Latest / StartUp Health NOW Podcast / RxRevu Is Bringing Drug Price Transparency to Doctors at the Bedside

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RxRevu Is Bringing Drug Price Transparency to Doctors at the Bedside · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] You know, when I think about this market, the first and most important thing to move into value, which is really what we want, 'cause what we're saying that is we're not getting the value for the money we pay.
• 0:21
  And, and for, for prescription drugs. We have to rationalize that. You're not gonna rationalize that unless you have transparency, right?
• 0:29
  I don't w- you can't say, you know, uh, is this cost reasonable or not unless you know the cost. And so w- we, you know, we think we're the- on the tip of a very big spear.
• 0:42
  [on-hold music] Welcome to StartUp Health NOW, the podcast about the entrepreneurs shaping the future of health and the health moonshots they're working to achieve. I'm your host, Logan Plaster.
• 0:56
  So for a long, long time, seemingly forever, the price that you have to pay at the counter for your prescription drugs has been in a black box.
• 1:03
  The drug maker, the insurer, the pharmacy, they've all got their fingers in this price, making it seemingly unknowable. That was, until some entrepreneurs took the problem on.
• 1:14
  With the recent IPO of GoodRx, the prescription discount platform now valued at more than $20 billion, it feels like the issue of drug price transparency is finally having its moment.
• 1:25
  So while GoodRx focused on giving patients tools for comparing drug prices, the company RxReview has been working for seven years, since before pharmacy tech was cool, to bring that price transparency directly to doctors writing prescriptions.
• 1:40
  Doctors know in general that prescribing generics will cost less than a name brand drug, but that's been about it. Today's episode is a conversation with Carm Huntress, CEO of RxReview.
• 1:52
  We'll talk about the logistical challenges that kept drug price transparency at bay for so long.
• 1:57
  We'll take a look at pharmacy tech over the last decade, we'll look at how the markets have shifted during COVID, and then we'll look forward at where this is all leading, how drug price transparency is essential to both the access to care and the cost to zero moonshots.
• 2:13
  Hope you enjoy. [on-hold music] Carm Huntress, thank you for joining me today, um, [lips smack] for this episode.
• 2:26
  Really excited to have you, um, and to learn more about what RxReview is doing right now. So thanks a lot. Yeah, thanks for having me. Real pleasure to be on, and, uh, longtime, uh, StartUp Health company. So- Yeah...
• 2:39
  we've been around.
• 2:40
  Yeah, I wanna get into that history a little bit because in kind of watching some of your material, your presentations, they go back to 2013, 2014, and so I thought as a way of framing the challenge that you're trying to address, kinda what was broken that caused, uh, the need for RxReview, maybe you could, like, tell us about how prescription, uh, transparency and the issues you're dealing with have changed over the last six, seven years since you started.
• 3:10
  Yeah. Well, there's a lot of things that are different and a lot of things that are the same. I was wondering, yes.
• 3:14
  Um, you know, so I think I'd start off by saying, you know, how we started, and it's, it's interesting, I just had my company meeting and we, we have this thing we call the Lucy Up award. Uh, and we- Say it...
• 3:24
  What was... Say that again. The Lucy Up award. Okay. Um, and we give it out every month, and our founder, Dr. Kevin O'Brien, um, was the one who came to me and said, "Hey, I think there's...
• 3:34
  You know, I wanna start a company around this idea of cost transparency and helping patients save money." Well, he started because his mother's name is Lucy. Okay.
• 3:42
  And he, he as a doctor kinda looked at, uh, her expensive medications and, um, very quickly recognized, "Oh, I, I can save you about $400 here by just changing some of your meds."
• 3:53
  And he said, "Geez, I bet there's a lot of other people in the same boat." Yeah. Um, and so we've coined this phrase, you know, Lucy Up. You know, help Lucy, you know- Mm...
