Healthcare organizations participating in alternative payment models (APMs) must increasingly manage financial results alongside clinical outcomes and quality measures. The challenge is execution, particularly as organizations take on greater financial accountability and risk.
Under VBC, financial success depends on more than efficient claims and collections. Accurate clinical documentation, Hierarchical Condition Category (HCC) coding and risk capture, quality results, population management, and payer connectivity all affect an organization’s ability to meet the requirements of its contracts.
These functions can’t live in disconnected systems and workflows. Importantly, VBC doesn’t necessarily replace fee-for-service claims. The Health Care Payment Learning & Action Network (HCP-LAN) framework describes a progression from traditional fee-for-service in Categories 1 and 2 to alternative payment models built on fee-for-service architecture in Category 3. Only Category 4 moves to population-based payments that are not directly triggered by individual services. This means that for many organizations, effective revenue cycle management (RCM) remains foundational even as reimbursement becomes increasingly tied to quality, cost, and financial risk.
RCM infrastructure therefore needs to connect clinical and financial information so organizations can identify risk, document accurately, manage populations, measure quality, and capture the financial value of the care they deliver.
Healthcare organizations that use a mix of payment models feel more financially secure
Many healthcare organizations operate across a mix of payment models, incorporating APMs alongside more traditional fee-for-service arrangements. Managing multiple payment models can introduce financial and operational complexity, as each may carry different reimbursement, quality, documentation, and reporting requirements.
At the same time, a mix of payment models may support greater financial stability. According to recent athenahealth research, physicians using a mix of payment models feel that their practices are more financially secure. For healthcare organizations balancing value-based and fee-for-service arrangements, effectively managing these different requirements depends on having the infrastructure to support them together.
Value-based care success hinges on effective use of an integrated healthcare IT platform
Data and connectivity are essential to managing VBC programs, where clinical and quality results are increasingly connected to financial outcomes. According to the 2025 Alternative Payment Model Measurement Effort, 44.9% of U.S. healthcare payments flowed through alternative payment models in 2024, with 28.7% flowing through models that included downside risk. As healthcare organizations take on greater financial accountability, they need the infrastructure to understand performance, manage risk, and act on clinical and financial information together.
Automation is just the beginning. Healthcare organizations also need technology that connects EHRs, patient engagement, and RCM capabilities. VBC programs may require organizations to track and report on the quality and effectiveness of care, associated costs, patient engagement, and other measures. An integrated platform can help connect the clinical and financial information needed to manage these requirements and outcomes across VBC contracts.
Interoperabilityis also key to connecting the data and injecting those insights into the clinical workflow within athenaOne®. The ability to exchange information across healthcare organizations, payers, and other systems can support care coordination, population management, quality, and other workflows essential to VBC.
With this connected infrastructure in place, healthcare organizations can focus on five key revenue cycle management capabilities that support financial and operational performance under value-based care.
Top 5 revenue cycle management considerations for value-based care success
Here are some of the most important RCM considerations for healthcare organizations managing or participating in VBC programs.
1. Accurate and complete clinical documentation
Accurate and complete clinical documentation is foundational to VBC. In addition to supporting appropriate medical coding and billing, documentation provides the clinical information needed for HCC coding and risk capture, as well as quality reporting.
AI-native documentation in athenaOne can help reduce the documentation burden at the point of care while capturing structured clinical information that supports these downstream workflows. That connection is especially important for risk adjustment: among Medicare Advantage and traditional Medicare patients with primary care encounters documented in athenaOne in 2025, athenahealth data show an 82% HCC recapture rate.*
2. Integrated platforms for electronic health records and medical billing
Healthcare organizations need technology that connects EHR and billing capabilities within a single platform. This integration supports accurate coding and billing while giving organizations the information they need to manage reimbursement and performance across VBC contracts.
Some technology providers also offer RCM for processes such as billing, helping organizations manage these workflows efficiently and accurately as they operate across different payment models.
