Episode #13 - Ari Saft, VP of Product at Tia

Written By Omar Mousa

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Description

Ari Saft is the Vice President of Product at Tia, where she leads the development of technology solutions that integrate virtual and in-person care for women’s health. With nearly five years at Tia, Ari has played a pivotal role in transforming the company’s product strategy to support its rapid growth from a single clinic to a multi-location operation. She brings a wealth of expertise in aligning product and operations, focusing on creating seamless healthcare experiences that prioritize both patient and provider needs. In our conversation, Ari shares her insights on:

  • Tia's Business Model and Vision: Ari discusses Tia’s evolution from a single clinic to a scalable, multi-location healthcare provider and how their mission to deliver high-quality, patient-centered care guides their product development.

  • The Challenges Behind the Product and Operations Relationship: Insights into the common friction points between product and operations teams as Tia scales and how to recognize the signs of a strained relationship.

  • Moving Towards a Productive Relationship Together: Practical strategies for aligning product and operations, rebuilding trust, and fostering collaboration to drive better outcomes for both teams.

  • Organizational Design and Culture: Ari's approach to structuring cross-functional teams and creating a culture that supports innovation, transparency, and continuous improvement at Tia.

  • Operational Hurdles with Moving from Custom-Built EMR to a Headless One: The decision to transition from a custom-built EMR to MedPlum, the challenges faced during this change, and how Tia managed the move to ensure agility and focus on their core value.

  • Tia's Future: Ari shares her vision for the future of Tia, including plans to expand their reach, refine their product offerings, and continue innovating to meet the evolving needs of women’s health.

In this episode of Concept to Care, Ari provides a deep dive into the challenges and successes of integrating product and operations in a rapidly growing healthcare company. Her insights on fostering collaboration, building scalable processes, and making data-driven decisions are invaluable for any product leader navigating the complexities of healthcare innovation.

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Some takeaways:

  1. Evolving Relationship Between Product and Operations with Scale: As Tia scaled from a single clinic to a multi-location operation, the relationship between product and operations had to evolve from product-driven innovation to a focus on operational consistency. Ari shared some of Tia’s structured approaches to managing this shift:

    1. Cross-Functional Teams: Tia formed "tiger teams" with representatives from product, operations, and frontline staff to ensure all perspectives are integrated during decision-making and project execution.

    2. Embedding Operations into Product Development: By embedding roles like "clinical product" directly into the product lifecycle, Tia ensures that operational needs are prioritized from the earliest stages of development.

    3. Iterative Rollouts: Tia uses an iterative rollout process to gradually introduce new tools, incorporating feedback at each step to minimize disruptions to frontline operations.

    4. Safe-to-Try Culture: Creating a "safe-to-try" environment encourages open dialogue about risks, allowing the team to address concerns collaboratively and build trust between product and operations.

    5. These structured approaches help Tia align innovation with the realities of delivering scalable, high-quality care, balancing the needs of both product development and operational efficiency.

  1. Recognizing a Strained Relationship with Operations - Red Flags for Product Teams: Ari discussed the telltale signs that product teams should watch for to identify when their relationship with operations is becoming strained:

    1. Misalignment on Priorities: If operations frequently pushes back on product initiatives or feels that their needs are not being prioritized, it’s a sign that the two teams are not on the same page.

    2. Lack of Early Involvement: When operations isn’t included early in the product development process, it can lead to friction later on. If product teams notice that operations teams are blindsided by new rollouts, it's a clear indicator of a disconnect.

    3. Recurring Feedback Gaps: A strained relationship often manifests in feedback gaps, where operations feels that their input is either ignored or not incorporated into the product decisions, leading to frustration and disengagement.

    4. Tool Frustration: If operations teams are consistently unhappy with the tools and systems introduced by product, citing them as disruptive rather than helpful, this indicates that product solutions are not aligned with operational needs.

    5. Communication Breakdowns: When communication between product and operations becomes reactive rather than proactive, with both sides working in silos, it’s a strong signal that the collaborative dynamic needs improvement.

  2. Expectation Gaps in Product and Operations Collaboration: Ari emphasized the importance of recognizing "expectation gaps" early on between product and operations teams. She explained that these gaps occur when there is a misalignment in what each side expects from the other, often resulting in misunderstandings and friction. As Ari put it, it's about realizing when you’re "having different expectation gaps" and working to "align on what each other's expectations are and meet in the middle." When product and operations don't clearly communicate their needs and goals upfront, both teams may end up working towards different outcomes, which leads to reactive problem-solving instead of proactive collaboration. Closing these gaps requires open dialogue, a willingness to understand each other's perspectives, and finding a shared path forward that aligns with both teams' objectives.

  3. Remedying the Product-Operations Relationship: Ari suggested several strategies for repairing a strained relationship between product and operations:

    1. Early Involvement and Open Dialogue: Ari stressed the importance of involving the operations team early in the product development process, starting from the discovery and design phases. This ensures that their insights and concerns are considered before any major decisions are made.

    2. Cross-Functional Syncs: Regular cross-functional meetings, where team members are encouraged to bring problems (not just solutions), help both teams collaborate on finding the best path forward. This approach shifts the focus from individual team goals to shared problem-solving.

    3. Building Trust through Radical Candor: Ari recommended using a candid and honest communication style to build trust between teams. By being open about challenges and potential issues, both product and operations teams can create a more transparent and supportive working environment.

    4. Super User Groups: Tia leverages super user groups to gather real-time feedback from frontline staff and operations. These groups provide insights into what works and what doesn’t, allowing the product team to make iterative adjustments based on direct input from end-users.

    5. Balancing Innovation with Operational Realities: Ari highlighted the need for product teams to balance their innovative ambitions with the practical needs of the operations team, ensuring that new tools and features do not disrupt workflows but instead enhance the team's efficiency.

  4. Structuring Cross-Functional Teams for Success: Ari shared her approach to structuring cross-functional teams to ensure effective collaboration between product and operations:

    1. Dual Organizational Focus: At Tia, the organization is split into two main groups: the innovation team (product, engineering, growth, and marketing) and the clinical and operational team (markets, real estate, and core operations). This clear division helps align focus areas and expertise.

    2. Embedded Roles: Ari highlighted the role of embedded positions like "clinical product" and "product enablement," which act as liaisons between the innovation and clinical teams. These roles attend product meetings, grooming sessions, and design syncs to ensure that both sides remain connected and aligned on goals.

