2018 United States Ambulatory EHR Enabling Technology Leadership Award

1. 2018 United States Ambulatory EHR
Enabling Technology Leadership Award
2018

2. BEST PRACTICES RESEARCH
© Frost & Sullivan 2018 2 “We Accelerate Growth”
Contents
Background and Company Performance ........................................................................3
Industry Challenges..............................................................................................3
Technology Leverage and Customer Impact.............................................................3
Conclusion...........................................................................................................7
Significance of Enabling Technology Leadership .............................................................8
Understanding Enabling Technology Leadership .............................................................8
Key Benchmarking Criteria ....................................................................................9
Best Practices Award Analysis......................................................................................9
Decision Support Scorecard ...................................................................................9
Technology Leverage ..........................................................................................10
Customer Impact ...............................................................................................10
Decision Support Matrix ......................................................................................11
Best Practices Recognition: 10 Steps to Researching, Identifying, and Recognizing Best
Practices .................................................................................................................12
The Intersection between 360-Degree Research and Best Practices Awards.....................13
Research Methodology ........................................................................................13
About Frost & Sullivan ..............................................................................................13

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Background and Company Performance
Industry Challenges
The US healthcare industry is undergoing a transformation that is altering business
operations every day in response to expanding political influence, changing regulations,
and evolving demographic dynamics. Providers across the country aspire to optimize
outcomes and streamline expenses with the help of high-performing healthcare
technologies that offer value-based, result-oriented, and user-friendly solutions.
The poor usability of legacy healthcare IT platforms that do not optimally support the
recently imposed final rules set by MACRA (Medicare Access and CHIP Reauthorization
Act) has compelled most US-based physician practices to re-imagine their healthcare IT
infrastructure priorities. Today, Frost & Sullivan points out that they are more receptive to
either upgrade or completely replace their incumbent electronic health record (EHR) and
billing systems. The fact that the current rip and replacement rate (for EHR) is estimated
to be as high as 50% in the United States is aiding progressive healthcare IT solution
providers that are capable of helping physicians assemble a safe, coordinated, auto-
updated, and remotely accessible healthcare IT environment that comprises both clinical
and financial IT products.
Frost & Sullivan notes that almost all of these vendors demonstrate some form of cloud-
based capabilities. In addition, in response to providers’ demand for an interoperable
healthcare IT ecosystem that authenticates and facilitates seamless data exchange across
the care continuum, these vendors report to Frost & Sullivan how they are actively trying
to evolve and add innovative features that can optimize practice profitability. Many
practices are currently at-risk of going out of business due to the lack of competitive
advantage and the involvement of multiple payers (e.g., private, public, out-of-pocket)
that are embracing performance-based reimbursement. Frost & Sullivan recognizes how
compliant and cost-effective healthcare IT vendors provide the tools needed for these
vendors to thrive in the ever-changing healthcare landscape.
Technology Leverage and Customer Impact
Commitment to Innovation and Creativity
Since 2004, US company Kareo, Inc. (Kareo) has broken ground as a pioneering cloud-
based healthcare IT vendor that specializes in HIPAA-compliant billing for US ambulatory
physician practices. In the last 14 years, the company has gradually added progressive
features into its core product portfolio to keep it relevant for a wide variety of customers,
namely doctors, practice managers, billers, billing companies, and new practices serving
patients that cumulatively represent more than 35 disease categories. Today, Kareo offers
clinical (EHR), financial (billing, managed billing, and collection), and patient engagement
and practice marketing (patient reviews, provider profiles, online appointments and

