Speaker 1: Hey there, product lovers. Welcome to the Product Love Podcast, hosted by Eric Boduch, co- founder and Chief Evangelist of Pendo, and super fan of all things product. Product Love is the place for real insights into the world of crafting products, as Eric interviews founders, product leaders, venture capitalists, authors, and more. Let's dive in now with today's Product Love Podcast.
Eric Boduch: Well, welcome lovers of product. Today, I am here with the Amar Kendale, who is the past CPO of both Livongo and Teladoc. Amar, why don't you kick this off by giving us a little overview of your background?
Amar Kendale: Sure. I'm trained as an engineer but like many folks I've spent the better part of my career as a product person. My path was through moving in the marketing side of the house, beginning as a development engineer, but finding myself enjoying being in the field with customers and gradually taking on responsibilities for upstream marketing. Eventually taking on the whole marketing function. Then really gravitating towards upstream strategic marketing and then ultimately product management. That's been my windy path. My entire career has been in healthcare, starting out in the areas of drug discovery and drug development. So, the pharmaceutical industry, moving into medical devices, moving from there into wearable devices, and then finding my way ultimately to digital health. Increasingly, speedy product development cycles over the course of my career, which is something I've really enjoyed terminating most recently in the software space. Software for healthcare is really where I found myself in these most recent roles.
Eric Boduch: What drew you to product management?
Amar Kendale: Starting out as an engineer, I think a story that's probably familiar to many, I found myself really enjoying the technical problem solving, but often being very curious about why we were solving a particular business problem. As I spent more and more time with our users, I learned that there was often information lost in, what we were being asked to build and what the users were really describing as their pain points. This was certainly the case in the area of health products, in part, because there are so many users, there are so many constituents and that's really what drew me in, the opportunity, as I saw it, to consider a wider group of stakeholders than had really been considered previously, or at least in my experience and trying to get more of that firsthand connection and contact to uncover what those needs are across a variety of stakeholders whose needs may or may not have been aligned, and that made it a really interesting problem to work on.
Eric Boduch: Tell me about your experience at Livongo and tele- health. Tell me about what teams you oversaw there, how product was organized. I'm interested.
Amar Kendale: Yeah, absolutely. At Livongo Health, I had the great privilege to join that company very early and participate in really shaping the product function. Like many of these stories, I think every company's needs are different. The product function evolves differently, based on where there's strength and relative weakness in the organization, what kinds of needs we're looking to uncover. The shape of what we ended up building out at Livongo, starting in 2015 or so in this digital health space was a product management function that was very closely tied to our colleagues on the clinical side of the house. We would really aim to build our teams in a way that we were pacing the growth with typically a person coming from the healthcare space and a person coming from either the consumer or enterprise technology areas, in order to create some really important bridging of the two worlds. My org included people who came from great consumer companies, early product managers from Barnes& Noble, inaudible who worked on hardware and software, a lot of product folks coming from consumer products like Shutterfly, dealing with very high uptime and liability and great consumer experience. Then balancing that with people who are coming out of places like other digital health or health care organizations, some folks with medical backgrounds themselves who were joining my product org. This really became the DNA that we started to foster. In some sense, a little bit of a departure from traditional Silicon Valley tech pedigree. This wasn't a team that was composed of former software engineers, although we had some former software engineers. We were just as inclined to bring on former designers, former clinicians and people from the healthcare industry as well. The things that we also found to be really important were because we were really tackling a new problem space, this area of what I would describe as consumer friction points in the healthcare experience, we brought design into this product org as well. We had product management underneath the same umbrella as our design team, which I know is, in some places, a common configuration, I'd say in healthcare, less so. In healthcare, more typically, we found designed to be organized and align more closely to engineering. In our case, we brought it over to the product management side for a few reasons. One, we were indexing very heavily on user research as a way to uncover latent needs. Many times, our end users, our consumers couldn't really articulate their needs. So, we needed to have a really strong research function. Then secondly, a lot of the design patterns really needed to be developed. They didn't exist in a way that was convenient for us to pull off the shelf, because we were uncovering so many new behaviors among our healthcare consumers. That iterative experience on the early end of the design process, in very close collaboration with product management was a really critical piece of our evolution as an org at Livongo too.