    3. Product Enablement Team: Tia has a dedicated product enablement team that works closely with the operations side to identify gaps and optimize processes before they are fully productized. This approach allows the team to validate ideas and requirements with operational input before building solutions.

    4. Cross-Functional Rituals: Regular cross-functional rituals like grooming sessions and design syncs include representatives from both product and operations, ensuring that each team is aware of ongoing projects and can provide input early in the process. This level of involvement helps mitigate misunderstandings and ensures that projects address real-world needs.

  5. Documentation as a Key to Scalability and Alignment: Ari highlighted the importance of robust documentation in supporting Tia’s rapid product evolution and cross-team alignment. By centralizing knowledge using tools like Guru, Tia ensures that operations and frontline staff have quick access to up-to-date information, reducing knowledge gaps and enhancing onboarding. Effective documentation also strengthens feedback loops, enabling continuous improvement and smoother scaling of innovations across the organization.

  6. Using Metrics to Drive Alignment and Accountability: Ari shared a simple but effective approach for using metrics to keep product and operations teams aligned. Here are the key steps she recommended:

    1. Define a “North Star” Metric: Start with a clear metric that reflects your company’s mission—like patient retention or engagement—and use it to guide decisions across both product and operations teams.

    2. Combine Quantitative and Qualitative Data: Use a mix of:

      1. Quantitative data: such as care plan adherence, appointment follow-up rates, and other measurable outcomes.

      2. Qualitative feedback: like patient satisfaction scores and direct user feedback to gain insights into areas for improvement.

    3. Regularly Review Metrics in Cross-Functional Meetings: Schedule frequent reviews of these metrics with both product and operations teams to ensure everyone stays aligned on goals and priorities.

    4. Tie Metrics to Measurable Outcomes: Make sure every product update or new feature is directly linked to these metrics to keep your teams focused on driving real, measurable impact.

  7. Transitioning from a Custom EMR to MedPlum: Boosting Agility and Focus: Ari discussed Tia’s move from a custom-built EMR to MedPlum, highlighting several key aspects:

    1. Why Tia Switched: The custom EMR became a constraint as Tia scaled, requiring too much maintenance and limiting their agility. Switching to MedPlum allowed Tia to focus on their core strengths—delivering superior care—without the burden of managing backend infrastructure.

    2. Benefits Gained: MedPlum's headless architecture enabled faster iterations and more customized interfaces, giving Tia the flexibility to adapt quickly to patient and provider needs.

    3. Change Management: Tia executed a phased rollout with clear communication and continuous feedback, ensuring a smooth transition and minimizing disruption to clinical teams.

    4. Key Learnings: The experience underscored the importance of focusing on core competencies and investing in scalable solutions that grow with the company, rather than becoming bottlenecks.

  8. Structured Roadmapping and Execution: Ari explained Tia's roadmapping approach, which emphasizes an impact-versus-effort analysis to prioritize high-value projects. Here’s how they execute this process:

    1. Quarterly Planning Framework: Tia sets clear goals each quarter, using an impact-versus-effort analysis to prioritize projects that offer the most value for the least effort.

    2. Impact over Effort Prioritization: Product, engineering, operations, and clinical teams work together to rank initiatives by their potential impact versus required effort, ensuring a focus on the highest-value projects.

    3. Regular Check-Ins: The team reviews progress regularly, adjusting priorities based on impact-versus-effort evaluations to stay agile and responsive.

    4. Transparent Execution: Roadmaps and updates are shared openly to keep all teams aligned, enabling quick pivots and reinforcing focus on impactful projects.

For a deeper dive into the conversation with Ari Saft, listen to the full episode and learn more about how Tia is revolutionizing women's healthcare through innovative product development and cross-functional collaboration.

Show Notes

Where to find Ari Saft:

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Where to find Angela and Omar:

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Referenced:

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Transcript

Ari Saft: [00:00:00] And communication breakdown where like each side you find like working in silos and collaborations actually like reactive rather than proactive. And so, you know, noticing those signs early, we use actually this phrase called like, you know, expectation gaps. Uh, a lot. So like, how do you, how do you realize that you're like having different expectation gaps and how do you then like work through and align on like what each other's expectations are and meet in the middle.

Angela Suthrave: Welcome to concept to care where we hear candid stories of success and failure, discuss strategy and dive into the details that offer advice on what to do and what not to do in health tech,

Omar Mousa: whether you're a seasoned pro growing your career or just starting out. Our aim for this podcast is to be relevant Real world and tactical.

We're dedicated to not only entertaining you all, but also empowering you with actionable insights that can be applied beyond the podcast, one concept at a time.

Angela Suthrave: This is Angela

Omar Mousa: and this is Omar.

Angela Suthrave: Welcome to concept to care.

Omar Mousa: [00:01:00] Today, we are joined by Ari Sapp, VP of product at Tia, a company revolutionizing women's healthcare by blending virtual and in person healthcare services.

In this episode, we explore the critical relationship between product and operations in a tech enabled healthcare services org. How to strengthen those relationships. How to design organizations for success. In the operational hurdles that come with major system migrations. Ari also shares the key indicators for when the relationship isn't working well and how to identify those red flags before moving toward a better, more collaborative dynamic.

With nearly five years of experience at TIAA, Ari offers a unique perspective on what it takes to align product and operations for sustainable growth. And success in healthcare. We hope you enjoy.

Angela Suthrave: Hi, Ari. Thanks for joining us today. Hey, Omar. Hey, Angela. How are you? Good. We're super excited for [00:02:00] this. So why don't we go ahead and get started? And it would be great if you could tell us a little bit about yourself.

Ari Saft: Yeah, absolutely. So, hey everyone. My name is Ari Saft. I'm the VP of product at Tia, a healthcare company that provides primary care and gynecology care to women.

I ended up in this role because I actually started my career as a elementary school teacher with Teach for America. And my first year teaching, I had 36 students in my classroom with just me. And so I brought computers into the classroom and really saw firsthand the power that technology can have to empower people in processes.

From there, I've worked in ed tech and healthcare, and I've been at TIA since February 2020.

Omar Mousa: That's amazing. And so you mentioned your VP of product at TIA. We want to spend some time talking about TIA's business model and vision. So TIA's undergone significant evolution over the past eight years, and you've been with the company for almost five.

