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Where Does it Hurt? An Entrepreneur's Guide to Fixing Health Care
A bold new remedy for the sprawling and wasteful health care industry.

I loved this book. Jonathan Bush is a goggle-eyed radical foaming for revolution in the house of healthcare...a singular new voice in American healthcare.
Atul Gawande, surgeon, professor, and author of The Checklist Manifesto

Where Does it Hurt? An Entrepreneur's Guide to Fixing Health Care

A bold new remedy for the sprawling and wasteful health care industry.

Where else but the doctor's office do you have to fill out a form on a clipboard? Have you noticed that hospital bills are almost unintelligible, except for the absurdly high dollar amount? And why, in health care, is the customer so often treated as a mere bystander—and an ignorant one at that?

The same American medical establishment that saves lives and performs wondrous miracles is also a $2.7 trillion industry in deep dysfunction. And now, with the Affordable Care Act, or Obamacare, it is called to extend full benefits to tens of millions of newly insured. You might think that this would leave us with a bleak choice—either to devote more of our national budget to health care or to make do with less of it. But there's another path.

In this provocative book, Jonathan Bush, cofounder and CEO of athenahealth, one of the fastest growing technology companies in the country, calls for a revolution in health care, one to give the customers Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physician-patient experience. more choices, freedom, power and information, and at far lower prices. As he leads readers on an eye-opening journey through American health care, Bush makes a compelling case that this revolution is already underway. With humor and his tell-it-like-it-is style, he forms his analysis from his own rich experiences in the industry. He picks up insights and ideas from his days as an ambulance driver in New Orleans, an Army medic, and an entrepreneur launching a birthing startup in San Diego. In struggling to save that dying business—and to get paid—his team created a software program which eventually became athenahealth, a cloud-based service company that handles electronic medical records, billing, and patient communications for more than 50,000 medical providers nationwide. Through his astonishing career, Bush has incubated a wealth of ideas about how to reinvigorate health care in America.

In Where Does It Hurt? Bush calls for disruption of the status quo through new business models, new payment models, and new technologies that give patients more control of their care and enhance the physician-patient experience. He shows how this is already happening. From birthing centers in Florida to urgent care centers in West Virginia, upstarts are disrupting health care by focusing on efficiency, innovation, and customer service. Bush offers a vision and plan for change, while bringing a breakthrough perspective to the debates surrounding Obamacare.

You'll learn how:

  • Well-intended government regulations prop up overpriced incumbents and slow the pace of innovation
  • Focused, profit-driven disrupters are chipping away at the dominance of hospitals by offering routine procedures at lower cost
  • Scrappy digital startups are equipping providers and patients with new apps and technologies to access medical data and take control of care
  • Making informed choices about the care we receive and pay for will enable a more humane and satisfying health care system to emerge

None of this, of course, will be painless. Bush's plan calls for Americans not only to demand more from providers, but also to accept more responsibility for our health, to weigh risks and make hard choices—in short, to take back control of an industry that is central to our lives and our economy. Only by pushing for such choices will we build a flourishing health marketplace, one in which the government, entrepreneurs, doctors, and patients can work together to shape health care that we all want, deserve, and can afford.

Upcoming Events

May 27
Google Author Talk, Cambridge, MA

June 2
Datapalooza, Washington, DC

June 3
AAOE Annual Conference, Washington, DC

June 25
Spotlight: Health at Aspen Ideas Festival, Aspen, CO

June 26
Techweek, Chicago, IL

September 17
Economist Health Care Forum, Boston, MA

September 23
Health 2.0, Santa Clara, CA

October 23
Partners Healthcare Connected Health Symposium, Boston, MA

November 20
HIT Leadership Summit, Atlanta, GA


"Health care has successfully resisted organizational innovation, to the detriment of our health and our economy. In Where Does it Hurt?, Jonathan Bush tells exciting accounts of current innovation, and irreverently imagines an attainable future in which a vibrant medical marketplace is driven by health entrepreneurs, of which he himself is a prime example. Patients, physicians and policy wonks alike would be well served to take the provocative and illuminating tour."

