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Anyone who has been watching Netsmart's rapid growth over the last two years has to have asked themselves at least once, "What does a behavioral health software company want with Allscripts Home Care and Hospice (March, 2016), HealthMEDX's Long Term Care and Home Health Vision application (October, 2016), and DeVero's forms-based point-of-care system (July, 2017)?" (Explore this recent history with our search engine at

We took that question to Netsmart's EVP of Corporate Development, Kevin Scalia. His game plan is clear, to connect as many healthcare services entities as possible into one coordinated communication system with patients at the center. He calls it the Netsmart "Health Home." "We have the largest market share by miles in the Behavioral Health market," he began. "We built a platform that works like an air traffic controller. It is connected to Emergency Department information systems, for example. Patients register with a local ED and our BH software customers get an alert when they show up. Now we are taking that model into Home Health and Long Term Care."

This movement toward a universal healthcare network is Netsmart's long-term goal. "As ACOs become insurance companies, they need connectivity help across business sectors," he continued. "We are already bringing all types of clients together to discuss how to work together toward this end. We do not have time to wait. In fact, we already have 15-20 Home Health clients connected into the network and four or five of those are already using our population health system to manage bundles and ACO relationships."

He also confirmed universal suspicions that there might be a good fit between the HealthMEDX system, which was built for LTC providers and later expanded into Home Health and Hospice, and the DeVero point-of-care application. He said that integration is already in process and has its first joint client. Talks have begun with other DeVero clients — including the San Jose company's marquee customer, Kindred — about wiring into Netsmart's national HIE network.

Scalia does use this language, that Netsmart's Health Home will become its own nationwide Health Information Exchange and that the company welcomes providers of all types to share patient data through it. "We are a founding member of 'Care Equality,' which recently merged with the 'Commonwell Health Alliance,'" he added. "That nationwide interoperability system has tremendous potential."

Though Commonwell has been as notorious for its one missing member as for the good it has brought to healthcare's interoperability needs, Scalia emphasized to us that Netsmart has a strong working relationship with Epic as well. The hospital, physician practice, and Home Health software company actively exchanges patient data with all Netsmart products, he told us.

Mutually Beneficial Acquisitions
With regard to Netsmart's wave of acquisitions, he explained that they target companies with good products and loyal customers that may not have the wherewithal to invest heavily in R&D. "We spend as much on R&D as the total budget of many other post-acute software companies," he asserted. "DeVero, for example, has a phenomenally successful User Interface for nurses and they can roll it out rapidly to large-scale clients, as they did for Gentiva and then Kindred. But no software company has ever been successful selling the same product to both small and large clients. We have always had a couple of EHRs in each market. As we talk to a client, we can detect which one they need. If a multi-business line company wants to have all its divisions on the same platform, Vision or Allscripts can serve and they can integrate DeVero on the front end if it suits their needs."

To facilitate matching software products to client needs, the company has built out over the past 7 or 8 years Netsmart’s CareGuidance™ solution suite, under the direction of Senior VP Scott Green. Green the teams charged with driving the company’s interoperability, population health, consumer engagement and analytics operations.

"We realized that one EHR is not enough to serve clients in a value-based purchasing world," Scalia concluded. "You need family engagement, 3rd-party cooperation, payer relationships. So we have different products for small and large organizations, and to accommodate companies rapidly growing from small to large, but they all wire in to one large EHR. This is what we did in Behavioral Health. The complexity of the HIE market is a problem for some. If each entity has to figure out how to configure a CCD, they may not have the bench depth in IT to do it. So, we built our own HIE, connected it with Epic, and can electronically push a referral in either direction.

Payer Engagement
He added that Netsmart is now working with Managed Care Organizations to coordinate care and payment. "We work together to identify what they do well and what we do well," Scalia said. "An MCO might remind someone when to get a colonoscopy but how do you deal with a frail elderly person with depression? They need help from both Home Health and Behavioral Health. If you do this effectively, payers would love to engage in a full-risk model but they can’t because they don’t have the IT infrastructure and the analytics. We do. Because we do, we can help our clients participate with payers in a way that is financially viable. They are clients become recognized leaders and more and more business gets funneled to them."

The EVV Situation
We asked Scalia about Netsmart's response to the 21st Century CURES Act and its mandate that every state establish an electronic visit verification mandate of its own. "If they need our assistance when they go into a state, we wire EVV providers into our network," he replied. "So far, we have developed interoperable communications with Dial N Document, Sandata, and CellTrak."

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.