Small and medium-sized (SMB) medical groups are prime candidates for tech-driven, value-based care transformation, but outdated enterprise architectures and payer fragmentation are holding them back.
The SMB care sector is awash with new health tech solutions. These tools promise better patient care through value-based contracts and incentives, smoother workflows, and increased efficiency. But there’s a big challenge hidden in this abundance: profit-driven frameworks that often prioritize financial outcomes over patient care have infiltrated healthcare and exacerbated ongoing payer fragmentation challenges.
The Current SMB Technology Landscape
This tension between care and profit is evident across the industry. Private equity-backed Integrated Delivery Networks (IDNs) increasingly acquire SMB primary care practices as anchors to their care models. While this consolidation may seem beneficial on the surface, given the increased ability to coordinate care, it often results in reduced competition in the market and IDNs gaining negotiation power over payers, making SMB care providers more vulnerable to being acquired through a vicious cycle.
The acquired provider often has less autonomy to make decisions, such as contracting for value or how they deliver care. The parent organization often restricts the technology options available to a clinic as it tries to standardize its provider network for better efficiency, data integration, and payer management.
Meanwhile, the provider that maintains independence faces financial strain, less favorable contracts with payers, and continuing operational struggles due to heavy administrative loads.
At the heart of the technology focus for both acquired and independent SMB medical groups is the primary technology they rely on—the electronic health record (EHR).
The EHR Ecosystem
Many SMB medical groups adopted EHR systems 15 years ago when the Meaningful Use program was introduced as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. These EHRs were not originally designed to address what is now ubiquitous in healthcare – interoperability and integration across point-of-care solutions and provider-facing innovation.
To tackle the issue of outdated EHRs, there is a growing tendency for third-party solutions to pursue direct integrations with these technologies. However, traditional EHR integrations are often time-consuming and cost-prohibitive and don’t fully address the need for workflow integration and collaboration between health plans and providers. The lack of workflow integration frequently results in multiple platforms and portals, increasing provider burden and frustration and hindering optimal care delivery.
Scaling directly integrated solutions becomes even more complicated, limiting their reach and potential impact. These limitations prevent a truly cohesive ecosystem and hinder provider empowerment.
Creating a Virtually Integrated Health System
The key to making transformation accessible to SMB care providers and scaling it across stakeholders (EHRs, point-of-care tech, payers, providers, etc.) is threefold:
1. Solving seamless EHR and workflow integration
2. Enabling easy access to longitudinal patient and multi-payer data at the point of care
3. Enabling collaboration with 3rd party digital health builders
We need a paradigm shift in how we approach healthcare technology to address these challenges. The future lies in EHRs that serve as central databases while integrating seamlessly with various best-of-breed solutions and stakeholders. This approach fosters innovation and stakeholder partnership and empowers providers to choose tools that best suit their needs and goals.
Imagine an “App Store for Healthcare,” where developers can create innovative solutions that easily plug into existing EHR infrastructure. This would democratize access to cutting-edge technologies such as predictive analytics, clinical decision support, and personalized patient care, making them available to independent providers of all sizes and facilitating seamless data exchange.
As technology vendors in the healthcare space, we are responsible for equalizing the opportunities available to independent SMB care providers. We must focus on seamless integration between best-of-breed solutions that are otherwise out of reach for such practices. Think of it as crowdsourcing innovation and distributing it where it belongs—at the point of patient care.
Managed Service Organizations, value-based care enablers, health plans, and accountable care organizations can all capitalize on this model and more seamlessly interact with providers (i.e., working with a middleware technology that seamlessly integrates into the EHR for the fulfillment of their data, insights, and applications). This approach can help keep providers independent while infusing transformation and value into their everyday lives and those of their patients.
Conclusion
As the advantages of a neutralized healthcare ecosystem take shape, small and medium-sized medical groups and care providers can double-click on digital healthcare’s benefits: improved workflow efficiency, reduced administrative burdens, and, ultimately, better patient care.
By transforming existing EHRs into central hubs, SMBs can scale operations without costly overhauls. This puts healthcare transformation within reach for SMB care providers and ultimately benefits all patients. As we move forward, we must prioritize open, collaborative ecosystems that empower independent providers and foster innovation at the point of care.
The future of healthcare lies not in consolidation but in equal access to transformative technologies. By embracing this vision, we can create a healthcare system that truly serves the needs of both providers and patients.
Oron Afek
Oron Afek is CEO of Vim.
