Newcomers to healthcare shortly determine the trade is a salad bowl of acronyms and abbreviations. Except for just a little annoyance and loads of affected person confusion, most are innocuous and don’t garner a lot response. Nevertheless, there’s one acronym that’s assured to elicit a wide range of feelings – from appreciation from CIOs for digitizing a bunch of paper, to exasperation from well being system executives who’re coping with its value, to unmitigated hatred from most clinicians who’re working with it day by day.
And that’s “EHR”.
Digital well being file (EHR) software program is sort of merely the bane of many suppliers’ existence – expertise they’re usually required to make use of, however was not constructed with clinicians (or, for that matter, the fashionable healthcare system) in thoughts. Whereas well-intentioned and with supplier adoption around 90%, EHRs total have been a disappointment and a nationwide nightmare for a myriad of causes.
From walled gardens to usability points to a vendor oligopoly that stifles innovation and doesn’t go away a lot room for significant competitors, among the hurdles which have hindered large-scale healthcare transformation – just like the migration to a value-based care system – might be attributed to the issues with EHRs.
Nevertheless, within the background, there’s been a counter motion rising with entrepreneurs and traders beginning to see white area forming – an area to spark a full EHR market disruption. Now, one of many leaders that would assist lead that disruption as we speak introduced a big haul of funding – an funding that indicators a brand new stage of maturity for the corporate.
Elation Health, an EHR platform that is primarily utilized by major care suppliers (PCPs), simply raised $50 million in Collection D funding to gas its subsequent stage of development. The increase included a really fascinating mixture of traders, particularly for these with excessive familiarity with the healthcare trade.
Elation Well being has raised $50M to allow the subsequent era of major care, and is searching for to … [+]
The spherical was co-led by Technology Funding Administration, a agency that focuses on sustainable investments, and Ascension Ventures, which is a strategic funding fund whose companions embody lots of the high U.S. well being programs. Extra participation got here from Threshold Ventures, Ascend Companions and particular person traders Fay Rotenberg and Jonathan Bush.
These final two names are of explicit notice (and never simply because they’re married), however as a result of they’re trade stalwarts with distinctive pedigrees. Rotenberg is CEO of major care startup Firefly, and Bush hardly wants an introduction, having co-founded and led his personal EHR behemoth in athenahealth.
So, what sort of well being tech firm would singularly appeal to the eye of a sustainable funding agency, a fund made up of main well being programs, high healthcare VCs, the CEO of a disruptive major care supplier, and a healthcare veteran who technically led a competitor?
The reply begins with the Elation founders’ background.
Household Follow Makes Excellent
Elation Well being was based in 2010 by siblings Kyna and Conan Fong, who function CEO and CXO (chief expertise officer) respectively. The familial entrepreneurs actually grew up in healthcare, working in and round their father’s major care observe that, apparently, began in Canada earlier than shifting to the U.S.
“My father got here dwelling from work sooner or later and stated he simply could not ship the kind of personalised medication he wished to within the Canadian healthcare system,” stated Kyna Fong in a current interview. “So we picked up, moved to the U.S. and had been tasked with mainly determining a wholly new system, together with every part from coaching employees to negotiating insurance coverage contracts.”
Siblings Kyna and Conan Fong are cofounders of Elation Well being
Kyna stated she labored within the clinic’s again workplace all through highschool serving to her dad successfully maintain the observe’s trains operating. It was that firsthand expertise that illuminated all she wanted to know in regards to the struggles that the typical supplier faces – acquainted experiences which have led PCPs to expertise higher rates of stress and burnout in comparison with a few of their friends.
However, the Fong siblings didn’t instantly rush to start out an organization. Kyna first turned a healthcare economist after learning recreation principle at Stanford, whereas her brother went into well being IT gross sales. Nevertheless, it was once they had been fascinated about how higher to implement a expertise technique of their father’s observe that they realized that every one of their EHR choices had been lacking a key part – the affected person view.
“We had been fairly shocked and disenchanted that we might have to rent extra employees or see fewer sufferers as a result of the IT programs had been clearly constructed for billing and never for precise affected person care,” stated Kyna. “That led us down a path of curiosity the place we ended up constructing one thing for our dad’s observe, and I suppose the remaining is historical past. That’s how Elation obtained off the bottom.”
At present, Elation payments itself as “the platform for revolutionary major care,” working with practices of all sizes and kinds, rising from its modest starting to a rising EHR star. Within the 12 years since launch, Elation has raised $108.5 million in whole funding and counts as clients every part from giant, enterprise-level well being programs with dozens of PCPs all the way down to impartial, community-based PCPs that will have a single physician.
