We spoke with Drew Garner, EVP of Engineering at Accolade, to dive into the cutting-edge technology responsible for enhancing the member experience. Garner discusses his leadership role in managing a global team and the innovative engineering philosophy that guides their work. He sheds light on how Accolade's technology personalizes healthcare, and his strategic vision for fostering an empowering and inclusive healthcare ecosystem through advanced digital tools.

What influenced your decision to join Accolade?

Throughout my career I have been involved in building online platforms for millions of users and hosting and building teams that cared thoughtfully about those experiences. In my previous role with travel and expense provider, Concur, we made sure that people were supported with information at their fingertips, especially under stressful situations.

I wanted to work for a company that has a deep impact and is mission-driven, like Accolade, and that I could point to every day as to the good it was doing for people. That is important to me because so much of our life is online now in the digital world, but I just wanted to have a purpose for good, so to speak, that I could leave every day knowing that the company's mission was doing good for people.

How does Accolade’s technology platform support personalized healthcare for members?

At the core of our strategy, we aim to ensure that the digital tools we deploy benefit both our members and the Care Team, facilitating meaningful interactions that allow for a deeper engagement. Central to our approach is the seamless integration of digital tools with personalized care experiences. By gaining a deep understanding of our members and their families, organizing data effectively, and pinpointing how our care team can offer optimal support, we ensure that each care requirement is addressed by the right person at the right time. This alignment of the member or care team journey with our technology expertise significantly alleviates the administrative burdens associated with digital documentation, making our systems more empowering and supportive. We must simplify through all the complexities what the next steps are for our members, empowering them to make the best decisions for themselves and their families.

With the vast reservoirs of data at our disposal – encompassing billions of data points across our platform – it's crucial to distill this information and make it accessible to foster meaningful dialogue. In the realm of personalized care, what stands out is our pioneering work in recommendation engines and the initiation of True Health Actions – population health data to help our customers identify how to best support their employees and save on costs. However, the challenge of accessibility remains at the forefront. Our goal is to ensure that our technology is universally inclusive, serving our care team and members alike, across a variety of devices to achieve universal usability.

How have your technology teams developed innovative solutions to support Accolade's Care Teams and members?

Over the last eight years, we've worked relentlessly to create a fully immersive digital experience for our users. Today, our members can consult doctors, second opinion specialists, and Care Advocates, access their data, and manage benefits and claims all through our digital platforms.

One of the most innovative solutions we've developed is our unique system designed to handle the complexity and constant changes within the benefits world. We receive over 100 million plan and program updates annually, indicating the dynamic nature of the sector. To manage this, we've constructed a modular, templated, automated system.

We've layered this system with personalized digital experiences on mobile and in our portal. Our care advocates can guide members through tailored benefit information, reducing hundreds of pages to just the essentials relevant to an individual member. This personalized approach is backed by our recommendation engine, True Health Actions, which helps deliver the right care at the right time to the right person.

Our journey over the last four years has transformed us from using a standard content management system to a fully custom, microservice API-driven, AI-enabled benefit system. This system integrates seamlessly with our claims and clinical systems, enhancing our understanding of our members and care team.

Could you share some insights into your leadership style?

My leadership style is rooted in fostering a culture of trust in making rapid changes through continuous integration and delivery. I strongly believe that this approach, combined with the emphasis on teamwork, sets us apart. I'm a big fan of delivering code to production in small, manageable portions at a swift pace. This doesn't necessarily mean that the shipped code is instantly accessible to everyone. Instead, it follows a sequence of introductions – from pilot stages to individual presentations – before we switch it on for our customers and broader audience.

The beauty of this approach lies in its simplicity. As software developers, we appreciate the process of incrementally layering value onto our products. It helps keep any apprehension about making changes to complex systems at bay. Usually, only senior team members are entrusted with altering such intricate systems. However, by shipping in simple amounts, and having systems in place that monitor both the frequency of our tests and their progression to production, we make this process more inclusive and efficient, and we seek immediate impact and feedback.

No one ships any software single-handedly at Accolade. We believe that everything is better when done in teams. All code is reviewed and must be approved by another team member, a policy deeply ingrained in our compliance procedures or sometimes, the entire team, depending on the size of the change.

You mentioned ‘everything is better when it’s done in teams,’ can you elaborate?

We firmly believe in the power of collective intelligence and the synergy of teamwork. Every employee brings their unique skills and perspectives to the table, contributing to our shared objective of delivering superior healthcare solutions.  Diverse teams with diverse viewpoints and experiences lead to a better product that is delivered faster.

Our philosophy is deeply influenced by Google's Project Aristotle – a study that underscored the importance of psychological safety as the cornerstone of highly efficient teams. This means fostering an environment where every team member can freely share their ideas without fear of criticism or judgement.

