As part of my series about “How Business Leaders Plan to Rebuild in the Post-COVID Economy,” I had the pleasure of interviewing Sanjeev Agrawal.
Sanjeev is president of LeanTaaS, a Silicon Valley-based innovator of predictive analytics solutions to healthcare’s biggest operational challenges. He works closely with dozens of leading healthcare institutions including Dignity Health, Duke Health, Oregon Health & Sciences, UCHealth, MD Anderson and more. Sanjeev was Google’s first head of product marketing. Since then, he has had leadership roles at three successful startups: CEO of Aloqa, a mobile push platform (acquired by Motorola); VP product and marketing at Tellme Networks (acquired by Microsoft); and as the founding CEO of Collegefeed (acquired by AfterCollege). Sanjeev graduated Phi Beta Kappa with an EECS degree from MIT and along the way spent time at McKinsey & Co. and Cisco Systems. He is an avid squash player and has been named by Becker’s Hospital Review as one of the top entrepreneurs innovating in healthcare.
Thank you so much for your time! I know that you are a very busy person. Our readers would love to “get to know you” a bit better. Can you tell us a bit about your “backstory” and how you got started?
After obtaining my bachelor’s and master’s degrees at MIT, I spent a brief stint as a chip designer at Analog Devices. I then decided to try out management consulting and went to McKinsey & Co for a few years, where I learned the basics of strategy, operations and finance while working with global businesses across the U.S., Europe and Asia. In 1997, I came to Silicon Valley and have been here since — first at Cisco Systems, then at Google as their first head of product marketing. Post Google, I’ve been fortunate to have held leadership roles at Tellme Networks (acquired by Microsoft), Aloqa (acquired by Motorola) and Collegefeed (acquired by AfterCollege). In 2015, I came across LeanTaaS when the company was solving interesting problems using predictive analytics. After I joined, we decided to focus entirely on healthcare operations because it is such a big need and a massive market where we could have a lot of positive impact. Since then, we have grown 400% year over year, raised over $100 million in the process, and work with over 300 hospitals across ~100 health systems throughout the U.S.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lessons or “takeaways” you learned from that?
In the early days of LeanTaaS, our CEO Mohan and I went to visit a large health system that was an early customer of ours and had seen great results. They had started an innovation fund and expressed interest in participating in our first round of funding that was ~$3 million in size. The funding was mostly spoken for, but we really wanted them as a strategic partner, so we prepared hard for a meeting with their leadership team, including thinking through various potential scenarios and outcomes. In the end, we decided the safest thing to say to them in the meeting that conveyed our sincere feelings was: “We have made room for up to $250K for you in this round because we really value your partnership, and we’d be willing to make the round a bit bigger if needed to accommodate this amount.”
When the meeting with their senior leadership team (including their CFO who managed their investment fund) started, we waited for an opportunity to open up for us to say what we had practiced. What happened instead was that they never asked us the question of how much funding we wanted from them. Instead, about five minutes into the meeting, the CFO, who is a pretty direct guy, said, “We have a $100 million fund, and we would like to invest $10 million in you guys.”
I am usually not at a loss for words, but both Mohan and I couldn’t believe our ears. We were both experiencing the same incredulous feeling of being in front of a partner who wanted to deepen their ties with us in a way we had never even imagined. They ended up investing in a separate larger round, and it’s been one of the best partnerships we could have imagined.
I suppose it wasn’t a traditional “mistake,” but my big takeaway from that meeting was to think bigger and believe in our vision even as a small company speaking to a large institution. If you are adding value to customers, the market will find out and the stars will align in your favor.
Is there a particular book that you read or podcast you listened to that really helped you in your career? Can you explain?
There is so much helpful content out there (e.g., a16z’s podcast, First Round Capital’s blogs and so much more) that it is hard to pinpoint just a few. Off the top of my head, there are a few books and articles that have both resonated with me and been useful in practice as an entrepreneur:
- “The Hard Thing About Hard Things” (Ben Horowitz)
- “No Man’s Land”(Doug Tatum)
- “Give Away Your Legos”(First Round Capital)
- “Crossing The Chasm”(Geoffrey Moore) — of course, an old favorite
I find I learn a lot from doing, thinking through things, and of course, from quick post-mortems on my mistakes.
