Veradigm Inc., together with its subsidiaries, operate as a healthcare technology and analytics company. The company is spanning across the three pillars of healthcare: Payer, Provider and Life Science.
The company’s portfolio addresses a range of healthcare industry needs, with the goal of transforming health insightfully, providing key healthcare stakeholders with data, insights and artificial intelligence (AI)-enhanced solutions. In particular, the company’s portfolio, offering some of the m...
Veradigm Inc., together with its subsidiaries, operate as a healthcare technology and analytics company. The company is spanning across the three pillars of healthcare: Payer, Provider and Life Science.
The company’s portfolio addresses a range of healthcare industry needs, with the goal of transforming health insightfully, providing key healthcare stakeholders with data, insights and artificial intelligence (AI)-enhanced solutions. In particular, the company’s portfolio, offering some of the most comprehensive solutions in its industry today, helps its clients advance the quality and efficiency of healthcare by providing electronic health records (EHR), financial management, population health management, deidentified data and patient communication solutions. Built on open integrated platforms, the company’s solutions enable users to streamline workflows, leverage functionality from other software vendors and exchange data.
The company delivers a unique combination of point-of-care clinical and financial solutions, has a commitment to open interoperability and has a large diverse healthcare provider footprint. The company’s solutions and services are sold to physician practices; life science companies; hospitals; retail pharmacies; laboratory centers; health plans; radiology centers; pharmacy benefit management companies; urgent care facilities; insurance companies; health IT companies; media agencies; accountable care organizations; third-party aggregators; EHR vendors; academic institutions; and governments (federal and state).
Ambulatory Facilities
The company’s assets, including EHRs, practice management systems and patient communication platforms, are all integrated into the Veradigm Network. The company connects over 450,000 U.S. healthcare providers via the Veradigm Network, covering over 200 million patients. Through its healthcare provider base and collaboration with other healthcare information technology organizations, the Veradigm Network provides life science and health plan organizations unique access to de-identified patient data, provider connectivity and analytics at scale as described below.
Healthcare Provider Footprint: The company’s healthcare provider solutions form the core of the Veradigm Network. Veradigm offers platforms, solutions and services that help healthcare provider practices of all sizes and specialties with closfud-based and hosted EHR platforms, practice management, revenue cycle services and patient engagement tools. Through the Veradigm Network, healthcare providers can access interconnected resources that support their clinical and financial objectives.
Point-of-Care Connectivity: The scope and depth of the company’s interconnected resources consists of point-of-care solutions connected to external industry stakeholders, including other healthcare providers, payers, life science organizations, laboratories, imaging facilities, public health entities and patients, as well as other third-party technology providers. The company provides bi-directional clinical and financial data exchange between payers and providers, in addition to targeted, scalable delivery of biopharmaceutical awareness messaging to healthcare providers via their EHRs through the company’s media offering for life science clients.
Scalable Data & Insights – With its significant healthcare provider footprint, the company provides scalable access to data and insights via direct connection with the point of care. These data and insights enable clients throughout the healthcare ecosystem to manage the evolution toward value-based care. For life science companies, these data and insights also provide efficient operating models for generating the real-world evidence necessary to accelerate the development of new therapies and to enhance the value of existing ones. Rich, scalable data and insights power the company’s patented risk adjustment methodology with dynamic intervention planning, enabling payers to identify actionable interventions and reduce unnecessary waste.
Provider Business: The company’s Provider business addresses key challenges clinicians face by delivering solutions that improve efficiency, help them demonstrate delivery of high-quality care at lower costs and enable patient-centered data exchange. The Provider business consists of two EHRs, practice management and revenue cycle management, which are patient engagement and enterprise resource planning solutions that streamline and enhance providers’ clinical and financial workflows.
Payer Business: The company’s Payer business addresses the core aspects of value-based care with a comprehensive solution that enables payers and providers to deliver improved patient outcomes. The company’s Payer business delivers four key solutions to its clients that constitute end-to-end solutions for health plans from analytics and data to engagement solutions and beyond enabling clinical data exchange; providing payer analytics around risk adjustment, quality and pharmacy; facilitating clean, accurate submissions to regulatory agencies; and allowing payers to engage with clinicians helping facilitate improved patient outcomes.
Life Science Business: The company’s Life Science business has two main components. The first is the company’s real-world data and research platform. The second component of the company’s Life Science business is the commercial media business, which partners with life science and other healthcare companies and their respective brand agencies to deliver media, advertising and education to clinicians. The company primarily markets its proprietary data by selling directly to pharmaceutical companies and through its partnerships and data marketplaces.
