Hard Problems, Smart Solutions: The Newfire Podcast

Welcome to Hard Problems Smart,
Solutions, The Newfire Podcast where we

explore the toughest challenges and the
smartest solutions with industry leaders.

I'm Brendan Iglehart, Staff Healthcare
Architect at Newfire Global Partners

and your host for this episode.

In each episode, we bring you
conversations with top innovators

and decision makers tackling the
biggest issues across industries.

Whether you're looking for insights to
drive your own strategies, or learn from

the best, you're in the right place.

Let's get started.

Hi everyone.

Welcome to another episode
of Hard Problems, Smart

Solutions, The Newfire Podcast.

In today's episode, I'm thrilled to
speak with Omar Mousa, who most recently

served as VP of Product and Engineering
at Ventricle Health, and then recently

left to start a fractional CPO services
firm and continue to do startup advisory.

He's a seasoned technologist with
extensive experience in product

management, go-to-market strategies
and operations, particularly

in the healthcare sector.

He has successfully scaled technology
teams and platforms, notably launching

a zero to one heart failure care
platform at Ventricle Health which

significantly drove growth and
improved patient care efficiencies.

He also co-hosts a popular and
excellent health tech podcast Concept

to Care, and actively advises startups
on product and market strategies.

Omar, thanks for joining
us today on the podcast.

Thank you Brendan.

Glad to be here.

And man, excellent.

That..

Impressive intro.

It's cool to be on the other side.

Yeah.

Alright, so to kick things off, I wanna
ask you about your journey in your career

'cause you've moved from working between
D2C initiatives, Propeller Health to

focusing RCM at Adonis and then, uh, most
recently doing VBC delivery at Ventricle.

So, tell me about what motivated
these transitions and how did each

role enrich your understanding
of healthcare technology?

Yeah.

Uh, Propeller Health was a late stage,
already acquired health tech company.

They were acquired by ResMed.

I was coming out of consulting, so I
broke into product management through

consulting, was doing serving government
clients, like agencies on their not

so interesting custom software, and I
wasn't developing the scar tissue that

one would develop when
living with a problem.

And so I wanted to break into product.

I thought that'd be a great place to live
with a problem or solve hard problems

in that role made the most sense.

And then the other thing was I
had gotten a healthcare sort of

flavor of a technical degree.

I was like, healthcare IT.

And so I knew I wanted to spend
my startup career in healthcare,

and so I found Propeller.

I grew up with asthma as a young age.

I kind of grew out of it, but Propeller
Health was solving for asthma and then

trying to break into the COPD space, I
joined as a product manager to help them

figure out like what does the application
experience for the patient need to

be like for, for the COPD population?

And so the takeaways.

We're like researching.

I spent a lot of time
researching the disease set.

Right.

So understanding COPD I might have
read over 50 research papers and

truly became an expert on the disease
and honestly learned a lot about not

only the clinical aspects, but the
nonclinical aspects of having disease.

And I think that was the thing that
resonated most when building the product

was the end user is receiving all sorts
of care, and it doesn't necessarily

like, the, the main problems they face
in their life are things like loneliness

or being tethered to their device, or
not being able to go to the grocery store

or see their granddaughter get married.

And so that was a major revelation for me.

'cause it was like, okay, I. The care
industry or healthcare does an okay job of

like the clinical piece, but the, but it's
good that these digital therapeutics are

out here solving for things like adherence
to medication, but also like how do I

build a really robust app experience for
patients so that they can do those things?

I think, transitioning to Cerebral,
I, I went to Cerebral after that, I

kind of saw the writing on the wall
with the direct to consumer services.

It was like as the pandemic went
blowing into full swing, um, so a

mental healthcare company made sense.

Hims & Hers was coming up.

RO was coming up.

I had even in 2019 written an
article about, Hey, consumers want to

take ownership of their own healthcare,
and so was just super eager to

get involved into a D2C business.

Found Cerebral pretty early as they
were, you know, in the series A,

closing their B. Um, they had two
product managers, but they weren't a

folks who were just really scrappy and
solving for the product manager role.

And so I joined, um, as like the first
formal product manager hire, um, and

after that and then they blew out the
team a lot 'cause they just raised a ton

of money and the team grew super fast.

But I learned how to work at
a super hyper growth company.

That company hit a $5 billion
valuation in two years.

It felt like

Uber, it felt like my shoes were
growing or I was growing outta

my shoes every couple months.

Experimentation is was super key
in business performance, right?

So different than Propeller.

Propeller was selling to pharma,
selling to uh, benefit pharmacy

benefit managers, even health systems.

Because Cerebral was a direct to consumer
business, like funnel performance

experimentation, AB testing, like a lot
of the traditional product management

skillset was very applicable here.

And I, it was just really fun.

And then also just learning about
the like, required capabilities

to play in a telehealth space.

You, you go to one telehealth business,
you go to another, you, you notice a

lot of the components are the same.

