July 28, 2023 Health, Product Management

Healthcare Roadmaps: Crafting Unique Patient-Centric Healthcare Experiences Amidst Other Priorities

In my years leading product and technology teams across various healthcare companies, balancing unique patient experiences with the integrity of foundational medical care has always been a core focus. Our objective is clear: enhance the patient journey without compromising quality.

In healthcare, we cannot risk gimmicks as our customers – patients in pain – expect excellence. This blog post explores how to strike the right balance between supporting core healthcare experiences and building truly differentiated features while utilizing limited technology resources effectively.

Whether dealing with chronic health conditions (Parsley Health), depression/anxiety/PTSD (Mindbloom), poor sleep (Proper), or long-term back pain (Vori Health), there are lofty standards of patient care to meet and we cannot spend all of our time on delightful, yet risky, whiz-bang features. This said, without creating a truly differentiated and delightful patient experience, these nascent companies cannot get a leg up on the entrenched industrial healthcare complex or other venture-backed competitors.

The Nuance Between Product Vision and Product Strategy

When developing any product, it’s essential to have both a clear product vision of long-term goals as well as a product strategy of critical near-term milestones.

The product vision sets your 5-10-20-year north star goals for the project. The product strategy is the collection of near-term milestones that allow you to continue on your journey toward the vision. The early strategic milestones in nascent companies are often behind-the-scenes moments like fundraising, key hires, or closing early sales deals.

Said another way, you can’t be a visionary if you fail to survive your early journey. The good news is that you don’t always have to create a well-tuned finished product to achieve these early milestones – for example, your operational margins need not reach their long-term targets and your technology stack may have technical-debt-by-design in the early stages.

Although a polished product isn’t an immediate requirement, a compelling value proposition is vital to attract investment, secure talent, and build customer trust. Striking a balance between foundational robustness and innovative flair is essential. Striking a balance between innovation and sustainability/durability is crucial.

A Balanced Approach

Accepting both the need to differentiate and that the product isn’t “done” in these early years, I tend to advocate for the following resourcing mix when starting out in healthcare:

30-40% for elevated activation/onboarding experience
30-40% for core healthcare experience
10-20% for high-value differentiated feature development

1. Elevating Onboarding/Activation Experience (30-40%)

An effective onboarding process is foundational to be successful as you can’t have a healthcare business without patients. In most of my roles, we’ve created dedicated teams focused on moving users through the awareness > consideration > conversation > activation funnel.

Excellence here requires continuous testing, quality analytics, a learning culture, and a fastidious mindset of experimentation, iteration, and improvement.

At Vori Health, we took a number of steps to improve our onboarding funnels, including:

Adjusting our technical architecture for agility, breaking these components away from our other core services to allow for faster development and deployment
Investment in specialized analytics instrumentation, including privacy-compliant session recording and anonymized aggregate analytics
A heavy focus on qualitative insight, through in-flow surveys and 1:1 interviews

We combined these approaches with deep cross-functional collaboration with our clinical and operational teammates to completely rethink the order of our onboarding sequence and drive a 700% improvement in our first-visit conversion rates.

2. Core Telehealth Experiences (30-40%)

There are no shortcuts in healthcare once patients are onboarded and are receiving care. The patient/provider experience needs to work flawlessly and ensure patients have frictionless access to the care they need via common features like scheduling, messaging, video conferencing, care plans/notes, and other medical-specific features (i.e., lab, imaging, testing integrations).

In an early-stage healthcare company, these foundational (aka commodity) telehealth features rarely need to be differentiated. As such, selecting a partner/vendor for these core telehealth services is a prudent path. Some things to keep in mind as you review vendors:

Compliance features. HITRUST and SOC2, in addition to HIPPA
Mature developer documentation, APIs, and SDKs
Realistic roadmaps juxtaposed with feature release notes that demonstrate a proven history of delivery
Robust partner integrations to share the load across the telehealth service landscape
Outstanding customer references
Strong revenues and/or investors to ensure the company is in it for the long haul

Interestingly, as your healthcare business grows, there are very compelling reasons to move away from vendor solutions, including costs as your scale, opportunities to differentiate your patient experience up and down the journey, and creating both small and large feature-specific operational efficiencies (at scale, every 1-2% efficiency boost has major impacts on COGS and margins).

