Latest / The Advancing Healthcare Innovation Show / E188: The Hidden Reason Your Prescription Costs So Much with Miriam Paramore

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E188: The Hidden Reason Your Prescription Costs So Much with Miriam Paramore · The Advancing Healthcare Innovation Show

0:11
Hello and welcome back to the Advancing
0:13
Health Innovation Show. I am your host,
0:15
Michael Stamatinos, and if you're new to
0:18
us, welcome. We're excited to have you
0:21
here because we are having just some
0:23
really fun conversations with real
0:26
healthcare leaders that are changing the
0:28
trajectory of the future of healthcare.
0:31
We're pretty passionate about a few
0:32
different areas. We're passionate about
0:34
access. We're passionate about
0:35
leadership uh innovation and and
0:38
actually the adoption of that
0:39
innovation. And if you're if you're if
0:41
it's your first time tuning in, let me
0:43
just take a quick step back and just
0:44
kind of give you the skinny on what
0:45
we're really trying to do here. So the
0:48
ethos of the show is highlighting real
0:50
people that are truly innovating within
0:52
our space and giving them the safe space
0:54
to be able to share their stories, share
0:56
their little wins, and share some of the
0:58
learnings with our audience and with our
1:00
community and ultimately with the world.
1:02
If you haven't had an opportunity to
1:04
check out any of the historical
1:06
interviews, however you're ingesting
1:08
this, whether you're watching it,
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whether you're listening to it, please
1:11
hit the subscribe button now so that any
1:14
of the new interviews come directly to
1:17
you. So, this next guest I'm actually
1:20
super excited about. I think sometimes
1:21
when you speak to someone um for the
1:24
first time or you have like an instant
1:26
connection, I'll say this is this is it.
1:30
But before I kind of dive into
1:31
introducing her, I want to sort of share
1:33
I want to share a moment. There's um
1:36
there's a moment that happens every
1:37
single day where maybe a patient walks
1:39
into a pharmacy all across the country.
1:41
This happens every single day. The
1:43
patient walks in with a prescription,
1:45
they hand it over, the pharmacist types
1:48
something, usually they pause, they type
1:50
again, and then they say a number.
1:54
And that number changes everything. But
1:57
for a lot of people, that number ends
2:00
the conversation. They don't fill the
2:02
prescription. They go home. I've seen
2:05
this happen numerous times. And they
2:07
figure that they're probably just going
2:08
to deal with it later. Or or or maybe
2:11
they just don't. And the truth is is
2:14
that half of all the patients in this
2:18
country in the United States,
2:20
they do not take their med medication as
2:23
prescribed. Half. And the leading reason
2:27
is cost. Not because it was too complex,
2:30
cost. So what makes that really hard for
2:34
me to accept is that savings do exist.
2:38
Um there's co-ay assistant that's out
2:40
there. There are low prices that are out
2:42
there. They're sitting inside of a
2:44
system that just never learned to talk
2:48
to each other. And today's guest, Miriam
2:52
Paramore, has spent more than 40 years
2:56
in this industry. She is so impressive.
2:59
She has built companies. She has run
3:02
them. She has helped kind of take the
3:05
administrative simplification piece of
3:07
the Affordable Care Act. She took
3:09
company to NASDAQ. She has sat in rooms
3:12
that most of us dream of sitting in. She
3:15
knows how to build technology. She knows
3:17
how to get things funded. She's deployed
3:19
things at scale.
3:21
And when Miriam took a look at this
3:23
problem, she did something that most
3:26
people just don't do. She started over.
3:29
She started a new company. She founded a
3:31
company called RX Utility. And what they
3:34
built is a platform that connects sort
3:37
of health systems, payers, pharmacists
3:41
and digital health partners at the point
3:44
of prescribing and pickup with real time
3:48
manufacturer co-pay assistance. So
3:51
meaning the right information gets to
3:54
the right person at the right moment
3:56
before they walk away.
3:58
>> Right?
3:59
>> So Miriam is an operating adviser at
4:01
Goldman Sachs. She's a limited partner
4:03
at uh Sevenwire Ventures. She's an angel
4:06
investor. Her track record is
4:08
ridiculous. Um, and I'm just super very
4:13
fortunate to be able to sort of have her
4:15
on the show today. So, I think she had
4:19
an opportunity to just sort of sit back
4:20
and coast and she's like, "No, no, no,
4:22
no, no, no. I'm going to fix this." So,
4:24
she's choosing to do this instead. So,
4:26
Miriam, it's so nice to see you. Welcome
4:28
to the show.
4:29
>> Thank you. Thank you, Michael. I'm so
4:31
delighted to be here. I'm It's a real
4:34
pleasure. It's a joy to get to talk to
4:36
you and thank you upfront for um using
4:40
your voice and creating a space for
4:42
other people to tell stories about
4:45
things that we can do together to make
4:49
our health care system in the US better.
4:53
Of course, globally too, but you know,
4:55
this is where I I live um and my corner
4:58
of the world. And then also really
5:00
touching people because the health care
5:03
system is sort of a mechanism but you
5:06
know each of us are are people um that
5:09
are just kind of going through life and
5:11
we're trying to
5:13
>> get and stay healthy um
5:16
>> inside a system that's very complicated.
5:20
So, um, removing the complication and
5:23
focusing on the people part. I know that
5:25
that's really where where you focus and
5:28
that's where your heart is. And so,
5:29
yeah, thank you for that the platform
5:31
opportunity to speak.
5:33
>> It's my pleasure. Um, before we kind of
5:35
dig into the nuts and bolts of things, I
5:37
want to before the companies, you know,
5:40
before like, you know, everything that
5:41
you've built, um, I kind of want to
5:43
start somewhere because I just was sort
5:45
of reading a bunch about you before
5:46
this, not like stalking, but just just
5:49
reading about you.
