athenaOne® for value-based care payment models

athenaOne for alternate payment models

Value-based care (VBC) payment models come with high complexity and real risks to reimbursement. More than a decade after the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the challenge has expanded beyond understanding the model.¹ VBC includes programs with different levels of financial accountability: MIPS ties payment adjustments to quality and performance, while alternative payment models may involve shared financial risk. Organizations participating in VBC now need to execute successfully across patient encounters, quality measures, payer contracts, and day-to-day workflows.

Physicians continue to see the promise of VBC, even as they confront the difficulty of putting it into practice. According to athenahealth's 2026 Physician Sentiment Survey, 55%* of physicians believe VBC could financially benefit their practice, but only 36%* feel comfortable with the concept of shared risk.² That hesitation applies to risk-bearing alternative payment models, not to MIPS participation. It also underscores the need for operational and financial support as organizations move into arrangements with greater accountability.

VBC models can help create better care outcomes for patients and bring patients and providers closer together. But success depends on giving clinicians and care teams timely, relevant information they can use within the clinical workflow.  

Perhaps the bigger question is this: Do your current EHR and healthcare technology tools help or hinder your success under a VBC model?

A  fully integrated EHR platform built to support the demands of VBC should help practices meet regulatory and quality-program requirements, reduce administrative burden, identify and address care and diagnosis gaps, support patient engagement, monitor performance, and connect clinical work with financial outcomes.

athenaOne brings these capabilities into the workflows that organizations use every day. Before we explore how athenaOne supports VBC execution, let's look at some of the biggest challenges practices and healthcare organizations face today.

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

1. Executing across complex VBC arrangements — Practices may participate in fee-for-value, shared-savings, global-capitation, and other arrangements, often across multiple payers. Each can bring different measures, reporting expectations, financial incentives, and levels of risk. Managing those requires organizations to align clinical workflows, staffing, technology, and financial operations. In the 2026 Physician Sentiment Survey, physicians identified administrative burden and reporting requirements as the leading VBC pain point.³

2. Keeping up with constant industry shifts — Practices using VBC models regularly encounter changes as payers update risk-adjustment methodologies, quality measures, and program requirements, and as value-based arrangements continue to expand across specialties. Staying on top of government requirements and commercial payer programs can be a headache, but it plays a large part in whether a practice can perform successfully over the long term.

3. Turning fragmented patient data into longitudinal insight — Clinicians working under VBC models need a comprehensive understanding of the patients and populations they serve. Relevant information may be divided among clinical records, claims, payer data, labs, pharmacies, hospitals, and other care sites. When these sources are not unified, organizations may lack a longitudinal view of patient health and contract performance, creating blind spots in risk, quality, cost, and care coordination. Clinicians may also miss information about social determinants of health and care delivered elsewhere that could influence care decisions and outcomes.

4. Getting timely insights into the clinical workflow — Access to more data does not necessarily translate into better decisions. VBC insights are often delivered retrospectively or through separate reports and systems, requiring clinicians and care teams to search for relevant information or respond after a patient visit. When care gaps, diagnosis opportunities, and quality priorities are not surfaced within the clinical workflow, practices may miss the chance to address them during the encounter. This adds work for clinical and administrative teams and increases reliance on post-visit outreach.

5. Driving patient engagement and adherence — Practices using VBC models need to prioritize patient engagement and communication because their performance depends in part on patients following care plans and receiving appropriate preventive and follow-up care. Without regular touchpoints and a connection to their care team, patients may miss appointments, screenings, or other important steps. Practices can then struggle to close care gaps, improve outcomes, and meet their quality-program goals.

