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 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 gonna do that with the CEO of Rx review. Karm, Huntress, fantastic conversation, fantastic solution. Looking forward to sharing it with you.

My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach. . Consultant and creator of this week in health, it a set of podcast videos and collaboration events dedicated to developing the next generation. Of health leaders. I wanna 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 want 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, uh, all the, all the support that they've given us this year as well.

Now onto the show. Alright, today I'm joined by Carm Huntress, the CEO for RX review, and I'm looking forward to this episode. I, I've been, uh, transparency is something we talk about a lot on this show and we talk about the, 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. Thank you so much for having me. It's great to be here. This is such a huge topic, and you guys are, you guys are doing a lot of, a lot of stuff in this space. Let, let's just start with, tell us a little bit about RX review and what you guys are doing. Yeah, well, RX review has been around for, uh, believe it or not, almost eight years now.

And we're really focused on cost transparency particular in, in, in, in and around drug cost transparency. So bringing that data to the point of care and really helping providers, uh, make the most cost effective decision for every patient when they're prescribing. The way we do that is 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, and then we bring that to the point of care. So providers can make the most, uh, informed decision when they're prescribing, uh, a new drug for a patient.

So they're, so the provider's actually looking at. What the patient is going to pay for the drug, essentially. Yep. Absolutely. It's, it's the, a simple way of thinking about it, 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 scent, this is at my CVS or Walgreens or whatever retail pharmacy they use.

This is what I'm gonna pay today. And then also provide the, 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, and look at a preferred drug by the payer that that doesn't have a prior auth. And then maybe a mail order pharmacy is more cost effective.

And so we'll show those options. So this is all about really addressing . The need for providers to prescribe more cost effectively, cost drug cost for patients has become a huge national issue, especially as we've, we've become much more consumer centric in terms of who's paying for the cost of their care, 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 wrap.

Additional discussion 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, uh, results as, as we've scaled up this data at the point of care. So, so scale is really important here, right? So you need, you need to be connected to all those pharmacies, all the PBMs.

You need to have the data on that side. And then the, and then essentially the network effect. Having the, the more, the more providers you work with, the more information you get and the more valuable the tool becomes. How, how widespread are you guys at this point? Yeah. We've, uh, been lucky to really experience some immense growth over the last, uh, probably two years.

On the payer and PBM side, we work with . The, the brand names that you would know, UnitedHealthcare, 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. Uh. 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, our network to bring this data to the EHRs at the point of prescribing. 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 and so we're scaling extremely fast right now. There is a immense need in the market for this data 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 closely together to really create the best provider experience possible. Yeah. There's the, the, the optimist to me, wants you to answer this question by the consumerization of healthcare, but I doubt what's is.

Is it, is it being driven by health systems? Is it being driven by the consumer? Where, where's it, where's the, the growth coming from? Yeah. I mean, I think there's a number of tailwinds. I think there's definitely, I. The, 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, is pretty significant from the provider perspective. And then you've got consumer-driven healthcare here, where patients are having harder and harder times 'cause their deductibles are higher, really covering the cost of their medications. And we're seeing some really bad situations where it's leading to bankruptcy.

So that's, those tailwinds really com combined altogether are forcing. The payers and PBMs to bring this data to market and make it available, and then aggregators like us bring it together. And then the, the EHRs 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 to date. So are, are you guys replacing the formulary? Are you typically replacing. A different vendor that's, that's handling the formulary at this point?

Yeah, that's, that's a great question. So traditionally 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 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 around and it, it could lead to a lot of delays in terms of the EHR having it up to date. 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's inaccurate 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're in their deductible, where you know what pharmacy is in network, out network 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 in a number of ways to getting, I. Real time individual, patient cost transparency data to the point of care and, and really cannibalizing traditional f and b in terms of a, a business market out there. 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 something and then the next patient comes in and I could see a different price and I could be sitting back and going, Hey, wait a minute. This, this price is changing. That accurately reflects what the real time, what the user or the patient who's sitting in front of me is, is going to pay.

Yeah. It's such a, that just identifies the complexity of what you're up against as a provider. I mean, this is, this is getting back to why this is so helpful in that the provider instantly has. Information that, for instance, on one plan, a drug could be covered and then another plan, it could not be covered.