4. BEST PRACTICES RESEARCH
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reminders) solutions to over 45,000 ambulatory healthcare providers across all 50 US
states
The latest product innovation from Kareo is a flagship solution called Kareo Telemedicine,
which provides the US telemedicine industry with a secure and HIPAA-compliant video
consultation tool for remote visits between patients and their physicians. The tool is
supported by an experienced customer service team and powered by agile cloud-based
software that can be implemented, operated, and managed remotely via Internet
connection. Separate download of heavy IT applications is not required. In this way, Frost
& Sullivan recognizes how the solution serves a critical purpose in saving substantial
operational costs that practices historically incur - while catering to patients who visit their
clinics to receive a diverse scope of healthcare services. Kareo Telemedicine is also fully
interoperable with Kareo EHR and Kareo Billing. It allows providers to perform
reimbursement eligibility assessment (in accordance with state telemedicine
reimbursement protocols and private payer mandates) seamlessly and helps physicians
prioritize appointments via EHR and practice management (PM) systems. As a result,
practices reduce patient no-shows and improve follow-up care.
Frost & Sullivan acknowledges that Kareo’s ability to guarantee private payer
reimbursement for virtual patient visits is truly unique among its top competitors, as lack
of reimbursement for telemedicine has restricted many providers from adopting the
technology. This has been made possible by Chiron Health, Kareo’s leading IT partner,
which incorporates an advanced telemedicine rules engine into the Kareo EHR workflow
and ensures that independent clinicians and physicians are reimbursed adequately for
embracing telemedicine. The two-year bipartisan budget, which was introduced by the
Senate recently (February 2018), also includes a specific provision (under the Chronic
Care Act) to extend the scope of telehealth to Medicare Advantage Plans from 2020. Frost
& Sullivan agrees that Kareo is well positioned to maximize value from this new legislative
rule.
Stage Gate Efficiency
Frost & Sullivan applauds how Kareo has revolutionized the cloud-based EHR market for
US-based physician practices with its modular EHR solution that can be custom configured
based on end-user preferences. The platform is deployed much quicker than legacy EHRs,
as solution accessibility is granted and authenticated via Internet connection. The ICD-10
compliant and MU 2015 Edition certified technology enables both physician and non-
physician providers to optimize practice productivity by allowing clinical documentation, e-
prescribing, patient charting, secure messaging, patient portal integration, consolidation of
lab reports, and dashboard-based analytics. More importantly, customers can transfer
procedure and diagnostic codes to Kareo billing seamlessly (without having to log into
separate portals). Practices that generate paper statements or deploy in-house coding
full-time employees can also partner with Kareo for processing billing documents at scale.
In this way, practices can streamline operational productivity, which has become a critical
prerequisite for many independent practices today.

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Another important element of Kareo’s products is their ability to remain fully interoperable
with each other. For instance, the practice management software can be deployed within
the EHR solution as an additional module. Pricing for both clinical and financial products is
bundled in such a way that practices establish cost competitiveness when compared
against other practices that dedicate separate IT investment for EHR and PM software
systems. All customers of the integrated solution are granted unlimited use of common
platform features - such as patient scheduling, appointment reminders, and HIPAA-
compliant messaging. In Frost & Sullivan’s view, these cloud-based solution features
grant impressive convenience to physicians, establish cost transparency for management
leaders, and improve the practice’s efficiency at an enterprise level.
Application Diversity
While Kareo’s clinical product portfolio stands out for being value-based, its financial and
marketing solutions position the firm as a truly diverse healthcare IT solution provider.
Most US physician practices cater to patient populations that represent a diverse payer
mix. These patients - coupled with others who are enrolled with either co-pay or high-
deductible health plans - pose critical challenges to practices that often fail to manage and
collect patient dues on time. Kareo properly solves this problem for practices that
currently manage in-house billing teams in dire need of third-party support. The firm
effectively reduces practices’ operational burden specific to record keeping, accounts
receivable (A/R) management, charge capture, and collection.
Kareo Billing digitizes the entire billing workflow and provides virtual support that
promotes paperless billing transaction and hassle-free collection for customers.
Furthermore, Kareo Billing is auto-upgraded at no additional cost and can be accessed
from virtually anywhere with a secured online log-in. Practice leaders also enjoy having
access to comprehensive reports that Kareo Billing’s built-in analytics engine generates
within a fast turnaround time. This allows key opinion leaders to prioritize patient reach-
out strategy (for collection) and ensure reduction of average A/R timeline for the
enterprise.
Kareo also caters to physician practices that are more receptive to outsource their entire
billing and collection office to a third-party IT provider to gain cost advantage and focus
exclusively on patient care. In particular, Kareo Smart Workflow, powered by Kareo
Medical Billing, was designed by doctors to help customers deploy a virtual team capable
of undertaking every complex element of billing, which covers the following:
• Specialty-specific billing
• Patient eligibility assessment from a single screen
• Charge capture during patient visit via multi-media enablers
• Rules engine optimization in accordance with national benchmarks

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• Claims monitoring
• Real-time measurement of outstanding payments and periodic alert for the same
• Billing productivity management via dashboard reporting
Kareo also offers practice marketing and patient engagement solutions to ensure that
every customer is well equipped to augment patient experience via personalized
communications. Kareo Marketing allows practices to establish a credible online presence,
which promotes convenience and transparency for every stakeholder, especially incoming
and outgoing patients. Features such as online patient scheduling, post-visit patient
feedback collection, and timely patient contact have allowed physicians to secure patients’
trust and attract new customers.
Overall, Kareo’s billing and marketing solutions help physicians streamline the cost of
billing and improve revenue objectives.
Frost & Sullivan believes a solution technology platform that supports the needs of
independent provider practices across diverse clinical, financial, and other critical business
areas is the correct way forward in terms of optimal client benefit from solution providers.
Customer Purchase and Ownership Experience
Kareo is not a pure-play IT vendor. In addition to its solution portfolio, the company also
offers a service team that is dedicated to physician practices’ training, hosting,
implementation, and optimization needs.
The team is available to assist physicians in various ways, including tele-consultation,
email response, or real-time online chat. Claims that are submitted by practices are
reviewed by the team with the help of a progressive billing technology (code-scrubbing
system) that clearly highlights patterns of diagnostic misinterpretation (involving clinical
codes) and prompts repeat submissions that ultimately prevent loss of payment. Despite
such measurements, claims that are rejected by payers would be analyzed by Kareo to
identify the root cause.
In addition, Kareo assigns a success coach to each customer account. The coach is
primarily responsible for onboarding new users and ensuring proficiency with all relevant
Kareo modules and functionality. The assigned coach delivers regular consultations with
practice leaders and in-house billing team members who greatly benefit from timely
information on their coding and claims and overall practice management efficiency.As a
result, Kareo’s key customers demonstrate industry-leading results and remain associated
with the firm for years.

