Episode #7 - Richa Gujarati, SVP of Product and GTM Strategy at HeartBeam | Former Apple Health

Written By Omar Mousa

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Description

Today on Concept to Care, we're joined by Richa Gujarati, the Senior Vice President of Product and GTM Strategy at HeartBeam. HeartBeam is a cardiac technology company that has developed the first and only credit card-sized 3D-vector electrocardiogram platform for home use.

We'll explore the genesis of Richa’s career in product and go-to-market strategy, tracing her journey through renowned organizations such as Johns Hopkins, St. Jude Medical, iRhythm, and Apple Health. You’ll discover the critical role of evidence generation in successfully bringing a healthcare product to market and learn strategies to achieve it.

Richa will delve into the intersection of product development and go-to-market strategy, offering insights on recognizing when these elements are in sync and how to realign your organization if they are not. She will share her expertise on competing with industry giants and maintaining a competitive edge, as well as tips on selling to health systems.

Additionally, Richa will provide her unique perspectives on the evolving role of product management in the health tech industry and advice on becoming a successful product manager in this field.

www.concepttocare.com

Some takeaways:

  1. Evidence generation is essential for a health tech solution to achieve market adoption, clinical acceptance, and patient trust. Without solid evidence, the solution is unlikely to succeed. To generate this evidence, it's crucial to get the technology into the hands of clinicians and patients. But how can you convince purchasing decision-makers to support this process? Product and go-to-market (GTM) teams need to be innovative in placing the solution with clinicians and patients. One effective strategy is to identify a clinical champion who will advocate for the solution and manage the administrative and cost burdens associated with its adoption.

  2. Traditional Clinical R&D organizations share some common themes with modern healthcare product management. However, they often lack the ability to assess how their activities drive long-term business outcomes, a crucial aspect of product management. Product can bridge the gap by effectively aligning clinical efforts with business objectives and demonstrating the impact of their work on business growth. Empowered product organizations have the agency to connect the dots between clinical, technology, sales, and marketing to drive key results.

  3. Taking a healthcare product from concept to commercial viability is challenging. Here are two strategies recommended by Richa:

    1. Start small and focus on a niche user problem

      • Starting small is crucial because behavior change in healthcare is challenging. Large-scale problems often don't prompt immediate behavior changes, but addressing smaller, acute issues can foster willingness to adopt new solutions.

      • Begin with a clear product strategy that targets a very specific problem with significant pain points. Ignore the total addressable market (TAM) initially and focus on a niche use case where the pain is acute and pressing. This problem should encourage customers and users to change their behavior or their thinking about the existing solution.

      • Solve the small problem and do it very well. By solving a critical problem effectively, you can gain initial traction with the target customer or end user. This approach not only demonstrates the value of your solution but also earns you the right to expand into other markets and address larger issues over time.

    2. Utilize journey mapping to determine where to expand and focus across the value chain

      • Journey mapping is an invaluable tool in healthcare, though often underutilized. It helps you understand how different personas interact with a particular solution, highlighting pain points and critical touch points throughout the user journey.

      • Once you've gained traction by addressing a small problem in the user journey, you can begin tackling larger issues. Journey mapping will guide you in pinpointing where to focus your efforts next, helping you identify opportunities to expand into larger-scale problems.

  4. iRhythm exemplified a classic David and Goliath story. By effectively combining product innovation with a strategic go-to-market approach, iRhythm successfully drove adoption, outperformed established competitors, and achieved significant expansion. Here is how they did it.

    1. iRhythm inherently knew that they were not going to displace incumbent cardiac monitoring solutions outright because they were part of a hospitals capital expenditure (CapEx) and so they would have to find a creative way to get their cardiac monitoring solution into the hands of a clinician for evidence generation / adoption

    2. iRhythm analyzed the existing cardiac monitoring user journey for care delivery teams and patients with the intention to find an acute problem to focus on and solve really well. They learned this:

      1. Cardiac monitors were extremely uncomfortable for patients to use and patients didn’t want to wear them for 24 hours which was a blocker for getting sufficient cardiac data

      2. Physicians lacked trust in the data being generated by the cardiac monitors given what they knew about the device’s poor patient experience and would have to order repeat tests to correct the device adherence.

      3. Lab techs suffered from administrative burden from having to analyze bad data and having their lab queues backed up with repeat testing results

    3. iRhythm identified the patient problem to be the source of all the problems faced across the cardiac monitoring user journey and deployed extreme focus on solving that niche pain point to stand a chance of converting one clinical champion to take on their solution without having to fully swap out the existing one

    4. iRhythm was successful because they picked a niche problem to solve for a niche patient population. Trough evidence generation and adoption from clinical champions they were able to “land and expand” from their niche solution to a broader set of solutions

  5. It’s important to have Product and GTM teams working in lock step to remove any friction filled touch points with the solution that could potentially prevent the product from getting into the hands of the intended end-user. Here are ways to mitigate that risk:

    1. Own the deployment and integration. Product teams should determine how the solution is deployed to any given customer and how it is integrated into a customers workflow. This will ensure best results.

    2. Create roles who are accountable. Consider creating a role called “Implementation Specialist” within your Product and GTM teams. The primary purpose of this role is to mitigate any risks associated with deploying the solution to customers and to ensure proper onboarding for optimal adoption.

  6. What advice do you have for product managers who want to change how their product and GTM teams collaborate. Richa provided the following advice:

    1. Focus on what you can change. Consider what actions you can take within your role to drive change. For product managers at any level, it's essential to focus on how the product they're developing contributes to long-term business outcomes and work backwards from there. Start by gathering evidence to support your hypothesis that product and GTM teams should collaborate more closely, and then share this insight with everyone.

    2. Adopt an experimentation approach. Start with a hypothesis, design a small test, and collect data. Share your findings on how the experiment could drive outcomes, secure buy-in for further investment, and prioritize the broader rollout of changes.

  7. Some advice on how to sell technology solutions into health systems:

    1. Build relationships. For early-stage startups, focus on building strong relationships. Find champions who will advocate for your product. Turn them into product advocates by involving them in the design and development process, making them invested in the solution. Invite them to be part of the journey, which increases their commitment and investment in your product.

    2. Enable your champions. Provide your champions with sales enablement materials to help them market and advocate for your product within their own organization.

    3. Utilize advisors. Identify potential advisors within target customer groups and leverage them to create a feedback loop, ensuring whatever solution you’re selling is effectively solving their customer problem.

  8. Lessons learned at Apple Health: Creating additional revenue streams with Apple Watch beyond direct-to-consumer (DTC) sales through partnerships with payers and pharmaceutical companies.

    1. Focusing on data for preventive care is crucial. Payers aim to reduce overall costs of managing their member population by offering plan benefits that entice subscribers and promote health, lowering care costs. Apple Watch features can help payers achieve these goals by motivating consumers to adopt long-term healthy behaviors, thus promoting preventive care and reducing downstream costs.

    2. Support and enhance clinical trial administration, data collection, and adherence with the help of Apple Watch. Pharma clinical trials benefit from tools like the Apple Watch, which seamlessly integrate into the daily lives and workflows of research patients or participants. This aids in patient retention and ensures accurate, consistent data collection.

  9. A fresh perspective on the modern-day product manager in health tech. Many experts define product management with detailed function descriptions and strict do's and don'ts. Richa offers a unique viewpoint that stands apart from the common narrative.

    1. Product management is about doing whatever it takes to drive business outcomes for your offering. That’s the essence of the role. It’s not confined to a specific function, job type, or workflow. It’s about doing whatever is necessary to achieve the business outcome. If you’re not linking your actions to business outcomes, you’re falling short in your role

  10. Attributes of a successful “hardware PM” in health tech

    1. Product Strategy is Crucial: Mastering product strategy and making informed trade-offs are essential skills.

    2. Long Feedback Cycles: Mistakes are costly due to extended feedback loops, so accuracy is vital.

    3. Understanding MVP: Have a strong grasp of what constitutes a true Minimum Viable Product.

    4. Implications of Trade-offs: Be adept at considering the implications of trade-offs in decision-making.

    5. Limited Iteration Opportunities: Unlike pure software, hardware doesn’t allow for frequent iterations.

    6. User Testing and Research: Conduct thorough user testing and research to prevent costly mistakes.

    7. Long-term Thinking: Plan strategically with a 3-5 year outlook.

    8. Buy vs. Build Decisions: Hardware PMs must strategically decide between buying and building, knowing the high costs of development.

    9. Independence from Apps: Ensure hardware performs its basic functions independently of the app to succeed as a hardware PM.

  11. Coaching PMs in health tech on engaging with customers

    1. Identify where users gather the most, such as Reddit groups and Facebook groups, to learn about their pain points and challenges as patients.

