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Three years after he was forced out of athenahealth, Jonathan Bush founded health IT startup Zus Health. Not surprisingly, he’s as animated and motivated as ever.   

The veteran health IT CEO left athenahealth in 2018 amid allegations including domestic abuse and sexual harassment as well as a hostile challenge from activist investor Elliott Management Corporation. A year after he departed, Bush joined Firefly Health as executive chairman and in June of this year, he founded Zus Health, which aims to create an open development platform for digital health companies backed by a shared data record. Zus closed an opening $34 million funding round led by Andreessen Horowitz.  

Bush, who co-founded athenahealth in 1997 with Todd Park, says the idea of a shared record came to both of them early in the company’s history. However, athenahealth found success in other avenues and never saw a need for that kind of platform during his time there. In the years since he has left, digital health companies have emerged left and right, giving him the hypothetical market for companies that could benefit from a shared data record. At the same time, the health care landscape experienced, as Bush calls it, “a successful, global beta production of virtual care.”  

All told, it led him to founding Zus Health. In this wide-ranging interview with Health Evolution, Bush discusses leaving athenahealth, why incumbent health care organizations are missing the mark on patient experience with surveys that ask about cafeteria food, and more.  

What is your vision for building Zus Health?  

When Todd and I started athenahealth, or rather when we turned to its current business model, we had an idea that we were going to create a health care extension on the internet. We were going to do that by taking doctors and getting them to [document] their daily life through what at the time would have been the [industry’s] first industrial strength internet native platform. We thought that would lead to a lot more coordination of care. We never really got to a shared record and there were a million reasons why. For one, it was really hard to re-platform our technology. Two, a lot of the providers on our platform didn’t want that in their heart of hearts. I mean they said they wanted it but many of them live on the monopoly pricing they have for their diagnostics. When athenahealth got sold and my workbench was wiped clean, part of what I spent some time thinking about was what would make there be a common record?   

Zus is the culmination of this idea that there is a new class of company that selfishly benefits from a shared data record. These highly targeted digital health solutions, where you have one guy doing alcohol treatment, another guy is doing primary care, and another guy is only doing whatever are very narrow. In that world, you can build something for them but what do they need? They don’t want an EMR, they want to build their own EMR. They don’t want to bill a claim ever in their life. What’s the business model? The idea of a software developer kit and a set of platform services that would allow other people to build their own billing platforms is what emerged. Hopefully, what happens is that goal of a shared record gets met here.  

All the money pouring into digital health presents considerable opportunities, so who are the companies Zus is targeting?  

Companies that profit from coordinated care, not companies whose CMIOs give speeches about coordinated care. The companies that actually profit from coordinated care that have in-built technology capabilities. Those are the target audiences. If you’re trying to create a monopoly, coordinated care outside of your walls may be bad, whereas if you have a point solution, you need coordination to prosper. That’s how I’m segmenting the market.   

Our initial builders like CityBlock, Firefly, and Oshi, are selling either a global bundle across a lot of providers, whole-life risk, or just flat out care coordination as a service. Of course, they profit from coordinated care. None of them have their own imaging department or whatever. It’s that kind of company. Initially, I thought they’d be many years of waiting for that kind of company to emerge but over COVID, there were suddenly thousands of entrants and tens of billions of dollars that have gone into these companies. I didn’t quite expect a global pandemic and billions of dollars all at once, but I ain’t complaining.  

What have you seen during COVID that made you realize the timing was right for Zus?   

A successful global beta production of virtual care is what I saw. How important is network development? Network development is defined as building a Noah’s Ark in every single city that you want to [service patients]. Well, what if you could just have one cardiologist for the whole country that you could instantly beam in? What if your network development became total technological integration and total collaboration? That’s kind of fun for the network developer but also for the specialist/expert. I can see some people quietly hoping this goes away. You’re building out a new network, going into a new market and you need no specialist, and you don’t have to do a deal with the troll under the bridge at the local medical center. That’s interesting to me.