5:51
>> Um, I want you to tell me about your
5:53
dad, Jack, and I know that he left the
5:57
family farm to become a preacher, which
6:00
obviously isn't which isn't a small
6:02
decision. And I think that's this is a
6:05
person that's choosing service uh over I
6:09
guess security in that sense.
6:11
>> What did sort of watching him make that
6:14
choice
6:15
uh teach you about life, you know, well
6:18
spent? What is that in ter and what that
6:20
looks like?
6:22
>> Oh man, Michael, thank you so much for
6:24
starting there. Now, I may be get all
6:26
emotional and lose here, but I'll I'll
6:29
um what I'm for those of you who can see
6:32
on on YouTube or video wherever, you'll
6:35
see that I'm wearing a necklace that is
6:37
an amperand sign.
6:39
>> Yeah.
6:40
>> And my father had this made uh by a
6:43
little jeweler in his little bitty town
6:46
in Eastern North Carolina and gave it to
6:48
me as a birthday present. I didn't even
6:51
know we were going to talk about this,
6:52
Michael. This is I just wear it. We're
6:54
just we're just unscripted here. So,
6:56
it's like I just thought about
6:57
>> I wear it every day. Um he was so so
7:01
very thoughtful and the time in my life
7:04
this was about 12 13 years ago. Um I had
7:07
gone through a really extraordinary
7:10
uh and sudden traumatic loss and a set
7:14
of uh consequences that really really
7:16
shook me and knocked me down. And uh I
7:20
was 50 years old at the time. Uh so
7:24
>> um you know he he gave this to me for my
7:27
50th birthday and and he wrote me this
7:29
beautiful poem with it and and he said
7:31
this is to help you remember
7:34
this is an and moment. This is not the
7:37
end of life. Not everything is over and
7:41
there will be better days and there will
7:44
be more opportunities
7:46
and you will you know laugh again th
7:49
those sorts of things
7:51
>> and that's the sort of person that he
7:53
that he was. My father uh Jack Paramore,
7:56
he really loved people and he had this
8:00
essence of curiosity and you know just
8:04
wanting to just really loved people
8:06
wanting to know and connect and so when
8:09
he made the decision to become a
8:12
preacher, it was a spiritual calling for
8:16
for him. Um, and it's it was certainly a
8:20
life choice that affected my mom and you
8:22
know obviously our our family. Um, and
8:25
it had not it wasn't an easy like road u
8:30
for for him in particular. But he lived
8:33
his life um focused on something that is
8:36
bigger than self. You know there are
8:39
things that are more important than
8:42
>> um you know what we may selfishly desire
8:45
at any one time.
8:47
um community,
8:50
others, being of service. These things
8:52
are just fundamental to why we are here
8:56
>> at all.
8:58
>> Yeah.
8:58
>> Okay. And so just don't think that
9:02
you're the center of the universe
9:03
because because you're not, but you're
9:05
important. We're all important. And then
9:08
when we connect, it's just like when we
9:10
met when you connect with other people,
9:13
this explosion of sort of energy,
9:15
positive energy, I think sort of
9:17
happens.
9:18
>> Yeah.
9:19
>> And he was a person who always sought to
9:24
lift up and encourage and create more
9:27
positive
9:28
um in the world. He he told me that, you
9:32
know, a sign of character is that if you
9:34
leave a place in a better condition than
9:38
you found it. And what he would use this
9:41
simple example of if you're a guest and
9:43
someone has you over and you have a, you
9:46
know, you're coming through town and
9:47
they say, "Oh, you can stay at my
9:48
house." You know, do you do something
9:51
just a little special for them? Do you
9:53
make sure that not only you strip the
9:55
sheets and you put all the dirty towels
9:57
in their laundry, but you know, could
9:59
you did you leave them a thank you note?
10:02
Did you That's right. Maybe, you know,
10:05
make sure that um you picked up
10:07
something for them that was just a
10:10
little bit of
10:11
>> um I didn't just come here to take, you
10:14
know, I came here to
10:17
>> um be grateful and then also to do
10:20
something for you. So, um, when he
10:24
passed away, kind of bringing it back to
10:27
healthc care, um, after a nice a long
10:30
life, he was about 87 and it was a
10:32
little over two years ago that that we
10:33
lost him,
10:34
>> but he had a collection of, um, chronic
10:38
illnesses that developed with aging. He
10:41
had heart failure, pretty severe,
10:43
multiple stances and things.
10:45
>> Uh, towards the end of his life, he had
10:47
kidney failure. Um, and he had a number
10:49
of other issues as well, but he lived in
10:51
rural North Carolina. He had pretty
10:52
severe melanoma on his face after he
10:55
spent all of his youth out in the
10:57
fields, you know, I mean, right,
10:58
>> no one had sunscreen in the like 19, you
11:01
know, 42, right? So,
11:04
>> wasn't a thing,
11:05
>> right? Wasn't a thing. So, um, but I saw
11:08
in a heartbreaking way the the
11:11
fragmentation of, you know, four or five
11:14
doctors at a time, no real quarterback,
11:18
rural setting,
11:20
45 minutes one way to a dialysis center
11:23
when he was really too old to drive.
11:25
Yet, his, in fact, he didn't even have a
11:27
license. his uh insurance company, his
11:30
insurance which was Medicare Advantage,
11:33
which is what I always thought was
11:34
Medicare Plus,
11:36
>> but it turns out it isn't Medicare Plus.
11:39
It's just
11:40
>> Medicare different. And one of the
11:42
things that was different for him is
11:44
transportation wasn't covered.
