Event Recap: Under the Boughs with Rajeev Singh - Part 1

The May 30 edition of Under the Boughs featured everything that has made the series so popular with the health care innovation community. Host Lee Huntsman and his guest Rajeev Singh, CEO of Accolade, shared their hard-won insights into the challenges facing disruptors in the sector, while also hitting some key notes around the opportunities that exist in the face of those challenges. This event was the last of the 2016-17 season, and among the most anticipated from a series that included a bevvy of amazing speakers throughout.

The Under the Boughs series is sponsored by BioEngage, an outreach effort of UW Bioengineering, and brings together the Health Innovators Collaborative and the Cambia Grove communities for inspired dialog that seeks to provide deep insights, fresh ideas and community connections.  You can find recaps of past events on our blog, or view this YouTube playlist of videos from the series here.

The event was attended by 120 guests, and Singh brought an unusual degree of candor and charisma to the conversation about a journey that he called the hardest thing that he’s ever done but also incredibly rewarding. As Huntsman helped tease out the qualities that have led to Accolade’s impressive traction to date, Singh was able to illuminate how his experiences—first as a major disruptor of the corporate travel sector at Concur and now as the CEO of a company aiming to do the same for health care—can provide guidance for others working to make our system more sustainable and more accountable to the needs of individuals and their families.

A Familiar Story with Unusual Results

To kick off the session, Singh shared Accolade’s origin story, including the CEO’s roots in tech. “We thought this was a place we could help people,” said Singh. “We thought—and we’re not the first tech entrepreneurs that thought this, I know that – this is a space ripe for disruption. A space where the consumer wasn’t at the center of the ecosystem, even though people were talking about consumerizing health care.”

“We saw a space that was getting flooded with investment, but that investment wasn’t seeing the kinds of returns that you otherwise might expect.”

“If you see that set of trends –entrenched incumbents, investments not getting the return they want, misaligned incentives—that’s a broken thing, and the only way to achieve something big is to find something really broken. If you’re looking to make change around the edges this is probably not the space for you, but if you really want a shot at something big, all of the attributes for disruption exist.”

In its earlier incarnation, Accolade was getting extraordinary engagement rates and NPS scores that dwarfed their competitors. Singh and his co-founders were then able to combine their expertise in technology with the solutions Accolade had developed around the engagement problem.

The Foundation for a Hi-Tech, High-Touch Model

Singh described the company’s business model, as well as what the service does. “We take this personal relationship, we surround it with clinical capabilities, and we wrap it all up with a technology platform powered by machine learning and that’s powered by all of the new capabilities that exist today – mobile, portal, analytics.”

“In health care you need three core components – you have a to have a human touch […], you have to have clinical capabilities, because if you don’t you’re going to have a hard time engaging that chronic population that’s driving a ton of your cost, and you better have the best technology capabilities in the world, because this is the most complicated … set of challenges to solve.”

Singh said the Accolade platform provides a center point for a host of solutions for the consumer. The model works in large part because even concierge medical services—including options for telehealth clinical consultations—are much cheaper to provide than acute care, ED visits or other inpatient or outpatient treatment.

When customers are spending $2 billion on health care, Singh explained, even a 3-5 percent savings is significant, especially when factoring in improvements to employee satisfaction and customer satisfaction.


Huntsman and Singh raised several key trends in health care:

Consumerism – “They way people talk about it is, ‘We’ve empowered consumers to make great decisions,’” said Singh. “Not totally true. Here’s what we’ve done: we’ve said ‘Your deductible is now $7,000, you should probably make good decisions or you can go bankrupt.’” He said high deductible health plans are not going away, and Accolade hopes to help those consumers.

Value-Based Care – “We have the best health systems in the world in this country,” Singh said. “[Seattle] is actually quite full of some people […] who have put their money where their mouth is on value-based care, but this city is unusual and that’s not true in every other city in the country. This is a regional space – people talk about the $3 trillion space, I really think it’s like 100, $30 billion spaces.”

“I think, value based care as a trend, yeah I believe it. […] There is a movement afoot, but are we going to see the top 50 health systems in this country really pressing down the gas on moving toward value-based payments […] and moving away from fee for service in the next 4-5 years? I don’t know about that, I’m a little skeptical.”

Innovation – In order for technology innovation to work, Singh said the data has to be set free. “Every great wave of technology innovation that’s happened over the last 30-40 years, we took data that was opaque and hidden behind firewalls, put it out here in the open world, surrounded it with open web services, and said ‘innovate.’ […] ‘Technology innovators across the world, play, [and] whoever builds the best stuff and reaches the customer in the best way will win.’ That’s really hard to do today because the data is still hidden behind firewalls.”

ACOs/Population Health – “We’re not delivering for an ACO today,” said Singh. “If that’s really the wave that’s going to overtake the industry, those health systems are going to have to figure out how to own that consumer relationship, either via companies like ours or on their own, not just at the [time of medical] event, or at the moment [of needing care…] but over the period between visits.”

More of the conversation is available in Part 2 of this recap—including portions of the conversation describing Accolade’s reception in the marketplace, some concluding thoughts from Singh and portions of the audience Q&A.

Want to hear a lightly edited copy of the whole conversation? Play the audio recording of the event below:

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