Can you share a little bit of how TIA's business model and core vision has developed over time? And. [00:03:00] What are the driving forces behind some of that change?

Ari Saft: So T has changed a lot, but throughout his existence, the mission of the company actually hasn't changed. It's to help women reach their optimal health goals.

The tactics on how to get there are really what's changed. You know, Tia actually started as a birth control recommendation app. And after like 200, 000 conversations, the two founders realized that women needed a place to get care. And they stood up a in real life clinic in New York in like eight months.

And then the plan was like, you know, have these in real life clinics and in different cities. And then COVID happened and we needed to stand up a virtual clinic. And then this evolution of TIA became, how can you have. In real life and virtual care supporting women and that's evolved now to partnerships with health systems, but truly like at the core of this has always been helping women and listening to our users what they want and what they need [00:04:00] and I think you know one of my Favorite things about working at TIA is that people really follow this mantra of strong beliefs loosely held.

People are willing to experiment, try new things, and evolve their thinking. And because that like vision north star has been so secure the entire time, it's just like constantly trying new things in order to achieve this goal. When your north star is not shifting, it's like, A lot, I wouldn't say easier, but everyone is kind of like rowing the boat in the same direction, even if the ideas are, can be contradictory.

Angela Suthrave: That's really awesome that there was stability with the Northstar and gave you the latitude because you were stable in the area to be able to experiment. One of the areas that we wanted to dive a little bit deeper into is the relationship between product and operations. So with TIA, starting with that single clinic.

In New York, it seems like you all still have a very product driven culture. And so tell us a little bit about the relationship [00:05:00] between product and operations and how has that evolved as the company has grown to the model that you described today and what challenges do you face in maintaining this

Ari Saft: type of balance?

So, you know, as you mentioned, Tia has grown from a single clinic to a much more complex operation. There are, I think it's like 10 plus clinics now in Arizona, LA, New York, San Francisco. And this relationship between product and ops has really naturally evolved over time. Early on product called the shots.

We moved quickly. We drove the culture, but as we scaled operations needed to be more in focus so that we could deliver consistently across clinics. At the beginning, you have those power users that really like have stars in their eyes when they think of TIA. Now we're at the point where, you know, someone.

Who might not have ever heard of TIA, you know, finds it off an ad and we have to make sure that they're going to get really good, consistent care. And I think the biggest challenge is, has been balancing innovation with the practicalities of [00:06:00] running an efficient reputable and like repeatable processes and care delivery.

So we're like constantly trying to align product vision with operational realities, ensuring that what we build truly supports frontline teams without slowing them down. And so it's just like a constant. Push and pull in both of those

Angela Suthrave: anchors. Can you share a story about one time that maybe stands out to you with the push and pull and how did it ultimately end up resolving?

Yeah, I have a great

Ari Saft: example right now. We are in the midst of rethinking how we handle scheduling. So as you can imagine, like scheduling is the backbone of any care delivery business. And. Taking one set of scheduling software and like replacing it with another scheduling software. Like that's a really big deal.

And so if you did it all at once, by the way, Tia is a very firm believer in agile development, which also can come at a head with like operations as well. [00:07:00] So, you know, we didn't want to just like replace everything at once. We wanted to do it iteratively and learn. And the, when we first brought this up with the operations team, it was very much a, like, We can't do that.

Like, you know, we can't teach all of our frontline team, our providers, like, this new system. We, like, we just can't do it. And That was where we started and today we are iteratively working through moving from our old scheduling system to our new. And the way we did this is really followed a thoughtful collaboration process.

We started out with like, what are you scared of? And kind of went through all of the things that people were scared of. And this was, you know, People feeling insecure in their job all the way down to us missing utilization numbers and then we built our acceptance criteria around these kind of like fears and ensured that we had check ins that we'd be like getting feedback on these pieces of fear.

So if it was around utilization. You know, every time we deployed a [00:08:00] slice, we would check in and be like, Hey, how does utilization with old system compared to new system? We actually had an ops representative in all of the meetings. And so we kind of like create these, you know, cross functional like tiger teams for big initiatives.

And so there was a provider representative, there's an operational representative, and everyone was on the same page of how we were working. And then there was also just some push and pull on release dates. And so product wanted like things out really quickly and the operations team was like, no, we need to train people.

And so we found this like middle ground of actually using super users and having a subset of different users on the front line who were either like culture carriers or managers start using the product and staging first so that when we went live, we, one, had feedback and then two, they could kind of like share what with teammates who were confused how to answer questions.

And so far we are, so the way we kind of split it up [00:09:00] is we did it by slices of specialties and we were like three quarters of the way through all of our specialties and so far it's, it's going well. But I think that this really, you know, one of us on one of our bigger cross functional projects and really like set a good foundation for how teams can work together.

Angela Suthrave: It sounds like One of the things that I've done is a pre mortem.

Omar Mousa: Mm hmm.

Angela Suthrave: Right, so you're sort of at the beginning of the project trying to figure out all the points of failure. And I really like your twist on it, which is, what are you afraid of?

Ari Saft: Yeah, I tell we use this phrase, like, safe to try. And so what, you know, how do you create the conditions of being safe to try?

And in order to figure that out, it's like, what is it safe to try and flipping that on its head? And I think that, you know, for anyone who's worked at a care delivery startup from the beginning, like you move really fast. You, I hate this phrase, but like break things. And I think there becomes a little bit of like [00:10:00] PTSD for the operations team where they're like, oh my God, like another thing that couldn't disrupt The way we do things and then the opposite happens where it's like no more changes.

And then, but in reality, like the changes are theoretically good. And so it's about building that trust and relationship. And then also having that feedback loop when something is not good, like being able to address it really quickly. So they're just like not living with chaos.

Omar Mousa: So you described early on, you know, product was kind of driving and then operation sort of as the company had scaled.

The relationship between product and operations had become a little bit more hard. Can you share some of those challenges that have you've encountered as you were, you know, directly related to scale? And how did you address those specifically?

Ari Saft: As we've scaled, one big challenge has been ensuring our product builds align with the on the ground needs of providers in our in our care team.

So with more clinics and teams, it's harder to keep everyone in sync. For [00:11:00] example, rolling out new tools without fully understanding the operational impact workflow disruptions because there's like, As a PM, like I can't know every single way the tool is being used anymore. It's not 10 people to address this.

