Aledade’s Patient Engagement Playbook | Douglas Streat, COO Aledade Care Solutions

Douglas Streat unpacks how they built patient engagement strategies to support over 2 million patients alongside primary care practices.
Hosted By:
Danielle Poreh and Nikhil Krishnan
Douglas Streat

Show Notes

In this episode of Ops I Did It Again, Douglas Streat, COO of Aledade Care Solutions, joins the thinksquad, Danielle and Nikhil to unpack how they built patient engagement strategies to support over 2M patients alongside primary care practices. Doug shares his tactical advice and learnings on how to create behavior change - we also get to play a fun game during it. It’s our most tactical episode yet.

This episode is sponsored by Out of Pocket, because no one is prouder than us than us:

To register for the upcoming Healthcare 101 crash course course visit:; Use code: IBELIEVEINME for $100 off

You should also check out our courses, including ones taught by yours truly (How to Build A Healthcare Call Center) at



Nikhil Krishnan (twitter:

Danielle Poreh (



Douglas Streat (



(00:00) Intro

(01:31) Introducing Patient Engagement

(04:29) Doug’s Career Insights

(06:19) The Role of Aledade Plus

(08:39) Redefining Call Centers as Patient Engagement

(12:56) Key Performance Indicators in Patient Engagement

(14:57) The Importance of Evidence and Experimentation

(17:05) Patient Engagement Game!! 

(20:12) Challenges of Patient Scheduling

(21:33) Role of Direct Mail in Patient Engagement

(27:57) Staffing Strategies for Rapid Scaling

(32:23) Importance of Characteristics when Hiring

(33:56) Practical Tips for Effective Patient Engagement

(37:45) Conclusions

Podcast Transcript

[00:00:00] Danielle: Uh, I think, uh, episode four is the episode that Nikhil became an operator cause he was, uh, plowing through all these tactical questions.

[00:00:13] Nikhil: I mean, he taught us, he taught us about where to AB test on patient engagement, and then we started AB testing on the podcast.

I I'd say that's live implementation. That's pretty good. I'll give myself a pat on the back.

[00:00:24] Danielle: Damn right. And we got

[00:00:25] Nikhil: to play a game. And we did get to play a game. The game is which of these messages do you think had the highest engagement rate? And so as you listen, you know, you get to guess along too, and see if you get it right.

[00:00:37] Danielle: Yeah, it was a great time. We learned a lot and, uh, he really, uh, just shared all of his best practices and learnings from like seven years of Alidaid. It's no small feat. He has an amazing career story too. I really enjoyed this episode.

[00:00:49] Nikhil: Yeah, we think you'll enjoy it too. So take a listen, tell us what you think.

And there's some practical tips you can implement tomorrow at your org.

[00:00:56] Danielle: Welcome on, Doug! We are stoked to [00:01:00] have you on. This is episode four of the project we didn't think would make it through four episodes, so Giving myself a pat on the back.

[00:01:08] Nikhil: That's commitment right there. Four. Damn right. Four. Four episodes. Well we're excited. Doug has been has been part of our operations uh, you know, knowledge fest sharing group for a while now.

Um, we've learned a lot from him and so we're really excited to have him on. Doug, thanks for

[00:01:27] Doug: coming. My pleasure. Thanks for having me.

[00:01:31] Danielle: Hard to pick a topic with you, Doug, considering your team is like hundreds of people and you do so many different things. But we decided today we'd talk about patient engagement and, uh, the magic kind of secret sauce you've built at Allidate around, uh, getting, getting patients to be really active in their care.

So that's what we're going to talk about today, but we thought it'd be helpful to kick things off with just hearing a bit about Allidade and the behemoth of your team and a little bit about that.

[00:01:57] Doug: Yeah, sure. Uh, it's, [00:02:00] I'm so excited to be here. I've been sort of fangirling over the first few episodes of the podcast.

Uh, you just dropped episode three. I'll reveal that we're recording this just a few hours after you dropped episode three and I cram listened to it, uh, before jumping on today. Um, I'm super excited. And Matthew, Matthew had some great insights on AI. So anyway, glad to be here. Glad to be episode four. Um, I work at Allidade, which is, uh, the nation's largest network of independent primary care practices.

we work with 1500 practices all over the country. Uh, 45 states totally agnostic to what market we work in. We serve more than 2 million patients and we take risk in value based contracts. We help primary care practices, many of whom aren't large enough to do this on their own, some of whom are, take risk, take, do value based care and do it really, really well.