3. Differentiated Feature Development (10-20%)

Consumer-centered onboarding and standard telehealth features are unfortunately not enough to win for patients, payers, and investors. As such, I always withhold a stream of technology resources to develop unique features that differentiate the company and build intellectual property/enterprise value. These features must address specific patient needs and leverage cutting-edge technologies. Here are a few recent examples:

Vori Health (Musculoskeletal care)

We built “Motion Guide”, a computer-vision-assisted physical therapy app that uses pose estimation ML models to track patient movement and then provide real-time and personalized corrective feedback.

Proper (Sleep health)

We built a sleep behavior tracker that helps customers understand sleep-impacting and sleep-promotion activities. There are 101 sleep trackers on the market, so we build something new, based on the leading clinical evidence – cognitive behavioral therapy for insomnia (CBTi) – in a beautiful engaging package.

Selection of these product efforts and features is of course hyperspecific to each business and should be done with the very best product discovery/experimentation/validation rigor that Marty Cagan and others speak to so eloquently.

Creating differentiation is both an art and a science and if you are relying only on gut instinct you are bound the fail. Sit with your customers, brainstorm widely, test ideas cheaply, prototype quickly, and keep iteration until you get closer to the truth. This is the fun stuff, for sure.

Striking the Right Balance

In conclusion, creating differentiated healthcare experiences while maintaining high standards requires a well-balanced approach to resource allocation. The mix of resources between activation, core experiences, and differentiated features should be an ongoing conversation without a one-sized-fits-all formula. To succeed, a combination of creativity, customer engagement, and rigorous testing is essential. If you’d like to discuss this topic further, feel free to get in touch.

March 21, 2022 Health, Product Management

Supporting Sweet Dreams: A Product Journey from Concept to Impact with Proper Sleep + Behavior Tracking App

As the Product Management Leader at Proper, a Redesign Health portfolio company focused on sleep health, I had the incredible opportunity to spearhead the creation of a groundbreaking consumer-facing product that changed the way our customers understand and optimize their sleep. Our journey from ideation to delivery was a remarkable adventure that brought together sleep science, novel user-centric design, and our passion for enhancing people’s lives through better sleep.

Inception and Ideation

The journey began with a vision to empower our customers to take control of their sleep quality and duration with the most research-supported intervention for poor sleep, Cognitive Behavioral Therapy for Insomnia (CBTi) – and to promote our consumer products (evidence-based, premium sleep supplements).

The science is clear: behavior change changes sleep quality. We recognized the growing importance of sleep in overall well-being and were eager to provide a tool that allowed users to bridge the gap between their daily behaviors and the quality of their sleep. Our goal was to create an intuitive, data-driven app that helped users uncover new insight into how their daily routines impacted their sleep patterns.

Our product and design team conducted thorough market research, analyzing user needs, pain points, and existing solutions. Armed with insights, we embarked on an ideation process that encouraged diverse perspectives. The world didn’t need another sleep tracker; rather we needed to build a behavior tracker that used sleep tracking metrics as core outcomes. Brainstorming sessions and design thinking workshops with customers and clinicians fueled our creative process, leading us to a clear vision of the Proper Sleep + Behavior Tracker.

User-Centric Design and Iteration

To ensure our app truly resonated with users, we adopted a user-centric design approach. We engaged in user interviews, focus groups, and usability tests to gather feedback at every stage of development. This iterative process allowed us to refine the app’s features, user interface, and overall user experience.

