The Health Management Academy

Episode 10

How to Solve Healthcare’s Engagement Problem

Episode Description

In this episode, Michael Serbinis, Founder and CEO of League, joins Renee at The Table. Sharing from his years as an entrepreneur in the tech space, Mike gives insight on engaging customers and solving big problems and how this applies to the healthcare industry. He also shares about problems and solutions for digital health, the value of mission-oriented teams, and the value of “fear as fuel.”

About Our Guest

Michael Serbinis, Founder & CEO, League

Mike is the CEO and founder of League. Before founding League in 2014, Mike had a long and distinguished career as an entrepreneur, engineer, pioneering technologist and investor who has transformed the way people live, learn, connect and do business. Read more…


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Renee DeSilva 0:06

Welcome back to the Academy Table. I’m Renee DeSilva, CEO of The Academy and your host and we are happy to have you back with us again. Recently, I had the pleasure of speaking with Mike Serbinis, a tech entrepreneur who is the founder and CEO of League. League, if you’re not familiar, is a patient engagement platform that offers a digital front door for providers and payers. As you’ll hear, in addition to his success as an entrepreneur, Mike is an incisive thought leader on all things engagement and solving big problems. Our conversation covers a lot of ground, but there are three takeaways that I’ll leave you with. First, I appreciate how clearly Mike articulates the key problems in digital health. Patients want their healthcare experience to be as seamless as Peloton or Netflix, frictionless, intuitive platforms versus point solutions. Next, Mike shares his thoughts on the value of building mission-oriented teams. He attributes part of his success outside of healthcare to having teams of generalist problem solvers with a “failure is not an option” mantra. Lastly, I love his sentiment of “fear is fuel” as an accelerant for change. It certainly applied to Mike during his time competing with Amazon in the eReader space and applies to leaders in healthcare today facing similar external threats. So with that, let’s head to The Table.

Mike Serbinis, welcome to The Academy Table. Happy to have you here with us today.

Michael Serbinis 1:36
Great to be here with you today. Thank you.

Renee DeSilva 1:39
I want to start with this concept of healthcare engagement or really engagement overall. I think as an industry there is a recognition that healthcare is lagging other industries as to sophisticated customer engagement. From your perspective, how do you define best-in-class engagement broadly?

Michael Serbinis 2:00
So this is where I’ve spent the last 25 years — building platforms that drive engagement across a broad number of different industries, very different types of services, but all mass consumer services that have reached hundreds of millions of users in every country and every language. This insight that I had was that healthcare was more stuck in a system of record transaction model during episodes of care versus more of a system of engagement model that is continuous, 365 days a year, and follows an individual’s entire life cycle that’s completely personalized to them. I had this bet that the future of healthcare was not like my grandparent’s cable TV, it was more like Netflix, more like the services that we all use and my kids use all the time that are personalized, digital, always-on, and follow you before an episode of care and then long after. That model of continuous engagement and the shift from healthcare to, more broadly speaking, health is the mindset shift that I think the industry needs to make.

Renee DeSilva 3:24
I love that. Your insight around a system of record, which, as an industry, we’ve spent multi-millions of dollars creating. That is very different than a system of engagement that meets people where they are, that customer, or that journey. Staying on that for a second, you talk about Netflix and there are other examples there that have very curated paths based upon who’s in front of them. When you think about this consumer-centric, digital front door, what do you think about the key building blocks of architecting a strategy around that?

Michael Serbinis 3:57
What you want in very simple terms is to connect each person who walks through the door with the right, next best action, activity, program, provider, or benefit that’s right for them at that point in time. You want to be able to do that across a broad spectrum of demographics, of region, geography, accessibility, or where they are even on the healthcare continuum — from healthy to acutely or chronically ill. That type of connection, if you can achieve it, is what can drive better service, better outcomes, better economics. And so building blocks. You need a very wide mouth to the funnel, so to speak. Give people many reasons to show up and walk through that front door, not just a point solution or not just some information that they’ll come for once and not again or they’ll come for once a year. That’s not going to get you too far. You need this idea of a one-stop-shop. Bringing people to 48 or 62 or some other obscure number that is more than 3 different places to engage — it just doesn’t work. Think of the number of apps that you engage with on your phone or the number of digital content services you engage with. We can’t handle that much complexity. You need to bring it together so that when they walk through that front door, it’s straightforward where they can go next. You need to leverage data. In healthcare, we are very caught up in systems of record and getting some data in someplace, on EMR usually. That’s not enough. You need a broader spectrum of data that you can then use to infer, make recommendations, make nudges, deliver that universal health journey that is more personalized for every user so that they keep coming back throughout the year for many reasons. It just gets better and better over time. That’s what we want to get to in healthcare.

