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Healthcare Data Platforms: Getting to Network Effects with Jonathan Bush

by John Moore III | May 17, 2022

Healthcare is a notorious slow mover when it comes to adoption of technologies and strategies. As new tech becomes available, it’s been a challenge for the industry to keep up with other sectors of the economy; the pace of implementation has lagged, to the detriment of patients, physicians, and everyone in between.

So what are the problems that need addressing? On this episode of our Executive Interview series, we sat down with Jonathan Bush, CEO of Zus Health, to look at the direction that healthcare is headed.

The network effect is a powerful moment in an industry’s advancement; it arrives when various organizations have created enough of an infrastructure that the existing framework accelerates product development, technology deployment and ultimately, customer satisfaction.

How can healthcare benefit from the network effect? What are all these data platforms really about? And how do we collectively move on from some of the archaic ideas embedded in the structure of care delivery? Check out our video interview or listen to the podcast episode below.

AI-generated transcript below:

John Moore III: So I’ve known you for quite a while. Since you were back doing “More Disruption, Please” up at your campgrounds.

Jonathan Bush: You were a “More Disruption, Please” entrepreneur yourself.

John Moore III: Yeah, I was trying to do something around mental health and medication adherence at the time. That was a great experience.

Jonathan Bush: You might have been early. It’s all the rage right now.

John Moore III: Yeah, I’ve noticed. We were definitely a little early for that. I don’t think the market was ready because everybody was doing EHRs at the time. You guys were solving the problems that everybody cared about. Obviously a lot has changed since then. You’re no longer with athenahealth. athenahealth has gone through new management twice or new ownership twice since you’ve been gone. So we can stay clear of the athenahealth stuff unless there’s anything you want to talk about.

Jonathan Bush: They’re still a great company, I think.

John Moore III: Yeah, they seem to be doing really well. And you’re now doing Zus health. So tell us a little bit about how your experience is working with athena led you to want to create Zus health.

Jonathan Bush: Well, Zus was was all the things that seemed really hard to do at athena or is all the things that seem really hard to do at athena. athena Serves more of a traditional office-based provider, health system and medical group. Those customers want to control their own data, are a little cautious about sharing it and how the architecture of athena is very much around people who have a visit to the office as their center of gravity ending in a medical claim. And what I have found to be exciting and interesting is the arrival now of thousands of companies that aren’t oriented around the visit to the office and aren’t oriented around the sort of the atomic unit of their world is not the medical claim. Companies that monitor drug adherence with lots and lots of Jiminy Cricket like texts and videos and support nudges companies like WHOOP and Noom and Calibrate that help you with weight.

John Moore III: And all those “worried well” services and apps.

Jonathan Bush: Yes, the “worried well,” you know as it sort of touches the blood brain barrier of traditional medicine and you know, the research has been clear for years, but now we’re starting to see it turned into practical businesses. If you do “worried well” well, you get less expensive on the intervention medicine side. And so all of these companies are, by their nature, right, they’re focused factories, they’re narrow. And they are very much interested in federating medical data. They don’t want to build a moat around themselves. They want to integrate themselves into care experiences of patients nationally and across many specialties. So they are happy to work in a kind of a on a shared record.

Jonathan Bush: So Zus has built the tools for that kind of company. It’s a national master patient index. It’s a national longitudinal data record, a vault for every American. And then it’s a series of APIs to build out tools like patient relationship management, a registration intake, referral, all the things that these new companies have as their sort of operational center of gravity. We go and deal with the old med world. We go get the claims and the charts and the scripts in the labs and bring them in so that these guys don’t have to deal with it. And then we provide a really highly performant FHIR native operational data platform to build on.

John Moore III: Okay, so how many people have you had building on it? Do you have anyone actually developing on this yet or is it early days?

Jonathan Bush: There’s a sandbox. Yeah, that you’re all welcome. zus.health. And there’s about 50 companies in there now. We’ve got one that signed a contract today, which we’re excited about. And, you know, we’re hoping that we’ll get a few dozen by the end of the quarter. Just getting those early stories built on the platform.

John Moore III: Just showing success, getting people to work out any of the kinks you may not have noticed yet.

Jonathan Bush: Can’t handle too many customers because we want the ones that start to be very successful. So we’re a little sheepish about too much P.T. Barnum at this stage.

John Moore III: Yeah, that makes sense. So there are a couple of themes that this brings to mind, as we’re looking at the whole industry writ large, that it sounds like your solution can address, and that is the concept of omni channel care and reconciling when patients are visiting multiple disparate systems, virtual care, in-hospital care, urgent clinic, whatever. So that’s your omnichannel side. And then there’s the virtual care side and what’s going on.

