How independent practices succeed in value-based care

The promise and reality of a value-based reimbursement model for independent practices

Value-based care (VBC) shifts the focus from the volume of services provided to the quality and outcomes of patient care. Instead of paying providers based on the number of procedures or visits, value-based reimbursement models reward healthcare providers for delivering coordinated, effective care that improves patient health and reduces unnecessary costs. For independent practices, participating in VBC programs offers the potential for healthier patients and financial incentives that truly reflect the quality of care delivered.

But the path to VBC isn’t always straightforward. Many independent practices face hurdles that can stretch already limited resources — like complex data collection, detailed documentation, and the need for seamless care coordination. Without the right technology, keeping up with payer requirements and tracking performance can feel overwhelming. As a result, smaller practices may struggle to capture the full benefits of value-based reimbursement — and for many participating in programs like MIPS, they risk facing penalties for underperformance rather than earning the rewards these programs promise.

This post explores the key challenges independent practices encounter when adopting VBC. It also shows how modern, integrated AI-native platforms can help manage data, streamline reporting, and coordinate care. With the right technology, VBC becomes a powerful driver of growth and better patient outcomes for your practice.

Meeting the challenges of a value-based care model

Value-based care models guide independent practices towards a widespread goal: to deliver better patient care while building more sustainable practices. These programs reward practices for keeping patients healthier through preventive care, managing chronic conditions effectively, and coordinating treatment across providers. When executed effectively, VBC supports fewer hospital readmissions, better patient satisfaction scores, and bonus payments that recognize commitment to quality, not just quantity.

The financial upside of VBC is compelling. Payers increasingly offer shared savings programs, quality bonuses, and risk-adjusted payments that can significantly boost practice revenue. For practices already focused on building strong patient relationships and delivering excellent care, VBC models can be a natural fit.

So why do so many independent practices find themselves on the sidelines of VBC?

The challenge often comes down to resources and infrastructure. Large health systems can deploy entire teams dedicated to data analytics, quality reporting, and care management. They may hire specialists to track metrics, generate reports, and ensure compliance with VBC programs.

Independent practices, however, often handle these complex requirements with the same staff managing everything else — from scheduling patients to processing claims.

The gap in VBC readiness isn’t about clinical quality, as many independent practices deliver outstanding patient care and maintain strong patient relationships. The challenge lies in not having the right data in the right place at the right time for the right user.

Consider what happens in a typical day: care gaps that could earn quality bonuses sit buried in payer portals that busy staff don’t have time to check. Critical hospital discharge summaries remain locked in hospital EHRs that require separate logins and manual searches. Lab results, specialist notes, and medication changes scatter across different systems, each demanding precious time to access and review.

Without technology that automatically brings this essential information directly into your workflow, participating in VBC programs becomes more about chasing data than caring for patients. The infrastructure challenge therefore is getting comprehensive patient information seamlessly integrated into your daily practice so you can act on opportunities as they arise, not discover them weeks later during a manual audit.

Fortunately, the right technology levels the playing field for independent practices in the following three core challenges:

The gap in VBC readiness isn’t about clinical quality, as many independent practices deliver outstanding patient care and maintain strong patient relationships. The challenge lies in having the infrastructure to systematically capture, analyze, and report on the specific metrics that VBC programs demand.

Core challenge 1: Data collection and performance tracking

The Problem: Independent practices may know they’re delivering quality care but proving it to payers is another story. Without dedicated analytics staff, practices often lack the resources to systematically capture, track, and analyze the dozens of quality metrics that VBC programs require. You might excel at managing patients with diabetes, but if you can’t easily pull reports showing your HbA1c control rates or medication adherence statistics, you’re missing out on demonstrating and getting paid for that excellence.

The Impact: This data gap translates to lost revenue. Practices miss out on quality bonus payments, shared savings opportunities, and risk-adjusted reimbursements because they can’t document their performance effectively. Additionally, without real-time visibility into quality metrics, practices may not realize when they’re falling short of benchmarks until it’s too late to course-correct.

The Solution: The right EHR system automatically captures the data you need to maximize quality bonuses and shared savings. Platforms like athenaOne® offer built-in, payer-specific quality measures that automatically track your performance against VBC requirements. Real-time AI-enabled care gap identification helps your team proactively address patient needs — like flagging overdue mammograms or identifying patients with uncontrolled blood pressure — turning quality improvement from a reporting exercise into an active part of patient care. Rather than relying solely on data captured within your EHR, you’re connecting directly to payers to access the exact same data they use to evaluate your performance.