11:48
>> So, it would have been under regular
11:50
Medicare. So, you go down the road and
11:52
you say, "Well, gosh, are you Medicaid
11:54
eligible?" Because, you know, you can do
11:55
the dual.
11:56
>> Yes.
11:57
But he made $500 living off of, you
12:01
know, his social security check.
12:03
Basically, he had he had $500 a month.
12:06
Too much money to qualify for the
12:10
Medicaid. Uh
12:12
>> yeah, it's that cliff
12:14
>> transportation. You're in or you're not.
12:16
Yeah.
12:16
>> Yeah. Competes. And so, um when you put
12:19
on top of that, like he always went to
12:21
Costco to get his drugs because those
12:22
were the cheapest.
12:24
>> Um
12:25
>> he
12:26
was not a person who needed very
12:30
expensive specialty drugs.
12:32
>> Right.
12:32
>> Okay.
12:33
>> Yeah.
12:34
>> But had he had that need, there is no
12:38
way in the world he would have been able
12:40
to afford it. It absolutely impossible
12:43
unless my sister and I, you know, helped
12:44
him, which which of course do.
12:47
>> But there are millions of people like my
12:50
father every day and they do not have
12:53
extra financial resources. they just
12:56
don't. And so those stories sort of come
13:00
together into what fuels my passion to
13:05
right now with this business called Car
13:07
Arts Utility, this piece of my life.
13:10
>> Um to help people afford medicine.
13:13
That's that's the mission of the of the
13:15
company.
13:17
>> I love the mission. I think that's why
13:18
we connected since we both care deeply
13:20
about access. Before we dig into RX
13:22
utility, I just want to spend a few
13:24
minutes about just sort of
13:26
>> earlier chapters in your life um because
13:28
you've been building healthcare
13:29
technology uh since before most people
13:32
in the industry even knew what an API
13:35
was.
13:36
>> Um what is the thing that you built
13:40
early in your career that you're super
13:42
proud of that almost nobody talks about?
13:46
>> Oh gosh. Okay. So this is the thing that
13:49
I'm most proud of that um no one would
13:52
ever know if I didn't tell. So um
13:56
there's there's a thing in healthcare
13:58
called revenue cycle management and a
14:00
bunch of your listeners may know that
14:02
but some may not. So you might hear this
14:03
acronym RCM revenue cycle management.
14:06
>> Well I go back to the day when claims
14:09
were printed and mailed from a provider
14:12
to a insurance company and then they
14:14
would mail a check back. Right? So, it's
14:16
a lot of printing and mailing and
14:18
postage. Um, first part of my career was
14:21
really getting all of that us into a
14:23
world of what's called EDI or electronic
14:25
data interchange. So, electronic claims
14:27
filing.
14:29
>> Um, so we kind of went up that ramp in
14:31
the 90s as an industry, but we were
14:34
still printing and mailing paper checks
14:36
back from payers to providers. So, file
14:39
the claim electronically, but here comes
14:40
the paper check in the mail.
14:42
>> Yeah. There were it's an inert well it's
14:44
an inertia reason around that and um
14:47
doctors had a a irrational fear that if
14:50
they allowed payers to pay them
14:52
electronically that somehow that gave
14:54
payers access to bank account so they
14:57
could also sell money
14:59
>> which wasn't you're spot on which wasn't
15:01
true but it was a fear and you know
15:04
we're in a world now everything is is
15:05
digital but you know 30 30 years ago
15:08
that wasn't true right and so Medicare
15:11
came out and said, "Listen, the only way
15:13
we're going to pay you is via electronic
15:15
funds transfer." And of course, we all
15:16
get paid by direct deposit forever. Now,
15:19
nobody thinks anything of it,
15:20
>> but but commercial payers weren't doing
15:23
that and doctors didn't want. So,
15:25
they're printing and mailing.
15:27
>> So, u this is during the Obama
15:29
administration, we had the Affordable
15:30
Care Act. So you're like 2008 nishish
15:34
that starts and you're in that
15:36
>> and I was working for a big company that
15:39
had a lot of lines of service in the RCM
15:41
space. We had a clearing house. We had
15:43
various workflow tools and so forth. It
15:46
was called MDON at the time and now it's
15:48
change healthcare but we took the
15:50
company public and changed the name. So
15:51
it used to have this old MDON name. Um
15:55
so I was like man this is so stupid that
15:58
we're still printing and mailing these
15:59
checks. what can we do? So, I didn't
16:02
know anything about lobbying, but um I
16:04
said, "Let's do this." I was in charge
16:06
of strategy and product for the company.
16:08
So,
16:09
>> we got a lobbyist to teach us how to
16:11
talk to Congress. And I went to
16:13
Washington. I created this um index that
16:18
showed how many trees we kill and how
16:20
much money we spend printing and mailing
16:22
paper checks in healthcare.
16:25
>> Yeah. And so, um, you know, you're on a
16:28
napkin, you're in com like I'm so
16:30
awesome
16:33
only senators can get on and and all the
16:35
meetings were like down in the basement
16:37
in this cafeteria.
16:39
So, you're like, "Oh, well, this is
16:40
somebody's aid or this is whatever." So,
16:43
because this is what's called a pay for
16:45
provision, it it actually got into the
16:48
law. It's in there. So, there's like one
16:50
sentence in the Affordable Care Act,
16:52
maybe a whole paragraph that that I I
16:55
can say I'm responsible for, and that
16:57
was a requirement that payers pay
17:01
providers by EFT.
17:04
>> Yeah.
17:05
>> So, we got rid of all of that waste. And
17:08
that is that I'm so proud of that
17:11
because
17:12
>> Yeah.