    2. Create and distribute surveys in these online communities to gather insights.

    3. Attend conferences to connect with users and industry professionals.

    4. Organize and invite users to participate in focus groups.

    5. Visit hospitals to observe procedures where your product is used, gaining firsthand insights.

    6. Involve engineering teams in these observations to enhance their understanding and gather valuable feedback.

Show Notes

Where to find Richa Gujarati:

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Where to find Angela and Omar:

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Referenced:

Check out our website: https://www.concepttocare.com

Subscribe to our newsletter: https://concepttocare.substack.com/p/episode-7-richa-gujarati

Transcript

[00:00:00] RIcha Gujarati: Yeah, so where go to market really comes into play here. And the reason why product and go to market have to be in lockstep is across these multiple stakeholders, not just about the product. It's also about how it gets integrated into the workflow. You know, so if you think about it from a customer ops, customer service perspective, that has implications on how you design the end to end offering.

[00:00:26] RIcha Gujarati: So product isn't just that single product. Touch monitor that goes on patient's chest and that voila, you're done. It's the entire suite of offering that we're 

[00:00:35] Angela Suthrave: offering as a result of it. 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, 

[00:00:49] Omar Moussa: 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.

[00:00:56] Omar Moussa: 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. 

[00:01:04] Angela Suthrave: This is Angela 

[00:01:05] Omar Moussa: and this is Omar. 

[00:01:06] Angela Suthrave: Welcome to concept to care. 

[00:01:09] Omar Moussa: In today's episode, we're excited to welcome Richa Gujarati. The senior vice president of product and go to market strategy at heartbeam.

[00:01:17] Omar Moussa: Heartbeam is a cardiac technology company that has developed the first and only credit card size, 3d vector, electrocardiogram platform for home use. We'll explore the Genesis of reaches career in product and in go to market strategy, tracing her journey through renowned organizations, such as Johns Hopkins, St.

[00:01:33] Omar Moussa: Jude medical, ibrhythm, and apple health. You'll discover the critical role of evidence generation and successfully bringing a healthcare product to market and learn strategies on how to achieve it. Reacha will delve into the intersection of product development and go to market strategy, offering insights on recognizing when these elements are in sync and how to realign your organization if they are not.

[00:01:55] Omar Moussa: She will share her expertise on competing with industry giants and maintaining a competitive edge, as well as tips on selling it to health systems. Additionally, reach a, we'll provide her unique perspectives on the evolving role of product management and health tech and advice on becoming a successful product manager in the field.

[00:02:12] Omar Moussa: Enjoy the show.

[00:02:19] Omar Moussa: Reacher Gurjarati. Welcome to the show. Thanks for coming on. 

[00:02:23] RIcha Gujarati: Thank you guys. Yeah, it's Amazing to be here. 

[00:02:25] Omar Moussa: Yeah, we're really excited. I think this is the first time we've brought someone on who has the go to market experience that you do. So we're really happy to get diving into this. Um, real quick, before we get into the meat, can you just give us a quick background on yourself and introduce yourself?

[00:02:43] RIcha Gujarati: Yeah. Um, so I'm a biomedical and electrical engineering by training actually, who stumbled into product management and go to market strategy. But pure accident. Um, I just happened to be enrolled that were very nebulous where I could take on activities like product strategy, roadmap development, um, and these organizations didn't have a product management function, you know, back when I started in health tech.

[00:03:09] RIcha Gujarati: Part of my management was a function that sometimes existed sometimes in and definitely wasn't a significant function that it is today with all the bus around it. So, you know, I graduated from Hopkins, um, majoring in sort of bio design, innovation and biomedical engineering. Co founded a medical device startup, uh, spinning out of that, uh, with, with an idea that we came across during the biodesign animation program.

[00:03:36] RIcha Gujarati: It feels spectacularly, but we learned a ton of things about what it takes to build a successful healthcare startup and how difficult it is at the same time. Um, and from there moved into working at big companies like St. Jude medical, which is now part of Abbott. It got acquired a long time ago. And Apple, uh, sort of helping drive product strategy, go to market efforts.

[00:03:59] RIcha Gujarati: And, you know, the role here from a product standpoint was very much focused on hardware enabled platform. So hardware, and then some ancillary software and services wrapped around it. In between, I've had a good fortune of sort of helping build healthcare technology from the ground up. So really being able to take products from concept zero to one, helping find product market fit, and then, you know, scaling teams of really wide variety, um, and, and different type of sizes as well.

[00:04:31] RIcha Gujarati: So, it's been an exciting journey so far, and, uh, you know, my passion continues to be really about building solutions that bridge that knowledge gap between consumers and healthcare, um, primarily technology solutions that make information that, uh, Otherwise would only be limited to healthcare setting or limited set of users within the healthcare, um, community and how do you make that readily available to the average consumer and what do they do with that information?

[00:05:01] RIcha Gujarati: Um, that's really want to have. I 

[00:05:03] Angela Suthrave: want to continue building my career and reach. You have such a rich set of experiences and. You know, you talked about the bio design innovation program at Hopkins where, you know, students are asked to come up with an idea and see that idea through. And you said that you all failed spectacularly, right?

[00:05:23] Angela Suthrave: And so this is really your first taste of healthcare entrepreneurship. Can you tell us more about that experience? And, you know, I think a lot of times we also need to celebrate failures because they help us to, to learn. And so wondering if you could share that story. So Hopkins bio design program was.

[00:05:39] RIcha Gujarati: Well, you could say my first exposure to product discovery work. And how do you really do proper product discovery and build a strategy from it, which, as you all know, is sort of at the core of what any PM should be doing. So, the way the by design program was set up was we had complete access to the Hopkins med school and every week was organized by a specialty area.

[00:06:07] RIcha Gujarati: So, you would basically. Go to that specialty, let's orthopedics have an attending assigned to you and you would shadow that attending around throughout that entire week. No matter how many hours they were working, no matter what procedure they were doing, no matter who they were interacting with, whether that was a patient or a staff member and you just observed, you observed and you ask questions and that really sort of inculcated, inculcated in a How do you build user empathy?

[00:06:38] RIcha Gujarati: How do you do journey mapping work? You know, when you're shadowing someone around for a week and you see them from a third party perspective, doing all sorts of various activities, you really start thinking critically about, well, does that really make sense? Why are they doing it that way? And you did, um, we did that across multiple specialties, and that's really where we stumbled upon this idea in neurology.

[00:07:04] RIcha Gujarati: So, when we were going through the neurology shadowing, one of the neurologists got assigned to us, talked about this condition called hydrocephalus. Patients, uh, these are mostly kids, young kids, it's a congenital condition, very easily treatable, you know, it needs an implantable, and that's it, all your symptoms are taken care of.

[00:07:27] RIcha Gujarati: But because that space was very small and was served predominantly by behemoths such as J& J, there had been no innovation in that space for 15 plus years. So for something that was so easy to solve for, the challenge was. A lot of revision surgery. So unfortunately, small kids would keep on having to come back to go to a very invasive revision surgeries.

[00:07:51] RIcha Gujarati: And then the technology was outdated that it just required a lot of frequent follow ups. And it was frustrating patients hated it. Their parents hated it. Physicians absolutely hated it. And we thought, okay, well, you know, we're a bunch of biomedical engineers, electrical engineers, we can do something about it.

[00:08:08] RIcha Gujarati: So we raised a ton of grant money, some external funding as well, and tried building a company in that space from that experience. What happened as we were building that company was we had to do a lot of pig studies in person model. Um, that's 1 of the key requirements for FDA, and those models are very, very expensive.

[00:08:30] RIcha Gujarati: So you can blow through a couple million dollars like that and the companies that I invite is and who are building medical devices or technology solutions where evidence generation is a key requirement. I. Talk to them about how to get creative with that model, you know, finding a, uh, clinical champion who's really vested in your technology.

[00:08:53] RIcha Gujarati: He wants to see it through. They could serve as a great site, and I think this applies to digital health companies or tech companies alike. Find a clinical champion who's going to carry some of the administrative burden, the cost burden of implementing your solution, because that's how much they care about this technology that they're willing to do something about it.

[00:09:14] RIcha Gujarati: That could really ease the cost burden associated with evidence generation. And I think in healthcare, you just can't get too far. If you are not generating clinical evidence, you know, you have to demonstrate improvement or change in outcomes, whether that's pair, whether that's provider, it doesn't matter.

[00:09:31] RIcha Gujarati: Everyone asked for it. Uh, so getting creative and, um, trying to figure out how to do it in a streamlined way is really key. 

[00:09:38] Omar Moussa: That's an incredible story. And not many people can say, you know, coming out of a program, they basically were entrepreneurs. I know it's becoming more and more sexy these days to do that, but that does, those were.

[00:09:49] Omar Moussa: Early 2008. 

[00:09:51] RIcha Gujarati: Yeah. Yeah. 