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 inter, inter 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. The same insulin and it is covered. And so those are the things that we're really solving that are, are really creating fan fantastic ROI and, and a lot of administrative, uh, savings for both providers and, and pharmacies and, uh, as well as the payers and PBMs.

So you have, you have some serious users. I mean UPMC, Cedars, Providence, uc, health.

Almost everybody has Surescripts, right? So, uh, 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? Yeah, there's, 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 in many cases, we live alongside 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, so our investors are health systems, so we're really focused on how we can help health systems.

What's that provider experience like? . 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, um, vendor in the space we're basically the best. I think this led to part of the reason why Athena picked us as a partner, 'cause they really want a great provider experience and we're delivering that. So those are the core differences that, um, we're really delivering at the, at the point of care.

I would also say that some of the stuff we're getting into in terms of measurement, into actually understanding how doctors are using this data. Is of real interest to our, our, our health system partners. And that's part of the reason they pick us too, just because, uh, we have pretty rich data and analytics we can provide them on, Hey, is this data really helping?

And how are providers changing their behavior? Yeah, so I, so it's almost like you had me at Hello, but now I'm gonna dig in a little bit here. I, I wanna talk about R-O-I-R-O-I and. Physician adoption. Right? So I, I assume the physicians use it because it's built into their workflow. It, it just pops up. It's pretty easy.

Or is there, is there a, is there a learning curve? Is there something that I'm gonna have to do within our health system to get the physicians to, to adopt it? No. And that's really the beauty of this, is that we've had these close partnerships with Epic, Cerner, and, and now Athena, where this is built into the native

Ordering, prescription ordering process. So, so it's not, it's not popping up Rx review, it's, it's Right, right. In the screens that they're used to looking at. Yep, exactly. It's in line in, in many cases, they, there's native buttons that they can have right in their ordering screen that they can look at the cost data.

And so that's what is, is, is really driven 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. 'cause 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. And that's what we really think has to happen. We spend a lot of time in earlier iterations so that the company trying to, you know, get providers to kind of use apps. Based approaches. But we really fundamentally believe this has to be part of native workflows.

And the way we talk about it internally is it's like about in, uh, what we call informed autonomy. We wanna 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. 'cause they have a lot of other facts around clinical effectiveness and the patient's, you know, history that are, they're using to rationalize that decision.

So we're just trying to get that right information right at that point of decision making to help them rationalize the most cost effective choice. So I, I, I mean, clearly I can see the, the benefits of the providers, the benefits to the. 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, where am I gonna find ROI with it? With your tool? Yeah. I mean, the first is sort of convenience or administrative cost savings. So if you look at, I. Just on a, a good, great example is on prior 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, uh, 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, uh, statistic and patients are getting their drug.

50%. I. 52% faster. 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. So that is just amazing savings. In terms of , when you think about . About 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 other patients who have affordability issues. So we're really happy with the ROI and . Both to the health system, right to the provider we're delivering, but also to our payer and PBM partners in terms of both cost save, direct cost savings, but also administrative savings around things like prior authorization.

So you talked about this a little bit before, and that was. It you now have a significant amount of data. Uh, are are the, are the providers putting that data to work? Are they doing some advanced analytics around that? 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, their be, their behavior change is still in, in the, in the low single digits, which isn't great. We definitely wanna maximize that change behavior rate when we're working with with providers. That's enough to really make a demonstrable effect 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 what values that providing to the, to the provider, to the patient and to the payer. And then we're really now in this movement into me, into saying, well, how could we improve that?

Right. And that has to do in a couple 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? You might have a system of a few thousand doctors, but there's only a small subset that are really driving a lot of that cost or unnecessary cost.

And then the second thing is really working with our, our EHR partners on the workflow. How, how are we, you know, showing these options? How are we making the easing, how are we making it the path, at least resistant 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. All right. I'm gonna, I'm gonna go off this a little bit. You and I, you get, you and I met, what is it, 5, 5, 6 years ago? Well, you were the, I'm, I'm, I'm sorry. I'm, I'm being terrible here. You were CIO back then, I believe when I first met you.

Yes. Yes. I used to be somebody, as they said. Yeah. Yeah. You, you were ACIO. The, the, the, when we first met, and I was. We were fighting for and for scraps back then, as I would say. Yeah. In terms, well, that's what I, that's what I wanna talk about. I mean, people love to hear that story of how did it start?

