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Saul Marquez:
Hey everybody! Saul Marquez with the HLTH Matters podcast. I want to welcome you all back to today's episode straight here from the HLTH event floor. I am with Rajeev Singh. He's the CEO and chairman of Accolade. He joined Accolade as CEO in November of 2015, leading the organization's strategy and operations through high growth. In 2020, Singh led Accolade through one of the first digital healthcare initial public offerings of the year. The following year, he led the company through nearly 1 billion in acquisitions of 2nd.MD, PlushCare, and HealthReveal. Accolade now works with over 700 employers and health plans serving over 11 million people across the United States. Prior to joining Accolade, he co-founded Concur, the global leader in travel and expense management company in 1993. Concur went public in '98 and grew to more than 800 million in revenue, over 4000 employees, and more than 25,000 customers before being acquired by SAP for $8.3 billion in 2014. Singh was president and chief operating officer as well as a member of the board of directors at Concur. He is an amazing leader and has decided to get into the healthcare space with the work he's doing at Accolade, and I'm excited to be joined with them here on the podcast for HLTH Matters. And so with that, Rajeev, welcome to the podcast. So great to be here with you today.
Rajeev Singh:
Thank you for having me, Saul, I'm delighted to be here.
Saul Marquez:
Yeah, so there's no question that we need more work in the benefits space, work that actually helps meet people where they are, work that helps people do what they do best at work so they don't have to think about the wellness aspects of things. Before we dive into the details of Accolade and things that you guys are doing, I'd love to learn more about you. What inspires your work in healthcare?
Rajeev Singh:
Well, I think anyone who makes the leap into healthcare ultimately acknowledges one core fact, that this is a system that's configured to deliver optimal results for the people that are experiencing the healthcare system, and yet for whatever reason is not. And so for me, I joined the healthcare journey late in life. I joined as the CEO of Accolade seven years ago. But for me, very clearly the mission was I'd learned a lot in my life. I'm unfortunately very old now. I've learned a lot in my life.
Saul Marquez:
You don't look.
Rajeev Singh:
Well, I appreciate that. Thank you for throwing that in there. Hopefully, that stays and doesn't get cut. The idea of applying everything I've learned to trying to solve a problem that could profoundly impact the lives of 330 million people in this country, like that was just too good to pass up. And so the opportunity for impact, the opportunity for good impact, I think that's why most of us are in the business.
Saul Marquez:
Love that. Yeah, sign me up too.
Rajeev Singh:
Me, too, yeah.
Saul Marquez:
So let's hone in on Accolade. Talk to us about Accolade. What type of value are you guys delivering to the healthcare ecosystem?
Rajeev Singh:
We're sitting here at HLTH and there's so much innovation happening in the halls behind us, and much of it is focused on a particular condition. Much of it's focused on a particular transaction, focused on solving a particular part of the problem. What was so impactful to me, as I began to study Accolade eight years ago, I took the job seven years ago as the CEO, was that Accolade had the audacity to think, well, we should solve the whole problem. Let's follow someone through their entire journey, let's ensure that we understand all of the conditions that they're facing, all the medications that they're on, all the help that they may need, which might include, by the way, that they can't afford their healthcare. They don't have a car to get them to their doctor. And that if you could follow people through the entirety of their journey and break down the obstacles, make sure that they don't fall through the cracks, you have an opportunity to improve outcomes, to lower costs, and ultimately, most importantly, to make people's lives better.
Saul Marquez:
Yes.
Rajeev Singh:
And so Accolade chose to be this umbrella that was going to solve the whole problem. And we're, now, as a company, 15 years into the journey, as CEO, I'm seven years into the journey, but you can see that the opportunity to actually create that value is very, very real.
Saul Marquez:
So seven years, has it flown? Has it gone slow? Like, talk to me about that.
Rajeev Singh:
In aggregate, it's flown by, on any given day, sometimes, man. I think anybody who's worked in healthcare who tells you, oh no, it's been a breeze.
Saul Marquez:
Yeah, yeah!
Rajeev Singh:
Has absolutely blown sunshine. On the other hand, the learning curve, the hydration for my brain of really understanding so profoundly complex and yet at its core, honestly extraordinarily simple, like we just need to do the right thing for the people that we serve, and when we do, good things happen, and so let's stop making it really complex. But yet there are some complex economic, regulation, and other factors that impact it, but I try to remind myself every day, Saul, I know I'm not answering the question, I'm just sort of riffing right now, but I try to remind myself every single day, this isn't that hard. Let's stop talking about how hard healthcare is. It's, the job is to do the right thing for the person that's trying to experience care, and when we remind ourselves of that every day, we can solve problems.
Saul Marquez:
That's awesome. It's great to keep it simple, and I love that about you and the way that you do things, and that's demonstrated itself in sort of the direction that the company has gone. So as CEO of a healthcare company, how do you define health equity?
