Put the Health Back in Healthtech: A Product Manager’s Perspective

Put the Health Back in Healthtech: A Product Manager’s Perspective

Build a healthcare-savvy team; build successful healthtech products

Good healthtech products are really hard to build. Every year healthtech attracts great technologists who have had personal experiences with the broken healthcare system. And yet, along with myriad silent disappearances, there are publicly reported flops in healthtech from scrappy start-ups and tech giants alike. What are some of the common pitfalls? And what can your company do to safeguard against them?

Map the players – patients, providers and payors – and understand their motivations

61% of digital health companies that start B2C end up pivoting to B2B and selling to insurance companies, employers, hospitals, or other healthcare providers. Some of this strategy change is natural growth – healthtech companies pilot by selling directly to consumers, and then gain traction and bigger partnerships. But many healthtech companies shift to B2B selling after gaining a hard-earned understanding of the healthcare ecosystem from some time in the field.

We’re all familiar with the patient-provider-payor dance in healthcare. Your company is (likely) trying to improve the health outcomes of the patient, whilst also delighting the provider, who bills your payor. Unlike in many commercial technology businesses, where customer usage and retention tells you a good story about the value of your product, the feedback loop in healthtech is more opaque given this complex tri-partite structure.

One way to minimize the swirl created by this fuzzy feedback is to map your patient, provider and payor stakeholder groups. If you like graphical tools, this might be useful. With each group, identify:

  • What success looks like. Simple phrases about each stakeholder, “Make it easy for the provider to pay for our screening test” can turn into company initiatives, which in turn can be used to guide product roadmaps.
  • How stakeholder incentives are aligned with this vision of success
  • How stakeholder incentives are not aligned
  • 3 most-likely failure modes

This exercise (hopefully) doesn’t pivot your direction, but instead helps clarify where you have dark or blind spots. Re-do the stakeholder exercise quarterly or twice a year to ensure alignment between your roadmap and the healthcare ecosystem.

Understand governance, risk management & compliance (or know when to ask for help)

Healthcare is a regulated industry. Depending on your company’s specialization, if you run a lab, you’ll be working with CLIA requirements; if you’re building medical devices, you’ll be working with the FDA, etc. These efforts require specialized dedicated resources. Additionally, almost all healthtech companies will be working with HIPAA protected data. Healthcare data is a hot topic today, including everything from massive data breaches to data-landgrabbing.

Product teams have to account for data compliance in your product strategy, design and implementation cycles. Basics & resources on HIPAA that product teams should know about include:

  • Various public cloud solutions now have HIPAA compliant offerings, including  Amazon Web Services, TrueVault, Aptible & ClearDATA
  • Remember HIPAA is more than technology – the regulations include incident response, risk assessment, operations management, policies & procedures and security & compliance. Training is required for anyone handling Protected Health Information (PHI). Compliance cloud platforms can help you manage this & the associated auditing: Reciprocity Labs, Aptible & ClearDATA
  • Your product managers (as well as your engineers) should be familiar with these HIPAA dev resources published by HHS

Establishing and maintaining trust in your healthtech product offering is core to your success. Give your teams the time and resources to manage the regulated aspects of the product in the right way, and save the headlines for your victories, not compliance violations

Pay extra attention to the seams

So you’ve built a beta release. Now for testing! Health problems are deeply human, and therefore the software solution workflow is embedded in a complex, multi-layered context: the real world. This is the zone in which healthtech products most often fail. Successful healthtech products are 1) integrated into the user’s workflow – and sometimes two or more stakeholders are users, and 2) interoperable with existing software or hardware solutions.

