Founder Stories: Jonathan Bush, Co-Founder of Zus Health and Athenahealth

Hey everybody, it's Jessica DeMasa with What's the Future of Health. I am talking to the who's who of health tech and healthcare innovation. And oh damn it, look who is back here to talk about the launch of his brand new company, ZUS, Z-U-S, like the father of Athena. We have none other than its founder and CEO, Jonathan Bush. Mr. Bush, it's a pleasure to see you.

It's a pleasure to be back with you, Jess. Oh my gosh, very cool for me.

Not only are you launching, but you have raised $35 million in a Series A led by Andreessen. You get Julie Yu on this board too, like she's on Fireflies. Other investors in the round: F Prime Capital, Maverick Ventures, and Rock Health. And what you are doing, and I'm going to paraphrase and then you're going to break it down for us. What you are doing is you are, you have created a company that is going to be the industry's first shared development platform backed by a single shared data record. So the whole middle of this development platform, you guys are going to be like the Amazon Web Services founding the internet, only you're going to do that for healthcare. Everything's going into one data record, kind of like an EMR. But the front end is left to those who know it best. Yes, unpack this for me.

We're done.

That's it, because there's a lot to talk about here.

It's BYOEMR. It's, it's a, it's a Build-A-Bear for, uh, EMRs and patient relationship management CRMs for all these fabulous new venture-backed digital healthcare companies that are being born and funded And each of them have to today build the entire full stack of technology or lose the ability to truly customize what they offer and have a unique value prop if they're going to buy, you know, not that there's anything wrong with Athena or Epic or Cerner or any of the off-the-shelf companies, but in buying those, you lose the ability to build your own thing. And what we would like to do at ZEUS is two things: give people the tools to quickly build their own thing well, and give them the benefit of everybody else's insight on each record that they serve by, by creating, as you point out, a shared record. Not shipping records back and forth, but co-use of records.

The word I saw in the press release was co-authoring interoperability, which I love the sentiment behind that. But talk through both sides of this for me, for somebody who may not have a tech background. So my audience has a lot of investors, it also has a lot of people on the innovation side of things who might be buying this stuff in, or HR benefits people. Like, explain to us, like, from the tech standpoint, if you are gonna like, um, to offer these developers this middle that's already baked, like, how revolutionary is that? Can you give us some context around that?

Not revolutionary. I mean, today many, many, many companies, when they want to take payment pass up the wonderful opportunity to build direct connections to all the different merchant processors in America. They just go to the Stripe developer kit, grab the API, and drop it into their workflow. They have eliminated millions of lines of code and maintenance for years to come by just using that API and paying for that service. Same thing with Twilio and messaging. This concept is not a new one. So, adding a specialist to a channel, or referring a patient to a specialist, or ordering a prescription, or a lab test, or any other diagnostic, all of these are commonly performed activities that now thousands of tech-forward companies are performing in addition to the traditional medical groups that we're used to seeing do this work. And these guys have developers, and plans, and product managers, and they would like to have the tech in pieces on the table for them to build their own thing with. But building the entire thing from scratch, you have a little bit of a too much work for too little gain in the early days.

Can you give us some examples, like specifically, like you had mentioned, like, okay, for payment processing, Stripe, like what are some of the things in healthcare that could be standardized that are not standardized in the middle of that stack?

Sure. I mean, the entire notion of making an appointment.

Okay.

All of the basic things for every, uh, every telemed, right? Connecting to a video stream that's HIPAA compliant, uh, texting a care team and turning the text thread into, you know, problems and care plans and treatments and tasks. All of those routines, uh, are being built, custom built, uh, or people are buying Salesforce or whatever. To replicate those kinds of capabilities. We'd like to have APIs for those that people can use in their own software very quickly and reliably. And of course, as you mentioned earlier, have the record that they connect to be connected to a common master patient index for the nation and eliminate all the digging about in the trash trying to find CCDs and claims and labs and other data on members. That you, that you may sell on, because now it's illegal to block that data. And so somebody ought to just consolidate and simplify the getting and organizing and normalizing of that data.

