April 2006

The Wal-Mart of EMR

Recently the Massachusetts eHealth Collaborative announced the winners of a $50 million EMR pilot funded by the Blue Cross Blue Shield of Massachusetts Foundation. Among the EMR vendors in the bake-off for the 180 medical group practice contracts: GE Healthcare, NextGen, Allscripts, eClinicalWorks. eClinicalWorks roasted the competition, garnering 170 of the 180 practices.

eHealth Collaborative chief Micky Tripathi says "that was somewhat unexpected" to the Boston Globe. But to those who follow the EMR market, it shouldn't be that surprising. eClinicalWorks beat out a host of larger EMR players. Why? I've heard competitors refer to eClinicalWorks as "the Wal-Mart of EMRs." This is a compliment, given the company's success in the small and medium practice group market. A regular Best in KLAS favorite, eClinicalWorks is cheap, easy to use, built natively on the Web, and strong on functionality without laboring under lots of bells and whistles. "Value," as Wal-Mart shoppers would say. And eClinicalWorks' independent customer Web site keeps the company honest and listening to their customers.

Do the EMR big boys have such responsiveness? Obviously those Massachusetts doctors didn't think so. These practices are for the most part small medical groups, who tend to follow each other like a herd and seek inexpensive, simple technology. Money wasn't an issue in this case, as BCBSMA financed the IT purchase. This make eClinicalWorks' victory all the more telling about its technology.

Sure, the contract value for eClinicalWorks' customers is much smaller than the Cerners and GEs of the world. The big dollars are still at the high end with hospitals (until, or if, Uncle Sam ramps up grants or tax breaks - see "Plight of the Small Doc" post), where the eClinicalWorks of the world rarely qualify. Nonetheless, the EMR vendor big boys should take heed of the lesson of Massachusetts.

Posted by Shawn Whalen on April 25, 2006 at 11:00 AM
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The Race for Better Healthcare

Massachusetts' recent legislation requiring every citizen to purchase healthcare insurance was widely reported in the media. The state's 500,000 uninsured, mostly of lower income, will be offered new, affordable plans and subsidies. People and businesses who refuse may face tax penalties. The interesting and still-to-be-developed aspect of this plan is the pay-for-performance requirement. All that additional Medicaid money (hundreds of millions) going to docs will be contingent on meeting quality standards. Said standards to be developed by 2007. The Boston Globe reports that Governor Romney has a web site comparing hospitals and doctors on quality and costs, using billing data to analyze individual hospital mortality rates and other measures. Hospitals are arguing for measures from clinical data or patient's medical records.

Massachusetts adds a dollop of liberalism in also insisting that doctors show they are reducing racial and ethnic disparities in healthcare outcomes. Surprise surprise, politicos and media have been silent on just how this will be done. Any ideas?

Posted by Shawn Whalen on April 21, 2006 at 4:00 PM
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Maximizing The Value Of Analyst Relations

Part One in an Occasional Series on Healthcare IT Public Relations

I wanted to depart from my usual industry issues to address a question we're frequently asked by healthcare marketers. How to maximize industry analyst relations? Gartner and their ilk often carry considerable influence among IT purchasers at large hospitals, networks and in managed care. As such, vendors want to know how they can most impress them, get included in their research reports and secure desirable placement in leadership grids.

The past few years have brought tremendous changes to the analyst industry. Consolidation continues, for example the merger of Gartner and Meta, HIMSS Analytics and Dorenfest, Forrester Research and the Giga Group. And new firms such as IDC's Health Industry Insights have launched. Meanwhile, the cash crunch among medical marketers has forced industry analysts to respond with more creative offerings.

These shifts changed the ground rules for an effective analyst program. A few years ago, analysts had time to take multiple briefings on an industry area to learn all they could about the companies in it. Today, many analysts will only schedule two meetings during a calendar year with non-clients. Conversely, they are more willing to be flexible in their consultations with paying clients.

That means making the most of your time with the analysts. Some healthcare companies focus on a few, key analysts for paid research, and work with them in close partnership. This focus enables executives to build strong analyst relationships that help them move toward corporate objectives.

