ORLANDO, Fla. -- SearchHealthIT.com doesn't make a habit of conducting video interviews with software vendors at trade shows, but we couldn't resist catching up with the colorful founder and CEO of AthenaHealth Inc., Jonathan Bush. His company charges for its cloud electronic health record (EHR), billing and practice-management tools, not by a flat fee, monthly subscription rate or yearly maintenance plan, but instead by the reimbursements the physician gets paid.
Features Writer Don Fluckinger sat down with Bush to ask him, "How can this business model possibly succeed?" and other provocative questions about the nationwide EHR rollout and where AthenaHealth fits in with its cloud EHR services. Bush's unvarnished perspectives -- especially about the economics of EHRs and health care -- will annoy some viewers and resonate with others. No one who's watched the interview, however, has come away bored.
Let us know what you think about the story; e-mail Don Fluckinger, Features Writer.
Read the full text transcript from this video below. Please note the full transcript is for reference only and may include limited inaccuracies. To suggest a transcript correction, contact firstname.lastname@example.org.
HIMSS 2011 video: CEO Jonathan Bush on AthenaHealth's cloud EHR
Don Fluckinger: Hi. I'm Don Fluckinger, features writer for SearchHealthIT.com. We do not usually interview vendors at trade shows, but this year at HIMSS, we were drawn to AthenaHealth, a company that provide at cloud-based electronic medical record and practice management system. I caught up with the company's colorful CEO, Jonathan Bush, who also happens to be the first cousin of former President George W. Bush. His unvarnished economic arguments for AthenaHealth's products will be a turn-off for some clinical leaders in the health IT sector, but certainly the chief financial officers will find this interview refreshingly candid. So, AthenaHealth has an EMR, and what other modules to go with it?
Jonathan Bush: Talking like a software guy there, Don. AthenaHealth has AthenaNet, which is the national network that organizes software knowledge and work for doctors. There are three services that we perform for doctors; we do their billing, with a service called Athena Collector, we do their medical records management, literally all the management - sending out their orders, getting their results, matching them, filing for paper performance, getting the money in a service called Athena Clinicals. We do all their patient population follow-ups with a service called Athena Communicator.
The idea is, we are a cloud-based service, so the software is free. All the modules are yours; you can take them and use them as much as you want. All we ask is that every time we generate a result for you, you pay us a small percentage.
Don Fluckinger: That is a very interesting revenue model. Explain it a little bit more.
Jonathan Bush: Sure.
Don Fluckinger: The way it was first explained to me was, the subscription fee is based on actual reimbursements?
Jonathan Bush: Actually, that is right, a percentage of the collections that come in from all of the different levels of service, whether it is just Collector, Collector plus Clinicals, Collector plus Clinicals plus Communicator, or any other combination, you get a higher, and higher, and higher percentage of your collection. It could be as high as 7% of your collections, if you did everything - if we were your entire back office, everything you do. Which we think is a lot cheaper than what people are spending today, and each service increases the revenue of the doctor, as well. Really, there is a huge upside, as well as the cost savings.
The way it works is, there is three major capabilities that we have mastered. One is software. We give away, in our little section of the cloud, you can use some really great applications. We have a really great - number one or two in every market segment - EMR, across the class survey. We have a really great, number one rated, bi-class practice management information system and we have a really fantastic brand new and not yet rated portal, patient portal.
Those are tools that are used, along with two other ones. Knowledge, so we have accumulated 40 million ways in the United States to get a claim denied, that we know about. There may be more, but we have learned 40 million of them. We have accumulated all the data needed, and when it should be captured, to qualify doctors for 30 different paper performance programs, and have injected it into our Medical Records Work. Actually, 20 of them are now injected, we got 10 more that we are building in. Every time a bonus program emerges from the payer world, we will be morphing our EMR to actually drive our doctors toward the path and places that will get them the best quality payment for the best quality care.