And then lastly, like how to organize
like teams and projects, et cetera, and

that, that sort of thing around outcomes.

And that was like really important
for my senior leadership growth.

I grew into a senior product leader there.

By the time I left, I had a
couple teams reporting into

my portfolio, which was cool.

Early, I built insurance at
Cerebral and so, uh, from zero

to one their insurance product.

And I knew a lot and I was talking to the
Adonis founders before they had started

the business and, uh, you know, really
jazzed about the, how broken our CM was.

And so I joined Adonis as employee
six, another zero to one situation.

Major takeaways from that business was
like I didn't join in a product capacity.

I joined as head of growth and I learned
go-to-market through just like doing and

just being scrappy and figuring it out.

So like how, what to helping
them determine what to build that

resonated with their vision, how to
message the product, how to sell it.

Built a CRM like workflow and go to
market motion around their products.

And then really like getting in front
of customers, just doing all sorts of

scrappy things, like going to conferences,
um, flying out to their, their office

and saying, we were in the neighborhood
and, uh, just doing all sorts of things

to drive demand generation and, and you
know, so I spent like a year with that

business and they matured to a point where

um, they have a real sales team.

They don't need, you know,
Omar trying to figure it out.

They had real salespeople, they had
real go-to-market motions, they had

product, and so I kind of, it kind
of made sense as like, Hey guys, like

I think you guys have grown and I
would like to go do product again.

Again, another like writing
on the wall situation.

We know a lot of care is moving towards
value and so I wanted to participate

in a value-based care business and
so about 19 months ago I joined

Ventricle Health as their head of
product, helped build out the team and

learned how to innovate on a payment
model or alternative payment model.

I never really touched
alternative payment models before.

It was always like direct cash
subscription based or fee for service.

And then, uh, really like care management,
care program, like selling a service

was like a very different thing.

And then the RPM, like how to
integrate RPM into a platform.

And then I've touched a lot of, you
know, in your world, you know a lot

about the interoperability on RAMP APIs.

Like I got to touch a lot of those
APIs to populate data at various

points of care and build out like
really robust enrollment workflows.

So I, I think, long-winded answer to
this I have had a bunch of different

little career changes and all within
the health tech healthcare space,

and I, I think it's formed a really
decent worldview of how care looks

like in in the startup environment.

Yeah.

That's really interesting.

Appreciate you sharing
that journey with us.

So I guess throughout that journey, I'm
always curious to hear from people what's

been the biggest surprise that you've
encountered and was there kind of a moment

or, or an obstacle or something you faced
that really shifted your perspective

on how tech fits into healthcare?

Yeah, I think three things.

Technology and healthcare
is like pretty bad.

So the infrastructure in place is like
behind, um, systems are disparate.

It's not like other industry verticals
like FinTech had their time in the sun.

You know, there are other, you
know, retail, they're just really

cool technology servicing other
industry verticals and because

healthcare hasn't received
that love quite yet.

It's starting to, but it, you know,
it's still has to pass a lot of hurdles.

The second thing is that most of
healthcare is supported by IT teams,

not by product development teams.

So the mentality is really different.

I've been at organizations where I've
been called like the IT team, and

it's like we are product managers and
engineers and product designers, and

we think differently.

Like, IT teams that manage a queue
of technology implementations and

aren't necessarily so entrenched
in what the user needs are.

But product teams generally are like,
Hey, I'm, I'm building for an end user.

I'm building for a problem.

I I'm KPId even differently.

Right?

There's still that tight or like
there's that balance to strike.

I, I think healthcare has not.

I think sometimes it makes sense
to have a healthcare like a IT

team, and sometimes it makes sense
to have product development teams.

And then the third and last thing,
it's like, you know, the mantra of

moving fast and breaking things,
or the lean startup like that.

Makes sense in some businesses, but
in healthcare it does not apply.

There is a lot of risk
associated with that.

The, the thing

you're breaking is often you and
me, so that's a little scary.

Yes, yes.

It's people's lives.

People's lives are at stake,
people's licenses, right?

Like the individuals who
are practicing care, there's

insurance against them, right?

Like they are taking oaths
to provide high quality care.

And so it, it's really, you know, like a
frame perfect thing that needs to happen.

And.

Yeah, not a lot of room for error and
so the "move fast break things" mantra

like grandiose and great sounding
like does not really make sense here.

Yeah, I definitely agree with that.

So you've noted in some of your kind
of past discussions are writing around

how health tech infrastructure isn't
really equipped to handle the volume

of, of data or unstructured data
specifically that's being generated.

In my world, interoperability, that
obviously presents a big challenge.

Can you elaborate on that issue
and, and talk about how you see

that problem coming to light here?

Yeah,

that issue's pretty exacerbated
by like a lot of things.

I'll try to describe a few, but I,
I think like healthcare, as I said,

is it's been around forever, right?

Yeah.

