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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

You Can't Maximize What You Can't Measure

by Tab Harris, Senior Director, Florida Blue

Like many healthcare stakeholders, payers like Florida Blue are operating in an environment of change. As new government regulations roll out and new payment models are implemented, we are constantly looking for partners who can help us successfully navigate this change. athenahealth is a resource that we have come to trust. Our relationship has developed into a strong and collaborative partnership with our open and transparent communications and collaboration.

How athena thinks about payer relationships is how Florida Blue thinks about them, too.  We believe in collaboration, and we see partnerships as a way to bring new insights and perspectives to our most persistent challenges. We seek out metrics and reports to identify opportunities for performance optimization. In our data-rich environment, we have found that working with a trusted partner like athena can bring value to our organization.

Florida Blue ranked 35th out of 214 payers in athena’s annual PayerView 2016. While we were pleased with our performance, the report reminded us that in today’s environment, we need to remain constantly focused on improvement. Lucky for us, PayerView uncovered additional opportunities for performance improvements, and athena was more than willing to help identify these opportunities.  Today, three key components make up our collaborative process:  

(1) We meet routinely to dive into performance metrics in order to spot and diagnose blips before they become full-blown problems;

(2) We use this data to identify opportunities for innovations that will help drive performance; 

(3) We hold each other accountable for any issues and follow-up. 

By leveraging athena’s vast data resources, these collaborations have provided new insights into our key metrics such denial rate and pushed us to look for new ways to improve.

During one of our recent collaborative sessions, affectionately termed the athenahealth/Florida Blue “Transaction-Palooza,” we reviewed how each of our key transactions has been performing. Digging deeply into our authorization management, predetermination of benefits, and eligibility transactions, both organizations pulled in subject matter experts from across their organization to identify opportunities to innovate transactions for the benefit of our members and providers. While these efforts are in their infancy, we are looking forward to exploring how they can help us improve.

Our partnership with athena remains strong and robust by demonstrating how far true collaboration can go. athena’s passion for data and data-driven performance optimization inspired us to modify our metric reporting process for our business partners, fostering a culture of performance management that will help drive needed innovations in healthcare.

We encourage other healthcare stakeholders to take advantage of collaborative opportunities like this in order to stay competitive in the future.  Our relationship has validated the idea that you can’t maximize your performance without measuring it. For a good look at how this can work, connect with athena’s payer team here

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