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Getting health care right

Getting Health Care Right: A Conversation with Sarah Ahmad

Highmark Health senior vice president of innovation and transformation strategy Sarah Ahmad leads a team that is all about getting health care right. From delivering decision-shaping insights, to defining and solving problems collaboratively across multiple functions, to the highly successful VITAL program, the Enterprise Innovation team has grown in size and influence since Ahmad’s arrival in January 2017.

Before joining Highmark Health, Sarah had over 20 years of health care experience in key leadership positions at a national insurance company. She also grew up around health care. Explaining that her father, a vascular surgeon, still works every day despite being almost 80 years old, she says his inspiring example “fuels that focus on doing the right thing for the people we serve.”

Ahmad describes herself as “a health care explorer.” While emphasizing that the work of transforming health care requires staying focused on goals, delivering on expectations, and constant accountability, she also points out that transformation can’t just be “I’m going on the path, and here are the things I need to check off. It’s more about being comfortable with the path kind of winding, and going where you need to go in that moment to learn and contribute the most that you can to solving a problem.”

From Customer Service to Human-Centered Design to Highmark Health

Don Bertschman (DB): Tell us about your health care career and how you became a health care innovation leader.

Sarah Ahmad, senior vice president of innovation and transformation strategy at Highmark Health and leader of the Enterprise Innovation team

Sarah Ahmad, senior vice president of innovation and transformation strategy at Highmark Health and leader of the Enterprise Innovation team.

Sarah Ahmad (SA): My path was not a planned one. I started as a customer service rep, just out of college, taking calls from health plan members. It was the best first job I could have, because I really learned to understand the complexities that customers face.

From there I continued to explore operational roles. I built a reputation as the “fixer” — I would come into a team and fix a problem from an operational point of view. I held leadership roles in employer group account management, product development, provider relations and network development and clinical operations, all key areas within a health insurance company.

That background taught me the inner workings of the company end to end. I knew exactly how things worked, and should not work, but I also lost sight of the customer a little because I was always looking at internal, operational issues. Then I was asked to help build a new part of the company, which was the innovation team. Accepting that role was one of the best decisions of my life, because I got exposed to a new way of thinking and solving problems that wasn’t about just fixing an operational issue, but instead went very deep to learn about the needs of the people we served. That was all through the lens of human-centered design, and our team went on to create many new solutions for people living with chronic disease, particularly helping people with diabetes.

On Coming to Highmark Health

Sarah Ahmad talks about some reasons she came to Highmark Health, including its unique integrated care delivery and financing system

[View MP4]

What drew me to Highmark Health was a couple things. The first is that this is an integrated system, so you have the health system, you have the insurance entity, and then you have all of the other diversified businesses that contribute to the overall experience. Being able to come into this environment and innovate in this environment — and when I say innovate, I mean create disruptive health solutions using an innovative method, an innovative process — being able to come into this environment and create those new health solutions for the people we serve — there’s no better place to do it, because you have that whole system, that end-to-end view, those connection points, that you don’t always get in, say, a pure insurance entity.

Enterprise Innovation: Who, How and Why

DB: Could you give us a short tour of how the innovation team is structured at Highmark Health?

SA: I’ll start with this — I firmly believe that innovation is everybody’s responsibility. It’s something that we should all be doing every day in any part of the business — a culture of innovation across the enterprise rather than just one area that owns it and does it. Inspiring that culture is something I believe my team does, and should do, including through teaching and sharing the way we do innovation.

Our team is made up of several functions. One is strategic insights and partnerships, which looks out into the world to uncover competitor intelligence, market trends, and key insights, and brings that back, not just for the sake of innovation, but to help drive strategy and partnering decisions for the whole organization.

Next is the human-centered design practice — a team of experts who can go into any business unit and help solve a problem through human-centered design thinking. This is incredibly unique — very few companies have an in-house design practice.

When we solve a problem, we start with the needs of the people we are solving for, figure out what’s going on in the problem space, and then design a solution. But now you have to create it, make it happen — and that is the work of our Accelerate25 team. They focus on the solution space.

And then there is VITAL, which started as an internal test-and-learn process to test innovative new health solutions — a digital therapeutic, a medical device, an implant, an app. When VITAL started, it funded the testing of health solutions essentially to help the health plan make well informed and faster decisions about covering a solution. What we discovered is that the cost evidence, care evidence, and experience evidence VITAL provided was so valuable to the health solution companies that they would pay for it. So we’ve evolved VITAL to a commercial offering with a few different product lines: opportunity assessment, test + evidence package, and post-study evaluation and impact tracking.

Nobody else is doing what we’re doing with VITAL, and very few can, because it’s having an integrated care delivery and financing system like ours that provides the data and evidence a health solutions company needs. We just announced our first commercial business partner, Omron. We have launched a test of their new hypertension product and patients are currently being enrolled in studies.

DB: We have a couple articles on VITAL programs and we’ll do another on its evolution soon. You mentioned “the way we do innovation” — could you talk more about what that means?

SA: We use an innovation process based on the “double diamond.” The front end of the double diamond is about discovering human needs, the problem space. That’s the ethnographic research we conduct to learn about a problem and the people impacted — interviewing patients, clinicians, caregivers, anyone who may be involved. Sometimes we discover the problem is different than we thought, and it’s because we took the time to listen, learn and empathize with the people we serve as part of defining the problem space.

A diagram of the double diamond approach

A diagram of the double diamond approach.

The back end of the double diamond is the solution space — design, development and deployment, including putting a prototype of a solution in front of people to see whether it meets their needs. The prototype validates desirability, and then we move on to validate feasibility and viability.

