Solving the Healthcare Equity Problem as a Whole with Rajeev Singh, Chairman & CEO at Accolade

[00:00:00] Hey everybody, Sam Marquez with the Health Matters Podcast. I want to welcome you all back

[00:00:16] to today's episode straight here from the Health Event Floor. I am with Rajiv Singh. He's

[00:00:24] the CEO and chairman of Acoleid. He joined Acoleid as CEO in November of 2015, leading the organization's

[00:00:33] strategy and operations through high growth. In 2020, Singh led Acoleid through one of the first

[00:00:38] digital health care initial public offerings of the year. The following year, he led the company

[00:00:43] through nearly one billion in acquisitions of second MD, plush care, and health reveal. Acoleid

[00:00:50] now works with over 700 employers and health plans serving over 11 million people across the

[00:00:56] United States. Prior to joining Acoleid, he co-founded Concur, the global leader in travel and expense

[00:01:03] management company in 1993. Concur went public in 98 and grew to more than 800 million in revenue

[00:01:11] over 4,000 employees and more than 25,000 customers before being acquired by SAP for 8.3 billion in 2014.

[00:01:20] Singh was president and chief operating officer as well as member of the board of directors at Concur.

[00:01:27] He's an amazing leader and has decided to get into the health care space with the work he's

[00:01:33] doing at Acoleid, and I'm excited to be joined with him here on the podcast for Health Matters.

[00:01:39] And so with that, Rajiv, welcome to the podcast. So great to be here with you today.

[00:01:42] Thank you for having me, so I'm delighted to be here.

[00:01:45] Yeah, so there's no question that we need more work in the benefit space.

[00:01:51] Work that actually helps meet people where they are, work that helps people do what they do best

[00:01:56] at work, so they don't have to think about the wellness aspects of things. Before we dive into

[00:02:01] the details of Acoleid and things that you guys are doing, I'd love to learn more about you.

[00:02:05] What inspires your work in health care? Well, I think anyone who makes the leap into health care,

[00:02:12] ultimately acknowledges one core fact that this is a system that's configured to deliver

[00:02:19] optimal results for the people that are experiencing the health care system. And yet,

[00:02:23] for whatever reason is not. And so for me, I joined the health care journey late in life.

[00:02:29] I joined as a CEO of Acoleid seven years ago, but for me very clearly the mission was,

[00:02:35] I'd learned a lot in my life. I'm unfortunately very old now.

[00:02:39] I'd learned a lot in my life. I appreciate that. Thank you for throwing that in there.

[00:02:43] Hopefully that stays. The idea of applying everything I'd learned to trying to solve a problem

[00:02:50] that could profoundly impact the lives of 330 million people in this country,

[00:02:54] like that was just too good to pass up. And so opportunity for impact,

[00:02:58] the opportunity for good impacts, I think that's why most of us are in the business.

[00:03:02] Love that. Yeah, sign me up too. Me too. So let's hone in on Acoleid. Talk to us about Acoleid.

[00:03:09] What type of value are you guys delivering to the health care ecosystem? We're sitting here at health.

[00:03:15] And there's so much innovation happening in the halls behind us. And much of it is focused on a

[00:03:21] particular condition, much of it's focused on a particular transaction, focused on solving a

[00:03:27] particular part of the problem. What was so impactful to me is I began to study Acoleid eight

[00:03:34] years ago, I took the job seven years ago as a CEO was that Acoleid had the audacity to think,

[00:03:40] well, we should solve the whole problem. Let's follow someone through their entire journey.

[00:03:44] Let's ensure that we understand all of the conditions that they're facing, all the medications

[00:03:48] that they're on, all the help that they may need, which might include by the way that they can

[00:03:53] afford their health care. They don't have a car to get them to their doctor. And that if you could

[00:03:57] follow people through the entirety of their journey and break down the obstacles, make sure that

[00:04:03] they don't fall through the cracks, you have an opportunity to improve outcomes to lower costs

[00:04:09] and ultimately most importantly to make people's lives better. Yes. And so Acoleid chose to be this

[00:04:15] umbrella that was going to solve the whole problem. And we're now as a company 15 years into the

[00:04:21] journey as CEO, I'm seven years into the journey. But you can see that the opportunity to actually

[00:04:27] create that value is very, very real. So seven years has it flown? Has it gone slow? Like, uh,

[00:04:33] talking to me about that. An aggregate it's flown by on any given day sometimes, man.

