LC Patient Access Platform: Build Roadmap

Phreesia + Assort Health Replacement → EHR Foundation Layer  |  Target: December 2026 Phreesia decision point
Current Annual Spend
$1.18M
Phreesia $1M + Assort $180K
Build Investment (Annual)
$275K
2 FTE ($200K) + infra/licensing ($75K)
Net Annual Savings
$905K
Post-transition, recurring
EHR Blocks Delivered
10
Reusable components for provider EHR
CONTRACT Phreesia Contract Analysis Executed 8/26/2024
Non-Renewal Notice
60 days (Section 7.1)
Mid-Term Termination
180 days written notice (Section 7.5)
Termination for Cause
30-day cure, BAA breach documented

Key Contract Findings

LEVERAGE
BAA Non-Compliance (3 documented failures)
150+ day breach notification delay, security safeguard failures, inadequate harm mitigation. Supports termination for cause under Section 7.3 or aggressive renegotiation leverage.
WARNING
No Unbundling Allowed
"Should Customer remove a Service from the bundle, the fee will not be reduced." You cannot negotiate down to only the features you use. It is all or nothing. Renegotiation is not a viable cost reduction path.
WARNING
Section 8.3 Non-Compete Clause
Prohibits using Phreesia products "to build a competitive product or service or copy any ideas, features, functions or graphics." Internal build must be architecturally and visually distinct. Firewall build team from Phreesia dashboard.
ACTION
Richard Chapman: Map Exact Term Dates
Determine when current term expires, when next auto-renewal hits, and the exact 60-day notice deadline. This is the single most time-sensitive action item.
$98.7K/MO What Phreesia Actually Does vs. What We Pay For Sep 2025 Invoice

Features LC Actually Uses (5 of 15+)

IN USE
Registration / Digital Check-In
Core intake across most departments. HTML forms + Athena API write. Build estimate: 6-8 weeks. This is the prototype delivered alongside this roadmap.
IN USE
Insurance Eligibility Verification
Real-time payer checks. Replacement: connect to Availity/Change Healthcare API. Integration is days of work; edge cases take 2-3 weeks. Becomes an EHR RCM building block.
IN USE
Co-Pay / Balance Collection
Card present + card not present. Replacement: Stripe Elements (tokenized, PCI SAQ-A). Current Phreesia rates: 2.19-2.24% + $0.25/txn. Stripe volume pricing is comparable or better.
IN USE
Clinical Screening Forms (PHQ-9, GAD-7, ASRS, HHF)
Standardized instruments in Peds, FM, IM. Published scoring algorithms. Build time: days once forms engine exists. Pushes structured FHIR observations to Athena.
LIMITED
Appointment Reminders
Replacement: Twilio SMS + SendGrid email. Scheduled jobs query Athena for upcoming appointments. Two weeks of work including confirmation/cancellation handling.

Modules We Pay For But Do Not Use

$0 VALUE
Health Campaigns / Patient Chat / OnCall
Disabled or 0% engagement. Billed at $0 unit cost but bundled into per-provider rate. Cannot unbundle per contract.
$0 VALUE
Self-Scheduling / SDOH / Surveys / Pathways / Payment Assurance
All inactive. Paying enterprise tier ($247-251/provider/month) for Tier 3 functionality (~$150/provider/month). Overpaying by ~$100/provider/month across 238 providers.
💰
Bottom line: $1.18M/year for registration, a credit card terminal, and four screening forms. Internal build replaces all five used features for $255K/year (2 FTE + infrastructure + API costs). Net savings: $925K/year, recurring. Every component becomes EHR infrastructure.

Timeline Overview: April 2026 — March 2027

Phase 1: AI Call Center
Phase 2: Scheduling Engine
Phase 3: Intake + Payments
Phase 4: Full Portal
Assort POC ends ~Jul
Phreesia renewal Dec
APRMAYJUNJULAUGSEPOCTNOVDECJANFEBMAR
PHASE 1 AI Call Center / Conversational Routing Apr — Jul 2026 (12 weeks)
Replaces
Assort Health ($180K/yr)
Decision Gate
Assort POC ends ~July
EHR Blocks Built
NLP engine, patient identity, call routing

