Get documents about "Buying Rx Medication Health Care Home Business
W
Description
Buying Rx Medication Health Care Home Business document sample
Document Sample
Leveraging HIT for
Medication Management
Community Health Information Exchange
Medical Office Perspective
Prepared by:
Michael Lake, Circle Square, Inc.
Presented for CalRHIO by:
David Murphy, SureScripts
david.murphy@surescripts.com
Circle Square Inc. Confidential 1
Topics
1. The state of key HIT initiatives today: technology at the point of care
in the physician practice
2. HIT market segmentation and vendor strategies
3. The drivers for the increased momentum of HIT versus a few years
ago
4. Leveraging advanced HIT (PHR, EHR, eRx) to enable RHIO
medication management objectives
Circle Square Inc. Confidential
2
Technology at the point of care
Physician Practice
Engaging the Environment
Practice Electronic Medical
Management Record
Physician
Pharmaco RHIO
Registration Notes Org
Scheduling Charge Capture Health
Exam Room
QIO PBM
Front Desk
Plan
Billing / Collections Labs
Clinical
Accounting Prescribing Pharmacy Hospital
Lab
Internal Workflow and Messaging
Communications to External Systems
Data Storage and Reporting
With
Back Office
Consumers, Patients, Members
Circle Square Inc. Confidential
3
HIT Market Segmentation and
Vendor Strategies
Circle Square Inc. Confidential 4
Companies providing solutions to physician practices can
be segmented by their business strategies
Multi-market Focused Niche Complement
Hospitals / health plans Physician practices ERx PHR
Pharmacies EMR PMS E-visits
Physician practices EMR/PMS Bundles Physician portal
Examples Examples Examples Examples
Cerner NextGen DrFirst CapMed
McKesson PMSI AthenaHealth RelayHealth
WebMD eClinicalWorks MedPlus Verizon
Circle Square Inc. Confidential
5
Multi-market strategists are the largest companies with
the best reach; they are now fast-following into
physician practice EMR and ERx markets
Segment Characteristics and Dynamics Key Companies
Leveraging hospital and health systems relationships into Cerner (Power Chart
ambulatory physician practices Office)
Hospitals and Automate hospital-owned practices and clinics (EMR) GE Healthcare (Logician)
Health Systems Support hospital to physician linkage programs with affiliated and McKesson (Horizon
Technology aligned practices (Lab and EMR) Ambulatory)
Providers Support health systems engagement with RHIOs Siemens (NextGen)
Physician’s with EMRs are more likely to support implementation IDX (Allscripts)
of CPOE in the hospital A4 Health (HealthMatics)
Historically large PMS companies have been EMR laggards
WebMD (Medical
Legacy Practice Protecting large, legacy client bases Manager)
Management Takeouts by EMR/PMS combinations have created recently Misys (Medic)
System (PMS) more effective clinical systems strategies
Acquirers Cerner (VitalWorks)
Little historical customer intimacy, now improving with EMR
IDX (GroupCast)
Pursuing multi-market strategies
Pharmacy Services Automation of retail pharmacy operations McKesson
Providers Pharmacy claims adjudication NDCHealth
Clinical laboratory
Others with HIT Quest (MedPlus)
Pharmaceutical manufacturer
assets Caremark (iScribe)
PBM
Circle Square Inc. Confidential
6
Focused strategists have solid EMR offerings with
weaker ERx functions than niche players; and
differentiate by target practice size and architecture
Segment Characteristics and Dynamics Key Companies
Leaders are fast-growing, with national distribution, some publicly traded
with market caps over $500 million Epic Systems
Larger Practices
Comprehensive and sophisticated solutions and services NextGen (QSII)
(20+ clinicians)
Large groups and IPAs buying for efficiency and strategic positioning Allscripts (MDRX)
Looking to expand into other markets including smaller practices
Also a growing segment (word-of-mouth) although companies with more
Smaller Practices limited reach and access to capital A4 Health (mid)
Mid-size (5-20 Many with mature products, developed over years, generally on PMSI (mid)
clinicians) Microsoft Windows platforms DOCS (small)
Smallest (1-4 Sales and services costs create obstacles to growth
clinicians) e-MDs (small)
Spending time with customers, however, increases intimacy
Formed to leverage the cost and service aspects of the Internet,