Renee DeSilva 6:11
Yeah. Let’s stay on that for a second, this episode of care model of engagement that is more than roughly two interactions a year. Do you think patients want to engage with their health more? This also may be a counterpoint which would be, in some ways, you want to try to design things in such a way where you have less decision making, more nudges as you talked about. I’d love your thoughts on, do you fundamentally think that patients have an interest in engaging with their health more?

Michael Serbinis 6:42
We are creatures of habit. We want to engage with services, content, products, brands, that give us that little dose of benefit. When it comes to healthcare, there’s so much pent-up frustration in services, products, providers, that honestly give us some benefit, but also give us a lot of cognitive dissonance about what doesn’t work, what’s not working. You see evidence in the market that if I were a healthcare CEO, I would say these are leading indicators, things like Peloton being on the homepage of many people’s mobile devices. Even people like me, while I’m interested in all things sports and fitness, I never would have thought that I’d be going to a service like that regularly, especially for activities that I think of as just more basic like going for a walk or going for a run. There’s evidence. Don’t look to the incumbents and where the market was, look to where the market is going and services like Apple and what Peloton is trying to do, new consumer-direct services like what Hims is doing. Consumers want to engage and they’re going to spend their time with the services that give them value in that engagement.

Renee DeSilva 8:13
Yeah, I think that’s right. I also think that we want and consumers and patients want to engage. We want that experience to be frictionless. We want it to be connected. We hear a lot about how with this boom and digital technology, the risk of that is that it can create greater fragmentation of care if not appropriately designed. That brings us to League. Tell us a bit more about the platform that you built.

Michael Serbinis 8:38
There’s a rapid acceleration happening in the market today in healthcare. The need for a consumer-centric digital transformation in healthcare is here. Part of that was driven and has been going on for years. There’s a secular trend and consumers wanting things more frictionless, more easy-to-access, always on. We’ve seen many point solutions which when I first came into healthcare is what I saw. I thought, “Wow, there is a sea of point solutions here that are nipping at pieces or parts of the elephant.” Certainly, COVID has helped. COVID has accelerated this trend. Beyond that, there are many new entrants where the bulk of capital has gone in the last 24 months, even in the last 6 months that are trying to change this. Organizations have been working on this problem of consumerization and digitization for some time, but they’ve got legacy systems, the challenges of budgets, finding talent, and all of a sudden you’ve got a hurry-up offense. No one has invented a time machine yet, so you can’t go back in time to start earlier. Everyone’s trying to assemble these point solutions and do either a custom build or outsource it because kicking the can down the road is no longer an option. Our view is, this is happening, it’s happening now, the consumer wants a better experience, more personalized, digital, always on. This pattern, we’ve already established that and that exists in other industries and it is here. What we know from other industries, point solutions eventually give way to platforms because the economics are better and the experience for the user is typically better. In healthcare, it’s even more needed because the surface area is massive. As Amazon or AWS is to millions of developers and Shopify is to millions of merchants, League’s platform as a service model to payers, providers, and healthcare organizations is there to help them build and rapidly transform their end customer, patient, member experience to deliver that modern, digital offering in healthcare. You don’t have to reinvent the wheel. You can just build on a platform like League and pay for what you use on a consumption basis. You can get there in a matter of months instead of years. You’re going to get to that impact that we all are looking for in healthcare.

