Leveraging Da Vinci APIs to Reduce Administrative Burden & Enhance VBC Success

For all the talk about value-based care, one truth remains: it doesn't work without real-time, reliable data. Yet too often, payers and providers operate in silos — leaving clinicians without the insights they need to deliver proactive care, and payers without the documentation to measure success. That’s exactly the challenge a large national insurer and Your Health were facing — until they teamed up with athenahealth.

The result: a scalable, standards-based solution that not only identified an average of 4.8 care gaps and 4.7 diagnosis gaps per patient, but also helped close 35% of CMS Star measure gaps, reduce administrative overload, and generate millions in cost savings. Improved workflows and a 12x year-over-year improvement in payer value (compared to 2023) earned the three organizations the 2025 KLAS Points of Light Award.

Here's how better payer-provider data exchange — powered by Da Vinci FHIR APIs and embedded directly into clinical workflows — can drive real, measurable change in value-based care (VBC).

Establishing a test group

The first step in tackling data-sharing and documentation challenges is finding the right starting point. The partners chose a focused test group for athenaPayer’s Care and Diagnosis Gaps solutions: Medicare Advantage members in the insurer’s network.

Initially, athenaPayer Care and Diagnosis Gaps solutions only assessed HEDIS care gaps and HCC diagnosis gaps. But with over 8.7 Medicare and Medicaid members in the insurer’s ecosystem, the tool needed to scale to meet the scope of the challenge. In response, athenahealth expanded its solutions, building new capabilities and infrastructure to support a broader range of payers and patient populations. This included sharing information on more than 20 million care gaps and extending support across the ACA and Medicaid lines of business to enable deeper collaboration and better care visibility.

Quality assurance for data exchange & connecting payers & providers

To improve visibility into patient care needs, the insurer worked with athenahealth to create a member roster of persons who were compliant or noncompliant with various VBC quality measures. This database became the foundation for real-time insights delivered through Da Vinci APIs, a set of standards integrated in the athenahealth solution. Two weeks before a member’s appointment, the Da Vinci APIs pull relevant data from the member profile to help uncover potential care or diagnosis gaps for providers to address during the visit.

To support this initiative, Your Health established a dedicated quality team that worked closely with the insurer to validate data accuracy and collaborated with athenahealth’s product team to continuously refine the tool’s outcomes. athenahealth serves as the bridge, offering data exchange between both parties and closing any existing communication gaps between the insurer and Your Health.

“We realized with this partnership between the insurer and athena, both organizations are very data-driven,” Your Health COO Will Stillinger recently told the Healthcare Innovation Group. “And when we paired our data-driven culture into that, the possibilities are really endless because athena gives us the data on the back end, the providers can see the point of care, and we can build out some pretty exponential reporting mechanisms for population health insights.”

The result? More standardized care gap assessments, streamlined workflows, and improved outcomes. And because the athenahealth program automatically sends updated documentation from Your Health back to the insurer, both sides benefit from a more complete and up-to-date clinical picture.

Closing care gaps while reducing administrative burden

Through the integrated athenahealth platform, Your Health and the insurer have streamlined data exchange, reduced administrative work, and improved patient care.

Using athenaPayer Care and Diagnosis Gaps solutions uncovered an average of 4.8 additional care gaps and 4.7 additional diagnosis gaps per the insurer Medicaid Advantage Member². This helps Your Health clinicians proactively address issues earlier, leading to better patient outcomes and higher satisfaction.

On the payer side, the insurer successfully closed 35% of their CMS Star measure gaps, and continue to accelerate their performance. For Your Health, embedding these insights directly into the EHR workflow meant clinicians can act quickly without jumping between systems, making value-based care feel more manageable and sustainable.

The partnership’s success didn’t go unnoticed. The insurer, Your Health and athenahealth were honored with a 2025 Points of Light Award from KLAS, recognizing their collaborative impact and innovation in value-based care delivery.

Harnessing the EHR to build a more connected health ecosystem

True progress in healthcare requires trust and coordination as well as technology. Seamless data sharing between payer, provider, and technology partner only works when it is built on open communication, shared goals, and adherence to common standards. In this case, adopting Da Vinci FHIR standards allowed the right information to flow securely where and when it was needed.

Additionally, embedding the solution within familiar electronic health record (EHR) workflows can ease health tech pain points for clinicians so they can focus on patient care. And starting with a targeted focus, such as specific measures and member populations, helps reduce complexity and ensure meaningful results.

Building on the success of this Medicaid Advantage pilot, the insurer and athenahealth are now exploring new use cases, including sharing information on social determinants of health and behavioral health, along with new tools for medical electronic prior authorization and referral management capabilities.

The world of healthcare changes constantly, so EHRs must adapt and innovate to meet the evolving ecosystem. This partnership shows how a shared commitment to data transparency, clinician support, and smart integration can drive real, measurable change. If you’re ready to discover how athenahealth’s payer solutions can help you close care gaps and support your value-based care goals, we’re here to help. Reach out to us today to discover how our innovative solutions can help you engage your patients.