The app’s core functionality was designed around the concept of self-reporting sleep-promoting and sleep-detracting behaviors. Users could effortlessly input behaviors such as bedtime consistency, media exposure before sleep, and dietary choices. These inputs, combined with sleep data from wearable devices or self-reported, formed the foundation for our data-driven insights.

In close collaboration with our product design partners, XXIX, we executed this vision with a novel visual identity that supported touch-friendly mobile inputs and circular, clock-inspired data visualizations.

The Proper Sleep + Behavior Tracker revealed correlations between sleep-promoting and sleep-impacting behaviors.

Testing and Validation

Testing was a pivotal phase of our product development journey. We created prototypes to simulate the app’s interactions and visualizations, seeking user feedback on usability, clarity, and overall appeal. Our team’s commitment to continuous improvement drove us to refine the app’s mechanics and aesthetics based on the invaluable insights from these tests.

During this phase, we fine-tuned the data algorithms that correlated sleep behaviors with sleep quality. Rigorous testing ensured the accuracy of our trend detection and data visualization components. Through this iterative process, we evolved from an initial concept to a robust product ready for deployment.

Delivery and Impact

The culmination of our efforts was the Proper Sleep + Behavior Tracking app — an elegant fusion of sleep science and user-centric design. The app empowered users to recognize the effects of their behaviors on their sleep quality and duration. Daily behavior inputs were artfully visualized alongside sleep data, providing users with real-time feedback on their sleep hygiene practices.

We optimized our data visualizations for both mobile and web devices, ensuring a seamless experience for users regardless of their preferred platform. Over time, the app’s trend analysis revealed patterns and correlations that allowed users to make informed decisions about their sleep-promoting and sleep-detracting behaviors.

The app was also leveraged by our team of Sleep Coaches, who worked 1:1 with Proper’s best customers to understand and improve their sleep outcomes.

In Summary

The Proper Sleep App represented more than just a technological innovation; it symbolized our dedication to improving lives through meaningful data insights. Our journey—from ideation to delivery—showcased the power of collaboration, user-centric design, and iterative development. The impact of the app extended beyond the digital realm, influencing positive behavioral changes and promoting healthier sleep habits.

As a Product Leader, being part of this journey has been a privilege. It reaffirmed my belief in the transformative potential of user-focused product development. The Proper Sleep + Behavior App not only enriched our product portfolio (supplementation is of course a data-backed, sleep-promoting behavior) but also enriched the sleep experiences of countless users. As we continue to evolve and innovate, this project remains a testament to our commitment to enhancing lives through thoughtful, data-driven solutions.

September 3, 2017 Health

How I’ve Adjusted My Diet to Master My Metabolisms and (Hopefully) Prevent Disease

I’m writing this post because someone close to me was recently diagnosed with a common and treatable form of cancer. My hope is that these thoughts are helpful for them, and others, as they reexamine their diet and lifestyle that may have contributed to their condition.

My opinions on diet change – rather, are refined – constantly. This is what I find works for me now, as I spend more time tuning into my body and correlating my body’s response to different stimuli, whether diet, exercise, mental health, and more.

I have to mention, that working with my wife’s healthcare company, Parsley Health, can help provide a framework, data, and clinical support for making critical changes in ones diet and lifestyle. I’ll also include some links below that I found helpful in my early education.

Some Basic Truths (As I See Them Now)

Sugars and its more complex form, carbohydrates, are generally unhelpful. Unless you are living a hyperactive lifestyle (rare in the modern age). Carbohydrates can be helpful if aggressively training, doing physical labor or want a few extra hours of pep once in a while but otherwise, they cause more harm than help.
Eating a high protein / fat / veg diet is generally a good fit for our predominantly sedentary (office work, driving, instagramming) lifestyle. Historically speaking, we should probably be eating more aligned with ‘famine’ than ‘feast’.
Reducing sugar consumption reduces inflammation. Inflammation, for me, reveals itself as a testy mood (and biting humor!), bad skin, depression, and joint pain. Inflammation generally leads to really bad things, including in theory, cancer.