  • Test early. Get your software into the users hands for feedback as soon as you can. Reid Hoffman famously said “If you’re not embarrassed by your first release, you’ve waited too long to ship.” In healthtech it is important to contextualize these early releases carefully – e.g. make it explicit to friendly users or pseudo-users that this release is for feedback only; ask if you can demo live and shadow them in their workflow to see how they use the product etc.
  • When doing customer research and gathering feedback, explicitly ask about the various usage contexts for different users. Pay close attention to what other software or hardware your solution needs to interoperate with to minimize friction. Try to understand what happens if workflow integration and interoperability doesn’t happen – it’ll help you prioritize, and more quickly understand your larger scale usage data later on
  • Articulate priorities around integration and interoperability to get a clearly prioritized roadmap, plus decision documentation. A useful tool for this is MSCW prioritization.

Real world usage context is a challenge for any software development effort. It is even more critical in the world of healthcare which includes high stakes decisions, quirky and complex workflows in a time-scarce environment. Elegant integration & interoperability will beat fancy features anytime.

There are lies, damned lies & statistics. Be rigorous.

There are often two types of evidence generated and used by healthtech companies – marketing data and clinical evidence. Marketing data is used to quantitatively describe the benefits of the product. These results must be real and attained through rigorous analysis, however they have not been achieved in a clinical trial setting. Clinical evidence is generated by running an experiment (the gold standard is a randomized controlled trial, but there are various other methods) which is designed to test the protocol’s impact on the intended outcome given a controlled context. Your product teams must understand the differences between these types of information, and communicate results clearly throughout the organization to avoid confusion around data claims.

Most healthtech products that are aspiring to be paid for by insurance companies will likely need to run a clinical evidence effort at some point. Get your team ready for this by familiarizing them with scientific writing. It’ll also keep them current on the medical research in your product area. Some resources:

  • Stanford uses this paper to teach to students the basics of academic reading
  • How to read a Clinical Trial provides an overview of how to interpret evaluate a clinical trial, and provides context on the statistical rigor involved in generating clinical evidence
  • Bradford Hill Criteria provides a great framework for unpacking the logical consistency of a clinical trial

These are good tactics for building a rigorous culture of scientific literacy in your product teams. Deepest expertise in this area, will come from team members with degrees focused in epidemiology, e.g. Masters of Public Health (MPH), or MS in Epidemiology and Clinical Research etc.

We all know healthcare is broken and we believe in the power of healthtech improve our lives. Understanding the complex healthcare ecosystem, accounting for governance requirements, thoughtfully developing for real-life user workflows and establishing a culture of scientific rigor will help you change healthcare for the better, ultimately both faster & stronger.

Elizabeth Brook Garrity

Elizabeth Brook Garrity

MDisrupt Guest Author

Elizabeth is a product manager with experience developing machine learning software-as-a-service. She developed her healthcare chops as a program manager at at UCSF, and at Dartmouth’s Masters of Public Health program. She started her career as a management consultant, after graduating from Harvard.

If you are a health tech founder looking for guidance on building or growing a healthcare savvy product team, talk to us—we can help.

The Critical Role of Medical Affairs in Healthtech Companies

The Critical Role of Medical Affairs in Healthtech Companies

“Great discoveries and improvements invariably involve the cooperation of many minds.”
Alexander Graham Bell

Medicine is shifting toward a more personalized, value-based experience. As this transformation continues, healthtech companies need to be able to communicate the value and clinical differentiation of their solutions more effectively. This will require incorporating healthcare experts, who are usually hired into medical affairs roles.

This, in turn, will require tight collaboration between the medical affairs group and other groups within the company, including commercial, R&D, market access, and product teams. Katie Anders, the head of medical affairs strategic solutions at Medscape, said, “Today, medical affairs must liaise with their R&D colleagues and fully grasp the science that supports their work. They need access to real-world data. They need the strategic thinking abilities and insights of their marketing counterparts, and the customer-facing skills of those in sales. And they must understand and operate under all of the rules and regulations governing industry interactions.” The healthtech companies that adopt this strategic model will ultimately create more clinically and commercially viable healthtech products and increase their chance of widespread adoption.

