This article is brought to you by Kipu Health. This article is based on a Q&A that took place during the BHB Value conference with Paul Joiner, CEO of Kipu Health. The Q&A took place on April 26, 2022. The discussion has been edited for length and clarity.
Behavioral Health Business: The theme today is value-based care. I think technology plays obviously a super important role in that, so I’m excited to dig in with you here. Paul, could you give me a quick background and then do a quick overview of Kipu, and your approach to value-based care?
Paul Joiner: My name is Paul Joiner. I’m the CEO of Kipu Health. I joined Kipu eight months ago. Prior to Kipu, I was a COO at Availity for six years and worked closely with health plans. I understand the health plan world and how data infrastructure supports value-based care.
With Kipu Health, we’re the leading Behavioral Health EMR in the substance abuse and addiction treatment space, predominantly in detox and residential treatment, with a growing business in outpatient care settings.
I want to comment on one thing around value-based care that’s really important, and you’ll see this as a consistent theme and that’s data. The key to data though that you’ll hear throughout the EMR story, the patient journey, and a little bit about our business, is it’s the attribution of the data that means everything. The patient’s name is one thing but being able to attribute that patient name to what programs they’re participating in, where they are in the care, all the metadata that wraps around the patient is really important.
From a pain point perspective for value-based care, how are you helping your clients at least either get started with value-based care, or how are you helping them to further their journey along the path?
With our EMR, we’re addressing these data requirements by assigning data to a specific user, fostering interoperability and alleviating the burdens on staff members as they adjust to new requirements.
We often hear from our clients that their staff is overworked and they don’t have time to train them on new processes. They’re looking for a tool that puts the right work in front of them and moves the data from a staff member to the next appropriate place in the care continuum along the way.
That’s where a lot of the pain points are. We’ve been working to ensure our EMR better supports the user experience and delivers a data structure that helps them move through the patient journey with ease and straddles a fee-for-service and value-based care environment.
Have you been able to make any progress? It’s obviously a challenge to get it out, but are you starting to make progress in terms of getting some stuff out, or are you helping people get what they need?
Yes, we’ve had some success. Providers of scale face a choice when it comes to supporting and straddling value-based care and fee-for-service.
The organizations succeeding are investing in value-based care, building the infrastructure and a team to do it. We then partner with them to ensure we’re getting the information to the right team or data warehouse. From there, they’re able to marry it with health plan data to support an outcomes-based reimbursement model.
How big are these providers typically?
We typically see a census of 300 in the substance abuse space.
Got it. They’re connecting with home and community-based services, or who are they trying to get the data to?
First of all, it’s just to the health plans. Second of all, transition of care to settings is still very manual, with a lot of files, FTP servers, and uploads and movement. We’re working to connect to move records, assign records out, and move patients around. Not everybody can be rolled-up or where they want to be, so they also need to be able to support entities that are contracted with each other to take on risk.
Do you guys have a roadmap in place for when you’d like to get there?
Yes. This year is all about getting the data structures correctly. We’re improving, we’re deploying a new patient portal to support our providers, a new scheduler, a patient logistics component, and then we are putting an interoperability framework together.
Are your customers, are they asking for all this kind of stuff?
Yes. The behavioral health world, in all segments of healthcare, they all go through this curve a little differently. The behavioral health role is moving very fast. That’s forcing us to move our technology faster and get ahead.
We’ve seen a lot of private equity roll-ups in the substance abuse space. I’m curious, are you seeing those private equity-backed companies? Are they starting to dabble more value-based care? Are they the ones asking for this?
They will, yes, because they’ll try to figure out or they’re going to try to de-risk the revenue reimbursement exposure. Private equity is going to put more pressure for more analytics.
In order to take on that risk, where are you recommending providers invest in technology specifically?