particularly for smaller practices
Functionality now competitive with more mature products with awards eClinicalWorks
from TEPR, KLAS, TETHIC, ACGroup, F&S
SynaMed
Web-based Dynamics center around “just right” sized services balancing efficiency
with customer relationship Bond Medical
Can more easily modularize functions, e.g., sell a prescribing-only option MedPlexus
Early stage companies with limited distribution make attractive
acquisition or partnering candidates
Circle Square Inc. Confidential
7
Niche strategists deliver the best functional solutions,
but many are struggling with the niche business model
Segment Characteristics and Dynamics Key Companies
Focus on ERx and frequently with minor additional functions, sometimes DrFirst
completely unrelated InstantDx
Electronic New scripts, renewals, DUR, formulary, RxHub and SureScripts
Prescribing ZixCorp
Generally early stage with unproven business models and limited reach Gold Standard
Acquisition targets by EMR, PMS (below) or new entrant Media
Focus on billing and collections either as software solution or as a service
priced as a percent of billings
athenahealth
Billing and Some serve a local area while some are national in scope
Lighthouse Medical
Collections Web-based solutions are emerging as newest entrants
(PMS) Local billing
Most are moving toward clinical systems, with ERx as an early opportunity
services
Relationships between billing services and web-based products represents
a major opportunity in the market
Focus is on a modular collection of niche products, positioning as “EMR lite”
Generally targeting larger practices, IPAs and health systems HealthVision
Most modern bundles are web-based platforms that also have appeal as Axolotl
Bundles
RHIO enablers. MedPlus
A variant of this model is likely to emerge to serve smaller practices in pay- Wellogic
for-performance programs
Circle Square Inc. Confidential
8
Complement strategists use their solutions to add
value to third party products by (1) attaching to them
or (2) providing infrastructure to support them
Segment Characteristics and Dynamics Key Companies
Focus on consumer personal health record
CapMed
Managed by patients and families, but also can be fed by EMR
FollowMe
Personal solutions (medications, lab results, etc.)
Health Record WebMD (Health Manager
Most mature EMR solutions include some form of PHR
PHR)
Variants include solutions like consumer medication
Various EMR extensions
administration support
Focus on extending the physician-patient relationship through
email services
Historically weak business model Relay Health
E-visits
Some health plans are paying for electronic visits Medem
In this model patients may request refill authorizations from
physicians
Focus on communicating directly with physicians through ePocrates
browser and PDA technologies
Physician WebMD (MedScape)
Areas of focus are medical content and reference information
Information Skyscape
Pharmaceutical manufacturers and payers have increasing
interest in these platforms for e-detailing
Circle Square Inc. Confidential
9
Complement strategists use their solutions to add
value to third party products by (1) attaching to them
or (2) providing infrastructure to support them
Segment Characteristics and Dynamics Key Companies
Stakeholder owned companies and public companies with different but
oftentimes complementary goals SureScripts
Clinical transactions (lab, Rx and referrals) are the focus as growth in RxHub
medical claims processing stalls in a mature market ProxyMed
Connectors
Cross-connections and alliances tend to evolve over time within the WebMD
segment NDCHealth
Technical and business standards are key conversations MedPlus
The Internet has a commoditizing influence
Large companies serving as prime contractors for major healthcare IBM and HealthLink
projects Accenture and CGEM
Integrators Global healthcare experience EDS
Increased consolidation among major players CSC
Increased investment in healthcare projects Perot
Initiate (MPI)
Tools companies are in the center of the evolving RHIO market
Quovadx (Integration
Providers of structured clinical content play a more important role as engine)
Tools health outcomes are part of pay-for-performance initiatives
First Databank (Content
