Analyst Day 2022 Showcases Steadiness and Sensible Growth

In early November, athenahealth hosted Analyst Day, aiming to update the analyst community on the progress the company has made over the last couple of years. Current economic conditions in the healthcare sector coupled with high levels of clinical staff burn-out are causing athenahealth to take a conservative approach to the market. At Analyst Day 2022, they made clear their wish to be perceived as the steady, reliable solution that providers can count on.

Highlights:

• Consistency and steady approach continue to be the 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 inception
• New features being primed for launch are mainly focused on fee-for-service model with intermittent sprinkles of VBC capabilities

Post-PE Acquisition

Under CEO Bob Segert’s leadership, athenahealth has grown by 2,000 employees throughout 2021 and demonstrated its ability to steadily meet expectations for customers and investors alike. The company was acquired by Bain Capital and Hellman & Friedman in early 2022 in a $17 billion transaction – a lofty valuation. There were several reasons for this figure, but the leading one is likely their proven product durability, coupled with strong confidence in the leadership team. A selective approach to investment in new functionalities coupled with squeezing all possible juice from the RCM fruit has indeed proven this group a slow and steady winner.

What is next?

While most company resources continue to funnel into the RCM core of the business, there are some new features that have recently launched, and others currently in development. Tools for chronic condition management debuted this year and have gained traction with some clients, but make no mistake – these new tools are still firmly rooted in fee-for-service (FFS) territory. While there are plans to scale these features in a way that can align them with VBC workflows, I remain firmly of the opinion that fundamentally different capabilities will be needed in order to truly meet the needs of their VBC customers.

Their remote patient monitoring (RPM) module still remains in development. We will most likely see this launch sometime in 2024, which seems somewhat far off given the strong demand for it here and now. While the rest of the sector is scrambling to build out their remote care functionalities as quickly as humanly possible, athenahealth – in sharp contrast – seems steadily focused on their core capabilities, preferring to approach the new horizon more carefully (and slowly) than their competition.

Payers

As most readers are well aware, payer platforms are another one of the hottest areas in the current market. Substantial resources are being invested to entice ever more payers, mainly by way of dangling access to data – lots of it. So far, athenahealth has managed to seduce at least a handful of payers, though most are small, and the lack of national giants leaves something to be desired. As they manage to snag more of the larger payers in the upcoming year, athenahealth can expect to see a measurably positive jump on revenues with increased reimbursements.

As it stands currently, automation of prior authorization and pre-certification workflows remain a tough nut to crack – not only for athenahealth, but also for all 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, we can expect to continue enjoying “Prior Authorization was not on file” denial codes populating on our monthly RC reports for many months, if not years, to come.

Overreliance on Outsourcing

Athenahealth has a huge team in India that has handled the majority of claims processing since 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 even entirely lost revenues as a result of this backlog event. From my personal experience leading an RCM team during my clinical work, I can state that this was hardly the first claims backlog event that occurred under athenahealth, though it was the most severe, and consequently gained the most notoriety.

I am curious how athenahealth plans to ensure such repeats can be avoided as part of their future-facing strategy, in the absence of substantial investment for automation, or for 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 as of the time of this writing, such requests have not yet been fulfilled for clients.

Impressions

The event was very well organized and informative. The best feature of all was the opportunity to speak with C-suite leadership; it became clear that athenahealth has invested a lot in their leadership team and continues to do so. It seems that VBC remains more than they care to chew for the time being, but if FFS continues to hold its strong grip on the majority of sector activity, I would not be surprised to see another acquisition down the road for far more than was paid earlier this year.

Only time will tell, but for now, lacking a crystal ball, it is time to prepare for the charms of the winter holiday season: gingerbread, amaryllises, first snows – and a pile of research to get done before 2023!