Tom Spann, Co-Founder, Vice Chairman and Chief Operating Officer, left a “pretty good job” at Accenture to create a company that helps patients manager their health care insurance. Accolade is hired by companies like Comcast to serve as a go-between for its employees and health care insurers. The company goes far beyond understanding why health care costs what it does. It works to help patients get the best bang for their buck by understanding what care people really need.
Tom Spann is Chief Executive Officer and co-founder of Accolade, Inc., an innovative consumer services company dedicated to improving the healthcare experience and helping individuals and families get the right care the first time.
Steve Krupa: I’m here to welcome Tom Spann, co-founder, vice chairman, and chief operating officer of Accolade. Welcome, Tom.
Tom Spann: Thanks, Steve.
SK: Accolade is doing a lot of interesting things in terms of getting consumers to interact efficiently with their health care product, mostly insurance. And it sort of gets to the first question, which is I don’t think health care scores well on customer satisfaction rating and so forth. And the industry is sort of in a state where they’re generally not popular with their customers.
SK: And it sounds like – and I think it’s part of the mission of your company to change that. Is that what you’re up to?
TS: Yeah. I mean nobody’s going to mistake any of the big health care companies, particularly the big payers, as great consumer experience creators. And you know, it’s interesting. I worked at Accenture for a long time before starting Accolade, and the Uniteds and Aetnas of the world paid us a lot of money to help them not talk to their members. Like come to the web, and it’s a shame because it’s probably one of the places that people most need a great level of service, a great experience. And it’s not just the payers. You know, providers are often in the same situation. And it’s part because – you know, it’s interesting to take a wide view, it might be the paternalistic nature of medicine, to some extent. But I find companies in health care, it’s never about the patient; it’s never about the consumer. It’s about the company and what they want to do. Like I need you to do this assessment, I need you to do – you know.
TS: And it’s like you might actually need to listen a little bit and understand what they want, what their goals and dreams are. You know, you want to create a good experience, you gotta make it about them, not about you. And so that’s what we’re trying to do.
SK: It’s like they’re doing you a favor, right? We’ll let you go to the doctor if you have to.
TS: Yeah. Some of it’s understandable, right, because you say, look, there area people make so many errors in health care, when you’re getting health care. You know, we call these process errors, whether it’s entering the system in the wrong place or not having good conversations with the doctors or not complying with – whether discharge instructions or just taking their meds. And so I think they put in a lot of speed bumps and barriers to make it hard to do the wrong thing, which on some logical level makes sense, but nobody’s making it easy to do the right thing.
TS: And that’s kinda what we’re focused on.
SK: Yeah, it’s funny. We’re both in the health care business, and I’ve reached the age now where I actually have more interactions with the health care system than, say, I might have had 15 years ago. And I never have a good interaction. I don’t. And I’m of course aware of it, and I know kind of like ins and outs, so I can explain to myself how to get through it. But I can’t imagine – what do you think life – I mean you guys much have done some survey on that information. What is life like for a less informed health care consumer than, say, us? When they turn around and they find out they’re sick or they have to go in for an operation and they start accessing care, they must be completely confused.