Eric Boduch: Talk to me a little bit more about how you managed that matrix of product management skills? How did you balance the different types of people you just talked about? Whether they're traditional software PMs or people that were clinicians and did you divide the group up as far as, did you have a design lead or those kinds of more interspersed in your product org?
Amar Kendale: On the spectrum of project heavyweight versus functional heavyweight, I would say that we did orient more towards a functional heavyweight model in our early years. Over time, it gradually morphed into a more project heavyweight model. But in the early years, our focus was really building a common language across the functions. Our leaders would spend time together and really try to shape what is this new process? What is the new framework we want to use to start to bridge these worlds? I'll give you an example of that. One of the things we started to appreciate was the way that clinical guidelines are often written is very much a provider mindset, which is understandable, because it's, of course, often healthcare providers who are writing these guidelines. But we had an opportunity to start to translate those clinical frameworks and terminology into consumer speak. The kinds of things we found ourselves doing were establishing a common base of understanding of the literature. Our engineering leaders and our product management leaders and our design leaders would all become conversant in the clinical topic area led by our clinical counterparts. Similarly, our clinical counterparts would become conversant in the design side of things, and particularly user research. That was the place where we shared an enormous amount of those primary research learnings directly with our colleagues. What would happen is typically, in these new areas that we would work together, we'd establish a common set of data that we're all looking at together, which then allowed us to establish a common language. With that common language, then we could start to build new products and services on that shared foundation of common understanding.
Eric Boduch: Now, in the case of, well, both Livongo and Teladoc, the companies grew pretty big, but you joined Livongo when it was relatively small. How big was it when you joined, how many people?
Amar Kendale: I joined Livongo in 2014, and at that time we had just raised our series A financing. We had not yet hired our first product leads or our first engineering leads. Initially on the R& D side of the house, the product development side of the house, it was really just me and our CTO at the time. We were responsible for really building that team out. We started with a single product manager and a handful of engineering leads in order to shape those early bets that we place, in terms of product investment, and we grew it from there. It really was, pretty much nearly a blank sheet of paper when it came to the product management organization, and that side of the house.
Eric Boduch: How big was the product team at Livongo when you guys got bought?
Amar Kendale: I think we were just over 70 people when we were acquired. That was a mix of product managers, designers. Because our company covered hardware, software and services, we also had a very strong program management function, particularly focus on hardware, which was playing some product management roles as part of their mandate. But altogether about 70 folks. Then when we combined forces with Teladoc, that brought us to well over 100. It was quite a large org and covering a really wide array of products and services.
Eric Boduch: Now, obviously the business and the product management organization changed a ton from when you first got into Livongo till, being CPO of the combined entity at Teladoc, right? Talk me through some of the major stages there and the challenges you had?
Amar Kendale: That's a great question. The kinds of challenges we encountered, we had the familiar class of challenges that come from hyper- growth. Our user base was growing. As a B2B2C business, we had two large stakeholder groups to service. We had an enterprise client that we service, and we had an end user that we serviced. The common issues that come up for a B2B2C service, we encountered all of those issues, plus the fact that we were going through hyper- growth. I'd say those were probably a familiar class of challenges that we encountered as we were growing. The other class of challenges that we encountered, I'd say, were specific to us as a healthcare company, in that we had a few other, what I would say, contributors to our ecosystem. Stakeholders, in the sense that they had a lot of influence over what we were building and how we were bringing it to market. What that meant was, whether that was distribution partners or whether that was influencers over the buying decision, and it meant that our product org needed to build empathy with those other groups as well, not because they were going to be touching the product in the traditional sense, but because they were going to be influencing its outcomes. It did create, for a more complex substrate, more complex set of stakeholders that we really need to understand very deeply, in order to do our work as product developers. I'd say that's something that is pretty unique to healthcare, in that there are so many folks around the table who have an influence over what happens in making healthcare decisions and delivering services.