Extensive research suggests that “purpose driven businesses” are more successful in many areas. When you started your company, what was your vision, your purpose?
I agree wholeheartedly. It’s a lot easier to motivate yourself and your team through ups and downs if what you do is not just for the paycheck or the valuation. We are very fortunate to be working on a mission that matters: to improve healthcare operations by applying the principles of mathematics to optimize supply and demand for medical care. We call this mission “Better Healthcare Through Math.”
Here is the basic issue: The U.S. excels in medical research, innovation, and clinical care, but our healthcare industry has failed to keep up with the growing operational challenges of the digital age. Health systems have invested millions in operating rooms, inpatient beds, infusion chairs, MRI machines, and other expensive assets, but their utilization of these assets lags far behind that of the airlines, transportation, retail and other industries. You can see this in the long waiting times for patients, overstressed staff, persistent scheduling dilemmas, and poor ROI and asset turns for the organization, even as many of these valuable assets sit idle for hours every single day.
Here is the fundamental problem: Matching a volatile, unpredictable demand for services with the constrained availability of supply (staff, equipment, rooms, etc.). The math currently being used to solve this problem is simplistic and outdated. Healthcare systems can harness the power of sophisticated, analytics-driven, predictive algorithms to optimize the matching of supply and demand, just as Uber, Amazon, Waze and the airlines do. We provide intelligently designed software tools to their front-line staff so they can make data-driven decisions on a daily and hourly basis in order to flatten demand peaks and create smoother patient flow and higher throughput.
We are working toward a future where increased patient access, lowered costs, and reduced patient waiting times are ALL possible at once. And better math is the pathway. As a country, if we don’t solve these problems, our spending on healthcare will keep ballooning to the point where we can’t all get quality care anymore.
Do you have a “number one principle” that guides you through the ups and downs of running a business?
We have four core values, and if I had to pick one principle among those, it would be “No Customer Left Behind.” It is a “North Star” that brings together all the key elements of making any company successful:
- Build products that solve hard and important problems for our customers (“Product Market Fit”).
- Reach customers in the right channels with messages that resonate (“Go-to-Market”).
- Deliver quantifiable results fast and several times what customers pay (“Quick Time to High Value”).
- Innovate and learn continuously (“Keep Building the Next iPhone”).
“No customer left behind” is the foundation of our culture, and we think it can enable us to create a large, meaningful business that matters and lasts.
Thank you for all that. The COVID-19 pandemic has affected nearly every aspect of our lives today. For the benefit of empowering our readers, can you share a few of the personal and family-related challenges you faced during this crisis? Can you share what you’ve done to address those challenges?
My extended family lives across the globe, and all of them have been affected in different but significant ways. My sister, her husband and her eldest son are all doctors in India and are on the front lines every day, caring for sick patients. My nephew, in particular, is an ENT surgeon who has to intubate patients in very close proximity. To be honest, there’s not much I can do except hope and keep urging them to be careful, which I know they are. And checking in with them frequently, which I do.
My kids (15 and 10) are home, and it’s hard for them to not meet up with friends. Being in front of a computer all day is challenging as they have moved 100% to virtual learning methods. We have tried to temper that with being more consistent in having dinner together, sometimes watching movies or Jeopardy together, going out for hikes and taking turns cooking. Our neighborhood is fun too — every Sunday we get out on the street and play Trivial Pursuit or Charades or something together.
At the end of the day, we are very fortunate to have the lives we do in the part of the world we live in, so the challenges we face are very small relative to those at the front lines of the crisis or those who have lost jobs or loved ones. I can’t really complain.
Can you share a few of the biggest work-related challenges you are facing during this pandemic? Can you share what you’ve done to address those challenges?
I have to say that working virtually has not been our biggest challenge given the nature of our business. Our team has been quite effective in working remotely, and in many ways, it has brought out the best in them. Every team member has stepped up, and in fact, April 2020 was our second-best month from a customer acquisition perspective.
The biggest challenges have been:
- The uncertainty of how this is impacting our customers, what their changing needs are, and making sure we are responding and helping the best we can.