TS: Yeah. I mean we did some research when we were starting out, and it was interesting. We asked people to do collages, one of the health care system and one of the health insurance business. So you might imagine the health insurance business was all bears and monsters and scary things. But the health care system overall, it was kind of this notion of, the way I sum it up is they do miracles really well, but it makes me crazy. I can’t even get a camp form for my kid, right? It’s the simple things that are really hard to do, but if I need a miracle for my kid, they can do that, so I’m happy about that. But we think of the experience that the reality of people, consumers in health care right now is there is – one is just there is a non-trivial health literacy problem. And sometimes even people that know a lot about the health care industry, there’s elements of benefits or health care they don’t know about. But 50% of people in this country are health illiterate, including to the Institute of Medicine. And people with low health literacy cost twice as much as people with high health literacy. So that’s a big issue. And then one thing we’ve learned a lot in our six years serving people is emotions play a huge role in, I think, the errors people make. It’s pretty well established in the science the kinds of errors people make in decision-making, and fear keeps them away from the doctors, and doing things they need to do sometimes, and anxiety doesn’t lead to very good decision-making. And it’s an emotional time. So we’re trying to deal with that. And then the third thing is they just, you know, 100% of people have real stuff. I can say “stuff,” right? Going on in their lives. You know, Sol Weiner, who’s on our medical advisory board, has done some really interesting research. And I’ll sum it up. I won’t get this quite right, but probably two-thirds of all waste in health care isn’t biomedical errors. It’s not the doctor prescribing the wrong drug for the protocol. It’s the doctor missing the fact that the patient’s not taking their meds because they can’t afford them, or people are too busy, or the doctors are – culturally they don’t talk about their substance abuse problems or they don’t question the doctor. It’s all these other things going on in people’s lives. Or they’re a busy executive and they don’t have time to go to the doctor when they should, or they put up with the system the way they should. And so that drives a lot of the errors as well, and there’s nobody helping them get over those kinds of barriers and finding alternatives. Particularly, the other thing is it’s just so fragmented. I mean the health care system is fragmented, and then you take payers, particularly large self-insured employers, and they just add 5 to 25 to 45 more programs. People just don’t think about all these things until they need it. So we felt you needed to simplify that, create one place to go and start to create someone who knows you with less transaction. The problem with that fragmentation is not only people don’t know where to go and so they don’t do anything, it’s also everybody you talk to only knows a piece of your story. You have to repeat it a hundred times, right?
SK: Yeah. I think that’s – I was having a conversation the other day, and we were talking about waste in the health care system. And I made the observation that you just know there’s waste in the health care system the moment you go see a provider, right? Because where else do you have to continuously fill out all that information over and over again? They know nothing about you every time you show up. Is that possible?
TS: Right. And after you fill that out, you still don’t know what’s going to happen, how much it’s going to cost you, who’s going to pay for it.
SK: Right. And so when I go to buy my Adele CD, right, because she’s got the new record out, I go onto iTunes to buy it, I hit a click, they’ve got my credit card, they know my email, they know where to download it, they know to download it to my phone, they know to download it to my wife’s phone. They know everything about me, but the health care system can’t figure out what my Social Security number is or anything when I go to a doctor. And I can feel the waste just when I arrive. So you’ve made it your mission to change that. And it sounds – it seems to me as I learned about your company. When did you guys – when did the light bulb come on, and what did you think you were going to be doing when you started the company, was it about seven years ago now?
TS: Yeah. So it’s, actually, I left my last job – actually, it’s interesting. It wasn’t my idea. It was our founding investors, and they recruited me into this world. So it’ll be nine years ago this February.
SK: And you left a damn good job to do it, Tom.
TS: It was a great – I used the phrase, “perfectly good job” under my breath more than once. But no, I wouldn’t have traded this decision for anything. And it’s amazing how little I knew about health care, just because I didn’t know the consumer experience. But the basic premise of taking over all the consumer touch points that an employer pays for, everything from member services to all the care management programs, one for nurse lines, everything, and just trying to create one integrated and seamless experience made sense to me. So we’re fortunate enough after a little while to sign up Comcast as our first customer and test the notion against – with 25% of their population against the other 75%. And we knew the first day. I think we got a whopping total of 30 some calls the first day in 2009. So almost six and a half years ago now. Just the calls were somebody obviously who could barely get off their bed, you know, their back pain was so severe, and their MRI was stuck in the system somewhere, and we had to get it unstuck so they could see their back surgeon on Friday. But in getting it unstuck, they gave us the opportunity to tell them they had options other than surgery, which they had no idea they could get injections or something else. And educating them at that moment was great. And just the stories, the first day a woman calls us. She’s just found out she’s pregnant. She had lost her first baby at four months without even knowing she was pregnant. She didn’t realize. She’s 300 plus pounds, smokes and drinks.
TS: You know, we had somebody we could build a relationship with who really wanted to have that baby. And she did, and has a healthy baby. So just, it was like we’re getting opportunities, we’re identifying conditions before there’s ever a claim for them. We’re identifying these contextual barriers and helping people to overcome them. We’re basically just helping people get the right care the first time. We could see it from day one. We had a feeling that was going to save money. We knew costs were going to go up, right, and people are spending more on meds, there’s more doctor visits, there’s more preventive visits. There’s certainly more behavioral outpatient visits. But over time, I mean it took a lot less time than we thought because we see pretty good first-year savings. But we could see basically just people spending less time in the hospital.
