Cardinal Partners’ Brandon Hull was an early investor in athenahealth, now a leader in integrating IT into health care. Hull interviews the company’s founding CEO Jonathan Bush to find out what athenahealth and other IT companies are doing right – and wrong – in their bid to make health care more efficient.
Introduction and Facilitator:
Brandon Hull, Managing Partner – Cardinal Partners
Jonathan Bush, CEO, President & Chairman of the Board of Directors – athenahealth
Brandon Hull is Co-Founder and Managing Partner of Cardinal Partners, a medical and life sciences venture capital partnership established in 1996.
CEO and President of athenahealth, Inc. He co-founded the company in 1997 and took it public in 2007.
Brandon Hull: I was privileged enough to be involved with the founding of the conference five years ago, and it’s gratifying to see a full room and a great program. At that first Digital Health Innovation Summit five years ago, we featured panelists who were selected from other industries, transportation, manufacturing, logistics, consumer services, and listen to their experiences and sort of a narrative of how other American industries automated, and saw the steady march of productivity gains that those industries enjoyed from their investment in automation technology. And we asked ourselves the question, What about healthcare? When are these productivity gains going to show up here? So here we are five years later. We’ve had the High Tech Act and the Affordable Care Act, countless demands imposed on caregivers with respect to disaster recovery, security, interoperability. Susan Dentzer said it was a $30 billion spend, and then Terry Edwards raised the bidding to 35 billion. I don’t know what the number is, but it’s a hell of a lot of money. We’ve achieved the goal of converting every American doctor into either – is either on an EHR or planning to be on an EHR. But their dissatisfaction and unhappiness is almost a meme, right, in – when you look at their reactions. At the same time, there’s no figure in the American healthcare system, in my view, and this has informed my investment philosophy from day one, there’s no figure more central to the delivery of care than the doctor as an individual, right? The doctor bills 11 or 12% of the national healthcare spend, but they refer 85% of it. So you control that doctors spend and their behaviors and their decisions and their work flows, and you control the healthcare economy. Unless you lapsed into a coma after the Robertson Stevens Healthcare Conference at the Pierre Hotel in 1995, Jonathan Bush needs probably no fulsome introduction. But as his first institutional term sheet investor and longest serving director, I’ve had the privilege to have a ringside seat at the company’s evolution. And I thought I would just tag up on a few fun facts about Athena that don’t necessarily get filtered through the press. October 2015, the first month we hit a $1 billion annualized run rate. Right?
Jonathan Bush: That’s success.
BH: Right? That’s something. $5 billion market cap. The market liked your earnings call last Friday. Interestingly, Jonathan, well known as a cheerleader for major themes in the automation of American healthcare as an exuberant zealot for improving caregiving in America through automation, obviously a pioneer in cloud-based services as applied to healthcare, people give I think or don’t notice, given that sort of high profile of that enthusiasm, the fundamental elements of success that he contributed to Athena’s growth. But one interesting metric that always blows my mind: Athena will have hired in 2015 a thousand new people in five locations around the company to across the world. So operationally, it’s a company that has really excelled. Sixty-nine million patient records in the –
BH: Seventy-three. Fun fact, National Health Service in the UK, 64 million. So there’s that.
JB: Five and a half Kaisers.
BH: Five and a half Kaisers. That’s a good one. So Jon has become the personification of the drive to create a cloud-based, interoptive internet for healthcare. We’re going to chat this morning about the current state of play in automating the doc’s workflow. But first, to see how it’s going, we’re going to watch a video and then comment.
