A health economics lesson from Jonathan Bush, at the helm of athenahealth
By Jane Sarasohn-Kahn on 5 March 2013 in Accountable Care Organizations, Affordable Care Act, Business and health, Connected health, Digital health, Doctors, Electronic health records, Financial health, Health care information technology, Health care marketing, Health Consumers, Health Economics, Health insurance, Health IT, Health marketing, Hospital finance, Hospitals, Internet and Health, Managed care, Medical innovation, Public health, Value based health
At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The poster-child (er, man) for this persona is Jonathan Bush, founder and chief of athenahealth.
I spent an energetic, mind-bending 30 minutes with Bush yesterday morning before the exhibit hall had opened. I framed our discussion in my discipline of health economics, and Jonathan consistently riffed on that context over the half-hour.
I pulled out an ad, featured in both the HIMSS daily convention tabloid and a major health IT trade magazine, reading, “It’s happening. Care is being delivered in more settings than ever before. The walls of your hospital no longer define the limits of your responsibility. You need to be able to “follow” your patients wherever they seek care — at an affiliated practice, in a retail clinic, or during a vacation getaway….Our cloud is open and we’re ready to connect. So let’s get started,” signed Jonathan Bush, Chairman and CEO.
I told him that it sounds like he drank the Kool-Aid of my public health hero Dr. Regina Benjamin, U.S. Surgeon General, who told the LA Times that health is where we “live, work, play and pray.”
He agreed, and said that’s why athenahealth is launching Clarity, their cloud-based solution for caregivers — athenahealth’s broad term for doctors and direct-care providers. Physicians are athenahealth’s number 1 customer constituency. That is their core base and their raison d’etre.
“It is not written that the caregiver will solve society’s problems,” Bush explained. “It is easy for the caregiver to do well and not do good.” What athenahealth has been trying to do is to help the physician accomplish both doing well (that is, being a sustainable business model) and to do right by patients in terms of being “there,” in the moment with people, driving better outcomes through adopting evidence-based practices.
Simply put: athenahealth’s job is to enable a business model where it profits from caregivers profiting from being more profitable.
There are several underlying principles that help this goal along. “Health information should be exchange in a self-sustaining marketplace…a farmer’s market for health information,” Bush further explained. “This is a national backbone.”
Second, “people need to profit from basic comparative advantage of caregivers,” alluding to Michael Porter’s “comparative advantage” research from my world of economics. “If something can be done in a cheaper, better place, everybody should make more money moving it there,” Bush asserted, noting the growth of retail clinics and other community-based lower-cost, high quality settings: ergo, delivering care where people live, work, play and pray. But, he noted, “today’s highest hope in a hospital system is to (have patients) drive downtown to the ‘U’ to get an MRI instead of going close to home” for the diagnostic exam. This is more expensive in time, convenience, and displeasure for the patient, and often more costly for the health plan and consumer, as well.
Third, “There needs to be intimacy between caregiver and patient. All the technology we bring to bear needs to increase true present moment awareness between patient and caregiver,” Bush believes. “The doctor is thinking about the patient,” so that the patient is thinking, in that “present moment,” “doctor, you are here for me as a caregiver.”
The role of the cloud-based system is to surveil the activities of patients to capture health encounters so that athenahealth care track the costs of care in near-real time. Again, the mission: to enable their clients (health providers) to financially benefit from reducing health costs throughout the cycle of care.
Athenahealth has had notable success working with smaller hospitals and physician groups that compete “in the shadows” with larger (often higher-cost) hospitals. In the value-based and accountable care era of health financing, it’s those caregivers who deliver quality care at lower costs who win. Athenahealth believes they’re a secret in providers’ sauce who want to win in that fiscally-challenging environment.
“When you want to be a network of caregivers that influences a population,” Bush promoted, “athena Clarity is your bio-surveillance, knowing where cost is happening” and identifying optimal care providers in the network. “The new revenue cycle is the clinical cycle,” Bush quipped.
In that network, it will be strategically important to encompass lower-cost providers in settings that can be appropriate to the clinical task, such as retail and urgent care clinics, pharmacies, and ambulatory care centers. “Today, those places are just trying to figure out how to break even on Pap smears and shots,” Bush recognized, but he anticipates their growth in the growing accountable care era.
Health Populi’s Hot Points: “What happens to retail health is the single most important arbiter of whether we can dig out of the hole we’re in,” Bush concluded, alluding to the health cost fiscal cliff facing America and Americans.
Ultimately, Bush and I were talking about a community health ecosystem, beyond accountable care “organizations” and more like accountable care communities. “You are a switch in a river of information,” athenahealth tells providers. “You are not an island of information.” Health information is generated well beyond the caregiver’s walls, as Bush’s quote in the ad, above, attests. Health information “happens” in schools, in pharmacies, at workplace clinics, and most assuredly, at home – the person/patient’s real medical home.
Thus, health information technology can be the backbone to promote health in communities, and while athenahealth is clearly in the business of making money with and for clinicians, they’re also talking about a mission that could lead to healthier communities – both in terms of public health and fiscal health.