We've focused on tighter collaboration with the ops team early in the product life cycle. We bring them into discovery and design phases very early. And we've also implemented more structured feedback loop to catch issues faster and make adjustments for bigger and wider rollouts. And this has helped bridge that gap between like innovation and operational efficiency.

Can you talk more about those feedback loops? Yeah. So there's a couple of different ways we do it. We have informal informal. One of the amazing things about TIA is that we actually employ all of our care team. And so they are all on the slack with you. And so if something is going wrong, you hear about it really quickly, which is really positive as a product manager, being able to like get that instant feedback can be a little overwhelming, but it is really positive.

And so we do have the [00:12:00] informal, like someone sends a DM and is like, Yeah. How do I get out of this screen? And you're like, ah, the UX did not make sense. And then we also have formal, which is, you know, we satisfaction with tools is really important to us. We know that it impacts retention. And so doing surveys on, you know, how's the tool best serving you shadowing, looking at efficiency of different workflows and time studies.

And then we do cross functional feedback meetings biweekly. And the, what we kind of, how we've oriented them are not like bring. What you want, but bring the problem. And so we have a group of people and they're bringing the problem. And then together we're collaborating on can we fix this with an operational change?

Does it need a product change? What's the minimal product change we can do? And that's been Um, Really great.

Omar Mousa: We faced similar stuff at Cerebral. I mean, you know, we built the platform from the ground up similar to you all. And I think you as a product manager who's been there so long. You're like, I know like [00:13:00] pretty much everything about the product.

And so it's like, I'm going to go to Ari. I'm going to ping Ari about this specific thing. Unfortunately, like that just doesn't like scale well, right? So you're, you're getting 40 pings a day. Eventually we got to the point where it's not, you know, I know the answer. I want to help you. But there's a priority to everything.

Like I kind of need to discourage this DM right now and I have to funnel you to a process, right? So do you, have you guys stood up like a. Intake in Slack or like a Jira Ticket system or something that can actually like in take those and get them triaged.

Ari Saft: I'm smiling because yes exactly same experience There's a couple different things we've done I will admit as you're moving really quickly at the beginning of standing something up You might not always take the moment to write really good documentation if I could go back to former re self four years ago, I would have been like document everything.

And now I'm a little document czar for all of the PMs that I manage. And that has been really helpful. We actually just implemented Guru for our frontline [00:14:00] team. And so we in partnership with clinical and operations have been ensuring that, you know, all of our different tech stack that the documentation's up to date.

And so they can ask Guru, like, Hey Guru, how do I close a clinical note? And that comes up and that's been really helpful in terms of other You know, random questions that come up. If it's just like a question about how product works, we have cross functional channels where the expectation is like 24 to 48 hour response time, unless you write like urgent.

And then if there's bugs, we have a JIRA service desk integration. Um, and just, we, we triage those based on, you know, urgency and impact. But. That's been helping. I definitely still get the, the occasional DM, especially from people who've been at TI a really long time and know that I'll answer it. But those, at least having the like bi weekly space to share what's happening or those channels for more urgent issues, it's like at least kept it a little bit more structured.

And In those [00:15:00] places, we get a lot of ideas and feedback to make the product better. So it's like good that they're out in the open because it sparks more conversation.

Omar Mousa: We asked how many, or like some of the challenges that you've experienced as you've scaled, that you were able to address. I'm wondering if there are any that just.

Have that like still prominent, still exist, have not been able to address.

Ari Saft: I still think we're figuring out how training works. I think everyone acknowledges how important training is, but there's a balance between like, how do you find enough time on the calendars for providers? How do you ensure utilization's not impacted?

And then training materials, like. What's the best way to train someone on different like types of changes. And so I think that's an area we're still evolving, especially this year. We're in the midst of like a big tech stack migration, which we'll talk about in a little bit, but that type of change is just so important.

so much bigger than like, Hey, we added an extra like button that lets you flag important conversations. So I think that's something [00:16:00] we're still learning. And then on the product management side, we're just a small scrappy team. And I wish that we did a better job at like soliciting ideas from the rest of the company right now.

It's in these cross functional meetings and we have processes with other team members of how they elevate ideas and problems, but it's like. Pretty like a couple people who are sharing it and we're working on these big projects. And so it's hard to like get the smaller idea in and think in a dream world, the way that like bugs funnel through, we'd also have ideas and we'd be able to really like talk to our stakeholders about them and before they come either like burning fire or, you know, part of okay, our planning.

So that's, that's something that I just like wish we did better, but there's only so much time in the day.

Angela Suthrave: I'm going to pull on a couple of things that you said. I think number one. A really great tip is to document everything. Oftentimes I find myself kicking myself because we made certain product decisions [00:17:00] and at a time we had great rationale and then fast forward three or four years people are like, well, why did you do it this way?

And then the details become super fuzzy. And I'm like, well, I know that we made a really smart decision based on the information we had at the time, but I wish I could recall the specifics. I think that also, you know, when you were talking about the training, we were all sort of smiling because that is a point of contention where you work for a care delivery organization is, you know, sort of this tension between building the product with wizards and tutorials.

And making it super easy versus like ops having to bear the burden of pulling people off of their phones or what have you, um, to attend a more analog type of training. So that's definitely something that is a challenge that I've seen across the board.

Ari Saft: And I think also different people just learn differently too.

And so, you know, we have, I also in the field of medicine, like. A lot of the providers we have, like, are [00:18:00] incredible doctors, but not necessarily, like, really good at working, you know, workflow tools. And so, like, how do you then set them up for success?

Angela Suthrave: We wanted to ask you a little bit about, have you had an experience where the relationship has been strained ops?

And what do you do? Like, how were you able to identify it before it really deteriorated? Do you have any stories you'd like to share or any guidance that you have for how to navigate these things?

Ari Saft: Yeah. I think there's some signs. I am very lucky that the core group of people that I work with, we've worked together a long time.

And so I think there's a lot of trust built up. And so you're able to really use radical candor in conversations. They can be tough and hard but we know that like we're all coming from like the same good place and oriented around the same goals. But, you know, it can be sometimes hard to like know that's about to happen and so some signs really include like, Misalignment on priorities when we're like [00:19:00] pushing things that operations like might not really want or need or the team struggles to adopt.

