it as high at 30 percent of all healthcare spend. The vast majority of that waste resides in provider-payer interactions e.g., eligibility checks, prior authorizations, duplicative care management and the list goes on.

Epic has had a payvider solution, Tapestry, for years. A big highlight at this year’s UGM was seeing the traction they are getting with their Payer Platform. Payer Platform is architected to facilitate an ever wider array of provider-payer processes. Payers must purchase an instance of Epic. Providers receive access to Payer Platform for free. While there still remains significant mistrust between providers and payers, what Payer Platform does is simply enable payers to electronically access files that their contracts already allow and the potential savings are significant.

While there still remains a lot of distrust between providers and payers, based on what I observed at UGM and the fact that 230 health systems have already signed up for Payer Platform, that inherent distrust is eroding.

I attended a number of sessions during UGM on Payer Platform and each session was standing room only. The sessions were packed! Clearly there is a lot of interest among providers who wish to learn firsthand from the experiences of early pioneers – and there is a lot to learn.

One of those pioneers is the Mayo Clinic. Mayo has been working with BCBS-MN via the Payer Platform and posted some pretty amazing results that include a 70 percent reduction in claims denials. When someone in the audience asked Mayo how many claims Mayo had to be appealed, Mayo said ZERO, as there were none!

But it is not an easy straight path to Convergence via the Payer Platform. Sitting in on a session where payers and providers spoke openly, a number of challenges were exposed. The most important one: What are your objectives with Payer Platform? Both providers and payers talked about the need for a common set of agreed to goals and objectives in launching such a Convergence program. And even getting to a common set of goals and objectives is not easy as the vocabulary each uses can have very different meanings.

Despite these challenges, both providers and payers readily see the value in working together to facilitate administrative processes with the ultimate goal of lowering expenses (FTEs). There are of course a wide array of other benefits as well, such as the one Humana told me: they are closing care gaps six months earlier with those providers using the Payer Platform. That is a huge win for any payer/provider pursuing Medicare Advantage.

Can I Retire Now?

When I started Chilmark Research nearly 16 years ago I saw a knowledge intensive industry who really didn’t have a clue as to how to manage and share that knowledge to improve the quality of care delivered and ultimately the patient experience.

The industry was frankly a mess.

Sixteen years on and UGM’22 has shown me that we are at last closing in on delivering more personalized care to patients based on near real-time, real-world evidence in workflow via Best Care. Sure, Best Care today only covers a limited set of diagnoses, and only so much data is in machine readable form, (e.g., no notes), but it is a start and one hell of a lot better than waiting years for some new journal article on a clinical pathway that on average takes 14 years to become common practice.

I personally saw how the manufacturing sector leveraged enterprise software and data to improve product quality. Now I have a front row seat to see how this unfolds in the healthcare sector – something I have dreamed of.

Secondly, shortly after getting into the healthcare sector I realized there was no way in hell I and my team were going to be able to address all the issues that befall this sector. I ratcheted back expectations hoping to move the needle just a little.

Years ago, we presented the Convergence concept to the industry. Based on our research, it was a forgone conclusion: to begin to “fix healthcare” needed to start with greater collaboration between providers and payers on joint goals. Most people thought we were crazy as provider and payer trust issues loomed far too large.

We pressed on and held our conference and though attendance was not what I hoped for, the right people were in the room. One was a contingent from Epic. Epic saw the vision, saw the opportunity and moved forward. Several years later they have a product and every national payer is now on the platform or in the process of implementing it as well as 230 health systems.

Speaking to one of the Payer Platform product managers after a session he looked at my tag and said “Chilmark Research? Are you the ones that created that figure?” I responded “the one titled Convergence, its red and blue?” “Yes, that’s the one – that’s our product roadmap vision.”

I was blown away.
Finally, after 16 years of hard work, we have indeed moved the needle.
I am satisfied.

Will I retire now? Big question for only my spirits know my true destiny. I do know that due to the progression of my disease, it does get harder with each passing year to carry on. However, I have grown to love this industry in spite of its dysfunctions and it is truly a noble cause to strive to improve the quality of care for both the provider and patient. We have also put together a great team of analysts at Chilmark that I am really enjoying working with. This makes it extremely hard to let go now when we are on the cusp of major advances in the delivery of care all supported by IT.

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