Health-care reform Rx: power to the people

As the debate about health-care reform rages endlessly, everyone with a vested interest (that’s all of us) might consider a few priorities.

Such as: Revamp the fee-for-service model–because when doctors get paid for each service they perform, costs go up inevitably. Reward value. Reduce end-of-life care costs. Improve delivery. The list goes on.

What may be most important of all? Empowering consumers. We explored this topic on Friday during a health-care roundtable that I moderated at Fortune Brainstorm Tech in California. Athenahealth (ATHN) CEO Jonathan Bush, a panelist in the session, tossed out a riveting fact: “Fifty-two percent of what a doctor orders disappears,” he told the group. In other words, more than half the time, patients fail to fill the prescription, get the mammogram, or do whatever else the doctor ordered.

Where or why, who knows? Technology is only part of the solution, said Kaveh Safavi, who heads the global health-care practice for Cisco’s (CSCO) Internet Solutions Group. “The notion that people will do what a doctor says is so naive,” he added.

Mona Williams, the PR boss at Wal-Mart (WMT), joined the session, and Bush gave her a nod. “You guys have helped,” he said, acknowledging that Wal-Mart has lowered prices for prescription drugs dramatically. Yet the world’s biggest retailer can’t do much about consumer complacency that keeps its employees and consumers from taking control of their own well-being.

The roomful of reformers and wannabes was captivated by a panelist from Ghana, of all places: Bright Simons, whose mPedigree Network is testing a technology to arm African consumers with information, via cell phone text messages, to ID fake drugs. (Counterfeit drugs are a huge problem in Africa.) Bush and Safevi contemplated whether similar technology could be used in the U.S. to inform and remind consumers to fill that Rx or get that colonoscopy.

Twitter could help too–but empowering consumers may not sit well with reformers in Washington, who have many vested interests in keeping the system complicated. Bush, who spent the day before our session meeting with people at the White House, says that nationalizing health-care would do the opposite of making consumers responsible. He wants consumers to have their own health-care savings account–and let them buy Xrays without an Rx and use walk-in outlets like MinuteClinic, part of CVS Caremark (CVS).

Bush, incidentally, is an intriguing character. The cousin of former President George W. Bush and the brother of Access Hollywood co-host Billy Bush, Jonathan “fantasized about being a doctor” but wasn’t smart enough, he told us. So 19 years ago, he decided to get an inside look at the system by driving an ambulance, in New Orleans. He witnessed inefficiency and logistical stupidity–and parlayed it into his vision for his start-up. Born in 1997, athenahealth began as a women’s health practice management company, aimed at reducing unnecessary C-section deliveries. Bush has evolved athenahealth into a  provider of Internet-based services, like billing and electronic health records, for medical providers.

He’s built a nice business. Revenues last year totaled $139.6 million, with 20,000 docs on the systems. Athena’s healthy profits have helped earn it a $1.8 billion stock-market value. Not bad for an ex-EMT. Here’s more from Bush on today’s “Paleolithic” health-care system, as he calls it, and his rallying cry for disruptive technologies such as the kinds that Google (GOOG) and Amazon (AMZN) have used to bring power to the people in other industries: