Embracing the Digital Health Transformation to Build a High-Performing Operations Team (Part Two)

This is part two in our conversation with Karan and Riley on investment in digital health, and the new opportunities on the horizon for founders and health-tech companies.

During the annual Medallion Elevate conference, we sat down with two leaders to dive into why now is the time to embrace digital technologies. Riley End is the Chief Operating Officer at Spring Health, which helps individuals and organizations thrive by eliminating barriers to mental healthcare. 

Karan Singh is the Co-founder of Ginger, an on-demand mental health company that combines data science and virtual delivery to provide immediate, personal support. He is also the Chief Operating Officer at Headspace Health, the world's most accessible and comprehensive digital mental health and wellbeing platform.

Below is part two of the conversation. Missed part one? Read it here.

If you enjoy this material, check out more sessions from the Medallion Elevate event. A lightly edited transcript of the session with Riley and Karan follows. The conversation has been transcribed and edited to the best of our abilities and please allow for a slight margin of human and machine error. Any questions or concerns, send an email to events@medallion.co for help.

A collective sink-or-swim mentality leads to winning strategy

Derek Lo: It makes a lot of sense. Is there anything you can speak about how you have innovated on the business model? 

Riley End: My answer is around provider quality and measurement and how we've been able to build a large network that we believe has connective tissue. The connective tissue comes from a shared excitement around the vision of precision mental health care, removing waste from it, and everyone acknowledging that we sink or swim together in it. It is a big challenge. I can't underestimate or underemphasize it to bring data and scorecards to providers on clinical, administrative, and operational factors. The overall goal of bringing data to them is to help them get better at their jobs. If they are stellar at their jobs, it's to help leverage what they are doing with their caseload. The first challenge is capturing the data but then actually being able to review it and take action against it, but also get buy-in so that the data isn't met with apprehension but with excitement. 

I want to make sure I answer your question, but the power of the data for our providers around provider quality and getting the adoption and, ultimately, excitement for it has been a challenge. It's also a really important piece of who we are today and where we're going.

Karan Singh: It's a big problem. We need a whole bunch of innovations in this space. It's [to your point] down to incentives. We believe that data plays a critical role, that prevention is a key part of this experience, and that you need to measure what matters. A big part of what we focus on is ideally catching people early in a subclinical context through nontraditional means like coaching and mindfulness content, and other strategies. But very quickly, then getting them to an escalated level of care as and when needed, tracking and demonstrating outcomes, and making sure the provider believes in that measurement-based care approach.

Which is a big reason we have full-time clinicians on our staff. They're a core part of the team. They need to be brought along on the journey. I think that resonates with me too. They need to understand the business model because they need to understand that by delivering care more effectively, we're pulling costs out of the system and unlocking affordable access to more people. I'd say maybe the tweak of the Tesla example or perhaps even the Uber example would be not to build the automated car that eliminates all drivers, right? It's to start finding automation so you can do what you do best and what you love. Eliminate many other parts of the job that are soul-sucking, incredibly challenging, and lead to burnout and other issues. Then allow them to practice their superpower and deliver great care, be transparent about that, and deliver the data that demonstrates when they may not be working well, helping them understand how to do that more effectively. I'd say a lot of alignment is the theme.

In operational management, what measures are you tracking regularly? How do you make sure you don't balloon that list to be so large that there are so many things that everyone has to keep a lookout for that they don't know what matters? I'm fighting the other problem: the garden can grow so big you've got to tend back down to just a few things that drive the needle and keep everyone focused on those things. I think that's true at all levels, from care delivery to unit economics and margins management to marketplace dynamics and making sure you're managing supply and demand. What's the one metric in each category that really rules them all and then stays focused on that?

Some data, is better than no data

Derek Lo: I feel like that's such a good reminder. Both of you mentioned your data-driven decisions are super important. How have you thought about making decisions where there isn't data or the data doesn't tell you anything useful?  