Throughout the process, we use the human-centered design methodology to keep the person we’re solving the problem for at the center of everything we do. A key principle of human-centered design is that we solve the problem with people, rather than just for them. Research, defining the problem, creating a prototype, fully developing and testing it, all of it is with the people we’re creating a solution for, the people who will use and apply that solution in real life.

DB: Does that human-centered design mindset make the purpose or application of innovation at Highmark Health different than you might find at other places?

SA: The purpose of innovation at Highmark Health is to solve the problems of the people we serve through both incremental and disruptive innovation. Some health care companies have innovation teams that focus on identifying innovative partners or investments so they may gain a return on that investment, and there is value in that. But we’re focused on what I call a return on health. My belief is that when we focus on our customers’ needs and deliver the best support, the best care and outcomes, and the best experience, people are happier, healthier, and they thrive — that is a return on health.

Inspiring the Culture

DB: Can you talk about how innovation, and human-centered design, impact the organizational culture?

SA: I believe that inspiring a culture of creativity and working together is core to what an innovation team should do.

We’ve grown our team organically from the ground up. At the start, we took on projects that we believed would give us solid wins with regard to helping our customers and employees, but also would help the company learn what this innovation process and human-centered design method could do.

One example of what I call the “exhaust” that comes off our work was being asked to partner with Talent Management on a new leadership program, Breakthrough. My team teaches leaders in the program about human-centered design. For people who have been in operational functions, this is an opportunity to get exposure to a new way of collaborating and solving problems. What’s great is that they then take this back to their teams, this mentality of putting the customer first, and a method to solve for a customer need in addition to a business system need.

Putting the person at the center of the problem means collaborating across our enterprise and all the way across the person’s experience. So it’s inherent in the way we work that we listen, we share, and we break down silos.

Working in this way requires patience and focus. Instead of “get it done fast,” we’re making sure we do the upfront research and allow space for moments that help us see the real problem. If we do something fast and the solution ends up not being very viable or not meeting the real needs of our customers, that’s obviously not cost effective and it may also cost us the trust of our customers.

On Partnering with AHN Cancer Institute

Sarah Ahmad describes how Innovation’s human-centered design practice worked with the AHN Cancer Institute

[View MP4]

We were asked to take on some work with the AHN Cancer Institute and partner with Dr. Parda and Don McNary to figure out what to do about welcome and waiting in our new cancer facilities. It was that simple — go figure out what we need to do different to improve the experience in the welcome and waiting areas. What we learned was that welcome is almost a state of mind; it’s not just welcome when you walk in the door, it’s not just that one time that you’re welcome, it’s feeling welcome when you’re in that cancer facility, and sometimes for many hours getting a treatment. Waiting is not in a waiting room; it’s not in the traditional space we think of. It actually could be when you’re in an infusion chair and you’re waiting for your treatment to be over. We learned a lot when we did this work, to figure out that it’s not just about the front door and waiting room, it’s all over the facility. So when we went to solve for that experience, we went way beyond the waiting room and front door. We went into the area of infusion treatment, we started looking at what does that chair look like and feel like. And we actually helped AHN make some really good decisions about the experience and some of the furniture, and some of the look and feel, and some things that we never would have thought we’d touch when we went into the project. It was a great experience for everybody to realize that.

Transforming Health Care

DB: So many organizations talk about transforming the health care system — what’s special about the transformation work being done at Highmark Health?

SA: I think our focus on transforming the experience of our customers and designing a truly value-based experience is very unique, and we can do this because of our integrated care delivery and financing system. We have the assets and capabilities to truly transform the experience of the people we serve, end to end.

DB: Looking at the national health care system, where is innovation most needed?

SA: An innovative mindset and human-centered design method are most needed to design a better overall health and well-being experience. So it’s not just when you call customer service, or a care manager helps you with a chronic condition, or you pick up a prescription or go to your PCP or you just want to lose some weight — we need to connect all the touchpoints, in a seamless way, to make it an easier experience overall that is good for your health, both mental and physical. No one wants an experience that is stressful or causes more anxiety than they are already going through. They want it to be better, and we can make it better.

I grew up with a father who’s a doctor, so I knew how to navigate the health care system when I needed help. I believe we need to deliver an experience that’s as though you know somebody in health care. That’s an experience that everybody deserves, not just people with a connection.

You see concierge medicine becoming more prevalent — but not everybody can afford that. So how do we take the concierge medicine approach and make it easier to achieve through innovation or technology? That’s what we want to achieve — an experience that may be a little more digital, but it’s like someone holding your hand across your health care journey. It’s high-tech and high-touch.

DB: In an interview while you were at Humana you talked about moving from a transactional relationship with health plan members to one that’s more about health and well-being. Is part of that defining success by longer-term measures like population health?

SA: As a company, and in the industry, it’s very important to partner with communities, and learn about the needs of the community — to think of the neighborhood as a patient, and look at social determinants of health as levers that we can pull to make a difference. That’s something we have an opportunity to innovate around as well. With human-centered design, we talk about people being at the center, but it’s people in a community, so the community needs to be part of that.

There is debate throughout health care about how much to invest, and where to invest, in social determinants of health. You’ll hear skeptics say, well, is this just for financial gain or do you really care about the community? Frankly, it’s about the community, it’s about helping people and doing the right thing. But if you invest in that return on health, it will come back in lower total cost of care, and we can reinvest that savings in new health solutions that continue to benefit our customers and communities.

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A national health and wellness organization as well as the second largest integrated delivery and financing system in America, Highmark Health and our diversified portfolio of businesses employ more than 43,000 talented people who proudly serve millions of Americans in all 50 states and the District of Columbia.

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