How Jonathan Bush Plans to Build the Health Care Internet

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Jonathan Bush, the high profile CEO of athenahealth, has a grand vision of the future of health care and it involves building a “health care Internet.” In this world, primary care physicians are power brokers, connecting and referring patients to a cloud-based network of super-specialists that can care for patients regardless of their geographic proximity.

Primary care physicians will be able to find specialists anywhere in the country, even the world, with highly specific skills and knowledge for their most complex patients.

Patients will have the advantage of being cared for by doctors who have treated hundreds of patients just like them, instead of by doctors who may only see patients with their specific disorder a few times in their careers.

It sounds compelling, but in our currently disjointed system, it seems like a distant dream. Bush, in a keynote interview at the Digital Healthcare Summit in Boston, admits, “We’re sort of Star Wars 1 here in health care … So, ok, the market doesn’t work so well in health care, but what we want is a network.”

Moderator Brandon Hull challenged Bush a bit. At the conference, Bush shared a music video parody that ridiculed EMRs. Hull noted the video’s message that, “Doctors hate EMRs … The last I looked, you’re in the business of selling EMRs.” Bush agreed that what we currently have is far from what we want and pointed to the lack of a coordinated vision on the part of the government as a key factor.

He cited the rush to tie physicians and hospitals to electronic health record systems without supporting infrastructure as one of the reasons for the lack of interoperability. To get to his vision of a fully functioning software enterprise system, Bush recommends taking a hard look at our current situation. “With everything in life, the first thing that you want to do if you really want to live fully is to stare vividly and unflinchingly for a very long time at the awkward reality of your current situation and then you can look off to your right and see a beautiful world that you wish you were in.”

Considering the current tech challenges in health care, Bush takes a sympathetic stance on the plight of doctors. During the talk he shared the image of a painting that he takes inspiration from, called “The Doctor” by Sir Luke Fildes. In it, a pensive doctor sits at the bedside of an ill child. “This guy, to me, is on the edge of his humanity…” he shared. “And what I believe is that digital health represents the wicking away of the things … that don’t require this level of presence is the job of the cloud and is the job of technology.”

It’s a beautiful vision, but is it realistic or even attainable?

The brutal truth about health care today is that the pensive doctor now has a large computer screen between her and her ill patient. Bush admits that we’re far from the vision currently and admits that doctors’ documentation work has become “life-sapping.” His long-term vision, however, is to make this work automated and routinized, so that doctors can be more fully present for patients.

Bush notes with irony that currently 12 million faxes are sent between the IT systems of health care providers despite the overwhelming adoption of electronic health records throughout the health care system. Bush attributes the stimulus of the ACA with the wide but ineffective adoption of EMRs. Speaking of the stimulus, in his usual colorful manner, he said, “What did Keynes say? If you pay a 100 guys to dig a hole and another 100 to fill the hole, at least you get the ball rolling.” According to Bush, despite requiring the collection of meaningful use data, the government has built no infrastructure to actually receive and measure it. He went on to discuss how regulations just add additional complexity to the system, which when worked around, create “ridiculous absurdities” and additional bureaucratic drag.

Still, he feels there is plenty of room for innovation, which is reflected in the creation of athenahealth’s innovation arm, called MDP, or More Disruption Please. Through MDP, athenahealth provides investment and support to start-ups and entrepreneurs who share their connected health vision. “We think of health care as a few trillion dollar industry. It’s thousands of a couple of billion dollar markets, all masquerading as one thing … My thought with MDP is that what we need is thousands of companies with no cost of sale, no cost of implementation, that are very results oriented, maybe they almost morph between a vendor and a provider, and they kind of come together and focus on these thousands of industries and get a 10x return because you don’t have to put very much in and the cost of sale, of implementation, is so low because you have this backbone to plug into an app store, if you will, that you can start verticals.”

Besides improving care of individual patients with a powerful network of providers, Bush feels the health care Internet can also create a new opportunity to study diseases. Under our current system, it is difficult to get enough patients with certain diseases in one place in order to conduct a study with high enough power, but that could change with enhanced technology. He also sees an opportunity to better address population health, not just in those with chronic disease – which is a focus currently due to the high costs of care of these patients – but ultimately other groups of patients as well, and the ability to do this at scale.

One regulatory shift that Bush seems to favor is the emphasis on fee-for-value versus fee-for-service. He argues that risk-bearing creates a rich market with a large number of buyers and sellers, competitively innovating cheaper and better solutions. His hope, through MDP, is to help create this rich health care ecosystem. He asserts that it’s not athenahealth’s objective to build or be the storefront for all of these businesses, but rather to simply encourage their development.

This long-view of health care and investment in MDP places athenahealth ahead of the hundreds, if not thousands, of other EMR providers. It shouldn’t surprise anyone if someday the much-sought-after and elusive health care Internet is ultimately hosted on servers built by Jonathan Bush and athenahealth.

 

This article was originally published by Healthegy.

Cool Startup: RubiconMD

RubiconMD team sitting 2

Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.