RamaOnHealthcare July 7, 2021
In this Q&A, Jonathan Bush discusses how we stand at the precipice of a perfect storm of healthcare trends – transformative technology, global pandemic, unprecedented funding, novel reimbursement, and shifting consumer preferences – and how that empowers a new class of digital health superheroes.
Jonathan Bush, Zus Health CEO
RamaOnHealthcare Q&A
RamaOnHealthcare (ROH): Welcome, Jonathan, to our thought leadership series. Congratulations on launching Zus Health. Let me start with a direct question. What is your company’s mission, game plan, and how do you aim for success?
Jonathan Bush (JB): Thank you for having me here. Zus is a platform company that provides a set of tools that builders can use to build their own software across the healthcare ecosystem from virtual care, hospitals, labs, doctors, and payers, all backed by a shared data record. Zus will help builders and engineers underserved by tools on the market today to frictionlessly participate alongside the legacy healthcare ecosystem and create extraordinary patient experiences.
A huge growth area is the connection between technology and healthcare. Today, we’re sitting at the intersection of information sharing-friendly policies, like the 21st Century Cures Act, never before seen levels of investment from Private equity and Venture capital into digital-first healthcare companies, and, like you said, the pandemic, which has all come together to create a thriving young healthcare movement. We plan to support this new generation of healthcare companies to develop their offerings at considerably greater speed and less cost while enabling them to share appropriate health information to improve care.
ROH: We are now experiencing a historical Health IT revolution as well as Digital Health evolution empowering patients-consumers. The three major federal initiatives: a decade of ongoing value-based models, price transparency, and interoperability are in play now. Where do you see the potential that will ease the challenges ensuring benefits?
JB: The continuity of these efforts has been impressive through the different administrations, and I’m optimistic that they will continue going forward. Value-based care innovation programs have finally broken the shackles of servitude that startups have had to the legacy fee for service system and allowed them to go directly for capitation, optimize for episodic bundled payments, build true patient centric medical homes. Some of these programs aren’t successful, and some are. However, we’re finding that path to value and quality rather than pure volume. When you combine that with the power of price transparency to really give choices around paying in cash or through my insurance and add in patient owned portability of data through radical interoperability, it’s a potent combination that gives startups the fuel they need to build something entirely new. So we’re here to support those models and advocate for them.
Value-based care innovation programs have finally broken the shackles of servitude that startups have had to the legacy fee for service system and allowed them to go directly for capitation, optimize for episodic bundled payments, build true patient centric medical homes.
ROH: We are now seeing transformative changes occurring radically at a rapid speed driven by new players: Tech cos, Retailers, Startups. Please outline your strategic objectives on leading the change in the disruptive markets.
JB: Zus is here to help a class that overlaps with all three of the players you mention: builders. When tech companies, retailers or startups want to embed health atomically in their software and create best-in-class patient care experiences, they’re building. But today’s technology doesn’t help them in that pursuit. They come expecting modern easy-to-use APIs, not a mystery punchbowl of archaic legacy formats. They come expecting that the repeatable, indistinguishable parts of healthcare have been commoditized, not that they’ll have to reinvent the wheel. They come expecting to be able to radically innovate, not to redundantly reconstruct. So regardless of which type of new player, they’re frustrated. Our objective is to fix that problem and let builders build.
ROH: Healthcare costs the U.S. nearly $4 trillion annually. Research shows that Social determinants of health (SDOH) accounts for up to 80% of health outcomes. We have an opportunity to create a virtual value ecosystem. Such a fundamental shift from the historically fragmented, volume models will have major implications. Please outline your thoughts on how Zus Health can create a seamless, end-to-end digital, data system as healthcare transformation is all about enhancing patient/consumer experience.
JB: There’s this wealth of relevant information that’s untapped, of which SDOH is a major portion. So when we at Zus look to create a true patient 360, that’s not limited by the horizon of just health data, nor is it limited to just defined SDOH. We want to create a comprehensive, continuous, and constant portrait of all aspects of that patient, enabling providers to understand and think about care in ways we couldn’t have even imagined before. And beyond that, we want to back that unparalleled picture with true patient empowerment. That level of involvement can be scary, but allowing patients to understand and participate and navigate is absolutely vital to creating the end-to-end data system and entirely leveling up the patient experience.
There’s this wealth of relevant information that’s untapped, of which SDOH is a major portion.
ROH: The pandemic expedited the adoption of technologies. The utilization of digital health, wearables, telehealth, and remote patient monitoring is shifting gears from historic slowness to acceleration – that is perhaps 10 times faster now. Please explain how the process and information flow for day-to-day health management will work while ensuring positive outcomes.
JB: The pandemic’s tailwinds can not be overstated in terms of how it has led to this new class of builders. The technologies you mention are now ubiquitous and well-known even to the infrequent patient. The shift from reactive, encounter-based, snapshot mode healthcare that has dominated our industry isn’t just to an episodic series of patient narratives, but has leapfrogged to entirely continuous and proactive care. As patients engage clinicians earlier in their disease through virtual means, as warning signals can be discerned from the mass of data being produced, as digital therapeutics take hold as potent alternatives to traditional pharmaceuticals, the builders with Zus are at the cutting edge in terms of using these tools.
