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athenahealth Population Health

Population health: the athenahealth advantage

We focus on results. Our network-enabled service model tracks performance at the client and network level, looking for opportunities to improve outcomes and drive better financial and clinical performance. Our clients consistently outperform industry averages in key population health metrics, such as improved shared savings and quality performance scores.

We work with your EHR. And every other EHR. Our EHR-independent platform lets you and your users access clinical data in a single, longitudinal patient record, made more robust with payer claims, pharmacy data, lab data, and more. Our service was built on the principle that we will work with any and all EHR vendors to surface the right data and make it actionable for you and your clinical teams.

We enable patient self-management. With athenaWell, our patient-facing web and mobile app, patients can easily access and self-report on their care plan wherever and whenever is most convenient for them. This gives your care managers visibility into patient activities between visits, helps keep patients on track, and increases care manager productivity.

Here's how we do it:

Pop Health

Data Management

It all starts with data. With 13 years of experience aggregating complex data from multiple sources, we've developed a confident, competent data aggregation experience for our clients. We take a consultative approach to data aggregation to help clients understand what data sources are most relevant and useful based on their business goals. Then we normalize your data into a single taxonomy—regardless of source. The result: a 360-degree view of network utilization and of each patient that is immediately actionable.

"What makes it so powerful is the sheer amount of data available through the system. It makes our work faster because it makes it easier to look across an entire slice of the population and then distribute that data in a safe and easy way.”

- Paul Aseltine, Manager of Informatics
New England Quality Care Alliance

Quality Management

How do you win at quality? With the right combination of data and expertise. athenahealth combines intuitive quality management reporting and dashboards with in-house performance coaching to maximize your organization’s quality performance. Quality dashboards help staff uncover patient-level care gaps to optimize pre-visit planning workflows and target patient outreach to bring patients in for needed care.  Performance coaches leverage insights from the athenahealth network and consumer marketing best practices to design and execute customized outreach campaigns to close care gaps as they arise.

As a result, athenahealth clients have outperformed the national average on 25 of 33 MSSP quality measures, including both composite measures.

“There are so many pluses with athenahealth’s Population Health. Between the automated outreach, the attributions, the scheduling compliance, and the ability to pool that claims data history, we can accomplish so much without a lot of extra work. It’s been a no-brainer for us.”

- Jay Schmidt, System Specialist in Practice Management
Capital Health

Care Management

More effective care for your patient population. More efficient utilization of your care management team. athenahealth Population Health makes it possible to reach more patients, more effectively.

We provide a curated library of care management content, featuring comprehensive patient care plans that include assessments, goals, and opportunities to engage patients in their own health. Our care management platform gives care managers a consolidated view of their patients, including quality programs and utilization patterns, and provides transparency for care teams across sites of care to facilitate better and more efficient coordination.

The athenaWell app creates visibility into patient activities between visits and empowers patients to track and report on their own progress against care plans. This added insight and efficiency helps you scale care management across more risk programs, and expand your efforts to address rising risk populations.

"athenaWell has enabled me to respond more readily to the needs of my patients. I am appreciative of having the ability to connect when a patient may need it most as opposed to catching up a week later. Of greatest benefit to me is having the ability to view a patient's progress, or lack thereof, within days of their office visit."

- Marion Rogers, Care Manager
Heywood Healthcare

Patient Management

With millions of lives covered on athenahealth Population Health, we know what keeps patients engaged—and so will you. Our fully integrated services allow patients, family members, and care teams to stay connected.  

Automated patient outreach capabilities help you send clinically relevant messages to patients via email, text, and phone, with clear calls to action. Outcomes are tracked at each stage of the outreach process, leveraging best practices from across our network to maximize patient engagement and improve clinical outcomes. Keeping patients engaged with their care team and taking an active role in their own care is achieved through the athenaWell web and mobile app. Patients can access—and self-report on—their care plan wherever and whenever is most convenient for them, increasing patient engagement and care plan adherence.

“[athenahealth gave us] an opportunity to allow us to scale our resources in a much more tactical way, while also leveraging some of the best practices and knowledge that they have gained in doing this. We’re now able to refocus the team on other high-value activities without having to make the investment of scaling a team to meet our at-risk populations’ scheduling needs.”

- Sam Starbuck, Associate Director of New Product Development
Privia Health

73 %

of 2015 MSSP clients earned shared savings


18 %

YOY improvement in aggregate MSSP quality score among MSSP clients



lower readmission rate than 90% percentile CMS benchmark



increase in patient:care manager ratio after 1 year


Our cloud-based services include:

Electronic Health Records

Our award-winning Electronic Health Records (EHR) service gives providers greater control, so they can focus on what they do best.

Revenue Cycle Management

Providers on our medical billing and practice management service get paid more, faster, with less work.

Population Health

Patient communication services that reduce no-shows by 8% and keep providers better connected to our patients.

Patient Access & Care Coordination

A complete end-to-end service for seamless care coordination across the continuum, no matter where patients seek care.


Clinical intelligence from the most trusted mobile medical reference is embedded inside our EHR workflow.