Components to Build

REPLACES ASSORT
Conversational IVR / AI Call Router
Natural language call tree replacement. Patient states intent, AI routes to scheduling, billing, nurse line, or provider callback. Handles the 80% of calls that are scheduling, Rx refills, and billing questions.
EHR BLOCK
Patient Identity Resolution Layer
MRN lookup, DOB verification, insurance matching. This becomes the universal patient identity service for every future module. Integrates with Athena patient demographics API.
EHR BLOCK
Athena API Integration Service
Centralized, authenticated API gateway to Athena. Handles scheduling reads/writes, patient demographics, appointment availability. Every subsequent phase depends on this.
NEW
Call Analytics Dashboard
Real-time call deflection metrics, resolution rates, transfer patterns. Ties directly to your Phase 2 FAQ strategy (call deflection measurement). Evidence base for the Phreesia decision.
⚠
Assort POC leverage: Run your build in parallel during the 90-day POC. Use Assort's call data to train your routing model. When POC ends, you have a working alternative and Assort's own data proving your call deflection rates. You never sign the annual contract.
PHASE 2 Scheduling Engine + Appointment Management Jul — Oct 2026 (14 weeks)
Replaces
Phreesia scheduling (~60% of contract value)
Decision Gate
Oct review: go/no-go on Dec non-renewal
EHR Blocks Built
Scheduling service, provider directory, appointment state machine

Components to Build

REPLACES PHREESIA
Patient Self-Scheduling Interface
Provider/specialty search, real-time availability from Athena, new patient vs. established routing, insurance pre-check. Responsive web, mobile-first. Builds on Demo 1 portal UI.
EHR BLOCK
Scheduling Rules Engine
Appointment type logic, provider preferences, visit duration rules, new patient gating. This is the same engine the provider-side EHR needs. Build it once.
EHR BLOCK
Provider Directory Service
Specialty taxonomy, provider profiles, location/hours, insurance acceptance. Feeds scheduling, patient portal, and future referral management.
NEW
Appointment Lifecycle Manager
Reminders (SMS/email via Twilio/SendGrid), confirmations, cancellation/reschedule workflows. Replaces Phreesia's reminder module.
REPLACES PHREESIA
Appointment Accelerator
Monitors cancellations and provider bumps in real-time via Athena webhooks. Auto-contacts waitlisted patients by SMS, matches appointment type, provider, insurance, and travel distance. Fills empty slots within minutes. 4-6 weeks build on top of scheduling engine.
NEW
Post-Visit Patient Surveys
NPS scoring, provider-level satisfaction tracking, automated SMS/email delivery 2 hours post-visit. Real-time analytics dashboard. Replaces Phreesia Enhanced Patient Surveys.
⚠
October checkpoint is critical. By October you need scheduling live with at least 3 specialties to prove the pattern before committing to Phreesia non-renewal. If not ready, extend Phreesia 6 months (should be available as a renewal option) and keep building.
PHASE 3 Digital Intake + Payment Collection Sep — Dec 2026 (14 weeks, overlaps Phase 2)
Replaces
Phreesia intake + payment (~40% of contract value)
Dependency
Requires Phase 1 patient identity + Phase 2 scheduling
EHR Blocks Built
Forms engine, insurance verification, payment processing

Components to Build

REPLACES PHREESIA
Digital Pre-Visit Intake
Demographics confirmation, insurance card capture (OCR), medication/allergy review, chief complaint, consent forms. All pushed to Athena pre-visit. Eliminates clipboard workflow.
EHR BLOCK
Clinical Forms Engine
Configurable form builder for intake, screening tools, PHQ-9, specialty questionnaires. Reusable across patient portal and provider EHR. FHIR Questionnaire resource compliant.
EHR BLOCK
Insurance Eligibility + Verification
Real-time payer eligibility checks via clearinghouse (Availity/Change). Co-pay estimation. This is a Phase 3 EHR RCM prerequisite. You're building it years early.
NEW
Patient Payment Gateway
Stripe or similar for co-pay collection, balance payments, payment plans. PCI-compliant tokenization. Replaces Phreesia's payment module and feeds into Athena financial posting.
PHASE 4 Unified Patient Portal + Lexi AI Assistant Jan — Mar 2027 (12 weeks)
Replaces
Athena Patient Portal dependency
Ties To
FAQ Phase 3 (AI/RAG patient access layer)
EHR Blocks Built
Patient-facing clinical data views, secure messaging, document management

Components to Build

EHR BLOCK
Patient Clinical Data Viewer
Lab results, visit summaries, medications, immunizations pulled via Athena FHIR API. This is the patient-facing read layer of the clinical data model from your EHR architecture.
NEW
Lexi: LC AI Patient Assistant
Conversational AI for FAQ, appointment management, Rx refill requests, billing questions. RAG-powered using LC's curated FAQ content (your Phase 1 FAQ strategy). This is the capstone.
EHR BLOCK
Secure Patient Messaging
Provider-patient messaging with routing logic, auto-triage for clinical vs. administrative, attachment support. Replaces Athena patient portal messaging.
EHR BLOCK
Document Management Layer
Visit summaries, after-visit instructions, referral letters, imaging results. Unified document repository with patient access. Foundation for provider-side chart.
REPLACES PHREESIA
Health Campaigns Engine
Rules-based patient outreach for care gaps (overdue mammograms, A1C checks, flu shots). Queries Athena for eligible patients, triggers automated SMS/email campaigns. Tracks booking conversion and revenue generated.
NEW
Care Pathways (Condition Workflows)
Post-surgical follow-up sequences, chronic disease management check-ins, maternity care tracks. Automated patient touchpoints tied to diagnosis codes and visit history. Replaces Phreesia Enterprise Care Pathways.