• 4:02
  save money on her medication, get transparency. You know, we're all patients, we're all trying to help our, our m- our mothers, our parents, our friends. Yeah, yeah. Yeah. Uh, especially in this environment.
• 4:11
  And so we have this Lucy Up award that kind of goes back to that founding story of, of why we're here. I think what's so interesting, right, is when w- when we started seven... You know, let's say 2013,
• 4:25
  if you look at the market then, you know, GoodRx was just kinda coming to fruition. Like, it had a little bit of visibility in the market. It was still a relatively small company. Um, the tech...
• 4:36
  And, and so not a lot of movement, right, in pharmacy IT. Um, and, and l- and we'll compare that to the delta in a minute. And then really the technology, right?
• 4:45
  In terms of for EHR maturity to take on cost transparency, the concept of cost transparency, like h- can I know how much my drug's gonna cost when I reach the pharmacy, that idea- Yeah, yeah...
• 4:55
  was, well, from a technology and sort of a conceptual idea was still really immature. Fast-forward today, okay, wow. You know, this is one of the hottest sectors out there, right? Yeah.
• 5:08
  If you look at what's gone, what's happened, you've got, um, uh, startups, incumbents, especially on the f- on the fulfillment side. So Hims, uh, you know, Roman, Nurx, Truepill, Amazon PillPack, Capsule, right?
• 5:23
  Yep, yep. It's, it's crazy busy, [laughs] and there's a lot of money flooding in to tackle it. Yeah. You've also seen this massive consolidation, right? You've got Aetna, CVS. Mm-hmm.
• 5:32
  You've got Cigna and Express Scripts, and you've got United and Optum all... You know, and those are two new mergers, um, United and, and are existing.
• 5:41
  But those are the big players, and they own, you know, 80, 90% of the market. Okay. Um, and so a real big change there.
• 5:48
  Um, and then on the pharmacy IT side, you know, we have a standard now, which is called real-time benefit check, which allows us, which is the core thing our business is done, which is transact with the payers and PBMs like...
• 6:00
  the Express Scripts or, or, or Optum- Okay... to get the real-time cost for the patient of what they're gonna pay for the drug.
• 6:06
  At the moment, the prescriber's writing or entering the prescription into the electronic health record.
• 6:13
  And so we've seen great maturity of the electronic health record in taking on this data at scale, and that's driven a lot of our scale, which we'll, I'm sure we'll talk about.
• 6:22
  Um, and, and number two, we've seen the payer PBMs mature around being able to run these types of transactions and then make, make them available at very large scales, um, for both, uh, you know, providers and patients.
• 6:34
  Interesting. Uh, I wanna get more into kind of what that market activity has meant for you and kind of what 2020's looked like.
• 6:41
  But in- for anyone watching this that, um, needs kind of a flyover of what you've built there at RxReview, sort of give me the, uh, elevator pitch. Yeah, sure.
• 6:51
  So we're, we consider us kind of the leading independent cost transparency, uh, uh, vendor in the market today, uh, focused primarily on prescription drugs.
• 7:00
  We're starting to do transparency other spaces, um, which, which we can talk about. Our core business is really in drug cost transparency. Mm-hmm.
• 7:07
  And so related to doing this at the point of care, and we, we had to make some hard decisions on the way getting here to this point as a company to focus primarily on helping providers around this.
• 7:18
  And the reason for that is, you know, we, we kinda said, "Well, you know, who really controls the prescription decision?" Mm-hmm.
• 7:25
  And it really is your doctor, and, and we really look at the transparency movement as the in- if we're gonna make a delta change- Mm-hmm...
• 7:32
  uh, in the overall prescription drug market and bring down costs, we've gotta get transparency to providers.
• 7:38
  So we're now, our network is, um, uh, approaching 150,000 doctors, probably gonna go to 200,000 in the next, uh, six months. Um, and we were at, like, a few thousand at the beginning of last year. A delta change.