Another sign is like feedback gaps when like operations feels their input isn't being considered early enough. Um, when there's frustration with the tools that actually like disrupt instead of enhance workflows. And communication breakdown where like each side you find like working in silos and collaborations actually like reacting.

And so, you know, noticing those signs early, we use actually this phrase called like, you know, expectation gaps a lot. So like, how do you, how do you realize that you're like having different expectation gaps and how do you then like work through and align on like what each other's expectations are and meet in the middle?

And so I think we're like constantly doing that because, you know, as an operator, you're not going to understand everything. product wants and product's not going to understand everything that operations is doing. And I have this analogy that I like to use called the pizza analogy. It's, it's real silly, [00:20:00] but like, let's just say, you know, providers want a Hawaiian pizza and like, you know, The virtual support team wants like sausage and onions and product says like you can have a vegetarian pizza.

And so it's about like coming together and realizing that like a vegetarian pizza is really yummy and it has all the veggies that you all wanted. You're just like not going to get your meat. And so like, that's kind of like how we've tried to

Angela Suthrave: do it. I like this idea that you name things too. I think when you attach a name to it, then I feel like it's this common vernacular for you to Identify it, name it, talk openly about it.

It

Ari Saft: makes it also feel less heavy and personal. You're just like, hey, we have misguided, misaligned expectations. Let's, and we call it like, let's go to from like confusion to clarity and like come up with a plan to like get us both on the same page. It sounds a little cultish, but like it does work.

Omar Mousa: No, it's expensive.

It's expensive. I've seen it happen multiple times where people are not operating on the same set of definitions, but [00:21:00] they're talking about the same thing. And they're in agreement, like they're actually in agreement, but they don't realize they are. And they're just, you know, talking circles. So we've talked a little bit about kind of how, you know, the tough parts of product and operations relationships.

Let's talk about how to move towards, like, a more productive relationship together. So. Now that we've outlined those signs that you mentioned of a strained relationship, let's talk about how we remedy them.

Ari Saft: Yeah, so I, I actually think that having a strained relationship between ops and product Is a good thing for excellent product development.

It keeps PMs on their toes. It ensures that like operations has a ton of input in what you're building. And I think when you're building product for a care delivery business, like, it's not like we're selling our tech, like we're building in service of people. And so it's important that those people are like leading the charge.

And I think that often people say [00:22:00] like, Oh, the PM's like the CEO of the company or the, of the product. And like, that's not the case when you are building for a care delivery business, like you're, you are in service of others. And so I actually think that strain relationship maybe strains the wrong word, cause it has like a negative connotation, but like that potion pulls, you know, This is the, this is the end.

And so I think, you know, it's involving operations early so that, you know, both teams are clear on what's being built, it's implementing those structured channels. Like I talked about and, you know, having those cross functional syncs, encouraging open dialogue. And like really having trust that like the ultimate goal that we're all aligned on.

Is in agreement and, you know, having those checks for understanding of like, this is what we're doing and this is why and explaining it.

Angela Suthrave: Can you talk about what you found to be the most effective strategies that you've implemented to foster this type of collaboration that we're talking about and making sure that there isn't that expectation gap and all parties are aligned?

I'd love to [00:23:00] hear maybe around like roadmapping and like how often do you visit

Ari Saft: those things? Yeah. So first off, I think the most effective thing that we've done is embed operational team members like directly into the product development process. So like we have someone whose job is called clinical product and they are essentially like the liaison in between.

And then we have someone on care operations and they're the liaison. liaison in between and product enablement. And so like, everyone is kind of like aware of what teams are working on and the person who has the, like the pulse of what's coming. In terms of roadmapping, we do OKR planning, like most companies, big OKR planning at the haves.

Sometimes we'll do quarter check ins. Something I've learned over the last, you know, decade plus in product development is like, Ask an engineering team to predict six months out is not happening. And so we, we try and do quarterly planning with our engineering pods, but we set expectations with our cross functional [00:24:00] stakeholders that like, these are very big blocks with error bars.

And this is like the range of when we want things done. And the way we think of roadmapping is like, we have the big projects, which is like, Kind of things that are coming out in iterative slices and the people who need to know when the small slices are coming out are in the know. Then we have smaller things that like we just keep people up to date on.

And so how I work with my PMs is we set the quarter roadmap and then we share that out. And then every week in kind of a sync together, we go over it more like, how are things moving? Like, do we need to pull things in? And, you know, especially at an early stage company, like, The world changes really quickly.

And so like what you said you were going to do in January might not be what you're doing in May. And so we're just like constantly having those conversations and asking ourselves, like, is the impact of the work and the effort, like, is that a good ratio? And are we impacting the most important metric right now?

And, and I think that like our teams have gotten really used to, not like [00:25:00] huge shifts and changes, but like acknowledging that. Other more important things could pop up or timelines go longer, and I think where we're really like trying to figure out right now is how do you plan for delays. So, you know, we know we'll talk about it in a little bit, but like we are rebuilding our electronic health record to use MedPlum and like.

That's going to be a huge thing for our providers and the way that we're doing that is we picked a test market to test in slices and then we're going to do like a big rollout to the rest of our, our markets. And those dates might change, like, like we don't know what they are now and yet, like, so how do we like protect against that?

Like we've blocked out time in the calendar and if it shifts, like what do we need to do? And so right now we're working on like backup plans and so like, do you still train people and then there's a delay or. Like what that looks like. So contingency planning, basically.

Angela Suthrave: Yeah, it's challenging because there is [00:26:00] uncertainty in how development is.

It's science and art, right? You can do a great job estimating, but at the end of the day, it's just an estimate. I think where I've, I've run into challenges is People love quarters. Like, okay, tell me what quarter you're going to deliver this. Right. So when I propose the now next later roadmap, it didn't go over great because we had people in, you know, customer facing roles who are like, well, this customer wants this, like what quarter can we tell them?

And so, yeah, I think, I think very similar challenges to. What you're talking about.

Ari Saft: I mean, it's hard because I mean, I have so much, such deep empathy is like providers need to know in their day when something's going to change. And like the operations team has such a heavy listing to train new people and like create all these training material.

And so like a moving date is really hard. So one thing that we've played a lot with is like feature flags. So like, we'll continue developing and getting things out. And then the partnership between product and ops will decide like, [00:27:00] when is the moment in time. That we like open up the feature flag. So that's been really, really helpful.