That's what we're focused on. And, uh, I've been here for a while. Alladade's existed for about 10 years. I [00:03:00] joined around seven years ago, uh, and have sort of been on the startup journey at Alladade when I joined. We were about a hundred people. Uh, today we're about 1500. I personally have had a bunch of roles.

I started as an analyst, um, writing SQL all day and thinking about building dashboards. Then decided that I didn't like sitting in a cubicle by myself for 8 hours a day and wanted to actually talk to people became a product manager as is, I think, a tried and tested path for for many people who have that experience, uh, loved doing that.

Was recruited away from, from that work by, uh, one of the few people who probably could have done that, which is the CEO of Allidade Farzad Mostashari invited me to be his chief of staff, uh, which I was honored to do for three years, and then, uh, I moved over to work on a business unit that we called Allidade care solutions to be the chief operating officer, which I've been doing for Uh, just under two [00:04:00] years now.


[00:04:01] Nikhil: What a journey. What do you think is the longer commitment? Uh, you working at Elevate or us doing four episodes of the podcast? Cause it's kind of a hard, it's kind of hard to pick between the two.

[00:04:12] Doug: It's tough to compare, but, uh, um, I'm hopeful that you will see the same revenue ramp on this podcast that Aladade

[00:04:18] Danielle: has.

We are looking for sponsors, so, you know, if Aladade is trying to get on. Yeah, um, actually curious, Doug, a small segue before we get into patient engagement. A lot of folks ask me about career paths and operations and like, how do you grow within that role? I'm curious as you look back. If you were to advise folks that are sitting in that cubicle, listening, being like, I want to get, I want to get into more senior role.

I want to lead people. I want to lead ops. But what's something you would tell them to focus on?

[00:04:47] Doug: I mean, the first thing I say to pretty much anyone who's asking me for career advice, and I have these conversations with my team all the time is the perfect job is where you can find the intersection of what you're good at.

What you want to be [00:05:00] doing and what is needed from you. Uh, and, uh, I think ultimately when it comes to doing great work in operations, it's ultimately about finding something that you love doing that you're decently good at and that the company needs. And that last one, I think is sometimes the hardest piece.

It's like, well, what, what actually is needed from me sometimes? And especially sometimes finding something that is needed that you also like can be hard. So sometimes I think in the early stages of a career, you have to compromise on one of those things. You might have to choose. Like, you know what, I don't love doing this, but it's needed.

Let me do that. but ultimately I think the longterm goal is find a way to be useful and indispensable and, and the rest sort of works itself out.

That's at least, that's the path that I think I generally took. And then there's also a lot of luck.

[00:05:42] Nikhil: There's no, no task too low is the framing. Someone shared with me once where it's like, there's gonna be a lot of tasks that people in the business just don't want to do. If you can become the like dependable person to get that stuff done, it's much easier to like use those chips later when you need to, which I [00:06:00] think is similar,

[00:06:01] Doug: similar vibes.

Yeah, for sure. And I mean, and have the courage to do things that maybe are a little scary or uncomfortable. I mean, I think Nicole, you probably, you know, that more than most people do.

[00:06:10] Nikhil: I am scary and uncomfortable. That's true. You should see a SABS that's scary and uncomfortable. Exactly.

[00:06:19] Danielle: So now you, now you have a massive group, a team that you managed.

Can you tell us a bit about what that team functionally does in the organization and just a bit more concrete?

[00:06:29] Doug: Yeah, so I sort of mentioned we work on sort of value based care with primary care. Uh, we're also a public benefit corporation and our public benefit mission is to deliver better health, better care.

Lower costs, sort of the trifecta, tripartite mission of healthcare. Creating a healthcare system that is good for patients, good for practices, good for society. In practice, that means that what we're trying to do is really align a [00:07:00] lot of incentives. We've been really focused over the first, uh, seven, eight years at Allidade on doing what's great for practices.

And one of the things that we realized is that there's even more we can do. We can do stuff that's great for patients too as an extension of those practices. We can serve patients directly as an extension of those practices. And, uh, that was sort of the genesis of Allidade Plus, uh, where we started thinking about what are some direct to patient service offerings that we can do as a, in otherwise B2B business, to help serve patients in the value based care context.

That became, uh, that became the, the, the foundation that we built Allodid Plus on, and over the last two years that we've been working on this, um, we have built a pretty substantial operation of services that exist as an extension of the primary care practices we work with. So we're, we're never competitive with our primary care partners, but we exist an extension of them.

