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Women's Health Financial Performance Factors

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Women’s health practices face unique financial challenges—such as high denial rates (up to 28%) and complex, multi-stage billing for prenatal and episodic care. Financial performance is driven by overcoming these administrative hurdles and optimizing clinical efficiency.

Key financial performance factors

  • Claim Denials and Rework: Women's healthcare claims see higher denial rates compared to the broader ACA Marketplace. Practices optimize revenue cycles by reducing charge lag and preventing denials up-front.
  • Patient Pay Yield (PPY): With patient financial responsibility growing, practice stability relies on digital engagement. Practices see higher payment rates and lower write-offs when they implement online bill pay and electronic statement delivery.
  • Episode-of-Care Continuity: Women’s health encounters can span months (e.g., prenatal labs, ultrasounds, delivery). Capturing all services without administrative leakage requires highly accurate charge capture workflows.
  • Value-Based Care (VBC): As fee-for-service margins shrink, financial security is found in diversifying revenue with VBC contracts and effectively tracking quality metrics.

athenaOne Women's Health revenue solutions

To tackle these specific vulnerabilities, athenahealth offers tailor-made technology solutions for Women's Health and OB-GYN providers:

  • AI-Enabled Revenue Cycle Management (RCM): athenahealth’s billing software continuously updates thousands of claim rules to prevent common errors. Their AI-native features help ensure obstetric imaging and procedures are correctly coded and authorized.
  • Patient Digital Engagement (PDEI): By leveraging the athenaOne for Women's Health platform, practices can deploy digital check-in tools, text reminders, and online payment portals to capture patient balances faster.
  • Holistic Patient Tracking: The platform links various visit types across a patient's care journey, ensuring streamlined charge capture and reducing the administrative burden on tight staff resources.
  • Built-in VBC Capabilities: The system automatically prompts clinicians with payer-specific programs and quality measure tracking at the point of care, streamlining participation in incentive models.