Acquisitions
On January 2, 2024, Veradigm announced its acquisition of Koha Health, a full-service revenue cycle management company. With this acquisition, Veradigm added to its depth of offerings as a leading provider of revenue cycle services in ambulatory healthcare.
On March 4, 2024, Veradigm completed its acquisition of Cascade Bio, Inc., which does business as ScienceIO (ScienceIO). ScienceIO’s models power diverse healthcare use cases while preserving patient privacy, including patient anonymization, record linkage, information extraction, summarization and predictive analytics.
Solutions
The company’s solutions drive value through a unique combination of platforms, data, software expertise, connectivity and scale. The company’s principal solutions consist of the following:
Provider
Veradigm streamlines and enhances clinical and financial workflows. The company’s solutions:
Reduce administrative burden associated with ever-changing regulatory and reimbursement requirements;
Improve practice financial performance by leveraging analytics, interoperability technology and professional expertise;
Deliver actionable insights to drive improved outcomes, reduce patients’ out-of-pocket costs and enhance patient understanding of their disease state and medication therapy; and
Improve efficiency of point-of-care decision making by integrating payer guidance directly into each provider’s existing workflow.
EHRs: The company offers two different EHRs for ambulatory healthcare provider medical practices: Practice Fusion and Veradigm EHR. The company’s EHRs deliver a unified patient record, workflow and consolidated analytics, helping to deliver improved patient care and outcomes. The company’s EHR solutions consist of the following:
Veradigm EHR is a flexible EHR solution for all sized physician practices, customizable and adaptable to specialty groups, with comprehensive clinical documentation capabilities to support increased adoption of population health management. The solution’s mobile offering, Veradigm EHR Mobile, provides on-the-go access to the platform.
Practice Fusion EHR is a cloud-based ambulatory EHR for independent physicians, primarily focused on smaller practices. Practice Fusion EHR is an intuitive, easy-to-use solution for clinicians in smaller independent practices. Key features include scheduling, billing, referral management, charting, document management, e-prescribing and value-based care. The solution helps drive operational efficiencies with smart charting that adapts to each practice’s specific needs and enables patients to receive their medications more quickly. Practice Fusion EHR also reduces administrative burdens by helping staff simplify front-office tasks and improve billing efficiency.
Electronic Prescribing: Veradigm ePrescribe is a full-featured streamlined electronic prescribing solution that facilitates safer prescribing and regulatory compliance and provides data for value-based and quality program participation. The Veradigm ePrescribe solution performs automated prescription insurance verification, medication history retrieval, automatic allergy / interaction checks, electronic prescribing of controlled substances and electronic prior authorization.
Veradigm Diagnostic Ordering and Results Network (DORN) offers streamlined application programming interfaces (API) integration to connect healthcare providers to hundreds of laboratories and radiology connections. DORN utilizes a standard integration format for all laboratory and radiology centers, eliminating the need to customize orders, results and compendium updates for each connection.
Practice and Financial Management: Veradigm’s practice and financial solutions support revenue cycle, claims management, budgeting and analytic functions for physician practices. In addition, the company offers solutions that help investment firms manage the practices they own or in which they invest. Offerings include the following:
Veradigm Practice Management is a revenue cycle management solution for physician practices of all sizes and specialties, including independent practices and those associated with health systems as provider-based practices. This EHR-agnostic solution helps streamline the management of medical practices, including scheduling, collections, billing automation, claim verification, address verification and denials.
Predictive Scheduler is an automated scheduling solution that uses predictive analytics and AI to help practices identify, prioritize and schedule complex patient panels. This solution is currently embedded within Veradigm Practice Management and can be integrated with additional EHR/practice management systems.
Veradigm Revenue Cycle Services empowers healthcare providers to find a path to lower the number of days accounts receivable are outstanding, reduce claim errors and result in fewer denials as compared to industry benchmarks.
Veradigm Payerpath is an end-to-end suite of revenue cycle management solutions built to assist organizations in managing every step in the reimbursement cycle, streamlining communications with payers and patients.
Veradigm Coding Services leverage coding talent, along with technology-enabled, autonomous coding and workflow tools, to optimize clinical documentation and minimize coding deficiencies that lead to reimbursement denials.
