November 18, 2020

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November 18, 2020: RxRevu is an integrated Real-Time Prescription Benefit solution. CEO Carm Huntress joins us for a conversation around transparency at the point of care. Three components come into play when making prescribing decisions, value-based care, consumer-driven care and the regulatory environment. How can we choose the path of least resistance to picking the most effective medication at the lowest cost? We have come a long way but are we only at the second inning for how this needs to work? We know the data helps make informed decisions but the final piece to the puzzle is measurement. How can providers use the data to change behavior? And what value is that providing to the provider, the patient and the payer?

Key Points:

  • Helping providers make the most cost-effective decision for every patient [00:01:55] 
  • Data now is patient-specific, cost specific and it’s in real-time [00:08:20] 
  • Finding alternative meds without prior-authorization means 50 minutes of cost savings per provider per script [00:15:20]
  • For every prescription switch we get, we’re seeing an average saving of $225 per fill [00:15:50] 
  • We tend to rush to consumer driven experiences [00:26:50] 
  • The pharmaceutical value chain is incredibly complex. There’s wholesalers, PBMs, providers, payers, retail pharmacies, specialty pharmacies, Medicare, Medicaid and commercial. [00:27:15] 
  • https://rxrevu.com

Medication Price Transparency at the Point of Care with RXRevu

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Medication Price Transparency at the Point of Care with Carm Huntress of RXRevu

Episode 330: Transcript – November 18, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT. Today we have a great conversation about transparency at the point of care and specifically around medication pricing. And we’re going to do that with the CEO of Arch Review Carm Huntress. Fantastic conversation. Fantastic solution. Looking forward to sharing it with you.

[00:00:21] My name is Bill Russell, former healthcare CIO, CEO, coach consultant, and creator of this week in health IT a set of podcast videos and collaboration events dedicated to [00:00:30] developing the next generation of health leaders. I want to thank Sirius healthcare for supporting our mission and the mission of the show to develop the next generation of health leaders. It is a mission that they share and, we really appreciate their support this year that has enabled us to, grow the number of services that we do for the community. we really want to thank Sirius for their support as well as our channel sponsors who have been fantastic this year. And we really appreciate them and all the support that they’ve given us this year [00:01:00] as well. Now, onto the show. 

[00:01:02] All right, today I’m joined by Carm Huntress, the CEO for RX review and I’m looking forward to this episode. I’ve been, transparency is something we talk about a lot on this show. We talk about the value and the power of transparency. And so today’s episode really is about bringing transparency to healthcare decisions. Carm. Welcome. Welcome to the show. 

[00:01:23] Carm Huntress: [00:01:23] Thank you so much for having me. It’s great to be here. 

[00:01:26] Bill Russell: [00:01:26] This is such a huge topic and you guys are, you guys are doing a lot [00:01:30] of stuff in this space. Let’s just start with, tell us a little bit about RXReview and what you guys are doing. 

[00:01:38] Carm Huntress: [00:01:38] Yeah, well, our has been around for a believer not almost eight years now and we’re really focused on cost transparency particular in and around drug cost transparency. So bringing that data to the point of care, and really helping providers make the most cost-effective [00:02:00] decision for every patient, when they’re prescribing and the way we do that, as we work with most of the national payers and PBMs and do real-time transactions to, when a provider is prescribing a drug, look at what the patient’s preferred pharmacy cost is, lower cost alternatives, and as well as drugs that maybe don’t have a prior authorization on them. And we get all that data from our payer and PBM partners. [00:02:30] And then we bring that to the point of care. So providers to make the most informed decision when they’re prescribing a new drug for a patient. 

[00:02:38] Bill Russell: [00:02:38] So there, so the provider’s actually looking at what the patient is going to pay for the drug, essentially. 

[00:02:46] Carm Huntress: [00:02:46] Yep, absolutely. It’s a simple way of thinking about, it’s like the patient standing at their pharmacy counter about to pay for the drug, but we’re showing that information to the provider at the point of care. And so they know down to the cent, this is at my [00:03:00] CVS or Walgreens or whatever, retail pharmacy, they use. this is what I’m going to pay today. And then also provide the provider. Hey, there may be some lower cost alternatives. if the drug has a prior authorization, there may be an opportunity to avoid that and look at a, preferred drug by the payer  that doesn’t have a prior off and then, maybe a mail order pharmacy is more cost effective and so we’ll show those options. So yeah, this is all about really addressing, [00:03:30] the need for providers to prescribe more cost effectively, costs, drug costs for patients is become a huge national issue, especially as we’ve become much more consumer. centric in terms of who’s paying, for the cost of their care.