Back to the days when we were
bleeding people out to cure them

of diseases, and it's evolved
and know technology has supported

various businesses or industries.

FinTech, like I said, has had the love.

Healthcare has a lot of legacy system
architecture, so most healthcare IT

systems were built on like very basic
relational databases or models optimized

for structure like tabular data.

We have things like diagnosis codes,
billing codes like most IT or healthcare

IT systems were built for the purpose of
billing, and that was like the whole 2009

American Reinvestment Act investment, like
everyone was building an EHR, but really

they were building a billing tool, right?

Medication lists, lab values, like.

But we all know that like when you
go to a doctor, you are interacting

with a physician who's like typing
the conversation that's happening.

Hey, I checked this, I did this.

I talked to the patient about this.

This was the response.

So there's a lot of free text
notes, images, unstructured data

that doesn't necessarily fit
within that system architecture.

And that's just like where all
the goodness is, where all the

good stuff and the the value is.

The other thing is a disparate system.

So there's just multiple systems
in the value chain, right?

There's front office, there's the
actual clinical notes or the EHR.

There's practice management
systems, there's platforms

that are doing, hey texting.

There's the lab system.

Like all of this stuff has very
valuable data that should be talking

and it doesn't, and it's siloed, right?

And so the data, we're just unable
to make sense of the full picture.

Like I can tell you where the
patient had an appointment.

I don't.

It was six.

There's a six month gap.

I can't tell you what's
happened in between that.

Right.

Data standards are getting better,
but they're still inconsistent

and they're old, right?

Like if you think about X 12, which is
used for claims, it's like that's XML.

I don't know how many systems you want
to touch these days that have XML.

I know finance has like some, some
like archaic data standards too, but

do a good job of like leveling it
up and kind of modernizing it a bit.

Um, we don't.

Healthcare struggles, I think, and,
and again, with that unstructured data

that's like living in clinical notes and
it just doesn't fit really well and we

can't do a lot of processing with that.

Another thing's like what I call vendor
lock-in, it's like there are proprietary

data formats, um, associated with

various systems, and then some like
EHRs, like closed APIs, or they're

just like not published tools, right?

So it's just like, I don't know how to
work with this unless I am a customer.

And then also the tool doesn't
really support a lot, right?

ETL process limitations.

So just legacy ETL tools.

If you go like look at like some
of the more modern stuff, like

I like how many ETL tools have
built connectors for Stripe.

Like Stripe is a beautiful
API or a beautiful platform.

There are ETL products for that.

But for healthcare, you know, you have
connectors like MuleSoft and things like

that, that are pulling HL7 data out.

But even there, it's just like
lackluster not so perfect.

And then the last thing is just
like there's no APIs, like even

companies, even products with APIs,

the APIs are just, they have
a couple requests, right?

They're not robust enough to really
achieve the thing that you want to do.

Um, API documentation's pretty weak.

Um, and then know, I just, I
engage with EMRs, I'm not gonna say

names of EMRs, but they might have
eight endpoints and the end points

are just like not that valuable.

So they check the box off
of like, yeah, I have APIs.

And it's like, cool, but can I actually
do the thing I wanna do with your APIs?

And that's, you don't really figure that
out until I have a two to three year

software deal and I'm kinda locked in
and my clinicians know how to use it.

And so I just think like,

all these things I've
mentioned really exacerbate.

It's just like a tech debt, right?

It's just, it's, it's
hard to come from that.

And so we need to really be
innovative and think creatively

around how to get around some of
these things and modernize ourselves.

Not to introduce buzzword
bingo too much, but I'm, I'm

curious to get your perspective.

The thing that was coming to mind
as you were talking about that was

AI and how that might help with some
of those problems you mentioned.

Do you have any perspective
that you wanna share on that?

I think unstructured data and like
large language models are really

good at reading text, right?

Lots of unstructured data lives
within EMRs, uh, coming from various

notes and labs and et cetera.

And I think, you know, these foundational
models are gonna be better than any of

us at reading through an entire patient's
life history of clinical notes and then

coming to some sort of assessment like
it also read all the research papers

and understands the literature and
understands like healthcare in general.

And so I think like LLMs are
gonna help us save a lot of

time in going through this text.

It's gonna help us summarize
all this information.

It's gonna help us extract
the things that matter.

It's gonna help us identify like if
A happens and B happens and like,

then C should probably happen, right?

So just like the things like find
correlation within that unstructured

data and it'll help us scale the
clinical workforce, uh, those who

are looking at that information
and making assessment on it, right?

So I think it's gonna empower clinicians.

Um, I also think it's gonna help
us take all that unstructured

data and get value out of it.

'cause there's so much nugget,
like great goodness in there.

And none of us, or I wouldn't say none of
us, but I, you know, we still have barely

breached the surface of like capturing
that value and taking advantage of it.

So I think LLMs are amazing.

I think AI is really gonna make
some big changes in healthcare.

That's why the venture community's
investing so heavily into it.