At the same time, it's important to communicate with the broader analyst community so that your company is not left out of significant research reports. So, let's assume that you have only two, one-hour briefings per year. That gives you just two hours to summarize 12 months worth of work. Here are some key steps that the experts at Schwartz Communications say can help:

• Think Carefully About Your Briefing Schedule--Determine the two or three most important announcements in the next six months. Schedule analyst briefings around each piece of news. Another potential strategy is to meet with analysts every six months with strategic updates that summarize your achievements over the past months and communicate your strategy going forward.

• Articulate Your Business Strategy--It sounds basic, but an analyst can only know as much about your business as you tell them. You need to be sure that your business strategy comes across clearly and cogently. Relate your business to significant market demands or technology shifts that have created new market opportunities. Describe the benefits you offer customers, not just the technical features. And make your presentation concise by sticking to the big picture rather than getting bogged down in minutiae.

• Think Competitively--While demonstrating your product and sales strategy is important, so is competitive positioning. Analysts specialize in looking at entire markets from the buyer's viewpoint. Help the analyst see where you fit in the larger landscape. Also, think very hard before attempting to create a new category. It takes a lot of marketing muscle--or a truly revolutionary offering--to build industry-wide momentum around a new category. You may be better off creating a unique niche within an existing category.

• Provide Access to Customers--Customers tell your story better than you ever can. They're the third party validation you need to prove that your business strategy works and that your technology and products are for real. That's why it's important that analysts have access to these customers. Even if the customer does not let an analyst quote them directly, the analyst can at least use the information on background. The customers will also be able to provide the hard facts and anecdotes that the analysts need to create reports.

• Cultivate Relationships by Adding Value --It's the analyst's job to look smart in front of their own clients. Analysts need you. Those vendor executives that provide industry insights, background and "word on the street" perspective are valued by analysts more than scripted executives who only talk about how great their product is.

• Keep the Communication Flowing--While your briefing times may be limited, the information flow can keep going. Send analysts periodic updates on your progress through email. Sales wins, management changes, partnerships, acquisitions and product announcements are all part of your corporate picture and will help the analyst get a sense of who you are and where you are going. Have your executive offer perspective and insights on industry news, which will bolster your thought leadership.

Analysts have a lot to offer your company by way of industry research, customer contacts and market insights. While in the past, many analyst firms required customers to take out expensive, all-inclusive contracts, most will now allow you to purchase services in a more a la carte fashion. Not only does this give you more control over your analyst budget, but it also enables you to play to the strengths of each analyst. A strong and comprehensive analyst program can help drive sales, partnerships and penetrate new markets.

I look forward to your feedback on future topics for this occasional series on HCIT PR strategy and tactics.

Posted by Shawn Whalen on April 18, 2006 at 2:30 PM
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The Price is Right. Not .

On April 3 the Wall Street Journal profiled Alan Hubbard, President Bush's point person on healthcare and a leading proponent of healthcare transparency. The debate about price data continues and so does hospital opposition. A cogent nail on the head of the issue in Matthew Holt's blog:

... Painful though it may be for the right-wing free-market crowd to hear this but no patient actually has the hospital "price" that is on the chargemaster paid for their care. Either the hospital is paid a discounted rate organized by the patient's insurer (e.g. the DRG case-rate Medicare pays), or the uninsured pay some fraction that they can--which is the subject of a contentious but separate debate. The relevant number for Hubbard and the consumer payment crowd is, what does the consumer actually pay out-of-pocket for hospital care? And the answer is, even with a high deductible plan, if they go near a hospital they pay pretty much their max out-of-pocket, and then not too much beyond that. And so the hospital's pricing schema is irrelevant to them. Which is why hospitals don't care about what their consumer pricing is and why they find it impossible to explain it.

Posted by Shawn Whalen on April 13, 2006 at 10:31 AM
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Medicare Part D: A New Perspective

Healthcare is pretty serious stuff, so when I saw a hilarious piece on Comedy Central's "The Colbert Show" about Medicare Part D I wanted to share it. Check it out here
and click the "Explanation: Medicare" link three rows down. A good laugh.

Onto serious matters...