• 7:53
  Wow, okay. Um, and w- we probably did about a million transactions last year maybe. Um, we'll do probably close to 30 million this year. W- what was the- So, uh- What's been the driver?
• 8:05
  How, how would you describe- Yeah... the drivers of that change? Well, it's two really big things.
• 8:09
  One, the EHRs have really started to adopt this standard, but they need companies like us that connect to all the payers and PBMs and aggregate the data together and then provide it, so any doctor seeing any patient on any health plan- Mm...
• 8:24
  can, can get the data they need, right, to, to know what the price is that patient's gonna pay at the point of care. So we bring that transparency to the EHRs, and we're doing that with Epic, uh, and Cerner at scale now.
• 8:37
  And I'm happy to announce that we just signed athenahealth, so we have now the three largest ambulatory EHRs in the US working with us, um, and bringing this data to the point of care.
• 8:47
  So, um- Is that a tech challenge inter- is that an interoperability challenge? Like- Yeah... what is it that makes it so difficult to get, or is it just a bureaucratic challenge?
• 8:58
  Uh, well, it's all, it's, yeah, I mean, it's bureaucratic in that there's a lot of other chall- you know, other things like COVID and [laughs]- Yeah...
• 9:04
  uh, uh, regulation that, that the EHRs especially are trying to meet. Um, it's two-sided challenge, right?
• 9:10
  We, we've had to work a lot with our EHR partners to get them to adopt these standards and make it available so the provider can see what the cost is. Yeah. Are there any restrictions?
• 9:22
  Um, what are the therapeutic alternatives to the drug that might save the patient money? And do that all in real time.
• 9:27
  And then maturing the, the payers and PBMs to be able to run these transactions at scale in real time and normalize all that data across these very arcane systems.
• 9:39
  Um, you know, these systems we're, we're tapping into claims systems, which are very antiquated. Some are mainframe-based systems.
• 9:46
  Some you have to look at multiple systems to, to, to pull together a f- complete transaction.
• 9:52
  So you'll have sort of a claim system that'll give you the pricing, but then you have, like, a coverage system that'll tell you if a PA or quantity limit is on the drug.
• 10:00
  You have to kinda do a lot of navigating of really complex systems. Um, we do have a really phenomenal engineering team, um, that, that figures out [laughs] all this stuff and is constantly maturing.
• 10:12
  Uh, our success rates were, you know, 93%, which is probably the highest success rate in the industry now, uh, in terms of perform- and both performance were sub two second, uh, sub t- sub one second in some cases, um, in terms of getting these transactions to the point of care.
• 10:27
  Okay. When you say successful at getting the transaction to the point of care, what does that mean? That, that w- it didn't error out. Okay.
• 10:33
  Um, um, that, you know, we had, we made a r- the doctor said, "Hey, I wanna prescribe Humira." Let's just take an example. We get that request out of the EHR. We normalize that for a payer PBM.
• 10:44
  We, we say, "Oh, this is a United member. Okay, let's go over to Optum."
• 10:48
  We then clean up that transaction and make sure it's well-formed, and it, you know, and then we request all the data, and then it comes back, and then we know we can send it back to the EHR, and the doctor's gonna see what they wanna see, which is the price of the drug and this- Yeah...
• 11:00
  other information. So we really have to ensure, uh, that that runs really well and that you get that success rate. And these are very meaty transactions. You know- Sure, yeah...
• 11:11
  you're passing around, you know, drug data and dosaging and quantities and, um, you know, 'cause you're, you're literally saying, what is that patient gonna pay at their preferred pharmacy that day- Mm...
• 11:22
  at their CVS or Walgreens or whatever it may be. So it's, it's a really hard thing to do well at scale, you know, where we're running mul- millions of these transactions on a monthly basis. Interesting.
• 11:33
  You know, something that we've written about, um, or at least in my work I've written about for years, is the issue of perverse incentives.