Jonathan Bush: Yeah. And I think the trick, right. We did this big meaningful use-based push clinical term of art, “meaningful use.” I’m not sure how meaningful it is, but legally.

John Moore III: It got things to happen.

Jonathan Bush: More meaningful than not doing it, maybe.

John Moore III: Yeah, exactly.

Jonathan Bush: But you ended up with many, many, many people who sort of think of themselves as the system of record, the center of gravity for a patient, even as as we just discussed, all these other approaches to care blossom up around those centers of gravity. And so what I think established providers are going to struggle with is if somebody is an omnichannel patient, if somebody is touching care, both in and outside of their kind of moat, data moat, can they handle them properly with the current technology environment or do they need to refer to some sort of system of patients record as opposed to system of buildings record?

John Moore III: We’re trying to get rid of the systems of record. I mean, this is something you probably remember us talking about for a while now.

Jonathan Bush: Everybody needs their records. I just don’t think that that’s necessarily—

John Moore III: The be all, end all.

Jonathan Bush:—the be all end all for clinical truth for a patient. And that’s what we’d like to see, at least in this kooky band of venture backed digital providers come into being.

John Moore III: Okay, so jumping off of the venture backed, I’m going to jump off on a tangent here. Before we start recording, we were talking about HLTH and HIMSS and, you know, the the potential fight brewing between the two of them. And you just came from HLTH. So you want to give me a little of your hot takes from both?

Jonathan Bush: I’ve been to HLTH and ViVE and now I’m at HIMSS, and I think I, as I said in my opening remarks, I recommend them for those who haven’t seen them here at the HIMSS, I don’t know if there’s a website or whatever, but the idea at HIMSS that the people who make software are the vendors and they stay in the basement in a pit, and then you go in occasionally for free cocktails and get preyed upon, then you go back up into the lofty classrooms for PowerPoints of truth about what we should do is a little bass ackwards. I think that technology moves at orders of magnitude faster pace than care protocols, and probably the two groups should kind of get together. And what I think is interesting about these digital health companies and the conference that seems to cater to them is that they don’t have that stark delineation between the software makers—

John Moore III: It was definitely broken apart for that one.

Jonathan Bush: I don’t know. I end up with not a lot of time to sort of wander, but the vibe I got at at those conferences was not there was a, you know, the software people were up in the classrooms and the provider people were hawking their wares on the floor. There wasn’t this delineation of the two. And I think that’s real. I think that that’s the way care will evolve best. And I think if you’re here to work on your career, I think that’s the vein, the swim lane you want to get in, you don’t want to be in a provider organization that can’t code. And not only you want to be in a coding organization that can’t provide necessarily. So I hope that HIMSS caught onto this and, and tries to move these two tribes together.

John Moore III: Yeah, that’d be great. That’d be great. So jumping back into what you’re doing with this. Tell me a little bit more about what you see as being kind of the big goal. Like how do you know that you’ll succeed with this? What’s going to feel like?

Jonathan Bush: Well, I mean, come on. You know, the great thing about entrepreneurship is success. You never succeed, right? You just clear the next false peak so you can see the peak that lies beyond.

John Moore III: You know, you’re a repeat entrepreneur, so you’ve been through the cycle a few times. You know that there’s always a point where you feel like you have succeeded with this venture.

Jonathan Bush: Oh, you’re right. So, you know, obviously Zus, we wanted to get funded, check, no longer considered success. You know, we wanted to recruit a stellar team, check. No longer considered success. But we’ve got we want to have customers—

John Moore III: How about the impact? How will you gauge whether or not you have been successful? As far as the impact Zus has had.

Jonathan Bush: I would like to see—I don’t believe that health care has experienced network effect. I don’t believe that the magic of multiple entities making a network stronger and stronger and seeing order of magnitude more value for their efforts by virtue of their connection to others kicking in yet. It’s all kind of a top down sort of waterfall-type approach to management and care delivery. I think Zus is the right architecture for people to kind of check into a channel on a patient and check out to take full advantage in an instant of all the work that’s gone on before by others on a patient without getting slowed down and thereby sort of just create some network effect, I think it’s a platform that can be used to provide a basis for a new kind of provider network, you know, instead of like, okay, we do dermatology because we paid a dermatologist $1,000,000 to move here to Cleveland and we got him an apartment. And we, you know, now it’s like, hey, I found this brilliant dermatologist. His wife is in a fellowship in Paris, and he is so good with this kind of lesion. So we’ve added him to all of the lesions that look like that. You know, we pay him 100 bucks and he spends 9 minutes and he’s happier than a pig in shit over in Paris, you know, and we’ve got this unbelievably precise set of diagnoses and prescriptions that we would never get sending to the one guy who tries to do all derm for everyone. That could be normal in a Zus world.