17:13
You're too young to know school house
17:15
rock and that there it was a little
17:18
cartoon for kids and it had this story.
17:20
I'm just a bill. Yeah. I'm only a bill.
17:23
It was like
17:23
>> I actually know that by the way you
17:25
know. Okay. Okay.
17:26
>> Yeah. Yeah. And I felt like I was in I
17:28
felt I had seen that when I was a child
17:30
and I'm like, "Oh, this is so
17:31
inspirational the way our country works
17:33
and you know you can have a voice and
17:36
you know you can help change things and
17:38
like here I am in this one little way
17:41
>> but it was kind of a big thing. It was
17:44
like
17:46
a year of waste.
17:47
>> It was just pure weight.
17:50
>> So um I used to feel really bad. This is
17:54
sounds may sound that man I'm just so
17:56
vulnerable. You just make me feel so
17:57
safe. So cut any of this that doesn't I
18:00
mean you can keep it or cut it. You do
18:02
it.
18:02
>> We're keeping it. Come on. Keeping it.
18:04
It's good.
18:05
>> But um I felt like gosh I I wish I could
18:09
heal people. You know I wish I could be
18:12
a doctor. I wish I could be an you know
18:14
wouldn't it be better if I blah blah.
18:17
But I've kind I came to realize that I
18:21
am a businesswoman and I'm a
18:23
technologist and those are kind of my
18:26
skills
18:27
>> and um that is also helpful.
18:31
>> Yeah. Yeah. So, so when you get to put
18:33
it into practice, when you get to apply
18:36
something that says this allows the
18:40
doctors to get paid faster without
18:42
killing a bunch of trees and it drops
18:45
out this administrative waste from the
18:47
system.
18:48
>> Yeah. I mean 11 billion is I mean that's
18:50
a that's a big number.
18:52
>> Nothing. Yeah. So, so we would then hope
18:55
that that would flow through to helping
18:59
um our system be um less expensive.
19:04
>> So,
19:06
>> unfortunately, you and I know and we
19:08
work on it every day. It it actually
19:11
really worked because our system is more
19:13
expensive
19:14
>> and our outcomes are not as good.
19:17
>> That's right.
19:18
>> Um as they were. So, you know, um, so we
19:22
have to keep trying. We have to
19:24
>> what else could we do?
19:26
>> What What a cool story. I'm I'm just
19:29
sort of thinking back on that
19:30
experience.
19:31
>> Like what did that teach you about how
19:34
change actually happens in our country?
19:38
Do you do you take that with you and
19:40
sort of kind of compound it and apply it
19:41
in a different way now?
19:44
>> Yeah. you know, it was my first um and
19:47
so this is this is roughly 2009. So this
19:49
is you knowif what 15 how many years ago
19:52
was that? A long time. Um I did not know
19:56
anything about rule making or law
19:59
makingaking really like what who do like
20:01
how does that happen? I kind of knew
20:02
there were committees and vague things.
20:05
So I didn't know something that's called
20:07
a pay for provision. And what that means
20:09
is if somebody's proposing a law, how it
20:14
gets paid for is always the question.
20:15
You know, like we raise taxes or where's
20:17
the money come from to do this new
20:19
thing. So a pay for provision means that
20:23
it pays for itself.
20:25
So you know whatever implementation
20:29
fees there would be associated with
20:31
upgrading to
20:34
>> um are paid for. So and the government
20:36
doesn't have to write checks. This is
20:38
just something that pays for itself with
20:40
its own efficiencies.
20:42
Those pay for provisions are the kind
20:44
that typically are nonpartisan.
20:48
>> So because when something's going to
20:49
cost something
20:51
>> Yeah.
20:52
>> somebody's the other side probably
20:53
doesn't like, you know, it's just
20:54
something.
20:56
>> Yeah.
20:56
>> So that was a big learning. If you're
20:59
going to bring an idea and there's
21:01
change associated and then there's
21:03
expense associated with the change, then
21:06
have some sort of pay for so that that
21:10
it's inarguable. And when you're talking
21:12
about something as nonpartisan as
21:15
printing a piece of paper and putting it
21:18
in the mail, it's hard to construct
21:22
a a political argument against it,
21:24
right?
21:25
>> Yeah. So, I I learned about that and
21:28
then I learned uh it was kind of funny
21:30
to me that we we would have meetings
21:32
with these uh elected officials, but we
21:35
actually never met with any of the
21:36
elected officials. We always met with
21:38
their staff. So, that's when I learned
21:41
that they don't read anything that their
21:42
staff does. And so, that's okay. You
21:45
know, I you don't really
21:47
>> It's like the game of telephone, though.
21:48
It's like you have that moment that you
21:50
need to give them that one golden
21:51
nugget. It's like what is the piercing
21:53
insight that you're going to give them?
21:54
they're not going to remember the
21:55
40page, you know, debriefing that you
21:57
spent hours on. It's like you need to
21:59
give them the snippet
22:00
>> that, you know, so you know, my world
22:02
everything's 8020. Like what's the 20%
22:04
you got to give them that's going to get
22:05
them 80% there or maybe ideally, you
22:07
know, the 5% is going to get you 95% of
22:09
the way there realistically.
22:12
>> And you're right. And you know, I also
22:14
learned that you know how people say,
22:15
well, it was a back of the napkin thing
22:17
and they kind of that's sort of a
22:18
throwaway.
22:19
>> Yeah. the napkins were the most
22:21
effective thing that I did in the
22:23
cafeteria. I was like, "Let me just show
22:25
you on this napkin." Because you got,
22:27
like you said, you have 15 minutes of
22:30
somebody that's got a thousand zillion
22:32
things to do. So being able to take um a
22:36
complicated concept and make it simple
22:39
and easy to understand such that it
22:42
sticks in the mind of a politician and
22:46
doesn't have baggage of like, oh my
22:48
goodness, I'm going to have to fight
22:49
everybody in the universe to get this
22:50
done. it it it can kind of check and
22:54
kind of go.