There are things that [00:08:00] maybe they don't have time to do or. They can't do, or they're not interested in doing, and they can refer to us, hand things off to us, and we can give those patients additional services that are good for them. Uh, and so today it's a team of about 250 people. They're focused on delivering care to patients, uh, as an extension of those primary care practices.

It's about a hundred people actually delivering the services. About a hundred people doing what we call patient engagement, which we're going to talk more about today.

And then a variety of folks in various roles doing products and operations. You've referred to the function as patient engagement, which like

[00:08:34] Doug: is sort of unique because.

Maybe other folks would just call it a call center, right? Like you have folks manning the phone, they're calling. It's like, why do you call it patient engagement? And like, how does that change how you approach it? Um, from like a KPI standpoint or like generally your operating philosophy

around that? Yeah, I love that question.

I've spent a lot of time thinking about this over the last year. Um, and. I originally [00:09:00] called the, called it a call center. And then I was reminded that, well, there's actually a lot of stuff that isn't calling that the team does. We send last year, this past year, we've sent 870,000 pieces of direct mail, 600,000 text messages.

We've printed 500,000 pieces of in clinic materials that get print, that get, you know, hung up on the walls. So like, yeah. Calling it a call center sort of denies all the, the, the importance of all those other things that we just did.

so folks were like, okay, it's not a call center.

It's a contact center. Okay, so great. Contact center includes stuff that's not calling, but it's such a, it's such a sterile term. contact center, it, it just, it, for me, it conjures this image of like fluorescent light bulbs and cubicles in like a giant, giant room with a bunch of people with headsets.

And you can hear all the conversations that are happening next to the person you're talking to next to you. And that's like, that's not what it is. First of all, most of these people work from home. There's no center to speak of, uh, that they're, they're sitting in their living rooms. Uh, and, and [00:10:00] second of all, the goal isn't contact.

The goal isn't calling. The goal is behavior change. It's engagement. And, uh, so to me, the, the, the two words in the phrase patient engagement. Patient is about centering the person that we're, that we're doing this thing for. It's not, it's not a sterile concept. It's a real person. It is a patient. And engagement is about centering the, active thing that we are doing, uh, which is engaging patients and so, uh, patient engagement to me is a more descriptive, meaningful, human way of describing.

Um, contact center type activities.

[00:10:37] Danielle: Did you see the, tear drop on my keyboard just


[00:10:41] Nikhil: This is, you're speaking Danielle's love language of call centers.

[00:10:46] Danielle: Yes, but at the end of the day, the channels that we deliver the care often are the same channels that you would use in a call center, but it sounds like the way that you've approached each one of those conversations is, is distinct.

Can you like give a concrete example or [00:11:00] something of like what, if you were to approach it as a call center and we get on the call, like I would do it this, but because we look at it as patient engagement, we do the same call, but architect it like this. Does that make

[00:11:10] Doug: sense? So I think when we're, if we were a call center, the goal would be to get through as many calls as quickly as possible, you know, just like, let's, let's just like hit some productivity targets.

That's the traditional call centers kind of way of thinking. What's your average handle time is a very common call center metric, which is like how long from the moment you're on the phone to the moment you're off the phone. And you want to make that number as, as small as possible, because that means you're addressing the issue as fast as possible.

For us, doing patient engagement, hand, we, we actually do not use handle time as a metric because of the perverse incentives that I think it creates, which is your goal is to get off the call. In fact, your goal is to stay on the call for as long as that patient needs you on the call to address the issue.

If a patient wants to talk to you about all of their medications, [00:12:00] not just the one you, you called about the fact that they missed their Resuvastat and pick up, but they're like, Oh, Hey, I'm having this issue with my Manjaro.

Can we, can we talk about these cost issues that I'm having? You're going to talk to them about that because that's what they need. You're centering the patient. So I think that's, that's a, probably an example of.

The way that we change the incentives for our agents and the folks that are doing our work. This episode of Ops I did it again, is brought to you by me because no one believes in me more than me. I'm teaching a Healthcare 1 0 1 crash course that starts soon. Uh, you can find it on the out-of-pocket website at out-of-Pocket dot Health.

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So if not average handle time, what are some of the KPIs that you use to measure [00:13:00] success? Yeah.

[00:13:01] Doug: So every agent on our team has, I I would say 3 categories of metrics that we. are holding them accountable to one is, productivity. So there is a productivity target. We don't use handle time, but we do measure, calls per hour.

Are you getting through, uh, are you getting through enough calls in an average hour, but that is balanced by quality, which is we score calls using a rubric and, uh, usually out of 25 points and five uh, ish ish competency areas at five points each and. And you're expected to hit a certain minimum threshold on your call quality.