[00:09:53] Omar Moussa: Yeah. You know, so, um, I think that's great. And it probably lended itself really well to you moving on to your next role after Hopkins. So let's talk about St. Jude medical for a second. Um, after completing the program at Hopkins in 2010, you joined St. Jude medical. Um, you know, as you know, most healthcare organizations did not have formal product management and it probably didn't join as a product manager.

[00:10:19] Omar Moussa: Like that was not your title and you told us you rolled up into the clinical org. Um, so talk about the, that, that, that transition from like creating the product function there and, you know, helping determine its scope and how that was when you were in the clinical org. 

[00:10:35] RIcha Gujarati: Yeah. So, um, you know, I, I roll up into the clinical R and D org.

[00:10:39] RIcha Gujarati: Yeah. And what was interesting when I joined that organization was there, there were a lot of elements of what we consider to be traditional PM that that organization was very much doing focus on user centricity. And remember, for St. Jude, the core user was really the physicians, not the patients.

[00:11:01] RIcha Gujarati: Patients were just the beneficiary, given the sort of decision making dynamics at that point. So, there was this, this focus and emphasis on engaging with physicians, broader healthcare community, um, doing a lot of voice of customer work, or what you may call user needs or PRD development work, running U. S.

[00:11:21] RIcha Gujarati: research with human factors. So, there were these common themes around what you might consider traditional product management. What was missing in that role was assessing how all of that drives. Long term business outcomes, which I also think is sort of fundamental to product management, right? And when I realized that that's the gap that I was seeing, so we were doing a lot of this great innovation work, roadmapping work, working with engineering and defining solutions.

[00:11:53] RIcha Gujarati: I was all fun. What did that translate into? How was it moving the needle from a business outcome perspective? So, I, at that point, because PM as an org and function didn't really exist. I reached out to folks in what back then was the product marketing organization and ask them, hey, can I do a little rotation with you?

[00:12:16] RIcha Gujarati: And for them, they were very commercial focus, right? Very traditional product marketing. How do you, how do you sell, how do you do sales training, user training, set pricing, revenue forecasting terms. But what was. Amazing for me was being able to stitch the 2 worlds together and bring some sort of an holistic perspective in terms of here.

[00:12:38] RIcha Gujarati: We're just thinking of a product concept and what it will take to bring it live. And now we're starting to connect the dots. As far as business outcome is concerned, and honestly, that's that's the type of experience that really allowed me to shape this perspective on. Okay. What does product management really mean in the health tech world and what should be the core set of responsibilities?

[00:13:02] RIcha Gujarati: Um, sort of stemming off from that. 

[00:13:04] Angela Suthrave: Tell us a little bit about, you know, taking a product from concept to when it's commercially viable. How do you know when you've done that? 

[00:13:14] RIcha Gujarati: Yeah, it all starts with product strategy, from my perspective. Identifying a really, really small sliver of a problem. That feels that has an acute pain associated with it.

[00:13:29] RIcha Gujarati: And what do I mean by that? Don't worry about the tab, particularly in health care, right? The time just explodes after a while. Find a niche use case where the pain is just so acute and so powerful that there is an imperative for the customer or the user to change behavior. That, to me, is sort of key to really gaining some initial traction and then wide adoption as far as innovating in the healthcare space is concerned.

[00:14:01] RIcha Gujarati: It all starts with that product strategy mindset, right? What is that small problem you're going to find and build a solution that solves for it 

[00:14:09] Angela Suthrave: perfectly. So you're saying that instead of Trying to solve something that has a really large total addressable market, but maybe it's like a pinch. It's not a huge pain point.

[00:14:21] Angela Suthrave: Try to find something that is really, really, really like a sore point where it may be a very small, narrow niche sort of thing, but you're solving it really, really well. And then the market, the market will. Um, you'll make it the economics work. 

[00:14:37] RIcha Gujarati: Exactly. It will work itself out because from there you earn the right to expand into other markets.

[00:14:44] RIcha Gujarati: But if you don't even solve for that, well, well, I'm sorry, you don't have the right to expand. And the reason why I say that to be particularly true for health care. As we all work in health care, and we know behavior change in health care is difficult, really difficult. You can have an amazing product, but the pain associated with going through that transition and change is just a nightmare, and it takes forever.

[00:15:13] RIcha Gujarati: But if you solve for a very small problem, but pain is really acute, people have a reason to change the behavior because what they're doing today is just not working for them. You'll hear them complain about it. You'll hear the line about it all the time. And that's when, you know. That they have a motivation, there's an inherent incentive for them to change.

[00:15:36] RIcha Gujarati: And from there on, once you get that initial traction, it's much easier to expand into other markets. It's much easier to expand into other use cases because you have gained their trust and credibility. But if you only chase after the largest ham, where. Perhaps people are having a hard time articulating the pain point.

[00:15:55] RIcha Gujarati: A, the barrier to change is that much higher, right? Because the TAN is so big, that means it's deeply ingrained within people's workflow. Um, so it just makes the change all that much more difficult. And as a real result, initial adoption all that much more difficult. 

[00:16:10] Angela Suthrave: And so because you're solving a very large pain point, the solution itself is sticky.

[00:16:18] Angela Suthrave: And that's how you drive the market penetration. 

[00:16:22] RIcha Gujarati: I think so. Yeah. The solution becomes so sticky because either there's really no alternative. So the alternative in some instances, because the pain is so great, right? Might be doing nothing. Um, so again, easier for your product to get adopted and build from there on.

[00:16:39] RIcha Gujarati: Or the alternative is just so Hateful and I'll offer some examples of that, um, you know, certain things that we experienced that I read them and and even a medical, but the alternative can can be so terrible that you have no choice, but to adapt this new technology because you're like, anything, anything will do.

[00:17:00] RIcha Gujarati: I just don't want to deal with what I'm dealing with today. And that in itself turns inherently sticky. And the other aspect of it, I would say, from from the perspective of driving adoption is identifying stakeholders who will be your advocates. So, you know, I'm a big believer in journey mapping. Um, it's it's it's kind of a tool that I think.

[00:17:27] RIcha Gujarati: Sometimes just not used really well in product management, but in healthcare, when you have your product changing so many different hands and have 5 to 10 different stakeholders who might intersect with it at some point, identifying how they might interact with the product and then what are you solving for them through that feature side or through that productization and leveraging them to become your advocates.

[00:17:52] RIcha Gujarati: Can go a long way. So, again, it all starts with identifying a really acute pain point, no matter how big or small the problem and and and then solving it so well that people become your fans and they're willing to be your advocates healthcare is is kind of a funny 1 where. It is interesting that word of mouth advocacy can drive and supersede over a lot of different other types of advocacy or marketing activities.

[00:18:23] RIcha Gujarati: Um, you know, that's why people invest so heavily in the medical world in KL advocacy work, uh, because physician to physician, there is that trust factor and they're more likely to adopt that new technology and new solution. 

[00:18:35] Omar Moussa: It seems like St. Jude medical was, you know, that rotation that you Self volunteered yourself for it was the genesis or the platform, the foundation for your career.

[00:18:46] Omar Moussa: Um, in product and go to market or that intersection of product and go to market. Um, so, so let's switch gears here and talk about that intersection a bit more. Um, you went, you mentioned iRhythm, uh, which is a cardiac monitoring product. Um, and as I understand the story, it's, it's a bit of a David and Goliath story with major incumbents like GE and Phillips dominating the space.

[00:19:08] Omar Moussa: Um, iRhythm was able to go public and stay public. Can you tell us more about that, that David and Goliath story? 

[00:19:16] RIcha Gujarati: Yeah, it kind of goes back to the point that I was making earlier, right? Solving for a very acute pain point, but solving it really, really well. So, you know, when the irons came into the picture, they were these at home cardiac monitors.

[00:19:31] RIcha Gujarati: It sounded like cardiac monitors didn't exist. They existed, but here was the issue with them. They're really uncomfortable for patients to use, so no one wanted to wear them for longer than 24, 48 hours. Physicians hated them because oftentimes the data that came back was just crap because of all the wires, people moving around, so they had to keep on re prescribing the product, couldn't come to a conclusion about the patient's conditions.

[00:19:58] RIcha Gujarati: The ECG lab techs hated it because all the repeat testing just added to their backlog about We're having to review the data and help the physician come to a conclusion. And as you can see, across that spectrum, everyone more or less hated the product. And the challenge, though, was existing cardiac monitors, particularly the likes of G and Philip.

[00:20:26] RIcha Gujarati: We're part of a capex investment, and it's not like all of a sudden the CFO of that health Texas health system would say, yeah, yeah, don't use it. Use this new monitor because they have invested so much into it. And as you guys know, most of these sales actors are 4 plus years long. And once they made that investment, they want to milk it.

