HIStalk Mobile Interviews Scott Storrer

Scott Storrer is President and CEO of MEDecision

Scott Storrer

Thank you for joining us today. To get things started, can you tell me a little bit about MEDecision’s history and the evolution of the company?

The company was started in 1988. I’d say, for the first 10 years our primary focus was to sell case management, utilization management, and disease management systems to health payers: many of the Blue Cross/Blue Shield organizations, along with other non-Blues. So for the first 10 years MEDecision really dominated in the payer market.

What we realized about halfway through year 10, was that we had kind of mastered the integration within the four walls of the payer. We really saw the power to begin to make that degree of integration external – i.e. to connect the case manager directly to the physician.

About 8 to 10 years ago we launched a product called iEXCHANGE, which essentially allowed physicians to do online real-time authorizations and referrals, and also to share what I would say, were low degrees of content between the physician and the case manager.

Then, about four years ago we began broadening the iEXCHANGE product and transforming it into a product which we now call Nexalign. It allows us to take payer-based data, and also case management notes, and put it into Nexalign. Within Nexalign, that data essentially bangs up against our proprietary clinical analytics and it identifies gaps in care in a patient’s treatment. Then, depending on those gaps, it puts forth a proactive treatment plan that both the case manager, and also the physician, can follow with a patient.

So if you think about it, our core has been around the payer market. Eight to ten years ago we saw the value of connecting the provider to the case manager. Then, most recently in the last four years, say, really has been the development effort around a product capability called Nexalign. Again, what that does now is it allows us to develop these clinical summaries which we can share back, on a real-time basis, to the case manager in the payer world, and also directly out to the provider.

Last year we acquired a company called Hx Technologies. HxTI was a company that was about 9-years-old that had with it several legacy HIE customers. We acquired the company because we saw the strategic opportunity to begin, on a regional basis, to enter into the HIE space with the ability to stitch together the disparate providers of EMR systems, and also other sources of ancillary data. So it gave us the ability to start bringing real-time clinical information into the Nexalign product and to marry the payer-based data that we have with real-time provider-based data and develop the most meaningful clinical summaries in the marketplace.

So again, we acquired HxTI last year and had fully integrated the company by year end. Then, just before HIMSS in March we launched the new HIE product called InFrame.

What also is important to know about us, when you think of us, we do dominate the payer space today. I’d say one-in-six insured Americans is managed on our platforms. That gives us access, in collaboration with our payer customers, to somewhere in the range of about 45-50 million individuals – medical history and case management notes.

Again, from a data perspective, this is a company that, in collaboration with its customers, is rich in data.

Is it true that most of the information that you have from the payer side, that’s within the context of case management and disease management?

Yeah, it would be that and, essentially, it’s the core claims data, lab, some degree of pharmacy, and then the payer-based case management. So if there’s something unique in a disease management program and a case management program, or unique within the notes for utilization management, we’re also able to bring that into the Nexalign analytical tool.

For years, the best data that’s been out in the market really has been the payer-based data. Where we had a leg-up for years is we actually were able to augment that with the case management notes, broadly. But we got to the point where products, with the power of analytics, can augment that data set with the real-time data that’s coming right from the provider at the point-of-care, so there’s quite a bit of power that brings to treating individuals and creating alerts. If you think about it, a lot of the payer-based data that’s being analyzed out there, generally, is about a month old.

Or, in some situations, we’re working with customers to get a cycle time down to two weeks. If you get to a world where you have payer-based data at about a two week level, and at the same time you have the ability to bring in real-time clinician data and run the rules set against that and create these treatment plans, it’s just that much more actionable.

With InFrame, we have several pure HIE customers. In Philadelphia, Fox Chase Cancer Center has developed the Fox Chase Health Information Exchange which digitally connects the center to its extensive network of partner hospitals and affiliates across the mid-Atlantic region. This allows them to remotely interpret advanced oncology imaging, such as PET/CT, so that patients do not have to leave their communities to receive world class care. It also means that partners can move more quickly to market with the latest diagnostic services, leveraging Fox Chase staff and expertise. That’s an example where InFrame’s standalone. Nexalign also can be sold standalone.

