Cerner Health Conference 2018: Interest in PHM Solutions Remain ‘Healthe’

By Matt Guldin and John Moore

Recently, we and 12,000+ others attended the Cerner Health Conference 2018, where the theme was “Smarter Care.” Overall, the event focused on building on top of the EHR, while much of the floor space and conversations focused on population health and revenue cycle.

Cerner Smarter Care CHC18

Key Takeaways

  • New CEO, Brent Shafer, is not the visionary that Neal Patterson was, but he is highly focused on customer success and operations. Expect Cerner to become more acquisitive (Lumeris) and pursue partnerships such as that with Salesforce.
  • Rising client interest in population health management (PHM) solutions – Cerner’s HealtheIntent platform – but uncertain timeframe as to when these solutions will truly scale across client base.
  • The event reinforced our view that Cerner is well positioned to capture a growing wallet share from its hospital & health system customers over time as well as adding new potential customers (e.g., payers, state Medicaid agencies, self-insured employers) via its HealtheIntent platform.

HealtheIntent platform

For several years now, Cerner has been focusing on moving beyond the EHR with its HealtheIntent PHM platform. At CHC18, Cerner was doubling down on this bet with the message “Smarter Care” with numerous sessions and a significant amount of exhibit space dedicated to this theme and platform. Today, Cerner has signed ~160 clients of which ~90 are currently live.

HealtheIntent is well positioned as an EHR agnostic solution that will give Cerner the ability to invest resources into developing solutions that think beyond the hyper-competitive zero-sum game of EHR contracts. Two major flagship HealtheIntent customers are also two major Epic customers (Advocate and Geisinger) and there is a clear opportunity to work with these customers to better integrate Cerner’s evolving platform with Epic’s similarly expanding universe of products.

A key challenge for any PHM vendor is developing strong services capabilities to assist clients in extracting the highest value from their PHM solution deployments. In August, Cerner made a significant investment in Lumeris, a company with a strong services offering that Cerner will leverage.

Integration with Salesforce provides Cerner with a strong competitive advantage

In line with the company’s shift toward consumer-focused healthcare, Cerner is partnering with Salesforce to offer providers an integrated patient engagement solution. Through this partnership, HealtheIntent data, which is collected from numerous sources, will feed directly into Salesforce’s Health Cloud.

Once the data is in Health Cloud, from within their EHR a clinician can quickly identify patient populations based on various criteria via a queried search. Once identified, a campaign can be initiated. Cerner plans to launch this product in 2019, and will be the only EHR company to have Salesforce directly embedded in its EHR and HealtheIntent workflows.

Revenue cycle still in flux

Cerner understands the importance of getting revenue cycle (billing) software right. Cerner has penetrated, to varying degrees, about 40% of its hospital clients with billing software, but those are mostly small facilities. Cerner’s software still appears visually outdated and lacking functionality, particularly for ambulatory practices.

One need only walk through the CHC18 exhibit area of third-party software vendors to see the demand for RCM solutions that work in the Cerner environment. Roughly 40 percent of all vendors were RCM vendors. Clearly, Cerner is missing out on fully capitalizing on this opportunity.

RevWorks interest robust, ITWorks continues to grow

Cerner is seeing strong demand for its RevWorks offering among smaller hospitals, and the firm is still hiring aggressively to support growth into 2019. Cerner has about 100 RevWorks clients, compared to 30-35 two years ago. One of the main reasons for Cerner’s early success in outsourced revenue cycle solutions is that the product comes with a demonstrable return on investment for clients with specific targets outlined before any deal is signed.

The ITWorks business is growing but acquiring clients at a slower pace than RevWorks.

DoD/VA

Now that MHS Genesis is up and running across the first wave of an initial 4 sites, the company took important lessons learned for future Department of Defense (DoD) rollouts as well as Veteran Affairs (VA) deployments. Cerner noted that the VA is not yet in the implementation phase as it is currently planning the largest install in the industry’s history.

Of these two massive installs, the one at the VA bears watching closely. A significant portion of veterans receive their care via Tricare (local healthcare providers under contract to VA). How Cerner drives interoperability across multiple venues of care nationwide, the potential role of HealtheIntent, the embedding of telehealth functionality and the list goes on will all be pressure-tested by the VA. The results of that pressure-testing will, in time, roll out to the broader Cerner client base.

