Sticking to its knitting: athenahealth aims for consistency
Despite the turmoil and economic uncertainty endured by providers during the pandemic, the company has seen growth with its focus on building off its RCM heritage.
Current economic conditions in the healthcare sector, coupled with high levels of clinical staff burnout, are causing athenahealth to take a conservative approach to the market. At its Analyst Day late last year, company executives made clear their wish to be perceived as the steady, reliable solution that providers can count on.
Highlights of the company's presentations to analysts included:
- • Its consistent and steady approach is being highlighted as key differentiators for their solution in the market.
- • Athenahealth has historically been a revenue cycle management (RCM) horse driver, and it remains as such.
- • Historically, the RCM engine that contains all the rules and processes for claims has been almost entirely manually maintained since its inception.
- • New features being primed for launch are mainly focused on the fee-for-service model with intermittent sprinkles of value-based care capabilities.
Efforts after the acquisition
Under CEO Bob Segert’s leadership, athenahealth has grown by 2,000 employees throughout 2021 and demonstrated an ability to meet expectations for customers and investors. The company was acquired by Bain Capital and Hellman & Friedman in early 2022 in a $17 billion transaction. There were several reasons for this valuation, but the leading one was likely the company’s proven product durability, coupled with strong confidence in the leadership team.
While most resources continue to be funneled into the RCM core of the business, some new features have recently launched, and others are currently in development. Tools for chronic condition management have gained traction with some clients, but these new tools are still firmly rooted in fee-for-service territory. While there are plans to scale these features in a way that can align them with VBC workflows, I believe that fundamentally different capabilities will be needed to meet the needs of customers.
As of late last year, the company’s remote patient monitoring (RPM) module was still in development. The launch is expected sometime in 2024, which seems somewhat far off in light of current strong demand. While the rest of the sector is rushing to build remote care functionalities, athenahealth seems steadily focused on their core capabilities, preferring to approach the new horizon more carefully and slowly.
Payer platforms are another of the hottest areas in the current market. Substantial resources are being invested to entice ever more payers, mainly by offering access to data. So far, athenahealth has managed to attract a handful of payers, although most are small. As the company manages to snag larger payers, it can expect to see a measurably positive jump on revenues with increased reimbursements.
Currently, automation of prior authorization and pre-certification workflows remain problematic –for athenahealth, as well as other EHR vendors. Enhanced payer commitments will substantially simplify the process, but that’s far easier said than done – at least, from the vendor side of things. Frustratingly, payers remain highly resistant to showing their cards. Absent legislation to force the issue, providers can expect denial codes such as “Prior Authorization was not on file” populating monthly RC reports for the foreseeable future.
Cutting reliance on outsourcing
Athenahealth has a huge team in India that has handled most claims processing since its inception, while a much smaller team located in the U.S. handles those claims that the primary team escalates. Last year, there was an incident involving a claims processing backlog in which many clients experienced delays, and some even entirely lost revenues as a result of this backlog event.
From my personal experience leading an RCM team during my clinical work, I know that this was hardly the first claims backlog event that occurred within athenahealth, although it was the most severe and gained the most notoriety.
It will be interesting to determine how athenahealth plans to ensure this doesn’t happen again in the absence of substantial investment in automation, or by hiring and training a more flexible workforce that can meet shifting demand without delay. There is growing demand for CRM help desk-type support for U.S.-based provider practices, but at the time this was written, such requests have not yet been fulfilled.
The focus on interoperability
Athenahealth also provided its perspectives on TEFCA and the impact of information blocking rules (IBR), how this was expected to affect its client base, and how athenahealth planned to effectively support clients’ needs.
Joe Ganley, its vice president of government and regulatory affairs, spoke about the opportunities that came concordant with the challenges of the COVID-19 pandemic. He noted that he has seen increased interest and accompanying investments into the digitalization of healthcare services and innovative tools for care provision.
Athenahealth is focusing efforts on reducing clinician burden and burnout, enabling cost reduction, improving care quality, addressing health equity, enhancing connectivity and helping to make healthcare more patient-centric. Ganley repeatedly said the nation’s providers are not anywhere near fully leveraging the power of technology in improving care; that will require better and more consistent aggregation of data.
Concern about information blocking
A customer panel discussion on technology-driven patient access was led by Jessica Sweeney-Platt, the company’s vice president of research and editorial strategy – the panel included Jessica Boland (director of behavioral health at Esperanza Health Centers) and Jen Carlson (integrative program coordinator at Whole Life Health Care).
Panelists noted that some athenahealth customers – especially those serving rural health, Medicaid populations and other segments – are facing challenges rooted in inequity and the resulting digital divide. Equity is pivotal to achieving interoperability – not the other way around, they contend.
Boland described the Information Blocking Rule as “the bane of [their] existence,” and Carlson agreed. Boland chimed in regarding their struggle with adolescent-age patients and confidentiality rules; balancing these competing needs with IBR requirements was described as tricky to manage and driven yet further from overall improvements in access. Many attendees similarly expressed the belief that the IBR lacked clarity, and that the eight exception scenarios are frustratingly unclear.
Future strategy
The company continues to pick up steam, said CEO Bob Segert in remarks during the event. The first three quarters of 2022 saw athenahealth signing up 2,200 new practices, despite poor economic conditions. As the number of independent practices continues to decline through consolidation and new models of care continue to gain traction, Segert laid out the following objectives for athenahealth -- to grow the network overall; to strengthen its leadership position within RCM; to make VBC a core pillar of the company; and to deepen interoperability throughout the wider ecosystem.
Segert stressed the importance of a connections-driven growth strategy and shared plans to build experiential and data interoperability across ambulatory and acute sites as part of this overarching approach.
Michael Palantoni, its vice president of product management and platform, emphasized that the industry is entering an era of “true interoperability” that entails platform-to-platform data exchange. He shared their belief that healthy ecosystems have three key players – platforms, orchestrators and utilities. In alignment with its overarching growth strategy, athenahealth intends to promote more thoughtful ecosystem design by inverting the traditional EHR approach and building from the outside in, rather than the other way around, using its OneSharp platform.
Elena Iakovleva is a research analyst and Fatma Niang an associate analyst for Chilmark Research.