HIMSS10 – Ingenix

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Dr. Eric Fishman speaks with Kim LaFontanna, Vice President of Ingenix. Ingenix is a large company serving the needs of health plans and physicians. Ms. LaFontanna discusses CareTracker, Ingenix’s PM/EHR web-based solution. While this product can scale up, it best suits the needs of small group practices. Ingenix completed significant research on the small practice demographic, and has found that this group is very heterogeneous in regards to office dynamics, change management, knowledge of technology, and organizational behavior/practices. Ms. LaFontanna shares that this data has guided development of the CareTracker system, as the company has made the product intuitive and easy to adopt with a small technology footprint in physician offices and workflow customization.

Category: HIMSS10, Tradeshows
Date: March 16, 2010
Views:5,746 views

Dr. Eric Fishman: This is Dr. Eric Fishman for EHRtv at HIMSS10 and today, we're speaking with Kim LaFontanna, Vice President of Ingenix. We're going to learn about their strategy in general and also a lot about the CareTracker product. So Kim, thank you for coming today.

Kim La Fontanna: Great, thanks for having me.

Dr. Eric Fishman: Let's learn a little bit about Ingenix as a company and then the strategy they have for the ambulatory market.

Kim La Fontanna: Sure. Ingenix is a large company. We serve the needs of health plans and physicians. Our real special sauce is that we connect the dots with analytics and data and technology to help bring the various constituents in health together and make it all work a little bit better.

Dr. Eric Fishman: Tell me about the CareTracker product specifically if you would.

Kim La Fontanna: Yes, we have a fantastic product called CareTracker. There's a practice management and EMR component and it was really billed as a next generation solution. It's all web-based and what we are really deeply interested in is the needs of the small group physician practice.

Dr. Eric Fishman: How do you define small group?

Kim La Fontanna: Under 10 physicians. Our product actually scales up nicely and meets the needs of large groups as well and we serve lots them but the particular dynamics around transformation in that small group setting is going to be what this country is going to try to figure out and spend a lot of energy on over the next 10 years. We really want to play an important role in that and are committed to that segment of the market.

Dr. Eric Fishman: I understand that you and Ingenix in particular know more than a little bit, and maybe more than most, about that market in particular. You've done a lot of research into the demographics of the 1 to 10 physician market.

Kim La Fontanna: Yes, we have. We've studied it this year quite a bit. We've done some survey work, we've done focus groups, a lot of individual interviews with physicians. The big findings are that there are lots of different dynamics, that it's a very heterogeneous population. The different segments of the market in terms of the technology, willingness to adopt their clinical, sort of interest and change in their practice patterns. Some of them are very deeply attached to the way they practice medicine, others are ready to look for some new ways to bring new information into their practice. Probably the most interesting thing for me is the organizational behavior aspect of these practices. A lot of them work like a family and many of them actually are family and many are not, but act as if they are. So it's a very informal set of connections. There's not a professional management, so change in those environments is really hard.

Dr. Eric Fishman: Let's go back to the first of this group that are dead set in their ways. They've practiced this way for 20 years and that's how they're going to practice forever. How do you incorporate a product like CareTracker EMR into an organizational structure of that nature?

Kim La Fontanna: Part of what we think about is how to make this easy to adopt and to meet various needs in a group like that where they're really sort of attached to their clinical protocols but maybe need to meet the needs of the payers that they serve in new ways. All of sudden they have this pay for performance program or different ways that they need to deliver care and report things out so they might want to adopt technology more for a registry purpose or pay for performance purpose than they would for evidence-based medicine.

Dr. Eric Fishman: So you'll find a specific reason why one person, the leader in a group, may wish to incorporate the technology?

Kim La Fontanna: That's right.

Dr. Eric Fishman: How long do you find that it takes an office to implement CareTracker EMR?

Kim La Fontanna: I mentioned there's two parts to the platform. There's a practice management and then the EMR and our clients work faster if they adopt both. There's about 60 days or so to get live on the practice management system and then depending on their needs and where they want to start and how they want to adopt, another 60 or 90 days to get live on the EMR. Then it's really a six month to even a year process to get it fully baked into all the processes.

Dr. Eric Fishman: Until they go to the "Aha, I'll never use paper again.

Kim La Fontanna: That's right, that's right. Till the paper charts start disappearing and they get excited about thinking about how to repurpose that space in the office where the charts used to be stored.

Dr. Eric Fishman: How much time do your trainers from Ingenix spend at an office during those two months and then three month period of time?

Kim La Fontanna: It varies. In the larger groups, we're onsite quite a bit. In the small groups, we can do an implementation end-to-end without ever visiting our client.

Dr. Eric Fishman: Do you do that commonly?

Kim La Fontanna: We do, we do. We have a whole set online tools - webinars, on-demand training, flexible ways to accommodate the different needs and the different ways these practices are structured.

Dr. Eric Fishman: If you could give us some of the differentiating features that make CareTracker EMR specifically appropriate for the small group practices I'd appreciate that.

Kim La Fontanna: I think I mentioned at the beginning it's a web-based product. That actually to us is the key enabling feature that the next generation of physicians who adopt HIT should look at and think about. What that means is there's a small technology footprint in the office. All you need is a high speed browser and a monitor which most practices or a lot of practices have today. It also means that behind the scenes, more importantly, the knowledge that's embedded in the system is shared widely. We can make one change in our system - a new required field for example - if meaningful use says you have to capture smoking cessation, smoking stats, which it does, we already have that field. But if we didn't, we could make that change and it's instantly deployed to all our desktops.