VIDEO: Yeah, I’m out that paper. No more chasing med records, writing so illegible, I’ll be HIPAA forever, bought the new software, and though we use it here, I can’t use it over there. Different systems everywhere. I used to chart on paper. All of my verbals recorded mixed up with the ward clerk. From diluted to Dilaudid, switch me to the EMR. Meaningless abuse “G” now catch me at the nurse’s station, mashin’ that f2 key, notes used to be a story, narrative but yo replace with copy paste, now a bloated ransom note. Me, I’m at the bedside, focused like a laser beam on the patient. Now come on, I’m treating the computer screen. Eight dozen warnings, click check boxes, alarm fatigue, Vaseline conflicts with Doxy, nurses they be burned out. We could use some OT, tell by your wrist guards that we most definitely on EHR, crappy software some vendor made us there’s nothing you can do, stuck with EHR, best practice popups will tire you, complain and they’ll fire you. We need a new chart, new chart, new chart. We need a new job, new job, new job. Catch me on the phone with IT, begging tech support, shooters like a TME be stuck in 1994. Innovation all around, but it ain’t in healthcare. Internet and apps for you but we get ancient software. Welcome to the EHR, go live and it don’t stop, Uncle Sam promoted it but gone is the intraop. CMS, EMS, PMS, holla back, for doctors it ain’t fair. These vendors act like they all kinda whack. Eight million stories. Out there, docs can’t take it. After this disaster happened, y’all won’t make it. How to train your dragon, Hotmail isn’t hot, mail if somebody’s saying it’s epic, we’re saying it’s epic fail. Electronic silo, teams not talking, paperless they say, but whole trees we dropping. Props to case management, long live the RT, long live the promises, whole team definitely hates EHR just a glorified billing platform with some patient’s stuff tacked on give us a new chart. This chart whack. ICD-10s are a disaster. Meet your new master. We need a new job, new job. Welcome to the apocalypse, Doc. Tech shouldn’t find us, connect us, not find us to the reason why we care. Patient’s face reminds us, designs like Epocrates that tap the app agiley and magically the team works. Let’s bite the apple, Steve, caught up in the inbox, now you’re insane, good docs gone mad, the clinic’s filled with them. Nurse in, they heart of everything. Data entry got them hurt. Life starts when the shift ends. Ten years of school, graduated to the OR, mommy busts a whipple she deserved a better damn chart. Autocorrect turning Chantix into Champion, patient needs a sleeper, 30 clicks for an Ambien. EHR, crappy software some vendor made us, there’s something you can do. Give us a new chart. Stand up and make our voices heard let doctors be doctors. We need a new job, new job, new job. Yo, it’s ZDoggMD. As healthcare professionals and as doctors, we know we need better technology to support what we do every day. So go to www.letdoctorsbedoctors.com and have your voice be heard. Big ups to Athena Health for being the only EHR vendor brave enough to admit that EHRs suck. Subscribe below, check out our other videos, and we out.
BH: So there’s that. We obviously cut it short for the interests of – it goes on like that. So I invite you to go take a look. So we get the point. The doctors hate EMRs. It makes them less productive, and as we just saw, grouchy. But the last time I looked, Athena Health is a company that sells, EHRs. So help me reconcile your support of the Let Doctors Be Doctors campaign and ZDogg in particular.