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Conclusion
Kareo is backed by both loyal institutional investors that have remained committed to this
firm for many years, and new investors that have agreed to partner due to the strength of
the company’s latest products, positive market reputation, impressive revenue growth,
and sustainable business models. Kareo serves an important US healthcare market need,
which can be characterized as physician practices’ growing appetite for outsourced billing
and collection services.
As such, Kareo has been reporting double-digit revenue growth for last few years. The
company’s latest revenue is an estimated to exceed $75 million.With its strong overall
performance, Kareo has earned the 2018 Frost & Sullivan Enabling Technology Leadership
Award.

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Significance of Enabling Technology Leadership
Ultimately, growth in any organization depends upon customers purchasing from a
company and then making the decision to return time and again. In a sense, then,
everything is truly about the customer—and making those customers happy is the
cornerstone of any long-term successful growth strategy. To achieve these goals through
enabling technology leadership, an organization must be best-in-class in three key areas:
understanding demand, nurturing the brand, and differentiating from the competition.
Understanding Enabling Technology Leadership
Product quality (driven by innovative technology) is the foundation of delivering customer
value. When complemented by an equally rigorous focus on the customer, companies can
begin to differentiate themselves from the competition. From awareness, to consideration,
to purchase, to follow-up support, best-practice organizations deliver a unique and
enjoyable experience that gives customers confidence in the company, its products, and
its integrity.

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Key Benchmarking Criteria
For the Enabling Technology Leadership Award, Frost & Sullivan analysts independently
evaluated two key factors—Technology Leverage and Customer Impact—according to the
criteria identified below.
Technology Leverage
Criterion 1: Commitment to Innovation
Criterion 2: Commitment to Creativity
Criterion 3: Stage Gate Efficiency
Criterion 4: Commercialization Success
Criterion 5: Application Diversity
Customer Impact
Criterion 1: Price/Performance Value
Criterion 2: Customer Purchase Experience
Criterion 3: Customer Ownership Experience
Criterion 4: Customer Service Experience
Criterion 5: Brand Equity
Best Practices Award Analysis for Kareo
Decision Support Scorecard
To support its evaluation of best practices across multiple business performance
categories, Frost & Sullivan employs a customized Decision Support Scorecard. This tool
allows our research and consulting teams to objectively analyze performance, according to
the key benchmarking criteria listed in the previous section, and to assign ratings on that
basis. The tool follows a 10-point scale that allows for nuances in performance evaluation.
Ratings guidelines are illustrated below.
RATINGS GUIDELINES
The Decision Support Scorecard is organized by Technology Leverage and Customer
Impact (i.e., These are the overarching categories for all 10 benchmarking criteria; the
definitions for each criterion are provided beneath the scorecard.). The research team
confirms the veracity of this weighted scorecard through sensitivity analysis, which
confirms that small changes to the ratings for a specific criterion do not lead to a
significant change in the overall relative rankings of the companies.

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The results of this analysis are shown below. To remain unbiased and to protect the
interests of all organizations reviewed, we have chosen to refer to the other key
participants as Competitor 2 and Competitor 3.
Measurement of 1–10 (1 = poor; 10 = excellent)
Enabling Technology Leadership
Technology
Leverage
Customer
Impact
Average
Rating
Kareo 9.0 9.0 9.0
Competitor 2 8.0 8.0 8.0
Competitor 3 8.0 7.5 7.5
Technology Leverage
Criterion 1: Commitment to Innovation
Requirement: Conscious, ongoing adoption of emerging technologies that enables new
product development and enhances product performance
Criterion 2: Commitment to Creativity
Requirement: Technology leveraged to push the limits of form and function in the pursuit
of “white space” innovation
Criterion 3: Stage Gate Efficiency
Requirement: Adoption of technology to enhance the stage gate process for launching new
products and solutions
Criterion 4: Commercialization Success
Requirement: A proven track record of taking new technologies to market with a high rate
of success
Criterion 5: Application Diversity
Requirement: The development and/or integration of technologies that serve multiple
applications and can be embraced in multiple environments
Customer Impact
Criterion 1: Price/Performance Value
Requirement: Products or services offer the best value for the price, compared to similar
offerings in the market.
Criterion 2: Customer Purchase Experience
Requirement: Customers feel they are buying the most optimal solution that addresses
both their unique needs and their unique constraints.
Criterion 3: Customer Ownership Experience
Requirement: Customers are proud to own the company’s product or service and have a
positive experience throughout the life of the product or service.
Criterion 4: Customer Service Experience
Requirement: Customer service is accessible, fast, stress-free, and of high quality.

