Better: Interview with Founder Adam Dole
B: You rejoined Better in the summer of 2014, after being a Presidential Innovation Fellow and an EIR at Mayo Clinic. How has the company grown since then? What are the main goals you have as VP of Strategy for this year?
AD: We have come a long way since we launched in April 2014. Those first few months really forced us to learn what we needed to not only meet, but also eventually exceed our member’s expectations month in and month out. The core DNA of our company is driven by an obsession to understand our consumer's needs and iterate on our customer feedback to deliver healthcare value to our members (defined by outcomes that matter to our members and divided by the member’s money and time).
LinkedIn founder, Reid Hoffman once said, “If you are not embarrassed by the first version of your product, you’ve launched too late.” This statement completely resonates with me. When you expect your customers to pay for your service, you better expect to hear from them the second you fail to meet their expectations. We are fortunate that those early members were as passionate as they were to provide us with this, sometimes critical and harsh feedback. There is no amount of funding or press that can replace the value of direct customer feedback. Those first few months of iteration were humbling, which had a huge impact on our ability to rapidly learn what we needed to deliver and now scale.
The last 6 months have been all about growth. The team is growing rapidly with the most talented and dedicated people I have ever worked with. We have been in the top 5 medical apps in the iTunes store and just recently launched on Android.
As Vice President of Strategy, I am responsible for market strategies that help us achieve our corporate objectives and align with our vision. As part of this, I am spending a lot of my time these days on business and partnership development. I fundamentally believe that to have the most impact on healthcare outcomes at scale today, partnering with the healthcare industry is paramount. John Doerr recently told a group of healthcare entrepreneurs, 'not to nibble around the edges.’ I think that advice is spot on and exactly why we are working with healthcare organizations such as Mayo Clinic. We are in the process of building out many more strategic relationships across the healthcare system that believe in what we are doing and want to see it succeed.
B: Of all the things the PHA can help with (e.g. resolving medical bills, finding doctors, giving tips, reviewing your insurance plan, etc.) which tasks are the most often requested?
AD: The US healthcare system has actually become quite good at solving the healthcare systems problems. Unfortunately, this has left the patient on the outside looking in to a very fragmented system over run with competing priorities and misaligned incentives. As a result, there is no one in today’s healthcare system that is working exclusively for the patient to ensure that their needs are being addressed across all of their healthcare. This is the responsibility of our PHAs.
I think we underestimate the administrative burden placed on patients and their caregivers when interacting with the healthcare system. As a result, our PHAs are constantly handling billing discrepancies on behalf of our members. It’s shocking to me how many people are being charged for things they should not have been.
Some people who have never heard of Better before, and discover us in the app store may be skeptical at first and interested in trying us out for things such as finding them a doctor or other healthcare resources that meet their specific criteria like scheduling their appointments for them. Once they realize their PHA is not only a real person, but actually working for them, the response is usually one of disbelief and they start opening up about other things going on that their PHA might be able to help with.
Open enrollment was also a very busy time for our PHAs who were not only helping members choose the right insurance plans for their family but also helping members understand their current healthcare benefits. Now that through the ACA, people are required to have health insurance, it is pretty shocking to me how many people don’t know what they are paying for and in many cases not getting much value out. Our PHAs are great at breaking these things down and surfacing hidden or underutilized benefits.
PHAs also provide comprehensive care coordination for members who are dealing with a chronic or acute healthcare issue, which in many cases may be on behalf of their child or even aging parent. Once our PHAs have solved real problems for our members, they begin to establish a deep relationship with their members, resulting in trust and accountability, which are essential in PHAs ability to begin to work with members on achieving their lifestyle and disease prevention goals as well.
B: The healthcare system is so complex - where do you find PHAs and how do you train them to be so efficient at navigating the system?
AD: Our Personal Health Assistants all have deep healthcare expertise from previous careers working in the healthcare system. Each PHA has a strong understanding of the complexities of the current US healthcare system from backgrounds working as registered nurses, health insurance experts, diabetes educators, CDC researchers, care coordinators and even wellness coaches. I believe that their unique differentiator is in their natural ability to develop strong relationships and trust with members and their natural tendencies to problem solve and fight relentlessly for our members…as though they were their own parents. We do not expect our PHAs to be domain experts in every topic that a member might bring to them. Each PHA is supported by a team of experts. We also have access to Mayo Clinic clinicians who support our team of PHAs with clinical triage and symptom support, 24/7.
Finding great people is our number one priority. Our experiences have shown that great people usually know other great people, which is why many of our PHAs are referred to us through members of the team or other trusted partners. Over the past year and a half, the team has built rigorous PHA training programs and protocols to ensure consistency and quality. That said, I am not sure that one can teach the grit and relentlessness that they all have, which is often required when fighting tooth and nail for our members to ensure that they get the healthcare they deserve…especially after the healthcare system may have abandoned them. The PHAs usually laugh at me when I say this, but I think of them as healthcare samurais. They are so good at navigating the healthcare system and advocating on behalf of members, I am constantly blown away at the types of things they do for our members on a daily basis.
It is our job to as a company to clear the path for our PHAs and build technology that assists them. If we are successful, our members should not think of Better as a technology company, but rather as a trusted relationship that they have with their team of expert personal health assistants, working for them. We use technology in the background to help scale those human relationships.
B: Mayo Clinic is an investor and a partner. As Better grows, will you be adding on additional clinics to help support unlimited access to nurses, 24/7? How will the business scale?
AD: Yes, absolutely. We have a non-exclusive relationship with Mayo Clinic that enables us to work with other healthcare providers. We are currently in discussions with a number of healthcare organizations that are interested in offering Better to their patients and members, and in some cases discharging their patients with Better at the point of care before a patient leaves the clinic. In some cases, hospitals may have their own expert resources that they want their patients to have access to through Better, which is never an issue for us. It was very important for us as company to not need to rely on technical integration as a barrier to work with patients. It’s refreshing to tell our members that we can work for them no matter what insurance they have, who their employer is and who their doctor is and that they always have access to the clinical expertise of the Mayo Clinic.
The part of the business that enables this to scale is the technology that we have built for our PHAs that enables them to manage a panel of members. This is essentially a CRM system for healthcare that enables PHAs to be both, proactive about setting staying one step ahead of their member in helping them achieve their goals, but also very reactive when a member has an urgent issue that requires immediate action to be taken.
B: Are there additional features that will be added in the next year we should look forward to?
AD: Yes, we have a robust product pipeline that we are really excited about. The mobile app that members use to communicate with their PHA team is constantly being updated and tweaked to make it easier for members to communicate with their PHA. The team is working on a feature right now that will provide a deeper layer of transparency into the services that are being worked on for a member. We will also be making it much easier for members to be able to refer back to previous interactions with their PHA team within the mobile app. I can’t provide too many details quite yet, but a web-based product is something that we will be addressing on the roadmap as well, which is going to be more and more important for us as we continue to work with people on Medicare. We are also in the process of making it possible for members to pay for Better through their FSA or HSA dollars and even one day have Better reimbursed by insurance under the money being set aside for care coordination services.