[00:20:44] RIcha Gujarati: They want to generate every single ounce of revenue from it. So, yes, the pain point felt by patients. Physicians and these ecg text was really, really acute. Um, it still wasn't enough from the head honchos of a health system perspective to search behavior. So, what we did was taking from that playbook going after a very, very niche problem, let's go after patients.

[00:21:14] RIcha Gujarati: And position the product for patients who really you couldn't use these monitors for, because, um, 48 hours of monitoring just wasn't enough. You needed to monitor them for longer. And why is just going to cut it. So, instead of the physician looking helpless in front of the patient, not being able to offer any answers, you didn't really have an alternative.

[00:21:34] RIcha Gujarati: So you were like, sure, I'll try it because, you know, it's not like I'm using the existing model anyways. And once they try it. They loved it, right? Um, the lab tech started really enjoying the experience because we were putting forward a nice summary report. You didn't have to go through paper trail and backlog of a folder worth of data to review the patient's ECG.

[00:21:59] RIcha Gujarati: Uh, you could just see a one pager summary and say, Oh yeah, This, this can go in front of the physician and make a diagnosis. Physicians loved it because they were getting quality data. Compliance was easier, and patients were happy with the product, found it much comfortable. So compliance was even all that much more easier.

[00:22:18] RIcha Gujarati: So it was a little bit of a trifecta and a flywheel moment for us where once they started using it for a niche patient population, you know, really difficult patients, you can't give them any answers. They liked it so much. That the ECG lab type administrators started putting pressure to start using it for more and more patients.

[00:22:41] RIcha Gujarati: And before we knew it, we were getting greater and greater adoption, expanding beyond even that initial set of user group or target patient population that we had identified the product for. And that's what I mean. We couldn't have switched that behavior. Had we gone in and say, Oh, swap out all your cardiac monitors and only use our product, we would have gotten laughed in our faces and, you know, kicked out.

[00:23:06] RIcha Gujarati: But because we start with a very concrete problem saying, Hey, for these patients, you don't have anything to offer. How about you try this product? See what it's like, and once they got the taste of a seamless experience, good patient experience, good patient feedback, it was much easier for us to expand from there on into another patient population and gain, you know, sort of more across a department level adoption that otherwise I don't think would have happened had we gone in with a very broad scope.

[00:23:37] Angela Suthrave: So you start with that strong product strategy. What is the major pain point that you're trying to solve for a small population? And then that way it sounds like the product and the go to market are in lockstep. And the way in is sort of land and expand. You say, just try it. And we're going to solve your problem so well that you, you can't help, but be really sticky and really penetrate and even displace, um, potentially the incumbents.

[00:24:06] RIcha Gujarati: Exactly. Um, yeah, so, uh, you know, where go to market. Really comes into play here and the reason why product and go to market have to be in that step is as you can see across these multiple stakeholders, not just about the product, it's also about how it gets integrated into the workflow, you know, so if you think about it from a customer ops, customer service perspective, that has implications on how you design the end to end offering, really, so product isn't just that single patch monitor, right?

[00:24:41] RIcha Gujarati: That goes on patient's chest and that while you're done, it's the entire suite of offering that we're offering as a result of it. You know, how does a physician prescribe that monitor who puts it into the EHR? How does it get put into the EHR? How do they review the results? How does the results end up in EHR?

[00:25:00] RIcha Gujarati: How does billing happen as a result of it is that entire end to end workflow and without having that go to market lens. If you would just focus on that core product. You wouldn't be solving for all these various touch points, right? You need someone who understands HR integration. Um, so to make sure that the product gets into the formally, the results get accepted easily into the HR system.

[00:25:24] RIcha Gujarati: You know, back then we didn't have the FHIR standard. And even today, it may not matter as much. Um, how do you push for billing? You know, how does this encounter get billed for? And, um, Putting honestly boots on the ground and implementation specialist, that's what we had to do, because we realized we were disrupting the workflow.

[00:25:44] RIcha Gujarati: We realized we were changing how cardiac monitors were to be utilized and deployed in these facilities. So, we had to make sure that, yes, the product is wonderful, but without them being sort of. Walk through that initial pain of destruction, change in workflow, and then seeing the light at the end of the tunnel.

[00:26:06] RIcha Gujarati: We wouldn't get anywhere with the market adoption, wide market adoption and traction. And that's where, you know, understanding the user and understanding all the various stakeholders that play a part in your product adoption is key, but then thinking through it from a complete experience perspective and go to market may very well be part of it in the sense that.

[00:26:27] RIcha Gujarati: You have to now spin up a customer ops function. You have to spin up an EHR integration function and you have to spin up, um, you know, some sort of an implementation specialist function just to drive that wide adoption and stickiness too. 

[00:26:41] Omar Moussa: Recha, you were able to move mountains effectively to get these groups to be in lockstep.

[00:26:47] Omar Moussa: Um, it's not always designed that way. And I'm wondering if you have advice. To, um, I don't even know, like if, if an IC product manager or senior product manager, like a principal could pick this up and run with it, or maybe it has to come from senior leadership, but what advice do you have to kind of dry, like for an organization that not moving that way, how do you get them to move that way?

[00:27:10] RIcha Gujarati: So let's, let's talk what, if you're just an IC or let's say a group product manager, what can you do within your capacity and purview to drive this? Ultimately, I think product managers, whether you're an IC, whether you are in leadership role, you have to think about it from how does what I'm building today drive long term business outcome and then work backwards from there, right?

[00:27:38] RIcha Gujarati: To drive that long term business outcome, what else do I need? Is my product sufficient or not? Collect that evidence. And then go socialize it. Talk to your leadership about it. Talk to every other leader of other functions about it. Um, and I'm, I'm sort of oversimplifying the things we had to do at iRhythm.

[00:28:01] RIcha Gujarati: Um, there was this element of understanding what needed to be done from a customer standpoint. There was an element of also convincing internal stakeholders. I mean, we were a cardiac monitoring technology company. Why would our CIO ever sign up for us to go into HR integration? I mean, that just made no sense.

[00:28:24] RIcha Gujarati: So, the amount of buy in that required, the amount of stakeholder management that required, and convincing leadership at a C suite level, why was an activity worth investing in, was really critical. And had we just thought about it, this is the small product within our purview, and that's what we're going to build and ship, we wouldn't have gotten there.

[00:28:44] RIcha Gujarati: But we had to demonstrate why it was tied to an outcome. And I'll say, you know, when you go in with that mindset, also go in with the mindset that you don't wanna ask for in army of team members as part of resources. That's that that's required to get the job done, approach it from an experimentation standpoint.

[00:29:09] RIcha Gujarati: So collect some theoretical data, demonstrate why it's important, get some buy-in. Approach it from a very much an experimentation standpoint, just like you would do, you know, product level experimentation. Hey, we're going to try this out in 1 account. Let's measure outcomes before and after see it sticks and don't hire a ton of resources to do it.

[00:29:31] RIcha Gujarati: Right? Get scrappy. Take some of the other functions on, um, get people to play a part into it from other functions. That's where influencing really comes in. Um, but, but get, get scrappy, run a pilot, demonstrate outcomes. And then, you know, it's much easier to get buy in because people see the results. And that's what we had to do.

[00:29:52] RIcha Gujarati: It wasn't overnight that, oh yeah, this is what we're going to do. We basically attacked it. Institution by institution 1st, we said we're going to run only 1 pilot and let's see what those outcomes look like. We didn't get to hire a single external resource. So, for a while, I was playing the sales hat to convincing CIO at that institution wide made sense for them to invest their resources.

[00:30:17] RIcha Gujarati: Um, and that's okay. Like, that's what was required to get the job done and. That it was a function worth spinning up and investing in. 

[00:30:27] Angela Suthrave: So we mentioned earlier that iRhythm was able to go public and that it was able to stay public. And I think that's hard to do in healthcare. I think it's hard to go public before you get acquired, and then once you're public, it's hard to stay public.

[00:30:44] Angela Suthrave: And so can you talk a little bit about how, um, IR was able to do that? 

[00:30:51] RIcha Gujarati: Yeah. Um, so I, I mean. I'll tell you what my perspective is and why it's hard to go public and stay public. One is, you know, in general, when it comes to retail investors, they're used to seeing quick outcomes and healthcare by default is, there's nothing quick about it.

[00:31:12] RIcha Gujarati: Sales cycles are really long. And if you think about it from a sales productivity perspective, and I remember this is a metric that, um, some of the investors used to ask us at iRhythm after we went public. What does your sales productivity timeline look like? In other words, how long does it take after recruitment for them to get, you know, perform at peak productivity?

[00:31:36] RIcha Gujarati: In some cases, that's 6 to 9 months. And imagine in an environment where you have to report quarterly earnings, how much patience does someone have where you all of a sudden hire 10 people, 15 people, and it's taking them a year to even show a result. And that's why I think it's really hard for healthcare companies.