And, you know, I'm really excited to see
what it's still like, we're still at the

first frontier and I'm really excited
to see what some of these startups do.

So pivoting back to kind of more
looking through things from a product

lens, I'm curious if you could tell
us a little bit about the challenges

that come along with in the know the
circumstances where an end user is not

the one who's making purchasing decisions.

How do you navigate a situation like that?

'cause it seems like you've
had some experience there.

Yeah, so healthcare in America is pretty
weird 'cause it's like sometimes you

don't even know why you are required
to use a specific service or your

affiliation with X, Y, Z organization.

Payers have members.

We are effectively members if you
belong to an insurance plan and

bucketed into various plans, which
dictate what sort of care you have.

And then we go through a kind of
adjudication process to figure out

like what is the cost share between
the patient and the insurance company.

And I think that is unusual, like
most services that you participate

in, like I want to get my lawn mowed,
I go out to a lawn mowing company.

I ask how much it's gonna
cost to do X, Y, Z service.

They give me a quote, I say, okay, and
then I pay for the service once complete.

Like this is unusual for any industry.

And then talk about healthcare just
has such a complicated stakeholder

mix like no other business.

Or industry has, like, you have the
doctors, you have the nurses, you have the

admin staff, the clinical coordinators,
the lab techs, you have the patients

themselves, the caregivers, the payers,
the pharmaceutical companies, the,

the brokers, the like, there's just
so many people involved and have like

interest in the value that's being
generated from a product or service.

And so, that dilutes the
mission or like the focus.

So I think that's how the
end-user is often missed.

Right.

So you just have all these
stakeholders, let's say, let's

talk about a service, right?

Like a, a healthcare service or
a tech-enabled service, you're.

The people within the company
aren't the people using the

product, and then you often don't
really have access to the patient.

And then like compliance and HIPAA
rules kind of make it hard to engage

those individuals anyways, right?

So I think that's one factor.

The other factor is like
market and funding constraints

are a factor here, right?

So if you're a startup and you just
raise seed funding and we think about

like go-to-market timelines for some
of these companies, they're long,

they're 18 months sometimes, right?

So it's just, I have X amount
of dollars to contribute towards

building a product or a service.

I only have so much time.

I need to do the bare minimum from
the patient side, but I need to get

distribution and I need to lock down
deals with payer or health system so

that you know, it's in that situation

it's like I need to live.

Or survive for the next fundraising round.

And so this is another way, like
the kind of the end-user, the

patient is missed 'cause it's, I
need to do X, Y, Z, C tomorrow.

The other thing is like
decision-maker are not the provider

sometimes or the end-user, right?

So if the end-user is a provider, they're
not making purchasing decisions or

if the end-user is a patient, they're
also not, they don't have any say

over the technology that's being used.

If you're a patient, you get a portal,
sometimes you're like, okay, I had like

nine of these portals at the different
little pri primary care doctors I've seen.

I guess I have to sign up for another
one and remember that password or like

you're a provider and you're like,
this is the lab that you're supposed to

prescribe, or this is the me, this is
the EHR that you're supposed to use, and

you just don't have much say over that.

And so ultimately what I think ends
up happening is like you have this

complicated stakeholder mix you
have to build to survive, right?

You have to build certain things
or certain features or solve

certain things on a go-to-market
perspective or distribution.

And what you end up with, it's like

something that provides some clinical
value, something that provides some

financial value, some operational
value, and then, but ultimately

from an experience perspective,
like no one's really happy, right?

Like you've made no one ultimately
like super, okay, you've truly listened

to me and you've solved my problem.

So I think from like a, if I were to do
like the ideal situation, I think from

like an order of operations perspective
is like deliver value to patients.

Health tech solution must deliver
meaningful benefit directly to

patients, whether you've improved
health outcomes, convenience, or

just a better experience, right?

The second thing is once you
have that go for ROI for payers,

so like this is insurers.

This includes employers.

Like you need to see measurable cost
savings or efficiency to justify like

this investment that you've made when
you're building this sort of things.

And then the third and last thing is like

invest in a sustainable business model.

So like a scalable health tech business
must balance patient outcomes and payer

value with like ops efficiency, right?

And so that's just like if
I were to go start a company

tomorrow, like that's the agenda.

So looking forward to feedback
loops here, and these are critical

in every industry, I would say,
but particularly so in healthcare.

And so kind of leading from the,
the previous question where you have

different stakeholder groups involved
in this whole equation, how do you

make sure that feedback from actual
users influences the products you're

developing and how do you balance that
with potentially some conflicting goals,

um, such as from parties like payers?

Yeah, the reality is you
get it where you get it.

Like you just hope it comes to
you, and if you don't, you need

to do a lot of work to find it.

But qualitative user feedback
is the predominant one.

So sending out surveys to either the
clinicians that are deploying your service

or using the technology that you build or
surveys to the patients that are using it

at Propeller, we did an advisory board.

