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An Entrepreneur's Prescription For Fixing Healthcare: Start Innovating!

Tuesday, June 3, 2014   (0 Comments)
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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.

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 your team?

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 needs.

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 company culture.

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.


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