Architecture: How Patient Access Feeds the EHR

Patient Layer
AI Call Router
Self-Scheduling
Digital Intake
Lexi Assistant
Patient Portal
↓ ↓ ↓ ↓ ↓
Shared Services
Patient Identity
Scheduling Engine
Forms Engine
Insurance Verification
Payment Processing
↓ ↓ ↓ ↓ ↓
Integration
Athena API Gateway
Clearinghouse (Availity)
Payment Processor
FHIR R4 Data Layer
↓ ↓ ↓ ↓
Future EHR
Provider Scheduling (reuses Phase 2 engine)
Clinical Documentation (reuses Forms Engine)
Order Entry (reuses FHIR layer)
ASC Module (Phase 1 EHR target)

Decision Gates

JULY 2026
Sign Assort annual contract or cut over to LC AI call routing?
By this point you have 90 days of Assort call data as training corpus and a working call routing prototype. If call deflection rates match or exceed Assort's, you save $180K/yr and own the IP. If not, you have data on what gaps remain and can negotiate a shorter Assort extension.
OCTOBER 2026
Commit to Phreesia non-renewal or negotiate extension?
Scheduling must be live with 3+ specialties, handling real appointment volume. If it is, notify Phreesia of non-renewal (check contract for notice period). If not, negotiate a 6-month extension at reduced rate, citing the partial feature utilization you've documented.
DECEMBER 2026
Is the intake/payment layer production-ready?
This is the harder lift. Payment processing has PCI compliance requirements. Insurance verification requires clearinghouse integration. If scheduling is solid but intake is not, you can still non-renew Phreesia for scheduling and keep a stripped-down Phreesia contract for intake only at a fraction of $1M.
Q1 2027
Begin ASC EHR pilot using patient access infrastructure?
By now you have patient identity, scheduling, forms, insurance verification, and a FHIR integration layer all in production. The ASC module from your EHR roadmap can be built on top of this stack rather than starting from scratch. This is where the "building blocks" thesis pays off.

Risk Matrix

Risk Level Mitigation
Athena API rate limits or access restrictions HIGH Audit Athena API contract terms now. Determine if current agreement covers the call volume your scheduling engine will generate. Richard Chapman should flag this in contract review.
Two-person team bandwidth during parallel phases HIGH Phases 2 and 3 overlap by 6 weeks. Dev focuses on scheduling engine while BA leads intake requirements and testing. Claude Code absorbs UI build work. If slipping, defer Phase 3 intake to January.
PCI compliance for payment processing MED Use Stripe Elements or similar tokenized solution. You never touch card data directly. PCI scope stays at SAQ-A level. Stripe handles the hard part.
Provider/staff adoption of new scheduling interface MED Front desk staff are the real users, not patients. Pilot with 3 cooperative specialties first. Get Gillispie to identify the early adopters. Phreesia's poor fit at certain specialties makes those your best candidates.
Phreesia contract termination timing LOW Contract requires only 60 days non-renewal notice (Section 7.1). BAA breach documentation provides backup termination-for-cause path (Section 7.3, 30-day cure). No unbundling allowed, so partial contracts are not an option. Richard Chapman to map exact term dates this week.
Assort Health POC data ownership LOW Confirm in Assort POC agreement that call routing data, transcripts, and analytics are LC property. You need this data for your AI training corpus. Flag to Richard Chapman.

Week One Actions

RICHARD CHAPMAN
Map exact Phreesia term dates: when does current term expire, when is the 60-day non-renewal deadline?
Section 7.1 requires 60 days notice. Change Order extended Initial Term 12 months from 9/1/2024. Determine if currently in Initial Term or auto-renewed Renewal Term. Also compile BAA breach documentation into notice-ready package (hold, do not send). Flag Section 8.3 non-compete to development team.
RICHARD CHAPMAN
Review Assort Health POC: data ownership, call transcript rights, analytics export
The Assort POC is generating your AI training data right now. Make sure you own it.
MICHAEL TABOR
Athena API audit: current API tier, rate limits, scheduling write access, FHIR R4 availability
The entire architecture depends on Athena API access. If there's a paywall or restriction, you need to know before writing line one.
CHRIS + HR
Post the dev + BA positions. Job descriptions need "AI-native development" as core competency.
12-week Phase 1 timeline assumes these roles are filled by mid-May at the latest. Every week of hiring delay compresses the build window.
Lexington Clinic IT — Patient Access Platform Roadmap Draft v2.0 — April 4, 2026 — Includes contract analysis + build-vs-buy