22:55
>> Um so I learned I learned that and then
22:59
um building on that over the next
23:02
probably 10 years of being involved in
23:04
all the data policy the things like
23:06
HIPPA high-tech and the rule making and
23:09
stuff like that. That's just tedious
23:11
work. You got to really really want it
23:13
to
23:14
>> just get in there and stay in the bits
23:16
and bites and the you know fields and
23:19
field definitions. But thankfully I'm a
23:21
nerd so I like I didn't mind doing it.
23:26
>> So then was it the series of things that
23:29
your life occurrences that occurred that
23:32
drew you to this problem? You're like I
23:34
I just I'm fixated on it. I have
23:37
relationships.
23:38
I have kind of pieces. I've done this
23:40
before. Because I think others that you
23:44
know at at that stage in their career
23:46
maybe they would have been like made
23:48
excuses of why they wouldn't do it.
23:51
>> What was it for you that just sort of
23:53
continued to draw you to this and say
23:56
where you had to make an excuse to be
23:57
like well this is why I have to do it.
23:59
>> What was that?
24:02
>> Well, I think my uh you know I mentioned
24:04
we talked about my father. Um my mother
24:07
also passed um in a similar time frame
24:10
and her they had been divorced for a
24:12
long time so they lived in different
24:13
parts of the country but
24:14
>> right
24:14
>> her her end of life was very different
24:17
whereas she was physically
24:20
um healthy in her body but her mind was
24:24
not healthy. She had dementia very
24:26
debilitating disease and over the last
24:29
seven years of her life very horrific.
24:32
When you work in the healthcare industry
24:34
and then you spend a lot of time with
24:36
people who are very ill and over a
24:40
number of years, you just see up close
24:44
um
24:46
all of the problems of the system.
24:48
>> Yeah.
24:49
>> Right. And and and you're working with
24:51
people that you love.
24:53
>> Um you know, my sister had a cancer
24:56
diagnosis. Thankfully, she was very
24:58
early stage. She's fine. Um but you end
25:02
up over the years everybody you know is
25:04
in healthcare. So it's very common for
25:06
people hey have you ever heard of this
25:08
medicine or do you know anything about a
25:10
clinical trial. So it it tends to be
25:12
healthcare tends to draw people as an
25:15
industry that actually sort of care
25:17
about other people healthcare really.
25:20
Yeah.
25:20
>> So you're sort of I've always sort of
25:21
been immersed in that and at this point
25:25
the the sort of towards the last part of
25:26
my career at the Optimizer X
25:28
organization I learned a lot about sort
25:31
of life sciences pharma as an ecosystem
25:35
versus healthcare service delivery in an
25:37
ecosystem.
25:38
>> How do they exchange information?
25:40
>> Yeah.
25:40
>> And how do they
25:42
>> talk to each other for the benefit of
25:44
the patient?
25:45
>> Yeah. So, um I I I saw that it really
25:49
there's really no digital bridge that's
25:51
meaningful there. They do direct to
25:54
consumer advertising, but in terms of um
25:58
they might as well be, you know,
26:00
Australia and North America in terms of
26:03
how
26:03
>> Yeah. A lot of distance.
26:05
>> Yes. In terms of how um the information
26:11
related to treatment
26:13
>> Yeah. shows up in a consumer's life at a
26:17
deep level, you know, when that
26:19
medication is needed. And in the middle,
26:22
we have all this administrative stuff
26:24
and we put things on formularies to
26:26
gatekeep what drugs you're allowed to
26:29
have. Um, that's pharma doesn't do that.
26:33
The health plans do that, but they kind
26:34
of come together and,
26:37
>> um, collude might be a little strong,
26:40
but they
26:45
fix the system through these PBM
26:48
functions that are under a lot of form
26:50
pressure now.
26:53
But the net result of that sort of
26:55
inside baseball as I call it is that we
26:58
have consumers paying list price which
27:00
is a totally madeup price list price on
27:03
drugs
27:04
>> when they're in their deductible phase.
27:08
Yet if their employer were paying for
27:09
it, you know, their employer would pay
27:12
50% less than the employee pays because
27:16
of the rebate.
27:17
>> So the Eloquist example
27:19
>> Mark Cuban uses and I think I I told
27:21
you, you know, yeah, if I'm high
27:23
deductive phase, it's $600 a bottle,
27:25
>> but if my employer paid for it, it's
27:27
$300. You know, it just it makes
27:30
absolutely no sense. And when it gets
27:32
down, what happens is
27:34
the the laws, the structures, the
27:37
business agreements are bu are built
27:39
around and and rightfully so at a at a
27:42
at a country level. They're population
27:46
based, which means I have a bunch of
27:48
people. I'm an employer. I'm going to
27:49
cover them with insurance, but I have to
27:52
cost shift and risk adjust. And that
27:55
shows up in premiums. Um, and then we've
27:58
got these co-pays and co- insurance and
28:01
none of it actually
28:03
does any good in the macro. Otherwise,
28:05
we would have cheaper healthcare and
28:07
better outcomes, but we don't.