[00:31:58] RIcha Gujarati: To a go public and then ultimately stay public because of this short term incentive short term pressure to show outcomes. Um, I think 1 of the things that I did really well is, as I mentioned earlier, really getting green into that small use case and then expand. So they were able to paint a really good narrative around what that expansion looks like.

[00:32:23] RIcha Gujarati: We have adoption for small, small use cases across all these institutions. Now, we're going to expand into them and you can expand pretty resource efficiently, right? Like, you don't have to all of a sudden hire an army of people to expand. So they, they were able to say somewhat lean. I wouldn't say too lean because we did go on a hiring frenzy because of all the resources available, but we were able to say somewhat lean.

[00:32:50] RIcha Gujarati: Um, as we were expanding to sort of satisfy the institution, the retail investors in trust and keep them hooked for the long term at the same time, because we knew that. The adoption was just starting, we were starting to see signs of. We're solving, we solve that small problem really well. And now we get to expand into all sorts of use cases and all of a sudden revenue was starting to honestly explode across certain institutions.

[00:33:22] Omar Moussa: Uh, let's let's talk about the topology or like how the how teams were organized. So, as I understand, you managed. Product and go to market teams, uh, under your organization, how are those teams organized? And why were they organized that way? 

[00:33:36] RIcha Gujarati: Yeah. So, you know, as I mentioned earlier, for iris, um, the product that the patch monitor was just 1 aspect of it, everything that came with it from a workflow.

[00:33:50] RIcha Gujarati: Implementation was also part of the product offering. So, initially, you know, within the go to market team, we had a team of implementation specialists who were responsible for training personnel within health institutions into how to adopt the technology. There were what you may call sort of patient support system specialists as well, who had to address grievances and concerns from patient because we wanted to establish a relationship with them and not have them go back to physicians and say, oh, I hate this product or something.

[00:34:26] RIcha Gujarati: This is not going on. We want it to be readily available and attack them. And then in the near term. Even HR integration, um, implementation specialists were also part of that team because we had to make sure we had line of sight on to the entire end to an offering and how it was being offered to the customers at some point, you know, when, when that entire service got really big, we were able to spin it off.

[00:34:54] Omar Moussa: So Richa, you've clearly, you know, ran product and held a bag, um, in healthcare. It's not like traditional software as a service sales, right? Like I can't just like Google how to be good at sales, right? In this industry, uh, selling it to healthcare buyers is like a concept that eludes a lot of people and it kind of feels like an industry secret.

[00:35:18] Omar Moussa: Can you talk about how successful health tech companies sell into health systems and payers, maybe playbook for us? 

[00:35:26] RIcha Gujarati: I mean, I, I will say part of it, it feels like a trade secret as maybe a little bit of it is because it is a heavy relationship based process and, um, you know, in order to establish this relationship, like, 1 of the things that I recommend to.

[00:35:45] RIcha Gujarati: Mason early state startups trying to sell into health care systems. Let's just talk about health care systems for a minute. You have to find champions. You have to find champions that are going to go back for you and from a, this is where merging on marrying partners when good market can be really helpful is.

[00:36:07] RIcha Gujarati: You find these champions, you turn them into your product advocates, so they offer perspective advice as you are actually developing and designing the solution. Now, they're part of that process, right? They are very much married to the solution you have developed because they came along with you for that ride.

[00:36:30] RIcha Gujarati: Then it's a little bit of an easier sell because they'll go around at least within that healthcare institution talking about your solution and you have the benefit from a PM and go to market strategy perspective that someone from an inside was offering that perspective all along and that's where a lot of these relationships could frankly get established when they're part of this ride with you.

[00:36:57] RIcha Gujarati: It's really tough, especially when it comes to healthcare system to develop a solution and just. Drop it off the wall, I think that kind of buy in takes a really, really long time, especially when you are trying to sell into large healthcare institutions, large ideas, um, you have to find advocates, uh, you have to find what I call sort of.

[00:37:20] RIcha Gujarati: Your referral network, so to speak, um, where, you know, bring them along as a group together and give them material to start advocating on your behalf, not in a marketing or say the same way, but in a very educated way that here is how I use the product. And here's how potentially the product could benefit you, but I just can't emphasize the importance of.

[00:37:48] RIcha Gujarati: Leveraging them as an advocate for your product, leveraging them as an advisor for product development and have groups of that, you know, identify stakeholders. They're going to have significant touch points into your offering and to your product and establish groups of that. So I'll give an example, kind of going back to them for a minute again, um, have a group of physicians, you know, certain type of cardiologists who are going to leverage your monitor.

[00:38:15] RIcha Gujarati: But then also have a group of what we would call ECG lab techs admin. And these are people who run large scale credit monitoring units and services. So have them as part of your product advisory board as well. And once you're ready to commercialize a solution, turn them into your Um, sort of what I, I call on the flip side, sort of commercial advisory group where they go around and evangelize the product, not just within their healthcare system, but at conferences at, um, academic conferences.

[00:38:54] RIcha Gujarati: And whenever they're have their own practitioner meetings, right? There are plenty of those that happened that industry is never invited to get them to talk about the product. Um, I think that's where a lot of these relationships step up stem from, and then those relationships sort of carry through. Even if these individuals move from organization to organization, but to me, that's a critical and a core part of how do you effectively sell into health care institutions and health care systems?

[00:39:24] Omar Moussa: Yeah, it's definitely a hard 1. I often, I mean, with every net new company, I scratch my head for a little bit on. Um, it does feel like a very strong coordination of lots of intimate referrals or warm intros, or I know someone at a specific pair and I can get us a conversation and, you know, all of that truly helps.

[00:39:47] Omar Moussa: And maybe that's just. You know, part of, you know, being great at sales, but it does feel like we have to work so much harder in health care to get your thing across the line. Then then not 

[00:40:00] RIcha Gujarati: 100%. Um, and that's why I'm saying approaching it from an advisory perspective. Like, Hey, you We're developing the solution.

[00:40:08] RIcha Gujarati: Would you like to be part of our advisory group to offer perspective is a little bit of an easier sell because you're not selling them a product yet. You're not asking me to buy anything you're offering them for advice and perspective. And honestly, what's interesting. This is relevant for startups is a lot of them are willing to do it for just equity and.

[00:40:27] RIcha Gujarati: It's a really good way to establish those contacts, establish those relationships, and get buy in when you may not have pre existing networks. Obviously, it's much easier when you have a pre existing network, but when you don't, um, approaching it from a, let's collaborate on product development is much, much an easier sell than you'd think.

[00:40:47] RIcha Gujarati: Here's a solution. Why didn't you buy it? 

[00:40:49] Omar Moussa: Makes sense. Let's switch gears here a little bit. Let's talk about, um, kind of traditional product management versus like, uh, product marketing or, uh, you know, some of the tech startup, uh, product management, um, you, there are many interesting things about you, but another one of the interesting things about you is that you came from Apple health.

[00:41:14] Omar Moussa: Um, Apple health builds products. From a very mature lens of we've been building products before across a lot of direct consumer verticals, um, from a product marketing angle, what was it like to work in that environment compared to a more loosely defined, flexible product org like an iRhythm? 

[00:41:36] RIcha Gujarati: Yeah, so what's interesting is Surprisingly, there wasn't a whole lot of difference.

[00:41:42] RIcha Gujarati: Um, the approach to product management, sure. And, you know, at iRhythm, you could just do a lot more on your own and never had to get any buy in. And, you know, there was just a lot more freedom and flexibility. But in terms of the fundamentals of how product development was approached, how product strategy was developed, and how go to market strategy was developed, There wasn't a lot of difference and I think if had I gone to Google and Facebook, perhaps that experience might have been dramatically different because they have these traditional verticals of product management and then product marketing, but at Apple, those lines are blurred tremendously.

[00:42:22] RIcha Gujarati: And in some way, you know, it's more, more, uh, resembling. Met tech or health tech, then it resembles traditional tech and there's a strong philosophy behind it that I clearly buy into. And, um, you know, I, I agree with, but, yeah, the, the day to day of, uh, you know, how do you develop that white space? Uh, how do you build a solution into that white space?

[00:42:49] RIcha Gujarati: How do you even identify it? Um, how do you think about. Product positioning, all of that was very, very similar because, you know, Apple PMs. They're not responsible for working in Jira. They're not. Expected to be, um, charging bugs or writing tickets and there isn't any of that expectation. The expectation is, can you work with the executive team to identify verticals that we want to enter?

[00:43:19] RIcha Gujarati: What does an expansion strategy look like? You know, if you have an existing hardware offering, what customer segment are you going to expand into with what value proposition? What are the features that you're going to build? You build a business case for it and that's it. Like, you move on. You work with engineering and providing feedback, but it's not a very easy.