[00:03:48] And, we’ve really been, focused on getting this information to the point of care in this moment of shared decision-making. So the provider and the patient can really have a rack. National discussion [00:04:00] about, can you afford it? Here’s some options. Let’s get you on the right drug. And we’re, we’re beginning to see some really fantastic results as, as we’ve scaled up, this data at the point of care.

[00:04:11] Bill Russell: [00:04:11] So scale is really important here, right? So you need, you need to be connected to all those pharmacies, all the PBM. You need to have the data on that side. And then the, and then essentially the network of fact, having the more, the more providers you work with, the more information you get and the more valuable the tool becomes. How widespread are [00:04:30] you guys at this point? 

[00:04:31] Carm Huntress: [00:04:31] Yeah, we’ve been lucky to really experience some immense growth over the last, probably two years. On the payer and PBM side, we work with  the brand names that you would know United healthcare, Optum, Humana express scripts, prime therapeutics, to name a few in terms of our payer and PBM partners covering, approaching about 200 million lives now in terms of, data, coverage, [00:05:00] for those members and those plans to bring this data to the point of care. And then we’ve worked closely with Epic Cerner and, most recently Athena health now is in our network to bring this data to the HRS. At the point of prescribing.

[00:05:14] So the providers have it, when they prescribe for a patient that network has grown, a year, a year and a half ago. Now we were at a few thousand doctors. We with Athena will be over 200,000 doctors in our network. [00:05:30] and so we’re scaling extremely fast right now. There is an immense need in the market for this data.

[00:05:36] And we’re really happy with the progress we’ve made in terms of building this network. I think the one other thing I’d say that’s been really great is that we do work with some of the premier health systems in the United States. So I think about, Providence and UPMC and Cedar, Sinai OSF, UC health here in Colorado. We’ve got some great premier customers, that are partners of us, and we work very [00:06:00] closely together to really create the best provider experience possible. 

[00:06:03] Bill Russell: [00:06:03] Yeah, there’s the optimist in me wants you to answer this question by the consumerization of healthcare. But I doubt that that’s gonna be the answer. What what’s driving the growth. And is it regulatory? Is it being driven by health systems? Is it being driven by the consumer where’s it, where’s the growth coming from? 

[00:06:24] Carm Huntress: [00:06:24] I think there’s a number of tailwinds. I think there’s definitely, [00:06:30] the sort of need from providers as they start to think about value. You can’t really do value based care unless what something costs. and so the need of this is pretty significant from the provider perspective, and then you’ve got consumer-driven healthcare here where patients are having harder and harder times because their deductibles are higher really covering the cost of their medications.

[00:06:54] And we’re seeing some really bad situations where it’s leading to bankruptcy, [00:07:00] because these drugs are so expensive. And then, and then the third component is really the regulatory environment where, we now have a part D mandate where. realtime benefit, which is what this is called. Real-time pharmacy benefit is the underlying technology standard is now a mandate for part D lives starting in 2021. So that’s those tailwinds really combined altogether are forcing, the payers and PBMs to bring this data to market and make it available. And [00:07:30] then aggregators like us bring it together.

[00:07:32] And then that the EHR has, have really opened this up into their native workflows. So we’re not an app off to the side. We’re really integrated just part of the native e-prescribing workflow, which means we’re part of every prescription decision. and that really has fueled our growth, today.

[00:07:49] Bill Russell: [00:07:49] So are you guys replacing the formulary? Are you typically replacing. a different vendor that’s handling the formulary at this point. 

[00:07:56] Carm Huntress: [00:07:56] Yeah, that’s a great question. So traditionally, [00:08:00] they talk about formula formulary and benefit data, which would typically tell you, this is a tier one or two tier two, or tier three drug. And, it was really only group and plan level data. What’s really changed now, is that data now is patient-specific and cost specific and it’s real time. Formula and benefit data traditionally provided by Surescripts was something was a static file that was kind of sent [00:08:30] around. And it could lead to a lot of delays in terms of the EHR, having an up-to-date.

