Interview with Izac Ross — Senior Designer at Collective Health
Healthcare + Design Episode #3
In this episode of Healthcare + Design, I interview Izac Ross, a senior designer at Collective Health. Collective Health is a healthcare startup changing the way Americans pay for healthcare in the United States.
“Design is not some “department” here. It is core to the business. Right now the biggest parts of our value propositions is our user experience. Design does not report to product, it does not report to engineering, it reports directly to the CEO.”
Can you explain your design career thus far and how your journey has led you to Collective Health?
I got my degree in service design with concentrations in industrial and interaction design back in 2011. Ever since, I had been in consulting at companies that work mainly in the finance and healthcare space. Working at companies like Philips Healthcare, Cooper, Moment; really cool places. As I continued down my consulting career, I definitely discovered that my passions were around complex, difficult, hairy problems that are generally in highly regulated spaces.
I reached a point in my consulting career where I really wanted to see something through. My boss at Cooper had made the switch to this company called Collective Health. When she was telling me she was making the switch my mouth started watering at all the interesting problems that are in the health insurance space. Unlike a lot of the other startups out there that chew around the edges of a lot of different problems, Collective Health is really going for the heart of it. Instead of a point solution we are really looking at changing the way we pay for healthcare in the United States.
What is Collective Health and what is your role at the company?
Collective Health is a complete health benefits solution. What that actually means is we help companies, that are about a thousand plus, provide insurance to their employees. What is fairly unknown in this country is that 80% of companies over a thousand don’t purchase traditional financial products to ensure their employees. Instead what they do is something called self-insurance. Self-insurance is where they pool their money and pay doctors directly out of that pool of money.
When you look across the industry of health insurance the satisfaction scores of the traditional products and services out there are terrible. Your health insurance shouldn’t feel like it’s Comcast. Right now if you look at net promoters scores, health insurance companies generally fall in the same place that telecommunications and cable companies fall, very very low in satisfaction. Our goal in addition to driving those services to those employers is to provide a great experience to their employees so that they will love their insurance.
Healthcare is a mess. How do you navigate such a complicated space to understand the industry, the problems, and the end users?
I hate being self referential but I think a lot of us out there and a lot of people at our company have had one or two bad experiences with insurance. Either through themselves or through their parents or their brothers and sisters. I think that’s where that the initial passion comes from. We acknowledge and have had experiences that show how broken the system is.
In terms of getting up to speed on those details, the background behind all that is a lot of time spent trying to understand the basic building blocks of insurance which are medical claims. Understanding how medical claims come in, how they are processed, how they are manipulated and used, how they are used across a benefits stack. Once you understand that a lot of health insurance becomes a lot clearer and you see a lot of the mess but you also a lot of the opportunities. Also, diving into how health insurances are explained. I spent a lot of time when I first started here understanding this document that generally explains insurance plans. You will have one for your insurance, I have one for mine. Reading those things albeit very boring is a really great way of understanding how these plans work and those “gotch yous” you experience when you make those calls to your insurance company.
How do you approach these challenges as a design team?
We are a design team of 11 right now. We want to grow that team to be more about 20 this year. It’s pretty awesome. We have three verticles, or audiences, that we spend a lot of time thinking about. The first one is our members, the people themselves, the people who are insured by the employers, who are our customers. We have teams for our members and teams for our employers. We have one third key team which is a team for our own internal tools. A team that helps build tools for our call center and our operations to help them actually give service.
Inside of each of those teams we have a set of multi-talented designers who feel comfortable either more on the visual side or on the structure and systems side or both. They all work together to solve whichever challenge we are trying to tackle next. Design is not some “department” here. It is core to the business. Right now the biggest parts of our value propositions is our user experience. Design does not report to product, it does not report to engineering, it reports directly to the CEO. This is something that doesn’t happen enough in startups and even big businesses. I know that our leadership cares about design and it’s a part of how we think about ourselves as a business and as a competitive quality to our products and services.
How does Collective Health foster that design culture in such a growing company and in a space that, historically, is not a focus for healthcare companies?
One of the things is really educating people about why design is such a big part of our company. It used to be when I started, I was the fourth designer we were 50 people now we are 200. That story is a little different back then then it is now. It’s making sure that people (inside the company) know we are the resource for making beautiful processes, services, and products across the organization. We end up doing a lot of training based on the user research we complete. We give an orientation to everyone about when you should have a designer in this conversation. In the organization we try to facilitate many conversations, not just product, but also operations and processes to make sure we are considering both our internal members and our members that are out there using our products and services. Hopefully we don’t do this everyday but when they need it.
How do you watch the end users use your product to really gain that empathy for them?
Every quarter our design team has a target number of users we need to talk to. It’s not a small number either. It’s a big chunk and it’s part of our responsibilities, as design, to go out and talk to our users or our future users. We are on a very cyclical cycle. Insurance really only gets purchased and switched of January 1 of the following year. Everyone goes through open enrollment from October to late November. So who our user is changes depending on the time of the year.