[00:04:39] I think anybody who's working health care who tells you, oh no, it's been a breeze. Yeah.

[00:04:43] It's absolutely blown sunshine. On the other hand, the learning curve, the hydration for my brain

[00:04:51] of really understanding. So profoundly complex and yet at its core, honestly, extraordinarily simple.

[00:04:58] Like we just need to do the right thing for the people that we serve. And when we do good things

[00:05:02] happen. And so let's stop making it really complex. But yeah, there are some complex economic

[00:05:07] regulation and other factors that impact it. But I try to remind myself every day,

[00:05:12] so I know I'm not answering a question. I'm just sort of riffing right now. But I try to remind

[00:05:17] myself every single day. This isn't that hard. Let's stop talking about how hard health care is.

[00:05:22] It's the job is to do the right thing for the person that's trying to experience care.

[00:05:26] And when we remind ourselves of that every day, we can solve problems. That's awesome.

[00:05:30] Now it's great to keep it simple and I love that about you and the way that you do things.

[00:05:35] And that's demonstrated itself in sort of the direction that the company has gone. So as CEO

[00:05:41] of a healthcare company, how do you define health equity? You know, let's just use the word equity

[00:05:46] and let's strike health. And let's speak to the idea that there are certain, I'll steal some

[00:05:51] constitutional words. There's certain unenailable rights that exist for human beings. One of them

[00:05:56] in my view and in the view of the 223 hundred people who work at accolade is healthcare is a human

[00:06:02] right. And that means that we ought to be able to experience every element of healthcare

[00:06:07] in a way that accrues value to ourselves and to our families and allows us to get to the outcomes

[00:06:14] that we deserve. Unfortunately in the United States today and unfortunately around the world,

[00:06:18] but let's just speak specifically to the market we serve and here in the United States, equity is not

[00:06:23] a reality. It's not a reality in certain zip codes. It's not a reality at certain income levels.

[00:06:28] It's not a reality in certain communities of color or of you name the areas where we see the

[00:06:34] inequality exist. And so we define health equity at accolade as the responsibility to ensure that

[00:06:41] everyone has the right to high quality healthcare. And unfortunately we haven't cracked that code yet

[00:06:46] in the United States. Yeah, there's a lot of work that does need to be done. So what are some of

[00:06:50] the challenges and obstacles that have hindered the industry from making healthcare more equitable

[00:06:56] and inclusive in your mind? I'm going to stay in the structural and the foundational elements

[00:07:03] and I'm gonna leave out because we could go for hours about the societal elements and the issues

[00:07:08] that really drive inequity beyond those structural and framework elements. But at a structural and

[00:07:14] a framework perspective, let's start here. The first thing you need to really experience high

[00:07:19] quality healthcare is access to a primary care physician. And the reality is if you live in certain

[00:07:24] neighborhoods in the United States or if you are a particular persuasion as it relates to your

[00:07:29] sexual orientation or otherwise, it's very real that you might not have access to a primary

[00:07:34] care physician. And even if you do have access to a primary care physician, you don't have one

[00:07:39] who's familiar with your history, with your background, with your heritage. Solving that problem

[00:07:45] is made materially more difficult in a country where we have a significant shortage of primary

[00:07:50] care physicians. And so our capacity to ultimately address the issue of the primary care shortage

[00:07:58] that exists in the country which sounds like an almost intractable problem but I believe is solvable

[00:08:04] is a significant part of ultimately creating the opportunity for equity. But so the primary care

[00:08:09] shortage part one of the story, the behavioral health shortage, part two of the story.

[00:08:14] Part three of the story is we're living in an inflationary environment, healthcare's already

[00:08:17] very expensive, high deductible plans are our reality for most people who are living in those

[00:08:22] underserved populations. And so now the capacity to afford the care even if you can find it

[00:08:27] is extraordinarily challenged. Those are just the structural impediments, let's not even get to

[00:08:31] the societal impediments. And so to address the structural impediments you've got to think about

[00:08:36] the problem differently and what we're excited about is it feels like the universe is ready

[00:08:42] to start thinking about the problem differently. Yeah, and you know I agree and really with a lot of

[00:08:46] the introduction of these consumer companies that are now in the game, the front door to healthcare has

[00:08:52] changed. There's more than just one. So there's an opportunity to do more. Do you feel like your