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Criterion 5: Brand Equity
Requirement: Customers have a positive view of the brand and exhibit high brand loyalty.
Decision Support Matrix
Once all companies have been evaluated according to the Decision Support Scorecard,
analysts then position the candidates on the matrix shown below, enabling them to
visualize which companies are truly breakthrough and which ones are not yet operating at
best-in-class levels.
High
Low
Low High
CustomerImpact
Technology Leverage
Kareo
Competitor 2
Competitor 3

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Best Practices Recognition: 10 Steps to Researching,
Identifying, and Recognizing Best Practices
Frost & Sullivan analysts follow a 10-step process to evaluate Award candidates and
assess their fit with select best practice criteria. The reputation and integrity of the
Awards are based on close adherence to this process.
STEP OBJECTIVE KEY ACTIVITIES OUTPUT
1
Monitor,
target, and
screen
Identify Award recipient
candidates from around the
globe
• Conduct in-depth industry
research
• Identify emerging sectors
• Scan multiple geographies
Pipeline of candidates who
potentially meet all best-
practice criteria
2
Perform
360-degree
research
Perform comprehensive,
360-degree research on all
candidates in the pipeline
• Interview thought leaders
and industry practitioners
• Assess candidates’ fit with
best-practice criteria
• Rank all candidates
Matrix positioning of all
candidates’ performance
relative to one another
3
Invite
thought
leadership in
best
practices
Perform in-depth
examination of all candidates
• Confirm best-practice criteria
• Examine eligibility of all
candidates
• Identify any information gaps
Detailed profiles of all
ranked candidates
4
Initiate
research
director
review
Conduct an unbiased
evaluation of all candidate
profiles
• Brainstorm ranking options
• Invite multiple perspectives
on candidates’ performance
• Update candidate profiles
Final prioritization of all
eligible candidates and
companion best-practice
positioning paper
5
Assemble
panel of
industry
experts
Present findings to an expert
panel of industry thought
leaders
• Share findings
• Strengthen cases for
candidate eligibility
• Prioritize candidates
Refined list of prioritized
Award candidates
6
Conduct
global
industry
review
Build consensus on Award
candidates’ eligibility
• Hold global team meeting to
review all candidates
• Pressure-test fit with criteria
• Confirm inclusion of all
eligible candidates
Final list of eligible Award
candidates, representing
success stories worldwide
7
Perform
quality check
Develop official Award
consideration materials
• Perform final performance
benchmarking activities
• Write nominations
• Perform quality review
High-quality, accurate, and
creative presentation of
nominees’ successes
8
Reconnect
with panel of
industry
experts
Finalize the selection of the
best-practice Award recipient
• Review analysis with panel
• Build consensus
• Select recipient
Decision on which company
performs best against all
best-practice criteria
9
Communicate
recognition
Inform Award recipient of
Award recognition
• Present Award to the CEO
• Inspire the organization for
continued success
• Celebrate the recipient’s
performance
Announcement of Award
and plan for how recipient
can use the Award to
enhance the brand
10
Take
strategic
action
Upon licensing, company is
able to share Award news
with stakeholders and
customers
• Coordinate media outreach
• Design a marketing plan
• Assess Award’s role in future
strategic planning
Widespread awareness of
recipient’s Award status
among investors, media
personnel, and employees

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The Intersection between 360-Degree Research and Best
Practices Awards
Research Methodology
Frost & Sullivan’s 360-degree research
methodology represents the analytical
rigor of our research process. It offers a
360-degree-view of industry challenges,
trends, and issues by integrating all 7 of
Frost & Sullivan's research methodologies.
Too often companies make important
growth decisions based on a narrow
understanding of their environment,
leading to errors of both omission and
commission. Successful growth strategies
are founded on a thorough understanding
of market, technical, economic, financial,
customer, best practices, and
demographic analyses. The integration of
these research disciplines into the 360-
degree research methodology provides an
evaluation platform for benchmarking
industry participants and for identifying those performing at best-in-class levels.
About Frost & Sullivan
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360-DEGREE RESEARCH: SEEING ORDER IN
THE CHAOS