Leader Spotlight: Understanding the root of the strategy, with Angela Suthrave

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Angela Suthrave is VP, Product Management at Accolade, a personalized healthcare company for employers, health plans, government agencies, and consumers. She began her career as a clinical dietitian and certified diabetes educator for four years before transitioning to a business analyst role at Evolent, a pioneer in health management. Angela later joined product leadership at Somatus, a value-based kidney disease company, before moving to Accolade.

In our conversation, Angela talks about the importance of understanding the assumptions, foundations, and boundaries behind a strategy — whether in overarching business goals, specific products, acquisitions, etc. She discusses how key KPIs aren’t always leading indicators, and how sometimes the North Star can actually be a lagging indicator. Angela also shares how her dietitian background provides a unique perspective and helps inform the products she develops for care teams, including doctors, nurses, and care advocates.

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Building products for value-based care delivery

To start, can you describe what Accolade does and how it helps its members?

Definitely. It’s hard to achieve scale in healthcare. Accolade is a public company and we help manage about 12 million lives. We started as a benefits navigation advocacy organization and evolved over the years to offer physician-lead advocacy. We expanded our solutions to include virtual primary and mental healthcare — through our acquisition of PlushCare — and expert medical opinions through our acquisition of 2nd.MD, a second opinion company.

I joined Accolade because its mission and strategy were so compelling. Coming from other organizations where I was addressing a narrow set of the population, it was great to come to Accolade and see that we could genuinely do population health at scale. People come to us because they need help understanding their benefits and which one to use when they have a specific need. Our digital health platform enables healthcare that is personalized, trusted, enhanced by AI, and connected to deliver results and better health outcomes.

For example, if you get a cancer diagnosis and your oncologist gives you a plan of care, it’s good to get a second opinion to make sure that you have medical certainty and options for alternative care paths. On top of all of that, we have a Trusted Partner Ecosystem where we partner with point solutions to provide best-in-class care for people with needs related to specific conditions. Going back to my example of a person with a cancer diagnosis, once they get a second opinion, we may also send them to a trusted partner that has a surgical center of excellence for the procedure.

Earlier in your career, you were a clinical dietitian and certified diabetes educator. How did your transition into product come about?

When you become a dietitian, you have to do a dietetic internship to get hands-on experience. It’s similar to a residency for physicians. When I was applying for my dietetic internship, I wrote in my essay that I wanted to become a Certified Diabetes Educator (CBE). Diabetes runs in my family, so it was important for me to understand the ins and outs of the condition and be able to help people manage it.

After the internship, I got my registered dietitian (RD) license and I was able to get the CDE license fairly quickly — by the age of 25. After that, I was really looking for my next chapter.

Some aspects of being a registered dietitian (RD) and CDE were extremely rewarding. I loved working with patients, teaching my cooking classes, and educating people on prevention. There were also a couple of things that frustrated me. At the time, for example, it was more lucrative to put a stent in someone’s heart after they had a heart attack rather than send them to a dietitian a few months — or ideally years — in advance to prevent it from happening in the first place. You see this often in the health system — fix the car after it’s broken rather than do the maintenance oil changes. I was also frustrated by the mentality of, “Don’t question it, just do it the way it’s always been done.”

So, I started seeking out something that would allow me to be more innovative and creative, as well as deliver preventive care at scale. That’s how I landed in product management — specifically at healthcare organizations that do value-based care delivery. I can build products and processes that allow clinicians to work at the top of their licenses and spend more time with the patients.

Understanding the goal of an acquisition

You’ve had a fair amount of experience recently with acquisitions. What challenges have you experienced in terms of integrating an acquired team or product into an existing ecosystem?

Sun Tzu has this quote, “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before the defeat.” I think about this with both components. First, with strategy, it’s important to understand the strategy behind the acquisition. Was it for synergy? Was it for new capabilities, such as proprietary technology or expertise somewhere? Was it for economies of scale?

The advice I’d give is to understand the strategy including assumptions, foundations, and where the boundaries are, and apply first principles thinking. The deeper that you understand the strategies of the acquisition, the more precise your path will be to its goal.

Once you understand the strategy, it’s important to understand how your team is contributing to that plan. Then, you can align your teams to accelerate that progress. Get to know the ins and outs of the company that you are acquiring. Who do they serve? What problem do they solve? What are their workflows? I like to do this through 1:1s, shadowing users, and by getting my hands on reference materials.

Once you understand how the two companies are going to come together, you start to frame out the new strategy for your role as it pertains to the product. What are the problems that we’re trying to solve together? What are the customer signals? What are the experiments saying? You merge all of that to create this new product strategy.

With acquisitions comes a lot of change, which can be hard for people. How do you manage the human element of the acquisition process?

Of course, we want to do this with sensitivity. When there’s an acquisition, there are obvious benefits — that’s why the acquisition was pursued in the first place. But, there are also very real impacts, such as role redundancies, changes in the cultures, departures of leaders, etc. It can really challenge an individual’s core identity. If they’re very driven by the purpose of the organization, and now the purpose has changed, what does that mean for them?

Change is hard. People need to feel heard and secure in their jobs. They need to feel like they’re being treated fairly, even if their people managers have changed. It’s always been really important for me to be able to provide those opportunities for feedback, input, and decision-making, and help people understand the “why” first and the “how” and “what” second.