At the beginning of the year, we are generally talking to the people we just brought on the previous year. We just wrapped up a project talking to 35–40 of our members across our portfolio companies really trying to figure out what worked, what didn’t work, what were the service failures, what were the things we did well, what were the things we needed to improve. That is going to feed directly into our next round where we are improving all those touch points for next year. We are going to shift from information gathering to evaluating prototypes and having potential members or members, depending on what we’re testing, come in and play with the latest and greatest from the design team.
So you are designing software for companies that help them better organize their insurance for people who work at their company?
We are not just designing software. Software is a part of it. We are actually designing the ecosystem. We have a call center here that we call our member advocates. When anybody ever has trouble with their insurance, at the companies we work with, they just us a call. Unlike other places, if you have ever had to call your insurance, there is a bunch of different IVRs that you have to weave through and you get to someone and they don’t actually know the answer so they pass you to three other people. At Collective Health, the person who answers the phone gets you the answer.
You wrote an article while you were at Cooper talking about “service design”. Is that what you are focusing on at Collective Health?
Yes, we are a “product company” but service is a huge aspect about how we think about what we are providing. It’s a huge part of our value proposition.
Can you explain what service design is?
A lot of the things that we work on these days aren’t tangible. I can’t drop the value on my foot. It’s not necessarily a product. We work in complex ecosystems today. A lot of those are networks of products and systems that add up to an intangible value.
In general, when you talk about that intangibility you are actually talking about the fact that you are building a service. Just like products, services can be designed to be useful, usable, and desirable. Unlike products where once they’re taken off the shelf the company has very little to do unless that object breaks, services have a ton of people in the background who have to make this service tick and run. You need to make things usable, useful, and desirable for your customers. However, you also need to make them profitable, acceptable, and awesome for your internal employees who have to execute that for the customers on a daily basis. You start getting into complexities but you start getting into tools like journey mapping, service blueprinting, ecosystem diagrams to design those usable, useful, and desirable processes that get used in these intangible systems.
A great metaphor that I like to use when explaining this is the iPhone. I went to school in a place where we had an industrial design, interaction design, and service design department all sitting in the same place. So me as an industrial designer, I am responsible to make sure this object beautiful, useful, and desirable. I need to know that there is an affordance for my finger to turn this device on or off. As soon as this device starts to have a dialogue with me, it’s having a conversation, that becomes interaction design. I click on something, some other message pops up, so on and so forth. As soon as this device starts to affect the world (i.e. I use it to rent a Zip Car, I use it pay for my donuts in the morning) that becomes service design. As soon as I am affecting the world with this device it becomes service design.
Could you explain the design process at Collective Health? What’s the process look like from start to finish?
We work across the company to identify needs and with our members and our research. There are things that come up in the sales cycle, or things that we didn’t realize in the operations center, and so we work to identify those things. On a quarterly basis we work to identify what are the things we are going to tackle this quarter. Once we have identified those things we work in a iterative, scrum style fashion in order to get to the end result. We will work together to plan it in the beginning, then work towards getting multiple prototypes that we can test, bring people in that we can test, and continue to refine them until we are delivering those interaction products or service products to the appropriate place to implement them. Throughout that process we do design crits and midpoint reviews with stakeholder all the way to the end where we are delivering that either to the engineers or to operations staff or to whichever part of the business we are delivering for.
What are some of the design tools that you use during the design process?
On the design front, the typical side, we are using Sketch. We are using for prototyping in the early stages InVision. In the later stages we are using whatever high fidelity prototyping tool any designer is used to. We use usertesting.com. We are playing around with recruiting platforms as well to get those users in the house versus online. I hate it but we are using Jira to work with our engineers. I hate Jira. Sorry Atlassian if you are listening. We are also facing new issues when we talk about rewriting an entire plan like, “where do we store that stuff? What’s the CMS that works with that?”. There is a lot of challenges that we are having to build the spoked tools to solve.
What does the transfer from a high fidelity prototype to a fully implemented feature look like? How do you interact with the developers to implement the design?
We are in sync with the scrums. We may not be always working on the same thing but in our scrum planning meetings and reviews we are demoing what’s coming out of our prototypes and research. There are opportunities for developers to raise red flags (“is this an interaction model that they feel is possible in the time alloted to be able to make this thing?”) We are constantly in touch with those people. It’s actually one of the interesting challenges that we are constantly in touch with a lot of the organization. Bringing everyone along the ride is something that is super important especially as we scale.
Data is so important to designing in healthcare. How do you design with the data available? How do healthcare regulations affect you when designing?
Instrumenting all the stuff (data) is really hard when it’s highly regulated. For those of you who are not familiar with HIPAA, it’s how you are governed in terms of keeping patient data private. It is super important and it does protect the consumer. I’m so glad we have these laws out there but it has a lot of heavy engineering and legal considerations that you don’t generally have to think about when you are dealing with your average consumer product. Those who are in or dealing with finance will likely feel a lot of the same pain.