SK: So how much – so when you went to Comcast and closed your first order with them, what did you tell them that you were going to do? Were you going to essentially be an ombudsman for their employees in terms of interacting with their benefit and their provider networks and so forth? What was the pitch?
TS: Well, we sort of told them we were going to reinvent the experience for their families of how they experience their health care benefits. So it meant we had to do everything that health plan currently does when they answer the number on the back of the card. So part of it is we replaced the number on the insurance card, which is a big piece of what we do. Because two-thirds of those calls are people about to use care. And that’s part of what allows us to get in front of so many of these episodes. And then the ones that aren’t people about to use care are people really grateful that we’ve untangled their bills and claims and whatever. And so they’re – it creates a kind of relationship that’s sticky, I guess, to say the least, and gets us a net promoter score of 70. So we told them that’s what we would do, that we would combine that with a lot of – I’d almost say traditional interventions, right? I mean we would go through the data every night. We’d get these claims because we’d give them the service. So that’s kind of nice. But we can identify gaps in care and all those kinds of things.
TS: And what’s going on. And we can help people with their chronic conditions like a disease management company. We can help people do treatment decision support like many companies have done. We can do nurse triage kinds of things. We just, you know, by getting our arms around the whole problem, being able to meet people no matter what condition they have, no matter where they are in the process. It could be they haven’t seen a doctor yet for the symptom or they’ve been trying to get it addressed for years. We had to be able to do it with a combination of services and clinical interventions, but in sort of our own unique model, build on influence science. So a lot of what we do is really provide, apply good, well, I sort of call it the influence science, but social psychology, psychology, all these sciences. And that’s a piece of why I like the more inbound model. And people give us a hard time say, well, you’re being reactive. You’re waiting for people to call you. Well, first of all, we’re addressing 90% of the claims dollars in the population every year. We do do outbound where we really see we’re missing something, but we sort of don’t need to do it. And it’s principles like consistency and reciprocity that really are leveraged. They called us, right? Eighty-eight percent of our relationships start with an inbound contact.
SK: And do you think they’re expecting a good experience when they call you? Maybe they are now, but do you think in the beginning they were sort of expecting you guys to be difficult, if you will? Oh, I’ve gotta call customer service.
TS: Yeah. We benefit. I often wonder – I’ve been surprised how long the net promoter score of 70 has held up because I thought to some extent we’re just benefitting from an exceptionally low bar, having been set by people calling the number on the back of their insurance card and not expecting much.
SK: Yeah, I expect a fight. So like I’m calling you, but we’re going to get into an argument, right?
TS: Yeah. One of my favorite stories is the one where they started out, “You guys didn’t pay my ambulance bill right.” You know, she’s just angry and upset. But you can feel that drop, that anger, when you say, “Oh, I totally understand how that must make you feel.” Just want to let you know we’re not Aetna or United or whoever it is they’re angry at for they think not paying the claim, right? We don’t pick a fight, but you called just the right place. We’re on your side. We can help you get this. You can feel them just exhale. [unclear] “So how do you know this ambulance claim wasn’t paid right?” “Because I take my daughter to the ER every two weeks for her asthma and this one was paid differently than all the others.” And you look at the dashboard and you see that mom is bipolar and off her meds, and unless you address that, you’re never going to be able to help this young girl with asthma. And so it’s this combination of data and technology and then human touch. If that woman had called a health plan, she would have gotten her claims fixed, but that person would have never wanted to go to “How are you doing?”, you know, and just sort of get to her issues. It’s amazing how often people call, particularly parents call about their kids. And you ask them how they’re doing, and it’s – you learn a whole lot more.
SK: So is your – Comcast was your first customer, so I’m assuming that this product, at least initially, was something that the more proactive, self-insured employers would be drawn to. And I think I read that you have a relationship with Independence Blue Cross down there in Philly. So I guess two questions. One, was Independence involved in the original Comcast pilot? Because I would imagine you need some help getting the data and the information. And then the second question is, have you been growing beyond the self-insured into the insurance company market?
