Specialist
Former SVP at Innovaccer Inc
Agenda
- Differentiation between EMR (electronic medical record) organisations and point solutions, including customer trade-offs
- Competitive landscape overview and profile differentiation among key players such as AthenaHealth, Arcadia, Innovaccer and others
- Relative end market growth opportunity across providers, commercial payers, ACOs (accountable care organisations), health systems and employers
- Hurdles posed by patient engagement challenges to population health vendors and efforts to enhance engagement capabilities
- 2023 growth outlook, potential consolidation trends and strategic assessments
Questions
1.
What major trends and developments have you been following in the population health management software market over the past 12 months or so that might better inform our Interview?
2.
How should investors be thinking about segmenting the population health management market and the relevant players within it? Could you lay out the competitive set and the provider end market, perhaps touching on EMR [electronic medical record]-adjacent population health solutions, larger pure-play population health management platforms, smaller speciality point solutions and so on?
3.
How much or little overlap is there with some of the provider-focused value-based care platforms, such as Privia, Aledade or Agilon? What are the acute areas of differentiation vs some of the pure-play population health management players that we’ve noted?
4.
How would you grade the level of customisation and tech infrastructure of the EMR solutions against some of the pure-play names? Does the lower price or ease of staying with a single solutions vendor justify the drawbacks in efficacy of the EMRs? I appreciate this will vary substantially by client.
5.
What’s stopping the EMR groups from getting more sophisticated, either organically or buying the technology via acquisition?
6.
How would you juxtapose the market opportunity within the provider segment? Could you compare small independent practices, ACOs [accountable care organisations] and hospital and health systems? What does the approximate comparison in total size and penetration potential look like?
7.
Are there any smaller upstart players that you think investors should be paying attention to in the market, with innovative technology or customised solutions for overall population healthcare cost management?
8.
Switching over to regulatory dynamics, the 2023 physician fee schedule lists a 2.8% increase for inpatient hospitals on the back of a 5% increase in 2022. How should we be thinking about the impact of a fee-for-service slowdown in terms of abetting or inhibiting adoption of value-based arrangements? Is it linear? What’s the indirect relationship?
9.
What downwards pressure are we seeing from CMS [Centers for Medicare & Medicaid Services] and CMMI [Center for Medicare and Medicaid Innovation] to increasingly raise cost-savings metrics on managed populations? To what extent might this dynamic inhibit value-based care adoption more broadly? Do you see this as a longer-term risk?
10.
In terms of the regulatory dynamics, what are the major implications of CMS extending the BPCIA [Bundled Payments for Care Improvement Advanced] model through the end of 2025? What’s your overall outlook for participation and general ACO performance in some of these arrangements?
11.
I appreciate you said there’s plenty of room for profitability right now. Longer term, however, if proof of concept has been established and profits are realised, why wouldn’t CMS step in and cap bundled payments or the upside in these arrangements, especially amid the Biden administration’s efforts to lower healthcare costs, which I assume will be followed by future administrations?
12.
What are some of the key pain points that are incurred with modernising and adapting payment systems to process value-based arrangements, and how are these efforts progressing? I’m thinking in terms of adapting payments software such as RCM [revenue cycle management], billing, even claims processing, in order to process value-based arrangements. What are the migration costs there and how are those progressing?
13.
What are the typical contractual dynamics in the provider channel? I appreciate this will vary substantially by vendor and customer demographic, but could you unpack the typical length and pricing in these arrangements across the various provider segments we’ve discussed in the relevant silos?
14.
How sticky are the contracts typically? How does that vary for the larger solutions or the EMRs vs more of the smaller point-solution players?
15.
What are typical implementation timelines to get customers up and running on the platform?
16.
How are some of the key outcome KPIs – perhaps considering reduced inpatient hospital stays, recurrence rates, total cost of care and so on – weighted relatively in terms of contract ROI or lifetime value?
17.
How much of a risk is increasing provider and health system consolidation in terms of contract negotiation leverage and/or pricing pressure on contract renewals?
18.
You’re saying that, for some of the commercial value-based arrangements, the health system is negotiating with the payer, and therefore they can get better bundled payments or contract stipulations, and it doesn’t impact the population health players whatsoever, there’s just more wallet share. Is that correct?
19.
What are your expectations for the adoption or integration of AI and large language models within population health management software? What improvements to patient engagement or data analysis might we see here? You mentioned the value-add of identifying patients sooner and more accurately as a substantial advantage.
20.
How do savings tend to trend over 1, 2 or 5 years and beyond for population health management software vendors? Where do savings plateau as care management capabilities become more optimised?
21.
What are your expectations for the broader expansion opportunity into new end markets such as life sciences? What does the use case and market size look like in that vertical?
22.
What are your expectations for industry-wide consolidation over the next few years? How might some of the fragmented nature of the market materialise in increased aggregation? What acquisitive activity might we see from PE or otherwise?
23.
Is there anything we haven’t mentioned that you’d like to highlight around the population health management software market?
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