Let's talk about the single record, because the single record has been like the holy grail, it feels like, for everybody in health data for a while. So how are you going to pull this off?

We are not the first people who have cut—

exactly—

coconuts in half. And set out to get the grail. We are the thousandth. Um, there's 3 big things that are different. Uh, first, there's been a change in law. So the Cures Act, which I worked very hard on, lobbied for, etc., uh, back in 2016, goes into final enforcement July 1st for, for claims, and, uh, a little early in 2022 for all medical records. That allows any American not just a HIPAA-certified, you know, NPI doctor, to demand that their data be sent to the apps and services that they, that they care about and that they want to make more powerful. So that's a change in law. Obviously, the change in the business environment is pretty profound. We are all now very comfortable with telemedicine, having had, you know, 2 years to only get telemedicine. The venture capital community has gone berserk in this space. So in 2020 alone, almost $15 billion in venture capital went into the tens of thousands of companies that are offering these kind of newer age behavior determinant type care delivery companies, payvider, techviders, that are kind of crossing the lines of past market delineations. So, there's huge new buyers for this that, as you point out, are not like the providers and payers of yore, who very much did not want their data shared. Right. Did want to duplicate tests, did want to duplicate people, did want people to think twice before going to a cheaper place for a given diagnostic for fear that the record would get screwed up. And these are all not bad people, but there is a problem when you're barely breaking even and someone's going to take all your highest margin business from you. This new generation of company isn't built on 90% gross margin x-rays. These are all very low fixed cost companies that are all margin, if you think about it, once you get the tech paid for. They don't have that need, and they are largely fractile in their business model. You got one company that's doing nothing but alcohol treatment disorder. You got another one focused on opioids, you got another one that's focused on asthma, you got another one that's focused on, you know, just hypertension. These guys are not gonna make it if they can't then pan back and see the whole picture of the patient. So, they actually selfishly want data sharing, uh, and insight sharing across the various slices of a patient's life, uh, whereas the previous generation did not. So, those three things are— and of course, Lastly, there's— we're now used to the idea of build-a-bear technology. We're used to the idea of not coding everything up ourselves. We're used to grabbing Twilio and AWS and, you know, all of the load-leveling capabilities that come extra at AWS and all the Stripe technologies for taking payment. You know, these are not new novel ideas anymore. Outside of healthcare, they're quite normal.

Well, so I mean, talk to me about the incumbents then that you had mentioned, because like you said, like they historically have not wanted to share their data. Now I understand that the law is there that's going to make them, there's a market coming up around them that, that's pushing for this. But like, how does this really happen in practice? Because I mean, you, you can see it if you look at some of those companies that are out there, you know, I mean, there's a reason there's a gigantic interoperability showcase at HIMSS, right? Like, stand out remarkable that people were able to pull this off and get Cerner to talk to Epic, get to talk to AllScribs to Athena. So how does this all work with the incumbents? Where's their upside on this?

They don't have an upside in this.

Okay.

Now there are lots of regular old doctors and hospitals that don't want to share data, that do want better automation, that do want cleaner billing, that do want new technologies of different kinds. And so it's not like the traditional players have run out of things to sell. But there's this new generation of company that really excited me. I worked very hard to try to attract entrepreneurs and product managers and engineers that could go anywhere and never really thought healthcare, because it's too boring and too lame and not sexy and too regulated. I worked very hard, acted like a real clown at times, trying to make it sexy and fun to come build things in healthcare. Now, that is not an agenda to work on. They're all here. Yes, they're all here. And the key now is to make sure that shit works for them, that, you know, when they put in $10 of effort, they can get $100 of reward. And so that condition is now met for the first time. If you had to sell Zoos to traditional doctors and hospitals to sort of sell against the Athenas of the world, Zooz would not make it, and I wouldn't want to, you know, compete with dear old Athena. I think the excitement is with these new companies, the, the more disruption please early members that have now become thousands of companies.