TS: Yeah, so Independence Blue Cross was involved. They were one of two big plans. Although even in the pilot, we probably worked with seven or eight different plans, everything from Tufts in Massachusetts to Aetna at IBC. But IBC was a big piece of the population. And every time they saw our results and we started talking with them, and we think we’ve got a solution that’s good for everybody, basically, in the United States. But it’s customers who really need to be the organizations accountable for the cost of the care. That’s where the benefits accrue, right? If we’re reducing hospital days and reducing medical costs by 10 plus percent, then that’s the first thing that’s going to pay us to do this. And so IBC put us on their fully insured book last July, so we’ve been serving them for a little over a year. And that’s gone well. And so that’s kind of fun. We signed our second insurance company, health plan customer. We launched them in October, and that one was a hospital-owned health plan. We got another hospital system, Temple. We’re seeing a lot of interest from providers as they think about being accountable care organizations.
SK: Yeah. Well, I mean so the real question is you’ve got an ROI story, I’m sure. If I think through it, I say the ROI probably breaks down – you’re probably changing the utilization dynamics in terms of moving people more to medicine and psycho-social treatments as opposed to ER visits and hospital stays, hopefully.
SK: But I would also imagine the employer is getting significant absenteeism and turnover benefits, perhaps. Are you able to measure all of that through your customers?
TS: In all honesty, I wish we were better at measuring it. We’ve seen some of those results. I mean it’s a mix of having good absenteeism data, and also I’d like to see longer – in some ways I’d like to see longer pilot versus control situations. So most of our employer customers, we saw early – first six, let’s say, we started with doing half the population, a quarter of the population, some subset, in comparing the results to the rest. And when we do that, we can see the absenteeism and productivity benefits. But then they pretty quickly want to put us against the bigger piece or all their population. So and they’re of course doing a lot of other things to drive –
TS: – drive people showing up to work every day. So it gets harder to measure. I wish we were better at measuring it. But I think a lot of evidence is out there that says, look, if you’ve been – take a dollar out of claim costs then you might be taking at least another dollar in productivity benefits, whether that’s absenteeism and presenteeism. I mean when we see hospital inpatient days going down 20 plus percent, I mean that’s gotta be somebody who’s either back at work or not distracted at work because their kid’s in the hospital. I mean it’s gotta have an impact.
TS: And I’d love to be better at measuring it. But I think employers understand that. And they also just understand the value of employees appreciating their employer for offering a benefit like this. This is a – health care, is a kitchen table issue for an employee and their spouse and family.
SK: Yeah, absolutely.
TS: It’s when being an employee of Comcast or Lowe’s or one of these companies hits home.
SK: So when I call in, I’m actually speaking to a person, but my sense is that that person has access to some pretty cool technology in order to help them navigate me through my issues, right?
SK: Give me a sense for what you’ve built and what you’re building for that.
TS: Yeah. If you think about how broad this job is, I mean particularly our nurses, a third of our health systems are registered nurses. So they’re trained and able to answer any kind of question. It could be everything from I need a new ID card to what’s my benefit here to I’ve got this rash, to I don’t understand what my doctor’s telling me. Or I’m feeling some symptom from meds. Whatever it is. And we have that broad a scope, of a role. We really had to design the technology for a purpose, right, it was kind of built for a purpose to do this. And gets all the information you need at their fingertips. And it’s gotta be not only about the clinical things, but again, given the psycho-social context importance, we have data for every employer and every community on what resources are available. I’m always surprised at how many people go on disability and wind up making food for medicine tradeoffs, right? And so we get them food banks so they can get their meds. Or sometimes it’s just you need things. … There’s some great clinics in 30 Rock, so if you’re a Comcast or NBC employee, that’s the right place to go for certain things. And so having all that, there’s resources that help people that are busy or financially strapped or whatever overcome barriers is a big piece of it. So the technology is there. And what’s cool is as we learn, we can continue to improve the work flows, right? We’re – from an analytics and data science side, we’re studying one of the – I think it’s one of the coolest problems, at least, if not most important, which is what works and doesn’t work to influence somebody to do the right thing for their health care. That’s a really important part of it.
