athenahealth: Stepping Out

by | Dec 1, 2020

John Moore, Alex Lennox-Miller, Jody Ranck, Brian Murphy

Stepping out painting

Roughly a year ago, athenahealth held its first analyst event. This event came on the heels of athenahealth’s protracted battle with an activist investor that ultimately took the company private and led to the exit of their flamboyant CEO, Jonathan Bush. That first event seemed more designed to assuage fears and sow trust in the new leadership team.

The week before Thanksgiving, Athenahealth held its second analyst event. This time it was less about the team and more about the progress they have made in the last year. We had three analysts in attendance and here are our collective thoughts. 

First the good

Excellent senior management team.

Over the last year the company has continued to strengthen its management ranks and instill greater discipline across the company and especially in product development and management. Athena always had impressive ideas but rarely executed them well, if at all. That appears to be changing under new leadership.

In the year of COVID, posting impressive growth.

In 2020, athenahealth has seen fifteen percent growth in bookings. Double digit growth is good in any year but in the year of COVID, where virtually all EHR vendors have seen flat to only very modest single digit growth, fifteen percent is noteworthy. Roughly fifty percent of growth is via expansion across their existing base, the other fifty percent is athenahealth taking market share from others.

Strong commitment to modularity.

During the event, the company emphasized its intent to support a highly modular architecture allowing practices to adopt only what they need, a critical differentiating factor for smaller practices.

Long overdue update to MDP program.

athenahealth was an early and lone voice when it comes to championing healthcare’s independent developers via its More Disruption Please (MDP) program. It is revamping this developer support program including a much-needed modernization of its API documentation. While MDP was once revolutionary, many of its tardier competitors have since built more modern documentation and supporting facilities.

Athena will support inclusion of externally sourced data via OneChart.

While every EHR vendor is taking this one to varying degrees, athena will leverage AI and ML to “pre-reconcile” outside clinical data sources and support controlled inclusion of this data in the EHR which should minimize physician burden.

athenaOne is the go-forward platform.

When athenahealth was taken private, it was combined with Virence, the former IDX/GE Centricity product suite. Ninety percent of the conversations over this 2-day event were about athenaOne. Some work is being done to drive commonality of the user interface of both athenaOne and Centricity, but that’s about it.

Quality reporting to be consolidated into single view.

athena users will access all quality reporting from one place in their application. Most ambulatory EHR customers must bounce between tabs, windows, and applications to get a complete picture of their quality performance. Athena is making life a little easier for its users, again minimizing physician burden.

Ongoing investments in Epocrates.

Always an outlier without any direct interdependence with the core EHR, Epocrates’ place in athena’s product set reminds us that an EHR IS a content resource for clinicians and patients. While epocrates’ current contribution as an ancillary content source might be hard for someone to appreciate now, its synergy with the EHR will increasingly apparent over time.

Despite advances, we remain puzzled on several fronts

Value-based Care (VBC) strategy appears missing in action.

Today, it appears that the extent of athena’s VBC strategy is simplifying access to quality reporting and the development of network and referral capabilities (but thin on details). As ambulatory practices increasingly turn to VBC-type payment models, it is surprising that athena’s strategy here lacks a broader, overarching vision.

Payer strategy, nothing but the ubiquitous “chart-pull”.

When asked about athena’s payer strategy, e.g. how will athena help customers participate in Medicare Advantage partnerships with payers? – there was no satisfactory answer. Instead, athena pointed to its Healthplan Data Exchange as to how they are working with payers. This is hardly earth-shattering as most EHR vendors are already doing this. Important to note that, with the exception of Epic, no EHR vendor today has a payer strategy that goes beyond the chart-pull.

Data Lake strategy also lacking vision.

As a SaaS solution since its inception, athenahealth has an absolutely enormous data lake of ambulatory-based, clinical and operational data. Epic has Cosmos, Cerner has its Learning Health Network and Health Catalyst has Touchstone. Each of these companies have clear strategies to leverage this data beyond basic benchmarking for research e.g., efficacy of treatment protocols, clinical trials research, etc. Athenahealth on the other hand had nothing remarkable outside of some very limited data sharing with a few academic research institutions.

Many new features did not seem innovative.

The company gave us quite an impressive list of future product enhancements but in retrospect, none of these new features were ground breaking. Yes, the enhancement will be well-received by their customer base which has been starved for significant enhancements in recent years, but innovative is not the word we would use to describe them.

Final Wrap

Athenahealth has had a tumultuous couple of years and preceding that had seemed to have lost their way in executing on the promise of more disruption. While their product development teams had countless ideas, athena’s ability to deliver on that promise was lacking. Athenahealth had simply lost its way. Having undergone a substantial shareholder fight over the future control of the company that ultimately led to it being taken private, it is important to keep this all in mind when looking at athenahealth today – athena had lost its direction, it was heading for rocky shores in a gale. 

The leadership team that has been assembled, while doing nothing terribly breathtaking on the product development front, has instilled confidence across its customer base, which is expanding. Clearly, leadership is taking a very tactical approach to steering athena away from those rocky shores. Results speak volumes. Their growth in 2020 is clear validation that the company is back in the game.


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