[00:43:39] RIcha Gujarati: Transcribed by https: otter. ai Detailed PM specific tasks that you otherwise would see at the, at a company like Facebook and perhaps Google. 

[00:43:49] Angela Suthrave: So the product managers sound very empowered in that sort of environment. And from what I understand Apple health, you worked on the Apple watch. And so what were the biggest problems that you had to solve there and what obstacles did you have to overcome?

[00:44:05] Angela Suthrave: If You're already in a very empowered product role. 

[00:44:08] RIcha Gujarati: Yeah, where do I begin? It was a really interesting experience and that, um, you know, as Omar pointed out, Apple's core bread and butter is selling consumer tech products and a wide variety of them and very successfully. Now come health features, you know, or health solutions that are all that much harder to build, have a longer product development cycle, because, as I mentioned earlier, you know, the key theme is evidence generation, evidence generation, that's expensive.

[00:44:39] RIcha Gujarati: And then the other challenge was, well, how do you do revenue allocation? And now how do I know if my. 100 Apple Watch didn't sell just because it's an Apple Watch or sold because of this health feature that existed on it. So there was a little bit of a revenue allocation and, um, resource allocation challenge in the sense that healthcare was very early stage with an Apple Watch.

[00:45:10] RIcha Gujarati: But then how do you demonstrate that, you know, like anything else, it had earned the right to keep on growing. Get more resources, invest more and healthcare development requires that kind of investment. So, there was that challenge, which I don't think we ever really solve for successfully. Honestly, I, there was, um, you know, there were ways that it was solved for through narrative building, doing some, um, buyer surveys, understanding sort of buyer perspective, post purchasing behavior sentiments, looking at usage, adoption and all of that.

[00:45:47] RIcha Gujarati: But it wasn't a perfect way, particularly when it came to revenue allocation. And then subsequently, how do you, how do you identify and allocate resources accordingly? The 2nd aspect of it was. I was a consumer tech company, not trying to enter the healthcare space and healthcare, you know, we've talked about it extensively.

[00:46:09] RIcha Gujarati: It's very closed off, very slow moving, somewhat resistant to change. And here we were building a solution that was going to honestly disrupt how certain things were done, how patients or users were monitoring their. Um, vital signs, how they were going to take that feedback and data set back to physicians.

[00:46:30] RIcha Gujarati: So physicians were very unhappy initially. And as the, in the early days, there was just so much pushback from the healthcare community about that product launching. They were not happy with it. There were all these, um, woes and cry about, you know, it's going to drive droves of people into emergency rooms.

[00:46:49] RIcha Gujarati: Um, it's going to make practicing a nightmare for us. It's Just a lot of complaints. So the other part of the challenge for us was we're building healthcare products. We had to bring the healthcare community along. We couldn't alienate them. We couldn't make it seem like we were developing things on the sidelines and just.

[00:47:11] RIcha Gujarati: Forcing them to adopt. We needed to gain their trust because the last thing we wanted was a user to take their Apple watch health data to a physician and for the physician to say, I don't want to look at it. It's all junk. That's not, you know, that's not something that we could have afforded and what made that problem even more complex was.

[00:47:32] RIcha Gujarati: Apple being Apple. Very secretive company. You can't share anything about what you're working on. So how do we bring the healthcare community along? Remember what I was saying earlier? The one way to build advocates is you bring them along during the product development process. We can't couldn't do that.

[00:47:50] RIcha Gujarati: Um, so there were a lot of what I would say, cultural challenges, you know, sort of this tension of building a health care product health care functions a certain way and then consumer tech and apple function a certain way. So, how do you, how do we solve for that? Then there was an incentive issue in the sense that.

[00:48:12] RIcha Gujarati: We're happy as long as more consumer tech products are selling, but is it selling because of health features? Is it selling because it's a wonderful tech product? How do we solve for that? And then how do we justify our existence? So to speak, um, and yeah, the last piece of it was, um, really, um, changing, um, perceptions around.

[00:48:36] RIcha Gujarati: What does part of development look like, you know, where you regulated environment and, um, how do we sort of bring the rest of Apple folks along for the ride as well? Um, and because there was a lot of great talent. And we wanted to take advantage of that, especially as we're building health care specific products.

[00:48:58] Angela Suthrave: And it seems like Apple was successful in doing that because for the Apple Watch Series 4 or later, you can actually take an ECG with that watch. Um, and I think that it's FDA approved, right? It is. 

[00:49:13] RIcha Gujarati: It is FDA cleared and they've been Numerous other features after that, uh, as a matter of fact, today, an announcement came out where one of the digital endpoints around a burden that's collected on Apple watch.

[00:49:26] RIcha Gujarati: Um, can now also serve as a secondary end point for all. Clinical studies, which in itself is a big deal because it's a digital biomarker that's now being accepted as. Biomarker, um, so I, again, you know, I don't, I don't think all of it has been fully solved for because cultural changes are just so monumentous and nothing changes overnight.

[00:49:51] RIcha Gujarati: Right? Everything is is a slow process, but I do think some of that was solved for. So, for instance, the notion of building the healthcare community along. We figured out a way to do that. We figured out a way to continue to run KOL advisory groups, product advisory boards with physicians, because I think even within Apple, everyone quickly realized that it was important to gain their trust and important to get their perspective as we were developing product for condition management, for preventative screening products.

[00:50:28] RIcha Gujarati: Transcribed by https: otter. ai Um, we needed to get the healthcare perspective, and we couldn't build an isolation. So we were able to solve some of that and the seriousness of what we were building and how profound of an impact it could have. Yes. It was your rolling. Yes. It was going to take a lot of dollar investments and resources, but the level of impact, I think, ultimately sort of convinced.

[00:50:50] RIcha Gujarati: Um, the broader organization that this was the right thing to do and one way to, uh, you know, sort of have a lasting impact on a user group. 

[00:50:59] Angela Suthrave: And I think it's really cool because it really merges or blurs the line between what is health and more in a clinical sense, as well as wellness. 

[00:51:08] RIcha Gujarati: Absolutely. And. You know, um, this is one of the most exciting aspect of health care for me.

[00:51:15] RIcha Gujarati: Today is this whole consumerization of health care in so many different ways, right? People are becoming more and more aware of what their health data means. People are getting very vested in it. Then there is this trend of a lot of wearables just being so readily accessible and you now have, you know, Your glucose monitor CGM that was reserved for type 2 diabetics readily available.

[00:51:43] RIcha Gujarati: You have your sleep metrics readily available. How long are you in REM? How are you in deep sleep? Um, very quickly, there is going to be a screening test for sleep apnea. I'm pretty sure via to mass cardiovascular fitness. I mean, all of this information is starting to be made available. The challenge is how do you.

[00:52:04] RIcha Gujarati: Package all of it together and really level that up into like true insight and true wisdom To to modify people's behavior, but I do think that's One of the most exciting aspects of health care today is this broad wave of consumerization of health care, people owning their health care data, making sense of it, making behavior changes, because I do think that's, that's going to be the wave that really pushes health care overall.

[00:52:30] RIcha Gujarati: Forward and, you know, the practice of health care probably in the next 5 to 10 years isn't going to be the same because of this. 

[00:52:36] Angela Suthrave: Yeah, completely agree. And then, um, I think while you're also at Apple, you were able to create new revenue streams. Through partnerships with payers, as well as with pharma. Can you talk about that?

[00:52:49] RIcha Gujarati: Yeah, so, um, you know, that that kind of goes back to the earlier challenge that we talked about is how do we justify our existence? If it was going to be continue to be because of hardware sales, it's going to be really hard to do resource allocation and, you know, watches and phones may just continue selling like hotcakes.

[00:53:09] RIcha Gujarati: Um, so we had to figure out new revenue opportunities. leveraging the health features and health features alone. And one of the hypotheses, particularly in working with pairs and leveraged companies was, can certain health features on Apple Watch help you reduce downstream costs by motivating people to make certain behavior changes.

[00:53:32] RIcha Gujarati: Um, and we actually invested a ton in evidence generation for that. We ran a lot of pilots with a lot of wide variety of pairs, some small, some large, um, that went on for several years under the radar. No 1 knew about it. No 1 talked about it. Uh, we worked with some national, uh, peers and providers, such as.

[00:53:54] RIcha Gujarati: The Singaporean government, for instance, well, in launching a nationwide program around healthy behaviors to demonstrate how it keeps people healthier and out of emergency rooms and, you know, prevention of chronic diseases. Um, and it's through this combination of data. I don't think the job is done yet.

[00:54:12] RIcha Gujarati: But at least slowly, you know, United is now starting to cover for it as a covered member benefit. Um, a lot of life insurance companies are starting to cover for it because they realize the benefit of a product that just fits into your life seamlessly. But can also at the same time motivate you to just lead healthier lives.