SK: Yeah. So it’s sort of the social science of how you get people to comply or to act in their own best interest in terms of health care, which everybody will say is a huge challenge, right?
TS: Yeah. And you hate to say everybody’s different, but everybody’s different. So and there’s – it not just clinically different. Even if they clinically look a lot alike, it’s really nice to say this is the protocol, but if the person can’t afford it or they can’t get there, or they’re flying around the country or around the world as an NBC correspondent or whatever it is, you gotta figure out how to make that work for them. And that to me still requires a human. And then all the influence science says the power of relationships is important, right?
TS: I think when you have a professional, and we think of it a little bit like a financial advisor, when you have a professional that you trust as competent and you like them and they’re treating you like a friend instead of a customer even, then we can be much more influential in getting people to make good choices and execute on them.
SK: So I would imagine the health plans are looking at your model and at some point trying to figure out whether or not they should compete with you by building their own capabilities or contract with you. My sense is that they’re behind where you are considerably. But you’re probably early in this market. I’m sure you’ve got some competitors. Where do you feel you spend your time trying to differentiate yourself relative to other people that want to do this, other companies, and the health plans themselves?
TS: Yeah. Well, we focus most of our efforts differentiating ourselves on results, right? So one of the advantages of working in health plans and, probably more importantly, working in this jumbo employer space is I talk about it as pilot versus control. But the controls aren’t – the control group, they’re the best of generally, usually health plans saying “Hey, we can do this too.” And so we’re like OK, let’s just go head to head. Let’s see what the changes in utilization are and see what the net promoter score is of us. And so more and more of our customers are out in the market saying health plans can’t do this, right, they can’t – you sort of alluded to their rankings in the consumer world.
SK: Do you know their net promoter score?
TS: What’s that?
SK: I said you must know some of their net promoter scores.
TS: Yeah. I mean the average is negative five. You know. And so it just – I think it’s hard to recover because it’s hard to be the person who says no. Right, because consumers know that the health plan is the decision-maker; they think they’re the decision-maker and whether or not their care is going to be paid for. And so you just – when you’re calling for – and these things happen to us all the time. When you call in for bariatric benefits, you know, by the second or third phone call with that woman, we can get her to disclose that she’s bulimic and we can influence her to not get bariatric surgery until she deals with her eating disorder. But that’s never going to come up if she’s talking to a health plan.
SK: That’s right.
TS: No matter how good that service is, right, or that I’m a meth addict or whatever, all these things that are real issues with real families in this country. And so if they could integrate all their services and replace all their technology and if they could deliver a much upgraded service experience, I still don’t think they would be trusted given their position. And if you’re starting from, you wouldn’t design it that way. You wouldn’t say, OK, the company that pays the doctors and decides what gets reimbursed is going to be the company that’s going to create the great consumer experience. That doesn’t make much sense if you were starting over.
SK: Well, listen, I’m not going to ask you to answer this question; I’m just going to make a statement. And that would be that as you begin to grow, those very same companies are going to look at you and say, “Maybe we ought to acquire this business,” and I hope if that were to happen, that wouldn’t dilute your mission here because the mission is so important. The health plans weren’t really built, in my opinion, to have a consumer-oriented value chain. They were built –
TS: I think that’s right. And I think the more innovative ones are moving there. We are very proud of our relationship in Independence Blue Cross. We had interesting discussions around sharing the branding here, right? Their members know exactly the person they’re talking to works for Accolade. But they also know that if they didn’t have an Independence Blue Cross product, they wouldn’t be getting this level of service. So I think something is working there, and I think we’re seeing more and more health plans thinking about being consumer-centric organizations and innovating around the consumer.
