athenahealth CEO Jonathan Bush urges health systems to rip a page from Uber's playbook

Many companies that are considered "disruptors" share one of many things in common: they leverage networks to orchestrate resources. Are health systems taking note?

"We in healthcare don't seem to be absorbing as quickly the business models and benefits of networks," Jonathan Bush, president, CEO and founder of Watertown, Mass.-based athenahealth, said at the 5th Annual Becker's Hospital Review CEO + CFO Roundtable. The perks of networks are especially evident with ride-hailing company Uber.

Uber's parallels with healthcare
Uber began in 2010 in San Francisco with only a few cars and the tagline, "Everyone's private driver." The service, which is now available in 507 cities worldwide, stemmed from the founders' idea for a town car timeshare. Passengers could enter their credit card information on the app, then call a town car or luxury car with the press of a button. The car would arrive at GPS-determined location and the passenger's account was automatically charged, tip included.

"The first Ubers were limo service drivers in limo service cars that had no passenger. They would have nothing to do for 2 to 3 hours at a time," says Mr. Bush, who has compared these cars to academic medical centers. "Can you think of any other industries besides black car limos that have a lot of extra capacity laying around a lot of time?"

Mr. Bush listed several other equivalents to black car limos in healthcare: hospital beds, surgeons, data centers and single-instance health IT. Uber continued to tap into excess capacity in the transportation industry and launched UberX in 2012, a low-cost option that expanded its fleet of available, licensed vehicles.

"Uber added a whole new category of capacity, and that created a whole new element of demand," says Mr. Bush. "This huge new ecosystem flexes and contracts with demand and happy hours."

So who is Uber in healthcare? Well, Uber is in healthcare.

Last year the ride-hailing app launched a one-day flu shot program in 35 U.S. cities, recognizing that fewer than half of American adults receive flu shots. With UberHEALTH, registered nurses traveled to locations at a passenger's request to distribute free flu shots for up to 10 people if a passenger purchased a $10 wellness pack, which included a water bottle, tissues, hand sanitizer and a lollipop. In one day, nurses vaccinated 2,057 people under the program in 2015. In 2016, it made the entire flu shot program free — no $10 wellness pack purchase required. (The number of flu vaccines delivered this year was not available at time of publication.)

Separately, Uber also partnered with Circulation for a service that lets hospitals dispatch a car to transport acute care and elderly patients to appointments, which helps reduce the likelihood and cost of missed appointments.

Mr. Bush discussed other disruptors that are leveraging networks to better orchestrate resources. One example is Candescent Health, which hoists radiology scans onto the cloud so a radiologist specializing in joints or a radiologist specializing in pediatrics can better spend their time reading those respective scans, specifically. "And a child in rural Wyoming can have her lung x-ray read a thousand miles away by the best pediatric lung radiologist in the country," Mr. Bush and his colleague John Fox, executive director of content for athenahealth, wrote for Harvard Business Review

An opportunity to not go the way of the taxi
By early 2016, Uber was valued at $62.5 billion. Its success has put traditional taxi companies under significant pressure. For example, this year the price of medallions to operate a York City taxi fell to $805,000, down 23 percent from the 2013 peak of $1.05 million. In January, San Francisco's largest taxi service — Yellow Cab — filed for bankruptcy.

"I have this idea that everyone here has an opportunity to not become a taxi," says Mr. Bush. "There's still not that Uber-like resource orchestration [in healthcare], but I'm seeing some hints of it emerging. One has to balance between being so early at something that you run yourself into a wall and so late that there's no chair when the music stops."

To bend healthcare's cost curve and improve patient access, Mr. Bush urges health systems and hospitals to take stock of the market-driven models around them that make the most of existing capacity and demand to ultimately reap the benefits of networks.

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