• 11:41
  I mean, in healthcare, people kind of, their incentives aren't aligned and working against one another. Mm-hmm.
• 11:46
  And obviously there are pieces of the healthcare system that would benefit from people paying more for their drugs, and you're coming in and helping them.
• 11:53
  So kind of where does RxReview, uh, fit into aligning people's as- incentives?Well, I think, I, I think you gotta...
• 12:03
  You know, when I think about this market, the first and most important thing to move into value, which is really what we want, because what we're saying that is we're not getting the value for the money we're paying, [laughs] and, and for, for prescription drugs.
• 12:14
  We have to rationalize that. You're not gonna rationalize that unless you have transparency, right? I don't... W- you can't say, you know, uh, is this cost reasonable or not, unless you know the cost. Yeah.
• 12:26
  And so we're, we, you know, we think we're the, on the tip of a very big spear that's going to start to sort of have this value-based discussion.
• 12:34
  Um, and it's exciting, because, you know, we're starting to talk to some of our partners around...
• 12:39
  I mean, not only talking about patient costs, but what, what is the plan gonna pay, and what's that total cost to care for the drug?
• 12:45
  Which when you think about from a provider perspective and taking on risk, that's a pretty important number to know.
• 12:51
  And to know it in real time when you're prescribing the drug is definitely gonna help, uh, lean into value. Um, and, and that's really the first step.
• 12:59
  Um, beyond that, you start to say, "Well, how well did the drug work?"
• 13:03
  And look at clinical data and clinical outcomes, and then sort of say, "Well, for what I paid and I, the clinical outcome I got, does it all make sense?"
• 13:11
  And so we think we're just really on this sort of the first phase that really needs to happen and get the market going into value, is make everything transparent and well understood of what people are gonna pay.
• 13:23
  Uh, and then we can really start to think about value. Um, and, and then rationalize that. What is it really, what's really worth doing? Yeah. Yeah. That's interesting.
• 13:31
  It's interesting to think that this piece that is so complicated and you've worked so hard on is still just this, the tip of the iceberg, tip of the spear, whatever your metaphor is. Yeah.
• 13:40
  A, a lot of people say, you know, you know, I, I still get this question. Um, and I got it even early back in 2013. It's like, w- you know, this hasn't been done? You know, like, how, how can doc- [laughs]...
• 13:51
  how are doctors prescribing drugs today if they don't know the cost, right?
• 13:54
  [laughs] Um, and uh, you know, not only back then and, and still goes on today, you know, a lot of that data that they were getting was actually inaccurate. It was static data that was kind of getting passed around.
• 14:05
  Yeah. It wasn't real time. Yeah. And so, [laughs] you know, it, it was the worst of the worst, which is not even is this, they, they are getting data, but it's actually the wrong data. Yeah.
• 14:15
  Um, and, and so, you know, we've had to do a lot to, to course correct.
• 14:19
  And I, you know, I mean, I think a lot of people are trying to do a lot of sexy things in healthcare right now, and I, I don't really look at it that way.
• 14:27
  I think we need really simplistic solutions to a lot of these challenges, and transparency is just one of those. I mean, you know, I, I don't face this as much, because we've, we've had success as a company.
• 14:38
  We've gotten to a lot of scale, and our, our revenues are growing really fast now. But early on, you know, I had a lot of investors say, "Where's your AI, you know, where's your AI pitch?"
• 14:47
  And I just say, you know, "This isn't, that's not what doctors need." AI is, is, you know, six iterations of this thing, right? It's a much further thing out there, because guess what?
• 14:57
  The AI can't intelligently tell you what the best cost, you know, cost basis drug would be for a patient without knowing the cost. So let's solve that problem first.
• 15:07
  Yeah, you get one response from the investor who says, "Where's the AI pitch?" And then every single one of the, what, 1.5 million provider or doctors says, "Please, I need this yesterday." Yeah.