Core challenge 2: Care coordination across the continuum

The Problem: Beyond your practice, your patients visit specialists, use urgent care, require hospitalization, and receive care from multiple providers who may not share information effectively. This fragmentation leaves you working with an incomplete picture of your patient’s health journey, making it difficult to coordinate care effectively or identify intervention opportunities before problems escalate.

The Impact: Fragmented information leads to duplicated tests, medication conflicts, and missed opportunities for preventive interventions. Because VBC programs hold you accountable for total cost of care, these gaps can result in avoidable hospitalizations and emergency visits that hurt your patients and your bottom line.

The Solution: You need a way to automatically pull together all this scattered information into one place. AI-native population health tools within athenaOne automatically aggregate information from multiple sources — hospital systems, labs, pharmacies, and other providers — giving you a comprehensive view of each patient's health status and care history.

Core challenge 3: Complex reporting and documentation requirements

The Problem: VBC programs come with extensive reporting requirements that can strain smaller practices’ limited resources. Between quality measure documentation, risk adjustment coding, and compliance reporting, clinical staff may find themselves with too many competing priorities with patient care. Each payer often has different requirements, creating a complex web of administrative tasks that can consume valuable resources. 

The Impact: The administrative burden can slow operations, burn out your team, and divert focus from patient care. Staff frustration grows when they’re pulled away from clinical work to generate reports, leading some practices to avoid VBC programs altogether rather than deal with the complexity. 

The Solution: Integrated reporting tools that automate compliance can transform this challenge into a competitive advantage. athenaOne eliminates manual reporting entirely, automatically produces payer-specific reports, managing risk adjustment documentation, and delivers real-time dashboards that keep your practice compliant without consuming valuable staff time. With AI-enabled reporting through tools like Sage™, athenaOne’s AI assistant, your team can simply ask in plain English for the information they need — no complex queries or technical expertise required. This automation frees your team to focus on patient care while ensuring you capture every dollar of VBC revenue.

How athenaOne enables value-based care success

The difference between struggling with VBC and succeeding in it often comes down to having the right foundation. While many practices juggle multiple systems, manual processes, and fragmented data, athenaOne takes a different approach — bringing everything together in a unified platform designed specifically for VBC success.

Consider what happens when a patient walks through your door. In traditional systems, their information lives in silos: clinical data in one place, quality measures tracked separately, and population health insights buried in yet another system. athenaOne automatically captures quality measures, updates population health registries, and flags any care opportunities the moment you see patients — all without additional clicks or manual entry.

Ocean Health Initiative (OHI) — a community health center serving Ocean and Monmouth counties in New Jersey — leveraged this integrated approach to transform its major VBC challenges. Before partnering with athenahealth, OHI spent more time gathering data than acting on it, relying on manual reporting processes that created delays and impacted its ability to meet federal mandates. After implementing athenaOne’s comprehensive analytics and reporting capabilities, OHI achieved a remarkable 77% reduction in the time required to generate insights, while simultaneously improving its operational performance with a 25% increase in encounter volume and 46% reduction in no-show rates.*

athenaOne synthesizes information from hospitals, labs, pharmacies, and other providers and presents it directly in your clinical workflow at the right time for the right user. Rather than forcing staff to hunt through multiple systems or portals, critical patient information appears automatically when and where it's needed, reducing cognitive load and enabling immediate action. This seamless integration enables proactive interventions that prevent costly readmissions and keep patients healthier, turning population health from a reporting requirement into a competitive advantage.

Critically, athenaOne eliminates the administrative burden that keeps many practices from fully embracing VBC programs. OHI’s experience illustrates this, as they moved from manual, reactive reporting to automated, strategic analytics that freed their staff to focus on patient care while achieving a 47% improvement in clean claim rates and 44% reduction in accounts receivable. Practices can participate in numerous VBC initiatives without adding administrative overhead.

From challenge to competitive advantage

The journey from viewing VBC as a regulatory burden to embracing it as a competitive advantage requires the appropriate foundation. The right technology can turn VBC’s greatest challenges into a practice’s strongest differentiators.

When quality reporting becomes automated rather than manual, when population health insights surface proactively rather than reactively, and when administrative overhead decreases while performance improves, VBC transitions from a requirement to a driver of success.

The practices that thrive under VBC have eliminated the friction between caring for patients and meeting program requirements. They’ve moved beyond juggling multiple systems and manual processes to embrace platforms that make VBC success feel natural and sustainable.

Ready to transform your approach to VBC? Discover how athenaOne’s AI-powered, integrated platform can turn your practice’s VBC challenges into competitive advantages.