One of the really critical things is having product lawyers who want to say yes to things and work with you to figure out what the optimal solution is within the constraints of HIPAA. I think when you go to a lot of larger organizations who are the original implementers of technology you will not find that legal position or collaborators with the design team. For anyone who is looking to be in a healthcare startup, in your interview process, you should meet with the lawyers who you will be working with. I’m lucky to have some of the best and brightest legal minds working alongside the design team to solve problems everyday. I highly recommend going through that exercise if you’re thinking about approaching anything in the healthcare space.
Hayden: When I hear designers like you and see companies like Collective Health addressing those problem, like it’s messy, you’re talking about designing with lawyers right next to you and your HIPAA compliant. That’s not a typical TechCrunch design startup story. It’s in an industry that’s not as “sexy” as the other ones that are out in Silicon Valley. It’s so needed though. It’s so cool to hear what you’re doing and you’re making it sexy and cool. Hopefully having more conversations with people and putting it out on the internet people will realize that they can provide real value to generations.
I have to say it is one of the most rewarding places to work because we are working to solve a huge problem in the US that makes people angry and go into debt. There’s a lot of emotion and problem around when you really need care you should have access to care. It’s cool to work on those problems.
What’s some advice you can give to other smaller healthcare startup design teams?
It depends. The biggest thing that I could say is to don’t get insolar with your design team. You can make something that looks super cool but will it get built. To answer that question:
a) Make friends with your legal team. It will make your life so much easier. Take them out for drinks. It wasn’t a challenge here but in the past when I was a consultant it was a huge barrier to getting things done.
b) Get your operations staff involved in the design process. No one is a bigger advocate for the user, generally, than those people on your team. They are the ones who will see everything that is going on. They may have specific opinions on which problems need to be solved first which is why you have to balance it out with research from customers.
Take those insights and convert those directly into solutions that solve those problems. Then work across the company to get buy in for those things. I’m lucky that a lot of the stuff I just said, at Collective Health, is just a part of our culture but, as a consultant, I recognize how hard some of this stuff can be.
What’s some advice you can give to young designers, like myself, interested in helping fix healthcare problems one day through design?
I can just think of even myself as a student and what I did. The things I think I did that were successful is, even as a student, I went to at least one conference in an area of interest a year. I met with people and shook hands. I tried to really understand the problems they were facing just like you would do user or stakeholder research. Talk to them because they are likely to have really good answers to what they are looking for and what they need. They can give you ideas as to where you may want to go. Convert your favorites of those leads into internships. By the time I graduated I think I did four different internships. Each of those were so incredibly valuable to me. By the time I graduated, I had over a year of professional experience. It made it incredibly easy to show what I was doing in school that could be perfectly applied to what I would be doing in my career. It gave a lot of confidence to the potential places I would work in my skills which was really nice. Then make sure you are following the people that you think are doing it the best in the industry and look at what they’re reading and tweeting. Follow those places and I think you can’t go wrong with those three things.
What are the main differences between a digital agency and a product company?
I want to separate out one thing. You used the word “digital agency”, there is also design consulting, and then yeah there is being an internal designer. There is being an internal designer at a startup and a large established company. I think all four of those are really interesting places. The beginning of my career was design consulting which I think is a little different than design agencies. As a consultant, you get a lot more facetime with your client. You work on smaller teams that don’t have intermediaries between you and your client. That is an experience that I recommend having at least once in your career because you learn how to tell stories, how to work on very complex problems with small teams with your clients. In general, I think digital agencies work on very big teams and humongous projects that are generally execution oriented. Generally, there is someone in between you and that client presenting your work. For both of those, I think you get to refine your craft much quicker because you are working on a variety of problems in a shorter amount of time. On the flipside you can also get stuck in that mindset and never fully realize any of those ideas that are coming out of your consulting or agency experience. Going in house at a larger company means you get smaller chunks of the pie to think about and work on. You know, for instance, Facebook has a whole team that just does search. I don’t know about you but I would go nuts if I was just working on a search box for months and months at a time. Being an internal designer at a startup is completely different. Especially a startup that is as complex as Collective Health. We arguably nine products depending on how you slice and dice it. In my year here I have gotten to touch almost all of those in some way. I get the best of both worlds and get to work on a variety of medium but I also get to see it through. I can see it’s actual birth into the world which is really cool.
What are some other healthcare startups that really have design at the center of their culture? What are some that you look up to and inspire you?
One Medical is one that always inspires me. Things like Omada Health that are more in the behavioral change space, which I think is a really interesting and important space to be in. Studio Dental is a project I worked on while I was at Cooper but continues to inspire me as a patient of theirs. Those are a few but you know I honestly get more inspired by other consumer services than I do healthcare. We are still at a point where healthcare feels like healthcare. Yes, to a certain extent, it should always feel like there is a seriousness and presence about it but I think it can go way more closer to consumer experiences without losing that. I get really inspired by platforms that connect multiple people because healthcare insurance is similar. Uber, Thumbtack, Amazon Home Services; things that connect multiple vendors to the consumer are really places where I get inspired from.
Thanks to Izac Ross for taking the time the talk!
Follow along as I post more episodes in the coming weeks by following Hayden Mills or the Healthcare+Design publication.
More information
Izac Ross on Twitter
Collective Health on Twitter
Learn more about Collective Health and their mission at collectivehealth.com
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