Most Interesting Vendor: Greenway Health: Starting the Shift to Population Health

Suffice it to say, 2013 was a memorable year for Greenway Health.

In September, the Carrolltown, Ga.-based company announced a merger with Vitera Healthcare Solutions (Tampa, Fla.). It was one of the biggest overall moves in the healthcare IT landscape in recent memory, combining the 2013 Healthcare Informatics 100’s 38th and 53rd biggest companies.  But that wasn’t the only time Greenway made news in the past year.

The company also went from public to private as part of the deal, expanded its relationship with Epic Systems Corporation (Verona, Wis.) and Cerner Corporation (Kansas City), and became the only organization to co-find both the Healtheway and CommonWell Health initiatives. A few months into 2014, it made another splash when it announced an acquisition of PeopleLYNK patient engagement technology.

Tee Green, CEO, who helped found Greenway back in 1998 and has been on hand for its growth and evolution, says this activity plays into its ultimate goal of providing more of a patient-centered technology focused on population health management. It’s a shift away, he says, from fee-for-service, production medicine.

“We saw the tide beginning to shift in 2013,” Green says. “Not only am I going to have to manage 30 to 40 patients on my schedule today, but I am going to have to manage 30 to 40 patients not on my schedule today. How do I manage diabetics that haven’t been in for a foot exam? How do I know who they are and how do I engage them?  I have to have technology that a) knows those patients haven’t been in and what kind of diabetics those patients are, and then b) can engage them electronically. We saw this concept of population health become more real to us last year.”

Tee Green

THE VITERA MERGER

The $644 million merger with Vitera is the most pertinent example of this philosophical shift. The merger came about when Vista Equity Partners, which owns Vitera Healthcare Solutions, bought Greenway’s common stock from shareholders. The merged company, under the Greenway name, has increased its overall customer base and market share.

Green says that with this move, the company can focus less on specific platforms and more on how data is moved between platforms. In particular, Vitera is a good match for Greenway because of its customer base. “[Vitera’s] footprint allowed us to get really excited about being able to connect these communities with PrimeExchange,” he says.

Research director Erik Bermudez of the Orem, Utah-based KLAS Research says that from the Vitera customers’ perspective, the merger was met with mixed emotions. Some, he says, were upset that the recent stability that Vitera/Sage (its name until 2011, when Vista bought Sage Healthcare) had finally achieved was going to be disturbed. He says others were happy because Greenway has a strong reputation in the market and they hope that culture rubs off on Vitera.

Interestingly, Green says that Greenway had looked at a potential deal with Vitera/Sage a while back, but couldn’t figure out a way to make it work. After Vista bought Vitera/Sage, they revisited the potential combination. It took several years but eventually a deal was hammered out.

Bermudez notes that any time a company expands its footprint it comes to the question of how to scale its increased size. “We’ve seen many vendors that are not used to being that big, where they are trying to scale and implement larger customers and [trying to figure out] their go forward product or deciding whether or not to maintain three EHR platforms, while keeping them enhanced, developed, and pushing the envelope,” he says.

FOCUSING ON INTEROPERABILITY  

In case it wasn’t already clear, Greenway is betting big on interoperability. During interviews, Green frequently touted the company’s PrimeExchange interoperable health IT engine, which he  describes as the largest health information exchange (HIE) not funded by the government. It can connect various clinical, administrative, and financial systems on the Microsoft.NET platform, supporting standards such as Extensible Markup Language (XML), Health Level 7 (HL7), and the continuity of care document (CCD).

“It’s this concept around data liquidity; that’s what PrimeExchange gives us the capability to do,” Green says. Some of this will include platforms from other vendors, he envisions. Last year, Greenway announced a relationship with Epic Systems, where the two companies’ EHR systems would be interoperable to improve care coordination for a large OB/GYN practice. According to Justin Barnes, who was vice president of government and industry affairs at Greenway at the time of the interview, and has  left to pursue other opportunities, Epic will work with your company if  it finds there is a business case for it.

In the vein of industry cooperation, Greenway is the only company that is a co-founder of both the CommonWell and Carequality initiatives. The two industry stakeholder groups are both focused on driving interoperability between different systems, although for different purposes. According to Barnes, CommonWell is driven by EHR companies as a service provider, focused on specific mechanics such as patient matching and consent management. Carequality, founded by the members of the Healtheway project, is driven by a wider net of healthcare stakeholders, to advance patient data interoperability at a more general level through specific use cases.

In either case, it doesn’t matter if Greenway is working with competitors, allies, or unaffiliated organizations. It’s about pushing ahead with an interoperable future.

“At the end of the day, all providers are adopting health IT at different volumes and at different levels. That’s only going to continue to increase. You need to create a smarter, sustainable healthcare system, through the use of innovative healthcare IT and interoperability,” says Barnes, who is the chairman of the EHR Association, another third-party group that Greenway works with. “We will all benefit from this, Greenway will. Silos of information really don’t work because you can’t track people. We want to be on the right side of the future.”

THE NEXT ERA

For all the initiatives, the partnerships, and the buzz, interoperability is still very much a mystery for most provider organizations, notes KLAS’ Bermudez. He adds that if Greenway can be the one to “solve” it, the company’s future would be incredibly bright. Of course, that’s very much a big “if.” Currently, he sees the company at a crucial point in its trajectory because of the Vitera acquisition.

“Right now, more than ever, Greenway is under a magnifying glass,” Bermudez says. “There are great opportunities for them ahead. They have the market share, they have the mind share, and the really have a lot of wind behind their sails. But along with that huge opportunity is the responsibility and challenges to not let their perception in the market slide.”

Erik Bermudez

One area where Greenway won’t have to worry about perception is in the stock market. With the move to private, as part of the Vitera merger, Green says the company can focus on the long-term view, rather than undergoing the scrutiny of quarterly reports. This long-term view, he says, is about breaking down the traditional walls of the hospital and the provider business.

“We see ourselves, over the next decade, being a major player of moving clinical information, financial information, and administrative information around the country, connecting our customers to information that allows them to truly improve health for their consumer,” Green says. “We have the assets and the footprint to do it.”