Patient Engagement: Veradigm FollowMyHealth is trusted mobile engagement software that provides value to healthcare organizations, patients and consumers. This comprehensive single vendor patient engagement solution promotes collaboration between patients and healthcare providers while addressing regulatory requirements. This patient engagement platform serves as the foundation for emerging consumer health initiatives, including automated secure messaging.
Enterprise Resource Planning (ERP): Veradigm ERP Solutions enhance an organization’s ability to effectively manage its supply chain and financials with a single solution, enabling managers to gain new insight into and gain better control over their success, along with the ability to manage expense and capital that is critical to the overall financial health of an organization. Offerings include the following:
Veradigm Fiscal Management is an easy-to-use accounts payable, general ledger, fixed asset, project accounting and fiscal analysis and reporting solution that helps an organization streamline processes, eliminate paperwork, analyze data and identify substantial cost savings throughout the enterprise.
Veradigm Supply Chain links the entire supply chain into a single, integrated process, providing single to multi-entity healthcare organizations with accurate, up-to-the-minute operational information that helps forecast supply needs, streamline processes, automate ordering, reduce overall costs and increase productivity.
Veradigm Point of Use is an agnostic barcode solution to automate patient charge capture and replenishment functions to optimize inventory quantities and reduce stock-outs.
Network Solutions: Veradigm Connect connects health technology applications with physicians and patients without the usual barriers associated with implementing new technology. This helps to streamline integration with electronic health records and practice management solutions in the Veradigm portfolio. Developers utilize the company’s proprietary APIs, Fast Healthcare Interoperability Resources (FHIR) APIs and other capabilities to streamline workflows and enhance functionality for clinicians, patients and other users of core clinical and financial applications.
Payer
Veradigm works with payers to enhance patient and provider engagement and improve payers’ financial performance by combining bi-directional interoperability, large point-of-care scale and an end-to-end solution for payers, including risk adjustment and quality analytics and reporting, encounter submissions and clinical data exchange. The company’s solutions:
Deliver insights to drive quality outcomes cost-effectively;
Enhance efficiency point-of-care decision making by integrating payer insights directly into the provider workflow;
Improve efficiency for payers and providers through high-speed clinical data exchange; and
Remove barriers to accessing effective care while raising patient and provider satisfaction.
Analytics and Reporting: The company’s analytics and reporting solutions for payers include the following:
Risk Analytics identifies and analyzes conditions with the greatest risk, calculates confidence-adjusted risk scores, prioritizes opportunities and recommends intervention strategies.
Quality Analytics enables prioritization and closing of most important quality gaps to drive improved results on quality metrics including Star Rating, Centers of Medicare & Medicaid Services (CMS) Quality Rating System and HEDIS.
Veradigm Comprehensive Submissions provides a unified platform for all programs to help manage encounter submissions for government-sponsored programs.
Veradigm eChart Courier is a solution that helps save time, office resources and expenses by automating the medical chart retrieval process. Health plans can not only make their own processes more efficient but can also improve the efficiency of network providers.
Collaborate is a health plan specific portal solution enabling providers to see gaps in care and respond and upload data directly to payers.
Veradigm Payer Insights is a solution that payers can use to deliver care gap alerts to their providers, within the patient’s EHR, as part of a network of payers. Alerts contain relevant, patient-specific considerations for the provider to evaluate, respond to and address with the patient.
CORE is the company’s end-to-end, in-office engagement program combining technology and services to improve clinical and financial outcomes and simplify patient care journeys. CORE facilitates appointment scheduling and adherence, drives actionable insights to the point of care, enables concurrent encounter coding and embeds clinical staff to help ensure complete and accurate documentation. This solution also includes analytics identifying risk, quality, utilization and health equity care gaps.
Life Science
Veradigm delivers solutions to help life science companies enhance patient care and provider engagement, support the medication approval process and optimize access. In particular, the company:
Provides real-world data (RWD) from EHRs, registries and claims, either as standalone or combined datasets;
Serves agencies and life science companies by delivering promotional ads via Veradigm provider platforms;
Performs retrospective and prospective real-world evidence (“RWE”) studies through Veradigm’s RWE services group; and
Provides deeper insights into patient conditions, treatment and outcomes through the company’s enriched EHR datasets with clinical notes augmentation using proprietary natural language processing models for multiple therapeutic areas.
