Tag Archives: Population Health Management

Signify Premium Insight: MEDITECH’s Expanse-ive Innovaccer tie-up

This Insight is part of the Signify Premium Insights (SPI)-Digital Health service, which will launch on 9 January 2023. From that date, this and all SPI-Digital Health Insights will be available only by paid subscription. Click here for a free one month trial of this service. 

In mid-October, US EHR vendor MEDITECH announced the launch of Expanse Population Insight, a new population health management (PHM) solution powered by Innovaccer.  

The tie-up between MEDITECH, an established tier-1 EHR vendor and Innovaccer, which has a reputation as a PHM/value-based care (VBC) disruptor, is a potentially potent combination.  

But as US hospital EHR buyers converge their procurement around large single-source vendors (like Epic) covering multiple different care settings, what does the future hold for Expanse Population Insight and, more broadly, the MEDITECH-Innovaccer partnership? 

The Signify View 

MEDITECH and Innovaccer both bring plenty to the partnership table. Since bringing the first iteration of its Expanse EHR solution to market in 2018, MEDITECH’s customer base has expanded and its annual revenues have grown. 

The company has carved a solid competitive position for itself, moving away from the point solution model of similar-sized rivals. Unlike CPSI (which only offers an EHR solution for small hospitals) or NextGen and eClinical Works (which offer only an EHR for ambulatory primary care), MEDITECH’s reach is wider and deeper. It serves not only small, independent hospitals (which are its core business) but has also established a foothold among larger health systems and Integrated Delivery Networks (IDNs). Just last month, MEDITECH announced a large-scale Expanse deployment for HCA Healthcare, a large healthcare service provider that manages 182 hospitals and 2,300 care sites across the US and UK. 

With a customer base of around 500 hospitals in the US, MEDITECH now sits behind only Epic, Cerner and Altera Health in the US hospital/health system EHR pecking order. While the company is highly unlikely to unseat its much larger rivals, notably only it and Epic are currently gaining appreciable market share in the US inpatient/health systems/IDNs market (see chart below).  

Innovaccer has a similarly impressive backstory. Its annual revenues have jumped more than five-fold from 2017 to more than $100M in 2022. The company currently has around 70 health systems on its books, and is valued at $3B. Innovaccer has built strong relationships with hospital IT buyers, and is viewed by many as the preferred independent PHM/VBC platform solution.  

Expanse-ive Strategy 

As a data aggregation solution, Expanse Population Insight plays neatly into the integrated care/PHM evolution in the US. Data aggregation remains the biggest PHM revenue driver at present (see chart below) in the US. 

The overall PHM US market is forecast to be worth $10.2B in 2026 ($5.3B in 2021).  

The tie-up also gives Innovaccer a better route to market than it has had historically. Rather than having to reply on selling its solution directly to buyers, Innovaccer can now leverage MEDITECH’s installed base and marketing might via Expanse Population Insight. And in MEDITECH it has a partner which is solidly grounded in the US EHR market covering all main care settings. The relationship has the potential to be expanded outside of the US, into countries such as the UK, where MEDITECH has a sizeable installed base of customers and Innovaccer has ambitions.  

On the face of it, this is an ideal match for both companies. Expanse Population Insight will not propel MEDITECH onto the top table of US EHR, but it will certainly give the current incumbents something to think about, in the short-term at least. There are, however, potential obstacles lurking in the shadows. 

Clouds Gathering 

MEDITECH’s growth trajectory may be impressive, and it may still be gaining market share, but it is still a far smaller player than heavyweights like Epic and Cerner. Without the resources to develop its platform solutions in-house, MEDITECH’s approach has been to seek high calibre partnerships. Hence Innovaccer, and also its early-2022 link up with Google, with the intention of integrating the tech giant’s CareStudio platform into Expanse. 

The Innovaccer partnership carries some risk. While MEDITECH’s core business leans a little more towards smaller, independent hospitals, Innovaccer’s PHM solution is far better suited to an IDN, where it can manage a whole population across multiple different care settings and where the reach into the community is much deeper. This risk might be mitigated by MEDITECH’s healthy roots in larger health systems, but in reality it is nowhere near as dominant as Epic in this. 

