Colleen Lindholz, president of Kroger Health, spoke about the grocery store’s plans to expand further into healthcare.


Kroger is look to assist customers who have issues with the accessibility and affordability of prescription drugs.

To that end, the Cincinnati-based grocery store giant launched a pharmacy savings club in partnership with GoodRx last December.

Lindholz also impressed the need to incorporate ‘food as medicine’ into the company’s healthcare plans.

Cincinnati-based grocery and retail giant Kroger Co. has ambitions to continue its healthcare expansion mission, according to Colleen Lindholz, president of Kroger Health.

Kroger is one of the largest grocery stores and retail companies in the country, with about 2,300 pharmacies and 221 retail clinics, offering it a sizable footprint to compete in healthcare. Lindholz has been with the company for more than two decades and has helped craft its business strategy focused on health and wellness.

“Our vision is to help people live healthier lives, and our mission statement states that we’re going to simplify healthcare by creating solutions that combine health, wellness, and nutrition to connect with people on a personal level,” Lindholz told HealthLeaders.

From Lindholz’s perspective, there are several opportunities for Kroger to grow in healthcare, most notably through improving prescription drug delivery in a way that benefits consumers and focuses on promoting ‘food as medicine.’ However, she also spoke to the lingering challenges Kroger faces, including industry consolidation, difficult negotiations with pharmacy benefit managers (PBM), and rising direct and indirect remuneration (DIR) fees.

Below are some takeaways from Lindholz on what lies ahead for Kroger in the healthcare sphere.


Lindholz said that Kroger, like other healthcare players, is subject to the pressures produced by widespread vertical integration and consolidation. Kroger’s strategy to drive prescriptions into its stores has been affected by the fact that it contracts with multiple PBMs, the major ones being owned by large health plans.

“We’re seeing a lot of pressure as far as reimbursements are concerned and DIR fees, which are escalating out of control,” Lindholz said. “I know there’s some activity going on in Washington right now with a call for DIR reform and where should most of the cost reduction be.”

Lindholz added that Kroger remains a supporter of the concept of DIR fees, citing the purpose for their initial creation as a way to provide a higher quality of care for patients.

“However, we are getting hit with DIR fees that are 300% ahead of where we were in 2016,” Lindholz said.

PBMs also compound the problem for Kroger, according to Lindholz, since they act as a negotiator with the drugmakers but ultimately set the standards for how rebates are passed through to pharmacies.

“The way that they measure us and the way that we compete to get those rebates back, where 2,300 pharmacies are compared to an independent that has five pharmacies, is crazy,” Lindholz said. “I think the way that they’re measuring it is all for their gain, not necessarily for the patient’s gain. We want the lowest cost to be at the point of sale where the patient actually is.”


A key component to addressing chronic disease is addressing what people eat, Lindholz said. Kroger introduced its free “OptUp” app in an attempt to correct some of the root problems that contribute to chronic disease.

In 2017, Kroger conducted a study to analyze A1Cs, the average blood sugar over 90 days, and blood pressure in diabetic employees and leverage nutritional science to assist them in making food purchasing decisions.

Kroger was so encouraged by the results of the study that it had nutrition and technology experts at the company design an app driven by the Kroger loyalty card  as a way to “simplify Kroger customers’ ability to shop for healthier foods.”

“The results were so statistically significant that we decided to bring the app to the market because we believe that over time it can sustain behavior change,” Lindholz said. “What we’re trying to do is be in the prevention space, specifically around diabetes, where we’re helping our diabetics make those food choices that they critically need in order to keep from progressing with their disease and going from two oral medications onto insulin.”

A spokesperson from Kroger said the company will soon be rolling out an update to the app to allow customers the ability to shop for healthier foods, even if they do not shop at Kroger.

Lindholz also commented that healthcare is a fragmented industry, citing the lack of communication between different electronic medical records (EMR) systems.

Lindholz said the company sought to create a solution to foster a better line of communication with systems that run on Epic and Cerner.