Renee DeSilva 11:20
Yeah. What’s interesting to me and it’ll be interesting to see how this plays out across the next couple of years is what makes healthcare hard. Part of it is that I don’t think any of us if we took a blank sheet would redesign healthcare the way that it stands today. You’ve got this phenomenon of, oftentimes the consumer of the experience is not the payer of that interaction. If you take models that are more direct to consumer, it can be cleaner in terms of how the payment and the service delivery or the value is connected. I wonder if you have any thoughts on that? In a world where it’s just how we think about the right people to have these conversations with, in your recent experience, has it been more of a payer conversation in your mind that’s focused on this, given how the business model works in healthcare?

Michael Serbinis 12:11
There’s a lot to unpack there. You’re right that the complexity in healthcare has, in part, led to making this transformation a lot more challenging. Certainly, from many organizations’ perspectives, a lot more costly, making the hurdle look incredibly high. Payers, whether those are organizations like Humana, which is one of our newest partners, are focused on this digital transformation. They see that whether it’s their customer, the end member or consumer, or, in fact, the employer, they’re making decisions, purchasing decisions, based on the direction and the digital transformation of the offering that Humana and other payers are providing. In their case, they’re using our digital infrastructure, our platform, to deliver a new front door to healthcare for their group and specialty members. We will architect, configure, and implement the platform with their systems and their content. The ultimate goal is to drive that superior experience, better outcomes, better economics, and this shift from systems of record and transactions, to systems of continuous engagement. It’s happening and I see it happening across the payer landscape. I was asked this question the other day by the CFO of a well-known payer who said, “We still use fax machines over here. Not every one of your customers, your prospects are going to have all kinds of amazing investments over the last 5-to-10 years or infrastructure that you can walk in and connect to. Some of us are still using fax machines.” I found that interesting. What I’ve seen is that everyone has a very complex environment. The surface area to deliver the kind of experience we’re talking about is large; no one can do it all. Everyone needs to think with a partner or partnership mindset which for a lot of these organizations is quite different; that’s quite a shift.

Renee DeSilva 14:37
Yeah. I think it’s also terrifying that so much of healthcare still uses a fax machine and is paper-based. We’ll leave that for a later conversation. Your background is interesting. I want to switch a bit and talk about you and some of the things that you’ve done leading up to your current area of focus. You are a serial entrepreneur. You founded a cloud-based document storage company. You then launched Kobo, which was an eReader that competed with Amazon. Two questions here. On the surface, these companies are in completely different industries. Where do you draw inspiration? Next, how do you generally think about identifying opportunities?

Michael Serbinis 15:16
I grew up inspired by the space race and NASA. I wanted to build, I wanted to solve hard problems. Ultimately, I wanted to make things. I had an early experience where, I know a lot of us are watching the Olympics right now, I won the “nerd Olympics,” the International Science and Engineering Fair sponsored by the DoD. I saw it was possible to make something and solve really hard problems and deliver something that a lot of people could use. When I was in college, I got a call from the now super famous Elon Musk and his brother Kimbal who were at college with me to move down to Silicon Valley and build something that we didn’t even have a name for back then. We would think of it as a search engine today. I was like, “Yeah, that is what I want to do.” Across search and then you talked about cloud storage, ebooks, email, like bringing email from once upon a time, believe it or not, there were only a few million people using email to that first billion consumers using email was, while it sounds pretty simple, it was an incredibly hard problem. I’ve gravitated towards solving these large-scale, consumer problems. They may sound pretty simple, but they’re always incredibly complex to execute. I’ve always kind of started with the inspiration that this is possible. We can imagine the future we want and that we believe in, that should happen, assemble a team, a mission-driven team whose sole purpose in life is to go figure it out. They’re rarely experts, but they’re mission-driven. Ultimately, there’s nothing sweeter than going through one of those journeys and impacting the lives of millions or hundreds of millions of people, including those who helped you make the dream become reality. For me, that’s been the inspiration. I’ve had the pleasure, the opportunity, and the good fortune of doing it across industries. I think that’s put me in a unique position coming into healthcare. I don’t think I can say that I’m new to it anymore; it’s been over six years. Mass consumer engagement, mass consumer experiences, things that sound simple but ultimately are complex under the hood that are enabled by platforms, it’s what I’ve learned how to do. My team and I have built a practice of being excellent at that over the last 20 years.

