SM: Jonathan, let’s start with your background and your personal story.
JB: I grew up in New York City. Medicine was the only career that nobody had done yet in my family, so I figured that would be a good career for me. I could be the best in my family in my profession and I would not have to be all that bright to do so! I have always been interested in health care because it seems to be a place where you can do well and do good. When I got to college, it occurred to me that you had to know a lot of science to be able to go to medical school, and I was not that good at it. It was just not my natural fit. I am more of a social creature and an idea person.
In an effort to learn more about medicine I got a job driving an ambulance in New Orleans. I found that while the doctors I ran into were incredibly competent, they were bored from time to time. They had learned an enormous amount of information, and now that they knew it their only calling in life was to continue delivering against that same body of information. I sensed frustration at times from them. It seemed that the connective tissue between patients and the very bright and capable doctors was really poor. It was a disaster.
I figured that no matter how bad I was, I could find a way to do this better. That really got me excited about the delivery system over the actual science of medicine. I wanted to be the innovator of a functional delivery system. At first I thought I was going to start an ambulance company, and that the ambulances would do more in the field to reduce unnecessary emergency room admissions, but there was already a company rolling up ambulance companies and I didn’t think I could play at the same time.
We then decided we would try to manage practices ourselves. athenahealth started as Athena Women’s Health, and we acquired an interest in a women’s health practice.
SM: Was Athena your first job?
JB: It was my first job out of business school. I worked for the George Bush campaign in 1988, I drove an ambulance, and I was a combat medic in the Army. I was a consultant at Booze Allan Hamilton and worked at my dad’s investment firm but I never did any one of those jobs for more than two years. It was an awkward ramble through those parts of life.
SM: When you were rambling through those possibilities, did you have something of the nature of Athena, no matter how nebulous, in your vision?
JB: Yes. I wanted to do so something where I was at the end of the food chain. I wanted to be touching actual patients. I did not want to be selling tools or capital, or many-orders-removed inputs. That is about the only thing I really knew at the time. I remember doing informational interviews, looking for a job, and I spoke to a McKinsey partner. I asked him if McKinsey had an actual health care practice and he said, “Of course, it is actually quite strong. We work for Johnson & Johnson and other companies like that”. I said, “No, I mean actual health care where there are doctors and patients”, to which he replied, “We have a not-for-profit where you can do pro bono work on your spare time for hospitals”.
I found it very odd that there was a formal McKinsey practice that you could build your career on selling the construction of drugs and devices, but if you want to help the delivery that it had to be done pro bono. Since then, McKinsey and others have obviously established such practices. That got me turned around. At one level I thought it was ridiculous, and at another level I thought it was wonderful because I realized there was an opportunity.
SM: What year are you talking about?
JB: That was my last year of college, so probably around 1993.
SM: Bring me to the genesis of athenahealth. What year was it, what was going on in the marketplace and what happened in your head that led you to Athena?
JB: I really wanted to do something entrepreneurial. I didn’t want anybody to say that I was given it all because I had a wonderfully sheltered and supported childhood. The idea of starting my own company and having it turn into something seemed like a good way to make a man out of myself, or not.