Rajeev Singh:
You know, let's just use the word equity and let's strike health, and let's speak to the idea that there are certain, I'll steal some constitutional words, there are certain inalienable rights that exist for human beings. One of them, in my view, and in the view of the 2200, 2300 people who work at Accolade is, healthcare is a human right. And that means that we ought to be able to experience every element of healthcare in a way that accrues value to ourselves and to our families and allows us to get to the outcomes that we deserve. Unfortunately, in the United States today, and unfortunately around the world, but let's just speak specifically to the market we serve here in the United States, equity is not a reality. It's not a reality in certain zip codes, it's not a reality at certain income levels, it's not a reality in certain communities of color or of, you name the areas where we see the inequality exist. And so we define health equity at Accolade as the responsibility to ensure that everyone has the right to high-quality healthcare, and unfortunately, we haven't cracked that code yet in the United States.
Saul Marquez:
Yeah, there's a lot of work that does need to be done. So what are some of the challenges and obstacles that have hindered the industry from making healthcare more equitable and inclusive in your mind?
Rajeev Singh:
I'm going to stay in the structural and the foundational elements and I'm going to leave out, because we could go for hours about the societal elements and the issues that really drive inequity beyond those structural and framework elements. But at a structural and a framework perspective, let's start here. The first thing you need to really experience high-quality healthcare is access to a primary care physician. And the reality is, if you live in certain neighborhoods in the United States or if you are a particular persuasion as it relates to your sexual orientation or otherwise, it's very real that you might not have access to a primary care physician. And even if you do have access to a primary care physician, you don't have one who's familiar with your history, with your background, with your heritage. Solving that problem is made materially more difficult in a country where we have a significant shortage of primary care physicians. And so our capacity to ultimately address the issue of the primary care shortage that exists in the country, which sounds like an almost intractable problem, but I believe is solvable, is a significant part of ultimately creating the opportunity for equity. But so the primary care shortage is part one of the story, the behavioral health shortage is part two of the story. Part three of the story is we're living in an inflationary environment, healthcare is already very expensive, high deductible plans are a reality for most people who are living in those underserved populations, and so now the capacity to afford the care, even if you can find it, is extraordinarily challenged. Those are just the structural impediments, let's not even get to the societal impediments. And so to address the structural impediments, you've got to think about the problem differently. And what we're excited about is it feels like the universe is ready to start thinking about the problem differently.
Saul Marquez:
Yeah, and, you know, I agree. And really with a lot of the introduction of these consumer companies that are now in the game, the front door to healthcare has changed. There's more than just one, so there's an opportunity to do more. Do you feel like your experience not having been in healthcare has given you an asset to be able to look at this in a different way than a traditional healthcare person would?
Rajeev Singh:
Saul, I'm going to take that question because I can only go in one direction. Given that I didn't grow up in healthcare, I have to say that it's a benefit. Here's what's true about a beginner's mindset in any space, and after seven years, I'm still trying to maintain that beginner's mindset. It's imperative that we don't accept broken as just the way it is. And I think I'm in the midst of writing a little blog post that I'll give you a sneak peek to. One of the questions we have to answer for ourselves if we're walking around these halls is, are we here to make money from the problem or are we here to solve the problem? And I think the beginner's mindset is imperative to really trying to solve the problem. It's actually fairly easy to build a company to make money off of a $3 trillion system that has enormous amounts of inefficiency. I think the question we should be posing to founders and to private equity companies and to venture capital companies is, don't we have enough of those companies? Isn't it time? Like, let's ask the question, are you trying to solve it or are you trying to make a buck? Because if you're trying to make a buck we should put you in a different pocket.
Saul Marquez:
I love that, well said. And so I love the approach to, Just solve it, you know, like, don't just come here to make a dollar, solve it, so many people need help. So what's Accolade doing to reduce health disparities and move forward toward greater equity in health?
Rajeev Singh:
So what Accolade is doing is the same thing I'd recommend for most of the companies that we have the fortune to partner with or the fortune to mentor and to guide. The first thing we're doing is we're actually taking down the last mile of care. And so when we entered the primary care space with virtual primary care physicians and behavioral health specialists embedded into that care, we had an opportunity to attack, one, health equity issues instead of actually only looking at the pool of physicians who are black physicians in Detroit who can serve a population that looks like them in that city. I can access a pool of physicians all around the country, that changes the equation. Being able to access that pool of physicians around the country and be able to work in, on weekend hours or after work hours changes the equation. Simple, simple things like that. But actually giving people the access to those physicians in the course of their care. We've identified an issue where triaging their symptoms and we say, I'm going to get you to a primary care physician in the next 15 minutes if you're available. When I get you to that physician, we're going to solve problems and we're going to address your needs. That's like magic for many people in this country who are, even if they have a primary care physician waiting 21 days, 21 business days to get to that appointment. And so we solve equity issues by solving the last mile. Don't tell them what the problem is, tell them what the problem is and say, here's the solution, we're going to guide you to the solution and get you the answer. That doesn't just have to be Accolade. If you're a women's health company that's working to help people address those issues, solve the last mile, like do the hard work. If you do the hard work, you're actually providing the answer and not the window dressing around the answer. And I think that's what we do, that's what we're aspiring to do in every problem we're trying to solve. In fact, one of the partners that we most recently announced, a company called Folks, is extraordinarily focused on the LGBTQ+ population. We know for a fact that that's a population, one, that struggle to find the primary care that they need, that struggle to find the behavioral health that they need, and struggle to find it within the context of a shared life experience. And so one of the things we're most excited about with a partner like that is the capacity to guide people to the care that they need, but then have them leverage a fully built-out ecosystem of providers, counselors, etc. who can work with them within the context of their lives. That's what we call solving the whole problem, and those are the companies that we partner with as well.