Then, Alineo, as you know, that is our core case management suite of products. Or, I should say the Alineo is the new capability of our legacy product, which was launched two years ago. We’re actually in the process of migrating our customer base over to the new Alineo product, but when you bring them all together is when it’s really powerful.

Now obviously, you guys have some great applications and functionality imbedded into your HIE solution. Are you interested, are you actively looking at initiating the conversation with a region to be a pure middleware provider?

You mean, as far as responding to more of the state HIE bids?

Yes. I mean, are you looking at going after some of the business where you’re not looking at deploying a high degree of functionality on the front-end, but you’re really interested in potentially getting in and being a participant, and sort of connecting the dots.

Oh, absolutely. Again, just a quick commercial on InFrame – InFrame was based on Hx Technology’s legacy product. As we integrated it last year, we made a number of meaningful modifications to the product and then launched it this year as InFrame. There are several market leading aspects to it, which really do create differentiation.

First off, and this is credit to Hx Technologies, but essentially, its founder, Dr. Elliot Menschik, has been very active with all the HIE Connectathons and those types of initiatives for a number of years. He’s been at the Interoperability Showcase at HIMSS. He’s been a key-note speaker on the topic of health information exchange for a long time.

The key there that I want to make with InFrame is today, that product can truly plug and play with anywhere between 80 and 90 of the major vendors that are out there; whether they’re EMR systems for other provider-based systems – Google’s applications, Microsoft, you name it. From an interoperability standpoint, there’s a tremendous amount of flexibility.

The other piece of it is HxTI really cut its teeth on distribution of scans and images, so it kind of grew up as a radiology exchange. To the best of our knowledge, it’s the only HIE infrastructure that is out there today that can transmit a diagnostic-quality image. What’s interesting here is from a state bid perspective, InFrame differentiates again because of its ability to connect. We’re finding the radiology component tremendously meaningful as we’re working through these opportunities. But I would also say that what is of interest to a state is the fact that MEDecision – 4 out of 10 times – has the payer as a customer in that state also; the two kind of go hand-in-hand when it comes to differentiation.

I like the story of HIE vendors who are just very clear about building an open platform. They may offer their own high-value applications to use that information, but they’re also very committed to supporting an open platform and welcoming third-party solutions. Obviously, historically, that’s been a huge limitation.

I tend to think that regardless of what vendors say anyway, if you want to be in this space, I can’t imagine a region investing in HIE and not having it be an open platform.

We’re right with you. It absolutely has to be open. If you think about another way that we differentiate from the other vendors – its support and mobility. One: we differentiate with InFrame because not only can we aggregate the data – go out, hunt it down, bring it in – but again, with the Nexalign product we have the ability to analyze that data. Some EMR companies would say within their four walls they can aggregate the data. They say they have analytics, but I think you know truly, they do not.

So again, what’s great about this is with InFrame, not only can we go into a state situation, but also we’re finding B2B opportunities. You know, Exeter hospital in New Hampshire is a current client of ours and we’re working with their outpatient facilities which run on…one’s on NextGen, one’s on Centricity. I don’t know the third player. I think it’s Epic or Allscripts. Essentially, what we’re doing is we’re stitching all of those systems together for the Exeter hospital system. But really what’s of value for Exeter is not only can we stitch together, but when we bring it together we have the ability to apply clinical analytics to that data; which again, none of those disparate EMR systems really have, to create meaning for the physician use. That’s a pretty important point of differentiation for us.

On mobility, we do agree with your definition of mobility. It’s really, how do you begin to move the data around? One of the things that we are talking with several of the large EMR companies with – now again, we do this with permission from our payer-based customers – but we are actually beginning to pilot pre-populating EMR systems with the payer-based data. Again, if you think about it, if you’re going live on GE’s Centricity system, it takes the doctor a year to maybe two years to get really, any meaningful data into that box, so to say, to create value at a patient interface.