Eric Boduch: Tell me a little bit more about the healthcare technology industry. It's an industry with a ton of stakeholders and you're someone who's looking to disrupt the industry, innovate. Talk to me about the balance in working in an industry like that with stakeholders that vary, you talked about from patients to providers, to internal board members, what was difficult?
Amar Kendale: What makes healthcare challenging is that there are often misaligned incentives among the participants in a given problem space or ecosystem. Moreover, in many cases, those misaligned incentives are also hidden. I'll give you an example. One facet of what we encountered was that our end users, we call them members at Livongo, they're members in our program. They chose to participate in our service. They were living a life typically in the management of their chronic conditions, in which their goals were to spend as little time as possible, having to deal with these chronic conditions. It's not fun. The right metrics are not engagement, it's actually, how do I do as little as possible to get the best possible outcome? I want to spend as little time on my health and spend more of my time living my life. You can think about that as being the incentive for the consumer, the member, is really what they want to do is get the best possible clinical results that feel the best. Feel the best, have to go to the doctor the least, just have the best health, with as little investment of time, money, effort, worry as possible. The motivation in the traditional healthcare system for a provider of healthcare services, in most cases is to deliver as much service as possible. Most providers, healthcare providers still get paid on the basis of how much service they do, or whether it's an appointment, whether you come into the emergency room. This is a great example of where incentives are pretty dramatically misaligned. As a healthcare provider, I don't have very clear financial incentives to do a lot to prevent you from coming in for a visit. Whereas the member, as a person, a patient, you have every incentive to stay out of the healthcare system proper. That's just one facet, and there's many of these. It has nothing to do with weather alignment of... I'd say moral alignment is there. Physicians are, in my experience, always in it for delivering the best results for patients, but the hidden aspect of this is that their financial incentives are different. Those are the kinds of, I'd say, a rat's nest that you need to really be uncovered and explore in order to figure out how do you construct the incentives so that they align more in order to get good results?
Eric Boduch: That seems like it's still an ongoing challenge and it feels like maybe it always will be in health.
Amar Kendale: I'd say it's an ongoing challenge, but there've been some really positive developments over the course of the past decade. I'll point out a few. One is that we are accelerating our progress towards a world in which providers are being compensated for good clinical results. This is a journey, we're not all the way there yet, but in many cases now, we're encountering providers who will see financial upside, if they're able to manage or control the total cost of care. Limit how much a person ends up coming in for those hospitalizations and emergency room visits. Those emerging models, started with the Affordable Care Act, they're continuing to unfold through this past administration, as well as in this current administration. I'd say there's consistency there, in terms of everyone recognizes that the healthcare system is broken from a financial perspective and needs to be fixed, and that this shift towards value is going to be a big part of how that happens. We are starting to see some really great progress. It does take some injection of energy in order to foster these models. An example that we were able to put into motion at Livongo was, we spent a lot of time with sharp focus on the experience and outcomes for our member and the experience and outcomes for the payer. That entity who was financially on the hook, liable for those healthcare expenditures, and it turns out that there's actually really great alignment between those two entities, and the member once again, spends as little as possible on healthcare and have the best healthcare outcomes possible. It turns out the payer wants the same thing because that's going to keep their costs the lowest. As long as we have those guardrails that make sure that whatever we do for our member is virtuous, we're not withholding care, we're delivering better preventative care, we're keeping people out of those high cost situations, but we're doing it in a way that's also maintaining clinical quality. As long as we do that, we can align the incentives between these two participants in the ecosystem. I'd say, of everything we did, that's probably what I'm most proud of, learning how to figure out, because it really has now broken open a new type of business model for the industry in our space, in the area of chronic condition management, that's demonstrating great results for members, because they are getting healthier with the help of technology and for payers, because they're seeing a hard dollar savings, they're seeing a year- on- year return on their investment in a way that's very measurable. That makes it easy to continue to invest, which is really what I think is going to create momentum in these sorts of models.
