Sustaining women’s healthcare in rural communities

Michelle Mainord is the practice manager of Cookeville Gynecology & Urogynecology, a women’s health organization that has served a large rural region since 2011 and partnered with athenahealth since its founding. We talked with her about how the organization approaches women’s healthcare access, staffing challenges, and financial sustainability while navigating the realities of rural care delivery.

Q: What makes Cookeville Gynecology unique, and who do you serve?

A: We are the only urogynecology organization in the region, serving a 14-county rural area. Patients often travel an hour to an hour and a half to reach us, and accessing specialty care in a larger metropolitan area would require additional travel beyond that.

As the central specialty location in the region, we provide local access to urogynecology care for patients across a wide rural geography.

Q: What forces or changes are shaping care delivery and operations for you today?

A: Staffing continues to be one of the biggest forces shaping how we deliver care and operate day to day. Finding qualified staff is challenging, but burnout and turnover also play a significant role.

While technology can help support staffing gaps, there are many aspects of women’s healthcare that still require people in the office, particularly for visits where in-person support is necessary.

Telehealth has expanded our ability to care for patients, but it is not a fit for all types of women’s health visits. At the same time, advances in AI (artificial intelligence) and technology are creating opportunities to retrain staff and realign responsibilities.

Q: How do you view the role of AI in healthcare, particularly in women’s health?

A: We do not see AI as something that will replace many jobs, but rather as a way to help us do our work more efficiently. The human touch remains essential in healthcare, especially in women’s health, even as technology continues to evolve.

AI brings opportunities to shift and realign responsibilities within an organization, rather than eliminate roles altogether. As patients have become accustomed to digital capabilities in other industries, those expectations are carrying over into healthcare as well.

At the same time, adopting new technology requires careful consideration of privacy, security, and HIPAA (Health Insurance Portability and Accountability Act) requirements. Any changes need to balance efficiency with the responsibility to protect patient information and maintain trust.

Q: How has your organization approached ambient AI so far, and what has adoption looked like for providers?

A: We have begun exploring ambient AI, and some providers have started using it, though it is still in the early stages. Adoption has varied, as some providers adjust more easily than others, and using ambient technology needs to be approached on an individual basis.

There is a learning curve involved, first for the technology itself and then for providers as they adapt their workflows to incorporate it. Providers still need to review what is captured and confirm that it reflects both what was said and the intent behind it.

Ambient AI is not a replacement for provider documentation, but it can act as an accelerator that supports documentation efforts once workflows are adjusted and the technology is properly understood.

Q: Where do you feel the most friction today in women’s healthcare delivery?

A: We feel the most friction when patients come to us after managing symptoms for a long time and are ready to move forward, especially in a rural setting where access to specialty care is limited.

As the only urogynecology subspecialty organization in the area, backlogs can develop once a care plan is established and additional testing is required, which can be frustrating for patients who are eager for the next steps.

Payer requirements often add another layer of complexity. Even when patients feel ready to proceed, payers may require specific steps to confirm medical necessity. While those processes are important, they are not always easy for patients to understand.

Having strong data and reporting through our partnership with athenahealth helps us navigate those requirements more effectively, support our revenue cycle, and better manage payer relationships in a way that protects access to care and keeps the organization financially viable.

Q: How has partnering with athenahealth helped support your revenue cycle and financial health?

A: Since partnering with athenahealth, we have seen clear improvements in our revenue cycle. Our days in accounts receivable (amount of time a bill remains unpaid) have improved, credentialing with new providers and payers has become easier with additional support, and our net collection rate is strong.

We view that as a partnership, having the right tools matters. But we also understand that we have to do our part for those tools to be effective.

Tools like Self Check-in (within athenaOne®) have helped support patient payment at the time of service and even before appointments, which is increasingly important as it becomes harder for organizations to maintain financial viability.

Access to reliable data has also made a meaningful difference.

In one situation, data from athenahealth helped us negotiate with a payer that was planning a significant reimbursement cut. By showing the impact that change would have on patient access in our community, we were able to secure a much smaller reduction than originally proposed.

Having that information allowed us to protect both our financial health and our ability to continue caring for patients.

Q: How have integration and reporting capabilities changed how your team works day to day?

A: Being on a single platform has made a meaningful difference in how we work day to day. Having automatic data collection and built-in reporting means we no longer have to manually pull multiple reports, which has been especially helpful as requirements have shifted from meaningful use to MIPS (the Merit-based Incentive Payment System) and value-based care.

Integration has also reduced manual work for our team. We now have bi-directional interfaces with our primary lab, the flexibility to route [laboratory results] based on insurance requirements, and more recent integrations with [technology from the company] Exact Sciences for Cologuard testing.

That connectivity helps streamline workflows and significantly reduces the administrative burden on staff.

Q: What advice would you give to similar independent organizations evaluating long-term technology partnerships?

A: When considering a long-term technology partner, we believe it is critical to see how a platform works inside an organization similar to your own. Hearing from peers who are facing the same challenges and using the system day to day builds a level of trust that goes beyond a sales conversation.

We also think it is important to look at the long term. Choosing a platform can feel like a gamble, especially in an industry where many vendors no longer exist years later. Partnering with athenahealth gave us confidence that the organization would continue to grow and evolve alongside us.

Cost is often one of the biggest concerns, and it can be intimidating without a full understanding of what’s included. While there may be less expensive options available, we’ve found value in fully utilizing the capabilities of athenahealth.

Over time, that has supported both our operational needs and our financial position.