Q&A with Athenahealth, Zus Health Founder Jon Bush

One of the earliest figures in medical technology is making a comeback.

In 1997, Jonathan Bush founded a women’s health and birth care clinic called Athena Women’s Health, but less than two years later, she turned around and built Athenahealth, a practice management and physician billing tool. Over the next two decades, AthenaHealth became a leading provider of electronic medical records and billing technology, with more than 100,000 providers using the company’s tools by the time Bush stepped down in 2018. Activist investor Paul Singer.

After being out of the game for three years after being, as he puts it, “completely canceled” (reports circulated about his treatment of female employees and ex-wives when he was banned from AthenaHealth), Bush Back to health tech. Zus Health is focused on creating a shared health data platform designed for use by growing digital health companies. Last year, Zus built his vision as he raised his $34 million Series A round led by Andreessen Horowitz.Bush has spoken first company About the changes happening in healthcare he hopes to take advantage of, how health tech founders succeed as VC funding deals, and what he says about Amazon’s acquisition of OneMedical.

What do you think is changing in healthcare? How will digital companies challenge the established healthcare system and what opportunities are there?
[With] For traditional health care providers, their care is locally relevant and their referral patterns are relative to others in the community. The hospital itself can only serve people who can drive there. They are fighting local battles for deep vertical monopolies.

Due to the pandemic and the continued evolution of the idea of ​​shared software tools such as Twilio and Stripe, thousands of businesses born and raised during the pandemic are using a new digital-first embrace. [experiences] To do the majority of care better. Instead of doing vertical monopoly play, I say, “Take one narrow thing—anxiety, prediabetes—and smash it nationally.”

These new companies don’t care about vertical monopolies. They don’t even plan to have an examination room, let alone a lab, pharmacy, operating room, imaging center.This new class of enterprise is combined with a new class of tools and digital-first embracing [healthcare] Now that I’ve created the window, I can get back to work.

What does Zus Health aim to do to help these digital health companies?
Since PowerPoint was invented, every PowerPoint slide in every conference held at every academic medical center has been asked, “Why isn’t there a common health record, or at least why isn’t there interoperability? ‘ is asking.

[Part of it is that] Medical Records is designed for the primary use case of defending payments. It’s really not something you write or watch to treat someone best. There is a lot of frustration because it is built as a data backing to pay for.

When a patient arrives somewhere, 90% of what’s happening is about what’s already happening elsewhere. Before anyone can give you anything, you have to do a ton of mapping. Expensive duplication.

Old health care providers don’t mind replicating it because they don’t want to know about anything else, and they probably have pharmacies, imaging centers, or their own labs. [expand their scope and keep that patient pool], so I don’t want to share the data with others. They don’t care what’s going on far from them.

[But now there is] This new class of companies are happy to share data on the most selfish of days. Because that’s not how they make money. They can’t win by controlling your referral patterns beyond what they focus on. bring. By being very focused, you can make a better product if you know what else is going on. [with a patient] No need to collect it yourself.

After all, they all need similar things [tool kit]—You need a CRM stack, must be HIPAA compliant, secure, and able to attach documents. These companies spent the most expensive capital ever raised (first round) to build it.

Zus said to these companies: Having basic patient data (which everyone needs) and performing patient relationship management is no match. Get everything cheap and good. It’s all API-first, so no one knows it’s Zus behind the scenes.

Zus’ dream is not to be a star. From Water Boy to Powerful Waterman. And that’s where it ends. We want to be an enabler for 1,000 great businesses. So many fascinating things will happen in our upper reaches if we can make it attractive.

Among the new companies building the new model you speak of is One Medical, which is doing primary care in a different way. What are your thoughts on Amazon’s acquisition of One Medical?
As traditional healthcare assumes increasingly deep vertical monopolies, which are increasingly at odds with consumer interests, and healthcare itself is increasingly The need for intelligent (always on) layers is increasing. Finally show your mastery.

The time-honored practices mastered by most healthcare systems lack the technology and other sophisticated information management necessary to keep them readily available when questions or concerns arise. However, most early digital health solutions lack detailed patient knowledge. Amazon/One Medical straddles both. The problem they face is consumer regulation. While Amazon was able to bring the true North Star closer to the customer than ever before, One Medical had to seek payment from one hospital provider to another. This conflict between the channel and consumer interest will become very difficult to resolve as the market heats up.

You know health tech well, but you’re back at founders at an interesting time. His VC investments in digital health are slowing. How did you approach building Zus in this environment, and what advice do you have for other founders?
Start with common tools. Don’t reinvent the wheel. Rent wheels and build something unique on them. When capital was plentiful and constraints were plentiful, you could be as sloppy as you liked and look good as long as you had more customers and some clinical results that experts could agree were real. It’s not true anymore.

You have to show long-term value, and you can’t show it if you’re throwing big bucks on shit that isn’t unique. Quickly get what no one else has and put all your R&D, design and product time into it and borrow everything else. At least until the bottom line stabilizes, or some kind of operational stability. That might be obvious advice, but people forgot it during this last orgy of near-free capital. Many young people started businesses without knowing it was a problem. give it to them.

In a very short period of time, I have seen this digital health space transform from a world that doesn’t even know what VCs are to people who think VCs are a human right. It probably won’t return to zero. ‘Sorry son, VC isn’t really for healthcare’ – but it’s like ‘VC is not for companies with no plans to make money’ .

Funding is one hurdle for new companies, but talent is another. How has hiring top talent into health tech changed since you started?
When I started Athena, there was a renaissance of people thinking the internet could do more than college blogs and choppy porn. Suddenly, with all these possibilities, no one was thinking about healthcare. [We asked ourselves,] How do you trick bright young people into actually learning their skills and into medicine? Arbitrage played a big role in building Athena. We have acquired extraordinary people that the healthcare industry could not otherwise find.

In the same way that the late 90s and 2000s tried to attract young, smart people to healthcare technology, it is now possible to attract existentially unstable individuals while working in their own workplaces. there are a lot of [tech job]We feel bad about improving our algorithms this month, but historically we’re going to set back when we move to healthcare. “What you’re working on is not sketchy. The tools here are cool and the scale is epic.”

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