What I Eat

What I Eat, Anytime

Caveat: fat is more caloric than carbohydrates so you can’t go apesh*t with this stuff. If you eat more than you burn, you will gain weight. The good news is that generally, a high-fat diet is more sating and you’ll have less of an urge to binge.

Avocados
Eggs
Oily Fish (canned sardines, smoked whitefish, and cured salmon are my favorites)
Low Sugar Nuts (macadamia, walnuts, almonds – cashews and other ‘sweeter’ nuts are out)
Tart, organic berries (blues, black, straw)
Healthy Fats (olive oil, grass-fed ghee, macadamia nut oil, coconut oil)
Organic, Grass-Fed, More Expensive, Hard to Find, Elitist-Unless-You’re-A-Small-Farmer, Meat (85% ground, bison, pastured happy bacon, dark meat poultry, low-mercury fish, etc)
Plant-Based Protein Supplements (pea protein is a good additive to shakes)
Salt
Spice (cumin, coriander, curry, etc)
Heat (fresh chilies, no-sugar hot sauces. Heat becomes a very good friend when you cut our sweetness)
Leafy Greens (kale, chard, etc)
High Acid, Low Sugar Citrus (lemons, limes, but not oranges)
‘Filler’ Vegetables (cauliflower, cabbage, summer squash, brussels. These guys are saviors – low calorie and often low nutrient, but terrific ‘bases’ to dishes to absorb fat and flavor and keep you full/busy eating)
Coffee / Tea (blend in some MCT powder or cacao butter in the AM and you’ll find it easy to delay your first meal and stay in a ‘faux fasted’ metabolic state until 11a or later)

What I Eat, Once In A While

No-Sugar Alcohol (dry natural zero-residual sugar wines, clear liquors like tequila mezcal vodka and gin)
Organic Seasonal Fruits (tomatoes, apples, peaches, etc)
Rice and Other Unsweetened Gluten-Free Carbs (so, I love Schezuan food, and I will half a half-helping of white rice when eating that food, but generally speaking this is a total cheat and should be done on rare occasions. French fries also fall into this category. I’ll have them when they’re good, but mostly not. Fun tip, french fries + mayo >>> french fries + ketchup. The addition of fat to the carbs helps mute your glycemic response. That response is a double negative when you add super-sweet ketchup to the potatoes. Again, pick your spots for this stuff – maybe 2x a week)

What I Eat, Basically Never

Sweet Alcohol and Other Beverages (all beers, all ciders, aperitifs, sweet vermouth, tonic water, sweet industrial wine, aka most wine)
Breads / Sweets / Ice Cream / Dessert (this goes out the window when I travel to France, but I absolutely feel it on the flight home)
Gluten Free Breads / Sweets (to be clear, these are metabolically disastrous in the same ways as gluten-full bread would be. Avoid)
Sweet Veg with Hidden Starches (corn, bananas, sweet potatoes, sweet winter squash)

Things That I Also Avoid For Other Reasons

Gluten. I’ve tested removing this on and off over the past 4 years and am clear that I generally do better without it. I bring it back in the fold on special occasions, with good results, and I have a hunch that a low-carb diet helps me manage the occasional high-quality gluten feast.
Dairy. Correlates with acne, so I avoid it.
Mid / High Mercury Fish. Large fish like tuna, mackerel. Heavy metals stay in your body indefinitely and removing them through chelation is a pain.
Processed Foods. Generally speaking, there are almost always nasties hidden in here.