I want to come back to that in a second, so don't think we're going to walk away from that. But I want to talk about your customer base because you guys already have some customers that are using this. You're already using Zooz. So Cityblock, Firefly, Oak Street, and then Dorsada, which is a specific, um, it focuses on maternity, right? Um, and layers on top of the EMR there. So talk to me about this client base and who else would be— I mean, like you said, like the more disruption please crowd, but is there any subset of them that would work best for Zeus?

Yeah, so first of all, nobody's using anything in production. These are guys that are early alpha builders, God bless them, that want to be leading edge, uh, and, and, and start the— we've got about 30 other companies that are in the Zeus community Like a More Disruption Please, kind of a booster group. We have a chapter on regulation and, you know, working with telemedicine law and other blockers to innovation. We have a chapter on tech and innovation tools, and then we have a chapter on business models. And we hope all your listeners join up the ZOOZ community by the time we're watching this interview. But I think the place we're at right now is day zero. So, you know, we've got the first feeds of payer data going into the first modicum of a platform. So the way the platform is going to work is you're going to have the MPI data is like layer 1 of the cake. Everybody can access the MPI like you can access LinkedIn, right? You don't need to be a member or pay anything. Second layer is the NCDI. It's all of the data that is now legally required sharing. That has its own governance access rules. You have to be a doctor or you have to have the explicit permission, a doctor treating a patient, or the explicit permission of that patient, that person, to get access to that second layer of cake. Then the third layer of cake is the proprietary vault of each builder. Firefly, it's all the exhaust from that text app where people are getting most of their care now. Through a continuous text thread. Okay. Interpreted and analyzed and turned into orders and prescriptions and things like that. Those 3 layers with the turn of the right missile keys can be shared, uh, across the entire builder community, with a specific partner, with someone that a given patient wants to see, uh, a whole picture with, or with none based on obviously the choices of the builders and the patients. But where we are right now is just in the very beginning of getting that first feed that first and second layer of cake in place. We expect in the first year of this to have all of the tools you need to build your own CRM on Zeus and to have that CRM connect to a pretty darn robust, normalized, 360-degree view of all the data that exists on your patients without you having to go around with a little bag, you know, a little handkerchief with your snacks and go up payer to payer and hospital to hospital.

Is that how they're doing it these days?

It felt like for me, man. I mean, Grossman is that— is he's building the data, uh, aggregation enrichment platform at Zeus, but he did all the connectivity at Athena. He had 400 people doing ETL for 10 years. Wow. You know, feed by feed by feed by feed. Uh, this time around, we expect it to go a whole lot quicker, and more importantly, we'll be able to spend a lot more of our time on enriching and normalizing, mapping in the Google location feed and the census data and all this other incredible stuff that the marketing world has on people that people in healthcare just simply don't have. Don't use.

Yeah, or they don't— yeah, they don't use it. They don't have it.

Right.

Okay.

So that's where we'll spend our time this time around.

All right, so more disruption please. We've talked about that. That was a movement. Unbreak Healthcare, another Jonathan Bush-led movement. I've also seen you now talk about this. As a movement. So what is this movement about? Does it have a catchy name yet? Will there be a Zeus cloud party to kick this off? Like, I need details on the movement.

Naming rights are available, Jess. Put it out.

The WCF Health Movement.

Sponsor. We are welcome. We'd be happy to call this the IBM Disruption Movement with the right bonus check from IBM. No, I think We've got our own, this thing called ZEUS Community, and we are, you know, going to do some larger movement work around, as I mentioned, the regulatory, the technical tools, and the business model stuff. We're gonna have in-person meetings and then ongoing chatter. And Dreesen Horowitz, who is leading this round, has done a huge amount of brand building for themselves in accessing entrepreneurs there, you know, healthcare needs— Absolutely. Data Eats World podcasts and their hackathons, and I mean, it's the greatest self-promotion machine, uh, ever built in the venture capital space. And I'm very excited at, uh, getting that machine aligned with Zeus and making sure that every new startup that's building something digital for healthcare, uh, finds out about Zeus because it's obviously much easier to build on Zeus from scratch than to take something you've already built and kind of chisel pathways over. We love the early guys. I think it's easier to use them. It'll be worth it using it for very mature people as we get more mature ourselves. But we really want those early guys. And so if, if Andreesen wants to call it the Andreesen disruption, please, I'm all for it.

