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Q&A: Jonathan Bush, Athenahealth President & Author


Jonathan Bush, author of “Where Does It Hurt?” Photo provided by Bush.

Jonathan Bush is the Chief Executive, President and Chairman of athenahealth, a healthcare information technology company. He recently stepped into the limelight by publishing a book titled Where Does it Hurt?: An Entrepreneur’s Guide to Fixing Health Care, and he’ll be speaking about American healthcare at The Economist’s second annual Health Care Forum on Sept. 17, 2014 in Boston.

Before co-founding athenahealth and publishing his book, Bush served as an EMT in New Orleans and was trained as a medic in the U.S. Army. He then switched over to the corporate world, working as a management consultant for Booz Allen & Hamilton. We caught up with him to get his thoughts on the American healthcare system, Obamacare and the physician’s role in the medical economy.

What inspired you to publish this book?

After nearly twenty years running athenahealth, where we work every day to help make healthcare work the way it should, I was disappointed by how few fellow innovators had joined the party. I’m a huge fan of Clay Christensen’s management theory of disruptive innovation, but that idea had not caught on in healthcare, and I felt like I was dancing alone.  I decided that I could help spread the word, and in doing so, not only clear up misconceptions Americans have about this industry, but incent entrepreneurs to join me in my mission to ‘open up’ health care. I ended up writing this book with the hope that people will reevaluate a lot of faulty logic.

What are some key points in your book?

The book outlines pockets of opportunity within the current healthcare system that that are primed for disruption. We’re on the verge of an oil rush – entrepreneurs can get rich, and also restore humanity to health care. This book will hopefully convince people that we’re not faced with an either/or scenario when it comes to introducing true market dynamics to healthcare or ensuring social safety for the country. It’s possible to have both. I’m firm believer that by introducing “shopping” to healthcare, we’ll see costs fall, quality of care rise, and doctors and patients gain more control over the care they elect and provide. Doctors will be the first real shoppers – health plans used to be, but they no longer can be; and patients will be, but they can’t quite yet.

Your intended audience seems pretty broad. Are you talking to medical students? Residents? Doctors? Entrepreneurs? 

I’m talking to all of them. There’s a tremendous need not just for entrepreneurs to move into the health care industry, but also for doctors to become more entrepreneurial.  The landscape is changing so rapidly—new payment models, government legislation, delivery network consolidation, and rapid adoption of health IT—and doctors just aren’t taught much of this in medical school. In addition to speaking to entrepreneurs, I hope this is a handbook for doctors and other health professionals, so they know what they’re walking out into once they take the Hippocratic Oath.

Do you think that doctors and medical students should be entrepreneurs in the American healthcare system?

It’s not that they must; it’s a matter of medical ethics. If a doctor isn’t shopping on their patients’ behalf, he’s fundamentally missing one of the most important parts of being a doctor.  Cost should be considered just as much as the clinical treatment itself.

Okay – so how would you suggest they start?

If you’re a doctor, get a risk contract and start competing on quality and outcomes. The entire industry is shifting away from fee-for-service, and you can’t afford to be left in the dust. Use technology as a partner; choose an open network rather than a stand-alone, static software system that can’t keep up with all the changes that health care faces today.

Your talk at The Economist Health  Care Forum is titled, “Has Obamacare failed or succeeded?” What are you planning to talk about?

We will never know if Obamacare truly succeeds or fails. To know this, we would have needed to pursue multiple paths simultaneously and actually reflect – along the way and down the road – on what was working and not working. Obamacare is a framework for a new system of care in America. Ultimately, it will be up to healthcare providers to make healthcare more affordable and make it work in a more connected way. Obamacare is the context; it’s up to us to make healthcare a reflection of our humanity.

What are your personal feelings about Obamacare? 

We need to stop debating frameworks and start doing the hard work. The health care market has been frozen for so long, and I believe in the power of the private market to usher in lasting change.  It’s not a secret that I’m critical of burdensome regulation, and I hope that the government will make health care more attractive to the private sector.

How do you think doctors should feel about Obamacare?

Over time, doctors won’t notice Obamacare at all. It will sink to the sediment of the healthcare pond along with countless other mandates that are just part of the context of the industry but that in many ways don’t have anything to do with the work doctors actually carry out. Doctors should feel like they can play in an environment that has room for entrepreneurship and disruption to the status quo. They need to understand how to navigate the narrow corridors of an industry that can allow innovation in care delivery, as well as how to seek out profit models through product management and delivering quality service.

You really stress that entrepreneurs should shake up the American healthcare system. What are three tips for entrepreneurs who want to change American healthcare?

One, enter. Don’t go into something easier. Two, seek to deliver cost-saving value propositions. Three, seek small customers first so you can be product centric rather than customer centric. Making your product better first will make your customers happier later.

For more from Jonathan Bush, register for The Economist’s second annual Health Care Forum, September 17, 2014 in Boston. Use the MedTech Boston Discount Code “EMPMPMED” to save $350.

Jenni Whalen

Jenni Whalen

    Jenni Whalen is the Executive Assistant of Editorial at Upworthy. She was previously MedTech Boston's Managing Editor and has an MS in Journalism from Boston University, as well as a BA in Psychology from Bucknell University. Whalen has written for Greatist, Boston magazine, AZ Central Healthy Living and the New England Journal of Medicine, among other places. She has also worked as a conference planner, ghost writer, researcher and content developer.

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