Epic: Strategy Predictions

The EHR landscape is dominated by a few select vendors. One of those is Epic Systems. There is no shortage of analytical commentary on the strengths and weaknesses of this otherwise secretive organization. This blog will discuss a few potential strategy options for Epic going forward.

• Global expansion: Epic and Cerner are currently in a battle to gain the majority share of the US market. As you can see in the infographic below, Epic is #1 in 22 states and Cerner is #1 in 15 states. A recent survey also found that Epic is poised to gain even more market share due to prominent mind share so there is still a lot of opportunity to be had. As the battle to gain market share in the US is fierce, Epic will also look to move further into other regions to offset the saturating US market. However, a recent deployment at Cambridge University Hospitals in the UK has led to significant financial issues. Epic's premium pricing position has led to the $300m implementation being met with cynicism over the proposal's value for money. If Epic is to penetrate other regions effectively, it will need to find ways to reduce initial cost outlay.

• Solution improvement in interoperability: Despite scoring the highest mark for interoperability among its competitors in a recent Healthcare IT News consumer survey, it remained the lowest scoring element of Epic's scorecard (see below.) This is evidently an industry wide issue that needs to be addressed.

 

• Bolster analytical capabilities with IBM's Watson: Epic has a large foundation of patient data and information. As it continues to gain market share in hosting this information, it will also aim to improve its analytical capabilities to derive real value from this data. Epic's experience with IBM on the DoD bid in working jointly with Mayo Clinic has forged a relationship which will see Epic explore how Watson's cognitive computing capabilities could be applied into Epic's EHR base. 
• Develop mobile health applications: Epic announced in late 2014 that it is building a data center to transition its healthcare IT apps to a cloud-based model due to growing demand. Coupled with this, Epic also announced that it would be working with Apple to develop mobile health applications for Apple HealthKit. Cloud-based health applications connecting healthcare providers and patients to Epic's EHR will improve its standing in the mobility space.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. TechTarget, Infographic: Epic leads Cerner in battle for EHR market, http://searchhealthit.techtarget.com/news/4500250294/Infographic-Epic-leads-Cerner-in-battle-for-EHR-market, 21st Jul 2015
2. EHR Intelligence, Epic Systems Tabbed to Expand Hold of Ambulatory EHR Market, https://ehrintelligence.com/news/epic-systems-tabbed-to-expand-hold-of-ambulatory-ehr-market, 13th Oct 2015
3. Healthcare IT News, Epic EHR adds to UK hospital's financial mess, http://www.healthcareitnews.com/news/epic-ehr-adds-uk-hospital-money-woes, 28th Sep 2015
4. Healthcare IT News, 2015 EHR Satisfaction Survey vendor report card: Epic, http://www.healthcareitnews.com/infographic/2015-ehr-satisfaction-survey-vendor-report-card-epic, 9th Sep 2015

Recent developments at TraceLink

I have recently been looking at the Life Sciences supply chain competitive landscape and in particular, a vendor called TraceLink. TraceLink labels itself as 'the world's largest track and trace network for connecting the Life Sciences supply chain and eliminating counterfeit drugs from the global marketplace'. It has also seen a few interesting developments as of late so here's a top 5 countdown along with my independent analysis, enjoy:

• Targetting the Brazilian market: TraceLink recently formed an alliance with Brazilian based pharma IT services and automation specialist, SPI. The motivation behind this move was to assist life sciences clients in meeting requirements for track-and-trace due in December 2015. Under these new regulations, life sciences organizations are required to have serialized and tracked three batches of product through the supply chain. This will then become mandatory for all pharmaceuticals one year later. TraceLink will benefit from early entry into the market, focusing on this regulation, but will draw attention from competitors eagerly watching how the market situation develops.
• Onboarding industry expertise: In July, TraceLink announced that it had brought three industry experts into its management team: Michael Ventura (Director, Industry Solutions) from GSK, Elizabeth Waldorf (Director, Global Traceability) from AMGEN and Marcel Zutter (Senior Implementation Program Manager, EMEA) from Abbott. Bringing in senior level management with decades worth of expertise at reputable Life Sciences organizations such as these only further validates TraceLink's commitment to the industry and aligns its strategy with market demand. 
• Partnership with the Yankee Alliance: Very recently, TraceLink launched the Yankee Alliance Preferred Partner Program. This enables more than 12,000 Yankee Alliance member pharmacies, clinics, hospitals, care facilities and physician practices to take advantage of reduced rates of its Product Track software in order to comply with the US Drug Supply Chain Security Act (DSCSA.) It makes sense for an organization to adopt the industry standard solution and although interoperable tracking software may not be a priority right now, it may facilitate some trend analysis in the near future to determine best practices for supply chain optimization. 
• Strong Q2 2015 results: Last month, TraceLink announced its Q2 results for 2015 and one of the highlights was that it had added 50 new customers within the quarter, resulting in a 76% increase in quarterly sales bookings and a 128% increase in year-over-year bookings. TraceLink also recorded a 178% year-over-year staff increase in Q2, exhibiting its growth potential. Growth in sales is primarily down to regulatory compliance pressures and although the full list of clients is not publically available, their expansion into Brazil is a definite contributor to these impressive figures.
• Nexus '15: TraceLink will be holding a track-and-trace event later this month to bring together experts and leaders from various disciplines to discuss track-and-trace strategies. Two major themes emerge from this announcement as TraceLink look to delve into how the Internet of Things (IoT) and Mobility will impact regulatory compliance. It will be interesting to see how TraceLink will prepare and react to the evolving regulatory landscape as new workflow processes become standard.

Many thanks for taking the time to read this blog. As always, if you found it useful and/or interesting, please share this on social media and if you have any comments or questions, please feel free to leave them below.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

Is "sharing" really "caring"?

The Telegraph recently published an article based on the announcement that high street pharmacies will be given access to NHS medical records in a move that has provoked privacy campaigners. There are arguments both for and against this move, which I have listed below:

Con

• The process: A large part of the argument against this move is the way in which national policy has been implemented. The test sample on which this policy was based came from just 15 patients. This is very difficult to justify and unfortunately adds to the already significant level mistrust in policy makers.
• The hard sell: There is concern that giving access to sensitive data to large commercial high street pharmacies will lead to the targeting of vulnerable patients with hard sell tactics. Despite the likes of Tesco stating that they would never use this data to market to customers, campaigners are not convinced.
• Confusion over guidelines: The results of the small sample found that pharmacy staff were confused about getting consent from patients before accessing sensitive data. This issue needs to be addressed to avoid data breaches and misuse due to human error or lack of training.
• Data security: Another concern from patients is that loyalty cards may be linked to personal medical records. The number of healthcare data breaches in the past leads to concerns that as medical data would now be bundled with other personal data held by the retailer, the combined value of this data would become more attractive to hackers.
• Confidentiality: One of the most fundamental arguments against this move is that there still remains a large portion of the population who simply do not want to share their data. The NHS has tried to calm these concerns with the insistence that pharmacy staff gain permission before viewing this data but undoubtedly a lot will still be unhappy that they have access to it in the first place.

