HIStalk Interviews Raul Villar, CEO, AdvancedMD

Raul Villar is CEO of AdvancedMD of South Jordan, UT.

Tell me about yourself and the company.

I’m the CEO of AdvancedMD. I’ve been with the company for the past seven years. AdvancedMD provides integrated, end-to-end solutions to the ambulatory market.

How would you describe the ambulatory EHR/PM market?

From a market perspective, we focus on independent physicians. We think the market is strong and growing. Some of the things that we’ve seen over the past four or five years are an explosion in mental health and physical therapy providers. Also, we continue to see about 20-25,000 new entrants in traditional primary care physicians.

The market itself is growing. We size the market at about 1.6 million doctors that we think are eligible to be on the AdvancedMD system.

Where does the opportunity come from?

We see the opportunity coming from all segments. When we break it down, there are definitely still new entrants into the market. New entrants are excited about cloud opportunities. They tend to be more open to new technology. There’s a whole bunch of folks who are on existing cloud solutions and we see those as great opportunities.

In the ambulatory space, the largest component of ambulatory is still running on-premise solutions, legacy solutions that they bought decades ago. Ultimately over time, as they look for new solutions, they tend to be great opportunities for companies like us.

How much penetration do cloud-based systems have in independent practices?

I would say cloud today is about 25 percent of the market. Like anything else in our day-to-day lives, we’re all becoming more attuned to leveraging the cloud. whether it be for personal enjoyment, music, TV, movies, banking, and those type of things. As people become more comfortable and familiar with the cloud and cloud technology, it is becoming more acceptable.

As the demographics of physicians change, the newer physicians want new technology. They grew up with it. We’re seeing that. It’s not 100 percent there, obviously. A big bulk of the physicians are in their 50s and 60s. Over time, that transition to technology will continue to evolve. In healthcare, it’s probably slower than anywhere else. I think we would all admit that in healthcare, with the sensitivity of the information and the data, people need to feel comfortable that they’re going to be able to provide service.

We’re seeing fewer and fewer objections to the cloud. It’s more about, how does your work flow help our practice? That has become the question. When I came here seven years ago, it was more about, is the cloud safe? Is my data going to get stolen? Am I going to have service? Am I ever going to be down? Now, it’s more about, tell me about the workflow of your solutions. Tell me how you can help us collect more for our claims and how can you help us with all of the government regulations that continue to pour down on the heads of the independent physicians.

How has usability affected physician EHR acceptance?

I’m kind of in the middle on the topic. The first-generation clinical solutions that we all developed, including AdvancedMD, were built to government regulation, not to physician workflow. It was frustrating to the physician to have to enter a lot of information that didn’t necessarily help patient care or help them with a diagnosis. The second generation of clinical solutions that companies like ours are developing are much more user friendly, easier to use, and enable physicians to create the workflow that works best for them.

No workflow is the same for any physician. Every physician has their nuances. For them to continue to embrace clinical solutions, we have to reduce the number of clicks. We have to clean up the user interface and make it easy for them to document the information and also learn from the information. That’s where the power is. How can they become more effective, because all the data is in one place and they can see it like they used to see with a chart?

Ultimately, we have to make the online clinical solutions as easy as a chart was for them to look at, understand the patient situation, and make the correct diagnosis based on the information provided. Most of the progressive vendors are making those changes in their new-generation clinical solutions. We’ll continue to see better adoption. It will also help with chronic care management and care management in general. That’s the critical component in healthcare. If we can all do a better job of making it easier for the physician to understand the information in an easy and simple format, it will be much more effective.

Is outsourced revenue cycle management growing?

Yes. Everyone is under pressure. We’re asking physicians to do more for less. It’s not a great place to be, from a profession perspective. The new dynamics of doing more for less and more regulatory overhang and more requirements to be reimbursed for what they did is putting a lot more pressure and creating demand for revenue cycle management.

Revenue cycle management though comes in two flavors. There’s software technology like ours that enables people to do it themselves with simple, intuitive tools. Then there’s also that same software wrapped with services. It really depends on the physician and their staff as to which they prefer. Some prefer to do it themselves and manage the ecosystem. Others want you to follow up and make sure that all the denials are resubmitted and they’re maximizing their reimbursements.

There’s interest in general in maximizing reimbursements. It’s done through software and it’s done through services. That’s really a behavioral decision by a physician of what they like. Some people like to do everything in house, some people like to outsource, and some people like to co-source. Our job is to be flexible enough to enable physicians to use any of the models that they feel most comfortable with.

It changes as their staff changes. Sometimes they may have an experienced biller and they want to do it in-house because they know how it works, they know their procedure codes, and they know their insurance companies. They have that dynamic tied down. But then there may be turnover and they’re replaced by someone who’s new and not as sophisticated. At that point, they may want to leverage services to help them follow up on denials. It’s about providing flexibility to the provider and letting them choose what solution they prefer.

How much information exchange do you see happening between your users and health systems?

We see a lot of that, and we’re seeing more and more of it. Our philosophy has been that we have to provide all the information to users so they can export it to whatever health systems or health organization that they want. We haven’t felt like we know what the outcome of healthcare’s going to be, whether it’s ACOs, HIEs, large health systems, or independent providers. There’s a lot of different care settings. Our mantra has been that we have to be able to enable patients and providers to take all their information and be able to port that information to whatever systems they want.

Being in the cloud makes that much easier than if you’re in on an on-premise solution or pen and paper. Ultimately, that’s one of the advantages, that over time, as healthcare becomes more open and data is exchanged more efficiently, it’s only going to help push more people to the cloud because the data’s already in that format. It’s easy for us to share data across systems.

You offer a physician reputation management system. Is that important to medical practices?

Today, it’s an emerging concept. If we think about what’s really going on in the macro environment, as high-deductible health plans continue to increase and the consumer is forced to pay more, then the consumer is going to care more about who they’re meeting with, how much it costs, and then how much they’re going to be reimbursed.

Independent physicians historically have been able to plant the flag where they’re located. They generate their clients within a 10-15 mile radius, depending on the density of the city they live in. That’s changing. People now are willing to go online. We’ve seen it in other industries, such as restaurants with Yelp. People want to go online, get a review, see where they’re located, see what it costs, and see the menu. We’re going to see the same transformation in healthcare. The demand is coming from the patient. As the patient has to pay more, the patient is going to have more questions.

None of us five years ago were that focused on how much an encounter would cost us. It was going to be paid for by someone else. As that share gets pushed to the consumer, they’re going to care more. Our physicians have come to us and said, we would love to be able to have our patients tell us how we’re doing after every encounter. If we’re doing really well, great. If we’re not doing well, we need to know. Sometimes in a practice, the breakdown can happen in the waiting room. It can happen at the front desk. It can happen with the nurse practitioner or medical assistant or it could be with the physician.

There’s a lot of different pain points. There’s a lot of people involved in delivering healthcare. The more information that physicians have, they can help to modify what’s going on in their practice and use it as a tool to attract more patients. We believe that physicians are going to need to compete for patients in the future. Today, it’s more on the come, but we’ve seen that people are extremely interested in it. They’re using it in their personal lives for a lot of different services. This is a very easy transition for independent physicians.

Where do you see the company going in the next five years?

AdvancedMD will continue to expand its product set. We’ll continue to deliver an integrated, end-to-end solution that includes practice management, revenue cycle, clinical solutions, reputation management, and patient engagement tools. We’ll continue to deliver that to independent physicians.

From our perspective, healthcare doesn’t need to be complicated. If we all work together, we can find a way to treat more patients more effectively and more efficiently. We’re just happy to be a very small part of that equation.