The corporate additionally gives assist to among the extra tech-savvy major care upstarts like Crossover Well being, Cityblock and Firefly Well being (which is smart contemplating Rotenberg’s funding). All instructed, Elation says that 24,000 clinicians use its expertise who give care to 12.8 million sufferers.
Giving A Platform To Clients and Companions For A Worth-Primarily based World
The tenet behind Elation is its “clinical-first” platform that’s designed to assist collaboration with the greater than 300 expertise and healthcare group companions that make a million or extra API calls to Elation’s platform a day. Elation’s open structure permits companions, together with its clients, to construct on high of its platform to raised swimsuit their wants. That is a key distinction from some EHRs which can be notoriously rigid and exhausting to work with.
“Conventional [EHR] programs are constructed round a declare. They’re engineered round what’s billable and their workflows drive in the direction of ensuring you invoice as successfully as doable. It was solely later that there was strain to undertake the medical piece, and as soon as that half was built-in, it was nearly secondary,” stated Kyna. “Getting paid is vital, however Elation optimizes across the affected person view, creating workflows for the supplier that allow them to supply higher care.”
Kyna additionally famous that, whereas Elation will assist its clients function in fee-for-service fashions, Elation’s longitudinal affected person view permits suppliers to raised reach more and more frequent value-based care fashions that reward for increased high quality. A 2019 study discovered that just about 40% of healthcare {dollars} had been tied to some type of value-based program.
“It is advisable to be shifting in the direction of a system that rewards for worth, not simply quantity. Then you definately begin to consider all of the issues that relate to what occurs between visits and to not simply when the affected person is in entrance of you in a standard billable encounter,” stated Kyna. “Sufferers are solely with a supplier a fraction of their time, however in a value-based system the place you’re accountable to outcomes, it’s vital that you’ve expertise that helps you higher drive behavioral change.”
Whereas value-based fashions nonetheless have a methods to go earlier than they absolutely take over the U.S. healthcare system, insurers are making them extra of an crucial for PCPs. In truth, by 2021 more than 67,800 PCPs had been in value-based relationships with one of many nation’s largest insurers, Humana. The continued transition gained’t be simple on many PCPs.
Main Care Challenges In A Quickly Altering Panorama
It wasn’t like protecting a observe afloat in as we speak’s setting was already a cakewalk. Despite the fact that primary care is a bedrock of group well being, the first care system in America is below great strain for a lot of causes – a few of which Kyna wrote about in a current Harvard Enterprise Evaluation opinion piece.
1000’s of major care practices have closed – especially independent ones – an issue that COVID-19 exacerbated. Then there’s additionally been loads of industry consolidation fueled by personal fairness. Main care might be so robust that many well being programs simply settle for that it’s going to by no means earn money and solely provide it as a loss leader to behave as a referral engine for higher-margin specialty care. There are every kind of debates about what function major care ought to play within the healthcare system of the long run.
Nevertheless, Elation is betting its enterprise on a major care-led future, believing it’s the one technique to construct a sustainable system that may obtain healthcare’s “Triple Aim.”
The small firm named after a rainforest appears to agree. Amazon simply despatched shockwaves via the media-verse when it acquired concierge major care supplier One Medical for $3.9 billion, demonstrating it, too, believes in major care’s future. Nevertheless, that’s not all excellent news for the remainder of the first care trade, because it might put much more strain on others – particularly impartial PCPs.
Amazon’s mastery over comfort and limitless warfare chest to scale might basically change the sport for the typical supplier group. Whereas not apples-to-apples, think about what occurred to many SMB retailers when Amazon’s e-commerce operation began to dominate.
The underside line for PCPs is that there’s a minefield of points to navigate, which is why EHR expertise will play a crucial function of their future.
Keys To Success
For Elation, lots of its clients see its software program as a key to each making certain high-quality care whereas additionally lowering administrative burden. One such supplier is a small impartial major care observe in Pittsburgh run by Rebecca L. Byard, MD.
Rebecca Byard is a major care doctor (PCP) and Elation Well being buyer
“I discovered the [Elation’s] structure to be extraordinarily intuitive, shifting from file to file, or shifting from place to position inside a file. It simply feels proper. Very not often do I’ve to go on the lookout for one thing that I do not know the right way to discover,” stated Byard, who additionally indicated she’s been annoyed with different EHRs. “I as soon as used an EMR that I needed to click on via each merchandise on the bodily examination portion of the file, and it was exhausting and time-consuming.”