SK: Right. Well, look, I mean if the deductibles keep getting bigger, right, and the choices keep being presented, almost in the form of a private exchange environment in a lot of these health plans, but even the large employers will be serving up health plans administered by health plan A, and a health plan administrated by health plan B. There’ll be choices in networks and how much comes out of your pay. All of those choices are being pushed out there in different combinations today, and that’s been a growing trend, not a declining trend. So as long as the consumer is going to end up having to be a part of this, the value chain has got to change, and the best way for them to change, I think, is to begin to adopt an expert in that. And it feels like that’s the way you’ve positioned yourself here.
TS: Yeah. I saw an interesting – you talk about higher deductible plans. I don’t know if you saw the study out of Berkeley last week, I think it was, where they basically said there’s no evidence that consumers in high deductible plans are better shoppers than consumers with low deductible plans. In fact, basically they said they just use less health care. And that’s what we see in the data. They just like, “Holy cow, this could be scary, this would cost you money. I’m not going to the doctor unless I really have to.” You know, not a way to optimize long term costs and get rid of these errors. Not to say these plans are bad, but they’re certainly bad with no support for a real human being to get to the right care at the right time.
SK: Yeah. I mean my whole career I’ve been turned on by the idea of getting the consumer engaged. And we’ve made investments along those lines. Certainly, one of the investments we made was to promote a high deductible plan under the thought process that some of the market actions that the consumer takes will have an influence. But there’s a counter argument to that. The counter argument is that higher deductibles sort of act as an obstacle for patients that are either chronically ill or on their way to chronic illness from accessing necessary care. I’m hopeful we’ll be able to create some sort of a hybrid model that gets to that issue where we can have an engaged consumer and we can also make sure that diabetics aren’t not seeing the doctor when they need to.
TS: Right. I think we see a fair amount of people going paycheck to paycheck where financial barriers are non-trivial, right?
TS: You want to find ways to get rid of those. But I think you can do that with the right combination of plan design and great support for people. And the other interesting thing is we’re doing a lot of the shopping for the consumer. So you look at – you know, we’re finding we’re this really cool platform for other innovative solutions, so Comcast has Castlight, for example. And our health assistants use that like crazy. I think we’re seeing 10x utilization from us because people, you know, they want to know what’s this doctor visit going to cost. And they think it’s a simple benefit question, but we can make sure, well, it depends if it’s in network or out of network; “Do you have a doctor?”; “No I don’t”; “Well, let’s find you a doctor”; and we can use quality and price transparency tools in ways consumers wouldn’t even have thought of using them. Or get them to telemedicine. Seventy-five percent of the weekday appointments with the doctor on demand at Comcast this year were from us. You see a lot more utilization of these things at the right time by just having a professional help move you around. So that’s pretty cool.
SK: So I want to get to a more personal issue here, but I want to give you a chance to give us some sizing parameters for the businesses, sort of to wrap up that portion of the discussion. Number of customers, number of members, a ratio of engagement. Where are those business parameters at today?
TS: So we’re serving 600,000 people today.
TS: We’re targeting to – we’re just having discussions, preliminarily targeting to get to a million by the end of next year. So it’s a cool business. It’s growing fast. Dozens of employers, although some of them are through our relationship with Independence Blue Cross, which is kind of a single contract there. But we really sense we are at an inflection point where people are starting to get it. It was fascinating to go to conferences this year compared to three years ago, and hear people talking about meeting consumers where they are. You know, the whole notion of consumer engagement that a lot of people were talking about three years ago, and obviously you’ve been in it for a lot longer than that, just feels different, how people are talking about it now.
SK: Yeah, they’re talking about it with a level of sincerity. I always felt years ago they were talking about it with a level of sort of hope that the idea would go away. But I don’t know –
TS: There’s been a lot of that, yeah.
SK: And look, your company is a nine-year overnight success, which sort of gets to this whole notion that I hope we’re getting to the point in health care where great ideas are tried a lot more quickly than they had been in the past. But certainly in this venue we’re getting there.
TS: What I love about where we are with Accolade there, and I’ll tell you, I don’t want to talk about Comcast too much, but Sean Leavitt came in after we had been serving Comcast for a few years, and he sort of really pushed this on his vision of we can be the company that rapidly introduces and tests all these new tools and innovations, right, without re-fragmenting the consumer experience. I think what you worry about when you have a great autism product and a great stress relief product and a great – you know, all these things, is that it’s still, it just could be more fragmented and more confusing. But put them on our platform, get a ton more use out of them, see the results and sort of help employers understand who’s delivering the best results and who isn’t by sitting at this center of the consumer relationship.