And every agent at, Aledade Plus gets at least four calls scored every month, and, and sometimes more. Uh, so you're expected to be productive. You're expected to balance that [00:14:00] with an appropriate quality. And then, of course, the third is you're expected to have effectiveness. So if you were churning through calls and getting off the phone super fast, we would see that your leading indicators of effectiveness were good.

You'd might, you might be choosing a call disposition that says, This was a successful outcome. I, the patient will fill the prescription. Okay, great. Uh, but then we have lagging indicators too that tell us whether that behavior actually happened. And so seven days later, I'll look and I'll say, Hmm, that patient actually didn't fill that prescription.

So your call disposition, which was our leading indicator of efficacy, wasn't actually true. And, we'll track that over time as well. So generally. Are you making enough calls? Are they high enough quality? And then are we seeing the outcomes that we expect to see are the sort of kinds of KPIs that we track?

That's pretty

[00:14:47] Nikhil: interesting. I mean, you guys can basically mostly only do that because you have access to like a lot of different data sets to and can connect the patient through them. Yeah, super interesting. So one thing that we talked a little bit about when [00:15:00] we're like discussing Um, You know, some of the topics we want to get in is like the kind of like a B testing you sort of do, uh, in this realm.

Right? So you have these metrics that you're. You know, maybe judging the, the contact center or, you know, your outreach on, but then there's like the methods to write that you're probably testing and trying to see what works with doesn't like, can you really tell us a little bit about some of the experiments you run, how you think about like experiment design and, and maybe some of the stuff you've seen that might be surprising.

[00:15:31] Doug: Yeah, this is, uh, one of my favorite things that I think is differentiated about Allidade relative to a lot of what I've seen in the market, which is, this is probably starts from having a founder who is an epidemiologist and wants to always look at data on pretty much every subject. I was just in a meeting a couple of weeks ago with Farzad, who's Allidade's CEO and my former boss, who I, who I love dearly.

And, and he was literally like in a spreadsheet. Like, in cell [00:16:00] P37, you use the truncate function. Uh, like that's the level, that's the level of depth that Farzad gets into when it comes to data. And so I think that permeates through culture. Our culture evidence is one of our values. And so, we do pretty You can take the man, you can

[00:16:13] Nikhil: take a person out of the Excel sheet, but you can't take the Excel sheet out of a person.

[00:16:18] Doug: That's more of a story. I'm trying to imagine removing an Excel sheet. That sounded very surgical, like we got to excise the Excel sheet from his abdomen. Um, anyway, um, evidence is one validates values. We are really focused on making sure that we know confidently that the things that we are. Doing work like legit work, not like they kind of seem like they work like academically.

We know that they work randomized control trial for propensity match control difference and differences like real academic study designs on little things and big things, but also little things this text message. We're going to do a [00:17:00] randomized control. test. We're going to have a holdout sample. We're going to have a B testing all the things.

Uh, so maybe a good example of that, uh, might be a fun game. We sent a, uh, this was a couple months ago. We sent three versions of a text message script out to patients. And the context here was annual wellness visits. Great value based care visit, get a patient in, review all of their conditions, make sure that they're totally Um, you know, doing great, uh, and if they're not doing great, make sure that that's documented, that you have a plan to address their issues.

Uh, that's, that's sort of, annual wellness visit's a core tenet of, of primary care. We, we consider it part of our core for one of our, one of our key, uh, key techniques in value based care. So we sent a text message to patients encouraging them to come in, three versions. Version A script was basically. Uh, practice name, colon, now is the best time to focus on your health.

Our healthcare team would like to see you for an annual wellness visits. [00:18:00] Call us today to schedule and then reply, stop, help message and data rates may apply, whatever. Version two, uh, patient name, colon. This is your practice. We haven't seen you in a little while and we want to make sure all your health needs are taken care of.

Call us to schedule your appointment. Scripting C was hello from the team at practice name. Our records show that you are due for a checkup with us. Call us to schedule it today. Which one?

[00:18:30] Nikhil: I haven't even, I haven't even looked at the answers and I am guessing it's two. Danielle, what do you think? I,

[00:18:38] Danielle: I feel like too, because there was like the trust thing and there was like the building empathy really early.

And then I was trying to review my notes from Irrational Labs, who's a behavioral change consultancy that was part of KnowledgeFest. And they literally did stuff just like this of like key words and I couldn't really pull it up in time.

[00:18:58] Nikhil: Gotta restudy. [00:19:00]

[00:19:00] Doug: Well, it turns out you're both right. So congratulations.