• 15:18
  You know, if, if anyone- Give me the cost of the drug. [laughs] Yeah, it's like, I just wanna know- Yeah... what I'm sending you home with, you know?
• 15:26
  Uh, y- every doctor I know, um, wants to help their, their patient get the, the best drug for the best price. It's just- Yep... just that simple. It's that easy. Right. Which, which leads me to a question.
• 15:37
  You know, I saw you in a presentation you made online, um, I saw you connect the dots between, uh, being able to present the best drug at the best price with physician burnout, you know?
• 15:50
  A- and it's easy just to have the story stop with the patient, like I'm glad they saved some money.
• 15:54
  But to go upstream and to connect those dots and say, "This really impacts, um, provider or physician well-being," um, uh, I'd love for you to sort of, uh, expound on that. Uh, what are your thoughts on that?
• 16:08
  Yeah, I mean, look, we've done... Th- this is the odd thing about healthcare IT, right? Every other time we've introduced technology to an industry, we've seen, uh, massive gains in eff-
• 16:20
  uh, improved outcomes, you know, better, you know, cost for value makes sense, right? Um, in every industry. T- healthcare has not achieved that. The inverse has happened.
• 16:31
  We've introduced technology, and things have gotten much more complex.
• 16:35
  Um, and these systems were really built, you know, [phone beeping] in a, a much, you know, sort of earlier, uh, iteration of, of IT, and weren't really built with the...
• 16:46
  You know, they were built, at least on the provider side, uh, with a focus on revenue cycle management. They weren't focused on user experience.
• 16:53
  And so you hear these kind of crazy statistics, like an ER shift, a normal ER doc clicks like 4,000 times in a shift. Um, you know, it's like an insane [laughs]
• 17:04
  sort of thought of like, you know, just to get through an eight-hour, you know, they're facing that much clicking around the EHR. And that's not even keyboard time, that's just mouse clicks.
• 17:13
  [laughs] My, my father is an ER, a physician, and I've, I've shadowed him on shifts just to sort of see what that's like. And, um- Yeah...
• 17:19
  besides the clicking around, just the sort of sitting at a desk charting for- Forever... a long time. Long time. And so, y- you know, the first...
• 17:28
  That and, and that is such a mas- massive contribution to what's happening to doctors, right? Is this just massive documentation that the overhead, they have to work at night and get everything documented correctly.
• 17:40
  The EHRs are kind of stopping them and hard stop alerting them all day. I mean, if w- w- if you used a computer like an EHR where, you know, every minute or so you get an alert in your face, you'd burn out, you know?
• 17:51
  Mm-hmm. And that's massive contribution. And so
• 17:56
  talk about a lot, and I love this phrase, um, which I got from one of my board members, which is a informed autonomy.Is what we want is these systems that are kind of monitoring behind the scenes and assessing the information and bubbling up to the doctor, "Here's your best options."
• 18:12
  Whether that be in diagnosis support, where it's sort of saying, "Hey, I'm sort of supporting you in kinda sort- sorting out the differential and what the diagnosis is here, and then here's the treatment options that are best for you."
• 18:23
  And what we've done in prescribing is we've expected way too much out of the doctor. Um, I, I always bring up this example.
• 18:30
  If you have a type 2, uh, hypertensive, um, [clicks tongue] let's say, diabetic in front of you, there's something... Our data scientists did this calculation. There's 1.3 trillion drug options,
• 18:43
  1.3 trillion drug options in front of that doctor in that moment, right? And they're trying to pick three meds for that type of doc- patient, which is a very common patient.
• 18:51
  You know, that's not something out of the norm.
• 18:53
  And, and so, you know, if you think about the clinical complexity we force providers into, the amount of knowledge they have to retain and understand, let's just take the cost issues out of it, just from a clinical perspective, and then this sort of very hard choice of, you know, what's the insurance and what you're gonna pay, it's not really a human computational thing, right?