[00:54:34] RIcha Gujarati: And this is this is where preventative care is coming to its head, right? This is where it's actually coming to life. It's not in the biggest sense, the way we would like it to be the way we would like healthcare to be. But I think that wave is starting and to me, that's. That's quite exciting. On the flip side, you know, with pharma, as you all know, in clinical trials, particularly, the hardest part is keeping patients in clinical trials and getting them to continue to collect data you want them to.

[00:55:08] RIcha Gujarati: And some of these trials are several years long. So any and every digital tool that can sort of seamlessly integrate, um, easy value add. And who doesn't like using the Apple iPhone and Apple Watch, um, to do other stuff, right? And now you get to build a couple of health metrics collection apps on top of it that also make it easy for you to collect data.

[00:55:37] RIcha Gujarati: So we did, um, Quite a bit of partnership work with them. I don't think we fully figured out a revenue stream through that process. There was a lot of proof of concept work done. Um, but to me, honestly, the pair part is a little more exciting because that's where you can see the healthcare needle moving towards.

[00:55:56] RIcha Gujarati: More and more prevention focus. 

[00:55:58] Angela Suthrave: I love that. I'm wearing an Apple watch. I wear it every single day. I have an Apple watch tan line in the summertime and it is, it is very motivating. Like I got to close my ring like in it and you're right. It completely is embedded in my daily workflow. So kudos to you.

[00:56:13] Angela Suthrave: You've had a huge impact. Um, at least my life. 

[00:56:16] RIcha Gujarati: Thank you. No, that's just so gratifying to hear. Um, I'm going to take a little bit of tangent because this is one of my favorite saying in product. Um, and I'm not sure where this, this wisdom came around, but one of the things that they would talk about a lot at Apple in particular is how do we know when a product has been successful in driving adoption?

[00:56:38] RIcha Gujarati: One of the metrics is, can you leave home without it? If you go back home to get it, Your product has gained successful adoption and, you know, it's it's it's a. It seems very intuitive, but it is really true is that for the longest time, you could leave your Apple Watch at home and you wouldn't bother going back.

[00:56:59] RIcha Gujarati: But I think that behavior has changed now. You don't just keep it in the drawer and forget it. You might actually go back because you want to, you know, measure your activity and, um, keep track of other things. And to me, I think, um, it's a really nice analogy to keep. Reminding yourself about anytime you're building a product, have I built something that requires you to turn back around and drive back home?

[00:57:21] Omar Moussa: Not a tangent at all. Very relevant. And quite frankly, I think it, you know, now I will think about that every time my cousin tells me, Hey, we need to get up or I need to close my seat ring. I've been sitting down too long. So, um, which, which, which is also a great segue into just like your, your viewpoints on product management as a whole.

[00:57:43] Omar Moussa: Um, and the role itself, I think. In our previous discussion prior to the recording, you shared a bit of a hot take you, you know, recent recent product management content podcast articles have been coming out trying to define product management, get very technical and prescriptive about what product management is.

[00:58:05] Omar Moussa: Uh, your perspective is unique in, in, in that regard. Um, what are your, what are the various types of product management you've seen? And what's your perspective as a whole? 

[00:58:15] RIcha Gujarati: If I were to summarize my viewpoint in one line, it's product management is doing anything and everything to ultimately drive a business outcome for your offering.

[00:58:26] RIcha Gujarati: And that's it, right? It's not defined by a particular function. It's not defined by a particular job type. It's not defined by a portfolio lane. It's whatever you need to do to get to that end business state and business outcome. And if it means thinking about go to market strategy, then so be it. If it means, um, you know, for a small part, developing customer service training documents and training customer service team members and bringing that up, then so be it.

[00:58:58] RIcha Gujarati: Uh, to me, you know, if you're not tying what you are doing to end business outcomes and how you're moving the needle forward for your business unit or offering, then you're falling short in some way or the other. Um, and that's, to me is, is the very definition of what it means to be a 

[00:59:19] Angela Suthrave: product manager.

[00:59:20] Angela Suthrave: Through all of your experience, you have that hardware component. And so it's difficult, more difficult, I think, or has a different set of challenges when you're a hardware PM versus a pure software PM. Can you talk about what skills make the hardware PM successful? 

[00:59:41] RIcha Gujarati: If you're not tired of hearing this until now, but I'll say it again, product strategy, you have to be really, really good at product strategy.

[00:59:50] RIcha Gujarati: And what I mean by that is you have to be really, really good at making trade offs, making really difficult trade offs. Um, and it's particularly true for hardware PRM, um, for the following reasons. So, feedback cycles when it comes to hardware development are very long. Um, your mistake, if you make a wrong trade off, can be very expensive and very costly.

[01:00:13] RIcha Gujarati: You know, imagine figuring out a feature is either not required or you build, you prioritize it. Wrong feature once the product is hitting the manufacturing line, things can get very dicey there. So understanding how to make those trade offs and really having a strong grasp on what is my real MVP. And everything else that's just ancillary is really important being really good at thinking through the ramifications of trade offs is really, really important because you just you don't get the opportunity for.

[01:00:53] RIcha Gujarati: Right or wrong reasons to be as iterative as you want to be. Now, there are the ways to mitigate it. And, you know, technology and all these advancements that have been made and use a research testing have made some of these things easier, and they're not as risky of a bet as they would have been, but you just still have to be really, really good at it.

[01:01:13] RIcha Gujarati: Um, I have found that product managers who are just probably really good at priority writing. And thinking very incrementally, unfortunately, aren't as good at being hardware PMs. Um, it's just a little bit of a struggle if you can't think long term, you can think 3 to 5 years out, um, and also don't have a strong understanding of, um, what is a good part strategy look like.

[01:01:41] RIcha Gujarati: This is a little bit of, from my perspective, a little bit of a unique skill set in the sense that a hardware PM also has to think very strategically about buy versus build. So, buy versus build question comes up more often. When you're building a hardware product, rather than a software product, because the software is cheap, but, um, as a PM, it's really difficult to get out of the mindset that something is going to be built internally.

[01:02:12] RIcha Gujarati: Right? And just just thinking that. Oh, we're going to acquire it, or we're going to work with the BD team and partnership, um, gets really, really difficult from a PM standpoint. But when you are a hardware PM, realizing how expensive it is to build something, and are you better off acquiring or licensing it out?

[01:02:34] RIcha Gujarati: Um, is that an easier thing to do for you and solution, um, because all that more important and being thinking very creatively about it. It kind of comes full circle to, you know, what is the role of a PM when it comes to hardware PM, you have to branch out a little bit too. Sometimes you have to where the partnership path, um, because.

[01:02:54] RIcha Gujarati: That's what's required to think through the end to end offering. 

[01:02:58] Omar Moussa: I actually, I wish I've given that more thought. I, I wouldn't have assumed that there were more buy decisions in the hardware PM. But when you say it, it's actually like, uh, that's seems like obvious. Like, Oh my God. Yeah, of course there has to be.

[01:03:14] Omar Moussa: You know, there's just so many components to some of these things that you can't recreate that. And part of scaling is just like figuring out when to actually build something and, you know, or replace it or swap it out and maybe to drive better unit economics or to improve a particular, you know, Functionality of the of the hardware, but, you know, some companies are really good at producing a specific thing.

[01:03:37] Omar Moussa: And they've met their master class in that. And there's no need to rebuild that. That's an interesting point. 

[01:03:44] RIcha Gujarati: Exactly. I mean, you know, 1 of the things that we coach early PMs on, particularly when they start. Working on hardware central products is, um, you write this business charter, so to speak, for your product, you talk about revenue generation, you hypothesize on units, how many you're going to sell?

[01:04:00] RIcha Gujarati: Because that's another part of it. But 1 of the key aspect within the product charter is. Should we build this? Or should we buy it? And if so, what aspects of it should we buy? Um, it really forces you as you're going into again, that product strategy and definition phase, what's more important to build internally.

[01:04:22] RIcha Gujarati: What aligns with your internal capabilities better than sort of, you know, just acquiring or licensing something out from from outside. It's really important. And the last thing I'll say, I have a lot to say on the last thing I would say is. Um, you have to get really good at hardware UX. Um, when it comes to a physical interface, you want to communicate a lot, but you have only so much.

[01:04:50] RIcha Gujarati: Real estate or ways you can say it, right? Um, if you, if your hardware has to completely rely upon an app to do even the basic jobs, then you kind of fail from a hardware product development standpoint. So, you have to think very simplistically from a user interface perspective as well, and you can't just outsource that thinking to a designer.

[01:05:13] RIcha Gujarati: That's just not possible. Um, when you are a hardware PM, 

[01:05:17] Omar Moussa: you talked about customer centricity earlier, and I just want to double click into that, um, for as it relates to the PM role. Um, I, I mean, I encounter a lot of ICPMs that lack this skill, and I think it's mainly because the consumer is often not really the buyer in healthcare and a lot of healthcare startups are actually like, I got to solve a use case first before I can even start thinking about like the patient or the customer.