[00:08:35] And that led to about a third of the time, the data being inaccurate. And I would say earlier on in our work, we found, a lot of providers saying, well, that data isn’t accurate all the time. And we had to educate them that this isn’t formula and benefit. This is really moving away from that to a real-time world where we’re really looking exactly where that person is in their benefits, where they are in their deductions. where, you know what pharmacy is in network out network [00:09:00] for them not just at a group or plan level, it’s really individualized, and getting that to the point of care. So this is a massive evolution, and a number of ways to, getting, real time individual patient cost transparency data to the point of care and really cannibalizing traditional FNB in terms of a business market out there.

[00:09:23] Bill Russell: [00:09:23] I love, I love the personalization aspect of it. So essentially if I’m a provider and I see one patient, I could be prescribing [00:09:30] something and then the next patient comes in and I can see a different price and I could be sitting back and going, hey, wait a minute. This price is changing. But that accurately reflects what the, real time, what the user or the patient is sitting in front of me is going to pay. 

[00:09:47] Carm Huntress: [00:09:47] Yeah. It’s such that just identifies the complexity of what you’re up against as a provider. I mean this is getting back to why this is so helpful in that, the provider instantly has [00:10:00] information that for instance, on one plan, a drug could be covered and then another plan it could not be covered.

[00:10:06] And that’s so important as providers have their tendencies and their habits in terms of what they like to prescribe. And so we’re really intervening on an individual patient basis to give them the information to rationalize, oh, wait a minute. this form of insulin on this plan will not be covered for this patient. And the next one comes in and I go to prescribe the same insulin and it is covered. And so, those are the things that we’re really [00:10:30] solving that are, are really creating fantastic ROI and, and a lot of administrative savings for both providers and pharmacies and as well as the payers and PBMs.

[00:10:41] Bill Russell: [00:10:41] So you have some serious users. I mean, UPFC Cedars, Providence, UC health. And as I think about that, almost everybody has Surescripts. Right? So, so this is part of the education of Bill Russell here. If I have Surescripts, do you replace that or is that, I mean, what does that look like? 

[00:10:59] Carm Huntress: [00:10:59] Yeah [00:11:00] there’s really two, two things. In certain situations, we have the same connections as Surescripts. in other cases we cover payers. They don’t, just because of Surescripts ownership, not everybody’s connected to them. So many cases we live alongside. It Surescripts. I will say overall, a lot of health systems are working with us, really for two, two reasons or maybe three we’re owned by health systems.

[00:11:23] So our investors are health systems, so we’re really focused on how we can help health systems. What’s that provider experience like. [00:11:30] And that’s really, the second thing is that we’re really focused on creating a phenomenal provider experience. And we’ve done a lot of really hardcore engineering to make sure that we’re providing a very high rate of success in terms of we’re about a 93% success rate overall with our payer and PBM partners in making sure this data accurately gets displayed to the point of care. Our EHR partners have told us we’re 10 to 15% better than any other vendor in the space. We’re basically the best.

[00:11:59] I think this [00:12:00] led to part of the reason why a Faena picked us as a partner, because they really want a great provider experience and we’re delivering that. So those are the core differences. That we’re really delivering at the point of care. I would also say that some of the stuff we’re getting into in terms of measurement and to actually understanding how doctors are using this data is a real interest to our, our, our health system partners.

[00:12:23] And that’s part of the reason they pick us too, just because we have pretty rich data and analytics, we can provide them on, [00:12:30] Hey, is this data really helping? And how are providers changing their brains? 

[00:12:34] Bill Russell: [00:12:34] Yeah, so I, so. It’s almost like you had me at hello, but now I’m going to dig in a little bit here. I want to talk about ROI, ROI and then, physician adoption. Right? So I assume the physicians use it because it’s built into their workflow. It just pops up. It’s pretty easy. Or is there a, Is there a learning curve. Is there something that I’m going to [00:13:00] have to do within our health system to get the physicians to, to adopt it? 

[00:13:04] Carm Huntress: [00:13:04] No. And that’s really the beauty of this is that, we’ve had these close partnerships without big Cerner and now Athena where this is built into the native, prescription ordering.

[00:13:16] Bill Russell: [00:13:16] So it’s not, it’s not popping up RX review. It’s it’s right. Right know the screens that they’re used to looking at. 

[00:13:22] Carm Huntress: [00:13:22] Yep, exactly. It’s in line in many cases, they there’s native buttons that they can have right in their ordering [00:13:30] screen that they can look at the cost data. And so that’s what is really driven the adoption, opposed to an app. that you’d have to, or a portal, that you might have to go off to, to look up this data. And that’s what makes it so powerful because one day the provider doesn’t happen the next day they go to prescribe another med and there it is, it’s available to them right in that native workflow.

