Value-based care (VBC) payment models come with high complexity and many risks to reimbursement. And many organizations today are using a value-based care or risks-based payment model. In fact, if your medical practice accepts Medicare or Medicaid—and 98% of providers in the U.S. do—that means you’re using at least some VBC payment model metrics.¹

VBC payment models in healthcare aren’t just pervasive, they can be effective, too. 96% of payers believe alternative payment models (APM) result in better quality of care, and in the same Health Care Payment Learning and Action Network survey, 96% also believe APMs result in improved care coordination for patients. VBC models can help create better care outcomes for patients and help bring patients and providers closer together.

But if your organization uses a VBC payment model, or is thinking of implementing one, do you know how to set yourself up for success with streamlined reporting and diagnostics to help maximize reimbursement? Perhaps the bigger question: do your current EHR and HIT tools help or hinder your success with a VBC model? Practices using a value-based care model need to ensure they’re not only meeting regulatory and quality program requirements for reimbursement, but also minimizing administrative burden, driving patient engagement, and getting the patient data they need to address care gaps.

athenaOne® can help medical practices and healthcare organizations using a value-based care payment model to monitor program progress and streamline documentation while getting the right medical data for better patient outcomes. Before we dive into those benefits, let’s take a look at some of the biggest pain points in market for value-based care practices today.

Top challenges and priorities for organizations using a value-based care model

1. Choosing a VBC model – Practices looking to add a VBC contract to their revenue mix can choose Fee-for-Value, Shared Services, Global Capitation, and other models. Deciding which program to join and whether it makes sense to do so given your patient mix and technology capabilities can be difficult for providers looking to make the leap.

2. Keeping up with constant industry shifts – Practices using VBC models regularly undergo shifts and changes as payers update their risk adjustment methodology, and as models continue to expand beyond primary care into other specialties. Staying on top of government regulatory requirements and commercial payer programs can be a headache for organizations under VBC, but it plays a large part in whether or not a VBC practice will succeed long-term.

3. Managing external patient data – Interoperability plays a particularly critical role for medical practices and healthcare organizations following a value-based care model. Clinicians working under VBC models need to adhere to quality program requirements like MIPS, local and federal government regulations, and more. These requirements and programs can be a huge source of administrative burden and burnout for clinicians. If clinicians aren’t enabled with the right patient data from across the healthcare continuum, they could fail to meet program requirements and receive lower reimbursement.

4. Obtaining comprehensive patient data – In order to develop a comprehensive and holistic approach to patient care, and drive better patient outcomes, clinicians need to stay informed on their patients’ health habits and wellness challenges. Social determinants of health (SDoH) include things like access to basic needs (food, housing), nutrition and diet, smoking, education level, ethnic background, and more. Without this critical medical data, and an EHR that can help identify cohorts based on SDoH, practitioners may lack the information they need to improve care outcomes.

5. Driving patient engagement and loyalty – practices using most VBC models need to center on patient engagement and communication, since practices are reimbursed according to care outcomes rather than services. Patients must follow their individualized care plans to improve their health, and without a connection to their care team, regular touchpoints, and a shared sense of responsibility, patients’ overall health may worsen, and practices may fail to meet their quality program goals.

How athenahealth helps you succeed using a value-based care model

These core challenges can pose a serious threat to healthcare organizations using any VBC model, but a HIT tool designed to help organizations thrive under quality programs can help create success. Using athenaOne, medical practices can satisfy quality program requirements, get relevant medical data from across the network, communicate effectively with patients to increase satisfaction and retention, and help manage evolving regulatory requirements. athenaOne helps VBC practices to leverage the collective knowledge of 150K+ providers on the network² to stay on top of new billing rules and medical codes and be in-the-know when it comes to things like MIPS compliance. What’s more, athenahealth's Care and Diagnosis Gap solutions have helped improve care for over 4 million patients.³

Below, we’ll show you exactly how athenaOne works to help your organization thrive under a value-based care model.

Optimize revenue cycle management to navigate regulatory and quality program requirements

While value-based care programs often emphasize patient care and outcomes over practice reimbursement, it’s still important to capture whatever revenue is available so you can continue to deliver exceptional care to your patients. athenaOne helps VBC practices optimize revenue cycle management so they can not only meet quality program requirements but build toward quick and accurate reimbursement.

Benefits of athenaOne to help VBC practices improve the revenue cycle and collect more:

• Care gap diagnostic tools: get detailed medical data on patients to help clinicians order the right labs, diagnostics, etc. to address and close care gaps.
• Collective knowledge that drives results: our medical billing rules engine leverages the power of our provider network, payer knowledge, and billing experts to automatically scrub claims and resolve errors, reducing rejections and accelerating reimbursement. It contains 30,000+ billing rules, including rules related to VBC initiatives, to help proactively identify and reduce potential claim errors and makes 4,500+ rule changes every year to help avoid costly claim errors.⁴
• Smart automation and scaled operations: innovative technology and robust services enable fast, effective progress through every step of the claim lifecycle, from submission and follow-up to denial resolution and payment posting.
• Prompt, accurate medical coding: a seamlessly integrated AHIMA/AAPC certified coding service takes on the manual effort of coding claims, resulting in quality-assured submissions that thoroughly capture the care delivered.
• Authorizations made easy: our continuously updated authorization determination engine and team of specialists work in concert to solve the authorization management challenge and obtain required authorizations as quickly as possible.

