Critical Innovation In Healthcare Claims Processing: athenahealth CEO Jonathan Bush (Part 5)

SM: Last year you were a $140 million company, correct?

JB: Correct. The fourth quarter’s revenue rate was 47% higher than the fourth quarter of the year prior. You can imagine things are continuing to grow.

SM: Let’s explore your sales model. You have the beginnings of a very efficient national healthcare system. Given we are in a bit of an emergency and need political will to make healthcare an efficient system, how can you accelerate adoption?

JB: Our sales model is one of  three direct sales forces. There is one for small practices: 40% of practices are in groups of three doctors or fewer. We have a small enterprise group that handles the large hospital chains and national accounts. In all cases, we sign a contract and set up each practice onto the network ourselves. In the small practices that can happen largely online, and nobody shows up at a small practices offices.

The biggest obstacle to scaling at this point is that nobody has heard of us. That is why I am so excited to talk with you and go on shows like CNBC or anyone who will get the name of athenahealth in front of people. Most physicians do not know there is such a thing as a software-enabled service that will do billing and medical records over the web for a fraction of what they expect the cost to be. Once we have convinced them we can do what we claim, it is very easy to sell to them.

SM: From an innovation standpoint, what are the other pieces of the dysfunctional healthcare system besides billing and claims processing that are potentially on your radar screen?

JB: The first piece of the supply chain is the lifecycle of the medical claim, and we have that well in hand. The next piece is the lifecycle of a physician’s order. A physician can order another physician’s time, or a prescription, or a blood test. Those supply chains are out of control and incapable. Most doctors have no idea if their patients go and get the things they order, and many times they never get the results back so they can never follow up with their patients. A recent study found that 35% of the women who had gotten annual exams and had abnormal Pap spears never found out.

SM: That is scary.

JB: It is. The Institute of Medicine has documented these kinds of error rates for years, and it is devastating because the doctor still gets paid. It is what a doctor would refer to as an unfunded mandate. We think by automating the supply chain we can save the doctor funding and fill the social gap. Over time, that may make the doctor more money because people will not be able to sue as easily.

The third supply chain is the lifecycle of patient interaction. A huge amount of unfunded work for a doctor is receiving a phone call from a patient asking questions, trying to change their appointments, getting directions to the office, or asking questions because they do not understand their bill. By the end of the year we will roll out a patient communication service so that stuff can be improved.

Most patients are frustrated by their ability to communicate with a doctor. Most doctors are frustrated with the cost and confusion of being available. Most patients would love to call 24×7 and get someone on the first ring to deal with their problems. We think we can provide that.

This segment is part 5 in the series : Critical Innovation In Healthcare Claims Processing: athenahealth CEO Jonathan Bush
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