The importance of generating real-world data 

According to Bain & Company (see figure below), 88% of US physicians consider real-world evidence a top criterion in their prescribing practices. Within a healthtech company, medical affairs can play a key role in helping to generate the real-world evidence required for health products to be widely adopted in the marketplace.

The Critical Role of Medical Affairs in Healthtech Companies 1

Furthermore, medical affairs experts are poised to help educate not only physicians, but also payers, to identify relevant data and real-world applications for higher quality patient care.

An overview of the medIcal affairs role 

In health companies, medical affairs departments evolved to serve as an independent counterbalance to sales and marketing departments. In FDA-regulated companies, specific laws dictate the claims that sales/marketing can discuss versus the information and indications that medical affairs is allowed to discuss.

Medical affairs very specifically never carries a quota and their KPIs are not based on sales performance or projections. The healthcare industrial complex is conditioned to expect different things from a medical affairs professional than from a sales/marketing professional—it is almost impossible for a single individual or department to serve both roles effectively, since the natural tension is part of a successful balance.

The essential elements of the medical affairs role are to:

  • Be the voice of and advocate for the patient. For example, would you want your doctor to be acutely aware of the likelihood of a false positive result? If so, then medical affairs needs to be the voice for the company’s collateral to meet this need.

  • Represent the needs and concerns of healthcare professionals

  • Be trusted by our healthcare professional clients.

The cross-functional role of medical affairs

If medical affairs departments are deployed and embraced strategically within a healthtech company, they can play a critical role in various aspects of the organization, including:

  • Business development Accelerate business development efforts when assessing new technologies for acquisition

  • KOL programs Engage and develop KOL-led sites to generate appropriate, necessary data proof points required for successful go-to-market strategies. This data generation allows the healthtech company not only to showcase its capabilities to other physicians, but also to payers for reimbursement strategies

  • Medical content Provide support for marketing in reviewing content and advising on messaging that resonates with target medical audiences

  • Product development Be a core part of the product development process to help make products with the correct product-market fit that truly solve  problems in health care

  • Market access Foster an understanding of the reimbursement landscape and provide the scientific messaging and dossiers so that payers understand the added value and ROI of their technology.

  • Stakeholder education Educate physicians and other potential stakeholders in health care. Help educate the leadership and commercial teams on how to accurately and effectively communicate about the technology with their customers.

  • Spreading the word, scientifically Medical affairs team members can also be medical spokespeople at conferences and with the media, by writing articles for scientific and medical journals as well as speaking at medical society meetings.

The value that medical affairs can bring to a healthtech company

McKinsey & Company interviewed numerous medical affairs executives to create a 2020 vision for medical affairs. Collectively, they identified  four aspirations that would create the most value for their organizations as well as the industry as a whole:

  1. Enhance patient access to, and best use of, optimal medical treatment
  2. Embrace patient-centric healthcare
  3. Facilitate coordination and integration of different medical data and types of knowledge
  4. Acquire and develop talent

Along with broadening the spectrum of external stakeholders with which medical affairs interacts, healthtech companies that strive for increased internal interactions will further excel.  These examples show how medical affairs can provide significant value to healthtech companies:

  • To further enhance patient access: medical affairs can collaborate with market access efforts to demonstrate economic and medical value.

  • To embrace patient-centric healthcare: medical affairs can collaborate with marketing colleagues to create collateral that integrates patient advocacy groups.

The preferred way to engage with healthcare professionals is changing; the primary focus is now on improving health outcomes for a greater portion of the patient population. If medical affairs collaborates with internal forces to provide business intelligence, business development, marketing, market access, and sales with a more patient-centric perspective, medical affairs’  value within the organization will increase. Providing real-world data, and increasing access to it, creates an opportunity for medical affairs leaders to leverage data while continuing to establish and maintain trust with external stakeholders and the medical community.

Medical affairs professionals who want to lead the change must be involved in various projects across the organization and communicate not only to the medical community but also to colleagues within the organization. This collaboration will only become more critical as therapeutics increase in complexity and as big data is utilized to assess outcomes in a value-based system. 