Renee DeSilva 17:52
It’s heartening. Your email example is heartening. When I was in college, I graduated in ’97, email was not a thing. It feels slow and grinding and taxing at the moment, but when you look at it over a 10-20 year aperture, the speed at which we can transform does give us a little bit of optimism in terms of driving that next wave in healthcare in particular. Your sentiment is a good one. Can we stay on this thread for a moment on solving big problems, assembling mission-driven teams, and how, oftentimes, they may not be experts but they are problem solvers and mission-focused? Any other insights on how you think about seeding teams where you’re tasking them to do what might feel intractable at the time? What do you think about the team dynamics in that regard?

Michael Serbinis 18:44
One of the things I’ve come to learn is the importance of what we would now call a beginner’s mind. It’s the, “I’m just going to figure it out — we are going to figure it out.” We — there’s no “I” in team — we are going to figure it out. I have no sense of how hard the problem is. I don’t know what you mean by impossible, but we’re going to, from first principles, we’re gonna figure it out. What entrepreneurs do is typically borrow from lots of other places. You have this point of view that nothing is unique; someone has done this before somewhere else. You have this perspective that failure is not an option. We will figure it out from first principles. We will build a group of people, a team. Where we don’t have expertise, because often you are generalists in the beginning, it’s important to be a group of generalists and not have some blinders that would otherwise restrict you, but over time you add specialists and you add other types of lateral thinkers. Those principles of a beginner’s mind and a team-oriented approach that starts with generalists have been key ingredients. It’s cliche, but this statement of, “failure is not an option,” it’s a pretty important ingredient when you’re setting out to build something. You just have to do it. You will figure it out. Believe me, you are not unique. Someone has done a version of this before somewhere else, you just need to find it and adapt it. You find some resourceful people and usually, they can figure that out.

Renee DeSilva 20:35
I love that sentiment. Let’s talk a little bit now about your time at Kobo. For those who might not be familiar with Kobo, the ebook reader is largely recognized as the only global competitor with Amazon in the market. I guess the question goes back to “failure was not an option” and leaning into the hard, tricky stuff. What was it like going up against Amazon in one of their most established spaces?

Michael Serbinis 20:59
They were about 9 months ahead of us, probably with their much deeper pockets. We know they had been working on this well before that. This idea of building a global eReading platform, so eBooks, readers, apps, every country, every language, any book that was ever written and will be written on any device in an instant. I mean, it was another example of assembling some point solutions and moving to platforms. That platform enabled an experience which ultimately was magical. I remember that to my grandmother or my parents at the time, it was like magic that a book could just show up. It’s like, “Where did it come from? It just came from the air!” People loved that magical moment. We wanted to bring that to everybody on the planet and we wanted to start with those who were the most passionate book lovers first. Amazon was already in the market. They were cooking up the Kindle, but it was a special device and it was $500. The average book reader that reads a book a month does not have $500, did not at the time have that to spend on this new device with a keyboard. Bookstores and publishers who were in the eye of a hurricane without any significant amount of resources or tech prowess to compete needed a way. We came up with this platform that made it easier, made it affordable, and ultimately could be end-to-end. While we went to all these bookstores around the world, the big chains such as Barnes and Noble, Borders, WHSmith in the UK, ultimately, the promise of cool, new technology was not enough motivation to move and to get off the starting line. The fear that Amazon was coming was an awesome motivator. Growth, revenue, more profit, nothing motivated an executive team or a board of one of these organizations, the incumbents, quite like the fear that Amazon was coming to eat their lunch so that they would get started. That drove action. We provided them a way to leverage their assets, their brand, their buying power, the trust they had, the loyalty that they had, their know-how along with our tech platform to get on the market quickly and to not only hold on to their customers but to enrich their customer experience to grow their base. Those that got moving and got moving quickly became winners in many new ways. They learned that data gave them all kinds of new opportunities. The ones that took too long became the Borders bookstores in the history books; they didn’t make it. The learning was, David can beat Goliath or many Goliaths but you can’t do it alone. In these shifts, there’s power in platforms and power in ecosystems that come together to solve the new problem and make that shift.