Eric Boduch: Yeah, that's interesting. There's always those challenges about provider payer and then the person, I guess, for one to have entered the patient. It sounds like a little bit of the provider dissonance is still there. Having the payer and the patient aligned, it can offset some of that. Is that accurate?
Amar Kendale: Yeah, that's extremely accurate. There's a number of different solutions for how to bring the provider along and make sure they're also benefiting and succeeding. One is, as I noted, to align the financial incentives of the provider with those of the payer and the member. That's starting to show up in some new models for what are termed, ACOs, Accountable Care Organizations have been growing in their stature. Medicare advantage is a type of health plan structure where there's financial incentives for more of the participants in the ecosystem to deliver value- based care. We are starting to see these things starting to happen, but yes, fundamentally it's exactly, as you noted, bringing the provider into alignment with these models that are really driving those clinical outcomes, which will in turn drive cost savings. That's really how things are going to succeed. In some cases it means turning over rocks, because this is an industry where there are some very comfortable places where there's a lot of profits being generated in ways that aren't as transparent as they really will ultimately need to be.
Eric Boduch: Yeah. We definitely see that. You have any tips for the startup CPOs out there that are building product in the healthcare space in particular?
Amar Kendale: I do, and I'd say, it comes in two different categories. There's the advice that I offer to the product executive who has come into healthcare from outside, and then there's a different set of advice I'd share with the product executive who's from healthcare, who's trying to innovate in this current paradigm.
Eric Boduch: I'd love to hear both.
Amar Kendale: For the latter, the healthcare innovator, product person who's been in healthcare for some time and has probably been very focused on the enterprise side of the equation. That's been the pedigree of where many healthcare technologists have come up. They've serviced payers, maybe they've service providers. The thing that I'd encourage those product folks to do is index very heavily on the tool kits that are used in the consumer space for really interrogating user needs. To me, I can't say enough about the value of primary user research when it comes to decoding healthcare behaviors. There's almost no shortcuts, is what I've really come to appreciate. It's a dramatically under studied area. How we make our health decisions, how we take on health behaviors, the myriad influencers of the things that ultimately dictate lifestyle choices, which then translate into health care activities and outcomes. Those are things that, in some cases they're taboo, they're topics that people just don't like talking about. In some cases, they're hidden, and we don't know how to explain what we're doing when it comes to our health. In some cases they're just highly variable. There's not enough commonality you can find in patterns. The ability to do efficient, primary research with consumers early and often to me, is something that I strongly encourage, and it's something that I'd say is still emerging as a tools of the trade for most healthcare product folks who do a great job of customer discovery with their enterprise client, but don't necessarily have the toolkit when it comes to consumer data and how they can use consumer data to make better design decisions. For the person coming in from outside of healthcare, it's funny because my advice in some ways is almost the opposite or somewhat counterintuitive, which is to say, forget everything you thought you knew about consumers and otherwise. What I recommend is taking a first principles approach, as opposed to trying to leverage existing design patterns. Because what I've often seen is there's false positives that get found when it comes to healthcare problems. An executive might come in, having built really great products for engagement, let's just say, in a different industry and observes a pattern and perhaps jumps to a conclusion, to put it somewhat critically, jumps to a conclusion that this is a familiar pattern. It's one they've seen before. Therefore, a known toolkit can be deployed and some expected results should show up. I think there, the caution I'd offer is that because of these issues of misaligned incentives, those things that seem superficially similar or identical, perhaps to a pattern that's been seen somewhere else, there's another layer to unpack, and it really requires getting back to the basics and understanding, why is that consumer making that decision? What are the factors? Because there's likely to be a number of latent factors that are hidden. I think that is, to me, one of the really big challenges and opportunities for people who are coming in from outside the industry is, one of the product superpowers is the shorthand of using familiar design patterns, but it can really be a liability when it comes to this problem space.
Eric Boduch: Yeah. I think that's always a challenge is just patterns that have worked before suddenly stop working and people need to identify and understand that. As much as we want to move them from industry to industry, there often are challenges between the different industries and moving them. One of the challenges I think for great product leaders is just knowing when their patterns no longer apply and being able to make that transition.