[01:05:42] Omar Moussa: Huh? So, I mean, how do you coach, uh, and it's not even focused on the patient entirely. Like it could be any customers or even buyers as well, right? Like the payers and the providers themselves. So how do you coach PMs to talk to customers? What type of forum? Like how often, you know, what are best practices?

[01:06:03] RIcha Gujarati: Yeah, so part of the answer is depending on what stage of the company you're in, are you a startup or, or a big company. But no matter what use case you're solving for, who you, who you're solving for, right? You have to get really close to all your stakeholders that are gonna have a touch point into your product.

[01:06:21] RIcha Gujarati: And if it's patients. And find them, um, and one of the things that I coach, um, PMs, particularly working in early stage startups with limited resources, or even like early stage founders. Is find your users where they tend to aggregate the most, you know, and your world is your oyster. Reddit groups, Facebook groups, especially when you work in health care.

[01:06:47] RIcha Gujarati: There are just so many health care conditions, specific communities out there. Join them, listen to what they're saying. It could be the best signal that you can leverage in terms of understanding that user profile. Um, I've had, um, you know, I personally have had some success with it where. Very quickly, I put together a survey, joined a Facebook group, um, around patients and individuals dealing with heart conditions.

[01:07:16] RIcha Gujarati: You know, these are, these are 100, 000 people that have all experienced a cardiac condition before, but why not learn from them? And literally within a day, you can collect so much feedback, push out a survey, get them to provide feedback on certain things. You would be surprised at how willing people are, especially again, it's it's a problem with solving for and if it's a pain point acutely felt people are going to come forward and answer those questions for you.

[01:07:46] RIcha Gujarati: So, get out there. Listen to the signals, find your users where they tend to aggregate the most, you know, their nurse practitioner communities. Find them there are administrative communities for certain times go to those conferences. Run focus groups. Uh, if you're not talking to your user groups at the minimum once every month, even if it's a 30 minute discussion, um, then I, I think you're sort of developing whatever it is you're developing in isolation and I push no matter what level of a PM you are, you could be a chief product officer.

[01:08:26] RIcha Gujarati: You got to be paying attention to those signals. I don't think anyone should be removed from that. As a matter of fact, this 1 practice that we used to have at St. Jude that I'm a big fan of is, um, taking forward that tradition from Hopkins by design program. We would go on these field rides where we would shadow procedures related to our product.

[01:08:48] RIcha Gujarati: We would see how product was being utilized. We would spend an entire week in 1 healthcare facility. Just seeing things how they were being done and do and, and we brought engineering leaders around. What better way to influence and drink into developing things for you and understanding the pain points versus, you know, them seeing it firsthand.

[01:09:12] RIcha Gujarati: I think it's, it's 1 of the most wonderful practices. That St. Jude had, and honestly, I wish every company had those practices more and more get in front of your customers, no matter what the medium is. 

[01:09:25] Angela Suthrave: Rachel, you are just a wealth of knowledge. Um, this is, I've, I've learned a ton. So thank you.

[01:09:45] Angela Suthrave: Where we're going to ask you five questions that are meant to be relatively simple. Um, quick and fun. So the first one is, are there any concepts in healthcare that excite you right now? 

[01:09:56] RIcha Gujarati: Yeah, I kind of already talked about it a little bit, but you know, this, this focus on preventative screening, which is a little bit of a side effect of consumerization of healthcare, right?

[01:10:06] RIcha Gujarati: I think it's, um, very much, um, starting to see with the. Accessibility challenge and what's all for with more and more wearables, continuous monitoring coming into foreplay where people are really starting to own their own health. They're curious about health, specific metrics want to take actions.

[01:10:29] RIcha Gujarati: Whether it's with a doctor or without a doctor, um, and to me, I think that's quite exciting because while the rest of health care from a practicing perspective still is very much disease centric, very pathological, consumers are starting to empower themselves and move into the preventive space. And I think as a result, that's going to pull the whole industry towards more prevention focus.

[01:10:53] RIcha Gujarati: Um, and to me, I think, um, that's going to be a really exciting set of years when that actually ultimately happens. 

[01:10:59] Angela Suthrave: Yeah, I couldn't agree with you more. I think right now we do sick care rather than health care. We wait till the car is broken, um, rather than doing regular maintenance 

[01:11:07] RIcha Gujarati: and people are quite honestly fed up of that, right?

[01:11:10] RIcha Gujarati: That's why they're taking matters in their own hands and saying, yeah, you know, I'm going to track my VO2 max, um, because it matters for my cardiovascular fitness. I'm going to monitor my sleep cycles and not wait until a sleep physician sends me to a sleep lab. Um, cause I want to take ownership of my own health.

[01:11:27] Omar Moussa: Reach up professionally, which three tools can you just not live without? 

[01:11:31] RIcha Gujarati: Yeah. So Miro, as I mentioned earlier, I'm a big fan of journey mapping workflow. So Miro, uh, definitely I use monday. com a lot. I, if anything, I've actually convinced my entire company to open monday. com for task management. We do a little bit of a roadmap on work there too, sometimes, um, in an engagement with engineering team.

[01:11:52] RIcha Gujarati: Okay. And then, um, this might not be a really popular tool, but dragon boat. So when you manage a portfolio of products, I, and again, your monitoring for specific metrics, outcome metrics, dragon mode, um, is, is quite helpful as well. 

[01:12:08] Omar Moussa: What, what is dragon mode exactly? 

[01:12:10] RIcha Gujarati: It's, it's like a. You can use it for product road mapping, but when you have like product portfolios, um, so if you have multiple product pipelines or product lines and you want to see, um, set specific OKRs and outcomes related to that, it's, it's pretty good for that, um, monitoring too.

[01:12:29] RIcha Gujarati: And, you know, communicating to exec staff, um, at the highest level, how your overall, uh, product, um, portfolio and pipeline is doing. 

[01:12:37] Omar Moussa: We will have to check it out. 

[01:12:40] Angela Suthrave: Yes, that one is new for me. What, um, are some of the most helpful professional or healthcare resources that you found? 

[01:12:49] RIcha Gujarati: Yes, there are quite a few, um, but I would say 2 books that if I can recommend to people and 1 is.

[01:12:58] RIcha Gujarati: Particularly true because of this whole hardware and software angle is a blue ocean strategy. Um, I have learned a lot from that book. I think, you know, it's been very effective in my career when I'm building products from 0 to 1. But particularly for anyone building in the hard tech space, um, deletion strategies definitely must must read.

[01:13:20] RIcha Gujarati: And the other 1 that I'm a really big fan of is the startup methodologies. And, you know, how do you, um, do or do prototyping work? How do you get quick feedback? And I know I said. It's a little hard for hardware, but. Because of the, a lot of the insights coming from the startup come around to that idea that, um, you know, we, we, we can still get early feedback, um, get early feedback on product concepts and get ready for their own.

[01:13:47] RIcha Gujarati: So those 2 books would be my favorite to recommend. 

[01:13:50] Omar Moussa: I'm honestly surprised by the blue ocean strategy. I, so I joined IBM out of the blue. of undergrad into their consulting practice. And that was our, like, cause you're basically a child still. That was our summer reading assignment was to read Blue Oceans.

[01:14:05] Omar Moussa: It's 

[01:14:06] RIcha Gujarati: a very simple book, but it's just, if you keep on going back to some of the. Practices mentioned into it. Um, I think that, you know, it offers a dependence. 

[01:14:19] Omar Moussa: 100%. Um, do you think product management is a science or an art form? 

[01:14:23] RIcha Gujarati: Uh, I think it's, it's an art. Uh, I am definitely in the camp that it's an art.

[01:14:30] RIcha Gujarati: Um, and I think it's because I don't see. Product management through a single lane lens through a very set of defined functions. I think it's a little bit nebulous based upon the organization that you're a part of. 

[01:14:42] Angela Suthrave: And lastly, do you have any shameless plugs? 

[01:14:45] RIcha Gujarati: Yeah, I'm, I'm not very active on social media, but 1 of the things that I am trying to do, because I see that as a little bit of a gap today is.

[01:14:54] RIcha Gujarati: Um, if you are someone building in the hardware and software space, so hardware enabled platforms for a combination of hardware software platforms, feel free to reach out, uh, either via LinkedIn or, or Twitter. Uh, I, that is a community that I am trying to cultivate and bring about more because, you know, again, very unique lessons there that, um.

[01:15:18] RIcha Gujarati: I think the entire community can benefit. Richa, thank you so much for being on the show. Absolutely. It was my pleasure.

[01:15:27] Omar Moussa: 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 Aditi Atreya.

[01:15:44]Omar Moussa: We're Angela and Omar, and you've been listening to Concept2Care.

 

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