Renee DeSilva 24:28
With fear as a motivator at times, which is a good segue to this notion of coming back to healthcare. I see that happening. Part of what The Academy does is we convene people in the discussion. You’ve been seeing for quite some time now the wheels turning around how some of these larger entities, whether it’s an Amazon in healthcare or many others that come to mind, there’s a definite sense for the threat that that imposes. It sounds like you would think that that could be a healthy way to drive strategy. Do I have that right?

Michael Serbinis 25:01
Absolutely. For most healthcare CEOs, there are a lot of reasons to be afraid right now — consumer satisfaction, NPS, any other measures, they’re very low. If you look at other categories in other industries, that should drive sufficient fear in and of itself. Second, big tech has shown up. Part of it is, they have to keep growing at the rate that they have promised investors. Healthcare is one of the only industries that looks big enough. From a perspective or disruption perspective, it looks ripe enough. Not all tech companies are equal here. Some are going to play enabler, some will play direct competitor, some will play indirect competitor, the wolf in sheep’s clothing that eventually is a threat. Some will definitely become that direct competitor. It’s complex. Pace is also something that I would be thinking about as one of the healthcare CEOs. The beginning of an exponential curve is pretty flat for a long time. It’s that old adage of, “In the desert, you can see your dog running away from home for days,” and then all of a sudden, there’s disruption. We’ve all become experts in these exponential curves watching COVID waves. One day it’s flat and one day it’s not. That’s where we are in healthcare. New entrants are also part of that. Capital going to those new entrants, massive amounts of capital compared to the, relatively speaking, small budgets in healthcare organizations, especially around IT. Meanwhile, you’ve got a broad surface area. It seems like you have a lot of reasons to be afraid. Yet, what I’ve learned being an entrepreneur is that’s just fuel. You have to go back to first principles, leverage the assets you have, be open-minded. All healthcare organizations have something that Amazon or Google or any one of these new entrants don’t have yet and that is trust. You can’t out-Amazon Amazon. Don’t think of a plan that requires you to build more than they are going to build with their balance sheet and their tech prowess. You’re going to fail. You have to leverage your strengths, partner where you are weak or where you don’t have strengths, and think about this as a longer duration change. It’s not going to happen in a year. You have to get moving now to make an impact as things go exponential on you.

Renee DeSilva 27:50
I agree. Providers do have trust from patients, certainly, the ones that we work with at The Academy often have brand recognition in their market. They often have, certainly not to the point that an Amazon would, but they certainly have strong balance sheets. I have been heartened by seeing this embedding in the DNA of, how do we disrupt ourselves and move this conversation forward? I would say that they’re very mission-driven and the heart of what they do is animated by the patient and they are not losing sight of that. The addressable market in healthcare, the TAM in healthcare, is people and patients and they’re tapped into that which is a big part of what will move this conversation forward. Let me ask you two wrap-up questions. The first is that you’ve been in the industry for some time now. You’re from Canada originally. What has been the biggest surprise for you on US healthcare?

Michael Serbinis 28:47
Growing up in Canada and California, two different places, two different systems, many of the same problems in healthcare. When it comes to the consumer and what they want in the future, there are equal doses of frustration and desire for change. I’ve had three big learnings. One, and this is a big learning for me about healthcare overall, is the surface area. The surface area of US healthcare is practically infinite. No one organization can solve it all or cover the breadth of that surface area. It screams for this need for a platform model. That’s one, the surface area is infinite. You cannot do this by stitching together point solutions. It’s a never-ending effort and you will not win at that effort. Two, one of my biggest learnings, frankly, over the last 25 years in tech, is that the simplest things are often the hardest to execute. That is even more true in healthcare. I remember having this conversation with Elon Musk and Peter Diamandis of the XPRIZE about, “Hey, what if we could actually make rockets reusable and they would just come back to earth after putting a satellite up there? Wouldn’t the cost of sending stuff into space just go down? It would save a lot of money and it would be less wasteful and more environmentally friendly.” Simple idea but it’s taken two decades. A simple idea in healthcare is, “It’s about the consumer, stupid.” It’s incredibly hard to make that work. That’s the second big one. The third is, wow, the amount of waste. Having worked in disrupting telecom or other elements of technology or publishing or books, I feel like I’ve seen enough large industry lack of productivity and efficiency. I’ve seen a lot of waste. Healthcare takes the cake here — investments in services, systems, processes, maintaining old ways that just don’t lead to value, that don’t lead to that value for the end consumer, the end patient. This is just a mindset problem. Doctors have been at the center with patients and care nearby. The consumer, whether or not they’re a patient today or not yet, the consumer needs to be at the center. If you start with that and their journey over time is one that you need to be a part of, that’s the key to getting out of this mindset, this very wasteful, unproductive mindset.