Karan Singh: We talk a lot about trunk versus leaf decisions, and by that, I mean, is this a decision that if we get wrong, the tree falls? 

Or is this a decision that you can largely roll back? You can roll it out, test it, see what happens, and be nimble and iterate, and depending on where you are; you add more or less time to that framework, if you will. I think we're constantly operating with not enough data. One thing that helps that I've learned over the years is running a clear strategic planning process and having alignment at all levels of the organization then makes the operational implementation of that strategic plan far easier. You've done at least a holistic view: you've developed a strategic plan, an annual operating plan that you've chunked into quarters, if not monthly targets, and then executing that, you're going to learn new data all the time. 

I think it's helpful to permit people to also, especially in the leaf decisions, just press go, get as much as they can, but avoid having to come back down. The decision that ultimately has to come back to me means there's probably something I didn't do well enough to set up another team so they could do it themselves. I think that's helped us, and scale is [about] empowering the nodes to be effective and to make the call because they're usually closest to it. But then sometimes also knowing when you need to pull the cord and say, hey, I don't know, this feels like it's a high risk, can we get a SWAT team together and make a call and make our best guess? Or who across the organization might have the best information to help us make an informed decision? I think the thing that kills most teams is A, trying to do too much and B, too much swirl before they try to do too much, and then they get nothing done at all.

Riley End: I've never heard the trunk and leaf approach, but I like it. My greatest mentor was the CEO at Bloc, and he wouldn't take no for an answer for [the statement] we didn't have the data. I've taken that with me. When someone says, we don't have the data or we can't get the data, [we reframe it as] you may not be able to get the exact data, but you can get some data. And if you can't get data from a system, you can talk to people, and enough people are data. So the first approach is, I hear you; what can we get? If we don't have the precise thing, how do we ensure that we have it going forward? We always talk about irreversible decisions at Spring Health, and when they're irreversible, they're likely to be the trunk, right? We need to ensure that we're making risk-mitigated decisions.

The degree of risk we're willing to take depends on the decision and therefore deciding if you don't have the data from the systems.

Shared alignment on measurement is key

Derek Lo: I like that. When it comes to balancing operations, how do you think about balancing the needs of the internal operations team and keeping the lights on with the needs of clinicians?

Riley End: The mentality is we don't have that distinction. We are one team. I think a small but important nuance, whether the provider is a full-time employee or a 1099 contractor, is an essential part of that connective tissue because we are one team. It's the sink-or-swim mentality. And that was a lesson learned at Bloc where we had hundreds of mentors teaching students in search of getting a new career and job for too long. There was an us versus them mentality; we were a student acquisition tool and a technology tool for them to decide how to use and teach their students. There wasn't shared ownership of the outcome of that student. Two years in, we flipped it on its head and created pod structures for our mentors that rolled up into program managers. It did unbelievable things to the business from a student retention standpoint, a job outcome standpoint, and a mentor satisfaction standpoint, not to mention the unit economics of the business. So we've tried to apply those lessons to Spring Health from the start, and the first thing I did was ask our director of mentorship at Bloc to come to Spring Health.

Gina has been running our care operations for four years here as well. So I think it starts with perspective. You can't just say it. You actually have to do it. With the provider network, we also have to be realistic about how much of their time and mind share we can get for the scale we're at. We have to be reasonable, respectful, and explicit about what we expect them to do and not do. A shared sense of ownership for the outcome of the members comes first and foremost and creates an environment where feedback is expected because they are the ones with the finger on the pulse all day, every day, working with our patients and our tools and our teams. 

And we're at a scale where we have very little problem deciphering the signal from the noise. When we get a great signal, that helps us operate more efficiently as a team.

Karan Singh: Yes. Our providers are the product. So we think about how we enable them to do what they do best and enable the rest of the operational team to strip away all the rest of the complexities so they can do what they do best. How do we create an environment where we can be the employer of choice? 