“Where the company has truly led the EHR market is with HealtheIntent. Rather than a walled-garden approach, Cerner’s HealtheIntent is architected for a more open future and its capabilities continue to expand even though market has been tepid. Cerner accurately saw the future and invested early for the inevitable move to value based care.”

Looking Forward

Cerner has been an innovative company since its founding. While not all innovations have been a success (much to some clients’ chagrin), the company has nonetheless made progress and continues to push forward. Their ambulatory EHR is gaining significant traction with larger IDN clients, and RCMwhile not there yetis closing the gap with competing solutions.

Where the company has truly led the EHR market is with HealtheIntent. Rather than a walled-garden approach, Cerner’s HealtheIntent is architected for a more open future and its capabilities continue to expand even though the market has been tepid. Cerner accurately saw the future and invested early for the inevitable move to value-based care.

Visionary leadership made Cerner what it is today. Hopefully, the company’s new leadership fully appreciates this key attribute. Only time will tell if the future focus of Cerner is operational efficiency at the expense of vision. While operational improvements are common in a maturing market, our hope is that Cerner continues to look beyond the near term.

Stay up to the minute.

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MEDITECH Look Ahead: Building on Steady Progress

Key Takeaways from MEDITECH’s Physician and CIO Forum 2018:
  • MEDITECH is moving its customer base to Expanse, the latest iteration of their EHR
  • Expanse has significant inducements for hospitals seeking to support value-based care and be more interoperable

Photo: Courtesy of MEDITECH

Last week, we had a chance to attend MEDITECH’s Physician and CIO Forum, an event the company uses to give its customer executives a look forward.

The more concrete developments described over the course of this two-day event include:

Voice Support

A lot of attendees were talking about a new capability planned for Expanse called the Virtual Assistant. The idea is to voice-enable aspects of the physician’s workflow. Even as MEDITECH, and all the other major EHR vendors, slowly improve the interface design of their EHRs, users still want fewer clicks and swipes and less data entry. MEDITECH, seeing the rapid adoption of voice in consumer markets, wants its users to be able to retrieve results or review charts hands-free. It indicated that it is experimenting with this Nuance-sourced technology at a customer site with a phased roll-out planned once it gains more experience. Sometime next year it will begin work on using voice in physician documentation as well.

Interoperability and FHIR

MEDITECH came out strongly in support of FHIR. It has three live customers who have implemented FHIR servers that support REST-style access. MEDITECH facilities will soon be able to offer FHIR-based access on the CommonWell network. It is also looking at more complex transactions from Project Argonaut to support patient questionnaires and scheduling that will rely on write access to MEDITECH EHRs. You can read our full analysis of their support for API access in the MEDITECH profile in our App Store report.

Mobile developers will soon have access to a new capability called MEDITECH Greenfield to develop patient- or clinician-facing apps. It will serve up a set of APIs based on MU’s common clinical dataset with plans to add other data types down the road.

Clinical Decision Support

MEDITECH will rely on CDS Hooks to offer Stanson Health’s content for a variety of purposes. It will be used to push some of the most common care gap alerts. It will also push recommendations to physicians based on the Choosing Wisely campaign.

MEDITECH’s approach to introducing new functionality allows its customer to keep the lights on and support the onrushing changes to U.S. healthcare.

Population Health Management

MEDITECH’s PHM story is a little clearer than it was this time last year. The company’s collaboration with Arcadia.io means that its customers will soon have access to an aggregated patient record of MEDITECH and non-MEDITECH EHRs married to paid claims. Customers will get access to a new suite of dashboards and reports that provide risk scores, care gaps, attribution, utilization, and costs on a per patient or per cohort basis. The company plans to roll this out to early adopters before the middle of next year.

Patient Engagement

The company talked a lot about its new downloadable app for patients: MHealth. This app will permit patients to manage a lot of administrative and payment tasks in connections with office visits. It also will offer questionnaires that will help with reconciling meds and allergies to the clinical record in the EHR.

Upshot

MEDITECH hospitals are under the same pressures to adapt to value-based care that the rest of the industry continues to struggle with. Many of the company’s actions over the next year will help them in different ways. MEDITECH’s approach to introducing new functionality allows its customers to keep the lights on and broadly support the onrushing changes to U.S. healthcare.

Allscripts — Stabilize, then Proceed with Innovation

At the recent Allscripts Client Experience (ACE, #ACEHHS18) conference, the company gave us a day and a half deep dive into their current strategy and initiatives. As much as Allscripts positioned themselves as the innovative leader among the leading EHR vendors, the fundamental reality was far simpler. This is a company that is seeking to stabilize its base, and that is a good thing.

Figure 1: Allscripts’ Advances in the Last Five Years

As most readers know, when CEO Paul Black took over the reins at Allscripts he had quite a mess on his hands. Previous management had grown the company through a series of acquisitions, but little attention was paid to how these various acquisitions would be stitched together to provide a comprehensive and cohesive EHR that extended from hospitals (acute) to small practices (ambulatory).

Clients were not happy, and Allscripts increasingly lost ground to both Cerner and Epic.

Under Black’s leadership losses have been stemmed, costs brought into alignment, and the bottom line has improved. Today, Allscripts has an acute to ambulatory EHR solution in Sunrise, which now represents roughly half of Allscripts’ annual revenue.

The company has also continued its acquisition strategy, picking up two other EHR platforms –  McKesson’s EIS business (see our original take here) and Practice Fusion. While hearing little about Practice Fusion at this event – after all it was focused on Allscripts’s acute clients – we did hear from a number of former McKesson (Paragon) clients that they were quite happy to have Allscripts as their new parent. As one Paragon customer told me:

“We have been ignored for years. McKesson failed to address known problems with their software. At least now we have a voice and Allscripts is making progress.”

In another session with two Allscripts customers, each related their thorough evaluation and due diligence research of current acute care EHR solutions. Their conclusion: The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount. This is likely true across the industry and why the long purported EHR replacement market never materialized.

The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount.

Stabilization Done – Now Innovate

In a brief conversation with Black, he was passionate in stating that he wants this company to be seen as the true innovator of the big three EHR vendors. He pointed to their precision medicine efforts with 2bPrecise, a young company started by the founders of HIE vendor dbMotion, a company Allscripts had acquired several years ago.

2bPrecise is now embedded within EHR Sunrise workflow and the company is working with six beta customers, including the Mayo Clinic. Today, Allscripts is the only EHR company that offers the physician the ability to match medication treatment protocols with a patient’s genomic information (e.g., how well a patient can metabolize a given medication) – pretty futuristic and promising work. But there is a fly in the ointment: who pays for this second order derivative to define patient-medication matching? No clear answers yet, though the move to value-based care (capitation) may provide accelerated adoption for certain, complicated diseases (behavioral health, cancer, etc.).

Another innovation they announced at ACE was allowing clinicians from within Sunrise to directly order (prescribe) a Lyft ride for a patient (original partnership announced in March). The use cases for such are numerous, from setting up an appointment (25% of low-income patients cite transportation as a leading cause of missed appointments) to taking a patient home upon discharge. Nice feature for both clinicians and patients.

The company has also been quite progressive on the patient engagement front, first with its vendor agnostic patient portal – FollowMyHealth and its recent acquisition of HealthGrid, a patient engagement tool based on texting.

Lastly, the company is in the process to move its core portfolio of products to a common client user interface (UI) based on progressive web architecture. This effort is in conjunction with their move to hosting their solutions on Microsoft’s Azure platform. Note: the move to hosted cloud services has taken the healthcare IT sector by storm. Three years ago, few CIOs were willing to go “off-prem.” Today, there is literally a tsunami of interest among CIOs looking to off-load the care and feeding of their EHRs and other applications.

Challenges Remain

The EHR market is dead in the U.S. To grow, one must either acquire other EHR vendors and leverage their maintenance revenues aggressively while cutting SG&A costs or look to the next generation of solutions and services the client base will need.

Allscripts has done a little of both but what concerns me most is their lack of a clear and compelling solution suite to support the migration to value-based care. Their messaging around population health (CareInMotion) was generic and this solution suite to support value-based care modalities still lags competing solutions. They are working to rectify these shortcomings, but they are slow in coming.

Their analytics story, quite surprisingly, was nowhere in evidence – little discussion during the sessions I attended nor highlighted in their product pavilion. Contrasting this with what I experienced this past week at Cerner’s own user conference, CHC, or at Epic’s UGM in late August, was striking.

The innovative efforts at Allscripts are heartening, especially those regarding patient engagement. Yet these efforts will not keep the lights on for most healthcare organizations as we migrate to data-driven care delivery models. The industry migration of clinical care from an art (little to no data) to a science (data-driven) is readily apparent – Allscripts’ own story on this, however, is currently not quite as clear.

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