Saul Marquez:
That's fantastic. Thank you, Rajeev. And a lot of it is navigation, right? I mean, where to go and what provider to get what from. Can you speak to that?
Rajeev Singh:
Man, it's navigation and it's, some of it, a lot of it is, to your point, like the capacity to get to the right physician at the right time. In our case, we can get you to one of our primary care physicians, but if you're going to see a specialist, wouldn't it be fantastic if we could get you to a specialist driven by data? How about one of the top 25% of the physicians in your network who specialize in the shoulder surgery that you're about to have? And what if we could also tie that to cost? The site of care? And what if at the same time we did all of that, we could understand the financial contributors to whether you can afford that surgery? Can you afford the deductible? Are there other problems we need to solve that are totally different than getting you to the doctor but have a lot to play a significant role to play in whether you can get to that doctor? That's where you tie physicians, physician quality, physician cost to the idea of navigation. You have to solve all of these problems because in context, the single biggest financial challenge most people face in their lives is affording healthcare.
Saul Marquez:
Totally. So, question, have you guys always, has Accolade always had their own physicians?
Rajeev Singh:
We haven't. It's been core to the way we thought about solving the problem, but 2020 changed everything in so many ways. That's almost a throwaway comment, but one of the things that very clearly did happen is access to virtual care became mainstream in the United States. And my mom and dad are 80 and 79 years old. Prior to the pandemic, they had never seen a doctor online. Today, my mom, my dad's different, you know, everybody's a little different, my mom doesn't want to go to the doctor's office anymore.
Saul Marquez:
Yeah, she's just like, Give me my doctor online.
Rajeev Singh:
Why would I ever do that again? My dad, on the other hand.
Saul Marquez:
Likes to go in.
Rajeev Singh:
Well, he's got opinions, and so he wants to talk it through with the doctor.
Saul Marquez:
I love that, I love that. Well, thanks for sharing this. And one of the things that I've really enjoyed watching Accolade through the process, I remember back the, seven years ago when, okay Centene says we're going to place a bet here, we think this is going to go somewhere. And today, the way that the company has evolved has just been very impressive. So I want to give you kudos, and the team at Accolade kudos for how you've navigated the pandemic, and now on the other side of it, the endemic, to continue growing as a company that adds value and seeks to solve problems, not just make a buck.
Rajeev Singh:
It's very kind of you to say that, Saul, I really appreciate it. All that credit goes to the team, you've met some of those team members, they're extraordinary. But we're just getting started, man, we're just getting started.
Saul Marquez:
I love it, man. Well, listen, I am so privileged to be here with you, so thanks for giving us some of your time and sharing with us the way that Accolade is making a difference. What closing thought would you leave our listeners with today?
Rajeev Singh:
The disruption that's occurred in the space over the last two years, two and one-half years, it's brought about unbearable amounts of pain for so many people in this country, it's brought about so many challenges and so many things that we can lament and look back on and regret. Let's not waste all of that pain without acknowledging that it has created opportunity that we have to take advantage of. If we let things slip back to where they were before the pandemic, we've wasted a massive opportunity to solve the most profound issue that faces this country. Healthcare is 20% of GDP, and it's on the way up, and that's not the problem, if we want to spend a lot of money on healthcare, so be it. The problem is our mortality rate is going down, the problem is that our outcomes are going down, the problem is our people aren't getting the care that they need. There's an opportunity right now in this window to have a material impact on what's happening, let's not miss this opportunity.
Saul Marquez:
Love that, Rajeev. Hey, I appreciate your passion and belief in the future of our country's healthcare. I think we're all lucky to have companies like Accolade to provide the services that you do. What's the best place that people can reach out to you or learn more about Accolade?
Rajeev Singh:
Oh, well, you should learn more about Accolade at Accolade.com. You should reach out to me by dropping me an email. You can drop me an email at RajeevSingh@Accolade.com. I'm pretty good about responding. If you've got ideas as to how we can make the ecosystem better jointly, I imagine there's a lot of innovators listening to your podcast, we'd love to hear your ideas.
Saul Marquez:
Love it, Rajeev. Hey, I really want to tell you appreciate your time.
Rajeev Singh:
Thank you very much for having us and for what you're doing.
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