JB: That’s why I went to liberal arts schools, so I could use words like duality. Yeah. So I think what we have is not what we want as a society. We were so desperate for it that we called in our Uncle Samuel to make us all do it, and Uncle Samuel is a kindly fellow who means well, but occasionally acts like a baby with an Uzi, you know, genuine feelings. But the reaction of minor movements, the consequences of minor movements, not in keeping with what the baby wanted. And certainly making everybody rush to an EHR at the time when the EHR was a noun; it still is largely a noun. People buy systems that really only talk to themselves or with great effort, you know, you can pull in an extension cord and connect. The feature functionality set mandated from on high: this is what is literally in Washington – I guess this is an in crowd, so you know that there’s a committee for the certification of HID and you had to go to the committee and show them, and they would say yes it is or it isn’t an EHR. And everybody got to throw their ideas, and so you had this sort of bad Mr. Potato Head as the only legal, acceptable EHR. So the business model didn’t catch up. So I think in everything in life, the first thing you have to do if you really want to live fully is stare vividly and unflinchingly for a very long time at the awkward reality of your current situation. And then you get to look, you know, off to your right and see a beautiful world that you wish you were in, and then your full life is about managing the tension, you know, moving between. And I think both internally and externally, it has to be acknowledged what’s wrong with what we have so that we can all engage creatively in the next act. I’m not sorry for Obama, I’m not sorry – I mean I’m not mad at him anymore. I’m not – it’s OK why we’re here, it’s OK that we’re here. But let’s really acknowledge it unflinchingly, and then in every ugly detail, and then we can get to work. It’s kind of fun to start chipping it away. Because we look at everywhere else in our life, and we’re on a network, right? It’s not a new idea that the network is the computer. I think it was like the third employee of Sun Computer Systems in 1984 who sort of first publicized at a conference – these are called conferences – that concept. And yet, you know, we’re sort of Stars Wars I here in healthcare, where we’re just rolling out, you know, the fully featured enterprise software systems. So anyway, it’s OK, the market doesn’t work as well in healthcare for lots of well-meaning reasons. But what we want is the network, right? What we want is to be able to kind of just as we stumble drunk to a cash machine in Prague and the cash machine figures it out and gives us our shekels and the exchange – oh, three dollars! – which is a freaking miracle that it was only three dollars for you to get that, we want that for healthcare actually as much as we do for cash and other things.
BH: Wait, let me stop you and put –
JB: Please. Otherwise it could go on –
BH: – And put a pin in –
JB: Oh, Jonah gave me 17 gallons of coffee. So if you don’t stop me –
BH: Put a pin in the network because that’s like the third question. The title of this conference is Digital Health.
BH: You have in the past used the Fields painting. Can we have the Fields painting up? As an illustration –
JB: The doctor, yeah.
BH: – yeah, the doctor. As an illustration of this relationship of letting a doctor be doctor. And this is a decidedly analog vision of the world. Before we diverge into the network concept, could you riff a little bit more on what – on that holy grail? How can you reconcile ZDogg with that guy?
JB: Right. So this guy to me is on the edge of his humanity. He is at the edge of his intellectual, emotional energy and is truly present there. He’s not thinking about what – is this a level 5 or level 4? If I spend 3 more minutes like this, will I get – you know, you can see big pharma over on the left. There it’s been tried, the bloodletting, you know, has already been tried, hasn’t worked. So the guy has you know, the wicking away of the things that we already know how to do has been done. And this moment, both the parents and the doctor are at the edge of the human experience. And what I believe that digital health represents, and I think of Athena as sort of an early out of gate digital health company, not a – I mean an old, out of date digital health company, not a new age, modern EMR company, looking forward to be obsolete and sort of sinking into the muck as a result of the people in this room. But that idea is – the wicking away of the things that don’t require this level of presence is the job of the cloud. It is the job of the technology. Anything that can be automated, could be routinized, can be figured out in an analog form must be done, must be done so that what’s left for the doctor must be – and it’s hard because I work for doctors I want them to make more money every year. But I refuse – I want to steal the dumbass work from them. Even though we all get paid for it, it’s slowly life sapping for them. It turns them into, in an almost imperceptible way, against society, against their social mission. Hospitals have this problem. They kind of want to make that outpatient surgery an inpatient surgery. So the idea is to get it done, get it done with the people who are ready to get it done first, and then we will actually return this moment. We will actually be the source of this moment for patients and families and doctors, not the thing in the way of this moment, which is our current role, I think.
JB: So it makes perfect sense.
BH: Yeah. You know, it’s interesting in the Let Doctors Be Doctors theme to me, you could have said the same about the automation of all these other American industries. You know, the FedEx guy’s goal in life is to deliver the package. It’s not searching for addresses; it’s not sorting which package goes where.
JB: That’s right.
BH: And one of the ironies of where we are at in digital health is the extent, I mean is our failure against that test of is this really resulting in better outcomes. So when they – I know that sounds like mother and apple pie, and we’ve been talking about it all morning. But just to tag up on those first principles, this is the early days.