“We’re building a platform that we’re going to be able to see across all of our pharmacies and will connect with the top 17 EMRs in the country,” Lindholz said. “It’s important in our quest to go after the triple aim and to decrease some of this fragmentation while closing gaps in care.”

“One of the unique pieces of that new platform is that it will be the first time that anyone’s ever included a food score. We’re going to test in Cincinnati with a cardiologist and an endocrinologist around getting to look at how customers eat, if we can help change their behavior, and will their overall outcomes be better over time?”


Given Lindholz’s background as a pharmacist, it should come as no surprise that one of her major initiatives at Kroger is improving the availability and affordability of prescription drugs for customers. To that end, Lindholz noted that Kroger currently has three central prescription fill facilities around the country that fill prescriptions overnight so Kroger can have the lowest cost to fill.

“This allows us to spend more time with the patients that are in the store and deliver the highest quality of care that we can at the lowest cost,” Lindholz said. “We’re doing a lot more one-on-one counseling with customers, both at the counter and also through a center of excellence that we have. We’re up 320% in clinical interventions versus a year ago and that is due to us putting a system in place that queued up pharmacists at the time either when they’re with patients at the store or through our call center.”

Kroger also launched a pharmacy savings club in partnership with GoodRx last December to assist customers dealing with high prices and limited access to prescription drugs.

“What that club does is it brings transparency and pricing directly to the customer. It costs $36 for an individual, $72 for a family, and we are delivering a significant amount of savings to the consumer,” Lindholz said. “What we’re doing with the savings club is cutting out the middleman. We’re taking all the rebates that we would get from the manufacturers and passing them directly down to our customers, which is saving them a whole lot of money.”




Cerner, Epic’s analytics tools prove most popular in clinical surveillance market

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Cerner and Epic offer the most frequently adopted clinical surveillance tools in the provider market, according to a KLAS Research report.

KLAS interviewed providers about their experiences with vendors offering popular clinical surveillance tools for its report. These tools review information from data sources such as EMRs to alert clinicians about a range of patient care activities that decrease readmissions and mortality. The most common use case for clinical surveillance tools today is sepsis detection, according to KLAS.

Cerner and Epic were the only vendors KLAS validated as having “extensive adoption” for their clinical surveillance tools. Of the 17 Cerner customers surveyed, most were using the vendor’s clinical surveillance for sepsis detection. The 18 Epic customers KLAS surveyed tended to use the vendor’s functionalities for sepsis detection, orders checking and floorwide alerts, among a few other less-common use cases.

KLAS noted that although Cerner and Epic were the most widely adopted clinical surveillance vendors, customers of these two vendors tended to be “less satisfied than customers of the other charted vendors in this report,” which included companies like Bernoulli and Stanson Health.

Cerner customers told KLAS they felt the system needed to better integrate with physician workflows and lacked customization options. Epic customers said that the vendor’s alerts were difficult to set up, but were pleased with its ease of use after implementation. KLAS noted Epic does not have a dedicated clinical surveillance modality, but customers have adapted its EMR to provide similar features.


Trinity Health chooses Epic for integrated EHR, revenue cycle management

St. Joseph Oakland is part of the Trinity Health system in Pontiac, Michigan. Credit: <a href="" target="_blank">Twitter</a>


The Michigan health system, one of the largest in the U.S., says it wants to roll out a single, enterprise platform to deliver “people-centered care.

It’s a big week for Epic implementations in the Upper Midwest. The world-class Mayo Clinic is ready to go live with its newly-minted system on May 5, after more than three years of work. And today comes news that sprawling Trinity Health, based in Livonia, Michigan, has selected Epic to build out its own enterprise-wide electronic health record and revenue cycle management system.

It’s a process the Catholic health system expects will take four years to implement across its 94 hospitals and 109 continuing care locations. The expected cost of the deal was not disclosed.

Trinity officials said the integrated Epic platform will allow the health system to improve experiences for patients and clinicians across the board.

“People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record,” said Mike Slubowski, president and chief operating officer of Trinity Health.

