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Orchard’s First Fruit

Well, well, well - ask and ye shall receive. From a few weeks ago: I don’t see anything distinct for Orchard customers yet, so either they’re not live or not distinguished as easily as Garden Plot Eight days later, my wish was granted! Epic’s public FHIR endpoint directory added an organization called Enterprise Orchard Shared Services (Epic org ID 38769) managing an endpoint named “PA Health Center Technology Alliance,” along with 36 facilities under the same brand: The Alliance’s main office 18 Union Community Care sites 11 Delaware Valley Community Health sites Six Community Health and Dental Care sites Off to the races we go! As far as I can tell, no trade publication or Epic has covered this yet - the only public traces I see are a PACHC annual report plus a few patient FAQ pages. I’m not sure why - I think it deserves way more attention! We learn who’s actually buying (and it isn’t who Epic pitched at UGM) We get yet another entry in Epic’s playbook for reaching the low end of the market We get a census of who Epic is coming for next Grab a basket and let’s start picking. An Unexpected Harvest When Epic announced Orchard at UGM 2025, the pitch was a dedicated instance for practices of 80 to 180 providers while keeping the prewired third party applications that make Garden Plot appealing. But the first customer to surface is not that profile at all! Instead, we see something entirely different and arguably more valuable to Epic. The Alliance is a subsidiary of the Pennsylvania Association of Community Health Centers (PACHC). As I wasn’t totally familiar myself, let’s add some quick background for readers who operate outside the safety net: Federally qualified health centers (FQHCs) are community clinics funded under Section 330 of the Public Health Service Act t They serve patients regardless of ability to pay, which results in a payer mix heavy on Medicaid / the uninsured As you might expect, this often results in margins too thin to fund an enterprise EHR on their own (especially in the current very tough funding environment) Every state has a primary care association (PCA), funded in part by HRSA, that supports its FQHCs with advocacy and shared services PCAs have historically been trade associations, so this move is notable in that PACHC is morphing itself into something closer to a holding company. In October 2024, its board voted to form the Alliance to contract directly with Epic and run a statewide technology hub for health centers of any size. A second subsidiary, the Pennsylvania Community Care Collaborative (PC3), is a clinically integrated network of 28 health centers built for value-based contracting. CEO Shelley Riser runs both PACHC and the Alliance and calls the arrangement a “family of companies.” From the latest annual report: PACHC is the only Primary Care Association in the nation with a wholly owned subsidiary directly contracting with Epic. Why does this matter way more to Epic than a single 120-provider group ever could? One contract may only bring in three health centers and 35 sites on day one, but every other PACHC member sits in the pipeline. Moreover, the distributor is an organization those health centers already trust, funded to serve them and literally governed by a board of their own CEOs. And if that wasn’t enough, every state has one! Grafting onto the Safety Net

Nov 9 • 4:46 AM EST • Health • healthapiguy.substack.com