One, buy a good EMR. From there, start at the front. How are you going to engage the patient? How are you going to get patients into your services? Then say, “Okay, what tools do we have for our clinicians?” Here’s the real key, in my opinion, the transition. How are you going to set up infrastructure and technology to move patients from one location to this less costly location at the appropriate time with appropriate information so there’s not a lot of rework?
In terms of your client breakdown, are most midsized, large, etc.?
For us, it’s mostly mid-sized. I would say, of our 900 to 1,000 contracts, about 60 of them are growing really fast.
When you are making that trend away from fee-for-service to quality-based reimbursement models, there’s a huge concern. Everybody’s having a hard time finding clinicians and finding people to work in the buildings. What are you seeing your customers do to make sure you can continue having those processes in place and continuing to grow the business?
Our clients are really concerned about staffing and virtual care; telehealth puts additional pressure on that as well.
Last week, we hosted a panel in California with about 30 clients. The discussion was supposed to be an hour and a half, and I would say 15 minutes was on documentation. That’s a big pressure on staff. Without proper documentation in the fee-for-service world, you’re not getting paid, and there’s a lot more claims and denials.
That also leads down the road to analytics for value-based care and taking on population health. It’s a precursor, if you will.
It sounds like your big focus is helping people get ready for the shift right now.
Yes. Again, it goes back to those key decisions. Do I need to add additional resources and knowledge? What systems do I need to buy? What systems do I need to leverage more? Then, how do I do the analytics to support it?
For you as the technology provider, eventually, do you have to go all in on one certain point, or do you have to balance that?
We have to balance it. I think most EMRs get in trouble by spreading across everything, versus being specific and defining where you want to be successful and differentiate.
To do that, you have to put interoperability in place, you have to do the data attribution, and you have to make sure you have a user experience that allows it to plug in to other things.
Are you looking at acquisitions and things to put onto your system at a certain point? Or are you looking to just integrate?
We may have to buy some assets. If the payers really do what they always do, which is risk-adjustment, we’re going to have to support that as well. That’s going to probably require some acquisition of knowledge and talent.
Let’s talk a little bit about telehealth and virtual care, as well as home-based care, if you don’t mind. I’d love to see, how are you guys integrating that?
We support a number of pure play telehealth providers. As an EMR, we have to manage both in-person and virtual care scenarios, where they go from a telehealth origin, now, they need to be sent to a physical provider. To a physical provider, we need to make sure that this telehealth experience they get back to the provider in compliance, do the monthly check-in, etc. We need to be able to schedule that and organize that for telehealth.
Tell me about the acquisition that Kipu made. It was a revenue cycle company.
Yes, we acquired Avea, a revenue cycle management company, and this is really part of our value-based care strategy. As an EMR in the mental health substance abuse space, you really need to be end-to-end, just because of the different sizes of the providers. We quickly identified that we needed to be on a fully-integrated control of the platform in the revenue cycle perspective. Linking the clinical data and the financial data will help us be able to support the providers as they move to value-based care. This all begins at the very, very beginning. That all feeds down into the clinical journey and into the revenue cycle journey, because that’s where it all starts.
How do you see technology helping providers match the best provider for each individual based on their license and things like that? Tell me a little bit about your thoughts there.
I’m going to end where I began, which is, knowing who that patient is, knowing physically where they are, and knowing what programs they need to participate, and getting the right clinician in is the name of the game.
If you’re going to take on risk as a provider and if your health plan is going to be handing risk over to a provider, you need to make sure that you’re going to be able to gauge that patient and get them to the right location at the right time.
Last question, in 12 months, where do you think you’ll be in terms of your list of things you want to get done?
We’ll have the data structures and hierarchy finished. We’ll have the second-generation analyst platform and the first components of the scheduling and logistics. From there, we’ll probably over-allocate in terms of the clinical documentation process, so that we can get that right, so that we can move data to the payers, and balance the straddle between fee-for-service versus value-based care.
Kipu Health delivers innovative technology solutions to manage care, improve operations and keep finances healthy so you can focus on helping patients recover. To learn more visit: Https://kipuhealth.com.
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