[00:13:49] And that’s what we really think has to happen. we spend a lot of time in earlier iterations of the company trying to get providers to kind of use app based approaches, but [00:14:00] we really fundamentally believe this has to be part of native workflows and the way we. We talk about it internally, as it’s like about internal, what we call informed autonomy. We want to make sure that we present the data in a healthy way. That’s not overwhelming the doctor, giving them everything. They need to make an informed choice because they have a lot of other facts around clinical effectiveness and the patient’s history and that they’re using to rationalize that decision. So we’re just trying to get that right information right [00:14:30] at that point of decision-making. To help them rationalize the most cost effective choice. 

[00:14:35] Bill Russell: [00:14:35] So I mean, clearly I can see the benefits of the providers, the benefit to the patients. let’s talk from an administrative side. So I’m gonna, I’m gonna spend some money to put this in. What’s the ROI. Where am I going to find ROI with it? Your tool. 

[00:14:50] Carm Huntress: [00:14:50] Yeah. I mean, the first is sort of convenience or administrative, cost savings. So if you look at, just on a great example is on prior [00:15:00] authorizations. So when we get a doctor to, that wants to prescribe a drug that has a prior auth, we come back and say, well, this, this drug is exactly the same, but it doesn’t require a prior auth that is saving 50 minutes. and this is data we get from some of our. Payer and PBM partners, 50 minutes of cost savings per provider per script. And so when you think about overtax providers and not having enough time or getting more productivity out of them and their staff, that’s a pretty significant. A [00:15:30] statistic and patients are getting their drug 50%, 52% faster.

[00:15:36] And so when you think about time to therapy, when you think about you have an ACO or a risk based model and medication adherence is really important, getting patient on therapy faster matters. Now there’s, depending on who the risk-bearing entity is, there’s real cost savings. For every prescription switch that we get, we’re seeing an average savings of $225 per fill.

[00:15:57] So, that is just [00:16:00] amazing savings in terms of what, when you think about out what you’re giving back to patients and payers in terms of cost savings. And then, about a 23% increase. When you think about compliance and adherence, right? 23% increase that the patient will obtain the medication and a 4% improvement in medication adherence. And that really has to do with getting them on a cost, a drug they can afford. Right where they, they don’t get sticker shock at the pharmacy. They can afford it. And then they stay on that drug longer than [00:16:30] other patients who have affordability issues. So we’re really happy with, the ROI and, both health system, right. To the provider we’re delivering, but also to our payer and PBM partners in terms of, both cost saved, direct cost savings, but also administrative savings, around things like prior authorization. 

[00:16:51] Bill Russell: [00:16:51] So you talked about this a little bit before, and that was, you now have a significant amount of data at, are the, are the [00:17:00] providers putting that data to work? Are they, doing some advanced analytics around that? 

[00:17:05] Carm Huntress: [00:17:05] Yeah. So we’re, we’re just starting to understand, you know how they’re using and changing their behavior. I think the good news is they’re changing their behavior change is still in the low single digits, which isn’t great. We definitely want to maximize that change behavior rate when we’re working with providers. that’s enough to really make a demonstrable effect, [00:17:30] because drugs are so expensive when you, when you pick a lower cost drug that is delivering a significant ROI, but the problem is we still have a long way to go. We’re kind of in the first inning, if you think about, or maybe the second inning, I should say, if you think about how this needs to work, right? The first thing is access, which we’ve really achieved and we’ve got scale now, 200,000 providers, we’re running. millions of transactions a month now. And, and really the next thing is then measurement. How are the providers using the data to change behavior? And then [00:18:00] what value is that providing to the, to the provider, to the patient and to the payer.

[00:18:04] And then we’re really now in this movement into, into saying, well, how could we improve that? Right. And that has to do in a couple of different dimensions. One could be education. we do see some, this is typically a long tail problem. You have a small set of providers that are really cost ineffective, and, and focusing on those providers, right?

[00:18:26] You might have a system of a few thousand doctors but there’s only a small subset that are really [00:18:30] driving a lot of that cost or an unnecessary cost. and then the second thing is really working with our EHR partners on the workflow. How are we showing these options? How are we making the easing and how are we making it the path of least resistance to pick the most cost-effective therapy and those are the things we’re really moving into, next year to really maximize the value we’re providing to, our payer and PBM partners. 