Omar Mousa: We've talked about cross functional teams a bit. I want to double click into the structure of how that's being done at TIA. So, you know, to ensure effective collaboration between those two groups, are there any specific roles or processes that have been like crucial in making that happen? Cross functional structures work.

Ari Saft: So in terms of an org structure, we have two main orgs. We have the innovation org and then the clinical and operational org. So in the innovation org, we, it's like product engineering, growth, marketing, that stuff, and then clinical and operations is what you'd imagine like markets, operation, real estate, et cetera.

And so what we've done is, as I mentioned, we have like roles that really cross into the different sides of the company. So a clinical product role. where like they are embedded in a lot of the processes that we do on the product side. That could be like coming to our grooming sessions, coming to our design syncs.

[00:28:00] And so they're really involved in those rituals. Same on the clinical side and on the operational side. And so we like, And then on the product side, we'll like go to their meetings too. One other thing that we have done is I actually manage a team called product enablement. And essentially what that means is we're thinking a lot about like the cost to build and ensuring that.

We really, really understand the problem before we build it. And so there's actually an offshore team that we work with and they essentially are like tech gap for us. And so they are responsible for a process that's often like was historically run operationally. We'll then like move it to product enablement and our PMs will spend a lot of time with those individuals understanding like what are the problems, what's really working well, and then we'll productize it.

And so that process has been really amazing to kind of. Give ops a little bit of like breathing room and then also us to like, learn really closely with this team [00:29:00] before building the wrong thing.

Omar Mousa: So that last thing you said there could be a tech enablement team, um, picking what to enable tech enable first or next is.

Hard. Um, so do you have a framework or a process for selecting the next thing to automate or tech enable?

Ari Saft: It goes both bottoms up and top down. I think the most important thing is like, there's a lot of metrics you can move, but like, what's the most important one that we're like, the team is orienting around?

And I think it goes back to what we were talking about before with like people being on the same page. So if like, One team is trying to move, you know, utilization and the other is trying to move new members like there's going to be like confusion. And so I think one thing we've done really well is like there is a metric that is the most important.

The rest are really important because it has to keep the business running. But like when two things come against each other, like, I think. That one is it. And so for the last year, it's been retention. And so a lot of things play in retention. And so when thinking about like, what is the next thing, a couple factors come into mind.[00:30:00]

I'm a simple girl. I just like impact over effort a lot. And like, what's the impact you're going to get for the effort of work? Reach is hard at TIA because like, we have just a lot of different audiences. And so you're, it's like, yeah, you have like 30, 000 members, but like. You know, if you're five providers in this market can't do this thing, then like there is no care delivery.

And so I tend to just think about like, what's the big problem we're trying to solve? What's the impact and effort? Can this be done by someone else? And when is the breaking point? And those kind of factors come in. And I think you, when you mentioned, like, is it an art or a science? Like there's the science piece of like bad analysis.

And then there's the like intuitive, like. Product sense of should we do this? Should we not? Also, I'm a big proponent, especially in care delivery businesses of commoditization. And so like there's also that second question of like, should you be building it? Like, is this something that like you are going to win at or should someone else build it?

And like [00:31:00] you bring that into your tech stack. And so I think all of those conversations are all of those pieces of the conversation are really important when deciding what to do. And. It's a startup. So at the, at the end of the day, it's like, is this going to break the business? How do we, how do we make sure that we're working on the thing that's going to like, that's burning the highest or like is smoking the biggest in the background?

Angela Suthrave: I have a couple of questions. So I guess when you talk about your tech enablement group, to me, that sounds like discovery. And so, would you say that Discovery is still baked into, like, all of your PMs job function? Or would you say that you separate that out into a different group and then your PMs sort Take it with that information.

Ari Saft: No, no. It's very much part of their, part of their job description. Like the product enablement team are just doing a lot of the workflows, but they're, they're not like they're coming up and being like, Hey, like this is a problem. Or like, this is something that I've seen, but the product and met managers are responsible for like shadowing for [00:32:00] participating, like helping the workflow.

Like I'm a really big proponent of like getting in the weeds. Doing the thing and so that they're very much like, like, observing and figuring out what we should build. And, you know, back to the scheduling example, our PM who figured that out, like, he's very talented at, like, uncovering really or untangling really naughty problems.

And he spent like 4 months like. Shadowing every which way workflow because scheduling impacts every workflow and basically like pulling out requirements and then getting alignment with all different teams on like what was a must have and what wasn't going to happen. And I think back to the commoditization is like, if you're going to.

Not build it and we were not going to build our own scheduling tool like you're never going to get a hundred percent So like what's the 80 most important? What's the 20 you're willing to like? Not build or be okay with and like get everybody on board

Angela Suthrave: The other thing that I'm really impressed by is your ability to say hey this thing retention in your place [00:33:00] is the most important thing.

My experience has been more that you have all these priorities, let's say four or five priorities, all these priorities are super high. And then when you try to execute against that, then you hit these teams that have to play a role in all of four or five priorities. And it's very challenging. And so I'm curious to know, like, how Tia was able to get to your one most important and then all your other also very important but not as important as your

Ari Saft: number one.

Um, trying to think that everything was important and realizing that, like, that isn't a reality. I think that you have to go through that learning process of being like, oh, focus on everything and then realizing that, like, it is physically impossible to focus on everything. On the product side, we have multiple pods and each pod kind of like owns a metric.

And so that is helpful. So like, well, you know, as a company, we're orienting around attention like retention pods have like priorities. And so [00:34:00] oftentimes, like For example, you know, a growth, the growth odd, it will, if something comes up for them that like could impact retention or could impact new members, like we'll have a conversation around like, what, like, where are you going to get the most impact here?

Like which, which one should we do? And I think that's where the art comes in is like the pattern recognition of like, Oh, we've done something similar before we saw this amount of impact. Like this is probably the best bet with our resources, but it's hard, especially because like. Well, product you're able to kind of like spread out on different teams.

Like, you know, the marketing team really cares about new members and like the ops teams, like really cares about utilization. But I think that we were able to like, realize that if we don't keep members, there is no business. And so like, that has to be the most important thing. And then it all kind of trickles down from there because it's like, The provider if a provider is being rushed in their appointment and the patient feels that rush like they're not going to [00:35:00] enjoy the appointment and so that's where like the efficiency and utilization comes in or like if you acquire the wrong patient and you're setting the wrong expectations, they're going to leave.