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

These core challenges can pose a serious threat to healthcare organizations using any VBC model. athenaOne combines clinical, financial, and patient engagement functions with tools for identifying care and diagnosis gaps, monitoring performance, coordinating care, and documenting accurately. Practices can manage this work within their existing workflows instead of relying on a collection of disconnected tools.

athenaOne is supported by a nationwide network that includes more than 170,000* clinicians, 268,000* clinical integrations. Collectively, clinicians using athenaOne see more than 20%* of the U.S. patient population.⁴

Bring value-based care priorities into the clinical workflow with AI-native capabilities

VBC performance often depends on what happens during the patient visit. Clinicians manage full schedules and have limited time with each patient. When a care gap, diagnosis opportunity, or risk gap is available only in a separate application, window, or report, they may not have time to find it during the encounter and miss the opportunity entirely. Surfacing relevant information directly in the patient chart helps clinicians see and address it while the patient is present.

athenaOne combines AI-powered clinical support with integrated performance tools. Clinically Inferred Diagnosis Gaps use AI to surface potential diagnosis gaps for clinicians to review during the visit. This can support more complete documentation and help practices identify relevant risk-adjustment opportunities without requiring clinicians to search through separate reports or systems. athenahealth's Care and Diagnosis Gap solutions have covered care for more than 8.2 million* patients.⁵ Primary care providers on athenaOne have an HCC recapture rate of 82%*, supporting a more accurate risk-adjustment picture for their patient populations.⁶

Data Explorer supports performance monitoring, patient identification, and population reporting, giving organizations visibility into trends and opportunity areas across their patient populations. Sage™, its AI-powered assistant, allows practice administrators to create reports by describing what they need in plain English. Data Explorer and Patient Level QMRI give practices patient- and population-level views of VBC performance, reducing reliance on retrospective reports and manual follow-up.

Connect clinical workflows, population insight, and network performance

Value-based contracts create different demands across an organization. Clinicians need relevant information during patient visits, VBC leaders need visibility across populations and contracts, and technical teams need to exchange data with payers, care sites, and other partners. athenahealth supports these needs through athenaOne, Population Intelligence, and athenaConnect™.

• athenaOne supports clinical, financial, and patient engagement workflows while surfacing care gaps, diagnosis opportunities, quality measures, and risk signals during the visit. 
• athenaConnect, the interoperability layer of the athenaOne platform, connects organizations with payers, ACOs, health systems, affiliated practices, and other care partners through a single point of connection.
• Population Intelligence is an add-on to athenaOne that brings external VBC data — including adjudicated claims, risk-contract eligibility and attribution, and payer quality feeds, including patient-level quality data files such as QRDA I files, directly into the patient chart. By normalizing these sources into a unified patient record, it gives care teams relevant context within the same workflow they use to manage patient care.

Connecting these layers can help organizations carry population-level priorities into patient care, track how those efforts affect performance, and coordinate with partners across the care ecosystem. It also reduces the need to reconcile separate data sources, reports, and workflows.

Optimize revenue cycle management for value-based care

VBC programs emphasize patient outcomes, but fee-for-service (FFS) claims remain central across much of the payment continuum. In the Health Care Payment Learning & Action Network (HCPLAN) framework, Categories 1 through 3 continue to run on FFS claims, even as Categories 2 and 3 introduce quality-linked payment and greater accountability.⁷ Practices therefore still need to capture the revenue they have earned so they can continue delivering high-quality care.

Financial performance may depend on complete documentation, accurate coding, quality results, risk adjustment, and efficient claims management. When care and diagnosis gaps are available during the encounter, clinicians can address quality priorities and document the care delivered. athenaOne coordinates this clinical work with revenue-cycle operations.

Benefits of athenaOne that help VBC practices improve revenue-cycle performance include:

• Collective knowledge that drives results: The athenaOne medical billing rules engine draws on payer knowledge, billing expertise, and patterns across the athenahealth network to help identify potential claim errors before submission, reduce rejections, and support timely reimbursement.
• Smart automation and scaled operations: Technology and services support each step of the claim lifecycle, including submission, follow-up, denial resolution, and payment posting. This reduces manual work for practice staff and helps keep claims moving.
• Prompt, accurate medical coding: An integrated AHIMA- and AAPC-certified coding service can reduce the manual effort involved in coding claims and support submissions that accurately reflect the care delivered.
• Authorization support: A continuously updated authorization determination engine and team of specialists help identify authorization requirements and obtain required authorizations as efficiently as possible.

These capabilities help practices manage fee-for-service revenue alongside the quality, risk, and documentation responsibilities associated with value-based contracts.