Dr. Eric Fishman: Do all of your users share the same installation if you will?

Kim La Fontanna: That's right. There's one instance of the product running on all the different desktops.

Dr. Eric Fishman: But obviously, physicians practice differently to tell us about the work flow customization that's available.

Kim La Fontanna: Yes, there's lots of different ways our client use the product today. Some of them, actually the doc is in the clinical exam room entering the notes right in the fields. Sometimes they're writing it on paper and handing it to a medical assistant.

Dr. Eric Fishman: Let me stop you here because I'm particularly interested in the method of documentation for maybe obvious reasons. I'm involved with Dragon Medical. Tell me what the various methods of documenting the history for instance might be.

Kim La Fontanna: We have a whole range. I would say the most common practice today is the physician taking notes on paper in the exam room and then entering it themselves after the visit or handing it to a medical assistant to document after the visit.

Dr. Eric Fishman: And that gets entered using typing, voice recognition, clicking, any methodology?

Kim La Fontanna: It depends on their preference but mostly it's typed in directly today and then the coding event happens using all that information. So again, the connection to the practice management system's important.

Dr. Eric Fishman: I think I interrupted you when you were talking about the work flow changes so if you could continue with that.

Kim La Fontanna: Generally, the first things people adopt are around prescription management, e-prescribing and then order refills.

Dr. Eric Fishman: Do you find that most of your physicians exceed the 80 percent rule that seems to be coming through?

Kim La Fontanna: Absolutely, absolutely, yes. They're usually thrilled with that. As soon as the EMR goes live that's the first benefit that they see is the ability to manage their patients coming in and calling in asking for refills. That's a pretty important feature. As I said, these registries offer an early adoption capability where they can track various panels of patients according to their payers requirements, according to their own sort of physician oriented care plan requirements. They love that. Then they work up into things like capturing the notes right in the exam room. That's sort of a later capability.

Dr. Eric Fishman: It's just a little complicated for many physicians. Now, we've spoken about many of the features and if you'd tell the viewers now about your target market. You said 1 to 10 physicians in many ways and you can do larger but what specialties, what environment do you think is best?

Kim La Fontanna: I talked about the heterogeneous nature of the small groups. The factor that is consistent across these practices is their economics. Most small group practices with some specialists, subspecialists excluded, most primary care small practices don't have an extraordinary amount of working capital and the cost of adopting technology is very daunting to them. That was one of the really key findings of our research this summer.

Dr. Eric Fishman: And so you've actually done something about that?

Kim La Fontanna: We have, we have. First of all, because our product's web-based, it's inexpensive to start. It's a subscription service, you pay a monthly fee. More like online banking than adopting and paying for technology in your office. There's not a big upfront capital investment as is the case with a lot of legacy EMRs. Paying on a per month basis is a lot more affordable and a lot easier way to manage the economics for a small group practice. The other thing we've done though is made available zero interest financing. It became clear to us that even though it's an affordable monthly rate, getting to meaningful use and getting your federal stimulus money is still a daunting challenge for many of these practices. So through a sister company, OptumHealth Bank, we've made available zero interest financing so physicians who select CareTracker can do so with no money out of pocket today.

Dr. Eric Fishman: Does that include the hardware, the training, the wireless?

Kim La Fontanna: We didn't make assumptions about hardware because a lot of practices already have it but all the training and the data import and the sort of implementation work is part of that.

Dr. Eric Fishman: No cost out?

Kim La Fontanna: That's right, that’s right and the beauty of the program is you can actually use the system with no money out of pocket up and through when you qualify for meaningful use, which we guarantee they will and then get your federal stimulus funds. You can then pay back your loan and have money left over because our price point is so affordable.

Dr. Eric Fishman: That's a neat concept. Explain your guarantee in a few sentences if you would.

Kim La Fontanna: There's lots of different guarantees out there. We think ours is actually pretty exceptional. We guarantee that our clients will actually get the money from the government. Not only that they'll get through meaningful use but they'll actually get the funds.

Dr. Eric Fishman: 2011, 13, 15?

Kim La Fontanna: That's right and they don't need to repay their loan until they have.

Dr. Eric Fishman: That is a good guarantee. We’ve spoken briefly about meaningful use and obviously, the regional extension centers are deeply involved in that. Can you tell us what relationship you plan on having with any of them if you would?

Kim La Fontanna: We're really anxious and we're sort of deeply involved in understanding how these regional extension centers are going to set up their processes.

Dr. Eric Fishman: You're not alone in that.

Kim La Fontanna: Right and it's great and it's exciting and we feel like we're pretty extraordinarily well positioned in this area since we've done this deep research and understand the needs of this market. We're also running a project called Physician Model Office where we're studying the implementation processes and the pathways of different smaller practices. We think we can really add an important voice to that conversation.

Dr. Eric Fishman: Kim, it's been a pleasure.

Kim La Fontanna: Yes, thank you so much.

Dr. Eric Fishman: Thank you very much. This is Dr. Eric Fishman with EHRtv. We've been speaking with Kim LaFontanna, Vice President of Ingenix. Thank you.

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