John Moore III: Outside of a pandemic.

Jonathan Bush: Outside of a pandemic. So that’s that’s the fondest wish for Zus.

John Moore III: So you’re pretty well known for being a bit of a firebrand in the industry and having some good hot takes. So I want your hot take on the platform-ification that’s been happening in the space and just everybody trying to be a platform. Obviously what you’re doing makes sense, but a lot of these other companies, it’s kind of a questionable avenue for them to pursue.

Jonathan Bush: I respect and support and encourage people trying to platform-ize. My take on it is that if your fondest wish, when you go to bed at night—you know your “one more thing, baby Jesus, before I close my eyes,” you know, “please make it really hard to never refer away from me.” You’re doing a good job at sort of preserving a health system that’s been there for a long time and provides a valuable community resource. But you aren’t really creating the liquidity that a good platform would create. Yeah, so my perspective is to come and find this sort of band of outcasts, this new kind of “More Disruption, Please” type crew that actually selfishly wants in their selfish “Evil Bill and Evil Ted’s Excellent Adventure”—data is all shared. Like that’s the greedy thing for them is that it works seamlessly. You can see everybody else’s homework before you try to take the test—that if I’m right, most of the people who talk about platform-izing themselves will struggle. But there’s so many ways of going and there’s so much improvement to go on in so many levels.

Jonathan Bush: You know, Innovaccer where I’m on the board, you know, they have a unified data model across all of their customers and they’re just amazing and integration and ingestion across all kinds of systems. Their customers don’t really want to share the data, but they could, you know, so that’s pretty close and certainly ideal for those who are where they are on sharing. But I don’t—no one knows. You know, these the Disney guy talked about asynchronous war is the way to go. Like nobody knows the kook that’s going to make this shit work. And, you know, maybe I’m already too fat and well heeled and, you know, get too many interviews too early in my company’s lifecycle to be the right one to do it. I’m certainly trying to be scrappy and trying to be focused on a narrow use case and make that viral growth happen. But we’ll see. There might be another guy down the hall here who’s going to do better.

John Moore III: So how does what you’re doing compare to some of these other data plays that are trying— like Truveta or what Epic’s doing with Cosmos? I guess Cosmos is all de-identified and it’s more about the data play—so I guess, how is what you’re doing going to be either competitive or complementary to that?

Jonathan Bush: As one would imagine, data is sort of where it is in this world where the atomic unit upon which everything is built is the claim. There are charts and other piles of data that feed the creation of claims that people try to monetize and use for all kinds of things. The claim is actually kind of a crappy sort of echo of care. And the care is a crappy echo of symptoms, right? You’re in there all day feeling something and it’s getting a little worse. “Is it getting worse? I can’t tell. God, it’s really hard to be today. Like, is that me?” You know, that’s going on, all that. And then all of a sudden it’s all kind of crunched into a seven-minute moment with your pants down on wax paper with a doctor. You know, it’s like and then the doctor takes the seven minutes and tries to crunch it into a code with a bunch of backup codes that explain why that code and not some other code. And then that data, that weird crunch up of a crunch up of a crunch up, that’s the data that everybody’s fighting over. Have at it! You know, what I’m more interested in and what the center of gravity, the atomic unit of these digital health companies is that continuous feeling. “How are you feeling now? How are you feeling now? What’s your blood glucose now? What’s your blood oxygen level now?”

Jonathan Bush: Like, is mom moving around today? Is she moving faster? Slower? Is she kind of holding on to the furniture a lot? That’s the stuff that doesn’t make it to the chart. That’s the stuff that will really evaluate whether this or that drug works or this or that rehab works or this or that doctor’s any good. That’s the stuff that we don’t have yet. So I’m sort of like, “Hey, you guys, you guys keep the claims.” And the CCDs, like those are all now sort of legally required sharing and we’re going to share them too. And we aren’t going to sort of guard them, you know, like Gollum and say, you know, “I have more cancer people than you.” You know, what I’d like to do is encourage these new providers to get everything, just all of it. Don’t worry about separating signal from noise. Give me the signal and the noise. And now we’ll start to learn from it. Now we’ll start to get upstream on the cause of disease and the effectiveness of care.

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