We like helped pay for patient
medication or gave them discounts on

things, even like Amazon gift cards,
like, you know, very general stuff.

But they were very empowered and
excited to help provide information.

'cause they're like, Hey, I, I'm
a super user of your platform.

I want this to get better for my own sake.

Now I have asthma or COPD and
therefore I'm willing to help.

The boots on the ground people
provide a lot of good feedback.

I can't tell you how many times, like
I got a Slack message from a nurse

about something very like seemingly
micro, but actually super impactful, uh,

just about the experience that they're
delivering, and that's really good.

I think the second thing
is like instrumentation.

So like building user feedback
loops into your product, there are

platforms that help you do this,
like CDP platforms, customer data.

That's what it's called.

CDP, customer data platforms,
and then building out your data

infrastructure and like instrumenting
various funnel experiences, right?

So like if you have an enrollment
workflow, understanding the various

points of failure or drop off if you
are measuring adherence or you're

measuring engagement in your app, right?

Like figuring out how to do that and
leveraging that to help inform decisions.

And then the third thing is like
patient reported outcome measures.

These are defined by the
clinical community called proms.

In mental health, we had PHQ-9s.

In cardiac care, we have KCCQ-12, right?

And so like, this is another
just indicator of like, is

what we're doing working from
a clinical perspective, right?

So ultimately, you know, just
qualitative feedback, getting your

quantitative feedback from like
instrumentation within the product

and then like other spreadsheets of
your, how your model's performing.

And um, and then patient reported
outcomes is how I would, it's how

we, how I've gone about these things.

I came across an article that
you wrote or you were quoted in

on, uh, making build versus buy
decisions and product development.

As you know, here at Newfire,
this kind of assessment is one of

the services that we offer to our
clients and help them out with.

So curious if you could share some
of what you've learned about making

that evaluation, and specifically what
are some of the key considerations

that often are overlooked by perhaps
executive teams when assessing?

How to, how to go about that.

Yeah.

It's a hard one, Brendan, and to your
point, like a lot of people want to know

like, are my, am I doing the right thing?

Because it could be detrimental
or very costly to the business.

Unfortunately, I, I don't think
it's a one size fit all approach.

It's not a build and it's not a buy
only, it's, it's usually a mix of it.

It depends, and it's like
probably a hybrid approach.

But I've thought about it in a way
of like, what happens if you buy

your, all your solutions or if you
build, and then what does the hybrid

approach look like and like what stage
of businesses should be doing what?

And so I, I can kinda
walk us through that.

Ultimately, I think the questions
you need to ask yourself is like,

what does core to your business,
like what am I offering right?

Is my EMR or like my ability to do
revenue cycle, the most important thing

about my business or if it's not like,
should I be investing so much effort

or engineering knowledge into that.

Second thing, stage a company,
which I talked about, and

I'll get into more detail.

Um, and the third thing is like, how
quickly do I need to go to market?

And if we're talking about a healthcare
service, it's very important.

If you buy all your solutions, what
ends up happening is you're, you're

kind of unable to compete with
incumbents in new entrants, right?

You're like not flexible enough

to adapt or you can't do anything
new or novel, like you're kind of

restricted within the technology that
you've bought and you're beheld to the

product roadmap of the vendor, right?

Which, who knows what that looks like.

Um, you also, when you buy
all your solutions, you can't

really develop any like IP.

You can't really say that your
service is delivered by any sort

of like intellectual property.

It's like your core experiences are
really the product or the byproduct of

something else that you've integrated
or pulled into the fold of your service.

And then I think the most
important thing, if you buy all

your solutions, you're gonna hit a
ceiling on impact on your metrics.

Right?

Um, hopefully most businesses
know what metrics are most

important to them, your ability to.

But when you buy something, like
you'll hit a certain, let's say you're

optimizing or you're using it to
the best of that product's ability,

getting every ounce of value out of it.

You hit a, you hit the metrics,
or you kind of measure your

progress against those metrics.

They won't improve unless you start
adding any sort of like investing

in, hey first appointment is really
important and the scheduling experience

within my product kind of sucks.

And so like I need to maybe deviate
out of my existing scheduling solution

and figure out a way to get first
appointment on the books faster, right?

If you build all your solutions,
you also run some challenges, right?

So, if you build everything, you end
up reinventing the wheel on things that

like you probably just shouldn't, right?

They exist, they're decent.

Again, it's not core to your business.

You probably should be focusing a
little bit more on your go to market

or innovating and learning on things
that are core to your business.

So every time you iterate on your product,
you're gonna get some learnings out of it.

Um, you also create a ton of tech debt
by making a ton of engineering investment

before you truly understand your
end-user population or your business.

And so if you're early on and you're just
building everything you, you're gonna

make costly assumptions that are gonna
have to end up in refactoring of something

or just redesigning an entire product.