BH: So on to progress now against that goal. You mentioned the network earlier. Athena’s goal is to create a vision statement, is create a healthcare backbone that lets healthcare operate as it should.
BH: What does that mean?
JB: We want the healthcare internet, right? So Bezos goes out and he gets a chunk of the Internet, and he makes it safe enough, reliable enough, connected enough to the offline world, right, so that the mainstream of us is happy to get some of our basic stuff done there instead of going off downtown, spending a half a day to get another pillow or whatever for – I don’t know what people get on Amazon. Whatever that is. We’re trying to do the same thing. We’re trying to get a chunk of the Internet, make it safe enough, reliable enough, connected enough to the outlying, offline world. We receive 12 million faxes a week from the IT systems of our neighbors. Thank you guys. You’re probably not here. But and we use 30,000 pounds of paper EOBs. All these things slowly wicking them away so that there is a baseline, so that there is an access point for the people in this room, fundamentally, right? Not just the digital inventors, but the doctors who want to extend their scope of service beyond sort of banging it out in the exam room each day, to really concentrate their knowledge against problem, which is what we’re talking about, what the opportunity is. Healthcare with a healthcare internet can pivot in a fundamental way, and be about problems, not geographies. Today, healthcare is fundamentally about geographies. People say healthcare is local, right? Well, it doesn’t have to be. All of radiology is digital, and yet there are those radiologists walking down the linoleum hallways of the hospital. Why are they there? I don’t know. It’s ridiculous. Seventy-five percent of dermatology should be digital, would be better digital. Eighty percent of cardiology. So the opportunity – cancer, you can’t get enough people with a type 3 breast cancer in one place to have a decent study of the problem as a physician. Right. If you want to be a type 3 breast cancer sub-subspecialist, you need a catchment area of something like 500 square miles to see enough of these things. So the opportunity, I think, because we just do the shit work, get the – it’s the billing, it’s the referrals, it’s the dances. You know, Yes, Obama, I checked the race and ethnicity of all my people, using the 13 census mandated categories. And yeah, yeah, yeah. But then what’s left is a baseline to come in and clip on what the people in this room, hopefully, please, are working on.
BH: Yeah. I sometimes worry that that 30 or 35 billion, whatever the number is that we’ve spent, is mostly on compliance.
JB: Who cares? I mean what did Kane say? If you pay 100 guys to dig a hole and a hundred other guys to fill it back in, at least you’re getting the ball rolling, right?
BH: Right, right.
JB: It really was a stimulus. I mean the pointlessness of it was perfectly Keynesian. It didn’t have to do anything useful. The fact that, for example, the government has never once received a single piece of meaningful use data. They don’t have the systems to receive the data. So we go to the website and we have to go – literally there’s a team of like a million people who go to the website, doctor by doctor by doctor, and each as the proxy of that doctor paddle through this attestation thing, and at the end say, you know, if you ask me for the data, I have to give it to you, otherwise, I’ll go to jail. Click. It’s like remember the federal bill where the farmers, the milk farmers, the federal guy would come the checkbook, cut a check and then pump his milk into the ditch? I think we still do that.
BH: Oh, yeah, with beans and stuff.
JB: So this is just like that to me. And it’s fine. It’s the clumsy – if we did such a bad job as venture capitalists, no offense, and Wall Street to let the industry suck so bad that the government had to come in and do a big, fat, dumb, sloppy thing to get it going, oh, well, shame on us.
BH: OK. We know where you stand now. I was going to ask you about meaningful use, good or – never mind, that’s for the after –
JB: IT’s meaningful but not for its use.
BH: So back to the backbone idea. There are other healthcare IT companies not represented here, as far as I know, who instead of being the backbone, also want to be the neck bone, the thighbone, the leg bone.
JB: Yes, right.
BH: Pretty much the –
JB: There are many at Athena who want Athena to be every bone.
BH: Talk about the more disruption program and how that works, and especially how it connects to what I think is one of the most powerful themes of this generation, which is just sort of a network effect.