Amar Kendale: Yeah, that's right. I think it requires a degree of humility, that takes some practice to develop. Because so often... The healthcare technology industry is really young. Frankly, there aren't a lot of people in it right now who have been in it for a long time. It's a nascent industry in many ways when it comes to the technology practice and the product practice. We need to bring people in from outside. We need to welcome them into this space and make them successful. But it does mean that in some ways, these folks need to take a couple of steps back in what they think they might know. That requires a degree of self- awareness and humility that takes some practice.
Eric Boduch: Take me back a little bit to the early days of Livongo, let's talk a little bit about product market fit and that vague concept. What was your experience with that? Did you have it when you first got there? How did you go about strengthening or establishing it?
Amar Kendale: Sure. When Livongo got started back in 2014, the hypothesis was this, that the area of chronic conditions broadly and diabetes more specifically, was an area where consumers were really struggling, trying to figure out how to navigate these complex decisions on their own. The crux of the hypothesis was if we could support these individuals, if we could make them more successful at making those countless micro decisions that they make. What to eat for lunch, should I exercise today and how much? Do I have time to run to the pharmacy to pick up my prescription? That those decisions were going to ladder up into a meaningful contribution to help outcomes. That was really the hypothesis. In order to validate it, we did something called Hassle mapping. This was ethnography lite. We watched our, potential users living their daily lives, we ask them to journal. We did some in- homes and we tried to get a handle on really, what were they actually doing? Not what they're telling us that they were doing in managing their health, what were they actually doing? The reality we found was, people were just spending a few minutes a day trying to do the minimum. But part of the reason they were doing only the minimum was, they were getting almost no feedback. They were getting almost no reward for those efforts that they were putting in. V1 of Livongo was really based on this idea that there was a category of hassles that we could solve simply by giving people more feedback, by giving them some context and insight into, in the case of diabetes, what do those blood sugar numbers mean, and what kind of actions could they take to get a better result? That hypothesis, it ended up translating ultimately into a design concept that we started to call return on invested time. The idea was, unlike a lot of things you do in your consumer life, where in a sense it's unlimited amount of time, to watch YouTube videos, for example, or hang out on Facebook it's the opposite. In this case, you have finite time, maybe five minutes a day, and the question is now, how much impact can we get out of those five minutes that you're spending on your health? How do we figure out what one thing to ask you is the right thing to ask you, that one, you're likely to take up and two is likely to move your numbers in the right direction? That was really the way we ended up defining the problem in the first version of our product, and we ended up solving it with a combination of hardware technology. We introduced a connected blood glucose monitor, a device that measures your blood sugar with clinical accuracy, but also relays that data to the cloud, and then gives us an opportunity to apply software technology, to interpret your numbers. We have now, the number you just gave us, plus history, plus what we know about people like you. So, we can give you some advice in the moment with the hope that that's going to improve your numbers. Then where things get really interesting is because we're making these round trips, we can also measure whether that advice worked or not, because we're going to keep looking at your numbers over time, and we're going to measure whether that bit of advice that says, we noticed that your numbers are running a bit high, why don't you take a walk after lunch? We can interrogate whether a question like that was actually improving people's outcomes or not. Then the final piece I'd add is because our ambition here was to do something fairly smart, fairly sophisticated, we knew that we weren't going to get there right out the gate. So, we made sure we had humans in the loop. We bootstrapped the more complex device that we knew we need to be able to offer with the help of our own team of certified diabetes educator. People extremely skilled at giving coaching and advice to people with diabetes in the moment. Very personalized, high- impact, clinically sound advice. All of that really rolled together into our V1. What gave us confidence that we were on the right track was that when we combine these components; the connected hardware, the software- driven feedback, and then the humans in the loop, we saw what we hoped to see in the first six to 12 months of our life, which was people were going to the emergency room less, and were going to see the primary care doctor less, for unnecessary visits, where they didn't need to, the numbers were looking fine, and they felt more confident in their own ability, they felt more empowered to manage their diabetes. We were doing this in a model in which they were really able to take control themselves, empowered with information to make these micro changes that laddered up to something clinically meaningful that was going to ultimately allow us to demonstrate cost savings. But in those early years, to answer your product market fit question, we were very happy to see the clinical results coming in, and that's really what gave us confidence we were on the right track.