And then lastly, if you build all
your solutions, like there's a

major upfront cost without promise
of revenue, and honestly with the

current venture landscape, you'll be
crushed 'cause it's, I think in 2021,

I knew a lot of startups that were
building their EMRs from scratch.

Now, if you come to me today and you tell
me I'm gonna build my own custom, EMR, I

tell you to get out of the room, like, I
don't know, maybe I'd say something nicer,

but I don't think that's smart anymore.

Those who did it and have it and have
done successful in that, like great,

they came in a different time, but
now I just don't think that's really

responsible or fiscally responsible.

So, with a hybrid approach,
I think it's the only way to

achieve the following, right?

You drive down your costs, you
increase margin, you ensure

sustainable unit economics.

You can also achieve clinical outcomes
and compete in a very, what I think

is like a saturated market, right?

There's just a lot of lookalikes
of various services and then you

probably, or hopefully don't die
before you achieve your goals.

I've also like thought
about it in stages, right?

So an early-stage company should
be optimizing on solving use cases

to prove out their hypothesis.

And like the best approach for that
is like, hey, use some existing

solutions off the wall, right?

Or off the shelf.

Key focus is gonna be on like cost
effectiveness, speed to market,

scalability and integral or like how
like integratable that platform is.

The second stage I would call
like growth stage companies.

They should be prioritizing revenue
and you know, plan to be a bit more

cash efficient, but not overly so,
like the best approach there is

that hybrid approach I talked about.

So it's like, you should be investing
in customizing or building solutions

that differentiate you in the market.

You should think about a balanced
investment in like build versus

buy and like how thinking
about flexible integration.

And then the mature company moves
from like cashing efficient to

long-term sustainable unit economics.

And I think the best approach for
them is like, I understand my business

and now I need to just build a lot
of custom software to help make that

business the most successful it possibly
can be and bring shareholder value.

And so like key focus is like te
tailored solutions, control and

flexibility of the solution itself.

And then long term ROI and the ability
to continuously innovate on that.

It's building a really robust architecture
and uh, I'm able to iterate fast

and do feature development quickly.

And so, long-winded answer to say like
it depends and it just, you know, it

depends on where you are as a company,
what's core to your business, and like

how quickly you wanna go to market.

But I always think it's the hybrid
approach is probably the best.

So Omar, I really appreciate your
perspective and it seems like a lot

of the things you've talked about have
been influenced by the scaling efforts

that you were involved within your
roles at, at Cerebral and Propeller.

So reflecting on those experiences, can
you tell me about some of the lessons

that you learned during those growth
cycles and how does that shape your,

your approach to build versus buy and
kind of just general product development?

Yeah, I think like, again, like
I really like the hybrid approach

and so for the buy decisions, there
are a couple things I consider.

I first consider capabilities and use
cases like, does this tool or technology

actually solve the use case I need
solved though, for example, like I need

to schedule patients with a provider.

Providers have their own availabilities
in these like friendly PC, MSO 10 99

bottles, and then patients have their own
ability and like we need to service both.

So does the technology allow me to
understand a provider schedule and

then allow a patient to schedule
directly from a calendar or even like

a clinical coordinator, do that, right?

So that's like, just
like a very easy example.

The next thing I consider, it's like
after it solves my use case, it's like

what does the user experience look like?

So does it not only solve my use
case, but does it solve my use case

better than like the competition
would, if that's really important.

And then do the users of
the system enjoy using it?

So for example, like for a CRM, you know,
enrollment CRMs are very good at like

sales motions and enrollment and funnels.

Salesforce is super highly
customizable and can help

solve any healthcare use case.

However, I've looked at like HubSpot
and I thought, oh wow, HubSpot has

like a really great user experience
and it's easier to understand

for that kind of resource, right?

And so like for the individual using
that, who's gonna have higher NPS?

Will the enrollment specialist
know how to use Salesforce or will

they prefer to be in like HubSpot?

Second thing is like scalability.

So like, do you have a
modular architecture?

And can your platform perform at scale or
like it should be adding new functionality

or can I scale in components independently
in my own architecture with this tool?

And then, will this tool
be able to handle scale?

Like is it 10 patients
it does really well.

Is it a hundred patients
it still does really well.

A thousand patients.

It does.

Okay.

And then like at 10,000,
it's just like awful.

Like I need to know those numbers
so that I can be responsible

about bringing these things in.

Is the off the shelf solution,
flexible or customizable?

Can I customize or configure
the solution to basically serve

my needs a little bit more?

Like obviously I can't make it do exactly
what I need it to do, but is there

custom dashboard reporting or does it
have APIs that I can leverage to allow

for custom development down the road?

Or is the data model flexible
and allows me to add metadata

to various things or objects?

Right.

So this is like things
that I would look for.

Security and compliance has
gotta be baked in, right?

You just gotta make sure PHI is not
overly permissive or, uh, it complies

with all the HIPAA regulation and
like, does the vendor sign PaaS?

Um, and this is the most important one,
probably it's like cost and ROI, like,

what is the total cost of ownership?