Drive better care outcomes and strengthen patient engagement

Patient retention and satisfaction are at the heart of VBC. For VBC organizations to improve outcomes, patients need to attend appointments, complete recommended screenings, understand their care plans, and stay connected with their care teams. Practices need tools that support this engagement without adding unnecessary administrative work.

athenaOne helps practices streamline clinical tasks during patient encounters, communicate with patients between visits, and offer convenient ways for patients to manage their care.

Benefits of athenaOne that help VBC practices engage patients include:

• Proactive communication: Targeted messages by text, email, and phone can alert patients to upcoming appointments, new results, wellness opportunities, and other care needs.
• Care-gap outreach: Outreach campaigns help practices contact patients who are due for screenings, follow-up care, or other services tied to clinical and quality goals.
• Convenient self-service: Secure online check-in, intake, scheduling, and payment options help patients complete routine tasks with less assistance from front-office staff.
• Online patient access: The athenaOne patient portal and athenaPatient® app allow patients to manage appointments, view test results, make payments, exchange messages, and access their health information.

These touchpoints can help patients stay involved in their care and follow through on recommended next steps. They also give practices practical ways to support care-gap closure and patient adherence across their VBC populations.

Enable clinical efficiency through interoperability and care coordination

Healthcare delivery rarely occurs within a single system. Patients receive care from independent practices, hospitals, urgent care centers, specialists, pharmacies, and other sites, making cross-system information essential to care coordination. Yet 73%* of physicians surveyed in athenahealth's 2026 Physician Sentiment Survey reported difficulty sending and receiving information across different EHR platforms, and 69%* said they struggle to stay current on care delivered outside their practice.⁵

These gaps have consequences under VBC. Coordinated transitions of care, accurate risk stratification, and timely clinical decisions depend on a longitudinal view of the patient. Exchanging more data is not enough if clinicians still have to search through duplicate, incomplete, or irrelevant information to find what they need.

athenaOne surfaces relevant external clinical data within the patient record. Information about prescriptions, labs, orders, results, and care delivered elsewhere can add context to the practice's own record and help care teams coordinate appropriate next steps.

athenaConnect is the interoperability engine of the athenaOne platform. It powers secure, bidirectional data exchange between athenaOne customers and the broader healthcare ecosystem, delivering relevant external information within clinicians’ workflows. This connectivity is included with athenaOne and connects practices with Surescripts, Labcorp, Quest, vaccine registries, prescription drug monitoring programs, health information exchanges, and nationwide exchange through CommonWell and TEFCA—without requiring practices to build and maintain a custom interface for each connection. As of December 2025, athenahealth connected with 100%* of eligible Epic and Cerner sites through CommonWell and TEFCA.⁸

Benefits of athenaOne and athenaConnect that support care coordination include:

• An insightful longitudinal record: The patient chart augments practice-specific information with relevant records, orders, and results from care sites across the country.
• Relevant information in context: External information is incorporated into the workflow so clinicians can review it alongside the patient record instead of navigating a separate system or sorting through an undifferentiated data feed.
• Simpler interface management: Because connectivity is built into athenaOne, practices can exchange data with payers, ACOs, health systems, and other care partners without building and maintaining a separate interface for each connection.
• Built-in connections to the healthcare ecosystem: athenahealth develops and manages connections to labs, imaging centers, pharmacies, registries, payers, hospitals, and other care sites that support clinical care and practice operations.
• Continuous updates: athenaOne's cloud-based technology is updated across the network, giving practices access to relevant capabilities without managing traditional software upgrades.

For VBC organizations, this approach makes external data more useful within clinical and operational workflows, where it can support care coordination, quality performance, and a more complete understanding of each patient.

Support value-based care execution with athenaOne

If your medical practice or healthcare organization currently participates in a VBC arrangement, consider how well your EHR and other healthcare technology support the work required to perform under it. Can clinicians find relevant patient information during the visit? Can care teams identify and address care gaps? Can practice leaders monitor quality and financial performance across contracts and populations? Can information move between the organization, payers, and other care partners without creating additional manual work?

athenaOne brings clinical, financial, patient engagement, performance, and connectivity capabilities together to help organizations manage VBC within their everyday workflows. Learn how athenaOne supports value-based care, or request an athenaOne demo.