Eric Boduch: I was going to ask you a question too about metrics, but it seems like you answered some of that, but maybe you can dig into a little more, where those numbers, and those answers, those things you were just talking about, that data, was that the metrics you ran your business by?
Amar Kendale: They were, yes. I think about them, very much as nested metrics. We had the very fast feedback that we could collect from our member directly, and that was in the form of this really high value clinical measure of blood glucose. Clinically important and expensive in the sense that a person's literally contributing a drop of blood every time that we get this data. It's extremely precious, very valuable, and clinically important. We could act on it, we could make a clinical judgment against guidelines, based on what we saw coming back. Other fast feedback loops we could build around our member were the advice, the kind of advice we could give and then the effectiveness of that advice. We could measure that as well. Those are what I would describe as the things that were really proximal to our member, and we could use those to make very rapid changes and evolution in our product. As you might imagine, this is something that you don't come across often in healthcare, where, in a sense, the kinetics, the dynamics of the condition itself lend themselves to consumer- oriented interaction and feedback, advice that you can take, and I can see if you like it or not on the order of days, as opposed to weeks or months. That was something really powerful. The other feedback loops that became really important for running our business, certainly clinical outcomes, really critical. One, because we knew we had to do the same or better as the standard of care. Our goal was to do significantly better, and we need to be able to measure that as firsthand as possible. That was both to ensure that we were delivering quality clinical experiences and services that were in keeping with what was needed from a health improvement perspective, but also because that would be the leading indicator of cost savings. As you might imagine now, the clinical feedback loop, now, we're talking about this is happening on the order of months. That's really the timeframe over which you see clinical improvement, and then cost savings is something that you can really start to pick up that happens over the course of quarters or even years. That's the outermost feedback loop in our system for dragging the business was, are we saving our clients, the payers in this case, or are we saving money, because we're reducing their total cost of care? After about 18 months of doing what we were doing, we were able to see that signal. That really allowed us to open up, in a sense, an entirely new category of customer, the mass market customer, not the early adopter, but the mass market customer who really needed to be convinced with data, that they were going to save money when they chose to work with us.
Eric Boduch: How did your metrics change, or did they change over time? Was it just a transition from those early indicators to the later indicators or did it change as the company grew?
Amar Kendale: That's a really great question. They did evolve, but they never really changed, in the sense that we never lost sight or reduced the importance of these metrics. These, even now, continue to be the core metrics for driving the business. What did change was the scope, and that was because, I alluded to the fact that we started with diabetes, but as we started to do more work in diabetes, we really came to appreciate a couple of things. One, our members, who were living with diabetes, very typically had another chronic condition that they were also living with. This other product condition or conditions were confounders. They made it harder for that person to manage their diabetes. Those could be things like high blood pressure or high cholesterol or in some cases it could be a mental health need. The coexistence of those factors, the co- morbidity of those factors was a real challenge. It really complicated things for our users. So, we had to figure out how to do something about that. That increased the scope of the metrics we needed to capture, because if we wanted to drive the best possible results for diabetes, it turned out, we needed to do a really good job of managing blood pressure as well. The product suite started to expand. We added monitoring technology for blood pressure, with a connected blood pressure monitor. We did the same for managing weight. We had the same for ultimately adding mental health support as well. Those metrics got added. They were all laddering up to the same downstream business metric, which was total cost of care. But those intermediate steps, we needed some faster feedback loops around each of these conditions, separately, so we could manage them independently, individually. We needed some faster moving clinical markers, so we can make sure that those clinical feedback loops were also being closed. Those tended to be more condition- oriented, condition specific. Then ultimately, those laddered up to the total cost of things we were looking for. That was really how the evolution happened for us. I think it's powerful, because it really represents, in many ways the reality of who we are as people. We're not defined by a single condition, that's not how we as people think about our own health, we don't really break it out as this is my diabetes task, and this is my blood pressure tasks. We just say, here's a bunch of things I need to do for my health. Often, we're looking for help in order to answer the question of which one will work, because I reflect back to my earlier comment about the five minutes a day. I think that what we found was it wasn't exactly that number, but the general premise that you have a finite amount of time that you can ask a person to spend, it holds whether that person has one chronic condition or five. Unfortunately, it's still only five minutes that you get of their time. How do you make that the most valuable five minutes it can be, across the entirety of what a person is dealing with in their health?
