It’s a question that has bugged Jonathan Bush for three decades, ever since he drove an ambulance in New Orleans one summer in college: Why isn’t there a “health care Internet?”
Bush tried to create one, of sorts, in 1997 by cofounding athenahealth, the Watertown health IT business that streamlines billing, records, and other back-office services for medical practices. He grew athena into a multibillion-dollar company before being forced out of the chief executive’s office in 2018 as Elliott Management, a hedge fund, pushed to control it. Elliott’s private equity arm, Evergreen Coast Capital, ultimately teamed up with Veritas Capital to buy athena for $5.7 billion after Bush left.
Well, Bush is back at that health care Internet thing again, launching a startup essentially across Arsenal Street from his old company in Watertown. Bush unveiled his new venture, Zus Health, on June 17, along with $34 million in equity financing led by the venture capital firm Andreessen Horowitz. The name is pronounced just like Zeus, in an intentionally cheeky throwback. (Zeus, of course, is the father of Athena in Greek mythology.)
Rather than sell technology directly to doctors and other health care providers, as he did with athena, Bush and his colleagues aim to sell software to other digital health startups. The goal is to offer a backend platform that software engineers and developers can use to manage tasks such as patient record acquisition, aggregation, translation, and sharing. Bush likens it to Build-A-Bear Workshop; instead of helping kids make stuffed animals, he is providing components for digital health app developers.
“It represents a new business audience in health care that actually wants to share records, they benefit from shared data while [many of] the established players don’t, and a set of tools to build stuff that just didn’t exist before recently,” Bush said. “If you want to build your own athena, if you’re the kind of person with the engineering, and the capital, and the business model, then you can come here.”
The demand for this technology accelerated with the widespread acceptance of telemedicine during the COVID-19 pandemic. It’s also expected to further pick up because of new federal rules opening up medical records for patients.
Bush hasn’t exactly been idle in the past three years. Among his side projects: investing in Firefly Health, a telemedicine-focused health plan where he is now executive chairman. To some extent, Zus is an outgrowth of Firefly: Zus is subleasing space in Firefly’s offices on Walnut Street in Watertown, and it licensed Firefly’s software code.
Zus employs 30 people now. Bush hopes to use this funding round to hire about 200 people over the next few years.
It’s not entirely coincidental that Bush ended up back in his old stomping grounds on Arsenal Street. The proximity to Cambridge is enticing, as is the rent — roughly half of what Zus would be paying in Kendall Square.
“Much of the criteria that caused me to locate athena here are still intact,” Bush said. “If you think about the software development community, what is the lowest-cost yet most convenient location for folks, [this address] is pretty close.”
Bush’s vision for uniting a community of software developers from disparate companies also hearkens back to his days at athena, when he presided over a marketplace for startups that wanted access to athena clients, dubbed “more disruption please” (a.k.a. MDP).
Julie Yoo, a general partner at Andreessen Horowitz, said she got to know Bush as a cofounder of the Boston scheduling software startup Kyruus, which used the MDP marketplace. Bush was an early investor in Kyruus.
Yoo, who is now based in California, said VC money is pouring into digital health startups. Demand for a shared platform to serve them should be high, allowing the startups to focus on what makes them unique.
“I meet with hundreds of entrepreneurs . . . that are building these virtual clinics, these digital health clinics, and they’re literally building the same stuff over and over again,” Yoo said.
Saving time for startups should also translate into saving time for patients — if all their health care records can be made easily accessible. “No longer will you have to show up at a doctor’s office and fill out that blank clipboard,” she said.
The MDP marketplace was a great idea, though limited by the boundaries of the athena network, said Carl Byers, a former athena chief financial officer and a college friend of Bush’s. F-Prime Capital, the local VC firm where Byers is now a partner, has invested in Firefly and now Zus; Byers sees a chance for his longtime colleague to take another big step forward.
“The next generation of [health care] software developers will not have to reinvent the wheel for about 150 different things you need to do well in order to have a highly reliable software application,” Byers said.
The launch of Zus is also another step toward building Greater Boston into a hub of digital health, Bush said. Employees will be allowed to work remotely, with just a few office visits required each month. But Bush hopes most will choose to live here and help Boston catch up with Silicon Valley in the fast-growing field of data storage and aggregation.
“Obviously, we’re not going to be religious and make people move to Boston,” Bush said. “But as a ‘Mass. patriot,’ I’m curious as to whether we can build up that kind of caliber in this ecosystem.”
As far as that faraway dream of a health care Internet is concerned, Bush believes he is getting closer, even if he still doubts he’ll live to see all the industry’s big issues resolved.
“I don’t imagine health care is done any day in my lifetime,” Bush said. “While I didn’t want to leave athena at the time, I believe the opportunity to start with a clean sheet of paper has been an incredible blessing. I’ve never been more intellectually challenged.”