Athenahealth CEO Jonathan Bush's Quest: A Healthcare Internet - InformationWeek

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Athenahealth CEO Jonathan Bush's Quest: A Healthcare Internet

Experiences as Army medic, ambulance driver, and failed healthcare practice manager gave Bush the idea for a new way of structuring healthcare.

If Athenahealth CEO Jonathan Bush was a superhero, he would be a wisecracking Peter Parker sort with a complicated origin story. As the nephew of George H.W. Bush and cousin of George W. Bush, Jonathan Bush said he was driven to find his own unique way to distinguish himself by doing good and changing the world. "Politics appeared to have been done," he said.

The standard Athenahealth origin story starts with a failed business, a scaled-up OB-GYN practice where former Booz Hamilton consultants Jonathan Bush and co-founder Todd Park tried to prove their theories about how to manage healthcare efficiently and at scale.

Finding that their greatest challenge was getting paid promptly, they enlisted Todd's brother Ed Park to write a custom billing and insurance claims application. That what was the beginning of what's now known as Athenanet, the suite of cloud applications that became a foundation of Athena's business. Rather than operating a medical practice, the Athenahealth business they founded in 1997 offered a combination of software and backoffice services to make other practices more successful. Other applications came later, including a top-ranked electronic health records (EHR) system, but Athenahealth started on the business side, with a revenue cycle management system called Collector.

[ Have meaningful use incentives merely propelled sales for a lot of lousy software? See Why Doctors Hate EHR Software. ]

Bush now runs a public company that is projecting revenue of about $600 million for 2013, while Todd Park left to serve in the Obama administration in 2009, initially as chief technology officer of the US Department of Human Services, and now as the White House CTO. Athenanet creator Ed Park remains with Athenahealth as chief operating officer.

How did Bush wind up in the healthcare business to begin with? His official biography mentions that he worked as an emergency medical technician in New Orleans and served as a combat medic in the Army, enlisting at the start of Desert Storm, the first Gulf War that was fought to repel Iraq's invasion of Kuwait. In a recent interview, the first thing I asked was whether his exposure to emergency medicine had anything to do with where he finds himself today.

"It has everything to do with it," Bush said.

Jonathan Bush (Source: Athenahealth).

Triage for healthcare
We met at Athenahealth headquarters on the outskirts of Boston, a converted factory complex on Arsenal Street in Watertown, Mass., which the Boston Globe described as "a 29-acre cluster of brick buildings that stored gunpowder in the 1830s, built cannons for World War I, and housed an Army materials lab in the 1950s." In official portraits and public appearances, Bush is a natty dresser with his hair carefully coiffed. He arrived for our meeting wearing a windbreaker and a backpack, having just come in on a rainy day with his dog Daisy in tow. Once in his office, he proceeded to peel and eat an orange even while keeping up a rapid line of patter.

Bush is known for his fast-talking, idea-packed, and sarcastic monologs. "I call it the Dennis Miller rant -- let's be blunt, he's a little cuckoo," Eric Coldwell, a financial analyst at Robert W. Baird & Co., told me in an earlier phone interview. At the same time, Bush makes serious points. "He knows when something is bullshit and he says as much. There are very few executives in the world who will call things like they see them without holding back."

"He's more passionate than perhaps any executive I've ever run across -- and I've come across some pretty strong Type-A personalities," Coldwell added. "If it's not true, he certainly has us all believing it -- he runs the company like he cares about this more than anything in the world." Coldwell, who describes himself as "a huge fan of Athenahealth's business model," said one of its strengths is its corporate culture and commitment to being the doctor's trusted partner and ally, and Bush sets the tone.

Yes, Bush said, his service as an EMT and Army medic is a significant part of his story. A college student at the time, he signed up "the day the bombers flew" for the Desert Storm offensive, although thanks to the rapid shock-and-awe that followed -- and the decision not to press on to Baghdad after driving the Iraqis out of Kuwait -- the conflict was over before he could be sent into harm's way. The news reports prior to the offensive envisioned something much different -- a long, drawn-out campaign against what was said to be one of the world's largest standing armies. There was talk of "more casualties per hour than any conflict since the first World War," meaning that the need for medics would be intense, he said. "Plus, I had this huge term paper due," Bush quipped. "I figured I had this training, and I had actually treated a fair number of gunshot wounds."

Part of being a Bush was "a terrible inflammation of the superego" that made him want to prove himself by doing something great, and at one time he thought he might accomplish that by becoming a great doctor. As a tryout for that role, he spent four months driving an ambulance in New Orleans. Returning to college at Wesleyan University, he found himself irritated by the "mousey" attitudes of the other students.

"They were cynical about my uncle -- all this stuff about 'he's sending the black man to fight the brown man to protect the white man's oil,' and I was like, no, he's not. The hell with it, I'm going to go," Bush said. Since the huge demand for combat medics never materialized, Bush spent just a year in the Army before returning to finish an undergraduate degree in sociology at Wesleyan, followed by a Harvard MBA -- not medical school.

A doctor friend had encouraged him to "try before you buy" and get some experience with the less glamorous aspects of healthcare -- suggesting that Bush was "a scattered guy" and might not be satisfied with the relatively limited number of activities doctors engage in once they settle into a specialty.

As the reasoning went, Bush recalled, "the closest thing to being a doctor is driving an ambulance in a busy city, and the busiest city is New Orleans, and they're poor, and they could always use help." So through an introduction to the city's police surgeon, Bush and a friend got jobs filling in for two women who were on maternity leave.

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David F. Carr
David F. Carr,
User Rank: Author
12/19/2013 | 12:39:33 PM
Athenahealth's Jonathan Bush to take a breather
Investors and financial analysts are probably reading too much into Jonathan Bush's announcement that he will take a sabbatical in 2014. He strikes me as fully capable of just wanting to take a breather ... or start another company on the side ... or maybe consort with the political side of his family. He's unpredictable, and that's part of what makes him interesting. But I think he also has a good organization in place that can survive for a couple of months without him.

Here's what the Motley Fool has to say about Athenahealth's financial prospects

What Everybody Ought to Know About athenahealth's Noisy 2014 Guidance (ATHN):
David F. Carr
David F. Carr,
User Rank: Author
11/19/2013 | 9:43:41 AM
A partisan perspective?
Does Bush's perspective strike you as ideological or partisan?

Actually, I'm told most of the Athenahealth employees lean Democrat, but that doesn't stop them from working hard every day to bring about a new healthcare marketplace where Athena gets to play a central role.
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