Jonathan Bush is CEO and coFounder of athenahealth, Inc., a cloud-based health technology and services company. In his recently published book entitled Where does it Hurt?: An Entrepreneur’s Guide to Fixing Health Care he
shares his fundamental belief in the need for systems-changing
innovations in health care. Ashoka approached Jonathan to draw him out
on his vision and driving principles.
Ashoka: What do you see as the biggest shift in business practices we are witnessing today?
Jonathan Bush: There has been a massive shift in how
business functions, because the Internet allows people anywhere to
access information and products. And for those who are selling an
information product, it allows instant access to a global market, which
makes it possible to design and sell customized products like never
before. We are also moving toward an economy in which repetition of
“business as usual” almost always guarantees failure. Sadly, these
revolutions have not yet reached the health care industry.
Ashoka: Why not?
Bush: Well, for one, because we don’t encourage
innovation enough among those who could be designing better services.
The doctors and caregivers who know how to create and deliver health
value, too often, do not think in terms of products and managing
products. In health care, there is a long tradition of a bureaucratic
business model that does not nurture or encourage the creation of
products based on people’s needs. I believe there has to be a shift
towards thinking about how to deliver services in a format and at a
price point that will encourage people to get engaged, and more
importantly to shop in health care. But, in order for that to happen, we
need to make sense of the piece parts. Right now, all of the
information is spread in a million places, and it is impossible to
assemble it in a way that makes sense.
It is also hard for caregivers to design and package products that
can compete for the health care dollar, because the system is incredibly
cost insensitive and inefficient, eating up a ton of resources without
always delivering value to the consumer.
Ashoka: Is this different in the US than in other countries?
Bush: Absolutely. In India, for example, since the
formal system is much weaker, there is an army of characters creating
massive change—and fortunes—by thinking differently, and by
product-managing care. In the U.S., there are pockets in which
innovative entrepreneurs are doing just this: they are designing
specific products outside the formal system that people need and want.
This is what Aravind is doing for
eye care. In the U.S., we have a regulatory environment that gets in the
way of health care entrepreneurship at a broad scale. This has to
change. Health care deserves much more innovation. And as far as
timing, it’s the perfect time to get in—the water’s great; with every
pain and inefficiency of the industry is an opportunity. We need the
crazy and brave ones to disrupt the status quo, and create new ways of
doing things and value everywhere. You just need to look around and see
all the people who are unable to get what they need at a price they can
afford, and then, create a business to serve them better.
Ashoka: What keeps you up at night?
Bush: The thought that people can’t shop for health care services in an informed manner.
For me, the solution is clear: it’s the creation of a health care
Internet. A web-based cloud that is secure and reliable so people can
entrust their information to a system that will enable product
development and broad information curation and access. It occurred to
us, at athenahealth ,
that it needs to be possible for people to package up health care and
market it in different ways. Doctors should be able to go on the
Internet and say, “I do hips for half as much money as any provider in
the country, and here are the statistics that prove that my success rate
is just as good, if not better.” It has not historically been possible
to repackage the hip as a product, price it differently, and market it.
And it’s not just hips. It’s colon care and pregnancy, etc. People don’t
get to shop for health care! The idea of the health care Internet is
the connective tissue between the different actors and providers.
Ashoka: This means a pretty radical shift: away from
seeing people as “the sick,” who need to be given a service, and toward
seeing them as consumers who are trying to manage their own health and
wellness. What are the major challenges of this transition?
Bush: The biggest challenge is that health care is
an extremely complex information product. All of this information needs
to be assembled and transported easily by people who aren’t part of the
same business—stock brokers do it all the time, for example. Imagine if
investors had to figure out how to valuate companies all on their own!
That’s the reality for health care, and it’s reckless.
The primary care provider needs to be enabled as a broker, who helps
the customer look at his/her health as a portfolio to be managed and
find the products and service levels they need. Iora Health
is doing just this: the health coach becomes an advisor, helping you to
find what you need. We need more doctors, and non-medical professionals
too, to start playing this role.
Ashoka: How will this affect the delivery of healthcare and the healthcare experience?
The critical part about health care is not knowledge—it’s
intuition. Technology is never going to be able to provide that. In
large part, technology’s job is to free up the doctor to act on his/her
hypotheses, and to act on empathy and humanity.
Ashoka: Internally, how do you structure the company to
encourage radical innovation? What does this mean for the management of
Bush: The walls of a corporation are dangerous. The
way a tribe holds together best changes with the weather. There is no
one set-up that is perfect: we have to be able to form teams with
different people as the situation demands.
Ashoka: What are the skills that you think are critical in this new economy?
Bush: Resilience, courage, flexibility, team work,
and imagination. And empathy. Empathy is the foundational skill for
innovation, since you can only design something useful if you observe
Ashoka: How do you encourage these behaviors on an ongoing basis at athenahealth?
Bush: We’re trying to make them part of our DNA. The
beginning of your career with athenahealth is an education in the
culture—teamwork, self-permission—individual expertise is less
important. Once you’re in your career, there are different programs. We
push hard for entrepreneurialism, and we’ve recently kicked off a
partnership with Harvard Business School.
They just launched HBx, and they had Clay Christensen develop their
first module on disruptive innovation. We are now putting all our vice
presidents through that program. Obviously change is hard, and people
are creatures of habit and feel quite comfortable in stasis. But that
is not an option. So a huge percentage of my time and energy is
dedicated toward teasing these things out so they become part of the
Ashoka: What’s on the horizon?
Bush: A changed health care industry with more
players. We won’t be the only health care Internet company, but right
now we’re sort of alone in terms of the robust platform we’ve built, set
of services we deliver, and network we’ve grown. We need even more
users and adaptations. It’s sort of like being the only guy in town with
a telephone. If we don’t get people to buy in and start making phone
calls, the telephone thing is only going to be so powerful.
This interview was conducted by Fernande Raine, senior team member of Ashoka US and co-leader of Cities of Changemakers. Source: http://www.forbes.com/sites/ashoka/2014/06/03/an-entrepreneurs-prescription-for-fixing-healthcare-start-innovating/