You know what? They should talk to me too, I think. I need some more Julie Yu in my life.

Right this second, I'll text Julie Yu and she'll be on with you before you know it.

I love it. I'd love to pick her brain. Okay. Okay, so I have another question for you then here too, because I mean, I love to talk like, I mean, you've been around this industry for so long and I want to talk real quick and just see, you know, with Zeus and with what you're doing here, enable these companies to skip that time-consuming, expensive, you know, process of having to develop the same stuff over and over again and also benefit from that common record. I think like, I think about that and I think about that in the context of what we experienced in the pandemic. Where everybody really felt the friction of just how bad things were in the traditional healthcare system with trying to get virtual care, with trying to find records from multiple physical offices that were like nobody was in the office to fax something over to you. So, I mean, do you feel like we're at a point right now where the market is starting to create almost like a secondary healthcare market for certain things? I mean, we've seen the rise of these primary care, yours included, uh, companies that are kind of operating outside adjacent to the system, building their own networks of providers offering their own benefits now, starting to design their own things. And we've also seen, I mean, retail jump in in a way they never have before. So you've got Walmart with their healthcare centers, you've got CVS MinuteClinic doing mental health now. I mean, and you have Amazon, of course, and it's now launched its own care provider. So I mean, like, what are your, your thoughts on this? Have we moved, like, where now the innovators are realizing they're no longer welcome in the data-locked-down traditional healthcare system, we just started our own over here. What do you think?

Well, you know, it's funny, I, I think maybe it was in one of these interviews with you at Health 2.0 where I said the great thing about healthcare is you can be like 20 years late and be freaking innovative. Like Star Wars 1 is just coming out in healthcare's movie theater, you know. And, and, uh, the notion of Clay Christensen, you know, disruptive innovation, going outside the core, doing something instead of badly compared to the establishment, but on a different demand curve, on a different cost curve, just radically cheaper, radically more integrated in its experience, and therefore radically more asset efficient. That is not a new idea. That's a—

Healthcare is.

That's a thing that's been going on for a bazillion years. Healthcare, there's a lot of blockers to disruptive innovation in healthcare, much of which we come by honestly. We love our hospital systems. Look at all the lives saved and the heroics that came out of these medical centers once they stopped killing people by accident when they realized that intubation was not the right first move. These are places that we hold dear for good reasons. Healthcare is a safety net service in addition to being a product. We're afraid of destabilizing it. There are good reasons, as well as naughty ones, why disruptive innovation happens so slowly, and that the pain and the cost threshold needs to get so very impossibly high before we'll allow energy to leak into disruptive technologies. But as you point out, I think the leaks have happened. I think these new approaches are getting real oxygen. They're getting real growth. They're getting real capital. They're getting real recognition. Firefly, obviously, is my favorite of them, but Amazon's probably not badly run.

Yeah, you know, they got a shot.

And there are many others, and a lot of the traditional navigator companies that weren't doing that well that I was a happy shareholder in, you know, are now saying, Jesus, I can't just navigate. I gotta do it. I got to do the care and then maybe buy the, the esoteric stuff rather than just give referrals, uh, to it. So people are starting to really put their money where their mouth is, uh, and these tech models. And I think, uh, the notion of, uh, of a shared record, uh, and a unified data model that's bigger than, you know, poor dear, uh, FHIR, which has some data points that are really There is an innovation iteration process there, but it is not sufficient for what we are talking about. These new models are now reaching critical mass. That is why I think now is the time for Zeus. I think that now there is enough. It is definitely happening. Is it going to happen really, really slow with way too much capital, or is it going to happen really quickly with a lot less? I think if there are some common utilities that speed people up and get their effectiveness up, uh, by making it easier to see what's going on with people, I think then, you know, we'll, we'll get to gratification quicker.

All right, so how do people get involved with the ZEUS community that you've talked about here? It's Z-U-S for those who are—

zEUS.health. Google it.

Perfect.