Speech-to-text has improved to become a part of many clinical database)
products
ScanSoft (Speech-to-text
Circle Square Inc. Confidential
10
Technology Adoption Life Cycle segments adopters by
characteristic buying habits; it also models adoption over time
Pragmatists
Visionaries Conservatives Products get stuck at the entrance to the
Enthusiasts Laggards mainstream market
The early market is willing to put lots of effort
Large Practice EMR into making a product work
The mainstream market requires a whole
Small product
Practice EMR – Does 100% of the job
– Has a compelling value proposition
ERx
Large practice EMR has crossed the chasm
Mainstream Market into the mainstream
Small practice EMR and ERx are getting
Chasm prepared for the crossing
Category % Characteristics Buy For
Enthusiasts 2.5 Venturesome – Cosmopolite – Dispersed contacts – Tolerance for uncertainty Technology
Visionaries 13.5 Opinion leaders – Integrated into social system – Judicious and successful use Product
Pragmatists 34.0 Deliberate – Interconnected with peers – Just ahead of average Market
Conservatives 34.0 Skeptical – Driven by economics and social norms – Low tolerance for uncertainty Company
Laggards 16.0 Traditional – Relatively isolated – Suspicious – Precarious economic situation
Sources: Moore, Crossing the Chasm, Rogers; Diffusion of
Innovations; Gladwell, The Tippling Point Circle Square Inc. Confidential
11
Drivers
1. Government 4. Maturing whole products
– CMS and MMA: ERx standards and – 130,000 physicians plus extenders
DOQ-IT – Large practice tornado
– NHIN and RHIOs: community pilots – Keys to adoption in smaller practices
and big tech involvement • Right equipment
– State initiatives and additional • Integration with PMS, PBM, retail
proposed federal legislation • Personalization: e.g., favorites
2. Other payers: health plans, PBMs, • Medication history
large employers • Focus on workflow
– ERx projects 5. Consumer health
– Pay for performance projects – PHR appeal to health plans, hospitals,
– Clinical history pharmacies, consumer orgs, techs,
physician orgs, manufacturers
3. Other healthcare stakeholders – E-visit technology emerging as PHR
– Providers: physician orgs and hospitals extension and integration
• EMR standards – Patient compliance and persistence
• Clinical integration and smaller support is core value
practices model
• ED links medication history
– Pharmacies
• Medication history
• MTMS
Circle Square Inc. Confidential
12
Leveraging ERx, EMR and PHR technologies to enable RHIO
medication management objectives (patient compliance and
persistence programs, medication history, e-Prescribing)
Physicians rate medication history and patient compliance functions highest among
reasons to adopt clinical solutions
All healthcare segments moving toward consumer health and patient compliance and
persistence (health plans, retailers, leading technology companies)
Focus on chronic conditions: hypertension, diabetes, CHF, asthma, depression, etc.
fueled by obesity data
HIT allows for patient interventions throughout the medication cycle: at initial
prescription; at first fill and refill; at renewal authorization
HIT allows for combining ERx, EMR and PHR technologies into a coordinated
program of patient education and reminders easily integrated into current efforts
HIT allows for collaboration throughout the community of care between patients and
care givers: in the practice, at the pharmacy, with the health plan, in the hospital and
at home
Future HIT opportunities include the Continuity of Care Record (CCR) which enables
a dramatic increase in clinical record sharing for outcomes research and care
management
Circle Square Inc. Confidential
13
The whole product concept for electronic prescribing
outlines those elements attractive to the mainstream buyer
and will facilitate Medication Management over time
Integration with True connectivity to
existing systems community pharmacy
(PMS and EMR) enabling renewals
Support for Integrated physician
implementation and practice to pharmacy
ongoing workflow
Core ERx
New Scripts
Clinical alerting (drug-
& Renewals Training for
to-drug) professionals and staff
Connectivity to PBMs
Broadband and WiFi for formulary and
medication history
Circle Square Inc. Confidential
14
Related docs