[00:18:59] Bill Russell: [00:18:59] All right, [00:19:00] I’m going to, I want to go off this a little bit. You and I, you and I met. Well, there’s a five, five, six years ago 

[00:19:05] Carm Huntress: [00:19:05] While you were well I’m I’m, I’m sorry, I’m being terrible here. You were a CIO back then. I believe when I first met you, 

[00:19:14] Bill Russell: [00:19:14] I used to be somebody, as they say 

[00:19:16] Carm Huntress: [00:19:16] You were a CIO when we first met and I was, we were fighting for, for scraps back then, as I would say, 

[00:19:26] Bill Russell: [00:19:26] Well that’s what I, that’s what I want to talk about. I mean, people love to hear that story [00:19:30] of. how did it start? It usually starts with like a doctor and and a smart technology person coming together and going, Hey, we can do something here. I mean, what’s, what’s your story. 

[00:19:40] Carm Huntress: [00:19:40] So, I got connected with Dr. Kevin O’Brien who’s our medical founder, and he really. The way, this kind of came to be, as he and I met and he had just, he’d done two really interesting things. One is that he worked with his mother on her prescription drugs. He was on a bunch of drugs and he just sat down as a [00:20:00] doctor and kind of went through and optimized her meds. And he realized, just by making some simple switches and other things that he could save her $400 a month for her on a fixed income.

[00:20:11] That was ia big deal. And he said, gosh, if you know my mother and, we have this phrase in our company called blue, her name was Lucy, and we have now a cup of, sort of a cultural phrase Lucy up, which means, do the best you can for every patient and, and Lucy up. But, but that was one really big thing that Kevin did and [00:20:30] realized, wow, there’s going to be a lot of, a lot of patients must have the same price problem.

[00:20:34] And then really the second thing was that he started sort of. Collecting all these, all these things, cost switches and cost options and ranking drugs in a book and he showed me this book, the first time we met and it kind of blew me away. I was like, Oh my gosh, there’s no transparency. There’s no understanding of efficacy. this whole industry is totally a pig. Someone’s like someone has to figure this out. I had no idea the challenge I was up against, [00:21:00] and we went through a really, I think Bill, when we met, we were going through an evolution of trying to figure out how to sort of get data or new data to the point of care, to help providers make more informed decisions, whether that was clinically based or cost-effective, based. We ran, we had a number of years where we, had a bunch of small little agreements with health systems. I think at one point we had eight and they were all different experiments, with different workflows, with portals, [00:21:30] with popups, with, we tried everything we could and.

[00:21:34] This is a classic story of, luck is the intersection of opportunity and preparation in that, we basically came to the market and we started talking to payers because we said, well, what data do you have? Can we get cost transparency data? And we were looking at formulary data and they said, well, we’ve got this new real-time benefit technology. Do you want to integrate it into some of your solutions? And we said, sure. So we started signing up [00:22:00] some of the bigger payers and PBMs and got some big relationships, and that really fueled our growth. And then really what happened about two, year and a half ago now is the EHR has opened up.

[00:22:10] The HR has finally said, Hey, there’s enough evidence here that this data is really going to be valuable and necessary for value based care. And consumer driven healthcare is fueling it. Let’s get it actually into our native workflows, but they’re not going to, an EHR is not going to go out there and do all these connectivity and data normalization. And these co you know, [00:22:30] do all this work that we’ve done to aggregate it. And that’s where the door really opened and accelerated everything. So our thesis was always right. but, we needed the time for the market almost to mature where we had all the pieces and just needed to put them together.

[00:22:46] And that’s really, the last two years has been a rocket ship ride of, of our growth and what we’ve seen. So it’s been a wonderful, somewhat classic, but, but wonderful story in terms of what we’ve done over the last seven or eight years. 

[00:23:00] [00:22:59] Bill Russell: [00:22:59] So just so people don’t take this lightly. The normalization of the drug data is pretty, the  medication data is pretty challenging, isn’t it? 

[00:23:12] Carm Huntress: [00:23:12] Yeah. I mean, we, we have, full-time clinical pharmacists that really spend their life looking at these transactions, especially when you’re doing millions a month. There’s a lot of opportunity to, a 1% improvement can, can mean 10 or 20,000 better transactions. So, it means a lot to us [00:23:30] to look at the data. it is a very highly complex transaction. You have to know, the patient information and their plan. Right. So all of that. eligibility, but for the tech listeners out there, we needed to know a two, two, two, two 72 71, eligibility request.