Uh, I think we've got zeushelp.com, we've got zeus.health. But zeus.health is— zeus.health is so cool.

I think it is.

Uh, I love that you can It turns out you can't change your Tesla account to a.health because they've already become old tech compared to everybody else. I guess they don't do the.health extension. Elon, if you're listening, please, buddy, come on, come along. But, uh, but, uh, you can, uh, you can Google it, whatever. The 17th, the site will be up, and, uh, we'll have our little minimum product there, just that that 360 and some basic tools for, uh, building an EHR. And, uh, not— excuse me, building a— building a patient relationship management app.

Patient management.

We'll add the EHR threads and payment threads, and all the other work streams will, you know, get online as fast as we can go. Hopefully all your listeners will call all their best engineer buddies and have them all, uh, join forces with us as quickly as possible.

All right. Are you building an EHR? What are you doing over there now? Now I gotta ask you. We're not.

We're giving you the utilities to build an EHR. So we want, we want people to build their own. Uh, this, this is a company for builders.

Okay.

This has no plans to be a, uh, to sell to doctors or hospitals or, or even to consumers. We, we want to be the, uh, the, uh, the inside. We won't be the toast inside these cool technology stuff.

I love it. It's a lesson learned from Athena. You're like, somebody else can do that part now. I'm just gonna do the cool stuff.

Jeff Bezos said of fourth grade, you know, I really liked fourth grade, but I don't think I want to go back.

No, nope.

And I really liked, you know, buying wine, you know.

Zeus cloud party. I'm gonna need a Zeus cloud party.

I still am in touch with, you know, dozens of the docs and hospital executives that I got to meet in my years at Athena and just loved it. But I'd love to coach and advise others doing that and instead really focus on the builders who are a really stimulating and exciting and just intellectually electric audience for me to work with. And I feel, not that I'm repeating myself and pitching it like Willy Loman in The Felices, you know, like I did for my later years at Athena, but that I'm really being challenged and thinking and learning as much as I'm pitching, more than I'm pitching even. Which for me is, you know, gets me back to work. That excites me a lot.

That's awesome. There's a lot of exciting business models out there for some of these health tech companies. So it'll be awesome to see how they can kind of skip some of the learning curve and the pain of having to do some of this other stuff and also who it might attract in that isn't currently in healthcare. Like you said, you've gone after those engineers, curious to see if there are any of those other companies out there that are currently in fintech or in like, you know, retail or anything like that who— the hard part was figuring out the, the middle part that was so healthcare. What happens if that goes away? That's pretty cool.

You make a good point. And you know, in healthcare we talk about big data, and big in healthcare is, you know, impossibly small to somebody who's been working at Google on search or Facebook or you know, even Pinterest. I mean, the scale of the petabytes that they have in live compute that they're, you know, searching through, uh, on a regular basis, and the number of identities and the softness of the match data that they have to get the right person matched with the right, uh, feed and engine, etc., is, you know, science at a level that people in healthcare just haven't even started to contemplate. And my hope is that with some good platform traction will get some of those people. Not that the world— not that it is very important to, you know, be able to Google cats carrying dogs up stairways on YouTube, uh, but I think we can find better work for these guys if we can find them a data environment that is at the scale that uses their skills. And that's one of my fondest hopes for Zooz.

I love that. We'll leave it there. So Jonathan, good luck. You'll have to come back and let us know how it's going. Jonathan Bush, everybody, the founder and CEO of Zeus D-U-S Health. Go find it at Zeus Health. And yeah, you'll have to for sure come back because I can't—

Oh, you know I'll be back.

Oh, I know you couldn't stay away.

I'll be outside the studio door every week until I get dragged away. I'm going to make you the weatherman.

I'm going to toss it to you mid-interview. And now from a weather report on how things are fairing—

I'll be there. Yes, absolutely.

Jonathan Bush. You know, when you talk to me about clouds. Thank you very much, sir. We will talk to you soon. If you want to check out more interviews with those who are changing the way we do healthcare, please head on over to my YouTube channel. That is youtube.com/WTFHealth. We'll talk to you guys soon. Jonathan, thanks again. We'll see ya.