Start-up firms looking for inroads in the health care industry should look for customers who understand their vision. That was one piece of advice offered by Jonathan Bush, CEO of athenahealth, during a session at the Health 2.0 conference taking place this week in Boston.

“Culture trumps capability,” he told the group of entrepreneurs and venture capitalists in attendance. He told the story of how the billing services/EHR/practice management system vendor made large inroads in the Ohio during the firm’s early days. Two staff at the Ohio State Medical Association personally clicked with Bush and championed the company’s services to its physicians. “We wound up with 14 percent of the docs in Ohio,” Bush said.

Bush said that athenahealth is actively seeking business partners to help it fill gaps in its portfolio of clinical I.T. products and to help introduce the firm to a broader range of clients. He cautioned the entrepreneurs in attendance to think small at first--explaining how oversized deals or even buy-outs may sound good, but can wind up diverting the company from its mission. “Don’t give away your company,” he said. “Don’t license your codes. Entrepreneurs should stay product-focused. Don’t bite off more than you can chew.”

Bush said the health care industry is full of opportunity for smaller companies, particularly in the emerging era of accountable care organizations. EHR goliaths may encounter limits to their growth and lack the flexibility of smaller firms, he added. “Hospitals can’t own their whole food chain and make everybody refer to them,” he said.

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