“At the same time, physicians and clinicians need tools that make it easier to practice medicine,” he said. “We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care.”

It’s the same appetite for a seamless and enterprise-wide system, across all locations and functionalities, that Mayo Clinic CIO Christopher Ross said was a factor in its choice of Epic back in 2015. That health system had been “steadily working toward a convergence of its practice” for several years, he said at the time, and best-of-breed would no longer suffice for achieving those goals.

At Trinity Health, the plan is to leverage Epic as a fully-integrated system for a single, comprehensive health record for every patient.

Trinity tapped Epic on the strength of the different products offered on that single, unified platform, officials said – not just enterprise EHR and revenue cycle, which will eventually go live at all of its hospitals, ambulatory centers, physician offices and continuing care programs, used by some 100,000 employee – but also online scheduling, e-visits and  online bill pay.

“We are confident a single platform will enable new levels of innovation, consumer focus, clinical and business integration and efficiency to help us build our people-centered health system,” said Slubowski. “It will also help align people, process and technology to create a culture in which people-centered care becomes the standard way we care for the communities we serve.”

Top Ambulatory EHR Systems by Hospital Implementation

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EHR system implementation has been on the rise over the past 10 years. This is, at least in part, attributed to the Centers for Medicare and Medicaid Services (CMS) Meaningful Use initiative that began in 2011. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible providers who demonstrated meaningful use of Electronic Health Record (EHR) technology received incentive payments. The intent was to encourage healthcare providers to utilize electronic data recording and sharing technology to improve clinical quality and care transparency.

More than 92 percent of hospitals in the U.S. use an EHR system, according to Definitive Healthcare data. The implementation rate is even higher among acute care hospitals, with over 95 percent of long- and short-term facilities using EHR systems. Vendors Epic and Cerner dominate the EHR market, holding a combined 52 percent market share. There are two varieties of EHR systems: inpatient and ambulatory. Inpatient EHR is designed for use on patients staying at a facility for at least one night and is therefore primarily used by hospitals. Ambulatory EHR is designed for outpatient facilities and small physician practices, where patient visits do not include an overnight stay.

Top 5 Ambulatory EHR System Vendors

  1. Epic
  2. Cerner
  3. Meditech
  4. CPSI (Evident and Healthland)
  5. Medhost

An EHR is the digital version of a patient’s medical history. Generally, a patient’s EHR includes demographic information, diagnosis history, prescription data, laboratory results, vital signs, immunizations, progress notes, and more. Digital records allow providers to quickly and easily share patient data with providers in other facilities, regardless of whether the facility is in-network. Electronic record sharing can improve patient care and experience by allowing providers anywhere to access and understand an individual’s medical history. This is particularly useful in cases where a patient may be unconscious or unable to communicate upon arrival to a facility, when a patient is visiting a facility out-of-state, or if a patient visits a retail clinic or freestanding urgent care clinic.


Lawsuit: Epic’s software double-bills Medicare, Medicaid for anesthesia services

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Health IT giant Verona, Wis.-based Epic Systems has been hit with a False Claims Act lawsuit that alleges the company’s software double-bills Medicare and Medicaid for anesthesia services, resulting in the government being overbilled by hundreds of millions of dollars.

The lawsuit, which was filed under the qui tam provision of the False Claims Act in 2015 and made public Thursday, alleges Epic’s billing software’s default protocol is to charge for both the applicable base units for anesthesia provided on a procedure and the actual time taken for the procedure. This results in the provider being reimbursed twice for the base unit component, according to the lawsuit.

The whistle-blower who filed the lawsuit, Geraldine Petrowski, worked at Raleigh, N.C.-based WakeMed Health from September 2008 through June 2014. In her role as supervisor of physician’s coding, Ms. Petrowski served as the hospital liaison for Epic’s implementation of its software at WakeMed Health.

Ms. Petrowski claims she provided examples to Epic representatives illustrating the double-billing practice, and the company initially ignored her complaints. “It was only after relator, Petrowski, reiterated her direction to fix this software setting that [Epic] relented and fixed it only for the WakeMed Health facility,” according to the lawsuit.

The lawsuit alleges the unlawful billing protocol has resulted “in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims.”

In a statement to Healthcare IT News, an Epic spokeswoman said, “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.”

The Department of Justice declined to intervene in the case, and the whistle-blower will move forward in the case without the government.

Most Significant Epic, Cerner Health IT Achievements of 2017

Epic EHR, Cerner EHR


Epic and Cerner continue to dominate the healthcare industry and this year the two health IT companies have made key additions to their portfolios.

Epic Systems and Cerner Corporation solidified their status as top dogs in the health IT industry in 2017.

Both health IT companies scored massive contracts this year, with Epic continuing to gain popularity among the private sector and Cerner expanding its presence in the public sphere.

Cerner and Epic have also found success expanding their health IT offerings into other areas of care management, including population health and revenue cycle management. The companies have proven their ability to stay ahead of the curve by continuing to add more products and technologies to their arsenal in keeping with developments in the industry.

Over midway through 2017, here are a few of the most significant achievements of the year by the biggest players in health IT:

Cerner, Epic, McKesson Among Top 5 Global Health IT Vendors

EHR Vendors

IDC ranks Cerner, Epic, and McKesson Technology Solutions among the top 5 largest health IT vendors to healthcare payers and provider institutions.

The winners of the IDC Health Insights 2017 HealthTech Rankings released this week named Cerner, McKesson, and Epic Systems among the leading global health IT suppliers.

IDC Health Insights supplied the rankings indicating new benchmarks for health IT hardware, software, and services vendors.

Among the top five largest health IT companies worldwide are Cerner, Epic, and McKesson. This list is the second annual global revenue ranking by IDC Health.

The 2017 HealthTech Rankings comprise the following two lists:

  • The Top 50 features the largest companies that derive more than one third of their revenue from healthcare payer and/or provider institutions. The largest of the Top 50 companies is Optum, a subsidiary of UnitedHealth Group.
  • The Enterprise Top 25 features the largest companies that derive less than one third of their revenues from healthcare payer and/or provider institutions. The largest of the Enterprise Top 25 companies is IBM.

Cerner was listed as the second largest vendor in the HealthTech Top 50.

GE Healthcare ranked third, McKesson Technology Solutions came in fourth, and Epic Systems ranked as the fifth largest health IT vendor to healthcare payers and providers worldwide.

“IDC Health Insights is excited to release the second annual HealthTech Rankings,” said Research Vice President for IDC Health Insights Lynne Dunbrack. “These global revenue rankings offer a valuable industry benchmark of the leading global technology and service suppliers within the healthcare payer and provider services industry.”

The top five largest vendors listed in the HealthTech Enterprise Top 25 in descending order were IBM, Royal Philips, Siemens, Intel, and Microsoft.

A recent KLAS global EHR market share report similarly named Epic and Cerner among the EHR companies enjoying the highest level of worldwide success across the industry in 2016.

While Cerner maintained its hold as a top contendor, Epic Systems and InterSystems gained more clients than any other EHR vendor last year due in part to the technologies’ vast scope of functionalities and usability.

Epic and InterSystems both boast a wide array of functionalities and user-friendly technologies, but InterSystems won more contracts last year due to its more affordably priced product packages.

However, Epic contracted 8,190 beds in 2016—3,000 more than the next closest competitor.

While Cerner was less lucrative abroad in 2016 than it has been in years past, the vendor still earned the majority of the market share in foreign markets including the Middle East.

The recent spike in contracts for EHR vendors both within the US and abroad are indicative of the widespread adoption of EHR technology in healthcare systems around the globe.