28:10
>> And so, being a technologist here,
28:14
right, in the age of AI
28:16
and having written cobalt code 40 years
28:19
ago, um, I was excited by the
28:22
technology, but that's not the
28:24
motivation. The motivation is could I
28:27
find a way to cut through
28:31
the nonsense of the current system if I
28:34
only focused on the consumer out of
28:37
pocket
28:41
>> could I cut through the system and
28:43
create a sustainable business
28:46
not um a charity so I'm working my way
28:52
through that and so far we're succeeding
28:54
ing because
28:57
>> so explain this to me. I mean, explain
28:58
RX utility to me like I've never heard
29:01
of it. Explain it the way you would
29:04
explain it to someone who just, you
29:06
know, handed a number pharmacy counter
29:10
and and and they can't afford it. Like,
29:13
explain it to me.
29:14
>> Okay, so this is the easiest way to
29:18
think about it. If I said to you, what
29:20
does gas cost?
29:22
you would say, um, that's four. Yeah.
29:26
459,
29:28
>> but one of the questions you would say
29:30
is, well, it depends on where you live
29:31
because if you're in California,
29:32
>> yeah, it's it's six bucks. Yeah.
29:34
>> So, there's always a little bit of a
29:36
variable, but you kind of know.
29:38
>> Yeah. You kind of have an orientation.
29:40
Yeah.
29:40
>> Yeah. If I said to you, how much does
29:42
Eloquist cost? Literally, no one can
29:45
answer that question. Why? Because there
29:50
are so many variables. It depends on are
29:53
are do you have insurance?
29:56
Are you in your deductible phase?
30:00
>> What is your co-pay for this? Is this
30:02
drug covered by your insurance?
30:05
>> Yeah.
30:06
>> Okay. And then
30:09
um is there a pharmaceutical
30:10
manufacturer co-pay coupon available
30:13
which you mentioned earlier?
30:15
>> Yeah. Then then the question is, is the
30:18
manufacturer starting to sell directly
30:20
to patients? You've seen this with the
30:23
GLPs, Lily Direct, and others. That used
30:26
to happen. That's a different price than
30:28
if you go to the retail pharmacy.
30:30
>> Okay? And then you say,
30:33
what does it cost if I pay cash? Now I'm
30:36
up to the sixth price point.
30:39
And if I use cash,
30:42
what people don't know is that cash
30:44
doesn't mean there's just a cash price.
30:46
Like if I go pay cash, you know, Kleenex
30:49
are always $3.99 now,
30:51
>> right?
30:52
>> It's it's it's $3.99 at Walgreens, but
30:55
it's $4.99 at, you know, CVS. So,
31:00
>> there are literally millions and
31:02
millions and millions of cash prices
31:04
that have been created by these cash
31:06
discount card vendors. The most
31:08
well-known is Good RX, but there are a
31:10
bunch of others. Single carry is a good
31:12
buzz is a good one.
31:14
>> And those price spreads for my eye drops
31:17
that I got after eye surgery last year
31:19
was one cash price was $15, one cash
31:23
price was $37, and one cash price was
31:26
$56.
31:28
>> Wow.
31:28
>> You're thinking, how in the world?
31:29
>> Quite a spread.
31:31
>> It is quite a spread. And that depends
31:34
on more inside baseball
31:37
between
31:39
retailies
31:41
and PBMs.
31:43
And every single one of these
31:44
dependencies I said has spread in the
31:47
middle because somebody's making money
31:50
>> right
31:50
>> this supply chain. So what I wanted to
31:54
do was to have a tool that says how much
31:58
does blank cost? Eloquist, WGO,
32:01
Skyrizzy, fill in the blank
32:03
>> and be able to give to the consumer true
32:06
price transparency and visibility for
32:09
their very best price. So it's like this
32:12
is the cheapest cash price for you.
32:15
>> Yeah. Yeah. this is your insured price
32:19
and there is or is not a co-ay coupon
32:22
and that's that price and there is or is
32:24
not a direct to patient pharma website.
32:27
So we've served so what we did was we
32:29
built a utility that's why I named the
32:31
company that I want it to be a
32:32
ubiquitous tool across the industry. We
32:36
focus on democratizing prices. We just
32:38
make it easy for the consumer to answer
32:40
the question what does this drug cost me
32:44
today?
32:46
Okay. So, that's what we built and it's
32:50
very exciting because data
32:54
can flow into any screen and everybody's
32:57
got enough screens and software.
33:00
>> Yeah.
33:00
>> So, data can flow there. And the thing
33:02
we're announcing on Monday, so but by
33:04
the time this is posts, we will I can
33:06
say this, we are launching our AI
33:09
companion called Mimi. Um, and Mimi
33:13
answers that question for you. So, you
33:15
just go to Mimi and it's free and you
33:18
create a pro a login and you say, "How
33:21
much does WGO cost?" And she brings you
33:25
back all of those prices
33:28
and then she can help you decide,
33:31
do you want to use cash on this one? Do
33:34
you want to use your insurance benefit?
33:37
Uh, which pharmacy is best for you,
33:39
cheapest for you? Um, and she can answer
33:42
education questions, too, like what does
33:43
this drug do and things like that.
33:46
>> That's amazing. I'm just thinking what
33:48
why has nobody been able to like surface
33:50
this information before?
33:52
>> Oh, boy. The wise. So, there's um
33:57
there's I I I have a hard time not
34:00
getting mad because people
34:02
>> So, yeah, it's your episode. you can get
34:03
mad,
34:04
>> hide the ball, you know, but I don't
34:06
want to be like, you know, I don't know.
34:08
I don't I'm not trying to be preachy too
34:10
much. That'd be my dad be preaching, but
34:13
>> but um
34:16
when you look at the way our health care
34:19
system works,
34:22
um primarily the way health insurance
34:24
works. Um the thought about keeping
34:28
costs down again tends to be at the
34:30
population level. that's controlled by a
34:34
group purchaser who is looking at how
34:37
much they're saving in the aggregate and
34:39
how many rebates they get back and rebet
34:41
dollars to hit their P&L and and like a
34:43
cash flush, you know,
34:46
>> and they don't take it all the way
34:47
through to the consumer. They just
34:49
don't.