Drive better care outcomes and increase patient retention and satisfaction

Patient retention and satisfaction is at the heart of value-based care. In order for VBC organizations to drive better outcomes for patients, and drive sufficient patient engagement, they need an easy-to-use tool that minimizes administrative work so providers can spend more focused time with patients. athenaOne not only helps medical practices to streamline clinical tasks during patient encounters, but it strengthens provider-patient communication and empowers patients to take control of their wellbeing.

Benefits of athenaOne to help VBC models streamline clinical tasks and empower patients:

• Measure satisfaction support: robust tools and guidance to measure satisfaction, like eligible patients, thresholds for success, etc., available directly in the clinical workflow enable practices to thrive across the spectrum of VBC program requirements.
• Real-time VBC progress reporting: athenaOne helps your practice view progress toward percentages needed for VBC metrics in real time. Tracking progress across the year helps your medical practice identify future areas of improvement.
• Proactive communication: targeted messages via text, email, and phone help alert patients to upcoming appointments, new results, wellness opportunities, and more, driving interest, action, and retention. Care gap outreach campaigns using athenaOne help you take better care of your patients and succeed in any VBC contracts or quality programs that seek to close care gaps.

athenaOne enables self-serve to help you increase patient satisfaction:

Patients today want convenience. By offering self-serve options through the patient portal and the athenaPatient app, athenaOne helps empower patients to get the care they need quickly and conveniently, with minimal impact on front-office staff.

• Convenient self-service options: secure online check-in, intake, and payment options help meet patients where they are, encouraging patient engagement and getting necessary verified information to practices faster.
• Online patient portal: the inclusive athenaOne online portal, as well as the athenaPatient app, enable patients to take control of their health information and manage appointments, test results, payments, messages, and more. This can enable your practice to meet VBC requirements for patient engagement.

Enable clinical efficiency via interoperability and care coordination

94% of physicians surveyed agree that getting the right clinical data at the right time is very important.⁵ Seamless interoperability between internal and external care teams ensures that providers always have the most relevant, timely clinical data at their fingertips, and that patients can quickly access results from across the healthcare ecosystem, allowing them to be more engaged as a result.

athenaOne proactively surfaces relevant clinical data at the point of care to help providers make more informed and holistic care decisions, and tailor their personalized wellness plans according to existing prescriptions, labs, medical history, and more from across the care continuum. In fact, athenahealth customers can stay connected through Patient Record Sharing with 100% of Epic customers and 66% of Cerner customers via their CommonWell and Carequality connections.⁶

Benefits of athenaOne to help VBC models improve care coordination:

• Insightful longitudinal record: a thoroughly informed patient chart helps curate patients’ health histories, augmenting practice-specific data with relevant, automatically sourced records, orders, and results from care sites nationwide.
• Better user experiences: instead of data-dumping, athenaOne allows users to interact with external information when and where they need it, helping improve patient outcomes and administrative efficiency.
• Built-in connections to the healthcare ecosystem: we proactively build and manage the athenahealth network so interoperability is optimized, connecting all practices to nationwide and local labs, imaging centers, pharmacies, registries, payers, hospitals and other care sites to support informed care and practice operations.
• Intentional innovation: athenaOne's underlying technology is automatically updated, enabling practices to immediately access relevant features and securely integrate other healthcare applications to meet their unique needs without effort or costly upgrades. This helps ensure organizations always have access to the latest features that help support participation in the ever-evolving VBC landscape.

If your medical practice currently uses a VBC model or is thinking about getting started with one, it’s time to think about whether your current EHR software and HIT tools enable you to succeed within quality program requirements and government regulations. athenaOne can help you increase patient satisfaction, strengthening the foundation of your practice, while also helping you ensure you’re meeting all requirements for annual reporting and attestation. Ready to learn more?

Try these related topics:

1. Why a shift to value-based care needs to include a shift in organizational values and technology

2. Optimizing revenue cycle management for value-based care success

3. What is meaningful use in healthcare?

4. Transform your patient-centered care practice

1. Centers for Medicare and Medicaid Services, “Annual Medicare Participation Announcement”, Nov 2023, https://www.cms.gov/medicare-participation
2. Based on athenahealth data as of Dec. 2023; M010
3. Based on athenahealth data from May 2022 to June 2024; M094
4. Based on athenahealth data as of Mar. 2024
5. 2023 Physician Sentiment Survey, commissioned by athenahealth and fielded by Harris Poll, Jan 2024
6. Based on Epic ⁠press release from May 2023 and data from the KLAS Interoperability 2020 Acute Care Ambulatory report; M025