What we can do is we can go back for up to five years and essentially, pre-populate five years of payer-based data into that EMR. Then, at the same time, create a clinical summary. Now again, that’s mobility in a broad definition using the Alineo data that we get from our payer-based customers, running it through Nexalign, and then pushing it into the EMR system. At the same time, once it’s in that one EMR system – as an example, if our HIE solution is deployed within that hospital group – again, once it’s in that one EMR system it can be shared amongst any other system that we’ll connect with. Or, any other HIE that connects into that system.

How usable is the payer-based data? When I say usable, I mean how accessible is it in terms of, are the payers willing to let you push that information in a broader HIE platform? Or, is it only to be used in very specific and strict use cases?

About 50 percent of our customer base tends to be more progressive on the payer side. These customers are the ones that, to be honest, when we go out to market our core care management systems, they now want to hear how we can help them with HIE. So how can we help them? I don’t know how familiar you are with Patient-Centered Medical Home models, but we can help on fronts or situations where the state governments are beginning to force them to interface with state-mandated HIEs.

So the more progressive, kind of forward looking payers are finally saying, “Listen, the dividing wall between payer-based data and provider-based data really has to come down.” That war is over. We’ve got to stop saying one data set is richer than the other, because the reality is neither one is 100% complete. But when you can bring those two together and analyze them at the same time; that is when both of the parties – the providers, and also the payers – are sitting back and saying, “Wow, this is truly impactful.”

There are some instances where plans have been slow to adopt some of our capabilities. I would say the intermediaries are really the pipes here. You’ve got companies like Availity; I’d say Emdeon, RealMed, NaviNet – these are really the claims clearing houses for providers.

Essentially, they’re taking the claim and pushing it through their exchanges back to the payers. We have partnered successfully with Availity, and we’re beginning to talk seriously with one other to have the rights to distribute patient clinical summaries, which Nexalign creates. Even though the summary data won’t be housed in an EMR, as an example, it will go from the Alineo into Nexalign. It then will travel through the Availity pipe to the provider portal within a provider’s office.

So we’re starting to see movement on that end, but actually getting to the end destination with data where it’s stored in an EMR – I know I’m repeating myself – but generally, we only have, right now, acceptance from about 50 percent of our customer base.

Are you looking to do anything in the way of more traditional mobile solutions?

Yes, in our development roadmap we will be resourcing the latter half of this year, and also all through 2011, on how do we begin to plug and play with a lot of the mobile apps that are out there to share this data; whether it’s the clinical summaries all the way through to case management notes, you name it.

The other area that we’re looking big at right now is the whole area of telehealth and telemedicine. From a device perspective – even though these aren’t what you’d traditionally think of a PDA or a cell phone – there are several companies out there now that have whole monitoring devices that are all Bluetooth enabled; which we have interest in because, again, this would give us much greater access to real critical pieces of real-time data that we need to make our clinical summaries that much more powerful.

To be able to pick up a diabetes monitor, in real-time, when somebody’s monitoring themselves in the bathroom after lunch and, in real-time, bring that information via Bluetooth technology into our environment, into our analytics and clinical summaries. And to send alerts out to that person’s family member – whether it’s a child that’s having an issue with glucose levels, for example, which we could share that via a mobile device. Or, it could send an alert right to the primary care physician, which then sends an alert back to the patient’s case manager.

That whole area is really where we’re looking hard right now to go; either on acquisition, or partnership with a device manufacturer and distributor.

Is there anything else that you would like to add? Any final thoughts?

At MEDecision, we’ve been in data sharing now, really, for the past 22 years. But the clinical summaries, which all of our customers’ case managers operate off of, that’s a core competency for us. That’s what we’ve been doing, and that’s really what this company’s been built on – is how do you take that claims-based data and that case management data and, using the analytics, how do you really bring meaningful use to the case manager’s desk?

Really, what we’ve begun to do; and we started four years ago with it, so it’s not like we’re just doing this overnight – is how do you take those same concepts down to the provider world and create that same meaning for them through the use of data? But what’s great about it is we’ve got the tool kit now to not only capture the provider-based data to bring it together, but at the same time, we bring along with that the potential of data on 50-million Americans – depending on customer appetite — to allow us to share that data.

I guess that’s just kind of a re-cap of everything we talked about, but it really is a shift out there right now. I think HIE is what’s going to enable that shift.

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