Posted by Shawn Whalen on April 12, 2006 at 10:18 PM
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Managed Care: Changing the Anti-CDH

Many years ago when I was in college, Harvard Community Health Plan was my HMO. I have only one memory of them. I didn't need much healthcare then and I don't recall why I was there (probably a general check up). What I do recall is sitting in the waiting room for almost 40 minutes, complaining, and being shown to the examination room. Then waiting another half hour. Being an impatient youth, I hopped off the table and walked down the hall to the offices. I found my doctor in his office, on the phone on a social call. I knew that because I stood in his doorway for a good minute before he noticed me and asked if he could help me. I told him he should have been helping me an hour ago and stalked off out of the building never to return. No surprise, Harvard Community Health Plan went bankrupt and had to be bailed out by the fine commonwealth of Massachusetts (who says socialist medicine doesn't exist in this country?) Today Harvard Pilgrim is a highly rated managed care plan, though I can't personally vouch for it.

Even if the doctor was to blame in my example, I like so many consumers was left with a bad taste for the HMO itself. How health plans treat their members is often the antithesis of the spirit of consumer directed healthcare (CDH). Health plan members often first hear from their health plan for a denied claim or payment request. No wonder they don't have a good reputation.

As media have widely reported, the Federal government kick-started CDH with proposals for HSAs, calls for more technology adoption and launching Medicare Part D. Pundits point out that consumers are gaining risk and increased responsibility, often without the tools and knowledge to make them informed decision makers. An often overlooked part of the solution is health plans, who have a stake with all parties and are a center point of communications.

Many health plans are not up to the task. MCOs have been marketing to employer groups and providers for so long that member/consumer communications have suffered. Take for example Medicare Part D. The often-reported difficulties of Part D are a microcosm of the broader challenges facing healthcare. The ill-prepared senior population had to grapple with a complex issue. Government and managed care's education efforts were weak, and the result was mass confusion and low enrollment.

What are the smart health plans doing to counter this? My uncle recently told me about his conversation with his health plan. They had called to remind him of drug and medical issues around his chronic condition and to check on open reimbursement issues. I was surprised - was he sure it wasn't his doctor or a nurse? No, it was indeed his health plan and the call had been automated, using the voice of a nice older woman. Apparently his MCO, one of the top three in the country, uses automated voice services. My uncle doesn't use the Web, and probably ignores letters as junk mail, so in his case the good old fashion telephone was the delivery mechanism for value-added, interactive information that improved his health while likely helping the MCO's bottom line.

This anecdote is echoed in the sophisticated member communication being done by such payors as Aetna, Unicare, Oxford Health Plans/United and others. An article in Healthcare Informatics explores how these vendors are closing the "information gaps" with their members. It's as much a trust gap as information gap. Aetna's MedQuery program sends e-mails and phone calls to members who have not complied with doctor recommendations. Unicare in Massachusetts followed up with members with chronic conditions, resulting in a much higher rate of best practice guideline adoption. These are smart moves by insurers that can ultimately improve outcomes while at the same time lower costs.

Managed care is due for an overhaul of their member communications. As my client Silverlink's CEO Stan Nowak says, the best plans of the future will be healthcare guides for their members, assisting them through the whole healthcare life cycle. Communications should be proactive and coordinated among the many departments of the MCO. The proper dose of value added data should be delivered at the right moment, instead of a deluge of information that goes unheeded. As so many other industries have proven, technology solutions exist to make this happen. Efficiency in operations can result in better healthcare.

Posted by Shawn Whalen on April 10, 2006 at 4:14 PM
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Blue Book for Healthcare? Read Carefully.

President Bush recently announced that Medicare medical procedure costs will be made public to consumers. Health plans like Aetna are posting hospital charges, and services like Subimo and WebMD are offering cost and quality data.

An article recently in the Washington Post reports on HealthGrades effort to become the Kelley "Blue Book" of healthcare by selling cost data. This is laudable and inevitable as consumer directed healthcare gains steam. Consumers with Health Savings Accounts paying more out-of-pocket expenses will welcome such data. But scratch the surface and this data can be tricky if not deceptive.

Average costs can be deceptive and exclude quality issues. Consumers should be weary of misleading cost averages - cost ranges are more informative. HealthGrades' topics are procedures only and exclude office visits, tests and drugs. Beyond this, the cost doesn't define exactly what is included. Geographic regions, an important factor considering cost trends across the country, are limited. Consumers are wise to ask their health plans about quality indicators and consult additional quality sources.

