Reimbursement for healthcare services continues to shift from fee-for-service toward value-based models focused more on care management and quality outcomes. Organizational success through this evolution hinges on aligning information technology (IT) strategy to adapt and dictate that the need to integrate information along the continuum of patient care has never been greater.

Software suppliers of electronic medical record (EMR) and electronic health record (EHR) systems have responded to the changing dynamic by developing new service extensions and business models designed to aid provider alignment.

For example, Epic is the top vendor of EHR systems for acute-care hospitals, steadily holding about a third of the market in the U.S. Back in 2007, Epic introduced an alternative model to traditional direct contracting. Dubbed Community Connect, it is a program that enables health systems and hospitals to extend the functionality of their Epic EHR software to independent community physicians and other health facilities. The idea is to foster better integration and create a technological bridge for the regional continuum of care while maintaining a level of independence.

As explained by KLAS, “Fundamentally, Epic’s model is such that Epic will only contract with ambulatory organizations if they exceed 200,000 patient visits per year.” Community Connect can fill the gap for organizations that don’t meet that volume metric, with a “model relies on a local host organization, which is typically an acute care organization” or integrated delivery network (IDN) by extending a host’s “Epic licenses to others through their core license.”

The benefits to both the host organization and the affiliated Community Connect provider group include:

  • Affiliate provider access to the clinical and practice management capabilities of Epic (rated #1 overall by KLAS for the past 12 straight years)
  • One longitudinal patient record connecting providers across a large geographic area with tools for population health and care management
  • Improved provider communications, service coordination, and a holistic unified view of the patient
  • Internal analytics that support Value-Based Purchasing (VBP) initiatives including accountable care organizations (ACOs) and required population health management needs
  • Benefits of a partnership to drive better patient outcomes while supporting independence
  • Opportunity for better alignment with payers to improve care quality and lower administrative and medical costs, reduce denials, and lower turnaround times on prior authorizations
  • Epic’s Community Connect capabilities allow for patient records and additional clinical content to be shared between organizations while the financial data is kept separate through the use of a system tool.

Thus far, it is reported that “nearly 40,000 providers have gained access to Epic through the Community Connect for better interoperability and patient data sharing.”

However, the Community Connect model has not always functioned without flaw. While enhancing interoperability, increasing referrals, and providing a lower cost EHR implementation, it has also sometimes incurred criticism for failing to deliver Epic’s highly rated overall experience. With Community Connect, according to KLAS, “The key difference is in who manages the relationship…the host organization manages interactions like service and support, implementation, and training. While Epic will sometimes step in and do some things directly for implementation or other pieces, the bulk of managing the relationship lands on the originating Epic customer.”

That technical burden doesn’t always meet great expectations. Back in 2020, a KLAS Pulse Check report found that, on a 100-point scale, survey respondents who worked directly with Epic graded the vendor a 91.3 overall score, while those who worked with Community Connect graded it a 78.8 overall score.

Supplying quality support for affiliates factors heavily. Demand for IT staff with experience in the deployment of EHR systems — including Community Connect programs — is extremely high. However, a combination of internal and external resources can be combined to create the team necessary to manage a continuity of care program effectively. Engagement by health system leadership is an overall key driver for success.

While the benefits are many, there are important considerations hosting health systems should address in terms of IT and business strategy prior to embarking on a program like Community Connect. These include:

  • Cost Modeling: Epic offers licensing options that host organizations can leverage to extend Epic into the community. Most large health systems leverage the “Tier” model, where key volumes from the new affiliate organization are added into the existing license to determine if additional tier(s) need to be purchased. This model allows many health systems the ability to extend Epic at little or no additional immediate licensing expense. With continual Stark Law extensions on the books, the host organization also needs to determine the amount of subsidy they can and are willing to provide the affiliate for both capital and operational funding requirements. A detailed cost analysis is highly recommended.
  • Infrastructure: The users at a new affiliate’s site will utilize either your internal infrastructure or may require an expansion by your cloud provider. The estimated growth of your Community Connect program should be reflected in your strategic capital/operating budgeting process.
  • Resources: A Community Connect program can be staffed by a combination of existing and new resources, but don’t overlook predictive budgeting. Qualified staff continue to be difficult to recruit, and costs for these team members have been rising.
  • Change Management: A focus on change management should be maintained at all times. Though Epic’s hierarchical design structure allows for functionality differences and separation between host organization configuration and affiliates, they are not completely separate. It is important to formally review each proposed change to ensure the continuity of the core host system.
  • Timeline: Most health system IT departments are already over-allocated from a resource perspective. It is important to set implementation timelines that are realistic and fair to your teams as well as to affiliate organizations.
  • Governance: A successful connect program requires more than advanced implementation and software management disciplines.  A strong governance council maintains alignment with the affiliate organization and provides a forum for communication and system enhancement requests.

The decision to implement any continuity of care IT strategy should focus primarily on value creation and the benefits realization for patients in meeting the overall needs of a community.

EHR/EMR vendor programs like Epic’s Community Connect can create an unparalleled alignment with physicians and caregivers across a service area by fostering a true team effort that can work from separate facilities for the purpose of providing the best possible care. Each participant can better collaborate via a single, completely integrated, and comprehensive electronic health record. That’s a definitive plus for enabling better continuity of care.

To adapt IT strategy and make the most of such continuity of care programs, analysis prior to launch should cover the following activities:

  • Define the benefits to both the health system and affiliate physician groups
  • Consider future affiliation and partnership planning
  • Understand and assess requirements for a health system to become a managed services/application hosting provider
  • Identify the research needed to determine the overall benefits of a program for the communities that are anticipated to be served
  • Illustrate the program decision factors including overall costs, infrastructure, resource and security requirements, along with potential compliance and regulatory issues
  • Consider lessons learned from recent similar program implementations