HIStalk Interviews Rachel Marano, Managing Partner, Pivot Point Consulting

Rachel Marano is managing partner and co-founder of Pivot Point Consulting of Brentwood, TN.

Tell me about yourself and the company.

I’ve spent my entire career in healthcare IT, almost 18 years. I’m a computer science graduate. I started my first job at Cerner, where I learned the healthcare IT industry through the Cerner consulting concept. I eventually moved into the hospital side, going to work for Advocate Health Care to get off the road. I did a good bit of implementation and then worked my way into the Epic space and became a certified consultant for a variety of consulting companies. I did everything from build to project management at the project director level.

I launched Pivot Point Consulting in April 2011 with the intent of continuing in the healthcare IT industry, but as a consulting group and a vendor. I’ve seen multiple angles of the industry — software development, the hospital side, the consulting side, and now as an entrepreneur in the healthcare IT space.

What are the most important things you learned from working with Cerner and Epic and their products?

Their products are achieving the same goal, but have different ways of getting there. Both have strong implementation methodologies. Obviously their philosophies and corporate cultures are different. Cerner’s support model is different from Epic’s. Pivot Point Consulting serves both markets.

I’ve worked on both sides and have seen the advantages of both systems, the integration, and how they play in the industry. My roots are Cerner and I spent a good part of my career in Epic, so I think they are equally important in this industry. They create tremendous value for organizations. Many of our consultants have found themselves in both worlds over the years.

Cerner has made a lot of advances in their interoperability and in the international market, which has given them many additional clients. Epic continues to grow domestically and internationally. Epic has a unique way of managing the implementations — giving feedback, doing progress reporting, and ensuring success in install, implementation, and outcomes — which is different from how Cerner manages its clients. They are different animals, with both achieving the same end goal but with different paths to get there. We’ve seen tremendous success with our clients on both products.

How has hospital and health system consolidation affected the consulting business?

It’s certainly a different landscape when there is a lot of merger and acquisition activity. But by definition, that creates opportunity for migration, implementation, and optimization in consolidating older systems to one standard system. It has created a lot of strategy, advisory, and assessment-level work for us and in the entire industry. We’ve done quite a bit of M&A work in the last few years in helping with pre-planning, organizational IT strategic planning, and infrastructure planning for M&A.

We’re doing a large M&A strategy session right now with an organization in downstate Illinois. They didn’t know how to approach the amount of M&A they will be going after in the next 10 years and how that would affect them operationally, strategically, and financially. We put together roadmaps.

Consolidation has, from a consulting perspective, allowed us to look at the industry differently and to see the future state of where these systems will be. Many of them will be unified, integrated, and on similar platforms instead of best-of-breed. We’re going to see a lot more organizations on one platform where they can transfer data more easily.

Are large health systems in less of a hurry than before to rip and replace the systems of the hospitals they acquire in favor of the corporate standard?

One of our larger clients spent probably $200 million on Epic implementation over the years. They were bought by a much larger organization. Things are integrated between the two systems other than the Epic instances. The large organization is maintaining its existing Epic instance and the smaller organization will maintain its Epic instance. They’re both on Epic, but they are running independently by design.

The sheer cost of starting again, redefining workflow, and standardizing all these things between the two systems almost makes the juice not worth the squeeze after these organizations have spent so much money. Things are working, they’re getting the reporting that they need, they’re compliant, and their workflows and operations are efficient with those instances. It makes great sense for some organizations, less for others. Ultimately cost, resourcing, staffing, and other competing projects all come into play into that decision-making. But for some organizations, once they sign on the M&A dotted line, they’re moving forward and starting with the migration.

What projects are floating to the top of health system lists?

We’re seeing a lot of patient engagement, population health, privacy and security, optimization. A lot of managed services, outsourcing the support of these systems. More organizations are shifting energy away from EHR to ERP. The concentration is now that we have the data, what do we do with it? How are we using those measurements to improve performance, clinical outcomes, return on investment, and cash flow? It’s a much more advanced space.