The problem for MEDITECH and Innovaccer is that, as much as they have the solutions to sell to the large healthcare systems and IDNs – and in truth there is still a loyal fanbase of hospital IT buyers who prefer independent vendors like Innovaccer – there is a defined shift in procurement towards large, single-source EHR vendors, and in particular Epic. The big IDNs and hospital health systems are very much Epic and Oracle Cerner territory, and there is a real risk that in this environment MEDITECH will lose out in the medium-term. 

It’s Complicated 

The MEDITECH-Innovaccer tie-up also throws up some other intriguing relationship dynamics. For one, it appears to sound the death knell for MEDITECH’s PHM solution collaboration with Arcadia Healthcare Solutions, whose data aggregation platform had been supporting MEDITECH’s Web EHR and analytics solution since 2018. This is clearly good news for Innovaccer. 

As is MEDITECH’s relationship with Google. The tech giant would have seen CareStudio as the first step towards forging a deeper relationship with MEDITECH. This deeper relationship could have offered other opportunities that utilise Google’s abilities to drive insights from data in VBC (e g via its Healthcare Data Engine (HDE) accelerators). The MEDITECH-Innovaccer deal appears to limit potential for future VBC product development between the companies in this area. That said Google and MEDITECH continue to develop their relationship in other areas. For example it recently announced that it was working with MEDITECH in terms of cloud services for Expanse.  

Innovaccer faces relationship challenges of its own, however, again around the broader trend towards consolidation around a single EHR vendor. We understand that some of Innovaccer’s customers, who are fans of the Innovaccer platform, are also supporting the development of Epic’s Healthy Planet PHM platform in order to support a longer-term strategy of IT consolidation around Epic. The assumption is that, once Healthy Planet’s functionality matches that of the Innovaccer platform, some of Innovaccer’s customers will migrate over to Epic. 

Measured MEDITECH 

MEDITECH is taking a measured, partnership-based growth approach. In the short-term, these partnerships will bear fruit and enable the company to compete with its larger rivals, and the Innovaccer tie-up will give it a sharper edge in PHM. While momentum is with MEDITECH and Innovaccer right now, the complex and ever-changing nature of the EHR and Value-based Care IT market in the US means that both will need to continue to innovate to stave off Epic.  

Signify Premium Insight: InterSystems and the great PHM cultural shift

This Insight is part of the Signify Premium Insights (SPI)-Digital Health service, which will launch on 9 January 2023. From that date, this and all SPI-Digital Health Insights will be available only by paid subscription. Click here for a free one month trial of this service. 

In theory, recent contracts that data technology provider InterSystems has secured with two Integrated Care Systems (ICSs) in the UK lays solid foundations for forays into embryonic European PHM markets. But they also raise wider questions on where exactly the UK PHM market is heading, how fast and, ultimately, where the likes of InterSystems fit in. 

The Signify View 

The two recent deals for InterSystems will consolidate data from siloed systems in the North West London and West Midlands ICSs. This is part of a broader drive by ICSs in the last few years to put in place ETL and shared care record solutions, bringing together EHRs from GP/primary care practices, social care councils, hospital trusts, mental health trusts and other hospitals.  

The five-year North West London contract, in partnership with Amazon Web Services (AWS), will enable social care, mental health and community trusts, local authorities and third-parties, to migrate their on-premises workloads to InterSystems’ HealthShare Health Connect Cloud on AWS. Ultimately, it will provide a better view of the health records of around 2.1 million people. Similarly, the West Midlands ICS deal will bring together around 400 health and social care providers from six local authorities in that region.  

While both deals further affirm the success of InterSystems’ HealthShare solution, they should also now be viewed in the wider context of the UK PHM market. 

The PHM Maturity Model (see below) shows the market’s expected evolution over the coming years. Currently, it is still in its formative years, with investment concentrated on data consolidation. Most of this investment has already taken place, thereby limiting the upside potential for the likes of InterSystems in this space going forward. 

Next Steps 

The focus will move to ICSs, Primary Care Networks (PCNs), acute trusts and other primary/community NHS providers examining how to leverage new harmonised patient data pools to support integrated care, and upscale a care management process that is, at present largely manual.  

To date, funding has concentrated on data aggregation tools that give a single view of the patient across different settings. A nice view to have, but not one that will save money for the NHS. The real savings will be in predictive, preventative tools for risk stratification, better care management workflows and clinical decision support. This is where we expect more funding from the likes of the Unified Tec Fund. 

In this regard, vendors and the ICSs say the risk stratification technology (developed by the likes of InterSystems, Oracle Cerner and Orion) is now in place to support the move into predictive analytics. 

Furthermore, PHM lies at the heart of the NHS Long Term Plan, which was launched in 2019. PHM is a critical building block for ICSs, and as a result government IT investment in this area should largely escape the expected swathe of cuts the NHS will be forced to make in the coming months and years. 

But, at last month’s InterSystems conference, we attended presentations by the West Midlands and Cumbria and the North East ICSs. While both insisted they had all the building blocks, and the integrated care records in place, they were unable to confirm when they would, or could, move on to the analytics and predictive phase. We published an insight following the InterSystems 2019 conference (see Insight here), and the narrative does not seem to have progressed much since. 

The Bottleneck

The barriers to progress appear to come from within the NHS at this stage. Achieving the first phase of the PHM journey was relatively easy for the provider, because it did not require healthcare professionals to fundamentally change the way they work. Using aggregated data is a similar process to that which preceded it. With overlay systems, healthcare professionals simply get a better, bigger picture of a patient’s history. The problem now is that, to make use of the more sophisticated tools now being developed, the NHS will have to undertake a cultural shift. It will need to move on from platforms, and invest in people and processes to proactively make use of the tools. This change will not come easy for the NHS. 

The UK healthcare infrastructure at large will also need to adapt to move this process forward. It will not be solely the ICSs responsible for driving change: PCNs will increasingly take the baton to make use of the predictive analytics tools at their disposal, and unlock the market. Given this, it will be PCNs that must be the focus of funding if the PHM market is to move forward at any speed.  

Hand Holding 

So, what is the role for the likes of InterSystems, Oracle Cerner, Graphnet, Patients Know Best and Orion in this PHM evolution?  

In the UK, these vendors have the analytics, care management and health insights-type solutions for PHM available to sell to the PCNs and ICSs when they are ready. In the meantime, however, the vendors will need to identify opportunities to drive new revenue streams. There are two potential ways this could happen. 

First, during last month’s InterSystems conference, we got the sense that the PCNs, ICSs and other stakeholders in the industry need some sort of guidance from vendors on how to take the next steps on this journey. The vendors therefore have an opportunity not just in analytics solutions, but also to becoming more embedded with the PCNs and ICSs to consult on and navigate IT strategies. 

Second, as the various PHM stakeholders work out how to move forward in the UK, Europe could still prove to be a happy hunting ground for data aggregation solutions vendors. Value-based care is in its infancy in Europe (especially compared to the US), and France, Germany and the Nordic countries are all embarking on journeys in this regard. The proven track records and experiences of Oracle Cerner, InterSystems and Orion in the UK could be a welcome springboard for them into new geographical markets.  

Leap Of Faith?

The UK ICS network is establishing a more connected, predictive, preventative healthcare system. This is paving the way for a transition to analytics, which is where the NHS will have real opportunities to save money. 

However, despite many of the ingredients being in place, this process has hit a roadblock. This roadblock will only be overcome if the NHS can overcome entrenched ways of working (and it is very much in its interests to do so), and if all stakeholders in the industry can find new ways to work together to drag the PHM market into a new era.  

The industry is talking the talk, but it is not clear if it is yet ready to walk the walk.

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Aetna

This profile is available to purchase as part of the “Population Health Management IT – North America – 2017”. If you have purchased this report you will find the profile within the report pdf that was delivered to you.

If you have not purchased this report please visit the Solutions page for further information

Cerner

This profile is available to purchase as part of the “Population Health Management IT – North America – 2017”. If you have purchased this report you will find the profile within the report pdf that was delivered to you.

If you have not purchased this report please visit the Solutions page for further information