athenahealth's Bush: 'Nobody's winning'

BOSTON—Eight-five percent of patients are not receiving regular well patient physician visits and 62 million Americans do not have a regular primary care provider, according to Jonathan Bush, CEO and president of athenahealth, who spoke at the 2014 Connected Health Symposium.

“USA ranks 42^nd in global life expectancy. We are crushing Pakistan. That’s not great,” he said.

It’s not much better for providers, he said. They spend an average of 8 minutes per patient visit and 59 percent don’t recommend medicine as a career.

“Nobody’s winning,” Bush said.

He talked about how Microsoft and Apple have evolved. “Microsoft was actually cool once. Apple was no competition. They could not get market share. Microsoft got lamer and lamer but they kept winning and stayed dominant in the computer sector. Apple got bigger by thinking differently.” When they introduced the iPod, they were actually selling computing rather than computers. That redefined the market.

Lots of things prevent the “Steve Jobs idea” of reinventing healthcare, Bush said. Reorganization of healthcare requires an underlying information backbone—some way of connecting the baseline information and someplace from which improvement can be measured.

But, healthcare suffers from “upper right quadrant syndrome,” a term Bush uses to explain how companies have much to gain by getting new customers. They compete, defend, innovate and win to defend what they have and those who do that well enough have enough customers. But, he said a natural phenomenon takes over in which companies need to “screw over their customers and employees in order to prosper because there’s not enough new soil to till.”

There is an opportunity for tertiary medical centers to get themselves out of their own upper right quadrant, he said. Cleveland Clinic, for example, has achieved 25 percent cost savings by closing two hospitals but hiring eight salespeople. Those salespeople go to large employers and offer a deal where they will do cardiac surgery, for example, on the employer’s employees for 25 percent less than the cheapest community hospital. The clinic flies patients in and out along with a loved one. This slow shift in case mix lets Cleveland Clinic concentrate on more advanced surgeries. That involves margin dollars that are much higher than procedures such as screening tests. That also makes the organization more attractive to fellows, grants and more.

“I submit to you the opportunity to push, the opportunity to be a nut,” Bush said. “While it will be very lonely and you’ll be boxed out for a long period of time, the right thing to do is to take the hazardous journey. It’s the only way you will change healthcare. Who’s with me?”