[00:08:59] experience not having been in healthcare has given you an asset to be able to look at this in a

[00:09:04] different way than a traditional healthcare person would? So I'm going to take that question because

[00:09:10] I can only go in one direction. Given that I didn't grow up in healthcare, I have to say that it's

[00:09:14] a benefit. Here's what's true about a beginner's mindset in any space. And after seven years,

[00:09:20] I'm still trying to maintain that beginner's mindset. It's imperative that we don't accept

[00:09:25] broken as just the way it is. And I think I'm in the midst of writing a little blog post that I'll

[00:09:33] give you a sneak peek to one of the questions we have to answer for ourselves if we're walking around

[00:09:38] these halls, is are we here to make money from the problem or are we here to solve the problem?

[00:09:43] And I think the beginner's mindset is imperative to really trying to solve the problem. It's actually

[00:09:49] fairly easy to build a company to make money off of a three trillion dollar system that has

[00:09:54] enormous amounts of inefficiency. I think the question we should be posing to founders and

[00:09:58] to private equity companies and venture capital companies is don't we have enough of those

[00:10:02] companies? Isn't it time like let's ask the question are you trying to solve it or are you trying

[00:10:07] to make a buck because if you're trying to make a buck, we should put you in a different bucket.

[00:10:10] Love that. Well said. And so I love the approach to just solve it. You know, like don't just come

[00:10:17] here to make a dollar, solve it. So many people need help. So what's accolade doing to reduce

[00:10:22] health disparities and move forward toward greater equity in health? So what accolade doing is the

[00:10:27] same thing I'd recommend for most of the companies that we have the fortune to partner with or the

[00:10:31] fortune to mentor and to guide. The first thing we're doing is we're actually taking down the last

[00:10:36] mile of care. And so when we entered the primary care space with virtual primary care physicians

[00:10:41] and behavioral health specialists embedded into that care, we had an opportunity to attack

[00:10:46] one health equity issues instead of actually only looking at the pool of physicians who are

[00:10:53] black physicians in in Detroit who can serve a population that looks like them in that city.

[00:10:59] I can access a pool of physicians all around the country that changes the equation. Yeah.

[00:11:03] Being able to access that pool of physicians around the country and be able to work in on weekend

[00:11:08] hours or after work hours changes the equation simple simple things like that, but actually giving

[00:11:14] people the access to those physicians in the course of their care. We've identified an issue

[00:11:20] we're triaging their symptoms and we say I'm going to get you to a primary care physician in the

[00:11:24] next 15 minutes if you're available when I get you to that physician, we're going to solve problems

[00:11:28] and we're going to address your needs. That's like magic for many people in this country who are

[00:11:34] even if they have a primary care physician waiting 21 days, 21 business days to get to that appointment.

[00:11:40] And so we solve equity issues by solving the last mile. Don't tell them what the problem is,

[00:11:45] tell them what the problem is and say here's the solution, we're going to guide you to the solution

[00:11:49] and get you the answer. That doesn't just have to be accolade if you're a women's health company

[00:11:53] that's working to help people address those issues, solve the last mile. Like do the hard work,

[00:11:59] if you do the hard work, you're actually providing the answer and not the window dressing around

[00:12:04] the answer. And I think that's what we do, that's what we're aspiring to do in every problem we're

[00:12:08] trying to solve. In fact, one of the partners that we most recently announced, a company called

[00:12:13] Folks is extraordinarily focused on the LGBTQ plus population. We know for a fact that that's a

[00:12:19] population one that struggled to find the primary care that they need, that struggled to find the

[00:12:24] behavioral health that they need and struggled to find it within the context of a shared life

[00:12:27] experience. And so one of the things we're most excited about with a partner like that is the

[00:12:32] capacity to guide people to the care that they need but then have them leverage a fully built out

[00:12:37] ecosystem of providers, counselors, etc., who can work with them within the context of their lives.

[00:12:44] That's what we call solving the whole problem and it's those are the companies that we partner

[00:12:48] with as well. That's fantastic. Thank you, Reggieven. And a lot of it is navigation.

[00:12:51] Yes. Right? I mean, where to go and what provider to get what from? Can you speak to that?

