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Hudson Headwaters Health Network

How an Important Regional Group Was Saved


In early 2008, Hudson Headwaters Health Network (HHHN), a Federally Qualified Health Center with 60,000 patients spread across 13 offices, was hobbled by outdated business processes and poor cash flow. With athenahealth, HHHN was able to increase collections, reduce DAR, and achieve PCMH Level 3 certification.



  • Located in Queensbury, NY
  • 52 physicians
  • 50 nurse practitioners, physician assistants, and nurse midwives
  • 15 locations
  • 65,000 patients


  • FQHC demands and needy population nearly cause bankruptcy
  • Bills sitting in Days in Accounts Receivable (DAR) for 85 days
  • Required federal data and business planning data painful to collect



  • Practice recognized as leading FQHC and able to finance growth
  • Reduced billing staff and still reduced DAR to 39 days*
  • Collections increased 79.32%*
  • Patient visits increased 5.72%
  • Patient no-show rate decreased 13.73%**
  • Both business and required regulatory data instantly accessible
Financial Success Drives Unique Mission of FQHC

Federally Qualified Health Centers (FQHCs) face challenges and requirements not faced by other medical systems, and Hudson Headwaters Health Network (HHHN) in upstate New York is no exception. The health system serves a rural geographical area roughly twice the size of Rhode Island.

“Because we are so rural, we oftentimes are faced with different challenges, based upon the ability of our patients to even get to where healthcare is provided as well as their social, economic and even age demographics,” says Cindy Reynolds, Vice President for Transformation and Clinical Quality, who notes HHHN’s patient population draws from a region that is second nationally for percentage of people 65 or older.

“With that age comes a lot of the chronic conditions,” says Reynolds. “We often see an older, and what we consider to be a somewhat sicker, group of patients than most private practices. In addition, because we see people regardless of their ability to pay, we see a lot of patients who haven't had health care in years and then work with them so that they can better self-manage their conditions, prevent them from deteriorating, and hopefully improve their healthcare status.”

Providing this care is expensive, and since a good number of HHHN’s patients can’t afford to pay, the system receives federal aid as a designated FQHC; it must operate as efficiently and economically as possible because it is closely monitored by the federal government. To maintain its status, HHHN must continuously collect and deliver significant amounts of operational and patient data.
Cloud-Based Services Provide New Financial and Clinical Opportunities

In 2008, the financial strain brought the health system to the brink of collapse. “We realized that we were facing very tight financial circumstances,” says Dr. John Sawyer, HHHN’s Chief Medical Officer. “We were at risk of becoming bankrupt. We realized that we were doing a very poor job of processing our own billing claims. And so we turned to athena to help us process our bills and improve our revenue cycle. athena was able, in less than a year, to turn our billing cycle around dramatically. Our days in accounts receivable improved tremendously. And our financial circumstances improved.”

HHHN reduced both the size of its billing staff and its DAR from 85 to 39, after partnering with athenahealth, which allowed them to increase collections faster and reduce overhead. This level of success made HHHN sit up and take notice of athenahealth’s other cloud-based services, including its EHR athenaClinicals, its patient portal athenaCommunicator and its population management tools in athenaCoordinator Enterprise.

The organization rebounded to thrive financially, which in turn allowed them to expand its capabilities and deliver new and better care services to its patient population. “What it means is not just financial security but new opportunity,” says Dr. John Rugge, HHHN founder and CEO. “What we were able to do with athena was not only give the kind of care we have always wanted to give, but also work with private practices and hospitals. We started a medical home pilot that we were able to lead on by virtue of having better records, better structures, and better information on our patients than any of our neighbors.”

Success builds on success and these efforts by HHHN led to new revenue streams with nine different payers, both public and private. “We have become not only a survivor but a growing program that is bringing in one private practice after another and is being looked to state-wide as the way to do robust primary care,” says Rugge.
New Patients From Affordable Care Act are No Problem

The next challenge facing HHHN will be the influx of new patients needing primary care due to the Patient Protection and Affordable Care Act.

“In the FQHC world we’ll have to be prepared for a whole new group of patients who suddenly have insurance and are going to be looking for care,” says Dr. Sawyer. “In many parts of the country they’ll turn to their community health center so it’s very important for all FQHCs that they be prepared to handle the billing processes for those patients.”

athena is the perfect partner to help with that, says Sawyer, because their patented rules engine for submitting claims is vast and always updating. HHHN will benefit when submitting new patient claims because athena has partnered with other FQHCs who are also submitting Medicare and Medicaid claims, as well as privately insured patient claims.
Thriving Under New Payment Models With Actionable Data

One aspect of partnering with athenahealth that particularly impresses HHHN is athenahealth’s ability to understand the peculiar needs of FQHCs and provide the tools and support that make operating a FQHC easier and more effective.

“The data is at our fingertips,” says Reynolds. “We can pull [Uniform Data System] information. We can get gaps in care reports related to UDS measures, as well as a whole host of other measures in the athena library. We are monitoring on a monthly basis not only the UDS measures, but Meaningful Use measures and other pay-for-performance programs or other initiatives that we have going on as the FQHC.”

For example, HHHN was able to easily qualify 34 providers for Meaningful Use funds, which has enabled HHHN to put additional intervention care programs in place. “We are now being seen by the federal government as a very efficient provider of healthcare for our region,” says Reynolds. “We really do attribute the majority of that to athena.”

© April 2014
* Our clients see an average 6% increase in collections and 32% decrease in days in accounts receivable. These metrics are based on a weighted average for athenahealth clients with valid pre-athenahealth benchmark data that had their 15-month anniversary with athenahealth between January 1, 2010, and October 31, 2013.
** Our ReminderCallSM clients see, on average, an 8% lower no-show rate. This metric is based on the change in average no-show rate among clients with ReminderCall that had been with athenahealth for at least 21 months and had their one-year anniversary on that service between April 1, 2010, and September 30, 2013.
† Doctors on athenaClinicals®, our cloud-based EHR service, are not slowed down, seeing no decrease in patient visits. This metric is based on a comparison of the average change in patient visits for clients without athenaClinicals with that for clients with that service that had been with athenahealth for at least 21 months and had their one-year anniversary on that service between January 1, 2010, and September 30, 2013.

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