Daniela Crandall MHS, PA-C

Daniela Crandall MHS, PA-C

MDisrupt Guest Blogger

As a clinician, I’ve cared for patients in outpatient, operating room, and inpatient settings. As a sales director in healthtech, I created strategic direction and handled tactical business plan administration and talent management. As a director of medical education, I was in charge of training strategies for both sales professionals and surgeons. Medical affairs experience included engaging KOLs, making C-suite level presentations, and engagement with healthcare systems, payers, and medical device executives.

Incorporating medical affairs into your company

If you are in the healthtech industry and want to assess the value of increasing medical affairs involvement with your organization, consider engaging with our consultants. We all want to provide the highest-quality care for patients; having  medical affairs experts work closely with your company can accelerate the widespread adoption of your health product. Talk to us—we can help.

We wouldn’t make drugs without chemists. So why make digital health products  without behavioral scientists?

We wouldn’t make drugs without chemists. So why make digital health products without behavioral scientists?

Humans are complicated, and changing our behavior is hard. 1, 2 Despite all the hype about artificial intelligence and personalization, most consumer-facing behavior change tools are incredibly unsophisticated, relying on basic self-tracking and superficially-tailored feedback to change behavior. Techniques known to be highly effective, such as such as disrupting habit streaks, and linking contextual cues to behavior, 3, 4 are noticeably absent in most digital health products. Maybe this is why most of these products don’t actually work.

Using science to sell apps—but not to build them

Most consumer-facing apps are not scientifically informed. 5, 6, 7 And even when they are based on evidence, implementation of the science into the product is often poor. 8, 9 This lack of science, however, does not prevent companies from using science to sell apps. On the contrary: A recent review found that over 40% of the most popular mental health apps invoked scientific language to support their effectiveness claims yet just one of these apps linked to published literature. 10

Many of the solutions being pitched or sold to us are behavior change solutions – buy this, wear that, ingest these insights about yourself, and you will be freed from pain, sleep better and lose weight! But peel back the marketing claims, and investors and consumers alike may bristle to find out that—to mention just a couple of examples— sleep-tracking apps can make insomnia worse, 11 and the published benefits of a daily blood pressure monitoring app (whose makers just raised $12 million 12) were based on just 2% of those sampled. 13

An alarming number of companies are publicizing results using inappropriate statistical techniques. For example, conducting what is known as a completers- only analysis involves selectively analyzing only those data from people who completed the trial/experiment, and ignoring the data from people who quit. This approach makes it way more likely you will conclude your product is amazing, because the people who make it to the finish line are inherently more motivated. We want to see your intent-to-treat results, which include the people who dropped out. It is also worth pointing out that the same statistical rules apply to both big and small data. Yet amid the promise of big data, many people have grown increasingly comfortable eschewing the fundamentals. 14, 15, 16 We need to remember that methods matter too: Applying the right statistical analysis can’t overcome bad execution or study design.

The mainstream media, investors, consumers, and industry players have been sold on the idea that behavior change is one appropriately timed nudge away and that we can educate our way toward healthier living. The expectation that exists in the space is wrong: You cannot simply click ‘like’ to change your behavior. 17

So how do you change behavior?

Behavioral science can help us design for behavior change, and build technologies that not only spark change but sustain it. 18

Behavioral science is the empirical study of human behavior across the lifespan. It encompasses fields such as psychology, cognitive science, public health and economics. Behavioral science emphasizes how context, and the social and physical environments, play profound roles in behavior, beliefs, and decision- making. People are different, context matters, and things change. 19 This table lists some behavioral interventions shown to effectively address common health problems.

  Links for references below correspond with number bubbles above.

Links for references below correspond with number bubbles above.

