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, by Jonathan Bush Stephen Baker
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Product details
File Size: 1677 KB
Print Length: 238 pages
Page Numbers Source ISBN: 1591846773
Publisher: Portfolio; 1 edition (May 15, 2014)
Publication Date: May 15, 2014
Sold by: Penguin Group (USA) LLC
Language: English
ASIN: B00G3L6LXU
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Amazon Best Sellers Rank:
#402,577 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
This is a useful book to understanding how to improve the healthcare system. Clayton Christensen who wrote the Forward labeled it a ‘bottom up’ view as opposed to the ‘top down’ view from the “The Innovator’s Prescriptionâ€. This feels accurate.The book is an easy read, a narrative in 4 parts written in colloquial language with personal anecdotes. Below are the principal ideas. Apologies for license in choice of words, omissions, or misinterpretations.I Observations from the front- general waste from underutilized high capital equipment (e.g. hospitals) vs specialist businesses that can employ continuous use for diagnosis or treatment (e.g. MRI in hospital vs MRI shop)- high capital based treatment options vs low capital options (not obvious high capital solutions necessarily produce better end results)- lack of market competition for procedures with patients sharing in any savings- no/limited treatment and insurance availability across state lines (e.g. analysis by expert radiologists or dermatologists via Internet … must travel to another state for expert services)- care organizations ownership can dictate type of treatment (e.g. home vs care facility for dialysis in doctor owned businesses)- system preserves profits for incumbents as opposed to allowing for alternatives (e.g. payment for blood dialysis and administration of EPO, an Amgen drug continued courtesy of big lobbying)- medical infomatics payment scheme broken … payment for doing it but without meaningful metrics to drive efficiencyII Disruption- inefficient “big†(academic) hospital hierarchy food chain … supporting community hospitals and clinics … clearly a role for “big†hospitals but role is solving complex cases, doing things others cannot do (not everything) * disruption by 1 stop shops (e.g. CT scans) or storefront businesses for high cap svcs (e.g. MRI) * disruption by 3d parties, WMT, WAG … to handle 70% of ER traffic * hospitals focused on ‘survival’ growth model by absorbing smaller players- better use of resources by coordination of primary care instead of pouring $$$ into hospitals, doctors providing chronic care and acting as coaches to patients for holistic careIII Technology- universal, accessible data … real time, fast- choices for technology based solutions should be made relative to the conditions of the patient rather than doing all possible always (e.g. recommended hysterectomy for 90 year old grandmother because of cancer)IV Conclusions, recommendations for …Government - encourage (enable) competition and innovation1) include entrepreneurs in the conversation2) trim ‘kickback’ laws that prevent patients from receiving rewards3) provide healthcare workers right to work and patients right to shop (across state lines, without licensing or purchasing barriers)4) expand Medicare Advantage5) provide Fannie Mae type financing for health insurance disruptor startups6) limit energy on tort reform (universal healthcare records will provide clarity and eliminate most suits)Doctors1) take risks - provide total care, packaged services2) organize instead of selling out and seeking refuge at inefficient, failed business model hospitals3) get connected on Internet ecosystemEntrepreneurs1) provide technology enabled services, not technology2) supply the ‘connective tissue’ to tie together healthcare elements3) think simple (to start)4) team up, band together to have a ‘voice’Patients1) learn about care2) know yourself3) demand/request your own dataAll sound right. However, it is hard to see solutions becoming a reality in a politically polarized world. The right wishes for a return to the dysfunctional system of the past. The left staunchly defends the dysfunctional system configured by the Affordable Healthcare Act that preserves everyone’s place at the trough and enriches the insurance companies. The right pines for an unfettered free market (albeit did not exist); the left wishes for social justice, healthcare as a “rightâ€, and systems caring for all needs for everyone … medical, dental, psychiatric (not possible without reforms). Constructive change appears impossible given an electoral system with legislators who are eager and willing pawns of special interests with. "Special interests†are more than health care companies and big pharma. They include healthcare worker unions, professional associations, patient/worker unions, tort lawyers, pension plans and a host of others donating as much or more as corporations. In the background the populace is clamoring for low cost or “free†coverage for everything, wanting to be on par with the most privileged. As Europe has learned (France) - even while not providing the most advanced services - this is not affordable and not sustainable.
Having worked for Athenahealth in the past, I've spent a lot of time with Jonathan. He's an engaging speaker, tremendously energetic, and really is a health-care visionary -- if not the visionary of our time. That may seem like hyperbole, but if you read the book I can tell you it encapsulates about as much of Jonathan as you can without meeting him. He communicates his thoughts well through his storytelling and analytical thought process -- and all with the spice that only Jonathan could add using his hilarious metaphors and analogies.Obviously there is a lot of opinion in this book, but if you have any experience in health care you will recognize some of the truths of the business and potentially see them in a new light....and maybe even see the same light at the end of the tunnel that Jonathan does.Its a fast read and an entertaining one -- and I heavily recommend it to both people in the industry as well as those not. Its the kind of book that will appeal to entrepreneurs, the business minded, and the health care minded alike. Jonathan is a visionary whether you agree with his viewpoints or not -- and its an amazing view into the birth...and the soul... of Athenahealth if you happen to be involved as an employee or a client.
Ryan Vavra's review was made as part of a critical review assignment for the Spring 2016 Economics of Technology seminar at the University of Nebraska Omaha, taught by Art Diamond. (The course syllabus stated that part of the critical review assignment consisted of the making of a video recording of the review, and the posting of the review to Amazon. Diamond reserved the right to modify the number of stars the student assigned to the book, in cases where Diamond had himself read the book.)
I had to read this book for a college class, and it is terrible. This is basically a story about Jonathan Bush's extremely privileged life, how his cousin and uncle were President, and how he thinks Democrats have ruined or tried to ruin healthcare, while his uncle and cousin did amazing things in the White House. He has no experience in healthcare, and is advocating for policies that would maximize profit for CEOs. If that is the perspective you are looking for, then buy this book.
I'm a physician and a programmer who has 25 years experience building EHR software. I read it to see what Jonathan Bush's vision of health care and to gauge his role in developing Athena. This book is a common sense discussion of how health care has responded in a dysfunctional way to a dysfunctional environment. It is about the 8th book on the subject that I've read and have found nothing in this book very unique other than being the story of Bush's company's development and rise in the market and it is worth reading for this alone. The style is light and readable and the anecdotes interesting and have a good human quality. He wants Athena to be part of the solution and not part of the problem.
Worth reading to understand why the healthcare system operates as it does. Identifies some areas ripe for more reform and other improvements. Great insights into how to let Mr. Market offload expensive but unsophisticated work from hospitals to perfectly-adequate lower-cost places, like CVS is doing with shots, screening, and tests at Minute Clinics. Great tips on areas where other entrepreneurs could make a positive difference on patient safety, cost, and quality of care. Uncommon sense by Jonathan Bush, with humor and irony that makes it a fun and inspirational read.
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