[00:19:03] Nikhil: People want to just be told that like someone's looking out for them They don't want to feel like they're part of

a protocol, you know Totally and like starting with the patient name. I think was an important one of that. It's like It's like Doug colon, like, okay, you're talking to me.

This is not a spam message. Um, and then, and then, yeah, we haven't seen you in a little while. That feels so warm. You care about me. You miss me. Uh, as opposed to, you know, our record show that you are due for a checkup with us. Sort of sounds like, like That's what my dentist says every year. Yeah. On my birthday.

My mom telling me to do my homework. On my birthday. On my

birthday. Exactly. Give

[00:19:38] Danielle: yourself the gift of

[00:19:40] Doug: cavities. Please. So, yeah, and so, um, specifically we saw the A and C, about 23 percent of patients ended up scheduling an appointment, and on B, 27 percent of patients ended up having an appointment. Um, so, look, it's relatively minor differences, but it's also relatively minor differences in words that have a four percentage point.[00:20:00]

Difference in impact. So, uh, I'm sure it

[00:20:02] Nikhil: all compounds also, right? Like you do a lot of small incremental things and the long term, it's probably like a very high engagement boost.

[00:20:12] Danielle: One of the things that I've, um, heard be really important in the equation of booking isn't. Is, uh, you know, you've got that one point of conversion where now they're like actively engaged in booking it, but then having really, really tight booking times from the point that you like tried to book it, did you experiment at all?

And like, is there a formula around same day appointments? Like, you need to have a lot of slots within 24 hours or just kind of anything formulaic around getting folks into the office.

[00:20:38] Doug: Yeah, so when it comes to actually scheduling what the practice is, which is what this text message was the word I was trying to get, we have, we have a little bit less control over over the practices sort of direct schedule.

So, so we, we can't control for that as clearly when it comes to the practices schedule. In fact. Uh, we [00:21:00] only were able to measure this pretty far downstream. We, we had them call the practice and then we looked at billing months later to see what the impact was. Uh, so that, that's, that's what we did in this particular study.

But we have tested that internally with our own scheduling when we reach out to patients. Uh, and, and we do see that how same day appointment availability is really important when we're scheduling for comprehensive advanced care planning. For example, not every patient wants that. Many of them want to, you know, get, get mentally prepared and be in the right head space.

But some of them are like, yeah, I'm ready now, transfer me. And you gotta be ready to capitalize on that moment. If, if they are,

[00:21:33] Danielle: why didn't you just like send them a mailer to, to sign up an appointment? Like, why, why did you do a text in that case? Sounds like you, you've got the mailer game on lock.

[00:21:42] Doug: Yeah, I mean, we, we actually did for a similar, we did a similar campaign with postcards.

Um, this was focused on patients who were new to Medicare. So, um, sort of a subset of, of the population. Well, welcome to Medicare visit is a sort of standard version of the AWV that's, [00:22:00] um, Just a little bit different, but, but largely the same. And so we sent a postcard to patients who were turning 65.

Welcome to Medicare. Come in for your Welcome to Medicare visit. Uh, if you've elected Medicare Part B coverage. Did it have a stock photo on it? It did have, it, there were several stock photo options, which we all, we also test that sort of stuff too.

But yeah, it had a stock photo. Uh, or I think we also have, we found some There's some interesting feedback that, um, sometimes stock photos, if they don't look like we're like, okay, here's a diverse stock photo, lots of different people on this, you should see yourself in this photo. And then in some of our communities, folks are like, there, there are no diverse families that look like this in my, in my community.

So I actually feel alienated by this diverse photo rather than feeling, uh, like welcomed included by this diverse photo. So that's been actually like from an equity lens perspective, sort of an interesting learning around. Healthcare is local, people are local, and depending on what community you're in, different kinds of [00:23:00] visual identities will be important.

And so we've also started creating, you know, postcards that don't have humans on them, or that just have cartoons, or that just have, you know, healthcare imagery, stethoscopes, stuff like that. Various kinds of options that practices can choose from. But on this, on this Welcome to Medicare visit thing, uh, where we sent a postcard on Welcome to Medicare visit, we actually saw that it didn't work.

Uh, the text message worked, the postcard didn't, and we spent a bunch of time reflecting on why that was. I think it largely has to do with a thing that I made a joke about earlier, which is that when you're about to turn 65, you are getting Like a dozen pieces of mail a day from every single Medicare Advantage insurer Trying to get you to sign up for their MA plan.