Eric Boduch: Interesting. I feel like we're at, I don't want to say a Renaissance, but there's a ton of tech being thrown at the healthcare marketplace these days, a lot of startups. What do you think about that? What do you think about what seems like this avalanche of new tech companies going after healthcare opportunities?
Amar Kendale: To me, it's very exciting. I mentioned this earlier that the influx of talent into our industry to me is something I'm extremely excited about, especially as a person who's been in this space for my whole career, it's one of those things where, I feel like I was early to the party and now everyone else has shown up. It's really a lot of fun. What I would say is, there is a lot of capital flowing into the space, and in a sense, it starts there, the capital's flowing in because there's been some great outcomes from a company building and creation enterprise value perspective. With those proof points, understandably, we have a lot of capital flowing into the space. Having seen a few of these business cycles before, the investment gets distributed a couple of different ways. You have your application- oriented companies, and then you have your infrastructure- oriented companies. The industry is now big enough to support infrastructure companies in a way that it wasn't even just a decade ago. These are the picks and shovels, folks, who are building tools that are specific to healthcare, but can be platformed across a number of different healthcare application areas. What I'm hopeful of, is that those companies are really able to deliver and get to critical mass, because they certainly have a large customer base that's now available to them, if companies are trying to build applications in our area. I see that as being something very exciting. At the same time, the flip side of that coin, is that if that market ends up staying very fragmented, then we may not see enough cohesion to see what that next generation of platforms is really going to be, that's going to speed up development. But I'm optimistic. I'm optimistic that in a sense, it's almost like as long as these infrastructure companies do a good job of problem definition, which means getting to first principles and making sure they're solving the right part of the problem, I think they're bound to build technology that's going to be reusable and scalable and called upon often by new application developers. As long as those application developers are similarly picking good problems and understanding them well enough, then I think that ecosystem can flourish as well. I think we will encounter, more than anything, a talent shortage. I think this is probably the thing that we're all really gearing up for in this next wave is, where are the great leaders going to come from, and how do we make sure they're successful on the product side? What kind of support are they going to need to be successful, when so often, they'll be coming from outside the industry and you have another cohort of folks who've been in the industry for a few years, who are now really accelerating in their own careers as product leaders, because of these lessons that they've learned that were pretty rare, and precious. I like to think that the product managers that we developed at Livongo and that we're developing at Teladoc are in this rare breed of folks who've been able to accumulate some really valuable experience. That's somewhat uncommon. Four, five, six, seven years of experience in our space, isn't that common. But I'm eager to see how that talent gets deployed across our industry, because it is probably, in my mind, the rate limiting factor in terms of what comes out.
Eric Boduch: Now, is there one market that you're like, I would love to start a company there or go after that market. There's a huge opportunity here today. Is there something in particular that excites you, maybe something people are already working on or should be?
Amar Kendale: I love that as a question. I find myself getting excited about a lot of big problem areas in healthcare, which, I feel bad saying it, but healthcare is full of problems and they need a lot more attention. I would say that, what I alluded earlier about value- based care and aligning incentives across the ecosystem, that to me, is something that's really critical. It is something that, you can build a business in healthcare without focusing on value. There are plenty of businesses that succeed and flourish on the basis of fee for service, utilization- based payment models. But I believe that in this industry, that the way for us to succeed as an industry is to build for the long- term. It's not for the quick flips, it's to build for sustainability. The way that healthcare as an entire market is sustainable is we have to take out waste. The fraction of GDP that gets spent on healthcare is unsustainable for our nation, which means-
Eric Boduch: What should it be?