How does your team approach and manage the constant change and complexity of healthcare to ensure continuous delivery and improvement?

Change is an inherent part of our workflow. We don't merely talk about it; we actively embrace it as a crucial part of our daily operations. Our ethos, embodied in the phrase "ship every day", is more than a catchy slogan. It's a living testament to our dynamic approach, so much so you can feel the push to ship, experiment and measure change in every daily standup happening in our teams, daily.

This mantra is not just about words; it's about action. It signifies our commitment to performing thousands of releases annually across all our services. However, we don't measure our success merely in terms of quantity. For us, the true value lies in the continuous improvement that accompanies each release and in the value that our care team and members see from these improvements as we roll them out.

Building on the "ship every day" mantra, how does the philosophy of continuous improvement and innovation specifically influence the development and enhancement of Accolade's technology?

Our approach mirrors the Japanese philosophy of 'Kaizen', which emphasizes the pursuit of small, incremental enhancements. This method may not yield dramatic changes overnight, but over time, its transformative potential is profound. If you were to compare some of our interfaces from a year ago to today, you'd barely recognize them as being from the same application. However, these significant transformations aren't noticeable within a week or even a month.

Every three months, six months, nine months, and certainly after a year, you'll see a visible difference. Take Accolade’s mobile app as an example – it's a completely different beast today compared to what it was just a year ago. This evolution is a testament to our unwavering commitment to constant improvement and innovation.

Accolade engineers work from locations in several countries. How do you lead a distributed team?

Accolade's engineering and technology team, which is a global team that spans five time zones from Canada to US to Europe, operates as a unified entity despite time differences. We leverage these variations to our advantage by fostering an environment of distributed authority and empowerment. Our teams are guided by weekly goals instead of daily check-ins, enabling them to function independently while maintaining alignment with the larger organizational objectives.

One of the key principles we adhere to is that decisions should be made by the agile teams working in the same time zone, rather than waiting for approval from higher-ups. This approach not only speeds up the decision-making process but also encourages ownership and responsibility among team members. We believe in transparency, inviting others to review our code and changes in a fully open test environment, fostering trust and reducing fear of making changes.

Moreover, we take advantage of the different time zones to carry out maintenance, changes, and testing when most clients are offline, ensuring minimal disruption to our services. With over 8,000 alerts and monitors within the platform, we ensure any issues are detected and addressed promptly, often before our clients notice.

This model of leadership in distributed teams is built on trust but verified through performance. Teams own their software changes and are on-call for any issues, thereby instilling a strong sense of ownership and accountability. We believe in moving as fast as possible, but not at the expense of quality.

What steps are you taking to ensure that Accolade stays at the forefront of healthcare technology?

One of the first things I did when joining Accolade eight years ago was to move all our infrastructure into the cloud, utilizing cloud-based development labs, deployment systems, and hosting systems. Additionally, we partner with over 200 external vendors, adding their engineering and development teams to our own. These partnerships extend our workforce to thousands, even tens of thousands of engineers when including our larger providers, integrating the collective innovation of healthcare advances, not just our own.

Our aim is to concentrate on the IP specific to Accolade and combine it with best-in-class systems wherever possible. We're proactive about staying updated with forward-facing modern web frameworks and mobile frameworks, and we continuously replace older systems and services with newer, more efficient ones.

Our Trusted Partner Ecosystem network is a testament to our collaborative spirit, integral to our service delivery model. It allows us to incorporate the best features and functionalities of our partners into our offerings through API integrations and file interchanges. This approach ensures that our members receive a holistic experience, characterized by cutting-edge, comprehensive healthcare solutions.

So, whether it's using new technology from major players like Amazon and Google or from innovative start-ups like AI21 Labs or ObserveAI, we provide our developers with the tools and frameworks to use AI and machine learning to enhance our service delivery. This approach helps us put valuable data at the right person's fingertips, ensuring we deliver the maximum value.

How is Accolade continuing to lead and innovate in healthcare technology to grow and stay ahead in the industry?

I'm incredibly excited about what the future holds. We see the upcoming year as a building block, combining the lessons from our past and our unified culture. As AI systems become more prevalent, we're committed to leveraging these technologies ethically, ensuring the security and privacy of our members remain paramount, and continually striving to improve our standards.

Despite being a relatively small engineering team, our experience with large cloud-based operations enables us to deliver outputs that belie our size. While we may not be predominantly a software company, we seamlessly blend technology with solutions. Our goal is to move fast, deliver value, and keep both our members, customers, and care team at the top of mind as we strive to improve everyday healthcare experiences.

Elevate your healthcare strategy with Accolade's innovative solutions; contact us at [email protected] to discover how we can transform your organization's health outcomes.