[00:23:47] We have to look at that data. We have to look at their preferred pharmacy. We look at the dose, the duration, the day supply, all those things kind of matter and they have to be formed just right. To get the right transaction, [00:24:00] to come back and actually get that drug priced appropriately. So, it’s a pretty robust, transaction set that we have to do. And then, a lot of our, our partners don’t know this, but we do they’re. They have, they’re all, there’s no vanilla. Right. Everybody has their own flavor of these transactions, even though there’s a standard around it. and, and some of them provide less data, some provide more data.

[00:24:27] And so there’s a huge amount of, [00:24:30] of normalization because ultimately it ends up in the same workflow every single time in the EHR. And we have to create consistency there. a great example is, a payer may come back and say, Hey, this is a 77. well, what’s the 77 mean it means with this drug’s not covered.

[00:24:47] And each one of those codes we’ve had to like hand code over 500 different code rules, that, if we just showed a provider 77, they couldn’t make a more informed decision. [00:25:00] So that’s incredibly important as we think about. So there’s some pretty hardcore engineering underneath the hood to get all this stuff to run smoothly and keep the trains going at the, at the volumes we’re doing now, as a company, 

[00:25:13] Bill Russell: [00:25:13] Seven, eight years at this would mean that you’re like 64 years in company time, the startup in, in healthcare. you’re one of the more seasoned people at this point. What do you tell those who are just starting out or just [00:25:30] getting ready to do their, their health tech startup? 

[00:25:33] Carm Huntress: [00:25:33] Yeah,  I’ll give my macro perspective and then kind of what I give individual advice around, because I do see more and more, healthcare early stage CEO’s coming to me asking me questions like this. And, and I think, the challenge your bill, sadly is we’ve invested a huge amount of money into healthcare. I mean, it’s, it’s kind of staggering. I know it’s in the tens of billions. it’s a, it’s a massive number now, [00:26:00] something like 7,000, 8,000 startups.

[00:26:02] As the last time I looked at data, from startup health on, on the statistics. And, I sort of sit here and say, have we really made. dent and I, I don’t think we really have. And I think the reason for that is everything that worked in other industries in terms of technology coming in and improving things and driving efficiency just doesn’t work in healthcare. And it’s really due to, if you, for lack of a better word, that irrationality of [00:26:30] healthcare. And I think that’s probably for me when I started and for new people coming into this space, you have to really understand. The incentives and the value chain you’re in. And I don’t think enough people spend enough time early on saying, I’m going to deliver value here and who’s it accruing to, and who’s going to pay for it.

[00:26:49] We tend to rush to consumer driven, experiences, but again, even in high consumer consumer-driven plans, you still have your, your, employer who’s covering some of the [00:27:00] costs or still in a lot of cases, a lot of it on the commercial side. and then you’ve got complexity with providers and where they are and their technology. And so I just think that was one of the hardest things for me. If, if we sat down and I tried to lay out for you, the pharmaceutical industry in the pharmaceutical value chain, it’s incredibly complex, there’s wholesalers, there’s PBMs, there’s providers, there’s payers, there’s retail pharmacies, [00:27:30] they’re specialty pharmacies, there’s Medicare, there’s Medicaid. There’s commercial, right? All these things you have to kind of continue to rationalize. And I think that, that a lot of early stage sub companies miss that and miss the target in terms of who’s accruing, what value and when, and then how do we fit into that value chain from a service or technology?

[00:27:51] Bill Russell: [00:27:51] That is such a great point. I have so many startups. I have that conversation and I say, okay, what’s your economic model house. Who’s going to pay you. And they said, well, these people are gonna [00:28:00] pay me. I’m like, Have they ever paid for this before? Well, no, but now they’re going to pay for it. It’s like, no, they’re not.

[00:28:07] Carm Huntress: [00:28:07] It’s just wild. And I see the same thing where, you know, and I think one of the things that we’ve done and I, I think this is so true is that we spent so much time focusing on the consumer and we’ve come to this conclusion as a company. Any prescription decision or any decision prescription or otherwise is made by the provider it’s not [00:28:30] made by consumers and consumers are I mean, I’m really, I consider myself a relatively well-educated guy and I don’t know how to sort out what is the right decision for me. I mean, I need a doctor and so, we’ve really had this heavy focus and I wish there were more startups focused on the point of care, the provider experience. We’ve spent so much time trying to get to the consumer, unsuccessful, and I don’t think we’ve moved the dial enough versus, what we could do with [00:29:00] the with the provider. I think of Atul Gawande’s I think, quote, he says, the most expensive medical device is the pen because the provider, not that that’s true anymore with EHR, but they’re writing all the orders. And I think that such a great quote. And I think about that often, because this is so much, I think the cost transparency, otherwise it’s, it’s really about helping doctors make the most informed decision for their patients that that’s cost effective. And that’s where we think the market’s going overall. 

