4 ways technology can help your organization with value-based care

Managing value-based care and risk-based programs is complex

For organizations in value-based care (VBC), the question has shifted: it's no longer whether technology matters, but whether yours is built for execution at the point of care.

Within the Medicare Shared Savings Program (MSSP), ACOs are increasingly choosing tracks with greater financial accountability. As of 2026, 82.8% of MSSP ACOs are participating in BASIC Level E or the ENHANCED track, both of which meet Advanced Alternative Payment Model criteria — the highest share of MSSP ACOs in those tracks since the program began. As more ACOs participate in these advanced tracks, they face greater operational and financial complexity.

To succeed in their value-based contracts, a healthcare organization may be required to excel in everything from coordinating care management across providers and care settings, to reporting on a broad range of metrics to multiple payers with different sets of requirements. And with reimbursements and a growing share of revenue hinging on success in value-based and risk-based programs, the health of your business — not to mention your patients — is at stake.

Technology plays a crucial role in any organization’s ability to reach their value-based care goals. Successful value-based care initiatives require a seamless exchange of data among various players, including labs, payers, hospitals, imaging centers, pharmacies, and other providers and care team members, whether they’re part of your organization or another. So, how can technology help simplify?

The essential role of experiential interoperability

For VBC teams, the key question is whether the team can use outside records to identify a care transition, confirm a service already happened, or decide what follow-up is needed, not simply whether data was exchanged. Clinicians need a complete medical history of the patient in front of them to make the best care plan. But that wealth of data can often lead to information overload. With too much raw, disorganized information at their fingertips, clinicians can struggle to find the patient data that’s most important and most relevant to the current encounter.

Your EHR can streamline the process of sifting through all that patient data, helping clinicians find the information they need at the right time. ChartSync automatically pulls in external clinical information, identifies and deduplicates key data, and surfaces it directly within clinicians’ existing workflows. athenaConnect™, the interoperability engine behind the athenaOne® network, extends that connectivity across a network of more than 170,000 clinicians and the broader healthcare ecosystem, including payers, labs, health systems, and other partners. By synthesizing program requirements and simplifying the clinical workflow, technology can help you improve patient outcomes and achieve success in your value-based and risk-based contracts.

Here’s how.

Proactively gain actionable insights into care gaps and diagnosis gaps at the moment of care

Improving patient outcomes is the key to success in quality programs. You need to make sure your clinicians have all the information they need to not only take excellent care of patients, but simultaneously keep an eye on various health plans’ requirements.

Your EHR can help clinicians stay on top of these requirements by identifying care and diagnosis gaps and proactively flagging them at the moment of care. Clinically Inferred Diagnosis Gaps, now being tested with a limited group of customers, uses AI and athenahealth chart data to suggest potential diagnoses that could map to CMS hierarchical condition categories (HCCs). The capability presents each suggestion for clinician review with links to relevant evidence, such as lab results, vitals, and encounter notes. This differs from a care gap in that a suggested diagnosis requires the clinician to evaluate the condition and document it only when clinically supported. The suggestion alone does not establish an HCC.

While some healthcare technology requires clinicians to proactively dig through this data, your EHR could instead be proactively flagging it to your clinicians, minimizing their frustration and time spent on administrative work and increasing the likelihood they’ll be able to close those gaps. When clinically verified diagnosis gaps are surfaced to PCPs, they act for 53% of members with those gaps.

athenahealth data showed an 82% HCC recapture rate among Medicare Advantage and traditional Medicare patients with primary care encounters documented in athenaOne in 2025. Together, these results demonstrate how point-of-care technology can support both clinical and financial performance in value-based care.

Let’s say your patient comes in to see a primary care doctor for their annual wellness visit. The patient has diabetes, so there are several key indicators the doctor needs to keep an eye on. The patient can’t remember whether they had their vision checked last year or two years ago. The EHR flags that an eye exam may be due, prompting the doctor to verify whether it was completed elsewhere and, if not, arrange the appropriate follow-up. The visit itself does not close the care gap.

The EHR has also surfaced other clinically relevant information, like the fact that the patient was recently treated at urgent care for a foot ulcer, a complication of diabetes. The doctor can review the record, assess the ulcer’s status, and document it as an active condition only when clinically supported. With that context, the doctor can determine what follow-up the patient needs and help coordinate their care.

For this to be possible, you need a high level of interoperability. Your technology shouldn’t just be pulling in data from all the different sources, but it can synthesize payer data and quality program requirements to help ensure your clinicians have all the information they need, without creating information overload.

Track progress on quality program requirements to help maximize revenue

The work to improve patient outcomes doesn’t start and finish with the patient encounter, of course. You can also leverage the data in your healthcare technology between patient visits to make sure you’re staying on top of all the requirements for every program you participate in. Data analysis and reporting for value-based care is complicated.

Population Intelligence can give organizations a broader view of performance across their patient population by integrating and normalizing data from claims, clinical, and other external sources within athenaOne. This supports risk stratification and helps teams track quality, cost, utilization, and other metrics important to value-based care. From there, your technology can also help make sure you’re on track with each program you participate in, so your team doesn’t have to juggle quite as many tasks. Tapping into comprehensive care gap reporting is a great place to start. EHRs can leverage payer data to find patients with open care gaps. And once you’ve identified those patients, you can initiate automated outreach campaigns through your patient engagement solution to help close those gaps.

For example, one high-performance physician group used their healthcare technology to identify which eligible patients hadn’t had a Medicare Annual Wellness Visit and execute an automated outreach campaign to engage those patients. Within 45 days, more than 30% of the patients contacted took action to schedule an appointment, and the campaigns created an opportunity to close 3,000–4,500 care gaps.*

Your technology can also track changes in quality program requirements, helping you stay up to date with what your payers are looking for. As requirements evolve, your EHR can integrate the new regulations and clinical practice guidelines into the clinical workflow and reporting dashboards, minimizing the work needed for your team to stay on track.

Reporting dashboards can help pinpoint areas for improvement, supporting continuous performance management and helping you maximize revenue. But quality measures provide only one view of performance under a VBC contract. Organizations must also consider total cost of care, utilization, patient attribution, and the contract’s financial terms. Closing a care gap or improving a dashboard metric may support better performance, but it does not necessarily result in shared savings or higher reimbursement.

Considerations for the future of value-based care

Value-based care has reached an inflection point. For healthcare organizations, the challenge is no longer simply participating in value-based care programs, but performing against increasingly complex quality, cost, and risk requirements. That changes what organizations need from their technology: not just tools that track performance after the fact, but connected platforms that help teams turn data into action across the care continuum.

That requires infrastructure that connects the clinical encounter, population-level performance, and the broader healthcare ecosystem. athenaOne supports clinical workflows at the point of care, Population Intelligence brings together data and insights to help organizations understand and manage performance across patient populations, and athenaConnect extends connectivity and data exchange across the healthcare ecosystem. Together, these capabilities can help organizations move from measuring value-based care performance to acting on the information that drives it.

Explore how athenaOne supports value-based care by connecting the data, insights, and workflows your organization needs to perform. Or request a demo to see how athenaOne can support your value-based care goals.