JB: Yeah. Right. So healthcare, you know, Joy’s law, the smartest people in the room or the smartest people on a problem will never work for you, not even most of them, because there’s just too many smart people becoming smart in too many places all the time. And so how does your business accommodate for all the smart people, or as many of the smart people in the world that are smarter than you that aren’t going to work for you, that don’t work for you? This is particularly important in healthcare where we think of healthcare, we actually talk about it with a straight face as a $2 trillion, 1 trillion, whatever our latest number of trillions – when someone figures out what a trillion is, let me know. It’s a meaningless word to me. But it’s not. It’s thousands and thousands and thousands of kind of couple billion dollar markets, all masquerading as one thing, right? And there are some things in common, you know, patient demographics or whatever. But my thought with MDP, more disruption please, is that there is – what we really need is thousands of companies with no cost of sale, no cost of implementation, that are very results-oriented. Maybe they actually almost morph between a vendor and a provider, they kind of come together, that focus on these thousands of industries, that you could actually make a 10X return because you don’t have to put very much in, and the cost of sale and implementation is so low because there’s this backbone to plug into an app store if you will, that you can start vertical, so you can start, you know, radiologists can all Uber their images around so that if I’m a breast guy, I can read lots of breast – many more breasts than any one mammogram machine could give me, or any one hospital’s mammogram department could give me in a day, really, really well. Today it’s a breast, a bone, a brain, just to fill my day. That idea is only possible when you get that geography baseline up. Then you need lots of entrepreneurs to try all the different vertical slices. Right now it’s all about chronic disease, getting out the 8% of people who are the obvious play, the drinkers, smokers, eater sugar people. The Americans. But there are going to be many, many more once we perfect the art of, you know rapid deployment, sort of wartime deployment of companies in this space. I think.
BH: I love that model. You missed the session earlier this morning, but Susan Dentzer from Robert Wood Johnson said that interoperability is not a thing, it’s an ecosystem. Which I thought you would have loved.
BH: And what I love about that ecosystem metaphor is that there’s no central planning there, right? There’s no master blueprint. Ecosystem to me sort of implies an environment where things grow organically, they live to sort of test against the survival of the fittest idea. And I think that’s what you’re trying to create.
JB: Yes, that’s right. We could never –
BH: Let a thousand flowers bloom.
JB: – we don’t know enough about cancer. We don’t know as much as Flatiron about cancer. We don’t know as much about radiology as whatever they’re called, that I’m on the board of that I can’t remember the name at the moment.
BH: Radisphere it was.
JB: Candescent. There are people that are doing this. And maybe we buy them, maybe we’re their exit. Or maybe they morph into providers or away from being providers. We want all these things to try at a low cost of entry to find the things that are going to pop.
BH: Moving to sort of a more set of specific application of Athena technology and postures to some of the discussions of this morning, value based care. And the pivot from fee for service. And someone gratifyingly said this morning, David from Cerner acknowledged, Hey, fee for service isn’t going away anytime soon. That’s good news for a company which is fundamentally a revenue cycle company, right? But nevertheless, we are going to move into this world of bundled payments and fee for value. Describe how that, first from a practical matter, strategically Athena adapts to that world. But then secondly, good, bad, what does that look like? How does it evolve?