Pro

• A necessary step: The ultimate goal is for a fully integrated healthcare ecosystem whereby insurers, providers, pharmaceutical companies and indeed the patients work together to improve the health of individuals and the nation. There are a lot of benefits that come from sharing, accessing and utilizing data (especially in mass) but with data kept in silos, this is simply not possible.
• Results of the sample: Although the sample used was incredibly small, the results “proved extremely beneficial”. These benefits have come from individual sites and so if used on a national level (a la population health), economies of scale would be achieved as well as leveraging analytical capabilities to improve healthcare delivery.
• Personalized service: Enabling access to medical data will promote a personal and customized service for the individual patient. A personalized service which aims to improve the health of the population will ultimately also lead to cost savings for the healthcare ecosystem. The bargaining power (although often criticized) of large retailers such as Tesco could also lead to lower pharmaceutical costs.
• Less pressure on family doctors: NHS England claim that sharing medical data with high street pharmacies will ease pressure on family doctors. Doctors will benefit from better processes as well as having a clear view of what pharmaceutical products have been purchased. It's also important to consider that the flow of data should not be one way and can benefit providers as well as pharmacies.
• Reduction in improper medication: A comment on the article also pointed out that some patients may struggle to remember the types of medication they are taking as well as the dosages. With high street pharmacies able to access your file (with your consent), this will reduce the number of instances of patients purchasing and taking the wrong medication or under/overdosing.

Regardless of the criticisms of this rollout, with the right regulations, safeguards and guidelines in place, many commentators believe the personal and social benefits will be become apparent very quickly.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. The Telegraph, Boots, Tesco and Superdrug to get access to NHS medical records, 09 Aug 2015, http://www.telegraph.co.uk/news/health/11790711/Boots-Tesco-and-Superdrug-to-get-access-to-NHS-medical-records.html

What can we learn from the Cognizant-Health Net situation?

For those following the healthcare IT market, you will more than likely already be aware of what has happened between Cognizant and Health Net. For those who are not, I shall quickly set the scene. 

In August 2014, Cognizant won a seven year, $2.7b engagement with California-based care management provider Health Net. Service was due to commence in the second half of 2015 but in July, it was announced that Centene Corporation was intending to acquire Health Net, which would delay the contract until after the merger had been completed and may not even go ahead at all due to the overlap with Centene's current IT services vendor landscape. Cognizant instead was able to extend its existing applications outsourcing (AO) and business process outsourcing (BPO) services for Health Net out till 2020 at a value of $520m as well as being able to licence some of Health Net's IP.

So what can we learn from this?

All IT service providers must be on red alert: The chart at the top of this page was produced by Everest (link to the article at the bottom) and shows how deeply entrenched IT vendors are within Healthcare Payer organizations. This chart acts as a warning to all vendors that they should be wary of their current client base and how it could potentially be affected by a merger/acquisition.

The Healthcare Payer ecosystem is shrinking: Centene's intent to acquire Health Net is just one of a series of acquisition announcements in the Healthcare Payer market this year. This was followed by Aetna's $37b purchase of Humana as well as Anthem's $54b purchase of Cigna. Suddenly, we're faced with a market where the top 7 have consolidated into a top 4 in a matter of weeks. There's even speculation that UnitedHealth Group may put in a counter offer for Health Net, which, if higher, would dissolve Centene's offer. These deals have been driven by market changes such as the Accountable Care Act (ACA) and the Supreme Court’s recent decision to subsidize poorer Americans. Keep an eye on UnitedHealth Group to see what its next move will be.

Consolidation equals both opportunities and threats for IT service providers: Although Cognizant's deal may have gone sour after the announcement, it looks as though they will survive after renegotiating the existing AO & BPO contract. As other Payers consolidate, existing deals may come under threat and clients may look to consolidate their vendor landscapes but new opportunities will arise as the newly merged organizations require IT support to ensure the transition goes smoothly and that IT systems are integrated properly.

Thank you once again for taking the time to stop by, I hope you found this interesting and thought provoking. If you have any comments, feel free to leave them below and share via social media.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Everest, Health Net – Centene Merger Leaves a (Slightly) Bitter Pill for Cognizant, 6th July 2015, http://www.everestgrp.com/2015-07-health-net-centene-merger-leaves-a-slightly-bitter-pill-for-cognizant-sherpas-in-blue-shirts-18205.html

Top 3: UK Coordinated Care Findings

Care Coordination is a key concern in the UK healthcare landscape as it is globally. The need for systems to be integrated in order to reap business process benefits as well as capitalizing on the sheer mass of data that healthcare organizations produce on a daily basis is driving healthcare providers to seek out assistance from IT service providers to not only establish an integrated infrastructure but to also guide them through the possibilities of what value can be attained through this exercise. Today, I look at three characteristics of the UK healthcare ecosystem and its current status with coordinated care.