Veradigm Real-World Data provides easy-to-use and research-ready RWD sets with access to millions of patient records. Datasets include:
The company’s large ambulatory EHR database sourced from the Veradigm Network covering a large diverse patient population nationwide, which is regulatory-grade, standardized and deidentified with statistical certification;
The company’s enriched EHR datasets with clinical notes augmentation using proprietary natural language processing models for cardiovascular, central nervous system, immunology, metabolic disease and more; and
Two of the largest registries of cardiovascular and metabolic patients providing expanded clinical insights.
Veradigm Real-World Evidence can assist life science companies in turning RWD into RWE, whether using data from Veradigm, the company’s Veradigm Network partners or other sources. The offering supports development of RWE by helping life science companies to identify, clarify and address their research questions by analyzing RWD sourced from the Veradigm Network and other data assets.
Veradigm Digital Health Media is a program where life science companies may communicate approved messaging through highly targeted awareness campaigns that combine significant scale and reach and measurable results built on a decade of leadership in point-of-care media, all in a manner designed to be compliant with the HIPAA and other applicable laws.
Strategy
The company’s strategy is built upon its position at the intersection of the key healthcare stakeholders, Providers, Payers and Life Science, to implement value based care to improve health outcomes. The company’s organic growth strategy focuses on booking new clients in each of its markets of interest and increasing its penetration with existing clients to expand its core Provider base in particular. The company has investments across the Veradigm portfolio and plans to evaluate inorganic growth opportunities, aligned with its markets of interest. The company’s strategy is also focused on enhancing the value of its offerings, including advancing AI-enabled clinical and financial workflow solutions.
By integrating high-value specialty practices into its EHR network and broadening the company’s reach in revenue cycle management solutions, the continued expansion of the Veradigm Network—through increased provider participation, enhanced data access and improved connectivity—will drive growth across all of its market segments.
Regulations
The company processes protected health information, both as a business associate to its clients and as a covered entity, and it is subject to significant compliance obligations under the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act and their respective implementing regulations (collectively, HIPAA). The company also processes personal health data and are subject to the Federal Trade Commission Act and an ever-expanding list of comprehensive state privacy laws in the U.S. the company must also comply with the federal Cyber Incident Reporting for Critical Infrastructure Act of 2022 and SEC reporting requirements that may require it to provide notifications of certain cybersecurity incidents before its investigations are complete and within short timeframes.
Competition
The company’s principal existing competitors include AdvancedMD; Advantmed, LLC; Aetion, Inc.; Altera; Apixio; athenahealth, Inc.; Availity, LLC; CareCloud; Clarivate; ConnectiveRx; CorEvitas, LLC; Cotiviti, Inc.; CPSI (Computer Programs and Systems Inc.); DoseSpot; DrChrono, Inc.; DrFirst; eClinicalWorks, LLC; Edifecs; Elation Health; Enli Health Intelligence; Epic Systems Corporation; Episource, LLC; Evercommerce, Inc.; Evidera; Evolent Health, Inc. ; Greenway Health, LLC; Harris Healthcare; Healthagen; Health Catalyst; Health Gorilla Inc.; Health Verity; Infogix, Inc.; Inovalon; InStep Health; IQVIA; Kareo, Inc.; Komodo Health, Inc.; Lexis-Nexis; MDToolbox; MEDHOST, Inc.; Meditech (Medical Information Technology, Inc.); Medsphere Systems Corporation; Merative, Modernizing Medicine, Inc.; NextGen Healthcare, Inc.; nThrive Revenue Systems, LLC; OM1, Inc.; Optum, Inc. ; OptimizeRx Corporation; Panalgo, LLC; Phreesia; Premier Inc.; R1 RCM, Inc.; Redox Inc.; RXNT; SimplePractice LLC; Symphony Health; Tebra; The T System, Inc.; TriNetX, LLC; TriZetto Provider Solutions; Verana Health; and Waystar.
Intellectual Property
Many of the company’s products include intellectual property obtained from third parties. For example:
Many of the company’s products are built on technology provided by Microsoft Corporation, such as the Microsoft SQL Server information platform, the Microsoft .NET Framework and the Microsoft Azure cloud platform.
The company also has products built on technology provided by Amazon Web Services.
The company also licenses content from companies, such as OptumInsight, 3M Health Information Systems, Wolters Kluwer Health, Elsevier, IMO and Clinical Architecture that it incorporates or uses in certain solutions.
History
The company was founded in 1986. It was incorporated in 2000. The company was formerly known as Allscripts Healthcare Solutions, Inc. and changed its name to Veradigm Inc. in 2023.
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