How much do I spend to implement it?

How much do I spend on the contract
itself, the vendor value, and how much

do I spend to like maintain it over time?

Are engineers having to do things or
IT specialists having to do things?

Are Ops teams having to do
things on a regular basis to

like factor all that cost in?

And then what does the
expected return on investment?

Sometimes the use case does not have
a expected return on investment, but

like you should have an assessment
of what does my percentage of

revenue should be for revenue cycle.

Like it's just a thing that we have to do.

It is tied to revenue that I do
collect, but is it a revenue driver?

Like, sort of, not really.

So what's a responsible percentage of
revenue that I'm allowed to spend on that?

And how does the cost scale?

Is it cheap at first?

But as I get more users on the
platform, it just gets really

expensive and hard to manage.

That's something to consider.

Um, for the build decision,
I think a lot simpler.

Is this use case core to my business?

I said this already, or like a
point of differentiation for me.

Um, if it is, then I need to
build that specific thing and

I need to plan for my roadmap.

Like maybe I solve for it
with a off the shelf solution.

At first, I. Um, that's fine if you're
trying to get to market quickly, but

if you're really trying to kill it
in that category, let's say you're

like in the referrals business.

I currently advise a company
that's, you know, helping connect

primary care providers with
high quality specialty networks.

And it's like referral is
like the main game for them.

And so of course the referral
experience needs to be built metic or

meticulous and like they've thought
through everything and that should be

like a build thing that they work on.

And they should be thinking about,
can I build that better than

any existing solution out there?

And can I drive a metric better
than any solution out there, right?

Because the metric is probably
one of the most important things.

And then the last thing with that,
like can I build it cheaper than the

total cost of ownership of any given
technology that's off the shelf?

So I think those are two things that,
those are things that I think about when

building and when I, and buying decisions.

So, Omar, I'm curious, how do you, how do
you navigate the differences between D2C

or direct to consumer and then clinical
product development in healthcare tech?

And what are some of the unique
challenges and opportunities

in in each of those pathways?

Yeah.

I think direct to consumer is so fun.

I think it's the most fun thing
that you can ever be a part of.

It's no nonsense.

It's like the best experience
wins no matter what.

It doesn't lend itself to.

Various factors that like
a B2B environment would.

So it's like it's very performance driven.

Pro product people thrive in
it because it's data driven.

And D2C lends itself to that.

Opinions backed without data

don't really farewell in that environment.

And that's kind of why I like it.

Um, for most consumer products that win,
it's simply because people love them

and not because they have to use them.

I talked about like people have to use
certain things in healthcare earlier.

Um, in a B2B environment, you need
to meet minimum capabilities usually

to play, I'm required to play in a
market, I need to have X, Y, Z feature.

And then they don't really, they do
optimize for business performance

and patient outcomes, but then like
NPS is like a luxury, uh, metric.

Like it's a luxury if you've
done a good job there.

So.

In D2C, if people don't really like the
experiences of a B2B focused product,

but a D2C one, like the experience
matters a lot, and if people don't

like it, they just won't use it.

Um, so that, I think
that's the difference.

You've recently been focused
on enabling value-based care at

Ventricle Health and specifically
tackling some of the challenges

of enrollment with VBC workflows.

So could you share some insights
on strategies you've implemented to

improve patient engagement with that?

With that problem?

Yeah.

And not that like we're perfect and we
figured it out, but you know, I've seen

a lot of people mess this up, right?

I think they view this differently
than a sales motion, and I

think that's inherently wrong.

Run this like a sales funnel.

Get a CRM, like CRMs are very
good at doing the function,

a lot of the function, they have
the features required to deliver

this service at a very high quality.

So get a CRM that you can push
PHI into, and then build on top

of that enrollment workflow.

Build competency in a
call center workflow.

So like use tools like Dialpad, right?

That are very good at that thing.

And then they have AI to understand
sentiment analysis and learn from

like how those calls are going.

And build like a traditional tree
structure, empower people with data.

We leverage ADT feeds, we lever
le leverage HIEs, we talk about

claims data, we get referral data,
we get transitions of care data.

Like all of that is super relevant
and should be incorporated

into the scripting somehow.

Right?

Like contextualizing, Hey, I'm
Ventricle and I'm reaching out

because you were recently discharged
from the hospital and oh by the way,

we know your primary care doctor.

He's cool with us.

We are friends, right?

That is a compelling message that drives
better engagement and performance,

and so win the hearts and minds of
everybody around you as well., Like,

multiple people touch the patient,
whether it's a caregiver or a primary

care doctor or their cardiologist or
other specialty providers, like you

want to be friends with all of them.

So like work with the payers to get
the provider attribution file and

like call every primary care doctor
and say, Hey, you have X amount

of patients with heart failure.

Like I'd like to be friends, like, I'm
not here to take business away from you.

I just wanna help support your patient.