Byard additionally stated she didn’t have to spend so much of time coaching on Elation, and it was simple for her to entry from wherever. “I can seize knowledge that comes from a fax instantly right into a affected person’s chart, which helps me keep away from printing and scanning issues instantly into the file.”
One other Elation buyer, Crossover Health, applied Elation’s software program throughout 28 of its well being facilities – a course of that took 32 months in whole. The 2 organizations share a typical view of a patient-centered care mannequin that prioritizes suppliers’ relationships with their sufferers. It’s why Crossover Well being makes use of expertise to take away as many friction factors and obstacles to care as doable.
For instance, Crossover Well being redesigned its in-person well being facilities and check-in course of, changing the standard ready room with a “host” the place sufferers can full check-in as much as 24 hours earlier than a go to. Sufferers can also replace their well being knowledge and full well being screeners at the moment. That info is then accessible of their Elation chart in real-time and is included into Crossover Well being’s “medical working system” as metrics and potential areas for proactive follow-up. The result’s a extra correct well being file, a seamless affected person expertise and fewer wait occasions.
Crossover Well being’s earlier EHR required too many steps to realize that stage of integration. With out structured APIs, there was loads of downstream upkeep, knowledge synchronization challenges and different operational points, which annoyed Crossover Well being’s expertise workforce.
These routine points that Elation helped clean out for each Byard and Crossover Well being could seem easy, however they signify the tedious duties that add a lot collective stress to supplier workflows – stress that in the end spills over to the affected person expertise and may have an effect on care high quality.
Scaling And Investing In Elation
If Elation continues to supply that stage of assist to PCPs at scale, then it’ll be more durable for bigger well being programs to disregard. Nevertheless, that additionally probably means the EHR incumbents will place an even bigger goal on the corporate’s again shifting ahead. Each challenges – scaling its enterprise whereas additionally more and more competing in opposition to the oligopoly – would require loads of sources, which is why as we speak’s funding is much more vital. Elation’s traders are bullish.
Jonathan Bush is CEO of Zus Well being and an investor in Elation Well being
“In contrast to any, and I imply any, different EMR within the nation, Elation permits clients to really code their very own options to workflows. That’s big and getting extra vital by the day,” stated Bush. “Whereas different wonderful new corporations provide superior iframe or nice low-code customizations, none present complete entry to the workflow API and invite clients to customise what they’ve. You’ll begin to see main medical teams – teams that may rent their very own builders – make the swap [to Elation].”
Bush first met Kyna when she was working in her father’s observe and stated he’s been a “great fan” ever since. He believes the Fong siblings’ proximity to the issues suppliers expertise whereas additionally having the event abilities to handle them are what offers Elation its “superpowers.”
Anthony Woolf, development fairness accomplice at co-lead investor Technology Funding Administration, believed that Elation was completely different from the entire different EHRs his workforce evaluated.
Anthony Woolf is a development fairness investor at Technology Funding Administration
“There are tons of EMRs that got here out after the HITECH Act, however the majority of them have an terrible product expertise with low innovation,” stated Woolf, who pointed to the poor Net Promoter Scores (NPS) that EHRs often have. “After we requested round to search out out who truly appreciated their EHR, the one firm folks stated to actually search for was Elation. So we chased them down.”
The ethos of Woolf’s agency is the idea that sustainability and profitability don’t must be mutually unique. He stated Technology Funding Administration focuses on corporations that “genuinely care about their stakeholders and staff, their provide chain, and their affect on inequality,” which match with Elation’s clinician- and patient-focused method.
Woolf, who “loosely” leads the agency’s healthcare investments, additionally thinks a value-based future is crucial for healthcare, serving as another excuse why he appreciated Elation.
“We consider in a risk-based system as a result of solely when your physician is accountable for your whole medical spending can they select to concentrate on what’s most vital first,” stated Woolf. “So we’re sturdy supporters of value-based care, and it has to take a seat on the major care stage, which is why you want a robust expertise system constructed to deal with it.”
The Future Of Elation
With its new funding, Elation plans to focus its funds to develop its market attain and so as to add new options that may additional unlock its absolutely API-enabled platform. The problem, although, will probably be to maintain convincing increasingly suppliers that the event alternatives supplied by the Elation platform are well worth the problem of ripping and changing their present system. It’s one of many issues which have made the established EHR distributors very sticky.
Nevertheless, the elements for a disruption cycle within the EHR market are all current, and one factor Elation has confirmed is that it is mature sufficient to compete.