Amar Kendale: Well, I think you look at any other developed nation, we're a factor of 1.5X to 2X with the next developed nations are, with no better outcomes. This is the key thing. As taxpayers, we're getting a terrible deal, we're overpaying for a service that's no better. Pick any developed country and look at the cost of healthcare, as a proportion of GDP, it's 10%, 15%, 20% of GDP, whereas we're in the 30s. It's outrageous to think about. But the reason it's such a problem is not because we shouldn't spend money on health care it's because those dollars could be spent in any number of other ways. They could be invested in any number of other industries where there's real value to create for us as a country. I look at it from the macro lens, we need to move towards sustainability, and I look at the way to move towards sustainability is to move towards value, is to strip out a lot of the waste that comes from misalignment.
Eric Boduch: Yeah. I'd like to think we could do it better than other nations too.
Amar Kendale: We do.
Eric Boduch: The competitive influence-
Amar Kendale: The kind of innovation profile we have, we're certainly capable. This is one too, where I really feel like we control all the levers. As a country, we control all the levels. This is all, we're the source of innovation, and we're the source of the waste, we're the cause of the waste, it is all internal to us. That helps, in a sense, it's the closest thing that we can fix.
Eric Boduch: What's your favorite product?
Amar Kendale: My favorite product, I've become increasingly partial to products that solve the interfaces across the complexity of multi- mode. My Peloton is a product I love dearly, and I love the way that it takes the multi- domain aspects of hardware and software, of course, on the software side, moving all the way up the stack into entertainment and the leading edge of engagement when it comes to health activities. It's a product I absolutely adore, not because I like riding bikes, but because it gives me a reason to keep up my own routine. What I find to be so effective about the product is, such a wide variety of users they've been able to really tune into something very fundamental as to what motivates people to get on bike. Another product in a similar vein that I'm madly in love with is the Sonos system. For similar reasons, crossing this really hard chasm of very sophisticated hardware, very low level software, and very great application experience, including some really complex integrations. In many ways, those have been my models. I actually think about, in some ways, the audio ecosystem, the entertainment ecosystem, it has a lot of parallels to the healthcare ecosystem, when it comes to its complexity of the constituent parts. Thankfully, there's a little bit more clarity when it comes to incentives, but those are two companies and two products and two product teams who I'm a huge fan of.
Eric Boduch: Awesome I'm fans of those two products myself. I have them both. One final question for you today, three words to describe yourself.
Amar Kendale: Number one, I'd say, curious, and I find myself just infatuated with looking at new problems. That's something that I'm really enjoying doing right now in this moment in healthcare, as you noted, a really Renaissance period in healthcare, which is a great time to be curious where there's a lot of information out there to learn from. The second, I'd say, is discerning. There was a time when I would have just gone all the way to critical and said I'm critical, which, I can be at times, but I think I've now tried to balance my criticality with some more suspension of judgment, which is something that I've learned over the years as a product leader, which ultimately I think has made me discerning, and I'm particular now about what I'm looking for in a product or what I'm looking for in performance. Then the third word is compassionate. I'd say that I've really learned to become a compassionate product person at Livongo. I've always tried to develop empathy with my end user or my stakeholder, but Livongo was the first opportunity I had to really get deeply connected with the challenges that our members are facing, at a level that I could never have imagined. It was everything from colleagues of mine who were living with some of these chronic conditions to the direct interaction I had with our members on a routine basis, to my own experience in using the products, to seeing my parents using the products. I think, it's given me a lens into the fact that the work we're doing, especially in healthcare is deep work, and in order to do it well, it requires a degree of compassion and empathy that you don't need in a lot of other industries, but you absolutely need in healthcare to do really great work.
Eric Boduch: Awesome. Well, thank you. Thank you, Amar, this has been a blast.
Amar Kendale: It has. Thank you for the questions. It's been a lot of fun.