[00:12:57] Man, it's navigation and it's some of it. A lot of it is to your point like the capacity to get

[00:13:02] to the right position at the right time. In our case, we can get you to one of our primary care

[00:13:06] physicians but if you're going to see a specialist, wouldn't it be fantastic if we could get you to

[00:13:11] a specialist driven by data? How about one of the top 25% of the physicians in your network who

[00:13:17] specialize in the shoulder surgery that you're about to have? And what if we could also tie that to cost

[00:13:23] side of care? And what if at the same time we did all of that, we could understand the financial

[00:13:29] contributors to whether you can afford that surgery and you afford the deductible. Are there other

[00:13:34] problems we need to solve that are totally different in getting you to the doctor but have a lot

[00:13:39] to play of a significant role to play in whether you can get to that doctor. That's where you tie

[00:13:45] physicians, physician quality, physician cost to the idea of navigation. You have to solve all of

[00:13:51] these problems because in context, the single biggest financial challenge most people face in their

[00:13:57] lives is affording healthcare. Totally. So question, have you guys always, has accolade always had

[00:14:03] their own physicians? We haven't. It's been core to the way we thought about solving the problem.

[00:14:09] Yeah, but 2020 changed everything in so many ways that's almost a throwaway comment but one of the things

[00:14:15] that very clearly did happen is access to virtual care became mainstream in the United States.

[00:14:21] Yes. And my mom and dad are 80 and 79 years old. Prior to the pandemic, they had never seen a doctor

[00:14:28] online. Today, my mom, my dad's different. You know, everybody's a little different but yeah,

[00:14:33] my mom doesn't want to go to the doctor's office anymore. Yeah, she's just like, give me my doctor.

[00:14:37] Yeah, why would I ever do that again? My dad on the other hand likes to go in. Well, he's got

[00:14:41] opinions and so you want to talk to him. I love that. I love that. Well, thanks for sharing this

[00:14:48] and one of the things that I've really enjoyed watching accolade through the process.

[00:14:53] I remember back the seven years ago when okay, Centine says we're going to place a bet here.

[00:14:59] We think this is going to go somewhere and today, the way that the company has evolved

[00:15:05] has just been very impressive. So I want to give you kudos and the team at accolade kudos for

[00:15:10] how you've navigated the pandemic and now on the other side of it, the endemic to continue growing

[00:15:17] as a company that adds value and seeks to solve problems, not just make a book.

[00:15:21] kudos. Very kind of you to say that. So I really appreciate it. All that credit goes to the team.

[00:15:25] You've met some of those team members. They're extraordinary, but we're just getting started man.

[00:15:30] We're just getting started. I love it, man. Well listen, I am so privileged to be here with you.

[00:15:35] So thanks for giving us some of your time and sharing with us the way that accolades making a

[00:15:40] difference. What closing thought would you leave our listeners with today? The disruption that's

[00:15:45] occurred in the space over the last two years, two and a half years. It's brought about unbearable

[00:15:50] amounts of pain for so many people in this country. It's brought about so many challenges and

[00:15:56] so many things that we can lament and look back on and regret. Let's not waste all of that pain

[00:16:02] without acknowledging that it has created opportunity that we have to take advantage of. If we let

[00:16:08] things slip back to where they were before the pandemic, we've wasted a massive opportunity

[00:16:13] to solve the most profound issue that faces this country. Healthcare is 20% of GDP and it's on the way up.

[00:16:19] And that's not the problem. If we want to spend a lot of money on healthcare, so be it.

[00:16:23] The problem is our mortality rates going down. The problem is that our outcomes are going down.

[00:16:29] The problem is our people aren't getting the care that they need. There's an opportunity right now in

[00:16:34] this window to have a material impact on what's happening. Let's not miss this opportunity.

[00:16:39] Of that, Reggie, hey, I appreciate your passion and belief in the future of our country's healthcare.

[00:16:46] I think we're all lucky to have companies like Accolade to provide the services that you do.

[00:16:51] What's the best place that people can reach out to you or learn more about Accolade?

[00:16:55] Oh, well, you should learn more about Accolade at accolade.com. You should reach out to me by dropping

[00:17:00] me an email. You could drop me an email, Rajeev.sing at accolade.com. I'm pretty good about responding.

[00:17:05] If you've got ideas as to how we can make the ecosystem better, jointly, I imagine there's a lot of

[00:17:10] innovators listening to your podcast. We'd love to hear your ideas.

[00:17:13] Of it, Rajeev. Hey, I really want to tell you, appreciate your time.

[00:17:17] Thank you very much for having us and for what you're doing.