A Payer-Provider Collaboration — and the Health IT Vendor Facilitating It
A collaboration between athenahealth, Humana and Your Health, a South Carolina-based primary care practice, was recently recognized with a 2025 Points of Light Award from research firm KLAS. Humana and athenahealth partnered to implement athenaPayer’s Care and Diagnosis Gaps solutions to identify and surface care and diagnosis gaps among Humana’s Medicare Advantage members.
Chad Dodd, vice president of product management at athenahealth, and Will Stillinger, chief operating officer at Your Health, recently spoke with Healthcare Innovation about the benefits of the collaboration.
Healthcare Innovation: Will, could you start by describing some of the challenges your clinicians face that a project like this can help with?
Stillinger: Your Health is primarily a geriatric primary care practice. We are in value-based shared savings with multiple payers. We've built a care team model to support patients. Primary care, in general, is very reactive. We built the care team aspect. We wanted proactive touches with patients, to have conversations about a longitudinal care plan. This allows the providers to have a better insight, but it also allows the entire care team to understand what's going on with that patient and allows for those additional touches.
HCI: How did your health get involved in this project with athena and Humana?
Stillinger: We're a very data-driven company, and athena is incredibly receptive to delivering that data to us. I joke that we're a healthcare company that's slowly turning into a tech company because we're so data-hungry. We have built this culture around data as the key to managing patients. We realized with this partnership between Humana and athena, both organizations are very data-driven, 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.
HCI: Chad, could you talk about how this work with Humana came together? I understand it involves a particular athena payer solution.
Dodd: That’s right. I think to understand the relationship and the partnership with Humana and with Your Health, it helps to step back and look at what's happening in the market. One is a growing transition to value-based care. Practices have this evolving mix of patients who are in fee for service and value-based care. Those needs are very wide and very different. As Will mentioned, the need and thirst for data to drive patient outcomes exists. There's rich information that a payer has that we want to unlock and provide to the physician at the point of care, right? We heard this from our practices. And at the same time, the payers are saying we want to provide this information because it provides better care, reduces our cost, reduces our risks, and it's better for the patient at the end of the day. So sitting in between these two as the technology platform, we thought it was a great opportunity to be able to marry the data assets that the payer has with the needs and the workflows that the physicians have. So that's what we've done.
We released a few years ago a product called Moments of Care, which is taking these data elements that the payers have, whether it's diagnosis gaps or care gaps, and bringing that into a common user experience, in the way that the physician works, in the way that they think at the point of care.
We're not forcing the physician to navigate lots of different portals, right? We're not asking them to go log in and have a different user experience, which drives that cognitive burden up and puts that administrative burden load on the position. We're bringing it to them in their workflow at the point of care where they need it so they can make the best clinical decision, reducing the administrative burden, reducing that overhead, and making it simple. So that's the journey that we've been on.
HCI: Is athena working with other payers on similar connections?
Dodd: Yes, we are. Humana is clearly one of the leaders in this area, but we know that data is going to come in from multiple payers, so we give them an API so they can insert data into the physicians workflow. We reconcile, we clean, normalize, and transform. But it's one user experience, regardless of the source of the data, regardless of the payer.
HCI: Are there other athena customers who have Humana-insured patients who could take advantage of this immediately as well?
Dodd: Yes, we support a wide range of customers, from a small single-physician practice up to large enterprises and everything in between. What we strive to do is to provide that same technology, that same platform, the same capability, regardless of the size of your practice, So some people say you’ve got to join a health system to be able to have access to this rich payer data or rich health system data. We believe fundamentally that everyone should have access to it. It should be ubiquitous. It should be available, because that's the right thing for the patient.
HCI: How heavy of a lift was this for the IT or interoperability teams at athena and Humana?
Dodd: Everything now is done through a standards and API approach. I can't comment on the development effort that Humana had to expose the data. The great thing about athena is it’s a single SaaS platform. So once we have that API approach, we can go from payer to payer and once we have that connectivity in, then all athena providers have that access, right? I think with the latest technology and innovation that's out there, we can minimize the barrier of the integration work, and therefore we can spend more time and focus on what really matters, which is that physician experience.
HCI: Did this involve work that has been done at HL7’s Da Vinci project?
Dodd: Da Vinci is looking at some standards around prior authorizations. We had these Moment of Care payer integrations, but we also have significant prior authorization work that we're doing with Humana using the Da Vinci standards. The goal of that is to reduce the burden of those prior authorizations on the physician and on the clinical staff at the practice as a whole.
HCI: Will, could you talk a little bit about this from your care team perspective? Are they spending less time identifying care gaps or doing administrative work?
Stillinger: Chad mentioned the reduction of administrative burden. I think that's a key point. Prior to this project, we had a large team of clinical support staff because every payer wants something done differently. We had to build siloed teams that would focus on specific payers. With this project, we've actually reduced that team down and repurposed those individuals to get in front of patients, as opposed to pushing paper. This whole project has allowed our team to shift from being administrative to patient-facing, which is incredible.
On the chart prep aspect, the staff are now educated on how Humana handles certain quality gap exposures, and we've taken that practice and implemented it across our entire company and said, ‘Hey, what we're learning from Humana will be coming down the pipeline from other payers, so let's keep this strategy going forward, so we can navigate the complex, fragmented payer world. So we shifted our entire mindset from being payer-focused to patient-focused.