Example Meals

Breakfast

Nothing.
- I don’t want to side-track us here but your body is probably designed to thrive fasted for upwards of a week, so skipping brekkie is no biggie.
- Don’t sweat hunger. A 3 day fast is a good way to get to terms with this feeling. It’s really not a bad skill to master, and I don’t want/mean to sound like a sadist. Hunger pangs pass quickly and I don’t find them to be a big deal.
- A fatted coffee (above) can help you feel like you’ve eaten while tricking your body to think it’s in a fasted state
- Counterpoint #1: Humans are almost certainly better designed to fast at night than in the morning. Moving your metabolic clock off your circadian clock is generally a bad idea. That said, evening fasting is much harder to do socially, so I think an AM fast is better than nothing — anything that limits your digestive period is probably a good move.
- Counterpoint #2: Per the circadian point above, fasting / low carb probably makes more sense in the winter than in summer (fewer available natural carbs, less sunlight)
Bacon & Eggs. Pastured bacon cooked without draining the pan with absorbing veggies (cauliflower, kale, onions, summer squash), fresh chilies, garlic and topped with two pasture eggs
Whitefish Omelette. Veggies cooked with a bunch of ghee, 3-4 quality pasture-raised eggs, whitefish, sage.
Protein Shake. I like Parsley’s Rebuild shake but actually find it a bit too sweet for me, so I’ll make it 50% rebuild and then doctor up the fat (MCT, coconut, cacao butter) and protein (naked pea protein) content

Lunch

Organic Buffet. There is a conscious Korean buffet near my office that offers a bounty of healthy, low carb options. I’ll often go with greens (both collards w/ garlic and kale with pepitas), baked salmon and some chicken salad
Nopal Taco Plate. My favorite NYC taco chain, Los Tacos Numero 1, opened an awesome in midtown, even more awesome is that they offer a cactus-based plate with salsas, beans, guacamole, and meat. I alter my order by skipping the cheese and tortillas
Chinese. Schezuan dry pot. Tons of flavor, mystery ingredients, and very little sugar/carbs outside of the rice which I eat sparingly and sometimes not at all.
Baked Chicken, Rice & Beans. Ok, so this is cheating, but intentionally so. Sometimes my body NEEDS carbohydrates and I give it some good one. This is a rare occasion, but perhaps: I had a bit too much to drink the night before, I have a big evening ahead (physically, socially) where I know I’ll use the extra energy, or I’m simply feeling depleted and I know my fix.

Dinner

Cauliflower and Ground Meat Stir Fry. Cauliflower, summer squash, okra, onions, cumin, cardamom, salt, fresh chilies, a little fresh tomato if summer, ground meat. Sometimes a bit of well-sourced chorizo goes into the pan first to add additional flavor. Top with parsley, lemon, and sea salt. I could honestly eat this every day.
Baked salmon and a ton of veg. Enough vegetables and you don’t miss the starches
Seafood curry. Full-fat coconut milk plus quality curry powder and whatever vegetables and seafood look good that season. Cauliflower or cabbage can add filler to replace rice.

Dessert

Ha, made you look. Help yourself to a second glass of residual sugar-free wine instead.

Thoughts? Disputes? Want to argue about nightshades? Great recipes to share? Shoot me a note.

Additional Reading

June 22, 2017 Health

My ketogenic experiment, aka ’empty is the new full.’

I celebrated my first Father’s Day last weekend with a 48 hour fast. I still know how to party!

My goal was to experiment with the ketogenic diet, which is said to have numerous benefits including weight loss, inflammation reduction, cancer management / prevention and improved mental clarity / performance. I am lucky to not suffer from any major known ailments, but I wanted to give it a try as I’ve learned deeply over the past few years that I am truly what I eat and the idea of a “self clean” cycle is quite appealing. I cut out gluten in 2014, dairy in 2016 and, well I guess now “food” in 2017. I kid, a bit.

Ketosis or “keto” is a metabolic state where you body turns fat > ketones > energy, instead of the more modern use of carbohydrates > energy. You can enter a ketogenic state by either truly fasting or tricking your body into thinking it’s in a fasted state. You do the latter by consuming ~75% of your calories from fat, ~20% from protein and ~0-5% from carbohydrates. With these macro ratios, you can stay in a state of ketosis indefinitely.