The last thing is work. Even if you have a great EMR, even if Obama gets out a gun and makes everybody buy this or that, the fact that most of the information in healthcare, including most of the information that comes out of an EMR, is on paper. The number one output of an EMR in the United States is a fax. So who cares? You did not improve anything; you just made doctors go slower by becoming their own transcriptionists. The last thing we do, is we send the orders out, we bring them back. If it comes in as a fax, we read the fax and data enter what we need to match it up to that original order so that there is a closed loop. Then we find out who sent that fax. We say, ‘Hey, how about you let us build an electronic connection to you?’ Little-by-little-by little, not charging for a module, not charging an interface fee, because we want to get rid of the faxes. To make money, we are building connections, onramps to our little information highway. That is the three major capabilities that we have, that we do not see anybody else building out there.
Don Fluckinger: That is a very creative and unusual revenue model.
Jonathan Bush: Amazon invented it, the software at Amazon is free; you don't pay for the warehouses. They have warehouses, trucks, software, and knowledge. The only way they make money is if you buy a book or a skirt.
Don Fluckinger: What makes you think that this model will work in healthcare, so much that you staked your company on it?
Jonathan Bush: Cash and control. The things that doctors, and I believe that all organizations and individuals have an Id and a super ego. Id is about sex, food, and survival, super-ego is about dying well, ending and looking back and saying, ‘I like the things I did.’ Doctors, I think, are rather evolved versions of that; they have a huge financial appetite, but they have a huge desire to look back on their actions and believe that they, not just did not do harm, but actually did a lot of good.
In order to do that, make cash by doing the right thing, is what all our products have in common. All our services are the best in the world at getting doctors cash for doing the right thing. You actually have to stick around and follow through. You cannot just give someone an application and say, ‘God speed, John Glen. If you use this properly . . .’ How many ‘use properly’ have you seen? It will slice, and dice, and bring world peace. What if you use it wrong? What if I am not the CIO of the year, what if I am just a regular CIO? What if I don’t have a CIO?
Then, it still has to work. Your information still has to work and still has to be online if the evolution curve is going to continue in healthcare. We are, in healthcare, fundamentally, at the beginning of the industrial revolution.
Don Fluckinger: How would you define the typical person who would use AthenaHealth? I am sure you are going to tell me that it would work for everybody in the world, from the solo doc, to Kaiser, but who is using it and what niche?.
Jonathan Bush: The phenotype, the species of doctor, or practice, or hospital that does best on Athena are the ones that care about cash as much as they care about care. It is the hospital that is in a turnaround situation, the hospital that is for-profit, the hospital that has a young, new, and ambitious CEO that wants to take it to the next level, and actually needs the money; broke. Those are the ones that do well. The major research institutions that get most of the money from chicken dinners, fundraisers, grants from Washington, those guys are not good customers. The guys like to invent their own stuff, cook their own food, and they don't outsource anything, those are the guys that are not a good fit for this. It is really about an orientation to cash and efficiency, rather than novel, new types of care that no one else does.
That actually, cuts out a lot of care. That cuts out a lot of the people in this room.
Don Fluckinger: Interestingly, cash and efficiency might be dirty words to certain CMIOs, so it's very interesting that you're bringing ‘controversial’ words to the equation.
Jonathan Bush: You said you are going to just say that I am good for everyone, but I'm not. You have got to actually . . . if you want Athena to work, you have got to let people go, you got to fire people. All these ladies or men who are typing in the EOBs manually, or the EMR department that is opening up all the faxes off the fax server and finding the order. All these reams and reams of smock-wearing hospital middle management-type jobs all go away. If you are not OK with that, you are not going to like Athena. I am telling you now so you can let our sales guy go somewhere else.
Don Fluckinger: As the American health system gets off paper and onto electronic medical records, with all this meaningful use legislation, no matter what form it finally passes in or ends up being codified in, where is AthenaHealth going to be, as far as a meaningful use?
Jonathan Bush: We guarantee payment of meaningful use dollars to our clients on AthenaNet.
Don Fluckinger: Alright. Thanks a lot for your time.
Johnathan: Thank you, Don.
Announcer: And remember, you don't know HIT, until you have read SearchHeathIT.com.