Centennial Sprint

100 sprints, wow!

We at Inbox Health just released our 100th product sprint to make patient billing better for medical billers, providers, and patients and what a journey it has been. A sprint is a short, time-boxed period (for us, 2-4 weeks) when a scrum team works to complete a set amount of work. Sprints are at the very heart of scrum and agile development methodologies with the focus on breaking complex projects -- like our Inbox Health Platform -- into bite-sized pieces.
Reflecting on these past 7 years, these 100 sprints of bettering patient billing tell a story along with lessons for the future.

The Sprints

Sprint 1 - The beginning. Like most cash-poor start-ups, our first office was modest, at best. We worked above a pizza restaurant in Bridgeport Connecticut in an office owned by John Ratezenberger filled with memorabilia from his days on Cheers and Toy Story. Surrounded by our yellow sticky-notes, we pushed through the first sprint with the ambitious goal to totally disrupt patient billing.  When the first season of HBO’s Silicon Valley series came out soon after we started the company, we swore the writers interviewed our first interns for source material.  Those early episodes perfectly capture the banter and caffeine fueled collaboration of the studio startup, from the high drama arguments with zany VCs all-the-way to cranking through months of work even after our cash ran out.

While no customer could yet do anything with that first sprint, it did lay the foundation for the myriad of improvements to come.

Our first 10 sprints focused exclusively on the patient consumer experience. We knew that paper bills were horrible at providing any understanding of why the patient owed and we were determined to change that. We built the foundation of an intuitive patient-centric platform that gave power to the patient. 

Sprints 25 to 50 - Rethink the process

Though our platform offered the best patient and provider payment experience at this point, it required double-entry between a legacy billing system. Double-entry, no matter how minor, could not be the backbone of our platform. Sprint 25 began a renewed focus on Practice Management system integrations to eliminate double-entry and its related human-error. WIth each new integration we could automate the full patient billing process for more billers and this continues to be a critical part of our roadmap.  

On the statement side, we were now offering a new digital billing experience to our patients with the addition of digital (i.e. sms and email) statement notifications. But just digitizing legacy processes was only half the battle. We started to rethink the traditional 30-60-90 billing cycle to deliver a more conditional, intelligent and self-learning automated model. We broke the status quo on how automated systems deliver medical bills to adapt its timing to patient and provider-specific preferences and behavior, and tailored the language and mechanisms based on what worked for each individual. Patients started to feel as if we built their billing cycle for them instead of the insurance companies. Our billers also started to realize quicker patient payments and less phone calls because patients were receiving bills they could understand through their preferred communication channel.

Sprints 50 to 100 - Iterate and optimize

The huge increase in patient use of our portal shed light on the inefficiencies in the current medical billing industry. Most billers worked across multiple practice management systems and lacked an aggregate view of their practices.  Our laser focus and earlier experience with integrations allowed us to turn these multiple practice management and EHR companies into our partners and allies, allowing us to bridge the gap between these different and disparate systems for many clients.

The latter half of our 100 sprints centered on enhancing the provider-centric view of the universe, and expanding the aggregation to medical billers who work with tens or hundreds of different doctor’s offices. Since each office can have its own billing system and complicated collection of arcane workflows, our engineering team integrated (and continues to integrate) these disparate data sources and connects them to one aggregate platform on Inbox health. Statements, SMS, email and all digital communication became centralized independently of practice management and electronic health record software.  When our clients sign up for Inbox Health, they no longer need an interconnected web of spreadsheets and human processes to work with each doctor’s back office system. Inbox Health’s team centralizes their workflow and automates it completely so they can focus on their businesses success and growth.

Lessons Learned

While I could write a book on learnings of the past eight years since we started Inbox Health, three themes stand out:

1 - Trust the agile process.

The agile software fundamentals of 2-3 week sprints and having all hands on the product has allowed us the flexibility to alter focus when required to meet our client demands. It’s been key to our success in these first 100 sprints. Though our team has grown, the lack of siloes combined with our flat engineering structure creates a feature-driven freedom where the best idea and approach to solving a problem always wins. Our team continues to grow as we double-down on our focus of bringing in top engineering and Product Management talent, but the agile process will stay as we give space to live again through smaller teams and independent cells. 

2 - Listen to the customer.

Pay close attention to the customer’s feedback about their daily workflow to make sure new features integrate into the customer’s existing infrastructure and legacy workflow.  For us, it frequently means integrating with older software that has rough edges.  Sometimes it even means branching out our logic and adding a custom condition in our billing cycle for an obscure “pay reason code” which winds up saving our customers, and us, $10k in wasted paper bills.  These are not ideas that can come from pretending to be Steve Jobs and waxing philosophically on the latest design trends; they can only be sourced directly from our customers themselves.

3 - Respect the idea of every member of the team (and pay close attention to the quieter ones).

Listening doesn’t end with the customer.  Whether it’s in the first job interview or the latest sprint plan, pay close attention to what your team says.  They’re the ones in the trenches wrestling with legacy systems and malformed X12 messages and they will be the first canary in the coal mine when a particular feature starts heading the wrong direction.  In that same vein, sometimes the work speaks for itself and listening simply means reading and learning an engineer’s personality and work ethic by reading the lines of code they write.  Many times over the years I’ve had candidates that spoke little of their accomplishments and remained detached from the social company events, but produced genius solutions to problems considered intractable by all others.

Next 100

Though we at Inbox Health have an exciting roadmap of big picture features planned through 2021 and beyond, the very nature of scrum development means you keep iterating and testing your innovations with your customer. As a result, I don’t know what the next 100 sprints look like. I do know we have a great backlog of ideas from both customers and employees that are sure to make the platform even stronger than today. I also know we have the right team that is passionate about patient billing and technology. Finally I know that the framework we created in the early days, and has sustained us for the past eight years, is the exact right one for the future.

Time for our next stand-up!