Green sign on a concrete wall that says "right decision" with an arrow pointing left

With payers increasingly rewarding value and expectations of the customer experience on the rise among all stakeholders, one of the key ways pharmas will differentiate their products is through understanding their customers’ pain points and providing tools and services that address them. For today’s physician, EHRs are a real pain, and prior authorizations are another. So we were interested to learn of a Avhana Health, a startup that is currently piloting a cloud-based clinical decision support system that sits on top of four of the big EHR systems – Epic, Allscripts, AthenaHealth and Greenway.

Clinical decision support (CDS), whereby individual patient data is algorithmically converted into patient-specific alerts and/or recommendations and guidelines, was a minor benchmark in the government’s Meaningful Use 1 and 2 programs, which were designed to speed health IT adoption. But it’s not something EHR vendors are especially well-suited to do, drawing, as it does, on multiple streams of data – claims data and population health data as well as EHR data. That’s where Avhana comes in with their bolt-on solution. The startup is making a play for two customer sets: health systems, for which it offers a plug-in CDS vehicle, and pharmas, for which Avhana offers an in to physicians’ workflow.

“We help physicians practice better care, but health plans are the ones incentivized to pay for better performance,” says Avhana co-founder and CEO Noah Weiner, “and pharmas are incentivized to get the physician to better follow guidelines.”

Avhana doesn’t write the protocols – they just provide subscribing systems with a plug-and-play way to get their employees using them, so that when one of their physicians opens up a case file in an Epic EHR, it triggers the creation of a checklist (doing so in 400 milliseconds, round trip). Weiner compares Avhana to earlier iterations of Netflix – “We’re not in the business of creating content, we’re a platform to distribute content. I like to emphasize the ‘support’ part – we don’t want to make decisions for the physicians. We just want them to make the best decision in a way that’s easier.”

Of particular interest to pharmas, Avhana’s product also streamlines the prior authorizations process, by which payers slow-walk patients and providers into opting for cheaper treatments. “We can run the criteria check in real time and auto-populate the prior authorization form for them,” says Weiner. Pharmas might sponsor this function for a therapeutic area, or use Avhana’s system to push sponsored info on therapeutic options (unbiased and category-wide, mind you – the better not to trigger those anti-kickback snares) to physicians, helping them to avoid dangerous drug interactions or treatments that are inappropriate for a patient.

But beyond speeding up prior authorizations and giving pharmas an in (however narrow) with some otherwise-impenetrable EHR systems, there’s value in Avhana’s example. These sorts of services, which speak to the bewildering complexity of physician decision-making and help to untangle the stubborn snarls built into our system of healthcare provision, present opportunities for pharmas to move beyond the pill and help physicians improve quality of care. In a value-driven world, making life easier for providers and patients – and thereby saving payers some scratch – will be rewarded.

DRG Digital Innovation helps clients pinpoint customer pain points to better differentiate their offerings in today’s increasingly value-driven health system. To learn how we can help you seize opportunities in the market, get in touch at questions@teamdrg.com.

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