Epic, Cerner hold majority of EHR market share in acute care hospitals

technology, EHR, EMR, doctor, physician, tablet

A new report from KLAS found Epic and Cerner each held about one-quarter of the acute care hospital EHR market share in 2016. Epic had 25.8 percent of the market, while Cerner had 24.6 percent. Meditech followed close behind, claiming the next biggest share of the market at 16.6 percent. McKesson and athenahealth were closer to the bottom of the pack, with 4.6 percent and 1.6 percent respectively.

These findings come as small hospitals are increasingly making EHR purchasing choices. KLAS found hospitals with less than 200 beds made 78 percent of EHR purchasing decisions in the United States in 2016.

Despite claiming their own unique portions of the market, each vendor went through a different experience in 2016.

With the largest market share, Epic is the “[s]ix-year leader in net acute care hospital growth.” Additionally, KLAS identified only two hospitals that left Epic in 2016, both of which did so involuntarily because they were spun off or acquired.

Cerner had the second-largest percentage of the market, primarily due to its wins in the small hospital space. “Small hospitals moved to Cerner more than any other vendor in 2016,” the KLAS report said. Though these hospitals seem to like Cerner CommunityWorks due to its integration functionalities, many community hospitals lamented both Cerner’s and Epic’s lack of customization capabilities.

Meditech claimed nearly 17 percent of the market, but many of its customers were wary of its ability to provide for their needs going forward. Still, Meditech snatched 17 new hospitals in 2016, and according to KLAS, “there are early indications that the release of Meditech’s integrated ambulatory offering and new development on the inpatient side are changing the market’s perception” of the vendor.

McKesson had 4.6 percent of the market. However, the vendor saw a “[s]ignificant decline in Paragon market share.” KLAS found few of McKesson’s Paragon EHR users were pleased with the system’s functionality.

athenahealth only claimed 1.6 percent of the market in 2016. Nevertheless, the vendor “[h]as maintained significant energy since entering the acute care market in 2015.” In fact, the “number of hospitals that contracted with athenahealth more than doubled in 2016,” according to KLAS. While one-third of its wins were in hospitals with more than 25 beds, the other two-thirds were in critical access hospitals.

Other notable vendors include CPSI, Medhost and Allscripts. Though it held 10.8 percent of the market, KLAS found CPSI wasn’t frequently considered among community hospitals. Medhost, which held 4 percent of the market, had a slight decrease in its overall acute care market share. Allscripts, however, had a net gain in 2016 and possessed 3.5 percent of the market.

Epic to add care management content to its EHRs

Dive Brief:

  • Epic announced that it will incorporate care management content from xG Health Solutions, which is developed by the Geisinger Health System, into its electronic health records (EHRs).
  • xG Health Solutions content helps to guide clinical decision-making with evidence-based assessments and care plans for 60 conditions commonly seen in care management programs, according to the EHR vendor.
  • The content should be available to users of Epics Health Planet software, a population management platform, by later this year.


University of Vermont Health Network to implement $112.4 million Epic EHR

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The University of Vermont Medical Center filed a certificate of need, or CON application, with the state of Vermont Jan. 3, seeking approval to create a unified electronic health record system across four hospitals in the University of Vermont Health Network.

The submission of the CON application signals the start of a regulatory review process for the project.

A unified EHR would significantly improve patient care by having all of a patient’s information available to a healthcare provider regardless of location whenever it is needed, health system officials noted in their CON application.

“If a patient needs to go from their primary care provider’s office to a specialist, that specialist would have instant access to the patient’s full record rather than just portions that can be shared electronically today,” John Brumsted, MD, president and CEO of UVM Health Network, in a statement.

“There are still times when the medical records are faxed or even hand-delivered by the patient at the appointment,” he added. “In urgent situations, and especially during an emergency, having immediate access to important information is critical. A unified EHR is foundational to our ability to collaborate fully to provide the highest quality care possible.”

The capital cost of the project, which is subject to CON review, is $112.4 million. It includes $3.1 million in capitalized interest. The total cost of the project over the first six years of implementation and operation is expected to be $151.6 million.

Done independently, it could cost up to $200 million for the four hospitals to upgrade their own systems, and it would lack the network connectivity, UVM officials calculated.