- Taking prudent austerity measures to make sure we pivot our spending on the right areas (e.g., online) and make sure we manage our burn.
- Delivering our products remotely, which in a healthcare B2B setting is unusual, but we are finding it quite doable since our customers are in the same boat we are, i.e.. having to work almost 100% virtually.
Given the above, we have worked hard to create new product and business plans and communicated them extensively to the team. We have spent a lot of time examining our assumptions and realigning them with market reality.
Many people have become anxious from the dramatic jolts of the news cycle. The fears related to the coronavirus pandemic have understandably heightened a sense of uncertainty, fear and loneliness. What are a few ideas that you have used to offer support to your family and loved ones who were feeling anxious? Can you explain?
A few ideas I have found personal benefit from and tried to convey are:
- Believe in the science and not the hype: There are all kinds of graphs and charts and news media that have their own biases. Try and get to the first principles to understand what kind of a virus/disease this is if you are going to read about it. Follow the scientists, not the politicians and the news media. Wash your hands, keep social distancing, and trust that there are thousands of people working around the clock to find a vaccine and a cure
- Your immune system is your best defense: Whether there is a vaccine or not, now is a good time to get yourself stronger physically and mentally. Eat better, move more, build up your immune system by taking care of yourself — it will help not just against COVID-19 (or 20 or 21) but against all kinds of disease.
- Every crisis creates opportunities: If you are a student who is confined to being home, see if you can learn that musical instrument you’ve been meaning to. If you are an athlete who can’t play the sport you like, go running or hiking if you can. If you are an entrepreneur, move your business model online before your competitors do.
“Woe is me” is not a great strategy. Get up, do something, keep moving and keep looking out for opportunities even in the messiness of reality surrounding you.
Obviously, we can’t know for certain what the post-COVID economy will look like. But we can, of course, try our best to be prepared. We can reasonably assume that the post-COVID economy will be a trying time for many people across the globe. Yet at the same time, the post-COVID growth can be a time of opportunity. Can you share a few of the opportunities that you anticipate in the post-COVID economy?
As we all adapt to a new way of life, we believe there exist many opportunities:
- Lower cost virtual business models for everything: education, medicine, business interactions, food delivery, entertainment, retail and lots more. Think Amazon, Coursera, Netflix, telemedicine and Peloton.
- Creating virtual communities and reaching “micro audiences” with targeted information and content. Think Livongo and PatientsLikeMe.
- Delivery and transportation businesses will be in even higher demand.
- In our core business, there is even more opportunity to increase patient access to medical care by optimizing how health systems use expensive, constrained resources. For example, we have developed a program that is doing extremely well to help health systems nationwide restore surgical caseloads by identifying the backlog and providing tools to accommodate the pent-up volume given each hospital’s available resources, such as rooms, staffing, beds, locations and so on. Similarly, we continue to provide infusion centers scheduling templates for our customers to use that respect social distancing guidelines yet maximize access.
Every business should be asking themselves a few questions:
- How do I make my business model more virtual; it’s cheaper and more effective in so many ways. What can I offer that is valuable and contentful and even give it away for free to build community?
- How can I add new features and capabilities to my product that make my goods and services even more valuable?
- Which of the things I was doing pre-COVID still matter? What pieces of my product roadmap should change, what projects should I accelerate, and what can I deprioritize?
How do you think the COVID pandemic might permanently change the way we behave, act or live?
The greatest challenge we foresee is establishing the trust and confidence in “how things are done.” We all know that travel may look very different when it returns as will going to movie theaters or hotels or restaurants. Our routines and apparel before, during and after any kind of team sport might be very different. Colleges and schools may look very different, and the digital component of everything might be much higher than before.
In the hospital context, the examples are in a similar vein — norms for social and virtual interaction will be built into how care is delivered:
- More telemedicine and home care. More progress has been made on these two fronts in a month than in the past decade.
- New templates and procedures on how to take care of infusion center patients — the most immunocompromised and at-risk patients — without compromising the safety of our nurses and doctors.
- Restoring elective surgical cases — the backbone of hospital revenue — without compromising patient and staff safety. Sixty percent of hospital revenues are derived from elective surgeries, and more than 80% of hospitals have actively canceled or postponed 70% of elective surgeries, so the need for comprehensive strategies is urgent.
