Unlocking strategic advantages with athenaPayer®

Empowering payers with real-time data, simplified operations, and stronger provider collaboration

If you’re leading teams focused on quality, operations, or network strategy for healthcare payer organizations, you already know where the friction points lie. Disconnected systems, delayed patient data, and manual processes continue to complicate how payers and providers work together — especially when it comes to delivering the right care at the right time.

athenaPayer was built to address those challenges head-on. With direct integration into a nationwide network of thousands of providers, athenaPayer gives health plans a smarter, more scalable way to exchange clinical data, address gaps in care, and improve both financial and clinical performance — without layering on more portals or administrative lift.

When it’s time to make the case for better connectivity with providers, use these talking points to demonstrate how athenaPayer supports the goals your teams are already working toward.

Because all of this is delivered through a single connection to athenahealth’s cloud-based, single-instance platform, there’s no need for one-at-a-time, practice-by-practice integrations.

A nationwide footprint with one connection

athenaPayer gives you access to one of the largest connected ambulatory networks in the country, spanning all 50 states¹. With that reach, you’re not starting from scratch or piloting region by region. You’re connecting once and immediately extending your operational visibility and clinical data access across your provider footprint.

For payers looking to move quickly and impactfully, this integration model helps teams align faster internally, deliver ROI sooner, and operationalize strategic priorities with minimal disruption.

Operational efficiency that scales

When data moves cleanly between systems, teams on both sides spend less time chasing missing information and correcting avoidable errors. athenaPayer reduces administrative burden on providers and payers alike, while enabling providers to receive reminders and take action directly in their native clinical workflow. And when providers take an action, athenaPayer sends that information back to the payer.

Payers leveraging athenaPayer can see:

• Reduced provider reporting effort
• Improved access to clinical information
• Lower expense to collect diagnoses documentation
• Reduced readmission rates and improved care coordination
• Improved member experience

And because all of this is delivered through a single connection to athenahealth’s cloud-based, single-instance platform, there’s no need for one-at-a-time, practice-by-practice integrations.

Real-time data, delivered directly into provider workflows

Rather than asking providers to log into yet another system, athenaPayer surfaces payer-generated data — like open care gaps and suspected and inferred diagnoses — directly into the EHR workflows providers already use. This makes those insights timely, visible, and actionable at the point of care.

This includes:

• Surfacing clinical data to support diagnosis and documentation
• Automating the medical prior authorization process
• Delivering ADT notifications to keep care teams informed and prompt follow-up care
• Promoting payers’ quality programs to clinicians and supporting successful performance

The result is fewer back-and-forths, faster issue resolution, and more aligned communication between health plans and providers.

Here's just one example of athenaPayer in action. A 300-physician South Carolina health system and a leading nationwide payer partnered to implement athenaPayer. Now, athenaPayer is uncovering an average of 4.8 additional care gaps and 4.7 additional diagnosis gaps per member. The healthcare organization's clinicians are able to implement interventions earlier, leading to improved patient outcomes and satisfaction; and the payer has closed 35% of its CMS Star gaps and is doing so more quickly.²

A better foundation for quality and risk programs

athenaPayer helps close the loop between payer insights and provider action — essential for member care and performance in value-based contracts, helping address Stars and HEDIS measures and closing diagnosis gaps.

Health plans can benefit from athenaPayer to:

• Share prioritized, plan-specific quality gaps directly with the care team
• Drive engagement through pre-visit and point-of-care insights
• Enable a data exchange strategy that actually supports shared goals

It’s not about giving providers more to manage — it’s about meeting them where they work and giving them the ability to act when it matters.

If you’re exploring options to improve payer-provider connectivity, make clinical data more actionable, or expand the impact of your value-based care programs, athenaPayer offers a proven, scalable foundation.

Learn how leading health plans are using athenaPayer. And if you’re building internal alignment — we’d be glad to help you tell the story.