Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care

By Jonathan Bush, cofounder and CEO of athenahealth, and Stephen Baker

Healthcare can seem to be like the weather; everyone talks about it but it can feel as if no one is doing anything about it. The American medical establishment is a $2.7 trillion industry. Bush offers ideas on what to do about it. He suggests that unshackling entrepreneurs and allowing them to make a profit.

In “Where Does It Hurt?Where does it hurt” Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physician-patient experience. The book is divided into three sections: his journey through healthcare, disrupting the ecosystem and technology in healthcare.

In part one Bush reflects on his time working on an ambulance in New Orleans and working in a birthing center. He explains how it is “ridiculously hard to get paid” for most healthcare businesses. Bush says anger is a fundamental fuel for entrepreneurs. A wound or sense of injustice spurs creativity and gives entrepreneurs the push to put in the time needed to change the system. As the cousin of one president and nephew of another he offers a unique view of the role of government in healthcare. I think you will find the section on ACOs (Accountable Care Organizations) fascinating.

Part two of the book on disrupting the ecosystem describes the “titans” or current market leading companies and how they might need to adjust or even disappear. He then describes “The crazy ones,” those upstarts and innovative companies who operate with the customer in mind and add efficiency to the healthcare system while still making a profit. Chapters on primary care and a medical home round out this section.

The final section on technology covers software, disruption, stark choices and fast data. A wide variety of issues in our healthcare delivery system, from insurance packages to data mining, is covered.

Bush does not offer all of the answers. But he tackles the hard questions and gives the read a great deal to think about.

Book review by Carol Meerschaert, MBA RD, director of marketing and communications at the Healthcare Businesswomen’s Association.

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