3. Population health and risk management
Managing VBC programs requires healthcare organizations to understand risk across their patient populations and identify opportunities for targeted care. A complete view of patient data over time can help organizations identify patients who may need additional support, coordinate care, and track quality measures.
The forthcoming athenahealth Population Intelligence will bring claims and attribution data into athenaOne workflows, helping organizations assess patient risk, manage care, and track quality within a single system. Bringing these insights into existing clinical workflows can reduce reliance on separate analytics tools and the work required to bring together data from different systems.
4. Accurate and compliant medical coding
Accurate and compliant medical coding is essential for VBC reimbursement and risk adjustment. Healthcare organizations need coding practices that align with the requirements of their VBC contracts, including HCC coding used to reflect patient risk.
Technology can also help bring opportunities for more complete diagnosis capture into the clinical workflow. athenaOne's Clinically Inferred Diagnosis Gaps capability uses AI to identify potential undocumented diagnoses based on information already in the patient's chart and surfaces them for clinicians to review during the visit, along with supporting clinical evidence. This gives clinicians an opportunity to address potential gaps at the point of care rather than relying solely on retrospective coding review.
Coding services can provide additional support for organizations that need help managing coding accuracy, scale, and evolving compliance requirements across VBC contracts.
5. Quality reporting and performance monitoring
Quality reporting and performance monitoring are essential to managing VBC programs. Healthcare organizations need to track and report on quality measures required by their contracts and identify where results are on track and where there are opportunities for improvement.
Data Explorer in athenaOne brings performance monitoring, patient identification, and population reporting into the same platform used to manage clinical and financial workflows. These insights can help organizations identify patient populations, track quality results, and focus improvement efforts without relying on a separate analytics platform.
Payer requirements for quality measures and reporting can vary and evolve over time. Healthcare organizations should look for a technology partner with experience across payers and the reporting capabilities needed to help manage these requirements efficiently.
Connecting the broader VBC ecosystem
For organizations participating in accountable care organizations (ACOs), clinically integrated networks (CINs), and other value-based arrangements, managing operations requires connectivity beyond an individual practice or health system. athenaConnect™ extends that infrastructure across the broader healthcare ecosystem, enabling the exchange of clinical and administrative data among healthcare organizations, payers, and other value-based entities.
athenaConnect can help organizations coordinate care, manage patient populations, and track quality across value-based arrangements. This broader view can help ACOs, CINs, and other organizations manage the clinical and operational requirements of VBC at scale. The connection facilitates seamless, bidirectional transfer of data, injection of ACO insights into athenaOne clinical workflows, and configuration of population health campaigns, local networks, and best-practice encounter templates.
Leverage athenaOne to optimize revenue cycle management for value-based care
athenaOne is an integrated healthcare platform that connects EHRs, RCM, and patient engagement capabilities. VBC spans the breadth of these three components, and a sound VBC strategy includes optimizing each of them.
The scale of the athenaOne network extends those capabilities. More than 173,000 clinicians are on the athenaOne network, with more than 268,000 clinical integrations immediately available to athenaOne customers, including direct connections to labs, imaging centers, pharmacies, and more.
athenaOne value-based care capabilities
athenaOne brings together capabilities to support clinical, financial, and operational needs under VBC, including:
- AI-native documentation to support accurate, complete clinical information
- Clinically Inferred Diagnosis Gaps to support more complete diagnosis capture
- Care management for personalized support of patients with multiple chronic conditions
- Data Explorer for quality monitoring, patient identification, and population reporting
- RCM capabilities and services to support accurate, scalable billing and coding
- Compliance and regulatory support for evolving requirements
Build the infrastructure for value-based care
Success under VBC requires healthcare organizations to connect clinical outcomes, financial results, and operational execution. The right infrastructure can help organizations meet the requirements of value-based contracts while managing VBC alongside other payment models and adapting as those arrangements evolve.
See how athenaOne supports the clinical, financial, and operational needs of value-based care. Request an athenaOne demo.