• 19:14
  Humans should just not do that. Yeah.
• 19:17
  Um, and, and that's really my belief in that we're kind of building, componentizing, and putting all the pieces together to create a system that drives informed autonomy and helps that doctor get to a small set of options, and they can assess, "Hey, is this gonna be too expensive?
• 19:34
  Um, are there clinical concerns here? How am I being an empathetic partner to the patient and understanding the social things that technology's kind of not so great at, to guide to the right prescription decision?"
• 19:47
  And that really is the future I believe in, and I think that's where technology should help. And if we do it right, the burnout issues will go away. Yeah.
• 19:55
  I mean, how cool would it be to a doctor if you have sort of these AI engines around you- Yeah...
• 20:00
  supporting in the diagnosis and treatment, and they're more complementary to you and get you back to why you became a doctor in the first place- Yeah... which is to be the empathetic s- sit by...
• 20:12
  You know, hold the patient's hand and talk about their condition and how we'll treat them and make them healthier. Like, that's, that's a great future. Um, and, and I really hope we can be part of that at RxE.
• 20:24
  Is the clinical decision support portion of this, is that part of the current product, or is that your future vision? Um, it's interesting.
• 20:32
  We, we had early technology that we developed in some specific clinical areas around that. I think it's gonna... You know, and we still have that sort of on the shelf. Um, I think we're gonna full circle here.
• 20:42
  [laughs] I think we're gonna do this thing where we kind of go out as a company, solve the cost transparency issues, and then start to come back and look at clinical, uh, efficacy. Mm.
• 20:54
  Because what you want, right, is I wanna, you know, get the most clinically effective drug at a c- at, at a cost and convenience to the patient, you know, that they ultimately can afford. Sure.
• 21:05
  That's kinda what you're trying to sort out. And so I think we're sor- we're in this sort of... We're figuring out the cost and convenience categories, right?
• 21:14
  What's, what's sort of the right cost for you, and what's convenient, you know, for you to... in terms of time, you know, driving from your home? Should we mail order it?
• 21:22
  If it's specialty, do we need to do a home infusion? Do we need to do it, um, on site? Um, you know, that... those are the cost and convenience things.
• 21:30
  And then starting to sort of say, "What's the clinical e- efficacy here? What's the most clinically effective thing that we could, we could prescribe?"
• 21:39
  And there is kind of a subset in every condition of, of how you figure that out. But those are, those are really... I, I think what we've had to learn is
• 21:49
  we're starting to get there enough with interoperability where you could have CDS tools that in real time could run both of these types of transactions, but we're still kind of early. Yeah.
• 21:59
  Um, it's, it's that challenge of sort of normalizing the clinical data in a, in a fast enough term for the doctor to get value out of those types of transactions and, two, doing the deciphering. Yeah.
• 22:08
  And a really good example is in type 2 diabetes. You've got, you know, the clinical guidelines for that, for just type 2 diabetes, about 157 pages. Wow. And I've tried to flip through it myself.
• 22:19
  I'm not a doctor, obviously. It's overwhelming at page three. [laughs] Yeah.
• 22:24
  Uh, you know, 'cause it's this big kind of, um, clinical, uh, guidance or flow, flow, you know, diagram of what you do depending on a whole host of factors with the patient, um, and cormo- cor- comorbidities, existing medications, um, you know, combination medications, um, their current A1C, right?
• 22:43
  All these things compound. And so, um, I do think it's a full circle for us. Yeah.
• 22:48
  But again, we've gotta look at this as phases, um, and providing value along each one of those phase to get to that future state where clinical data's really evaluated alongside these transactions. Makes sense.
• 23:01
  Um, you mentioned this a little bit at the very beginning, but, uh, how did COVID impact your company?
• 23:07
  Yeah, I mean, so what we saw, uh, very clearly was health systems did a, a full hard stop, um, pretty much across the country.