Medicine is complex, health plans and doctors calculate rates differently, and quality definitions vary. Buying healthcare is nothing like buying a car, and quality can't be graded on a star basis like movie reviews. Only if accurate pricing is coupled with quality reports on doctors and hospitals can consumers make knowledgeable decisions. Otherwise consumers and their wallets will be in for a rude awakening.

Posted by Shawn Whalen on April 7, 2006 at 3:49 PM
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Consumer Health Data Online: Error, Page Cannot Be Found

As RHIOs form and an eventual national health information network is reached, healthcare data will come to live on the Internet. This is ultimately a good thing and necessary to improve care and help reign in costs long term. But according to a recent study by Health Industry Insights, it will take some convincing of consumers.

The survey of 802 insured patients found that one third of respondents were uncomfortable sharing their health information with doctors if it was going to be made accessible on the Internet. Half wanted to control access to Internet-accessible information. Fifteen percent didn't trust their health plans to protect the data.

Not surprisingly, 72% value the confidentiality of their medical information as much as their financial information. Do these 72% think that their financial information isn't residing in private and public Web sites? Like anything else, time and sustained education of consumers will ease their reluctance.

Posted by Shawn Whalen on April 3, 2006 at 9:25 PM
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The Plight of the Small Doc

I recently called my doctor to schedule a check-up and learned he had dropped my insurer. Said payor shall remain nameless, but my small group practice doctor had had enough battling to get paid in a timely fashion. When the job of getting paid is tougher than the practice of providing care, you know something is broken in the business of healthcare.

While the WebMDs, Cerners and Intels of the world are grabbing headlines and joining hands in a healthcare interoperability kumbayah, the majority of doctors in the United States are being left out in the cold. These are the doctors of small and medium-sized practices that comprise 70% of healthcare delivery and who most need technology. Ironically they are also the group least able to afford EMR or PPM technology.

My doctor had a rudimentary EMR that didn't address the reimbursement cycle management that is the financial lifeblood of any practice. This is the boat the majority of small and medium sized practices are in. Hundreds of payors offer thousands of benefit packages, each a little different from the other. Medical practices can't keep pace. The result: claims denied or delayed up to 70-90 days, a payment cycle that would put most companies out of business.

Sure EMR increases doctor efficiency and streamlines workflow, but a truly useful EMR solution gets docs out of the reimbursement management morass with automated coding and payor interaction.

We've all heard solutions to tackle this problem. I agree with what my now-former doctor said: neither the vendors nor government alone can fix healthcare, it will take combined public and private efforts. A few weeks ago at HIMSS, Rep. Phil Gingrey, M.D., (R-GA) recommended tax incentives to encourage EMR adoption. His proposal calls for increased deductions for healthcare organizations that purchase IT. Financial incentives must be in place to motivate the purchase, then the technology must truly yield ROI to maintain its use.

Posted by Shawn Whalen on at 9:21 PM
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Shawn Whalen, Senior Vice President

A PR and marketing veteran and a member of the Schwartz Communications team since 1996, Shawn has extensive technology and strategy experience with both start-ups and established companies. He manages a variety of clients in healthcare IT and communications.

Shawn provides clients with strategic counsel, company positioning and market-influencing messaging. Key to Shawn and his teams' award-winning success is translating complex technologies into compelling business stories. He counseled clients on communications strategy related to mergers/acquisitions and IPOs. Shawn and his teams regularly power hit clients into such media as The New York Times, The Wall Street Journal, BusinessWeek, Forbes, Fortune, CNN, CNBC, network TV and key trade press. Shawn is a multiple recipient of the Publicity Club's Bell Ringer award and Bulldog Reporter Gold award. He also serves on the Healthcare Technology Advisory Board of the Massachusetts Technology Leadership Counsel.

Prior to Schwartz, Shawn was with Cudaback Strategic Communications, where he worked with such clients as Arthur D. Little, PC World, IDG and the Computerworld Smithsonian Awards. Previously, Shawn was account executive with Public Information Resources, a marketing firm specializing in education. Shawn enjoys writing and has freelanced for local newspapers; in 1993 his book Campus Clips was published. Shawn has a B.S. in journalism and a B.A. in English from Boston University.

Though providing commentary on the Healthcare IT Blog for Schwartz Communications, Shawn's commentary may not reflect the views of his employer or co-workers.

Posted by Shawn Whalen on at 9:16 PM

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Posted by Shawn Whalen on at 9:10 PM