Ops I did it again by Out of Pocket

The episode moves through three connected ideas. First: clinical trials have a UX problem. One in five trials recruits zero patients. Half under-recruit. Paul's early work was understanding why – and fixing it. The answer was almost never the science. It was that patients had no parking, caregivers had no wifi (or babysitting!), and the protocol assumed everyone could get to Mass General by 9 AM on a Friday via public transit. Solving that required showing trial designs to actual patients before locking them, and listening to their recorded reactions rather than just summarizing their survey scores. Second: measuring patient experience is genuinely hard. There are no inches of insomnia. No pounds of pain. Patient Reported Outcomes – PROs – exist because the most burdensome chronic conditions don't have actual units that can be measured. There are thousands of PROs, many are outdated (the fibromyalgia questionnaire from the early 2000s asks how well you can vacuum and cook for your family), and most were designed for clinical trials, not for weekly check-ins on a mobile screen. So for you, Product Manager/Engineer/Builder: how are you going to measure whether your Care Model actually improves patient health? Third: building PROs into a product creates specific traps. Paul runs through the ones he has seen firsthand: copyright violations (most scales are licensed and litigation can cost millions), engagement drop-off (5–10% of users is a good day for consistent tracking), incentive fraud (cash rewards attract bot farms), the nocebo effect (asking about pain can worsen it: hey, 1-10 scale, how itchy are you right now?), and the regulatory ceiling – go too far with your tracker and you've crossed into medical device territory, with all the compliance that comes with it. The Five Things to Know Before You Build 1. You probably don't have permission to use that questionnaire. Most validated scales are owned by universities and licensed for a fee. Saying you found it published online doesn't mean it's free. The database PROQOLID lists rights holders, and some of them are quite litigious  2. Only about 5–10% of patients will track at the cadence you're planning. The ones who do are not representative of your broader user base. Obsessive trackers skew your data. Users with executive dysfunction may not be able to log in, let alone complete a questionnaire. 3. Cash incentives destroy your data. If you offer a financial reward for completion, expect an avalanche of bots and fraudulent responses. Survey researchers report 80–90% fraud rates in incentivized studies. Things that seem to work better: setting group goals, an AMA with the scientists behind the study, and giving users a summary of what their data revealed. 4. Asking about symptoms can worsen them. The nocebo effect is real (for example: scale of 1-10, how itchy do you feel right now?). Paul's team designed positively-framed questions ("how well are you sleeping?") rather than deficit-focused ones ("how bad is your insomnia?") specifically to reduce iatrogenic harm. 5. Interpreting a score triggers regulation. Tracking is fine. Saying that a score of 5/5 means "severe" COULD make your app a medical device and suddenly make you beholden to a lot more regulation Brought to you by Nirvana - Nirvana delivers real-time eligibility checks and cost estimates and plugs right into your existing workflows For inquiries about sponsoring the podcast, email sales@outofpocket.health Resources Paul Wicks on LinkedIn — linkedin.com/in/paulwicks Paul’s newsletter, ProofPoints Paul’s podcast, Prove It! Paul’s website, ProofStack Health RAAPID Inc course on Risk Adjustment: V28, AI, and multi-million dollar settlements. Apr 7-9 Sponsor the Hardware Hackathon! Apr 17-19 in SF! PROQOLID — eprovide.mapi-trust.org — find the rights holder for any validated PRO scale PHQ-9: free, validated, widely used depression screener GAD-7: free, validated anxiety scale Timestamps 00:00 — Paul's origin story: ALS research, patient communities, and clinical trial ethics 03:00 — PatientsLikeMe and showing trial protocols to patients before locking them can actually INCREASE recruitment 11:00 — What PROs (Patient Reported Outcomes) are, why there are so many, and why none of them agree 18:00 — Pharma, payers, providers, patients – and who actually cares about PRO data 26:00 — The fifth stakeholder: scale developers. Beware for license fees and lawsuit risk 30:00 — Which patients actually track data, and what to do about everyone else 33:00 — False starts: psoriasis body maps, crab-to-clam scales, and positive framing 38:00 — The regulatory ceiling and pharmacovigilance