And so I mean the

[00:23:49] Nikhil: ads are crazy You just see them on TV. You see them on the billboard like they're everywhere. It's nuts

[00:23:54] Doug: Totally, and so I think we were probably just trying to we were intervening at a moment [00:24:00] That was already very noisy in patients lives And we were we were never going to make an impact on them coming in for for their wellness visit But we're still we're still trying stuff like that What is that?

[00:24:10] Danielle: What's like the last mailer that you were like, this is the dopest mailer ever and like, you're really

[00:24:15] Doug: proud of? I don't have the results on it yet, but I'm feeling really optimistic about a mailer that we sent this fall. We, we called it the Care Gap All in One Mailer,

and it, it's a mailer that, uh, summarizes All of your, all of the open care gaps that we believe you to have based on our data, up to three, because we decided that if we, some patient, there's a long tail of folks who, there's not a lot of people, but some people who have like eight, and we thought it'd be a little overwhelming to get eight care gaps in a, in a mailer, but up to three care gaps that are high priority gaps, um, hypertension, A1C, Uh, medication adherence issues, colorectal cancer [00:25:00] screening, breast cancer screening, whatever else.

Uh, and it, it sort of walks through, here are the gaps, here's what you can do about, here, here's the reason why this is really important for you to do, and here's what you can do about it. We've seen that direct mail, like in envelopes that you have to open. Is actually more effective in general than postcards, um, because it feels less spammy postcards feel postcards feel like, uh, here's another ad, uh, when you have to open the envelope and it's in a windowed envelope, you're like, Oh, maybe this is a bill.

So I'm definitely going to open it and then you open it and you're like, okay, I'd have to read it. And then once you, once you're reading it, you're like, okay, I'm going to finish reading this. Uh, and so we find that that's a really, and it's, it's detailed and engaging and it gives people tactical next steps that they can take for their health.

And so it's good for the patient too. Uh, and so I'm pretty optimistic about this one having a big impact on our, uh, care gap closure rates this year. Stay tuned.

[00:25:54] Nikhil: Isn't it sad that like if you get a postcard and you're like, postcard bad, and then you get like a piece of mail and you're like, [00:26:00] ooh, might be a bill.

And then you open it and you're like engaging with it more. It's like, that's like sad state of the world. Um, Like, I'm curious, like, do you have patients actually fill out what their preference of communication is, or like, at the beginning, do you have, like, some guesses? On what it is. Like I imagine like that's a big part of this, right?

[00:26:22] Doug: I so desperately want to do that today. We don't do that yet. Uh, I, I think it is the next frontier. I actually think this is a really interesting application of potentially of machine learning, where you can say, how long, how long until I hit the keyword? Yeah, exactly. I think, uh, I think this is a really interesting application of machine learning because seriously, you could say like, what are the characteristics of patients that are going to be engaged most with a text message versus direct mail versus a phone call and like, or even you could do this with with visual imagery that I mentioned earlier.[00:27:00]

Like what is the right kind of image to put on this postcard for this kind of patient or for this patient specifically? I mean, with generative AI, you could literally have a custom image on every postcard for, uh, for every patient that was specific to their context. I don't think we're going to go that far, but broader point is we don't do that today in part because it would be really hard to collect all that information in a consistent way and sort of a standard data format, but man, it would be such a treasure trove to, to know that.

And we're starting to. We're starting to test that and learn. And as we build our sort of repository of results, we're starting to build the, the training set that one could eventually, uh, build an ML model from. Yeah, I'm sure

[00:27:38] Nikhil: you have like lots of cohorts of people that like when a new net new person enrolls.

Maybe they look very similar to other patients in that you're already taking care of and can like start making guesses around how they engage their preferred methods and all that kind of stuff. So, um, super interesting. Uh, one thing I wanted to touch on. A little bit is [00:28:00] like the staffing that has to happen behind the scenes to enable a lot of the patient engagement stuff that you guys are doing.

Um, so I'm curious, just like, first of all, you seem to have staffed like extremely quickly, right? Like, I think one thing that a lot of people listen to this might, you know, struggle with is like, look, if you have to start scaling very quickly, how do you maintain? That level of like quality bar that you expect, um, you know, a lot of, a lot of, especially for things like this, where it's maybe more complex patients, there's a lot of training that goes into it.

Like curious if you have any like, like thing you could share with people on like what you've learned from quickly staffing up, uh, in org to support all these things you've been talking about.

[00:28:43] Danielle: And even deciding how, how much to staff up. To, to Nikhil's point around like, uh, forecasting or like any tools that you think were, were good, like, uh, compasses in, in that whole journey.