[00:29:30] [00:29:30] Bill Russell: [00:29:30] Yeah. what really resonates with me? My son for the first time in six months, my wife actually left. She went to visit a friend and she just came home. But for six days I cared for her father and he has his. morning pills is, his dinner pills. And then he has his, before he goes to bed pills. And it’s, probably about 12 pills, 10 to 12 pills and, each not all of them, but a significant number of those are prescribed. [00:30:00] And, that’s between, between caring for him. And trying to pick the right plan and all that stuff. And and talking to my parents and, learning all the new terminology and the things about, my mom says to me all the time, I’m in the donut hole, I’m in the donut hole.

[00:30:19] Well, I’m like, I mean, it’s, this really matters to somebody who’s on a fixed income. The amount they’re spending on their meds is a significant, [00:30:30] significant amount of stress for them. And a significant amount of. trust, they have to place into that position, to, to help them. So having that information at the point of care is just, is so critical. It’s such great service. 

[00:30:44] Carm Huntress: [00:30:44] Yeah. I mean, I couldn’t agree more. I mean, if you look at, I think 70 and old over, are typically seven or eight, seven or more medications, that’s at least the stat I have in my head or around, [00:31:00] how many medications they are, and, and, this is one of the real challenges I think that we underestimate around doctors is that, just on a clinical basis, sorting out those seven or eight meds is, is computationally very hard human brain is just not built to sort of sort out, okay, well, what’s going to interact with what and side effects, and is this the most clinical effective option for where they are in their, condition and then you pile on top of that to your [00:31:30] point, right? Medicare part D plan or whatever it may be, that supporting, the cost side of it and then rationalizing, well, is this the most cost effective and then can they afford it?

[00:31:42] And that’s really where we kind of see, as we iterate on this, whole model is. really coming back to the doctor and say, Hey, we’ve looked at it, all the options we’ve analyzed the clinical effective we own and analyze the cost and the convenience for the patient. And here’s the best [00:32:00] set of options. We still want to give you some flexibility, but there’s sort of this sweet spot of like, where all this makes sense, but it’s not a, I think a lot of people sit there and say, well, doctors should just be able to figure this out. You really can’t. It should be done by computers for the most part, and then make recommendations, to what would be the best choice, no different than a shopping experience that we have online today, where we get really good recommendations.

[00:32:24] And we, that narrow our, our lists. We can filter, we can do all sorts of stuff to get it and [00:32:30] make the most informed decision that really has to be brought to the point of care. And that’s my big hope as we continue to evolve this industry, and, and continue to expand cost transparency more globally.

[00:32:41] Bill Russell: [00:32:41] Well, great solution. I’m glad you’re still around after eight years, even, after, as you say, picking up the scraps early on and, I, I appreciate that you guys stuck with it and, and have had so much success, especially over the last couple of years. Hey, thanks for coming on the show. I appreciate it.

[00:32:57] Carm Huntress: [00:32:57] Yeah, thanks for having me, Bill. It’s been great. 

[00:33:00] [00:33:00] Bill Russell: [00:33:00] That’s all for this week. Special thanks to our channel sponsors, VMware, StarBridge Avisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent Advisors, healthNXT and McAfee for choosing to invest in developing the next generation of health leaders. We really appreciate their support. don’t forget to sign up for clip notes. send an email, hit the website. we want to make you and your system more productive. This show is the production of this week in health IT. For more great content check out the website this weekhealth.com. Check out our YouTube channel. We continue to modify that and make [00:33:30] that better and easier to find things that you are looking for there. please check back every Tuesday we do news day, every Wednesday, we try to do a solution showcase every Friday. We do, Interviews with industry influencers and we will continue to do that through the end of the year. And then we have some interesting things lined up for the new year. And I can’t wait to share those with you and we will start sharing those with you here shortly. So, thanks for listening. That’s all for now. [00:34:00]

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