- Reconfiguring inpatient bed units and emergency departments to care for those who need help in a timely manner.
Considering the potential challenges and opportunities in the post-COVID economy, what do you personally plan to do to rebuild and grow your business or organization in the post-COVID economy?
We have swiftly moved to adapt our product to what customers need, so in fact, our business growth has accelerated on several fronts.
We spent the first couple of weeks listening and gathering information to determine how we could help. Based on direct feedback from our customers, we have made several changes within our products. For example,
- We enhanced certain features in our operating room tools to better triage requests for surgical time for acute non-COVID cases. We created a free Elective Surgery Backlog Recovery Calculator that any hospital can use to determine how long it will require to complete the backlog of procedures postponed during the crisis. This model projects the estimated number of cases canceled and different options for increasing OR capacity in the future, like increasing prime time utilization or extending working hours.
- To help our infusion center customers create the maximum distance possible between patients, we’ve developed new templates that let them change the sequence of patient scheduling. Here too, we are predicting how long it will take to absorb the postponed infusion treatments many of our customers will need to backfill in the coming weeks.
- Similarly, we’ve been working on a capacity huddle that models the need for inpatient beds and tracks the ad hoc capacity our customers are bringing online to handle COVID-19 and other urgent inpatients. As the situation evolves in the coming weeks, we’ll keep making adjustments.
We have an awesome team at LeanTaaS, and one of the reasons we have stayed strong — and possibly even gotten stronger — is how well the team has responded and aligned around the new goals we have set.
Similarly, what would you encourage others to do?
Remember that the fundamentals of building strong businesses have not changed post-COVID, and so we plan to continue to focus on them:
- Identify the pain points your customers/market want solved and solve them better than anyone else. The faster you can identify how the specific pain points have changed post-COVID, the sooner you can modify the solution you provide. For us, this has meant focusing our team on making sure we dig deep into the changing needs of our customers and then identify the solution and resources to make changes needed.
- Question your assumptions, chalk out a path, and set/communicate new goals as needed. Particularly with all the changes in their market and with their customers, your customers will not buy the same things and not in the same way they did pre-COVID. For example, we are finding parts of our business that are less relevant due to telemedicine, and then there are other parts that have grown exponentially because the need has become even stronger. Finding a way to align our business to these changing winds has been a very high priority, communicating them clearly, and setting new goals is a must so everyone knows the what, the why and the how of the new plan.
- Don’t be afraid of the answer. If the answer is to stop certain businesses, realign resources, don’t be afraid. Change breeds opportunity even if it’s scary. For us, our culture is pretty scrappy and lets us make those changes quite fast without too much resistance.
- Don’t be penny wise. Being cost conscious is good, but cutting to the bone can hurt a business in ways that are hard to recover from. So, follow the adage: measure twice and cut once.
- Be scrappy, be resilient. Expect and plan for some customer churn and build it into your plan; we certainly have. If it doesn’t happen, it’s a pleasant surprise, and if it does, we will be prepared for it.
Above all — never, ever, give up!
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“You can’t change the direction of the wind, but you can adjust the sails to reach your destination.”
COVID-19 is not the first time life has thrown a curveball nor will it be the last. I grew up in one country and came to another very early in life. I graduated college during a recession and, like many of us, went through the period after 9/11 and 2008 wondering if the world would ever be the same. Similarly, we have seen many epidemics before, not quite as drastic in their impact as COVID-19 but potentially damaging in other ways. In every case, when the “direction of the wind” has changed, what has helped is “adjusting our sails,” i.e., thinking through “what does this mean and how can I, my team, my friends, my company and my family adjust our priorities and behavior to the changing reality?” No one finds change easy, but the sooner we accept that the world doesn’t work how we’d like it to, the easier it is to find the signal through the noise.
How can our readers further follow your work?
In two ways:
- Through our website, especially the resources page: https://leantaas.com/resources/
- By joining our user communities. For example, we have an “iQueue Learning Network” that perioperative leaders can join at www.linkedin.com/groups/13851156/.
Across both of these channels, we share what’s going on at the company as well as news and events regularly.