[00:28:54] Doug: This is really one of the hardest things. And I think we're still learning on [00:29:00] this one. Workforce planning, uh, is. Top priority for my team. If you ask any, anyone on my team about sort of what I'm thinking about going into 2024, most of them would probably say in the top three things, workforce planning, because this year we actually didn't manage demand as effectively as I wanted to throughout the year.

And we had moments where we had lots of patients who we wanted to call and we just didn't have quite enough people. And that's, that's just like hard things. You also don't want to overhire and then have people sitting around without work to do. And, um, matching supply and demand, especially in a world where.

It's inconsistent is, is hard. So I don't have the answer on workforce planning, except to say that we're building, we're building our own models internally, looking retrospectively at what we've seen in terms of seasonality and trends in the past and trying to model as best we can. What I can say is, uh.

This gets easier once you have scale because we can share resources internally. So I mentioned that we have several teams. We have, we have a team of folks that's dedicated to making [00:30:00] calls for comprehensive advanced care planning. We have a team of folks that's dedicated to making calls for adherence, folks that are dedicated to making calls for patient scheduling.

And while those are their default positions, we have had moments this year where you've said, actually, we're going to move some folks from scheduling over to adherence or from, uh, Advanced care planning over to scheduling because that's where that's where there's demand right now. And so, I mean, this is just sort of queuing Siri operations math, but the more you can, uh, the more you can generalize skill sets, the, the more flexibility you create for, for variants.

Uh, so that's, I think that's one, one learning we have generally when it comes to actually hiring in the first place. I mean, we've been blessed with a pretty talented recruiting team. I think some of our learnings there are one. Having evergreen job postings, I think in it, it's common to sort of post a job and then pull it down once you've hired the people you need to hire for that role.

But if you're going to have, if you, if you're operating in a [00:31:00] way that's sort of getting to scale, just like post it and have it there and let people apply on a rolling basis and keep the pool fresh because you're going to have attrition and you're going to want to be able to pull from that. That pool, you're going to be looking to grow.

You're going to want to be able to pull from that pool. So don't, don't need to tie the job posting to a specific requisition number. And then when the requisition number gets closed down, you pull it down. That's a little too tight, you know, bureaucratic and, and formal. If you, if you're really operating an organization at scale, that needs a lot of people who are of the same kind of person, I think the other, uh, insight for us on hiring was to.

To this is sort of like a traditional classic traditional learning, but the sort of, uh, fail fast strategy of hire people, give them a chance, train them as best you can. And then if things don't work in the 1st 90 days, that's okay. Set an expectation that the 1st 90 days is a time to see if it works out.

And if it doesn't.

You know,

and on mutually good terms. We do that sometimes and, [00:32:00] and, and that's okay. Our work isn't for everyone. So that's the other thing I think is just making sure that you don't just sort of let issues linger if it's not working for, for in either direction.

[00:32:10] Danielle: Are there any like interview best practices or tips you can, you've, you've learned through talking to so many folks that others could, could adopt themselves, questions or just like case studies, things that you've seen be really effective at assessments.

[00:32:23] Doug: Yeah, I mean, one thing that I think we care a lot about is consistency in interviews. Um, so easy to introduce bias into the interview process if you ask one candidate one set of questions and another set another set of questions. So we're pretty intensive about people asking. Uh, you know, these are your questions, ask these questions in the interview, um, and you are going to become an expert on asking these questions.

That's the other thing, the more you ask the same sort of questions, the more you are able to calibrate on what a good answer to that question is. If you're asking different questions every time you interview, or you're sitting in a different slot on the interview panel every time you interview, then you're not becoming an expert as an interviewer.

And honestly, [00:33:00] interviewing is as much a skill, being the interviewer is as much a skill as being the interviewee. So, so making sure that people are. Really like tight on what they're asking. That's sort of like number one. Um, number two is I think you, you, there's all sorts of, we mostly ask behavioral questions for, for these roles.

Uh, but I think you also want to assess passion for the work. It's hard work, patient engagement, particularly folks who are on the phones every day. Uh, you are, it's emotionally. You are on the phone with folks who are sick in some form or another, for the most part, and you are talking to them about hard things, and you're trying to drive behavior change.

You're trying to help them help themselves and help us help them. And that takes work, and you have to love doing it. If you don't love doing it, you're going to burn out. And so assessing passion during the interview process is, I think, a really important thing. Key

[00:33:55] Nikhil: piece. So for people listening to this podcast, obviously we like to leave them with some [00:34:00] like practical tips and takeaways and you're going to be our first test of like the most explicit version of that.