• 23:14
  You know, we have, um, roughly 400 systems we're integrated with across the US, so we have a very broad reach in terms of seeing. The drop-off was pretty extreme. Um, we saw,
• 23:26
  I don't know, about a third or half, depending on what market we were in, of clinical, you know, prescribing just stop, you know? Pres- cor- prescribing stopped? Actual prescribing?
• 23:37
  Okay, so- Yeah, so we actually- If, if patients weren't coming into the clinic, the... just prescriptions weren't getting written. Yep, exactly. And so we had that hard stop.
• 23:44
  Now, we've seen pretty much that come back and start to grow well. I think what we're gonna see, you know, the...
• 23:51
  what, what, what we saw earlier this year, where systems just shut down, and, and we had to be super respectful. You know, I just would call up, you know, potential prospects and say, "Well, how can...
• 24:01
  You know, what do you need from me today? Do you need to, to cry on my shoulder?" [laughs] Yeah. "Do you need to... Do you need a, you know... Y- you, you need PPE? What do you need?"
• 24:09
  Um, we, you know, we, we did a bunch of fundraisers to help health systems during that time. We literally just shut down our sales.Um, and it, it really became, how do we help our communities?
• 24:17
  How do we help our health systems get through this because they're in crisis mode?
• 24:21
  Um, and, you know, we saw them, not only the stress on the employees and the nurses and the clinical staff, but, you know, we were getting phone calls from some of our larger health systems that were, were losing 50 to $100 million a month.
• 24:35
  Um, you know, that, that, that's the kind of thing that was happening for about six months. Yeah.
• 24:40
  Um, we've come out of that, and I think what we're gonna see, I don't think we're gonna see the same shutdowns going into next year.
• 24:46
  We're still gonna see that distraction cost, though, to health systems in terms of having spikes in cases and having to deal with that, and then IT resources that are tied up in other things.
• 24:57
  Um, I, you know, we look at it as it's just denying the inevitability of it, right? Like, cost transparency will come to these systems. We'll get it to the doctors. We'll keep maturing that market.
• 25:06
  It just might take longer. Sure. Um, and we might have... You know, in some ways, I think it's interesting. We've lost, um, I think we've lost six months to a year in terms of the maturity of that market. Mm.
• 25:17
  But I also think this really wonderful thing happened in that a lot of... What we saw was really interesting.
• 25:23
  We saw the systems that were heavily embedded in elective, um, procedures and, um, fee for service, hemorrhage cash. I mean, just hemorrhage money, right? 'Cause all that stopped. Mm.
• 25:36
  And the systems that were more footed in value and had their own health plan, um, what happened, right, is the premiums went up,
• 25:45
  and, and, you know, nobody utilized any costs, and so their balance sheet was so much healthier.
• 25:51
  And they were much more resilient to COVID, and I think that just really did a wonderful thing to wake up a lot of systems to say, "We gotta stop this. We gotta stop the insanity of this fee for service world.
• 26:03
  We've gotta move into bill- value. We've gotta become more resilient, and, and the time is now." And so and then you look at things like telehealth and the accelerate. Everybody... Nobody's ever gonna use telehealth.
• 26:15
  Well, turns out everybody uses telehealth. Um, and we've seen systems come back to a healthy, I'd say, 25 to 30%, uh, utilization of, of telehealth. You know, it's not gonna go away.
• 26:28
  It's gonna stay at much higher levels, um, in a healthy state where you... You know, if you're just doing a follow-up- Yeah...
• 26:34
  and there's no reason to be there physically, like, telehealth's the best, and I, I've done it twice this year myself, and I think it's fantastic. Yeah.
• 26:40
  So I think that's really what we're gonna see, um, uh, as systems really have woken up in a, in a healthy way to where they need to go and move into value, uh, and, and start to shed some of these old models that, that aren't gonna work in the future anymore.