34:50
>> So they they stop at the group.
34:55
>> So you want to take it all the way
34:57
through to the consumer out of pocket.
35:01
>> Yeah. Okay. But it doesn't. So you got
35:04
to care about that last leg and and and
35:07
and that's what I I have chosen to care
35:10
about, you know, for this particular
35:12
tool. Um so now we're working across the
35:17
spectrum. It's very exciting. So now we
35:19
are actually working with pharmacies
35:21
providers, a lot of direct primary care
35:24
doctors and you know those people that
35:26
have gone outside insurance, they're
35:28
like listen
35:29
>> all cash all the time. Okay, that's all
35:32
very growing very fast. About
35:35
>> it's go it's it's almost 15% of all
35:38
prescriptions that are filled people are
35:40
using cash now
35:42
>> and just
35:44
>> interesting almost 15%.
35:46
>> Wow.
35:46
>> Yeah, it's big decent chunk of the pie.
35:49
I didn't expect that.
35:50
>> Right. It was surprising as I got into
35:52
it. Well, you know, people don't even
35:55
know insurance is so complicated. People
35:58
don't know this simple fact that tier
36:00
one generic drugs, tier one co-pays is
36:03
usually around 15 bucks. Sometimes it's
36:06
10, but it, you know, 15 tier tier one
36:09
on a formulary.
36:11
>> Um, if you pay cash for that $10 bottle
36:13
of drugs, it's the cash. It cost you $2.
36:18
>> So consumers don't know that cash is
36:20
cheaper than insurance a lot of times.
36:24
And
36:25
>> that crazy,
36:26
>> but they should know, you know, that
36:28
people should know. And you're not
36:30
saying not to use insurance because you
36:34
do want deductible, you know, but if
36:36
you're in a high deductible, my
36:38
deductible is $10,000. I got to buy a
36:40
heck of a lot of $10 bottles worth of
36:42
pills before I hit my deductible. So
36:47
people haven't done it because
36:49
there's no
36:51
strong revenue model around pure
36:56
consumer savings focus.
37:00
So, uh,
37:02
>> you know, it it we're capitalism and
37:04
that we are all of the financial
37:06
incentives for the players in the market
37:08
are how to make themselves more money
37:12
because they're they're they have to
37:13
create shareholder value, you know, and
37:16
there that's not, you know, there's
37:18
nothing wrong with that. But um it's
37:21
those are
37:23
it's a it's a complicated reason, but
37:25
there there are
37:26
>> there are systemic design reasons that
37:29
people just don't care how it hits the
37:32
individual out of pocket
37:34
>> is the last last mile and and a lot of
37:37
people just stop before they get there.
37:40
>> You mentioned something earlier about,
37:41
you know, you're figuring out the
37:42
business model, like where's the
37:44
business model today? Who's who's the
37:46
customer? Like who pays you? How how
37:48
does that work? Yeah. Um, so because we
37:51
developed a an AI a modular AI platform,
37:55
we started at the bottom with open AI
37:57
and anthropics. So our solutions are
37:59
trained on multimodal.
38:01
Then we have our knowledge base on top
38:03
of those models. Then we curated
38:06
proprietary data sets about pricing
38:10
>> and so people can subscribe to the data
38:12
set layer
38:14
>> and they can then inject those prices
38:16
into their systems. That's what I want
38:19
>> because I want all the prices to come to
38:21
the surface.
38:24
>> Doesn't matter to me how you surface it.
38:25
Just get it
38:27
>> out there. Right?
38:28
>> So the second layer or the next
38:31
subscription layer is I don't want just
38:33
the price data streams. I'd like the uh
38:37
p um intelligence the the decisioning
38:41
layer of which price and comparisons so
38:45
they can subscribe there and then if
38:48
they do not have an AI companion um or
38:50
an AI guide like Mimi, they can
38:53
subscribe to Mimi, they can white label
38:56
or turnkey her and they can go and get
38:58
the whole stack. So depending on where
39:02
you are in your um own technology
39:05
infrastructure,
39:07
if you're a payer, PBM,
39:11
benefits navigator,
39:13
member engagement, patient engagement,
39:16
pharmacy systems, provider systems. If
39:18
you're touching a person, you're
39:20
touching their medicine information.
39:22
>> Yeah, that's right.
39:24
So bring forward price, bring forward
39:28
savings opportunity in those workflows
39:31
wherever that makes sense and everybody
39:34
is going to be AI conversational within
39:37
five years if not two. So if we can help
39:42
jumpstart conversational interaction
39:45
with consumers,
39:47
um we we want to do that. And an and and
39:50
a great example of kind of a next step
39:52
is we're doing it for medications right
39:54
now, which is big. That's a there's a
39:56
lot, you know, 20,000 medications in
39:58
rotation right now for prescriptions.
40:01
But when I was at the WBL conference
40:03
last week, one of my tablemates, she
40:05
runs a company called SimplyFed. I'll
40:07
give SimplyFed a shout out, and they're
40:10
lactation
40:11
um consultants and solutions that are
40:14
paid for by insurance. Yeah.
40:17
>> Do you think that we could put
40:18
information there about breast pumps
40:20
because all of my patients are so
40:22
confused about whether or not their
40:25
breast pumps are covered by insurance?
40:27
>> Yes. Yeah. We went through this
40:29
ourselves, my wife. Yeah.
