Health Care's 'Radical Improver'

'It's a little bit like talking to a young prince," says Jonathan Bush, chairman and CEO of Athenahealth, a major player in information technology services for physicians, of his recent visits to Capitol Hill. "'So—tell me about this market thing that your people use,'" he says, mimicking the political royalty with a grin and extending his forearm. "'Wait: I must catch my falcon!'"

Athenahealth's headquarters, on the banks of the Charles River outside Boston, is a world away from D.C., and it's clear, as he continues his metaphor, that Mr. Bush enjoys the distance: "And these princes, they mean well and they're lovely," he says, "but they're living in this alternate universe where there's no such thing as a market in health care and they don't understand why one might be remotely useful."

He pauses. "That's weird to me."

Mr. Bush is an outlier in the generally buttoned-down world of the health industry. He's exuberant, hyperactive, speaking in frenetic running monologues; it's not hard to see why the political class might be taken aback: "I still have to keep going to Washington and sucking up," he says, switching metaphors. "Because the problem is when you have a baby with an Uzi, right, they might accidentally mow you down. But here's the thing . . . they're brilliant people. It's just that the idea of a market in health care never occurred to them."

As Mr. Bush sees it, the profound problem with U.S. health care is that there's "no landscape of choices, or choosers." Due to the complexity of America's third-party laundromat for health dollars—your doctor's clerical staff bills your treatment to an insurance company picked by your employer, and it pays him with your money via premiums or foregone wages—"few doctors in America know the actual value of the services they render."

Athena's core business helps them manage their practices and get paid, but the larger purpose of the company, which he and board member Todd Park co-founded in 1997, is to try to shore up health care's resemblance to a normal market. It has grown into one of the country's most innovative health IT firms.

Athena began as a San Diego birthing clinic and floundered because it couldn't cope with back-office volatility. All transactions were conducted on paper. No one understood how to navigate the dense and bewildering coding rules for dozens of different insurers or the fee schedules for government payers like Medicaid. Claims were denied with no explanation or vaporized in purgatory. The clinic went bankrupt in 18 months.

With Mr. Park (who has joined the Obama administration), Athena designed a program to digitize records and automate billing. It now colonizes the wilderness of paperwork and habitual financial chaos that defines running a doctors office, and it is also moving into clinical record-keeping for individual patients. Some 15,000 physicians in 43 states use Athena as a virtual office, a number that is growing at an annual 30% clip.

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