Human-centric product design and the impact of COVID-19: an interview with Dr. Alan Spiro, part two
As we see how the COVID-19 pandemic has impacted members’ approaches to their health and healthcare, understanding how programs can adapt to fit individuals’ needs and meet them where they are is key. In this conversation, serial entrepreneur Alan Spiro, M.D., offers insights into how organizations can do just that. As Co-Founder, Chief Medical Officer, and executive VP of Accolade, Spiro served as program architect for the company, which raised $220M in its initial public offering this year. More recently, he served as Chief Medical Officer and Chief Growth Officer at Blue Health Intelligence, where he was able to develop data-driven solutions to help BCBS Plans and their provider partners deliver value-based, contextual care solutions. He also served as Chief Medical Officer at Anthem National Accounts and Medica.
Spiro recently joined Pager’s Board of Advisors, and Nick D'Addezio, Pager's VP of Business Development and Strategy, took the opportunity to speak with him about building and scaling human-centric solutions, and potential learnings for the industry in a post-COVID world. This is part two of a two-part series. Part one can be found here.
Nick D’Addezio: Many of the things you discuss are themes that really permeate the Pager values and culture. What was your initial introduction to Pager, and what do you think the future for Pager looks like?
Alan Spiro: To start a bit earlier, one of the reasons I joined Blue Health Intelligence was because I had a lot of experience and worked a lot with analytics and data science. And I knew that when we started Accolade, one of the challenges was that it was expensive. I thought that if we could apply analytics to choose the best people to form trust relationships with, and it wasn't related to their disease as much as who they were, you can make it more affordable.
If there was a way to make these kinds of services more affordable, then I thought that would be a tremendous advantage. When I met Gaspard [de Dreuzy] and Walter [Jin], it was really interesting to me, because it was an opportunity to apply techniques and technology to make the kind of experience I wanted so much for people – a person-centric, rather than patient-centric, experience – more affordable. And any time you make something more affordable, by definition you're making it more accessible. So that was my first introduction to Pager, the idea to make that kind of service scalable, to make it available for everyone.
There's a quote from Konosuke Matsushita, who is the founder of Panasonic. To paraphrase what he said when he started Panasonic, then Matsushita Electric, in Japan, "The goal was to make electronics as plentiful and cheap as water." When you make something cheap and plentiful, you're actually really doing a tremendous service to the world, and that's how he saw it, and that's how I see Pager in certain ways.
When you're working for a company such as Pager, you’re addressing a direct need for so many people – enabling simple, affordable access to quality healthcare. If you're not getting that sense of purpose that comes from working for Pager, then you should. It's a tremendous opportunity, in my mind, to change the world. It might sound dramatic. I don't think it is.
The stress that accompanies illness or poor health can be challenging. How can we think about designing solutions with these challenges in mind to create a better experience?
Being sick, or having someone you love be sick, is extremely stressful. And people are afraid of dying. I used to train health assistants at Accolade, and I had my 10 secrets of medicine. One of those was that a minor illness is “an illness someone else has”. Everything I have is major. And you have to think about it in those terms for the people who may have a sore throat, but be afraid that they're going to stop breathing. They may have a sore throat, but someone they know died of throat cancer.
You don't know the broader context, so you have to understand that being sick is inherently anxiety-provoking. You have to understand how people feel, not just what they want or what they need. Pager is in the position to help these people.
A lot of times when we say “help,” we think we're just talking about imparting knowledge, but people will not even hear the knowledge part if they are upset, anxious, and depressed. You have to put feelings first, then facts. If you're on the phone with somebody, for example, and they're not talking, there's something else there. You have to figure it out and approach it in such a way so that you can both give them the information and get them to that point where they can hear it.
How do we think about scaling these human-centric solutions?
There's no question it can be scaled. If there are certain things you can find out about a person beforehand, that's great. Sometimes, it's actually being willing to be silent longer. You can be silent for 40 seconds, just waiting for someone to answer rather than trying to fill up the time.
When it comes to questionnaires and bots, you may ask a few quick questions beforehand that are related to how they're feeling to understand upfront before you get into the symptoms of the disease. There are different ways to do it. You have to experiment. You have to see which techniques work.
I firmly believe one of the great advantages of being a young company is the ability to experiment and to turn on a dime. It's critical. And you do that in as formal a way as you can in order to set up studies and measure what you do. As I mentioned before, you can measure things, like feelings, you can measure interactions, you can measure just about everything. And you have to set it up to do that so you know which of these is most effective.
Have there been any experiences where the data really surprised you?
