A team of epic alumni based in Madison, Wisconsin, is launching a company called Prosperityehr built around a cloud -based electronic health record designed to help behavioral health organizations to simplify operations and improve patient care. CEO Melissa Tran and the Chief Income Office Jesse Vogel spoke with Health innovation about the market opportunity they saw in the EHR behavior health space.
Health innovation: I was interested in listening to their history, because both were epic students. What are some things about his experience there that led him to see this opportunity?
Vogel: What we saw working with larger health systems was that many times the health of behavior was more a cost center than a service line. Many large medical groups would offer behavioral health services, but was reduced over time. I was in Epic from approximately 2003 to 2014 and at that time, many of those groups began to outsource a lot of behavior because it did not reimburse well enough to continue offering it. From our point of view, we think about what happens with these patients when they leave the walls of a larger health system, and I can tell you this: the data does not go with them. As a patient or family member, when he leaves the super highway of the largest health systems of the largest health systems and enters behavioral health, he realizes that none of that data came with me. So, if you are talking about the attention of the whole person, this is something that must be addressed.
Tran: We were in Epic and we could see many of the challenges that people experienced in terms of integration with behavior health. We are very aware of the health systems that use completely separated records or electronic documents for their behavioral medical care, and that is very separated from epic, the cerners, the athenahealths. It was not uncommon that he was going to talk to someone as a doctor from the emergency room that said: «Gosh, if we only had information from a behavior health perspective, we would not have had to put that person in restrictions.»
Then we saw an opportunity. We saw how much there was a need for integration and interoperability. We saw what worked and did not work from a great EHR perspective, and we also saw how many disparate systems that existed. We think we have the rare opportunity and part of the experience that had worked directly with the suppliers, as well as with an EMR to make the change in the behavioral health space.
HCI: When you observe the potential customer base, are they mostly smaller practices compared to the departments of large health systems or large mental health practices?
Vogel: The vast majority are smaller. There is a lot of consolidation, but you are predominantly talking about smaller groups. There are many group practices that are 10 or 15 or 20 suppliers with an aspiration to grow, and that is the size group to which we are mainly directed.
HCI: When you looked at the current ehr behavior health market, what did you see? Are there a couple of players who dominate that, or are there a wide variety of small EHR offers?
Tran: There are many different EMRs that are doing very specific things. And there are some who started 30 years ago that are smaller and have a central customer set. And there has been a lot of mergers and acquisitions in the behavioral health space. That is happening both on the side of the practice and on the side of the EMR. Then you are seeing this great landscape change. Many of the suppliers need an update to meet some of the needs of compliance and interoperability.
HCI: Did you make an acquisition of a company that already existed to be the baseline of what they started?
Tran: We did it. We acquired a company called Theramanager in August 2022. I affectionately call our geriatric startup because we are starting with a 30 -year -old company. They are a good example of a company that was doing the right things from the point of view of the user base, but they also knew they needed to change. They knew that interoperability was not their strong suit, and it had to be. So we acquire the company in 2022. We entered and said: «Hey, there is all this good knowledge, there is this customer base of the really strong community that can help us create a specially designed solution.» So we have customer advisors, we have focal groups, we do a lot of user research, and from there, we have really worked to launch this new product.
Vogel: The electronic health registry that was first launched as part of the company’s foundation was a specific EHR of behavior health in the early 90s, before there really was something like that, and was designed by a psychologist. He was recently talking to a client and she said they had been using the system almost since it started. Now we are migrating to the new platform. She is super excited about the fact that the things that contributed in terms of knowledge to the inherited system, can see that the transition forward, things that matter the doctors. But now, as Melissa said, we have the opportunity to think about how we really make this scale. How do we do this interoperable? How do we weave things such as compliance and usability and productivity and all the things we know matter?
HCI: Did you receive any risk investment to build the new platform?
Tran: We are thrown with many angel investments. Jesse and others in the team we have this very personal connection with mental health and behavior health. Everyone knows someone who has been affected.
HCI: I understand that you have paid a lot of attention to the income cycle. Is that a problem with which these suppliers fight or where did they see an opportunity to improve?
Tran: Yes, it is also one of our interoperability plays. We are integrated with a couple of different technologies to ensure that people have, as an example, a built -in compensation house. They have the opportunity to really see some data in real time in terms of denials and eligibility. We also think about the fact that many people in behavior health need help in terms of thinking about things like accrediting. We knew we needed to know the cycle of revolutions super good due to all changes in the landscape that are specifically happening in behavior health.
Vogel: These practices are realizing that payers are moving the target line all the time, and the regulations change, and if it does not have the incorporated automation, it is really difficult to climb without adding a lot of administrative overloads, without adding more people to pursue all those things, so that they pay it. Well, the problem is that reimbursement is not significant enough to be able to hire all those people to do that job. Many of these groups want to add suppliers, but if it does not have a technology that allows you to keep the administrative overload low, it is almost impossible.
HCI: I saw that your EHR had an architecture ready for AI. What does that term mean to you?
Tran: We know that there are many different tools out there. And, frankly, in behavior health, there is a lot of nervousness around AI tools. Then, in our current customer base, as an example, only 14% of people said they felt totally comfortable with the idea of AI. But although there are different levels of comfort, there are different components with which we must be able to ensure that we can integrate, things as environmental documentation tools.
Another area is working with our community to help create those AI tools, both from a perspective of the income cycle and from a clinical perspective. There are people who use chatgpt as online therapist, right? The best we can do, from the point of view of architecture ready for the AI is to start on that trip with the suppliers, to develop those tools with them to feel like a safe space. It feels like something they can use, and is clinically validated, which I think is also a comforting thing for patients.