JEFFREY FLIER, MD, Dean of Harvard Medical School

"This is a compelling, entertaining story—an insider's perspective on American healthcare by someone who has been closely involved in its reshaping. Few people amass Jonathan Bush's kind of experience or articulate as clearly what lies ahead. A lovely read."

Abraham Verghese, physician and author of Cutting for Stone

"Jonathan Bush is not only a brilliant visionary but he walks the talk when it comes to tackling the dysfunctions of our health care system. Reading this book will help you understand why things are as broken as they are and inspire you to be part of the fix."

Regina Herzlinger, Nancy R. McPherson Professor of Business Administration, Harvard Business School, and author of Who Killed Health Care? America's $2 Trillion Medical Problem—and the Consumer-Driven Cure

"Where Does It Hurt? teaches us all that great entrepreneurship does for reform what yeast does for bread. Jonathan Bush has done it, and now he's sharing the recipe."

Governor Mike Leavitt, Secretary, United States Department of Health and Human Services (2005 to 2009)

"Jonathan Bush is one of the most charismatic and outspoken people in healthcare IT. His passion for driving innovation is changing the industry. The tale of disruption in his book offers lessons for us all."

John D. Halamka, MD, Chief Information Officer, Beth Israel Deaconess Medical Center

"I loved this book. Jonathan Bush is a goggle-eyed radical foaming for revolution in the house of healthcare—with the crucial, page-turning difference that for thirteen years he's actually been delivering on it. His story alone is worth the price of admission. He's driven ambulances in New Orleans, remade child delivery in San Diego, and has built an Internet company that is transforming the way people practice medicine. And along the way you'll learn more about the real world of how healthcare works than should be possible for a book this interesting. Jonathan Bush is a singular new voice in American healthcare."

Atul Gawande, surgeon, professor, and author of The Checklist Manifesto

Jonathan Bush

Jonathan Bush is Chief Executive Officer, President, and Chairman of the Board of Directors of athenahealth, Inc. He co-founded the Company in 1997 and took it public in 2007 in the most successful initial public offering that year. Today, athenahealth remains one of the health care information technology industry's fastest growing companies.

Bush's views on health care and the idea for athenahealth were born from failures with the earliest iteration of its business model. Bush co-founded and operated a birthing clinic with the idea of franchising a network of clinics that viewed pregnancy holistically. Bush would soon realize that his birthing clinic vision was challenged by his business' own inability to track outstanding claims to insurers and get paid in a reasonable timeframe. This challenge would shape the formation of athenahealth as it is known today. As a result of the challenges with the clinics, Bush and his partners set about designing a solution to address the costly administrative inefficiencies that plagued their business. In doing so, they came to realize their circumstance was more typical than unique and that the solution they architected had great application and utility for the broader health delivery system. Given his vision for an information infrastructure that makes health care work as it should, Bush is focused on creating a true, win-win marketplace that enables a broad and efficient exchange of health information.

Bush's passion for health care extends beyond the evolution of athenahealth. Previously, Bush served on the frontlines of health care as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant in the health care practice of Booz Allen & Hamilton.

Bush is an active commentator on all things health care and a believer in free market economics. A well-recognized innovator and disruptor, Bush's vision has been chronicled in publications from the Wall Street Journal and Fast Company to National Public Radio and captured on the stage at events from Fortune Brainstorm Tech to The Economist's Ideas Economy.

Bush obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

Stephen Baker

Stephen Baker is author of The Numerati, a primer for the age of Big Data, and Final Jeopardy: Man vs Machine and the Quest to Know Everything, the "biography" of IBM's Jeopardy computer, Watson. He was a senior technology writer in New York for BusinessWeek until 2009, and previously wrote for the magazine from Paris, Pittsburgh and Mexico City. He has degrees from the University of Wisconsin-Madison and Columbia University's Graduate School of Journalism. His dystopian novel, The Boost, is to be published in May, 2014. He blogs at and tweets @stevebaker.

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