In this episode of Ops I Did It Again, Michael Rado (aka Rado), Co-Founder and CPO at Photon Health joins the thinksquad aka Danielle and Nikhil to break down how they built and scaled products to support over 20,000 e-prescriptions a month. Rado shows a live demo of their build (on YouTube version) and candidly shares his learnings on how to scale with optimization and automation in mind. This episode is sponsored by Out of Pocket, because no one is prouder than us than us: https://www.outofpocket.health/To register for the upcoming Healthcare Call Center 101 crash course course visit: https://www.outofpocket.health/courses/how-to-build-a-healthcare-call-center; Use code: ANSWERS for $100 off; Next cohort starts 4/16- 5/2To register for the upcoming Healthcare 101 crash course course visit: https://www.outofpocket.health/courses/healthcare-101-crash-course; Use code: IBELIEVEINME for $100 off; Next cohort starts 4/23-5/9Hosts:Danielle Poreh (https://www.linkedin.com/in/danielleporeh/)Nikhil Krishnan (https://twitter.com/nikillinit)Guests:Michael Rado (https://www.linkedin.com/in/michaelrado)  Timestamps:(00:00) Intro(01:45) Michael Rado and his journey to Photon(03:14) How Photon Health works(07:36) Courses by Out Of Pocket!(16:49) What photon automates and measures(24:23) The approach towards product development at Photon Health (29:25) Practical experiments for orgs to try 

Explore a digital health operations playbook with tips for scaling, finding product-market fit, and defining encounters. Learn from Rahul Agarwal about building a clinical workforce and scaling operations. Discover strategic advice for managing healthcare encounters and optimizing operations through standardization.

In this episode, Kerem Ozkay and Ayo Omojola from Carbon Health share insights on AI tools, patient care strategies, and unique marketing approaches. They discuss tech-enabled healthcare levers, SEO strategies, and AI integration. The guests also explore the impact of tone on patient interactions and the challenges of revenue cycle management. Additionally, they highlight the value of clinicians with diverse skill sets and the importance of effective communication in healthcare initiatives.

Nate Brown  joins the Thinksquad, aka Danielle and Nikhil, to share lessons learned from scaling a 90 person care team in 3 years at Thyme Care.We break down their organizational design, recruiting best practices (which includes lots of role play) and how to generally think through building alignment at different levels and stages of a start-ups evolution.This episode is sponsored by Out of Pocket, because no one is prouder than us than us: https://www.outofpocket.health/You should also check out our courses, including ones taught by yours truly (How to Build A Healthcare Call Center and Healthcare 101): https://www.outofpocket.health/course-library--- Hosts:Nikhil Krishnan (Twitter: https://twitter.com/nikillinit)Danielle Poreh (https://www.linkedin.com/in/danielleporeh/)Guest:Nate Brown (https://www.linkedin.com/in/nate-brown-50a4a625/)--TIMESTAMPS(00:00) Introduction(01:48) What is Thyme Care & their mission(03:53) Nate's journey & role(06:22) Measuring qualitative data(08:25) The hiring process(14:38) Role play in interviews(23:17) ‘Pods' in organizational design(25:33) Measuring success and adjusting for patient needs(26:56) Company planning and aligning goals(35:17) Conclusions

Douglas Streat, COO of Aledade Care Solutions and an expert in patient engagement strategies, joins the hosts to discuss innovative approaches to healthcare. He shares insights on creating behavior change and emphasizes the importance of meaningful interactions over traditional call center tactics. The conversation includes the significance of data-driven methods and innovative outreach, such as direct mail. Plus, there's a fun game that illustrates effective engagement techniques while providing practical tips for enhancing patient care.

Sandy Varatharaja, Healthcare Ops expert, discusses 12 tactical healthcare ops tips, including thinking like a product person, running a drip campaign, creating offboarding docs, utilizing schedule sending, upgrading software to AI features, and prioritizing rituals and frameworks for success as an operator.

Matthew Woo, Co-Founder & Product at Summer Health, discusses how Summer Health builds an AI-first company. Topics include improving SLA and reducing wait times in healthcare, BAA agreements and exploring multiple language models, enhancing user research surveys with AI, using AI to score empathy in provider-patient conversations, and finding the right problems for AI.

HouseRx discusses how they built their product, emphasizing the importance of learning, building relationships within the team, and recruiting product-minded individuals. They highlight the value of flexibility in the product, metrics for measuring success, and the investments made early on. Their approach focused on collaboration, continuous improvement, and delivering a better experience.

Ajay Haryani, MD, discusses incorporating texting into patient care, measuring value, tracking SLAs, and building a field-based team. They explore the benefits of SMS for communication, centralization in healthcare, and understanding communication preferences.