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Behavior change science can tell us what works and what doesn’t. 35 If digital health technology companies ignore behavior change science, they will fail to produce meaningful, long-lasting results. 36

Behavioral science + 21 st century technology

Behavioral science has undergone radical transformation in step with the technological revolution. No longer must we rely on humans to self-report what they are doing—now wearables and sensors can passively detect behavior throughout the day. And in instances where we must ask people questions, new technology-enabled methods can illuminate the behavioral context, such as what the person is doing while sedentary, having cravings, and feeling blue. 37

The data accrued from these newer methods are reinforcing long-held (but previously untestable) hypotheses about the non-linear nature of change. 38, 39 They also enable us to intervene at the right time. 40, 41 In other words, we can get closer to automating human support than ever before. These new data also provide strong evidence that conclusions drawn from group-level data are extremely imprecise for individuals. 42 Fortunately, we can now optimize interventions at the individual level and realize the power of behavioral phenotyping. 43

For example, let’s consider how people react differently to self-tracking. We know that some people reject it because of waning motivation – they get negative feedback and stop tracking themselves. Measuring individuals’ determination, resilience, and/or coping style can provide insight into who will benefit from consistent tracking and feedback. For those who respond poorly to consistent tracking, reframing failure as within one’s control can overcome the tendency to avoid. 44

Wellness apps: A behavior change opportunity

Historically, our focus has been on helping people once they get sick, focusing our investment dollars, product pipelines, and healthcare reimbursement strategies toward treating disease. On its face, this makes sense: There is a lot of sickness to treat. Six in 10 US adults have at least one chronic disease, and four in 10 have two or more. 45 By 2030, the number of adults with three or more is estimated to almost triple from 31 to 83 million. 46 Including lost productivity, the economic burden of chronic disease is estimated to be a staggering 20% of our gross domestic product or $3.7 trillion. 47

But, what if we helped people before they got sick? What if we could recoup some of that $3.7 trillion, and pump it back into our economy? Lifestyle behaviors drive most chronic disease incidence, morbidity, and mortality. 48 These behaviors include smoking, excessive alcohol consumption, insufficient physical activity, and poor sleep habits. 49 With the help of science, these behaviors can be changed. And while there exists a dizzying number of consumer-facing wellness apps that claim to change these behaviors, very few have published evidence to indicate that they do so in any meaningful way. 50

Shockingly, even highly valued healthcare startups do not publish peer-reviewed evidence on their apps’ effectiveness. 51 If we are to move the needle on health, this indifference toward evidence and limited use of science must come to an end. We simply cannot afford to fall victim to the illusory truth effect whereby we accept evidence to be true based on how often we hear it repeated.

Digital health won’t advance without behavioral science

Digital health companies should have behavioral scientists embedded in their product development teams from the very beginning. Companies should also include behavioral science in their medical affairs departments, for both evidence generation and strategic leadership. The most forward-thinking companies will have chief behavioral science officers. 52

Within product development, behavioral design should operate in concert with user- experience design. 53 Behavioral design involves translating science into products and services. In addition, behavioral science should be positioned to work alongside analytics and data science. Establishing behavioral-data science architecture is necessary for many reasons, including planning experiments and interpreting users’ engagement data. Digital health companies need to go beyond a focus on the number of monthly or daily active users and ask themselves, what effective engagement looks like. 54, 55

Four questions for evaluating a product’s behavioral claims

  • What evidence supports these claims?

  • How was this evidence generated?
  • How is behavioral science informing product/service design?

  • Who is responsible for pilot tests/experiments?

Remember: Behavior change is hard. Science helps.

gina merchant

Dr. Gina Merchant, PhD, MA

MDisrupt Guest Blogger

Dr. Gina Merchant is a behavioral scientist specializing in digital health. She is an expert in user/patient engagement, how our social networks influence our health, and behavior change design. Gina has a PhD in Public Health, and an MA in experimental psychology.

Disrupt has a network of behavioral scientists; If your company needs this type of expertise to help you build your health product, talk to us—we can help.