A team of Epic alumni based in Madison, Wis., is launching a company called ProsperityEHR built around a cloud-based electronic health record designed to help behavioral health organizations streamline operations and improve patient care. CEO Melissa Tran and Chief Revenue Office Jesse Vogel spoke with Healthcare Innovation about the market opportunity they saw in the behavioral health EHR space.
Healthcare Innovation: I was interested to hear your story, because you were both Epic alums. What are some things about your experience there that led you to see this opportunity?
Vogel: What we saw working with larger health systems was that a lot of times behavioral health was more of a cost center than it was a service line. A lot of big medical groups would offer behavioral health services, but it shrunk over time. I was at Epic from about 2003 until 2014 and in that time, a lot of those groups started to outsource a lot of behavioral health because it didn’t reimburse well enough for them to be able to continue offering it. From our vantage point, we thought about what’s happening to those patients when they’re leaving the walls of a larger health system, and I can tell you this — the data isn’t going with them. As a patient or family member, as you leave the electronic health record super highway of the larger health systems and you go into behavioral health, you realize none of that data came with me. So if you’re talking about whole-person care, this is something that needs to be addressed.
Tran: We were at Epic and got to see a lot of the challenges that people experienced in terms of integrating with behavioral health. We’re well aware of health systems that are using completely separate electronic health records or paper for their behavioral healthcare, and that’s very separate from the Epics, the Cerners, the athenahealths. It was not uncommon for us to go talk to someone like an ER physician who would say, ‘Gosh, if we just had some information from a behavioral health perspective, we wouldn’t have had to put that person in restraints.’
So we saw an opportunity. We saw how much there was a need for integration and interoperability. We saw what worked and didn’t work from a big EHR perspective, and we also saw just how many disparate systems that were out there. We thought we have the rare opportunity and some of the experience having worked directly with providers, as well as with an EMR to effect change in the behavioral health space.
HCI: When you look at the potential customer base, is it mostly smaller practices versus departments of big health systems or large mental health practices?
Vogel: The vast majority are smaller. There is a lot of consolidation happening, but predominantly you’re talking about smaller groups. There are a lot of group practices that are 10 or 15 or 20 providers with an aspiration to grow, and that’s the size group that that we’re primarily targeting.
HCI: When you looked at the current behavioral healthcare EHR market, what did you see? Are there a couple of players who dominate that, or is there a vast array of small EHR offerings?
Tran: There are a lot of different EMRs that are doing very specific things well. And there are some that started 30 years ago that are smaller and have a core set of customers. And there has been a lot of M&A activity happening in the behavioral health space. That’s occurring both on the practice side and also on the EMR side. So you’re seeing this huge landscape shift happening. Many of the providers are needing an upgrade to meet some of the compliance and interoperability needs.
HCI: Did you guys do an acquisition of a company that already existed to be the baseline of what you started from?
Tran: We did. We acquired a company called TheraManager in August 2022. I affectionately call it our geriatric startup because we are starting with a 30-year-old company. They are a good example of a company that was doing the right things from a user base standpoint, but they also knew that they needed to change. They knew interoperability was not their strong suit, and it needed to be. So we acquired the company in 2022. We came in and we said, ‘Hey, there’s all of this really good knowledge, there’s this really strong community customer base that can help us really create a purpose-built solution.’ So we have customer advisory boards, we have focus groups, we do a lot of user research, and from there, we’ve really worked to launch this new product.
Vogel: The electronic health record that was first released as a part of the company’s founding was a behavioral health-specific EHR back in the early ‘90s, before there was really anything out there like that, and it was designed by a psychologist. I was recently talking to one customer and she said they have been using the system almost since it started. Now we’re migrating them to the new platform. She’s super-excited about the fact that the things that they contributed in terms of knowledge to the legacy system, she’s able to see it transition forward — things that matter the most to the clinicians. But now, like Melissa said, we have an opportunity to think about how we really make this scale. How do we make this interoperable? How do we weave in things like compliance and usability and productivity and all the things that we know matter?
HCI: Did you get any venture investments to build the new platform?
Tran: We bootstrapped with a lot of angel investments. Jesse and I and others on the team have this very personal connection to mental health and behavioral health. Everybody knows someone who has been impacted.
HCI: I understand you’ve paid quite a bit of attention to revenue cycle. Is that an issue that these providers grapple with or where you saw an opportunity to improve?
Tran: Yes, it also is one of our interoperability plays. We integrate with a couple different technologies to make sure that people have, as an example, a built-in clearing house. They have the opportunity to really see some more real-time data in terms of denials and eligibility. We also think about the fact that a lot of people in behavioral health need some help in terms of thinking through things like credentialing. We knew that we needed to know rev cycle super well because of all of the landscape changes that are happening in behavioral health specifically.
Vogel: These practices are realizing that the payers are moving the goal line all the time, and the regulations change, and if you don’t have automation built in, it’s really hard to scale without adding a bunch of administrative overhead, without adding more people to chase after all of those things, so that you get paid. Well, the problem is that the reimbursement isn’t significant enough to be able to hire all those people to do that work. A lot of these groups want to add providers, but if you don’t have a technology that allows you to keep the administrative overhead low, it’s almost impossible.
HCI: I saw your EHR as having an AI-ready architecture. What does that term mean to you?
Tran: We know there is a lot of different AI tooling out there. And frankly, in behavioral health, there’s a lot of nervousness around AI tools. So in our current customer base, as an example, only 14% of people said they were totally comfortable with the idea of AI. But even though there are different comfort levels, there are different components that we need to be able to make sure that we’re able to integrate with — things like ambient documentation tools.
Another area is working with our community to help create those AI tools, both from a revenue cycle perspective and also from a clinical perspective. There are people who are using ChatGPT as an online therapist, right? The best thing we can do, from an AI-ready architecture standpoint is start on that journey with providers, to develop those tools with them so it feels like a safe space. It feels like something that they can use, and it’s clinically validated, which I think is something that’s comforting to the patients as well.