1. Healthcare providers struggle to coordinate care outside of the hospital: Between 2013 and 2014, the National Survey of Bereaved People (VOICES) was commissioned by the NHS to assess experiences of care in the last three months of patients' lives. The key point that stood out the most in my opinion was that healthcare providers struggle to coordinate care when the patient is outside of their usual care setting whether that be a hospital or at home. By no means is there a lack of technology in this area to enable coordination as there is a multitude of devices and means of communicating between care sites. The healthcare ecosystem however struggles with streamlining, integrating and standardizing workflow processes and in conjunction with telehealth technological developments, this is where IT service vendors need to be able to add value to their clients and ultimately their patients.
2. The introduction of the NHS vanguard sites demands care coordination: In January 2015, the NHS launched a program inviting individual organizations and partnerships to apply to become 'vanguard sites'. These are, in essence, test cases for new models of care going forward. Looking at the requirements set forth by the NHS, it is clear that success will not be possible without coordinated care. Throughout the ideologies of what the new models of care will look like, we see direct references to becoming an "integrated provider", having a "joined-up electronic health record" and using "patient population segmentation". In fact, the description of 'Enhanced health in care homes', even references how new telehealth technologies can be applied to provide better care. Together with MarketsandMarkets' forecast that the Population Health Management market will grow at a staggering 26% CAGR between 2013-2018, this further supports the need for IT vendors to sharpen up their integration capabilities and offer solutions that genuinely deliver coordination across the IT landscape.
3. The NHS is investing in support for harnessing technology such as interoperability: On the 31st July 2015, the NHS published a support pack for all vanguard sites. In section 5 of this document, it speaks to what will be made available for participating vanguard sites. Apart from a £200m transformation fund (of which around £140m remains unallocated as of this blog post), they plan to provide dedicated support for items such as interoperability, information governance and digital strategy. They are also looking to leverage best practice examples both from within and outside of the UK and so IT vendors will need to ensure they have solid case studies to back up their sales pitches.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Office for National Statistics, Statistical bulletin: National Survey of Bereaved People (VOICES), 2013, http://www.ons.gov.uk/ons/rel/subnational-health1/national-survey-of-bereaved-people--voices-/2013/stb---national-survey-of-bereaved-people--voices-.html?format=print
2. NHS England, New care models – vanguard sites, http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/
3. MarketsandMarkets, Population Health Management Market worth $40.6 Billion by 2018, http://www.marketsandmarkets.com/PressReleases/population-health-management.asp
4. NHS England, Vanguard support package launched, 31 July 2015, http://www.england.nhs.uk/2015/07/31/vanguard-support/

Accenture: Using terminology as a competitive differentiator

I'd like to reference two articles in this blog post if I may. The first was written by Stuart Lauchlan of Diginomica entitled 'Don't mention the outsourcing, but dig deep into digital at Accenture'. In this article, he credits Accenture with entering the 'digital' market early as it is now reaping the rewards of strong, consistent growth. Lauchlan later goes on to recall how Pierre Nanterme, Accenture CEO, chose to abandon traditional terminology such as 'consulting' and 'outsourcing' as he believed they did not represent Accenture's true capabilities. My initial reaction to this is that it was a clever and easy move to make. Although there has been significant changes in the IT world, does Accenture still outsource? Yes. Does Accenture still consult? Yes. Nothing has changed drastically, yet it has re-branded its marketing strategy to align itself with market demand.

The second article I'd like to refer to was written by Varun Sinha entitled 'How Accenture Has Emerged as a Threat to Infosys, Wipro'. Like the former, this was written following Accenture's quarterly earnings announcement and it goes on to describe how Accenture's growth both signaled a growing market for India-led vendors but also increased competition as Accenture continues to grow faster. It is touched upon briefly in this article but what struck me was the notion of whether Accenture's decision to abandon traditional terminology was a way of differentiating itself from traditional, India-led competitors.