JB: Well, I think at a really, really fundamental level, innovation happens best, entrepreneurship happens best when there are many buyers and many sellers, and freedom to move. Right? When you’re having to deal with 12 remaining payers, or whatever the lumber of payers left that are just have such market –
JB: Yeah. Whether you throw in some Blue plans – I don’t know. But you know, it’s like dealing with someone in the organ donation suite. There’s no one really there. I mean they’re technically alive, but there’s no one to work with. And even if you could get a deal –
BH: Is that the donor or the receiver in that metaphor? I just –
JB: Just – you meet a great person somewhere buried in the bowels of Aetna’s business development incubator blah, blah, blah, and you think, Oh, we got a meeting, Oh, we got another meeting. Ooh, we got a memorandum of understanding. You’re not going to get anywhere. They can’t do anything with you. But yet a lot of the ideas, business models require demonstrating a savings and getting a piece of the demonstrated savings. So what I like about the movement of risk or global budgets is you’ll end up with more buyers. You’ll end up with some kook health system in Massachusetts that’s trying to take on the big academics because they have lower rates, let’s say, and so they’re always looking for the thing that’ll deflect the hospitalization or that will find and follow the overweight trucker. So you have suddenly a new buyer that’s small, and if you have that multiplied by all the health systems in the country or all of the Privias, these kind of risk focused kind of practice entities, Alidades, you suddenly have many buyers to try your technology on. You find the crazy ones, to quote the Apple ad. They turn out to be right, and you get to pop. If you’re waiting for the Supreme Court of risk to take your case and have a reading and make a decision, you’re dead. So that’s what I like the most about risk. And then of course, the fact that you can make money keeping people well is appealing. Most of the things that we’re doing don’t really actually totally need – there’s plenty of kind of training bra business plans that’ll work in a fee for service environment, and then will carry over. You think about even in fee for service, if you’re a hospital, you really want to be full, but you want to be full with the sick people because someday when risk comes, you’re not going to want all these people that belong in a 23-hour facility filling your building, because that’ll be a black swan, and you’re dead. So things that migrate a hospital to a high, rich mixture of sickness in their beds actually help hospitals in a pre-risk world. And there are lots of other examples of that, where getting ahold of a population, doing your mammograms is profitable because mammograms are profitable. I mean in a fee for service world. So getting those early business plans right, they can work and prosper in that sort of tweener period, I think. And then hopefully it migrates, and we actually get new entrants, new people with new capital who come in and take a new look at what it is to take care of people. And that’s what the people in this room, I think, represent.
BH: Yeah. The transition to fee for value represents actually just more complexity for the caregivers and that’s –
JB: But remember Ray Kurzweil. All this requires more – you know, the government’s created all these crazy requirements. We got them now. We can do them. It’s like silt at the bottom of the pond. It’s still a deep pond. You know. We do this. We take on ridiculous absurdity, but then we bake it in. Think about how much reporting the airlines do when you swipe and grab a ticket on the shuttle. Oh, this is on the security hotlist and this person’s lalalalala off into the reporting ether. You don’t know about it because they figured out how to deal. We get better at stuff at a faster pace. In fact, we can sort of commoditize stuff and still have room to increase our appetites with the way we deal with technology as species, as a society. So it’s OK. It’s a bummer, it’s a waste. You can see that. You can fixate on all the bureaucratic drag. But there’s plenty of room – that stuff will be automated out, and there’ll be plenty of room, I think, sitting on top for real innovation.
BH: Relate that. You mentioned hospitals. And a big news item in 2015 for Athena Health was the acquisition of RazorInsights and the WebOMR acqusition.
BH: And Athena’s very public foray into the inpatient setting.
