Jason Mabry is founder and CEO of Optimum Healthcare IT of Jacksonville, FL.
Tell me about yourself and the company.
I started my career in the healthcare industry about 10 years ago. Before that, I worked in the information technology industry. I’ve been focused for the past 15 years on consulting services and the last 10 on healthcare providers.
Along with my business partner Gene Scheurer, we started Optimum in 2012. We have built a company that has grown to over 500 consultants servicing about 75 healthcare systems nationwide. Our services include advisory, EHR implementation, training and activation, Community Connect, security, analytics, and managed services.
What consulting services are you finding are most in demand?
I’ve seen the trends and the evolution of service lines over the last 10 years. When we first started the organization, our clients were looking to us for implementation work. Implementation work was the focus and still is. Systems consolidate and form super systems. Clients are updating their EHR platforms and sunsetting old ones. That work continues.
I’m asked all the time, "Is this a short runway? Do you see this ending in the next two years?" I’ve been saying no for 10 years. All our clients are involved in some degree of implementing, optimizing, or upgrading.
Implementation work has been our bread and butter. We’ve been involved in all phases of that life cycle. From advisory services — where we assist clients with the associated cost and planning around implementing their EHR — to the implementation and build work and eventually the go-live and training.
Over the last two years, we’ve been developing services lines to help our clients prepare for the challenges they face in the coming years. The implementation piece is still there, but clients are looking to the future. They’re thinking and planning how to successfully transition to a value-based care model. They’re thinking about analytics. They’re thinking about Epic Community Connect.
Our focus and our value lies not just with providing key resources to support implementations, but working with and advising clients to proactively prepare for the future — regulatory changes, technology innovations, patient-driven healthcare choices, shrinking margins, and much more.
We’re also strongly focused on managed services. Healthcare organizations have spent an enormous amount of capital on implementing their EHR systems and understandably want to protect the investment. They’re finding, however, that the traditional means of supporting their users and systems are both expensive and ineffective. It’s getting hard for them to justify the large operating budgets being allocated for support. We’ve developed a methodology in this area that’s resonating very well with our clients.
Simply put, we do it better and cheaper. In this new space, we know it’s not good enough to say, “We can do this very well in your place, but it’s going to cost you.” We have a methodology and approach that we know allows us to do it better for less. Our leaders aren’t career consultants, but rather people who have demonstrated success and innovation inside healthcare organizations. They know an effective approach to support goes well beyond having staff who know the mechanics of tweaking the inanimate software system. We’re well aware of the expectations and complexities put upon healthcare IT leaders from inside their organizations. Our managed services method brings relief and credibility to the leaders as much as it provides line staff who do the day-to-day work.
Are you seeing hospitals holding back on implementing new products or services due to uncertainty about the Affordable Care Act?
I’m not. I see the opposite. I’m seeing clients planning for it. They, especially the physicians, are absolutely focused on that. As we transition from a transactional-based model to a financial model more focused around the prolonged well-being of the patient, we’re seeing these CMIOs focus on analytics, evidenced-based care, device integration, home health, and population health. I expect we’ll begin to see healthcare organizations looking to cut costs based on this uncertainty, and when we do, we’ll be here for them.
We recognize that providing services in this space isn’t about working with organizations with unlimited budgets. We understand the cost constraints healthcare organizations are under and our main objective is to stretch the value of their healthcare IT dollar, so they have more resources available for direct patient care efforts. Whether those cost constraints are coming from uncertainty about the future of ACA or something else, the result is the same for us — driving value for our customers.
Are any of them actually doing something with population health management?
The transition to value-base care is top of mind for almost all of our clients, from large health systems to small physician groups. Each of them is in a different phase of evolution in their journey toward patient-centered, accountable care.
We recognized several years ago that population health was going to be the next approach to improving health outcomes for healthcare providers. For us to be able to guide our clients through this period of transformation, we made a strategic decision to broaden and deepen our services in several key areas. Analytics, process improvement, and usable smart technology are some of these areas that we focus on when working with our clients in this space.
We know that healthcare providers must be able to deliver high-quality care with exceptional service at a reduced cost without burning out the providers or staff. Helping them understand their data to produce accurate, timely, and actionable information about the health of their patients, operations, and finances is critical. Next, we know that the workflows of 10 years ago in the ambulatory and acute care settings are not efficient in today’s world. So we focus on Lean methodology to establish new processes that create value for both the providers and the patients.
Finally, we understand that implementing technology that is neither intuitive nor helpful to the client does not create value. So we leverage our knowledge of the EMR and other third-party applications to adapt the technology to enable the efforts around process improvement and the ability to capture useful data. There is a huge focus right now on consumerism and technologies that empower patients to take control of their own healthcare needs. This is really exciting for us as it fits nicely into our service model and will help further value for our clients and their patients.
Are you seeing an interest in exchanging information among competing health systems?
We are. We still see some hesitancy in the marketplace. However, with the M&A activity, the need to find alternative and less-costly EHR options, and the federal regulations geared towards performance-based reimbursement, we’re seeing organizations opening up to options they wouldn’t have considered previously.
