Tonic for Health: Success Story of the Remote Team

This week we’re happy to introduce our interview with Boris Glants, CEO and Co-Founder of Tonic for Health, the leading patient data collection and payments platform among large enterprise health systems, payers and pharmaceutical companies in the USA with the development and design team located in Ukraine.

Tonic for Health aims at providing great assistance to both patients and medical staff. Why was it vital to start such a project? How did that idea come up? And how difficult that was to get the very first client?

My co-founder and I started the company 7 years ago, and, basically, I think that problem has always been there in front of us. Every time we as consumers of healthcare going to a health system we have to fill out paper forms. There is one paper form after another: so many different paper forms; and the funny part is that every time you have a new form that asks the same set of information. It doesn’t make sense. When you think of the Soviet system: that’s what I remember being sick as a child, you had that book with your illnesses but you had it at home. It was yours. It was like: “This is my medical record and I carry it with me.” So, somebody can come at home and do this or take it to the doctor when I going and they look at it.

"...the best about Tonic is that a patient can fill out the symptoms prior to the appointment, therefore, will not repeat the same information several times ..."
The American system is completely different from the actual paper- and who-owns-your-data prospective: that stays in the doctor’s office. So, if you want to know, where is the paper or what have you been sick with? You don’t know since there’s no record, right. I think just the fact that filling out the forms and checking in and doing all of that has been a very mandate process. So, when we first started working with… It actually started as a proforma project for my co-founder when he was doing some branding work for a hospital system. He asked about the work they were doing (they were collecting data of women to determine the risk of breast cancer) and realized they would have to conduct the survey every year and, literally, asking 700 questions in some papers. It was shocking but also made us think of what could better. We thought it could be done on the web, an iPad, etc. And we thought about that and decided on how to build this, and got our first customer, UCSF, a well-known medical institution. Afterward, we got one client after another, and slowly large systems started buying Tonic for their purposes. Actually, the best about Tonic is that a patient can fill out the symptoms prior to the appointment and, therefore, will not have to provide and repeat the same information several times which is very beneficial.

Tonic for Health Team

Your team is located in Ukraine. I would like to ask you how actually has this cooperation started? And how did you come up with the decision to start working with the Ukrainian developers?

So, basically, yes. We have a team, we have about a hundred people in Kyiv right now. So, we have like different ways of working with them. It’s our team, that really dedicated to us and, you know, they are working on our product. So, we’ve been doing it for about 7 years now. As to your question, how did it actually started? So, having been born in Ukraine, in the Eastern part of Ukraine (I’m from Donetsk), I was always looking for an opportunity to put your cultural knowledge to work and I remember talking to my wife. Then she told me that I was forgetting my Russian, I’m not speaking it anymore. Therefore, I needed to put it to my work life, so this was way before the current company that I’m with. I started looking around which of the countries which speak Russian or speak some Russian that I would actually like to work with. Those were Russia, Belarus, and Ukraine. And I’m like Russia and Belarus are dictatorships, therefore, no. Ukraine? - Hey, a democratic government seems to be moving Westward, etc. And they speak Russian. Great! Let’s go there, and I happen to be from there. So that was kind of a decision, so, honestly the impetus to work was actually driven by my desire to create a working life that utilizes Russian language and after I started working there I discovered that people, the town that’s there and then gets out the more business decision kind of came out because, honestly, economically it’s much more efficient way of doing things. Another important part for me has always been on how you create an environment where it’s not an outsourced type of company, so you actually involve them from the product design because of that our team is built completely there: product management is there, design is there, development is there, and everything is there. It’s not designed in America, built in Ukraine, etc. Yeah, literally, the input is in but fundamentally it is designed in Ukraine, built in Ukraine for the American audience. So that aspect has always been a very-very important part because if you think about outsourcing in general, and the economics of outsourcing if you literally just utilize people to execute, I think you’re getting a certain efficiency of capital because it’s cheaper. But, if you look at the environment that Ukraine offers and the favorable taxation system that they have for developers: they are actually given the ability to build the product. And I think the return will be more exponential because a lot of creative ideas are there. For us, it is a double win, right, because for the talent, for the folks that come to work at Tonic it’s an opportunity to create something, not just to fulfill somebody’s order. And for us, it’s an opportunity to do it in a completely different way. So, everybody wins from this kind of approach, that I think we tried to recoup. It has its challenges, especially for us, because we’re in healthcare and our team members in Ukraine were not familiar with the US healthcare. So, they travel a lot, they come over to see how it works here; how it looks like to be in an American clinic; how it looks like to be a part of a healthcare system here.

Tonic for Health Team

Since you’re working with the healthcare system the following questions will be related to the development of both business and the work processes. What was the most challenging for the product development? What challenges did the development team face?

As to the first client, we were very lucky since we had a relationship and a client had a need. The need was real and we decided to give something of value. It means you can’t be everything for everybody. Since we wanted to build a product, a scalable business, the real challenge wasn’t to learn about our first customer but to learn about the actual space and the most repeatable problems that we can solve with our product, and how do we build a scalable business around this. The technology is very easy to build, but it’s not very easy to sell. In terms of business, there should be a strategy that will help you sell the same product to thousands of people. And that was the biggest challenge for us in healthcare because a lot of their needs haven’t been discovered.

The main challenge for the team, probably, was the time zone. Picking the best time for calls was difficult. However, our senior people, mostly from the Product Management team, who are more customer-facing and need to have some deep understanding in the sphere and the required knowledge, they really have a slightly shifted schedule when they have to do much work at night as opposed to our morning. That has been a kind of side effect. But, if you’re a Product Manager or Lead Designer, and you need to talk to the client, the calls are not always going to be at a convenient time. That’s why that openness and willingness were important. The other thing was to introduce the team to the US healthcare in order to better understand and address the needs of the local people. Great initiatives from our Lead Designer helped to fill in the information gap and get the team closer to the product. Moreover, we often bring seniors to the USA and give them a chance to communicate with medical personnel and make Tonic better for patients and doctors. Since not everything still can be done from Ukraine, folks from senior positions do spend some time here. And, if you are a senior executive, and are focused on your career, this work is like having a baby: you should be available 24 hours a day. Actually, the level of responsibility is what really attracts them.

"...we give people an open field to make mistakes and learn from them; we give challenges and difficult tasks to make them stronger..."

And, finally, the biggest challenge we have had, is supporting the team remotely. I needed initiative people, since, in the beginning, they had to work for at least 6 hours on their own without getting any feedback from me. However, on the other hand, that created lots of benefits because you would give them tasks, explain it and then just you’d see the final result. People make mistakes and they also have time to analyze and correct them. And with the time, their quantity reduces from 30% of mistakes to practically no mistakes. Why I believe it’s attractive for people to work at Tonic is that we take into consideration a couple of different things. First of all, we’re looking for people who derive meaning from the work they do. We want people to love what they otherwise it won’t bring any use to the product. Therefore, we give people an open field to make mistakes and learn from them; we give challenges and difficult tasks to make them stronger. I prefer to err on developing people as opposed to overemphasize quality and to micromanage to get the best possible quality you can by moving responsibility and let the person do one’s best. They develop the best they can and they grow through the mistakes they make. I think this is the main and most important thing that bridges that distance. You see, if you want people to do a lot, you should let them do a lot. In our case, the distance allows us to do this. That forces people not to rely on my presence but drives to their own decisions. Therefore, the shared responsibility is what leads to success.

Tonic for Health Team

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