It is an incredibly competitive labor market, and talent is in low supply. Many providers, especially in behavioral health, but also true in other parts of medicine, have been burnt out working in environments where it largely just churns and burns and where they have to get through as many visits as possible. 

How do you create the right environment and attract the right talent upstream? It starts with people, attracting the right people, setting up the right incentives, and giving them the right training and the right ongoing education so they can master their craft, but then building a robust supply chain and making sure that you understand at all steps in that process.

How do you create flexibility to scale up or down as you need it? How do you ensure you have the right forecast to dial up or down? How do you do things like credentialing, licensing, and other strategies to drive the fungibility of your supply? Because we live in a dynamic environment where exogenous factors can spike the demand you didn't forecast, you need to be able to meet that demand. Those situations put pressure on the provider team. So much of this is ultimately about how you create a sustainable experience that allows them, again, to be able to deliver on these core metrics and ultimately reach your core sort of both revenue and targets. 

It goes back to what we've been saying. It's about ensuring there's shared alignment on measuring what matters. It's about sharing that data with everyone, so everyone clearly understands the state of affairs, but again, it's a balancing act. Riley, I think I heard you say your management structures for your clinical teams. Creating pods or a similar structure where we have a group of providers has been such an incredible force multiplier on their camaraderie, connection, and then their ability to deliver great care, and it's obvious. It's so simple, and yet it can have a pretty profound impact.

Those things excite me: the simple yet can become scalable solutions you can roll out that drive excellence and sustainability.

You have to be a short-term company to be a long-term one

Derek Lo: Amazing. What advice would you give on managing costs and running things effectively today?

Karan Singh: We've been operating in a world where it's about sustainable growth. Margins, cash flow, and budgets matter. Looking for opportunities and improvements, you can leverage to do less but do that better. That's a huge focus for us. We're continuing to think about ways where we can have our investments go further, and considering external tools is a critical part of that strategy.

Riley End: I think it's a tremendous opportunity, is the advice I'd give. Having been through tough times before, either macroeconomically or with companies close to shutting down, those are the times when you find out who the best leaders are, and it's the right forcing function to make necessary decisions.

I've found it challenging to make efficiency decisions when it's rainbows and sunshine. For our team, the way we're approaching it is what I spoke about earlier. If we were to build this today for what we know the market is, we would build it 30% more efficiently. 

We're in a fortunate position to enter what could be a recession, and there's a lot of uncertainty. Our goal is to ensure that we come out of that in an even greater position of strength to ultimately realize our vision. 

So I would not get caught up in the degree of uncertainty, and I would keep it simple. A great mentor of mine, when I had my startup, said, look, you have to be a short-term company before you can be a long-term company.

And to be a long-term company, you need to know your next corporate milestone in this environment. It may be profitability, even on a small scale. It may be a bridge round. It may be an acquisition. So know what it is and the short list of KPIs to get you there. And Karan mentioned, obviously, a huge one, gross margin burn. Know what those are, and ruthlessly prioritize and be okay with drawing the line and saying no to things below it.

Derek: Amazing. Well, thank you both so much for spending time here. I know you both are super busy, so we appreciate it. The advice you shared is super valuable.

Karan: Thanks, gentlemen. Appreciate it. Good to talk.

Riley: Thank you, Derek. Thanks, Karan.

Karan: Thanks, Riley. Derek. See you. Bye.

About Medallion Elevate: The Future of Healthcare Operations

At Medallion's inaugural debut, Elevate: The Future of Healthcare Operations, healthcare executives, founders, and leaders came together and highlighted the collective optimism of an industry that's ready to elevate and advance the industry. 

It represented actionable insights, disruptive ideas, and ground-breaking insights from some of the best healthcare leaders, visionaries, investors, and founders. For more information and to view the sessions on-demand, visit: https://elevate.medallion.co/events/medallion-elevate-2022/registration

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