Multi-Specialty Medical Group CEO Details Reasons for EHR Switch

Prime Healthcare, an 80-provider multi-specialty physician group based in West Hartford, Conn., recently made the difficult decision to switch EHR vendors. In an interview with Healthcare Innovation, Susan Albano, M.B.A., Prime’s CEO, said the move is driven in part by the need to succeed in value-based care.

Healthcare Innovation: Before we get into the EHR switch, could you tell us a little about Prime Healthcare’s history?

Albano: Prime was founded in 1998 by a group of primary care doctors in the Hartford market. At a time when there was a lot of capital investment coming in to buy practices, and hospitals buying practice, they were passionate about staying private.

The initial concept was for our primary care group, but at the time, there were some pulmonologists, endocrinologists and gastroenterologists who were double-boarded and were doing primary care. They were brought into the practice. We have since evolved into a true multi-specialty group.

HCI: Could you talk about your previous health IT experience? Were all those specialties on the same EHR or a variety of EHRs?

Albano: Prior to 2015 we had a mixed bag. Some of the providers were on an EHR; many were still on paper. In 2015 we all went onto a hospital EHR. So then it was a requirement at Prime.

HCI: Which hospital system were you connected to for that?

Albano: Trinity Health of New England, which is one of the ministries of Trinity Health.

HCI: Were there some pros and cons to staying on that EHR?

Albano: About a year and a half ago, Trinity announced that they were going to move everyone nationwide, all of the Trinity network, onto a single instance of the EHR. Since 2015, we’ve optimized our EHR for our needs as best we could. The new instance is going to take away all that optimization, so we felt we would be going back into what we consider the dark ages. We were going to lose functionality that we had spent quite a bit of time putting together, and it was a much more rigid system to begin with, now becoming even more rigid.

HCI: So you started looking around at what your alternatives were?

Albano: I had honestly been looking at athena for many, many years. My late husband was a physician who was a very early athena user. I was very familiar with the company and with the EMR. Honestly, the only reason we had not gone to athena earlier was because we were receiving a subsidy to be on the hospital-based EMR. It was a financial decision to continue with the EMR that was meeting our basic needs, plus a little bit more. When this happened, we just said we have to have a system that will meet our needs; otherwise we won't survive in the in the environment that we find ourselves in.

HCI: When will you go live on athena?

Albano: December 3 is our go-live date. We're in the build phase right now.

HCI: What are some features of athena that seem like they're going to be helpful to your clinicians?

Albano: The biggest thing for us is that we fully embrace the value-based environment, so all of our contracts now have upside and downside risk. From my perspective as a practice leader, there are really three main components of succeeding in value-based care. The first is provider engagement. You need to have providers who are willing to work in this environment. The second is you have to have good contracts with the payers. But the third, and really the most important to optimize your experience, is you have to have access to data — usable, reliable, available information that will help us manage our patients. Athena was our best option for that.

HCI: The Trinity EHR is an Epic system, so that had to have some interoperability benefits. Is athena promising you can get the same flow of data with other hospitals and providers?

Albano: Yes, and that's critically important to us. You know, just because you're on one instance of Epic doesn't mean we communicate with other instances of Epic. We felt that athena has the information transfer capabilities and the interoperability that we are not going to lose the functionality we have had in Epic.

HCI: Is there any challenge with getting all the legacy data out of one system and into the other?

Albano: I would say yes. Because the hospital is going live on their new instance, they're obviously very busy, so yes that will be a challenge. But we have the right people doing it, and on the athena receiving end, we feel very confident about how the data is going to come in, how it's going to be organized, and how we’ll access it.

HCI: Is another one of the benefits having more configurability to the needs of the individual physicians?

Albano: There's so much flexibility with athena that we've never had in our legacy system, and certainly we would have had even less going forward. There are so many enhanced options that will help us in our new contracts. For instance, in our GI group, the recalls for colonoscopies. Athena has this seamless system where they can send out notices in primary care. It's important that we have a touch point with all our Medicare patients at least once a year. There are so many features of athena that are going to make our life easier.

HCI: Does Prime have a robust IT team and leader who can help make these decisions? Or do you run a pretty lean operation?

Albano: We do run very lean. We have always outsourced our IT to the hospital. But we were lucky enough that the retired CIO from our hospital system happens to be a friend and lives in the area, and she has been consulting with us and is working for us on a part-time basis to help drive this. It is one of the challenges we face. We are going to have to change our system and probably hire someone to manage these functions going forward.

HCI: You mentioned being in these upside/downside risk arrangements, in your contracts. In Connecticut are the commercial payers pretty advanced in thinking that way, because not many medical groups around the country would tell us that all their contracts are value-based.

Albano: Well, of course, Hartford, Connecticut, is considered the naton's insurance capital. It doesn’t mean they're always on the forefront of these things. But I have found that, yes, we have been in value-based agreements for many years now. And, you're right, when I travel around the country and talk to some of my peers, I'm shocked to find out that they're not there. We've been in downside risk with Medicare for five years now, and we just this year entered some downside risk agreements with some of the other commercial and Medicare Advantage players. So I would say this region seems to be a little bit in the forefront. We’re looking forward to primary care capitation. We're looking forward to new models. Again, without, the proper engagement, the proper contracts, and, more importantly, the proper information and the tools, we won't be able to get there. So athena is that tool that we see serving us now, but also into the future.