In 1997, Jonathan Bush and Todd Park opened a woman’s health and birthing practice, where they were constantly struggling with denied or unpaid claims from insurers. Insurance companies have a complex claims system that made it difficult for doctors to navigate, and with everything being done by hand, often claims would get caught up in the system.
Indeed, International Data Corporation (IDC) research consistently points to healthcare as one of the most paper-intensive industries in the US. With limited resources and a huge concern for patient privacy, hospitals and providers have been cautious in making the transition to the digital age . Healthcare is a trillion-dollar industry, and its main employers studied medicine, not business or finance. Considering that the healthcare industry is heavily regulated and documentation is imperative, the market opportunity is massive for digitization. 
In a paper industry, it’s not only difficult to track patient’s health records, but to maintain records of payments with payers and insurance companies.
“Because you’re a doctor, not a billing expert” 
Since Bush and Park’s business was falling apart, they decided to take on the insurance companies, and they formed athenahealth Inc. This new software company was designed to track insurance claims and manage payments to ensure that doctors were paid and claims would not be lost .
Athenahealth has a strong business model for removing the administrative pain point for doctors associated with different health plans. At the core of its business model, athenahealth doesn’t get paid unless doctors do. They claim an average of 6% increase in collections, and take a percentage of payments their client receives . The pricing structure illustrates clear alignment of physician goals and athenahealth revenue model: If the doctor doesn’t get paid, athenahealth doesn’t get paid.
Over the past 20 years, Athenahealth has become much more than a software company fighting insurance battles. They have grown into a company that offers incredible tools that allow doctors and health providers an improvement in the way that they connect with patients out of the medical office.
The cloud billing and practice management system software has become known as athenaCollector. Recognizing that this platform was a huge untapped market, athenaheath expanded to further service physicians by offering athenaClinical and athenaCommunicator.
AthenaCommunicator is the way athenahealth helps doctors to keep patients engaged in their own healthcare. It consists of a medical scheduling system that has led to a decrease in no-shows and last minute cancellations. Patients can use it to schedule appointments, pay bills, or reach out to their health provider .
AthenaClinical is the Electronic Health records (EHR) system. EHRs allow doctors to connect with more patients, while still increasing the quality of care they are given. Doctors can access patients charts remotely, alert them of critical lab values or potential medication errors, and connect patients with their own health records in a safe a secure manner. For a patient who may see specialists or other doctors within their network outside of their primary care, it allows each of the doctors to see the entire history, and provide better diagnosis and treatment options.  To further streamline their EHRs Athenahealth has incorporated epocrates, a mobile drug reference, into athenaClinical. This allows doctors to easily look up appropriate dosing and contradiction when prescribing medicine.
The Future for athenahealth
In 2014, the American Recovery and Reinvestment Act mandated that all public and private healthcare providers adopted the use of electronic medical records to maintain Medicaid and Medicare reimbursement levels . That same year, 74% of sales represented customers who bought all three options and athenahealth saw significant growth in revenue, proving that both their business and operations models were successful.
Like many healthcare companies, the presidential election of Donald Trump has left many wondering if they will be left scrambling. Athenahealth has profited from the Affordable Care Act quite a bit, but their CEO Jonathan Bush is not worried about Trump’s promise to repeal Obamacare. “We’re going to have the laws that we have. We’re going to have the regulations that we have. There’s going to be a lot of chatter about blowing them up. Nothing’s going to happen. And then it will be up to the players in the market to innovate” .
If Bush’s bullish outlook proves to be incorrect, it could really slow the adoption of athenahealth’s various platforms. Analysts were predicting longer sales cycles for the company and slowing topline growth before the results of the election . It would be wise for athenahealth to consider improving its customer acquisition strategy since a government mandate may no longer be part of the sales pitch.
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