It's funny. I think a lot of what you see from data is almost obvious once you think about it. I was once involved with doing an assessment of admissions to psychiatric facilities. And I looked at the data, and one of the things that popped out at me was that people did not get admitted to psychiatric facilities by psychiatrists and by mental health professionals, they got admitted by emergency room doctors.
In some ways, it was one of those “duh” moments. But it was also something that made us develop a program to get better crisis intervention for people in mental health emergencies in emergency rooms, which dramatically decreased psychiatric admissions. One of the things I did at Blue Health Intelligence was to encourage staff to not just depend on claims data, but to include socioeconomic data into the analytics as well.
We found that this data is critical in terms of predicting. If you want to predict who's going to end up in an emergency room for an asthma attack, you're much better off looking at the economic status than by any medical indicators. There are a lot of factors. But that's the correlation. And if you don't have that in your analytics, you're going to miss things.
How do you persuade other healthcare leaders who may not see value in certain metrics and tools that these more personalized, more intelligent healthcare solutions are valuable for their patients and their organization?
“The fact is that from a business perspective, doing the right thing in healthcare saves money.”
You have to translate it into business. I'll go back to Accolade for this. I'm very grateful to the initial investors, because here we were, saying, "If you give people more service, and if you are really helping them in ways that are meaningful, you are going to save money as an employer." In our initial business, we took full risk, and agreed to get paid only on a percent of savings.
We set up a pilot, and we proved it. The fact is that from a business perspective, doing the right thing in healthcare saves money. The program to keep people out of a psychiatric hospital saved a ton of money on psychiatric hospitalization, but it also improved treatment rates and recurrence, because it turns out that one of the hardest things for any psychiatric patient is going through transitions. And we avoided the transition of going into and out of the hospital, so we improved the care.
There are so many ways to do this. I also currently advise another company – a food-as-nutrition company. And it's striking how much cheaper and better the right nutritional therapies can be for people, as an example. There's really a synergy between helping people in a meaningful way and creating a financial model that works.
What do you think the COVID-19 pandemic is teaching us as a society about medicine and healthcare? And what kind of advancements do you see continuing in a post-COVID world?
In some ways, I've been involved in telemedicine since the 1980s, when I first did a home telemedicine study for the United States Veteran’s Affairs Department (VA). We've never been able to get the traction needed to acknowledge that this is really an important way to interact with people and to help people. But COVID has changed that dramatically. Now, I think we'll always have this telemedicine piece. But the other thing is that telemedicine has also thrown in our face something we've also known.
I've been involved in health disparities work and research for a long time, and I've been involved in the Harvard health disparities course that they give every year. And it's something that people nod about and give some recognition to, but they don't really accept it. And now, with the numbers we're seeing around the country with COVID-19, and the fact that if you're poor and Black or Hispanic, you are of increased risk – not just of getting the disease, but for getting hospitalized and dying from the disease. It's something that we can't ignore. It's in our face, which is so, so important.
“The idea that we’re starting to very literally meet people where they are [in healthcare], rather than make them come to us, gives me great hope.”
How do you tell people to socially distance when you also tell them they have to go to work, because everybody's home and they have to be the delivery people? They're increasing their risk. How do you tell homeless people to shelter in place, or to go to homeless shelters, which are overcrowded? So we're seeing, up close and personal, unfortunately, a lot of things that we have to pay attention to that we have not been paying attention to.
What gives you the most hope in terms of addressing some of the inequities and gaps in healthcare today?
Well, I think that what's happening in healthcare is going out of the clinic, the office, the hospital, and into people's homes and lives, and into their pocket through apps. And that gives me great hope, the idea that we're starting to very literally meet people where they are, rather than make them come to us.
But I have other kinds of hope. My wife is a physician who's retired now, and she went to Duke. When we were dating, it was still the early phases of women in medicine. When I was at Columbia, we had 10 classmates who were Black or Hispanic. That's a whole different realm now. I’m seeing hope in that.
I work with students at Spelman College, which is a women's college and a historically Black college in Atlanta, and you see the passion in these young women who go into medicine, and it's fantastic. That gives me hope.
I think the greatest opportunity to improve the world is by new companies and entrepreneurialism. I really believe that. A company like Pager has a tremendous opportunity to do that. The company that I work with in the food-as-medicine space has a tremendous opportunity to do that. I'm seeing companies like that pop up all over the place. My son's most successful company started manufacturing organic, biodegradable tampons, which they also give free to women in third world nations.
In the context of Pager, this idea of getting into people's pockets, getting into their homes, getting to be where they are, is critical. There are lots of different ways to really change the world, and I think Pager is one of those ways.
In case you missed it, read part one of the interview, where Dr. Spiro discusses building trust with members and listening to the data.