And so I think we were able to identify that like that's the crux and like everything actually builds off of that.

Angela Suthrave: All right, so let's switch gears and talk about going from a custom built EMR to a headless one. So Tia did build its own EMR, and then now you're moving your entire care delivery model to be built on top of the MedPlum platform.

And so tell us a little bit, I feel like there's a story there and maybe some learnings. So we'd love you if you could share that.

Ari Saft: First off, shout out my Blum. You're great. Second. Yeah. I mean, when Tia first started and built their first clinic in New York, they stood up their platform really quickly. And this was also of the age where like it was epic or nothing.

And so, you know, we just kept building things. And [00:36:00] I think this period of time was also when venture dollar was a lot cheaper. And so the idea was like, we'd have this big engineering team and we'd have our own EMR and like, You know, we would control everything. And in the dream, like, you know, the scheduling example I gave in the dream, we control scheduling because the way that appointments are connected.

And like, that was really important for us to like helping women achieve their optimal health goals. Like, imagine you could have, like, you know, you know, be up, have one appointment that like ladders into another, like all these different models that would like really be unique to Tia. But the reality is, is like, The world doesn't look like that anymore.

Venture dollars are not cheap anymore and they're being spent on not innovation, but on like profitability. And so I think we realized that we were not spending our time in engineering on anything really that was like unique to TIA and made us special and where we wanted to win. It was like, we would build like a flag that, you know, if you.

typed in a patient and they had a duplicate name or like a [00:37:00] safety alert. And it's like, why are we doing this? Like, like this is not unique, but it's so crucial to clear delivery that there's like the product that they're using is safe. And so we started thinking about like, how do we best leverage our team so that our engineers are building the things that like are going to keep our patients here and are going to like make our team really efficient and be able to.

Make our patients happy and the investigation I did with our principal architect, John, is we looked at a couple different options. We were like, okay, like, do we just go with it? And we were like, no, like, T has such a unique model that we need to be able to control the experience. And then we were like, okay, well, like, you know, they have.

you know, ish headless EMR we could build on top of and we found that it would be too restrictive. And with MedPlum, we were able to build our own UX, which is like the most important part. It was what our, you know, our, we've been saying the entire time since the beginning is that like experience is what drives us being able to deliver relational [00:38:00] care, which is like going to change primary care and that.

Enabled that MedPal enabled us to do it. Also, they're built on Fiery APIs, which are interoperable and we have partnerships with health systems. And it just kind of like made a lot of sense that this was, you know, the next step for us.

Omar Mousa: So how do you, you know, these are major changes, right? And I'm sure it's not the only major change that's been done throughout the history of TIA.

So when, when building product, how, how do you build product efficiently without creating disruption for clinical teams? Like What strategies have you found effective deployed to minimize operational thrash?

Ari Saft: Well, it's strategy has not been effective is when I was the PM of a very big operational change and we didn't have any training.

So that was my good lesson learned in the first year of Tia. COVID had happened and we stood up a virtual clinic and so we need to be able to like check patient in virtually. And so we built this like. beautiful check in system that like, you know, could verify your insurance and get your payment method.

And we just [00:39:00] like, we, I, I deployed it without like, you know, any training for our care coordination, FDA team. And it was, didn't go well. And so I feel like I will forever remember The like, look on our operations lead face, and I will never repeat that ever again. So I think, you know, it's, it's kind of what we talked about before, which is like, how understanding and working and partnering with your cross functional team on like, what changes need, what type of training, you know, something can just be like, and have, you know, an email that's sent to the group and our weekly, weekly email.

Some is just so intuitive that like, you don't even really need to do anything. And others, it's like. Different levels of training where, whether you're like pulled out for in real life training, you receive a, you know, a PDF and you think as we make these bigger changing or changes, we're recognizing that like we need to give like real learning time.

I mean, like Epic makes every provider that uses Epic, like do like three weeks of training. I mean, the idea is that it's so intuitive that we wouldn't [00:40:00] need that, but you know, something that I have realized over the years is that like. Frustration with technology and inefficiencies with technology, yes, like we could have built things better.

Badder, but a lot of it has to do with training. And like, if someone is not trained on a tool, it's going to be hard. And so I think that like, that's kind of where we're approaching these bigger changes is like ensuring that people have the, the understand the tools. And then something we've been doing is our VP of brand has, is leading these super user groups.

And so it is a group of like 20 people that went through this application process. providers, frontline team, and every week they meet and have like a really honest conversation about what's being designed, the North Star vision and give feedback. They test things early. Like I'm not even allowed in the session.

It's like the PMs and them, it's like very tight knit. And I think that's been really useful too.

Angela Suthrave: So you're currently undergoing this transition to MedPlum. What are the key [00:41:00] lessons that you have learned so far and I guess just tell us about How it's going and if somebody else is going through this right now, what would you tell them?

Well,

Ari Saft: we're very much at the beginning of this transition, but I already have a lot of learnings I think two really stand out for me. One is We are so used to the technical talk, headless EMR, FHIR standard APIs, that like, it's really important to spend the time to write the story and help your, the, the ultimate users understand what's going to happen and why.

And what it will look like. And I think something that you know, TI has done really well and you know, hats off to Ali, our VP of brand is like build that vision together. And so it wasn't just like, oh, this thing is coming? Question mark. Or like iterative slices and you don't know where it is going, but at the same time, they're seeing like, this is the longterm Northstar vision.

And like, now we're working on these small [00:42:00] pieces that get us there. And so I think that's been a really important learning. And the second is just like, you know, the importance of thorough planning and phase rollouts to minimize disruption. You know, I think at first there was a lot of fear on the op side of like, what is this going to look like?

Like, are you just going to completely change how we write documentation, how we learn about patients, blah, blah, blah. We've had to be very, very thoughtful about like what we do first, because we're moving not just from a new AMR, but it's an iPad app to a web app and another, you know, you know, we want to do this because longterm it will enable us to like develop faster and like be able to address changes faster.

It's just going to take us a little time to get there. And so we've had to like be really thoughtful about like. What does that look like? I think I mentioned before, like a test clinic and then like a bigger rollout. We're doing appointment prep first. So like getting the clinical resources in MedPlum first.