SK: Very good. So talking with Tom Spann, co-founder, vice chairman, COO of Accolade. Sort of wrapping up our discussion, I’d like to just sort of get into an interesting topic for me as a venture capitalist, you know, we take companies from sort of the beginning to the stage where they become very large, and the founders have the opportunity to build their own culture, create their own – I always say you’re creating your own country, right? Whatever values you want to have, you can have in your own company. Nobody can tell you what they ought to be. But as you progress along the way, you divvy up in the beginning management tasks based on what has to get done and eventually you give yourself titles. And you’ve been the CEO of this company for quite a while, and I think you made what seems to be a personal and professional decision to become the chief operating officer and hire yourself a boss. And I’d sure like to understand, in whatever level of detail you’re willing to share with us, what led to that decision and how you feel about it.
TS: Sure. I think part of what led to it is the realization I’m not sure you can have the company you want, but you do a company that looks a lot like you. All of its cultural flaws I think build on my personal flaws too. You wind up taking everything very personally. But it was interesting. The slightly long version of the story is we almost went down a path of hiring a COO as I wanted to have more operational discipline. When I stepped back and reflected on it, I said, you know what, this company is a really interesting point where it obviously needs to scale. When you think all 300 million people in this country need health assistance, and that’s a big market opportunity which requires a level of technology investment and talent, that becomes critical. We need to up our game in analytics and data science where we had a great team doing great work; it’s just, again, it’s just a hugely broadly scoped problem as we think about being a platform and understanding how all these other tools are working. That was important. And then so anyway, it just – as I looked at it, I said, what we really need is to become much more of a technology company without losing the human soul, that’s important. And so I went to the board and said, that’s the kind of skills we need, and I think we ought to offer the CEO title to make sure we get just the right person, the best possible person. Because I just kicked around hiring a chief product officer –
TS: – and I just, you know, you just get a different level of person. I’m not sure I would know what good looks like, and as much as I pride myself on starting my career as a COBOL programmer, I’m not the modern technology guy that Accolade needs. And so there are points where I thought – I was always amazed at how many amazing technology executives were interested in the role, which made me feel great that we could attract the kind of talent we could attract. But there were days where I thought, you know, we weren’t going to get that combination of killer technology and product skills and somebody who got our culture and skills, right? The one thing you don’t want to screw up in a business like ours is the culture.
TS: And that would kill me to do that. But I think we found that person in Raj Singh. So November 2, beginning of this month, we announced Raj was our new CEO. And one of the attractive things about Raj was he was able to bring a couple of folks including Mike Hilton, one of his co-founders at Concur, which was – he and Mike founded, really the two of them, and turned it into one of the largest SAS product companies in the world. So the fact that Mike and Rob Cavanaugh on the sales side still wanted to work with Raj said something about the guy as well.
TS: And they were also just good guys. And so –
SK: You know, a lot of these guys that have done it before end up being mission driven, too, right, to say, oh, I had my home run or I did well, and now I want to go get my hands on something and make a difference in health care. That’s why I think health care appeals to a lot of those guys, you know?
TS: I think that’s right. I think, you know, there was a piece of that in Raj that reminded me of me nine years ago. These guys are nine years younger than me, right, so there’s an element of here’s somebody who has had some success and probably could kick back, but really wanted to do something that made a difference in the world, like me, wants to set a good example for his kids in terms of what he’s accomplishing in life, and not just play golf and retire. And so he’s got that passion, I can tell. He was looking at health care before we were introduced, and I think he tells me he’d almost given up on starting a health care business. But when he saw Accolade and kind of came to visit and meet health assistants and hear them serve clients and sit with them, he calls it our dirty trick. We pull in people; you gotta fall in love with the business when you do that.
SK: Well, listen, Tom, thanks for sharing your story with us. I really appreciate you talking with me today.
TS: Steve, it’s been fun. I enjoyed it. Thank you very much.
SK: All right, thanks.