Renee DeSilva 31:27
I think that last one in particular, the challenge with putting consumers at the center in a highly regulated industry is that your regulators often drive a lot of that disconnect. Trying to get through that noise and getting to that route, I think is important. Your comments are all incredibly incisive. I have to ask before my final question: given your long history with being fascinated by space, would you be one of the people who would raise their hand early? Did you call Elon and ask for a ticket on his next space venture? What’s your thinking on that?

Michael Serbinis 32:00
No chance. No chance. Back to my point about complex things, they may sound simple, but they take a long time. We’re a long way away from safe space travel or low Earth orbit travel. Not for me, not right now, it’s a pass.

Renee DeSilva 32:22
I’m sure your wife and children appreciate that sentiment?

Michael Serbinis 32:25
They do.

Renee DeSilva 32:27
Now to my final question which I ask all of my guests. The inspiration for this podcast, The Academy Table was, for me and all of us, we get so much joy from being in conversation with people that we find interesting with good food in front of us. If you could curate your ideal conversation, any two people, who would you have join you at that table and why?

Michael Serbinis 32:49
I asked this question at dinner last night to a group of people. I got some spectacular answers that are nothing like the answer I’m about to give you. Everybody went for politicians and world leaders and a lot of famous people. I’m going to give you an unconventional answer. The first is the ingredient that I hope to get from the two people I would invite for dinner. The first is Maya Angelou. I had dinner with her. Honestly, it stands out in my life because of the way that her words and her warmth made me feel. I would want that again. Everyone should have that in their life. It was so enriching in ways that my limited, non-poetic set of words cannot describe. I would hope that I get that again from other people. I don’t know if that’s going to come from Tom Brady and Dave Grohl, but that’s who I’m going to give you. Tom, he’s an inspiration, the discipline, the consistency, the devotion to excellence in winning. Love him or hate him, dinner with the GOAT would be awesome. He’s a student of the game. I appreciate that. The second is Dave Grohl. I’m a music fan. I’m sure people are like, “Who is Dave Grohl?” I hope people know. He was the drummer for Nirvana and lead or frontman for the Foo Fighters and another student of the game, a musician, an incredibly creative and talented musician that I’ve just gotten to love and follow. To the point where when I started League, it was called the Everlong Project, named after a very famous song by Foo Fighters called Everlong. It had these lines, these two verses “If everything could ever feel this way forever; if everything could ever be this good again.” For me, that captured the sentiment of what it feels like to build something that changes lives and impacts so many people. You just want to do it again. Seven years in with League, it feels pretty good. There’s a lot more to do, but it feels pretty special.

Renee DeSilva 35:02
Well, I think that would be a fantastic table. I grew up in Rhode Island as an obnoxious Patriots fan from when I was a child, before they were good, before the Tom Brady era. I am for him. I think there is something to people who are committed at that level. That’s impressive. Maya Angelou, “When people show you who they are, believe them.” That is one of the mantras that I follow, which I heard directly from her. That must have been a pretty special moment. Thank you so much for sharing that.

Michael Serbinis 35:35
My pleasure.

Renee DeSilva 35:36
This has been a great conversation. Thank you for joining us and delighted to connect with you. I hope that you will come back again.

Michael Serbinis 35:43
Thank you so much. This was great.

Renee DeSilva 35:46
Thanks again for joining me at The Table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website or by subscribing on the podcast platform of your choice. If you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.