ROH: The current trend is shifting control from provider, payer, pharmacy benefits manager to employer, and consumer by creating retail, transparent models. How do you see the current business model evolving to integrate and align payment systems requiring a complex medical coding system and never-ending documentation?
JB: There’s this bloat, the unending series of middlemen and leeches that have seeped into crevices inherent to this fee for service system that fundamentally sits contrary to market forces. The shift of business models to value-based or transparent care doesn’t inherently get rid of the bloat – HEDIS and STARS and quality metrics are built on good data. But as we leap into this new era, we do get to make the choice to rebuild in a way that cuts off the cruft and just delivers care cheaper and breaks apart the Matryoshka doll setup. We can bake the natural language processing and wearables and AI and all the technologic advances of our time into the software to undergird and automate those metrics with all that new data we just talked about. Our builders are doing that and Zus geared to help them in that pursuit.
There’s this bloat, the unending series of middlemen and leeches that have seeped into crevices inherent to this fee for service system that fundamentally sits contrary to market forces.
ROH: There is now a movement toward home health delivery of care (a shift of care services from the traditional hospital acute and post-acute care services), that should empower the consumer requiring a new mindset. How could you accommodate non-traditional settings and integrate lifestyle and pro-active health risk management in the coming years?
JB: Consumers value convenience and that’s not limited to retail delivery or ghost kitchens or Uber. We’re seeing more convenient, lower friction experiences take hold in every industry. Virtual care is absolutely a piece of that puzzle that the pandemic accelerated, but home health complements that vision as we move the needle back to in-person. Legacy tools too often presume a brick and mortar facility, the standard fee for service appointment and encounter workflow, the convoluted claims processing. Breaking apart the core components of healthcare workflows is hard, but that’s why it’s so important for us at Zus. The assumptions of yesterday just don’t hold any longer, so giving builders the legos to create is fundamental.
ROH: We are now living in a “digital, data health” world that will make use of data science to improve health and caring for people, while at the same time encountering privacy and security issues. What’s the trade off in your mind? Please explain. How does your product address and improve health information security?
JB: Healthcare in the paper era was the ultimate fragmentation of the health record into siloes. Each practice or even department had their own slice. In the electronic era, with data being more liquid, exchangeable, and aggregatable, those slices are starting to come together into bigger fractions. That’s incredible from a technology point of view – you can start to really overhaul the way we care for patients and level up America’s healthcare. With that centralization, however, comes risk – each data leak exposes more and each organization has broader views into data they perhaps shouldn’t. So we as a country have continued to take a fragmented, interoperable approach for fear of that. Interoperability has always entailed handoffs and meant selective sharing between siloes. We can do better – we want to promote co-authorship at Zus. No provider should have to battle to see the full picture necessary for truly superlative care. More importantly, no patient should either. Patients should and will be co-authors in their care journey. It’s not an either or situation – privacy, security and completeness are all simultaneously improved when patients and providers are given the tools to frictionlessly collaborate. Messy handoffs, invisible data, and lack of participatory tooling just mean communication occurs redundantly out-of-band, over and over again. It’s time to stop the endless Groundhog Day that patients and providers continue to slog through. With patients actively involved in how and where their data is shared, we get the benefits of the electronic era alongside the privacy of the era before. So that’s what we’re building at Zus.
ROH: This is a suggestion; you are welcome to comment. The transformation we are now experiencing requires a learning system that would educate stakeholders, communities, and consumers on a daily basis. During the past five years, RamaOnHealthcare has become the continuously current educational resource of healthcare transformation and innovation for diverse healthcare professionals and health-related industries. We have the experience and expertise to collaboratively enhance the value and market of your product to benefit the industry and consumers.
JB: You know, to aggregate and create a patient 360 is pretty similar to the educational healthcare 360 you’ve built out here. I definitely see some interesting parallels between the missions of Zus and RamaOnHealthcare in that way. I’ve enjoyed being on with you today and I think myself and the team would be thrilled to chat again or collaborate in the future.
ROH: Where do you see the healthcare transformation market headed in the coming five to ten years and how Zus Health is positioned?
JB: For all the reasons and changes we’ve chatted about today – the rapid changes of regulatory landscape, the unprecedented funding, and the pandemic as a forcing function to drive change, it’s seeding some incredibly fertile ground. We believe the builder community is positioned to continue to build better and better experiences, to find new ways to deliver care at double the quality for half the cost, to scale nationally untethered from geography. These builders that are hyper focused on a particular disorder or foundationally attuned to a particular community’s needs are simply operating at another level. This is a seismic shift. At Zus we’re taking a bet, one that could be absolutely wrong, that we’re seeing and will continue to see the tide turn and we’ll hit this inflection point in 3-5 years where betting on builders is no longer a gamble – it’s common sense. And the old school will have unequivocal FOMO and the tools of today will look downright prehistoric. So Zus wants to be the agent of change for all of that transformative revolution and enable hundreds of these builders to thrive.