So that like, that's the first thing that providers are really [00:43:00] working on. We've done some virtual support team workflows also like labs and facts. And so we're, we're like introducing it in ways that like make sense with the broader organization's goals. Oh, I think the third is like. Kind of related to the first is like timing when you're not in the weeds of product development.

The timeline of product development is confusing. And so having people being like, okay, you said you wanted this thing. Like, why isn't it here tomorrow? And we're like, oh no, this is like a, like a year and a year to your thing. Like this is really big. And so I think that, that has also been a good, important learning of like, how do you help people understand why the product development process can seem slow to them?

Omar Mousa: All right. I wanted to ask you about metrics and I'm asking for myself, like, you know, please help me with this metrics between commercial or like GMs and operations, clinical operations, [00:44:00] and that in a tech enabled services environment, it's like really hard to discern what, what does product own? What is, what does the GM own or what does clinical or operations own?

And, um, I don't think I've been a part of a place that's really figured that out. So like, how do you guys think about that? Like who really owns what and what makes sense in your mind? Current state versus ideal state.

Ari Saft: Yeah. I don't think it's super clean and it's hard. Product is interesting because. We own, I wouldn't say we own, we're inputters into everything, but it's not like our solo metric.

And so like, you know, ops team utilization and provider MPS, like the growth team, new members. And so we kind of are like inputters in it. And I think the way we think about it is a lot with the OKR structure is like when we're going through OKR planning, we, we have like leads who are responsible for like a work stream.

And then the Kind of the, the projects underneath get their [00:45:00] own art. We call them RPs, responsible parties. And so you have the owner of a metric, which might be like collections and that's, you know, the, our RCM person, but all of the different people underneath have like a mini metric that they're responsible for.

And the idea is if like, Everyone's succeeding on their mini metric. The big metric is going to win. And then the person in charge of the big metric is responsible for like diagnosing when it's off and like working with the, like whoever it might be that is causing, causing the mini metric to go down. So I think there's kind of like a scaled thing that's happening there.

It's not perfect. I think it's really hard because like everything is so interconnected. Right. I think it goes back to like. Really close cross functional communication. We have an operating metrics review meeting every other week where like people who are leading teams are hearing like in the weeds, like this is how many appointments we had.

This is how many members we grew. So like you're getting that [00:46:00] input and kind of understanding how that's going to impact other decisions. But when I hire, that's really what I look for more than anything is like, can you make those decisions? connections and not just like take the information as face value because it's so hard when you like Own things with other people.

Angela Suthrave: We've really loved diving into tia It's definitely a company that is very interesting that we've been following for a while Can you tell us a little bit about what's coming up for TIA?

Ari Saft: Yeah. We're growing. So, uh, we're adding another clinic in West Hollywood very soon and more to come in 2025. We hope to continue delivering excellent care to women, especially preventative care because we know preventative care really, you know, pays dividends not for us as humans in the future, but also our insurance companies.

We also have a couple of new fun product lines that we have in beta right now. I figure you're in New York or Arizona. We're testing out some cosmetic Derm like Botox, chemical peels, things like that, because [00:47:00] feeling good about yourself also helps your body too. So more to come.

Omar Mousa: And I think it's time to move into our exciting concept closing call. Cool. So first, and we've talked about frameworks, but. Are there any frameworks, methods, or processes that you found to be especially useful just in your work that others may also find useful?

Ari Saft: I think I mentioned this, but I'm a very simple girl.

Impact and effort. How much bang do I get for my buck? Like that, that really drives my day to day.

Angela Suthrave: Can you tell us about a tool that is highly valuable to you that you think others may not be using and should? Oh, I don't think I'm using

Ari Saft: anything that other PMs aren't, but the combination of my like notes app, chat, GPT, fig jam, and loom is like controlling my life.

Omar Mousa: Loom. God. Oh, I love that. Loom now integrates with [00:48:00] Confluence.

Ari Saft: Well, now integrates with Confluence and it can help you with documentation, which I have to admit is my like Achilles heel. So.

Omar Mousa: Transcripts

Ari Saft: of your, of your, of your loom and just like putting that in your documentation. It's great.

Omar Mousa: Yeah. Yeah. That's solid. Are there any concepts in healthcare that excite you?

Ari Saft: Yeah, I mean, I don't want to sound trite, but like, I'm really excited about the application of AI in healthcare. I'm less excited about the idea of AI replacing providers.

I actually think the relationship between provider and patient is like absolutely crucial. I'm most interested in how we can use AI to create efficiencies, especially in like care delivery practices, so that we can enable patients and providers to spend more time with each other. Thank you. And not like doing admin tasks.

Do you think that product management is a science or an art? Cop out. I think it's both. Um, you know, you have the science part, which is like data analysis, strategy, market research, you know, you know, measuring how much, you know, how much [00:49:00] impact something had. And then you have the art, which is like intuition, you know, leadership to innovate, inspire teams, understanding customer needs.

Like you have to balance these two in order to be successful and build user centric products.

Omar Mousa: And lastly, where can people get in contact with you if they want to reach out? And do you have any shameless plugs?

Ari Saft: Oh yeah. Are you. w. saft at gmail. com and then please check out astia. com and use promo code re 4, 4, 5, and I'll get you 50 off your annual membership.

Omar Mousa: Oh, wow. Okay. Well, yeah, that's,

Ari Saft: that's,

Omar Mousa: that's a first for the concept to care. I think we're going to definitely put that in the show notes. And then send me

Ari Saft: feedback on everything. You don't like, that's what I want.

Omar Mousa: I mean, we, we love this. I just, I, I'm glad to be, you know, providing financial value for the first time to our audience.

Ari Saft: Well, now I can track how much by [00:50:00] using my own code. So, you know, I'm curious.

Omar Mousa: Yeah. Yeah. All right. Well, Ari, thank you so much for coming on the show. Angela and I really enjoyed it.

Ari Saft: Ah, thank you so much.

Omar Mousa: Hey, thanks so much for listening to the show. If you liked this episode, don't forget to leave us a rating and a review on your podcast app of choice. And make sure to click the follow button so you never miss a new episode. This episode was produced and edited by Marvin Yue with research help from Aditya Triya.

We're Angela and Omar, and you've been listening to Concept2Care.

 

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