Thought Leaders in Healthcare IT: Lauren Patrick, CEO of Healthmonix (Part 3)

Sramana Mitra: How common is using a system like yours in a practice? If you took the entire gamut of providers, what percentage does your category of technology have in that spectrum?

Lauren Patrick: There’re 1.4 million providers in the US. What CMS has done is say, “If you don’t provide data to us on this program, we are going to penalize you 9% of all of your Medicare payments in the following year.” We get a very large percentage of providers that participate in this program.

They can choose to do this through their EHR. If they do it through their EHR, their scores will be a lot lower. A lot of times, not all of the data are in their EHR. Half of the providers in the US do it that way just because it’s easy. They get a low score and are happy that they avoided that penalty.

If you do it really well, you can get a 7% commission on all of your Medicare payments. Those are the people that come to us. What we try to do is help them not only get a better quality score but also get a better quality score by improving their quality practice with their patients. 

Sramana Mitra: What is that 6% to 7% incentive? Who gives that?

Lauren Patrick: CMS gives that incentive. For some providers, they’re billing a million dollars a year. That can be a hefty incentive. If you’re an organization of 60 providers, it can be even more. For the orthopedic practice, they receive an $800,000 incentive from this. 

Sramana Mitra: When people are doing your methodology, they are buying a subscription?

Lauren Patrick: Yes, it’s an annual subscription for providers. We work with them each year to build a dashboard and allow them to work on improvements. At the end of the year, we help them send all that data to CMS. 

Sramana Mitra: What percentage of the providers out there are doing this quality monitoring function through their EHR versus a specialty provider like you?

Lauren Patrick: It’s about 50/50. 

Sramana Mitra: That’s pretty good penetration. What do you charge?

Lauren Patrick: Our list price runs from about $250,000 to $700,000 per provider depending on the level of service. If you just want to send your data in and have us send it to CMS, it’s a lot less. When you start looking at some of the data integration, the price goes up.

Sramana Mitra: From where you sit, what are some of the trends and open problems in your industry? If somebody were to start a new company in your space, what kind of problem would you recommend they go after?

Lauren Patrick: The biggest problem that we see from a technology standpoint is interoperability. Every EHR is a commercial venture and they don’t want to share their data with other people.

Patients go to different providers. So, nobody has a complete picture of that patient. Pulling that data together is a real challenge. That’s really the button that needs to be pushed in order to make all of this work a lot better.

Sramana Mitra: Got it. Thank you for your time.

This segment is part 3 in the series : Thought Leaders in Healthcare IT: Lauren Patrick, CEO of Healthmonix
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