The Bush Health-Care Solution

Chris Masciola, practice manager for Professionals for Women's Health in Columbus, Ohio, signed on with athenahealth in 2001. "They blew us out of the water," he says, cutting days in accounts receivable down to the high 30s, from 61.

What athena calls its "secret sauce" is its rules engine, a horrifyingly complex piece of software that tries to incorporate every single coding change, billing-address modification, or regulatory shift in the industry. There are currently more than 40 million permutations, each of which spawns constant changes and exceptions -- if, for example, Aetna were to require a "Q" before any back-surgery-related claim number. In effect, athena has created a dynamic knowledge-management system in which employees and customers are encouraged to share what they learn.

There's no question that the spirit at athena starts at the top. Bush, 36, a hyperactive Sean Penn look-alike with a penchant for off-color, surprisingly impolitic comments, is the big-picture guy with real-world experience; he volunteered and served in the Army as a combat medic and even spent a summer as an EMT in crime-ridden New Orleans. Park, 32, a voluble first-generation Korean-American with a small frame and a booming laugh, is slightly more bookish and earnest but equally energetic. The two talk over and through each other but rarely fight. "They're a fantastic pair," says David Knott, the managing partner of Booz Allen Hamilton's New York office who hired them in the early 1990s. "The world is a better place because they are in it."

Bush shares some mannerisms and background with his more famous cousin (neither distinguished himself early on, but both ended up at Harvard Business School; both make those funny arm-chopping gestures). He has fond childhood memories of his older relative, who would sometimes stay at Jonathan Bush's family's apartment in New York. "He was a really fun guy," Bush says. "Like, a cool dude. We're all fun, but he was definitely way fun."

There are some big differences, too. This Bush lives not in Washington but in Belmont, Massachusetts, probably one of the bluest towns in one of the bluest states. He coexists comfortably with an employee whose vegetable-oil-powered car proudly displays its bush=satan bumper sticker in athena's parking lot. This Bush has five kids and wears Lance Armstrong-style bracelets imprinted with athena's logo and the words teach and learn to remind employees what the company's culture is about.

And this Bush is so comfortable with himself that he merely reddens when Park shares the story of a trip they took to the Bahamas together when Bush's first child was a newborn. While Bush's wife was swimming, Park heard the baby cry hysterically and then stop abruptly. He ran to the other room, only to see Bush trying to calm his daughter by putting her to his, er, breast. "I have a very spiritual and crunchy exterior and a hard-core business interior," says Park. "Jon likes to pretend he's the hard-core guy, but he is the softest-hearted, most emotional, weepy, spiritual guy inside." Bush, whose syntax can be reminiscent of Dubya's, says the impulse to serve runs in the family: "What am I going to do, what's my little avenue that's sort of playing along the same lines, you know, impacting social good?"

He's also driven to succeed, though -- and that can sometimes mean learning from failure. Although athena is now growing at a 50% annual clip, it stumbled in 2002 when it mishandled the outsourcing to India of the electronic conversion of paper "explanation of benefits" forms -- the form you and your doctor get that explains what was and wasn't paid. Pandemonium ensued, as clients suddenly had no idea what services they were being paid for. This was exactly the kind of mayhem that athena had promised to end. The tech team mobilized to solve the problem, and Park came up with the idea of a guarantee, which offered a cash refund of up to 20% of the practice's monthly fees if athena didn't meet certain deadlines. "People in our space are not accustomed to getting this kind of response," says Park. "It turned out to be a great brand-building moment for us."

Next, athena intends to stake a claim to the potentially most profitable part of the market by digitizing the actual doctor's appointment itself. The company is spending $2.1 million developing a product called athenaClinicals, an electronic service that will roll out in 2006 to track and measure everything from diagnosis to medical transcription to lab results. But many other larger and more-established companies are eyeing this market, too, so it won't be easy.

Yet Bush and Park have the advantage of a committed team behind them. "I love this firm," reads one recent response to an employee survey. "Many of us believe that we are doing more to save lives than Mass General! I don't know if we are right about that, but the passion in the air when people are working to save lives is the best and most addictive drug I've ever been exposed to." Now, there's a prescription for success.

Jennifer Reingold is a Fast Company senior writer.