Almost all of our clients are focused heavily on patient engagement initiatives in one way or another. How patients are interacting with their patient portals and what their experience is like from a technology perspective. Systems are in place, we’re live, software is working. Operations, workflow, and clinical and revenue cycle are functional. Where do we go from here in these Phase 2, 3, and 4 post-live scenarios?

Do health systems know what they want to do with population health and patient engagement or are they looking for direction?

Both. More-tenured organizations that have been on these EHR platforms and have software, analytics platforms, or tools are much further ahead in deciding what their initiative looks like or what it should mean. We have small organizations that haven’t even said the word. They’re looking for our guidance and our advisory around the right moves. What tools should we be working with? What vendors are good in this space? Should we be bringing Healthy Planet live? Should we be doing some type of integration?

Most of our large organizations are already underway and have someone leading the charge with population health in some regard. Some of our smaller organizations that might be a little bit further behind are looking for direction and directive. Some don’t know how to approach it, it’s lower on their list, and they’re still trying  to get their technology in order.

What do CIOs tell you is the hardest part of their job?

I haven’t heard as much about CIO turnover. You’ll see it with M&A, but jobs are also evolving into other areas. Some of our CIOs are more focused on innovation and driving revenue into the IT department where before it was more about creating a specific technology infrastructure.

Their challenges continue to be resourcing. I hear this consistently. How do we continue with additional future-state projects with the existing staff? How do we leverage organizations and potentially managed services or outsourced solutions to maximize our organizational resourcing?

Definitely innovation. We have CIOs who are focused on developing programs internally in their IT departments to drive revenue, to create revenue-generating entities within their organization that can align potentially with their IT shop. Potentially consolidating efforts with other local hospitals, leveraging other IT departments and their resources. We’ve seen a lot of unusual approaches to the post-EHR implementation world in CIO roles and evolving how they play in their organizations.

What are the issues most commonly involved when a health system calls you wanting to replace an incumbent consulting firm?

Typically we find that organizations are unhappy with the relationship, the level of consultant talent, or potentially the level of experience and ability. A lot of times, we’re called on because they’re unhappy with the level of service.

But we also find that organizations are looking for a firm that can do more than just one thing and can cast a wider net of service offerings. The group understands their culture, nuances, and their uniqueness and are able to go in other directions, whether it be at an advisory level, a managerial level, legacy, potentially on revenue cycle or clinical, training, and managed services. We’ve seen a good bit of that and we’ve seen organizations that are looking for companies at a certain KLAS level, where they’ve had vendors that have fluctuated in that KLAS standing. Organizations consistently say they’re looking for vendors within the top 10 in their category and that’s who they stick with.

Our focus is relationships, trusted advisory, strategic connections with our clients, and offering value. Being able to identify a challenge and provide a solution. We can do that at more of a strategic level, but also with staffing. We’re trying to approach it differently. We definitely do staffing, but we’ve always been a firm that has been consultant led and consultant driven. We have a different vision on how we work with clients and how we engage with them.

What are the biggest opportunities and threats for health systems, CIOs, and companies in the next 3-5 years?

Merger and acquisitions. We’re going to see in the next 10 years more and more organizations being consolidated, with fewer and fewer independent organizations. The challenges come with combining facilities, the cost of doing that, and technology integration. That will drive the future of the healthcare market. The continued advancement in the technology itself will also change how we are leveraging data.

Do you have any final thoughts?

Our organization is evolving and certainly has changed over the years. When Pivot Point started, we were focused pretty heavily on Epic and Cerner implementation. At that time, that was where the industry was, and that was the main focus of most organizations. We have changed with the times and evolved with the industry and continue to meet the needs of our clients.

We have cast a wider net into some of these divisions, departments, and areas where we see challenge and opportunity. A lot of that is around that managed services space and assisting clients with post-live initiatives. We’re going to continue to see more organizations putting energies in and around that as well as the strategic and more challenged areas around privacy and security, population health, mobility, and even compliance and infrastructure and technology.