BH: How does that relate to Let Doctors Be Doctors and to the challenges of value based –
JB: Well, I’ll tell you. For this room, I’ll call it for the first time a challenge. I’m throwing down my glove. Like why weren’t you there? Why is there no cloud based hospital solution? Why is it us going, a bunch of dorks focused on the doctor, trying to create a hospital, a cloud based hospital? I think one of the great entrepreneurial – I mean it’s easy for us, right, we get the referral, we get the guy who’s shooting the ball into the pinball machine so it’s easy for us to follow the patient and get all the bumpers, right? So the hospital is a bumper, the imaging centers a bumper, the lab’s a bumper, the pharmacy’s – and we’re gonna get them all onto the healthcare internet. We don’t actually need to serve them all. We’d be more than happy to marry up to networks of labs, marry up to networks of radiologists, pharmacies, or pharmacy backbones or radiology backbones or operating room backbones. Think about how much better rheumatology would be if all of the rheumatologists were on the XG, you know, rheumatology app, and they knew exactly every other rheumatologist’s definition of the same kind of swelling in real time in the exam room. That idea, we will build a store brand for everything that doesn’t have a credible cloud solution. But we don’t want to. So there it is, dudes, go and do the work. And we’ll prop you up. We’ll sell you on the first meeting because we need that. We can’t do – you gotta have – there’s an agency, notwithstanding, you know, companies that are able to sell to everyone. I mean there’s an agency element to these kinds of business plans because there’s so much iteration. You’re free to change the app every day if you want. We write new code into Athenanet every night nowadays. So you really want to have as your overarching sort of true north an alignment, a selfish, you know, I win when you win alignment with some species in the pond. So if we’re trying to be something to everybody, we’re not going to do as good a job as somebody who’s only job is one particular species. Right. If all my job is to crush the rest of the world and lay a path for radiologists or dermatologists or cardiologists, I’m going to be a better – my ideas are going to be better, my courage is going to be higher, my closeness to the problem is going to be better than somebody who’s trying to be everything to everyone, which is what we’re finding ourselves having to be. And I’m not that into it. I mean it’s great; it’s like free market share, but you know what I mean?
BH: I do.
JB: It’s the dead silence. It’s a little –
BH: no, I’m just –
JB: I talk too much –
BH: I’m absorbing and formulating.
JB: – and I don’t say enough, I say too much, I don’t know.
BH: Do we have a mechanism for questions or should I –
JB: No could based hospital –
JB: There’s somebody who had a cloud based hospital went by Cupid. That’s not a cloud based hospital, Cupid. Come on. It’s reported –
BH: I have a final question. So we’re sitting here 3 years from now for the eighth annual Digital Innovation Summit. And the Let Doctors Be Doctors campaign has, beyond all expectations, succeeded beyond all hopes and dreams. What does that actually look like? What is – ZDogg sort of retires from making videos and just treat patients because he’s so incredibly fulfilled. What – is that really a reality, and what would it look like?
JB: I think we migrate to a world of brokers and specialists. So you have primary care doctors that sort of become almost a Merrill Lynch FA. You know, they know all the best fund of funds. You know, this dermatologist is the best guy for that kind of psoriasis. He’s in, you know, Austin, but his data center queues him up, and I can get you in for a digital screen. I’ve got all the equipment here in my primary care office or in Walgreen’s for that matter. That you have a whole set of brokers, personalized physician can be broker. Private practice can be broker. And then there’ll be all kinds of almost like Revolution Health. Remember Revolution Health –
JB: – which didn’t make it, but you could imagine them being kind of virtualized primary care broker. So there’s all these guys that are brokers, from the retail clinics up through a private practice, and different strokes for different folks in that space. Maybe there’s some pay out of pockets to levelize. And then the specialists become real specialists. And they can detail not in their neighborhood through golf outings and med school affiliations, but through real detailing. They almost take on the same challenge as pharma, queuing, driving the kind of stuff that they can crush really well at a great value. So and they get problem – and medicine becomes the real delivery of the problem fix medicine becomes super specialized and super regionalized, maybe even nationalized.
JB: And then the brokerage, the explaining to people what – you know, that’s a cancer, this is what we do about it, you know, these are the best places in the country for that particular flavor, you know. And I either in my platform, you know the Merrill, the bankers, the private wealth people all try to get you to buy from the platform, so you could imagine platform primary care docs that have a preferred platform, and then specialized guys. That’s kind of the world that I’m seeing is that rationalization of what used to be a stock broker going out with a ticket, giving you an idea into these funds, and then funds of funds in healthcare.
BH: I’ve always viewed Athena from day one as a market place where the incentives in the healthcare economy are translated to the doctor to influence their behaviors. And I still think that’s a great metaphor for what it is and what you’ve accomplished. Well, thank you very much. We are at risk of ending exactly on time. So with that, I will thank you –
JB: Great success.
BH: – and congratulations on the billion dollar run rate, and all you’re doing.
JB: Thank you, sir. Thank you, guys.