When these companies are coming together, it’s important to make sure that you’re retaining that value. You need strong communication plans and a plan to integrate not only your products but also your teams and how you work together. There will be cultural differences, so you’ll have to be ready to address those.

In my role, it is really important to have a unified, shared product vision that I’m communicating clearly across the organization. This goes both internally and externally to our customers and the people that support our customers. This helps unify people — they’ll understand where we’ve been and where we’re going. If they have questions or input, we are bringing them along for the journey, rather than telling them after the fact.

Post-acquisition, how do you measure the success of the integration from a product management standpoint?

Accolade does a great job of outlining the corporate objectives in our North Star metrics. We look at things like member experience, which are our patients, and we measure that via NPS and how much care we’re delivering. We want to make sure that we are addressing people’s needs before they have big issues. Primary care is a big focus of ours, and as such we look at how many primary care visits we’re able to deliver.

We are constantly looking at North Star metrics related to employee experience as well. We do a quarterly employee engagement survey, so I get to see my team’s engagement in lots of different areas such as career growth, action, and engagement.

There are two things that I believe are vital: the team’s participation rate in those surveys and the comments that come in. If people are not even bothering to fill out the survey, that’s an issue that we need to address. And while aggregate measures are helpful, I pay extra attention to the comments. If people have taken the time to write specific comments, we take those seriously. We want to figure out how we can be proactive about the feedback that they’re providing.

The North Star as a leading vs. lagging indicator

You mentioned the aspect of scaling earlier. What frameworks and processes have you found most effective in scaling product management practices at a growth-stage company, and how do you tailor those to meet the unique needs of the organization?

We use Atlassian products, and we’ve created a structure that works well for our organization. Our product and technology teams are pretty big, and because we’re serving so many different business units, we have to be very organized in the way that we structure the work. Our aim is to give people very clear roles and responsibilities so they understand exactly what problem we’re trying to solve and which North Star metric that work is tied to.

To do this, each fiscal year, we identify the big rocks that we’re going to go after. Under each big rock is a list of the initiatives, and each one has an Atlas page, which is where we can capture things like meeting notes, key decisions, and stakeholders. With each initiative, we do a kickoff to discuss the scope of work. These big projects can span multiple quarters.

Additionally, it’s also important for us to understand progress, risks, and how the work aligns with the company objectives. We have owners over each of these initiatives, and each initiative is broken down into epics — typically a quarter’s worth of work. This allows us to see the overarching strategy, key metrics, and how it breaks down individually so that we can track progress and risks.

In terms of measuring the effectiveness of the project, are you measuring against the North Star?

Sometimes in our work, the North Star is a lagging indicator. In this case, we set up leading indicators for ourselves where we feel like if we hit them, then the lagging indicator will follow.

For example, if we are trying to make sure that people are being preventive and proactive in their care then the number of primary care physician visits that we deliver is a lagging indicator. The leading indicator is personalized recommendations, what Accolade calls True Health Actions. If a patient calls or messages Accolade and the care team on our side can see that this person hasn’t been to a doctor in over a year, then their True Health Action is to see their primary care physician.

The frontline care team will talk to the patient about this recommendation, and we track that as well as the member’s disposition. Was the member interested? If not, why weren’t they interested? We go down multiple steps into that conversion funnel.

How many members said they were interested in pursuing the recommendation? How many patients then proceeded to book the appointment? How many of them were able to attend the appointment? Those are the leading indicators.

What about members that you may not hear from? For example, say someone is due for an annual visit but hasn’t called in for whatever reason.

That’s the million-dollar question — how do we get unengaged people engaged in their care? People fall along a continuum, and along that continuum, there are two axes. One is patient risk and the other is patient engagement. We measure risk by low, medium, and high, generally. In terms of engagement, this means how much someone participates in their own health. Do they have low, medium, or high engagement?

That breaks down the population and gives us a strategy based on where patients fall across those two axes. If we have someone who’s very high risk with no or low engagement, disproportionately, we need to spend our resources to get those people engaged before something happens. Meanwhile, we might have someone who’s low-risk and very engaged. That’s great. The strategy is different depending on which cohort we’re talking about.

At Accolade, we spend a proportionate amount of time and resources based on our risk models or stratification, as well as our True Health Actions. We then deploy them across several different channels.

Making decisions at the lowest level possible

Lastly, you spoke earlier about how your background provided you with an inside view of a clinician’s workflows and the limitations they have with certain tools. How does your background influence which features you prioritize when you’re developing or enhancing tools used by Care Advocates?

As a leader, I believe that decisions should be made at the lowest possible level. In my mind, my job is to make sure that people understand our company objectives and goals, the product strategy, and that we are putting together processes that allow our product team to be successful at scale. They need to be completely equipped to determine what problem we’re solving, how we can solve it, and the impact of the change to the North Star or lagging indicator in collaboration with engineering and design. We also work closely with finance to model out our assumptions and impact.

We do a ton of discovery before we put down code because we want to make sure that our assumptions are correct. We may think that solution A is the right way to solve this problem, but we could find that we’re wrong. We take the time to create prototypes, perform experiments, and understand what our assumptions are. The data tells us how prioritization takes place based on impact, as well as the effort level of that work.