40:30
>> Did you? Okay. So, so imagine just
40:34
having a tool just to say, you know,
40:36
does this does my insurance cover this
40:38
and where how much does it cost and
40:39
where can I get it the cheapest? Just as
40:41
quick interaction,
40:43
>> just a quick query. Yeah. You don't want
40:45
to have to. I mean, we had a we had it
40:47
was it was a it was a process. You know,
40:48
you get a phone call, you it's a lot of
40:51
work, but to be able to have that
40:52
instantaneous
40:54
>> kind of loop that that's that's nice.
40:58
>> Yeah. Yeah. So I I know that um you know
41:02
you're an operator but you're also an
41:04
investor and you know you coach CEOs at
41:07
Goldman Sachs Portco companies and
41:09
you're an LP at 7 wire and you angel
41:12
invest. When when a founder walks into a
41:15
room and and you know within five
41:18
minutes that they have or they don't
41:23
have what it takes. If they don't have
41:24
what it takes,
41:26
what do you actually see?
41:30
This is a really great question because
41:32
you put your finger on the most
41:35
important
41:37
thing of whether a company is fundable
41:39
or not because especially early stages
41:43
investors are really investing in the
41:45
person
41:48
>> more
41:49
than the business plan even though the
41:52
business plan needs to have something
41:54
good about it. Um, what I see the most
41:59
when I can say they do they don't have
42:01
it is they do not understand
42:05
the
42:07
market and the problem they're trying to
42:10
solve. And so they're kind of a hammer
42:13
looking for a nail.
42:15
>> Yeah.
42:16
>> Right. That's a they really are
42:18
>> problem or a solution looking for a
42:20
problem. And when
42:26
you don't understand your customer
42:30
and the market they're in,
42:33
>> you're just making things up. They might
42:35
they might be sort of rational things
42:38
you're making up,
42:39
>> right? But you can't succeed because
42:42
you're not close enough to what the
42:44
customer really needs, where the market
42:46
really is, and if someone is ready to
42:52
listen to what it is you have to say.
42:55
>> Yeah.
42:58
>> And if and if you had to go back and
43:00
kind of tell yourself something at the
43:02
very beginning uh of your career, the
43:05
version of you that was just starting
43:06
out, what I guess what would you say?
43:09
boy, you know, one of the things I wish
43:11
I'd had earlier was more confidence, but
43:14
I um but I would say in with respect to
43:18
this sort of like the creation of
43:21
solutions or creation of companies, I
43:24
too just did not
43:27
I I was more in love with what I saw as
43:29
solutions to things than I was educated
43:34
on what the world needed or what the
43:36
market needed or what the sector needed.
43:40
So, it was really cart before the horse
43:43
thinking. Well-intentioned.
43:45
>> Yeah.
43:46
>> Just just not appropriately placed. And
43:49
you've got to be um very grounded in um
43:55
somebody needs what you've got. And that
43:57
takes it's more strategic than you might
44:00
think.
44:01
>> It's more listening, less talking.
44:04
>> Yeah.
44:06
And before I forget, where can people go
44:09
to uh follow you, follow your journey,
44:12
follow everything that you're doing with
44:13
ARX Utility, like give us a little
44:15
snapshot before we wrap.
44:17
>> Thank you so much for that because I
44:19
love it when they do that at the end of
44:20
podcast is so cool.
44:22
>> Um, so anybody can email me Miriam
44:25
Miriamxutility.com.
44:31
Um, or follow me on LinkedIn. Awesome.
44:35
Yeah. So, what kind of first off, thanks
44:39
for sharing the stuff that you shared
44:40
about with your dad. I wasn't sure where
44:42
I was going to go, how that experiment
44:43
would run. I just decided to do that in
44:45
an instant. Um, so that was appreciate
44:48
you being a good sport about that. But
44:50
it kind of shows the human factor kind
44:53
of behind the thing that you're building
44:56
and the rationale in terms of going in
44:59
and wanting to do this. It it makes it
45:01
makes total sense.
45:04
there's amazing operators that are out
45:05
there that build stuff that continues to
45:08
kind of stand the test of time and I I
45:10
find that to be really fascinating. So,
45:13
the fact that you've been at this
45:15
consistently for 40 years, making a
45:17
difference, being in those rooms, and
45:19
then just having the willingness to sort
45:20
of share those stories with our
45:22
community means everything to me. Um,
45:24
and if you if someone if you're
45:26
listening to this and you found that to
45:27
be particularly helpful, um, I think the
45:30
best way that you could showcase the
45:32
love and support for what Mary and her
45:34
team are doing is to actually share the
45:37
episode, like it, comment on it, let us
45:39
know what stood out to you. I think the
45:42
stories that she shared in and of itself
45:44
are actually u world class. So, let us
45:47
know about that. And if there is, by the
45:49
way, a topic that you want us to explore
45:51
or even a leader that you think is um
45:54
notable that that you want to hear from,
45:56
please drop us a note, let us know. We
45:58
do read those. We do proactively
45:59
outreach to folks, try to get them on to
46:01
the show. This isn't just a platform
46:03
that's only about content. It is an
46:05
interactive community. It's a living,
46:07
breathing thing, and we try to feed it.
46:08
We try to nurture it as best as
46:09
possible. So, thank you so much for
46:12
listening, Miam. It was a delight and
46:14
joy to have you on today. Obviously,
46:16
we'd love to hear more about what's
46:18
going on with the company and you know,
46:19
I always kind of leave the door open for
46:21
additional chapters of your story to be
46:24
shared on the show. Uh, so for those
46:26
listening, please keep building with
46:28
purpose, keep moving things along, and
46:31
we will see you next time on the
46:33
Advancing Healthcare Innovation Show.
46:35
>> Thank you so much, Michael. I really
46:37
appreciate it.
46:38
>> Pleasure.