Proponents of ketosis argue that the human body evolved – and thrived – in a state of feast and famine, which is quite opposite to today’s super consistent / available / non-seasonal calorie bonanza.

Gentlemen, Stop Your Engines

I prepared for my keto experiment by enjoying a low carb, high protein, high natural wine dinner on Saturday. On Sunday and Monday, I treated myself to a few coffees blended with coconut oil and medium chain triglyceride (MTC) oil.

The fast went surprisingly well. Only at 4p on day two was I slightly bothersomely hungry, and that passed within an hour. I limited my physical activity, but felt good and slept well.

I entered at ketogenic state (as measured by urine test strips) mid-day day one, with my ketone levels increasing throughout the fast.

Maintenance

For day two dinner, I broke my fast with a dinner of fatty bacon, mixed in with summer squash and mushrooms. Not bad at all. I thew in a ‘ dessert’ of coconut milk, avocado and a half packet of stevia (gross by darn my sweet tooth).

My break-fast mealThe amount of fat required to maintain keto is daunting. Especially as our modern western brains attempt to unpack all of the “low fat” marketing that clogs the airwaves. As I entered ketosis, I became keenly aware of all of the high sugar products marketed to us – ice cream, burgers, breads. I wanted them badly! I think the key is maintaining a diversity of lipids. Olive and coconut oils are saving my ass, especially as I find ghee a turn-off (must be from my dairy-free palette). Nuts – macadamias are the best combo of fat minus carbs – also help out a bunch. And the coffee delivery method is key – my morning recipe is 1tsp MCT oil, 1 tsp coconut oil, 1 tbs ghee and a pinch of cinnamon. Delicious.

I began exercising day three and felt great. A short HIIT run felt better than average. There is research indicating that oxygen efficiency is boosted in keto. Divers particularly enjoy keto as it greatly increases their dive and breath holding times. Strength training felt good, perhaps because it felt good to move after a few days of fasting.

Early Outcomes

It’s been a less than a week, but here are some of the notable takeaways:

I feel pretty fantastic. Euphoric really. That’s awesome
My energy has been very good, and constant throughout the day
My skin has improved. Sugar starvation is great for inflammation, including breakouts
I’m rarely hungry

However, it’s nearly impossible to eat out (“I’ll have your fattiest steak please, with a side of olive oil” has been said more than once this week) and my cooking options are quite limited. As some of who loves food / cooking / taste diversity this is a problem. It’s also a bit painful to remove even more from my diet, especially after already maintaining a gluten and dairy free lifestyle.

Next Steps

All in all, I’m super pleased with this experience – both the fasting and the state of nutritional (non-fasting) ketosis. I’d like to continue to experiment and practice both in the future and add them to my toolset when I need a boost or change of pace. I’m already thinking about the following regimens:

Keto Mornings: eat early the night before (6p) and mini-fast until lunch the next day, with only a MCT/coconut oil coffee in the AM. (2x a week)
Keto Quick-Weeks: fast Sunday PM – Monday AM, and then do strict keto through Wednesday / Thursday. (1x a month – 1x a quarter)

My thinking here is that a break from our carb driven diets has to the a helpful change of pace for our metabolisms. The euphoria is a nice bonus too!

This meal meets the appropriate ratios. Watch out for those tomatoes! Carbs are hidden everywhere, sigh.

Resources

Dr. Dom on Tim Ferriss. Even though Dr. Dom’s built like a linebacker, he’s done some of the most thorough metabolic research in the business. The links in the podcast’s ‘show notes’ are excellent.
Carb Counting Spreadsheet. Good reference. You will google a lot on ketosis, and often find yourself disappointed. “brussels sprouts have 1.8g net carbs! man!”)
Ruled.Me. Great overall resource, including this veggie guide.
Keto SubReddit. Dig carefully.
Eating Academy. The hard science.