• 26:55
  Yeah, that makes sense. Um, you know, I, I've seen you give presentations about the company, and it's very clear, um, that this is very personal to you. Uh, you've been at this for six or seven years. Uh- Almost eight.
• 27:10
  Almost eight. It's a topic that if people aren't in the know could sound maybe a little dry, you know, prescription price transparency, right? It's like- Yeah.
• 27:21
  Um, and yet it's very clear that to you this is something much bigger, and it's personal. So as kind of a closing question, um, why is that? Yeah, so I mean, my story goes back to my childhood.
• 27:34
  Um, you know, by, I, I lost my dad to pancreatic cancer at 7 and my mom, uh, to, uh, colon cancer at 15. And I had to face, um, you know, some really tough stuff as a kid.
• 27:49
  Um, and I saw first-hand kind of the failing of the medical community, um, and care at that time, right, of, of what, how just terrible this could be, and I, I'll never for- you know, back in the...
• 28:04
  You know, my, my mom carrying around all her paper records and just sort of all that stuff, and as I've gotten into technology, just seeing that need and, and understanding how many patients have gone through that suffering.
• 28:16
  Um, and you know, we're seeing it so much this year with COVID and, and how many lives have been lost around it. Um, and you know, I, I have...
• 28:24
  And so I've always had this sort of like fundamental need to wanna be in this space in healthcare, you know, uh, and, and that personal story with my mother and father has just carried with me my whole life to sort of like we've gotta make healthcare better in this country, and make it more, um,
• 28:43
  you know, more approachable. And, um, and it, and, you know, I think the combination of technology will solve so many of these problems. Mm.
• 28:52
  Everything from, uh, you know, what we do today in bringing cost transparency to the market, but, but also really changing, uh, the way we deliver care and really curing people of a lot of these diseases.
• 29:04
  And so for me it's just incredibly personal, and, you know, I just, I think it's a, it's a travesty that we live in a world, it's 2020, and we're still having this discussion. Yeah.
• 29:13
  You know, shouldn't we just fix this stuff? Shouldn't we just make this happen and get on with our lives, and so we can get to the, the next stuff? Yeah.
• 29:21
  Uh, the important stuff, the AI stuff, the, the, you know, informed autonomy and, and, um, uh, all the things that we should be really giving doctors from a technology perspective.
• 29:32
  Um, and I think the last thing I'll say is just, like, we live in a world where, you know, medical, minus COVID, right, medical errors is the third-leading cause of death in this country. That is an absolute...
• 29:44
  And it's, you know, pushing 20% of our GDP. Um, and I, I have two boys.
• 29:49
  I can't imagine a world, I can't leave this world, um, w- with them in, in the state it is today, and, and if it gets worse, you know, that's not gonna be an answer for me. Yeah.
• 29:59
  And so that's why I'm so dedicated, and I get up every day trying to solve this problem, and I'm incredibly committed to it. And the stats around medical bankruptcy are just as, as staggering. Just as staggering.
• 30:10
  I mean, it's, it's, a, you know, we've got COVID issues, right, forcing a lot of people into, um, a bad financial situation.
• 30:17
  But, you know, it, it, it's, it, uh, it is right up there in terms of the leading cause of bankruptcy in this country, and that is a shame as well.
• 30:25
  We should be able to create a system that is a highly efficient, driven by technology, um, where we can deliver care at an affordable price that delivers the outcomes we want.
• 30:36
  That, that isn't an impossibility, and the fact that we hold onto that idea, um, needs to, needs to change.
• 30:43
  Well, Carm, thanks for spending the time to, uh, to share with me, uh, not just the update but your, your passion as well.
• 30:48
  I thank you for spending, uh, the last seven years on this or more, and, uh, appreciate that I know you're gonna, you're gonna stay at it. So thank you very much. Yeah.
• 30:58
  Thanks so much for having me, and have a good rest of your day. All right. You too. Be well. Yeah. Bye.
• 31:04
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