Essentially, they know they have to get ahead of this and are implementing the technology to enable it. If the power of a patient’s healthcare is going to be put back into their hands, they will begin to look for different options that best meet their needs. These may be accessing services at different locations, often out of network and often at competing locations. The patient is a smart consumer, so sharing across networks to care for the patient and not manage transactions is key. I think you’re going to see interoperability move forward at a faster pace than we’ve ever seen.
How do you see the balance of power shifting among what is arguably just four significant inpatient EHR vendors?
As a consulting company, we’re vendor neutral. However, we see two large vendors gaining a preponderance of market share. We work primarily with Epic and to a lesser degree Cerner. We support others such as Meditech and Allscripts as well. Then there are all the intermediate, peripheral, third-party vendors associated with the enterprise EHR products. But primarily, those two are the ones rising to the top on a regular basis during vendor selection. It’s no secret that a large part of our consulting staff is subject matter experts in those two areas, including our thought leaders and our line staff.
What we’re seeing outside the US is quite different based on the market. Epic and Cerner are still dominant in commercialized Middle Eastern regions and Europe, but are not yet major players in the Latin-speaking markets. This brings an entirely new set of vendors such as Philips and InterSystems that were built to support Latin speaking markets as a base language.
Is an ecosystem developing around Cerner and Epic where clients are willing to look outside their core solutions, or are those vendors are increasingly promoting those external solutions to their own customers?
Organizations have spent a lot of money on these enterprise systems, so they obviously want to get as much out of them as possible. I think most organizations have a policy of looking to their existing platform for any functionality being pursued before entertaining another vendor as an option. I certainly think these two vendors’ solutions have created a basis for an ecosystem, but there is always room for innovation and exceptions on the periphery.
From an application perspective, I think most healthcare organizations look at their EHR system and their ERP system as their two main hubs. So you have Lawson and PeopleSoft on the ERP side and we do a lot of work in that space as well. But yes, most peripheral applications run through the enterprise systems or as an adjunct to those core platforms. The idea is to drive down costs and increase integration through the use of enterprise platforms.
Are health systems that have developed innovation centers or started an incubator to create rather than simply consume technology seeing success from the time and money they’ve invested?
Absolutely. They’ve seen more end-user engagement because of it. Sometimes innovations are born out of multiple optimization cycles, but we know multiple clients who created their own innovation lab with some of their brightest clinical and technical minds. The end result is to improve the technology they’ve implemented and take the user experience to a higher level.
How has Epic’s Community Connect program touched the small-hospital and the physician practice markets?
It gives those organizations an opportunity to tap into some of the best and most technologically advanced EMRs without all the overhead. It’s a different paradigm. The hospitals themselves turn into the vendor. They have spent months and sometimes years optimizing their own system, so if you’re a recipient, you’re going to be receiving an optimized version of that instance. Epic, for example.
For those that can’t really afford to install their own instance of, say, Epic, or are too small to purchase Epic, this gives them an opportunity partner at a better cost with the hospital. Health systems providing the EMR have already gone through the pains of implementing and optimization. The receiving partner is getting all the lessons learned, documentation, tools, and best practices from the hub health system. Private practicing physicians have all the lab, radiology, and inpatient data at their fingertips allowing for immediate patient care.
As the industry moves from volume- to value-based care, accountable care organizations, and clinical integration, the need for a Community Connect model will continue to be in demand. Sharing information on one platform eliminates the need for interface development and enhances the ability to integrate clinical data.
What’s the demand for vendors hosting their own solutions?
It makes sense. These folks are in the business of providing for patients. With the information technology arm of the hospital requiring more and more investment, I think they view potential outsourcing as a solution to that.
In a particular market, you may have five or six Epic clients that have their own data centers and their own individual staff members devoted to the product. There’s an opportunity to consolidate that. There are opportunities to outsource some of that overhead and reinvest that back into the clinicians, back into the hospital staff.
As we move into the next phase, where margins may be thinner, healthcare providers are looking for ways to cut overhead. Outsourcing is a way to do that. A number our clients are listening to the conversation around managed services, such as a hosted data center or application support.
What was the single most important change you saw in the consulting business last year and what do you think it will be in the next year?
Last year as health systems moved past the large-scale EHR implementations, we saw a noticeable uptick in services involving optimization, data governance and analytics, ERP, managed services, and security. I believe next year we still see massive growth in these same areas, but also a focus on services that help navigate the implications of MIPS and MACRA.
Do you have any final thoughts?
We are excited to be so deeply involved in this industry. Our focus from the beginning has been improving patient care and improving the patient experience. The healthcare industry is exciting because of all the innovation currently underway. Healthcare is growing up at a rapid pace.
The shift from transactions to value-based care will create opportunities for innovation. We’ve seen that in the financial services industry, where instead of going into the bank to check your balance or to move money around, you have an app on your phone. The healthcare industry is moving toward involving the patient in his or her own healthcare in a similar fashion.
We’ve been involved in multiple implementations, but it really hits home when you walk the halls during a go-live. You’ve devoted so much time to bringing this system live and now it’s finally getting turned on. You walk through the NICU and other parts of the hospital and see that patients are at the center. They are the ones affected. Everyone in our company is focused on how to make that experience better.