Instinctively, when you hear the word 'outsourcing', it leads you to the thought of reducing operations in one country in favor of a lower cost country. This fundamental thought process was originally a competitive differentiator for India-led organizations but with Accenture's repositioning of terminology, it can now bask in the perceived imagery of higher value services at a premium.

Finally, I looked at relative R&D spend statistics among some of the largest IT services vendors to see whether this repositioning was potentially supported by investment. Although it doesn't go into detail of how R&D was spent, Accenture's R&D spend as a percentage of its annual revenue rose from 2.01% (2012) to 2.50% (2013), a rise of over $150m, before settling back down in 2014. Other vendors had either reduced/maintained R&D spend or increased its percentage as part of a lower annual revenue whereas Accenture saw a rise in both. Although not conclusive, this suggests that Accenture could have invested in digital technologies to support its marketing efforts.

I commend Accenture for the foresight to take this step. The question I'd like to leave you with is this: 'Which era will we be entering next?' Maybe 'virtual services' for example? I'd love to hear what you have to think so please leave your comments below and if you've enjoyed reading this post, feel free to share it on social media.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Diginomica, Don’t mention the outsourcing, but dig deep into digital at Accenture, http://diginomica.com/2015/06/26/dont-mention-the-outsourcing-but-dig-deep-into-digital-at-accenture/#.Va0P7PlViko, 26th Jun 2015
2. NDTV Profit, How Accenture Has Emerged as a Threat to Infosys, Wipro, http://profit.ndtv.com/news/corporates/article-how-accenture-has-emerged-as-a-threat-to-infosys-wipro-775537, 26th Jun 2015

Analyzing the Genpact Payer infographic

I recently saw an infographic from Genpact (available here) on the top concerns for Payers and found it very interesting and insightful. The survey was conducted across 920 senior executives in Payer organizations in North America.

The survey found that the top three concerns were: Compliance, Customer Satisfaction and Cost Reduction. It then goes into what solutions Payers believe would have a material effect on these concerns. At this point, I'd like to present the data in a slightly different way. The table below shows the percentage of survey respondents who believe that the solution on the left can have a material impact on the top three concerns at the top.

* Colours represent heat mapping from low response % (red) to high response % (green)

There are several ways of looking at this but one of the biggest takeaways for me personally is in the BI & Analytics row. 

Almost 3/4 of survey respondents believe that BI and Analytics can help reduce costs. This may not be where your eye is immediately drawn to from this table but when you read further down, it then shows you that Payers' BI & Analytics capabilities are still viewed as immature by almost a third of respondents and that 40% believe they are unprepared. It seems as though, even across industries, we have only just scratched the surface of what is possible through the use of analytics and so it is understandable that Payers will require support to achieve the full potential of this solution area.

If we work our way down the infographic, we then see that 51% of respondents believe that an improved use of Information Technology can have a material impact on the function and that 70% have initiatives underway in BI & Analytics. Although this is a large percentage, why isn't it higher? Presumably, some Payers are holding back to see what lessons are learned by early adopters but at this stage, surely they are risking falling behind the pack. 

If we finally look at the last two rows, interestingly we find that respondents do not believe that BI & Analytics doesn't necessarily require Business Process Re-engineering or Advanced Organizational Structures. Other areas such as Customer Service and Claims Processing & Adjudication score much higher as necessary for improvement.

If we therefore look at BI & Analytics in its entirety, in regards to this infographic, we see that the potential value to the Payer is huge as is the opportunity for IT vendors to support them in making this a reality. 

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Genpact, Healthcare COO’s untapped strategic lever: Advanced operating models, http://www.genpact.com/docs/resource-/healthcare-coos-untapped-strategic-lever-advanced-operating-models