Can you help the messaging of
like Ventricle or whatever care

management product is helpful, right?

And then make it seamless, right?

So like the funnel should just feel
easy for both the enrollment person

facilitating, the Ops person facilitating
and then the actual patients.

Use local phone numbers so that it doesn't
feel like they're getting spam calls.

Um, try out different call scripts.

Even experiment with AI Chatbots
like ElevenLabs makes a really

mean LLM for this, and I think
people should play with that.

Now, try, this is an
ongoing experimentation,

you should treat it as such.

Just because it's very clinical in
nature doesn't necessarily mean like we

need to think too differently about it.

I think we need to maintain
regulation and be thinking about PHI.

But other than that, like help the
Reforge content always talks about like

retention is a byproduct of activation.

Like think about activating the
patient, get them quickly to that

aha moment of what the value is in
your product or your service, and use

your enrollment workflow for that.

So Omar, stepping back to perhaps a last
formal question that has nothing to do

with healthcare, technology or products.

What's your morning routine?

I'm curious for someone who knows so
much about this stuff, you gotta be a

go-getter in the morning, is that right?

Or Or Tell me about
how you start your day.

Ooh, I don't know if I'm a go-getter
in the morning, I do the typical

hygiene things, like I have to shower.

My hair's longer than normal now, and I
used to think it was funny when my hair

would just look all disheveled on calls.

So now I try to get clean, at
least look presentable for cameras.

I'm a bit obsessed with making coffee.

I like a good pour over, so I'm
always trying out new beans.

My 23andMe, if you've done
it, it has a caffeine report.

That caffeine report suggests that I am
more likely to consume more caffeine than

the average human who's done that test.

So I think that's pretty cool.

I play, this is weird.

I, I play a few rounds of
like three minute chess in the

morning when I drink my coffee.

So it's, you know, quick, rapid fire.

I don't really care about the outcome.

It's just like a nice, think about
something, but not really in the morning.

And then I will start my work day
with either meetings or deep work.

Just depends on my schedule.

All right, and as we wrap up
today's discussion, I'm gonna shift

the dynamics here a little bit.

So you've shared with us, Omar,
a wealth of knowledge about your

background in scaling operations and
navigating complexities of health

tech product development, and then
pushing the boundaries of BBC.

Now, I'd love to give you the four.

So do you have any questions for me?

Oh, that's different.

Yeah, I do.

I, this is actually self-serving and for
concept of care, I, I always wonder like,

from a product manager's perspective in
healthcare, like what are the, what do you

think are like the most important things
that like a product manager or product

management function should be thinking
about when building in health tech?

I think this is perhaps like a, uh,
the easy answer and, and the one that

a lot of people would give, but I
really like to be centered around the

patient experience and I think that
that is rooted in the fact that we

are all patients and I've had a lot of
experiences personally among my family in

the healthcare system, and there's just,

there's just so many things that
you encounter as a patient that

are not designed around you,
whether that be digital products

or, you know, the insurance system
or all sorts of things like that.

And it's, it's so meaningful to
me as a patient when I encounter

something in healthcare that does
seem like it was designed for me and

was designed around the needs that
I have and the concerns that I have.

I like to keep that really in focus in my
work to make sure that we're ultimately

serving the people that are, they're
getting the care and, and the reason

that whole healthcare system exists.

That's awesome.

Thanks.

Omar, I really appreciate
our discussion today.

If people wanna follow up on anything we
discussed here today or reach out to you,

what's the best way for them to do that?

Yeah, it's been a ton of fun.

I'm, I'm very responsive, so
my email is omousa16@gmail.com.

If you DM me on LinkedIn,
I will likely respond.

I'm, I have a pretty high
response rate Concept to Care.

Check us out.

It's a really good podcast
about building in health tech.

I have an amazing co-founder and co-host.

Her name is Angela Suthrave.

She's a product leader building
in healthcare and AI right now.

And both her and I have just like these
awesome conversations that we want to

share with other folks, and we've decided
to bring people smarter than us to come

talk about those conversations, and
so we hope people are getting value.

Yeah.

I also have a Twitter,
it's called Omar M Health.

I, I will respond there too.

I'm not as active there as I
wish I'd or I'd like to be, but.

Yeah, and there's a Substack.

Concept to Care has a Substack, so check
out our sub substack follow, subscribe.

Um, there's some good content there
that we publish, so I'm very accessible.

Omar, thanks so much for sharing
your perspective on strategic product

management in healthcare with us.

I really enjoyed the conversation,
especially around the key factors

for deciding whether to build or buy.

Um, very, very insightful there
and I think your work at especially

various scaling companies,
really frames the importance of

considering lots of different
viewpoints when developing products.

So thanks for that.

Yeah, same here.

Thanks so much.

To our listeners, hope
today's conversation was

insightful and inspirational
to your own product journeys.

Thanks for joining us on Hard Problem
Smart Solutions, the Newfire Podcast.

I'll see you next time.