Um, if you were, this is our AB testing, you know, um, if you were to give like three pieces, like three experiments, orgs today. that are maybe like lower lift or easier just to test out that you guys have found have been very effective. What are some, what are like three things you think people should, should give a test?

[00:34:26] Doug: Yeah, so I think the first thing that comes to mind for me there is we want to, you want to make sure that you're leveraging patient trust in your work. Healthcare's hard, it's scary, particularly if you work with seniors as many folks do in healthcare. Uh, there's a lot of, a lot of scamming happening out there, there's a lot of mistrust.

Building trust is the number one thing you can do. And one strategy that we found really effective there on our calling is, uh, call masking, where we actually will [00:35:00] take all 10 digits of the practice's phone number and call from that caller ID with the practice's name listed as the caller ID and their whole phone number listed as the phone number.

What that did for us when we started testing that was took us from about a 27 reach rate when we were previously, we were just sort of masking area codes. So like. You have a 917 phone number. I'm going to call from a 917 phone number and maybe the next three digits will be similar, but it's not going to be.

It's not going to otherwise be familiar. Uh, and that had about a 27 reach rate. Not horrible. Um, that's over three calls. We would reach about 27 percent of patients. Not great. When we replaced that with the practice's phone number and the practice's caller ID, we jumped to 68%. Of patients reached over the course of three calls.

mean, that's, uh, more than doubling our, like almost two and a half X are, are retreat just from that one [00:36:00] change, huge impact. Another thought there is, uh, think about multimodal approaches. So we've talked a little bit about various modalities that exist. The best answer is not to choose one, but actually to.

Create a coordinated experience across modalities. And we've seen success, for example, by little things, text a patient a little bit before you call them to tell them that you're going to call them makes a big difference so that when they see the phone number ringing, they're like, Oh, this is maybe this is spam, but it's, it's a spammer who had the courtesy of texting me before, before they called me.

So clearly they care and it just like, it makes a huge difference in breaking through and again, building trust. And then, I don't know, the last thing that I would say is. Make things easier for your agents. Um, we have seen that I mentioned all the agent productivity metrics earlier. One of the biggest barriers to agents being successful is, is not their skills or their knowledge, it's whether the [00:37:00] tools we've given them and the processes we've given them are smooth.

And we have done a lot of work, still have a lot of work to do to make those processes simpler stuff like, Oh, instead of making you copy and paste Uh, documentation template into the notes every time you have to write notes. We're going to make it, uh, you know, available for you already. Or we're going to let you click buttons instead of free text.

EHRs have done a lot of this to the point of annoyance, I think, for many clinicians. But there, there is a good in between where you're not just forcing people to freestyle their free text, um, and, and servicing information to them that they need in the right moment without overwhelming them. Expanding modals automatically for them when they reach a page that's sort of in a way that's context aware to what they're trying to do when they get there.

Those kinds of things go a long way. Well,

[00:37:45] Nikhil: that was actionable as hell. Love it. if anyone wants to reach out to you or, you know, there's things that, uh, you know, they want to jam with you about and they're trying to do their own A B testing.

Like what's the best way to get in touch with you? Learn more about

[00:37:57] Doug: what you're doing. Yeah, for [00:38:00] sure. I am. My email's very easy to remember. It's that the benefit of being an early employee at a startup is getting the first name at. And, uh, uh, I'm also a, a frequent Twitter slash x lurker if you'd like to, uh, follow me or dmm me there.

Uh, and then also on LinkedIn, all of the.

[00:38:20] Danielle: Can you give your address in case

[00:38:21] Nikhil: people want to send it? Yeah, I need to send it. What if I want to send a direct mail to you and flood the zone, you know?

[00:38:28] Danielle: Shoot me a DM and we can talk. You actually, you weren't part of KnowledgeVest this year. But, uh,

[00:38:33] Nikhil: Sure, we know where you live.

Yeah, we sent postcards out.

[00:38:36] Danielle: We sent postcards this year. Nice! That was, uh, well we probably shouldn't say what they were in case we want to run it back. Thanks, Deidre.

[00:38:43] Nikhil: That's true. That's true. It was a surprise. Surprise. I

[00:38:46] Doug: feel like I need to sign up for KnowledgeFest v3 so that I can find out what these push cards are all about.

[00:38:51] Nikhil: Heard it here first. Exactly. Doug, thanks for joining us. Thank you, Doug. And, uh, we'll see you soon.

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