Usually it starts with like a doctor and a, and a, a smart technology person coming together and going, Hey, we can do something here. I mean, what's, what's your story? Yeah. 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 is he and I met and he had just, he'd done two really interesting things.

One is that he worked with his, uh, mother on her prescription drugs. He was on a bunch of drugs and he just sat down as a doctor and kind of went through and optimized her, her meds, and he realized just by making some simple switches and other things that he could save her. You know, $400 a month for her on a fixed income.

That was a big deal. And he said, gosh, if you know my mother, and we have this phrase in our company called, her name was Lucy. And we have now a cup, 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 realized, wow, there's gonna be a lot of, a lot of patients must have the same problem.

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 opaque. Someone's, someone has to figure this out. I had no idea the challenge I was up against. 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, 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, with, uh, popups with. We tried everything we could, and this is a classic story of a. Luck is the intersection of opportunity and preparation.

in that we basically came to the market and we started talking to payers. 'cause 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 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, eh R has finally said, Hey, there's enough evidence here that this data's really gonna be valuable and necessary for value-based care and consumer-driven healthcare is fueling it.

Let's get it actually to our native workflows. But they're not gonna, an EHR is not gonna go out there and . Do all these connectivity and data normalization and these con, you know, 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.

And that's really the last two years has been a rocket ship ride of, of our growth and, 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. So just so people don't take this lightly, the, the normalization of the dr the drug data is pretty, uh, the Medica medication data is pretty, uh.

Challenging, isn't it? 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, 10,000 better uh, transactions. So means a lot to us 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 that eligibility and the For the tech listeners out there, we need to know a 2 2 2 72 71 eligibility request. We have to look at that data. We have to look at their preferred pharmacy. We look after 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 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 the, the. Our, our partners don't know this, but we do, they're, they have their 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 of 'em provide more data, and so there's a huge amount of, 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 a 77 mean? It means that this drug's not covered and, 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. . So that's incredibly important as we think about.

So there's some pretty hardcore engineering underneath the hood, uh, 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, se seven, eight years at this would mean that you're like, uh, 64 years in company. Time this startup in, in healthcare. Uh, so you're, you're, you're one of the more seasoned people at this point.

What, what do you, what do you tell those who are, are just starting out or just, uh, getting ready to do their, their health tech startup? Yeah, I, I'll, I'll give my macro perspective and then kind of what I give individual advice around. 'cause I do see more and more healthcare . Early stage CEOs coming to me asking me questions like this.

And, and I think the challenge here, bill, sadly, is we've invested a huge amount of money into healthcare. I mean, it's, it's kind of staggering. I, I know it's in the tens of billions. I. It's a, it's a massive number now. Something like 7,000, 8,000 startups is 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 a 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. It's really due to if you, for lack of a better word, the rationality of healthcare.

And I think that's probably, for me, when I started and for new people coming in 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 gonna deliver value here, and who's it accruing to and who's gonna pay for it?

We tend to rush to consumer driven experiences, but again, even in high consumer driven plans, you still have your, your employer who's covering some of the cost or still in a lot of cases, a lot of it on the commercial side, I. And then you got complexity with providers and where they are and their technology.

And so I, I just think that 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 and the pharmaceutical value chain, it's incredibly complex. Yep. There's wholesalers, there's PBMs, there's providers, there's payers, there's . Retail pharmacies, 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, 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 perspective.

You know, that's a, that is such a great point. I so. Startups. I have that conversation and they, I say, okay, what's your economic model? How, who's gonna pay you? And they say, well, these people are gonna pay me. I'm like, have they ever paid for this before? No. Well, no, but now they're gonna pay for it. It's like, no, they're not

Yeah. Yeah. It's, it's just, it's just wild. Uh, and I see the same thing where, you know, and I think one of the things that we've done, and, and I, I think this is so true, is that we spend so much time focusing on the consumer and, and we've come to this conclusion as a company. Any prescription decision or any decision prescription or otherwise is made by the provider?

Yeah, it's, it's not made by consumers, and consumers are really, I mean, I'm really, I consider myself a relatively well ed, 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, 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, with the provider. I think of, uh, AUL Gawande's, I, I think, quote, he says The most expensive medical devices, the pen , because the provider, not that that's true anymore with EHRs, but they're writing all the orders.

And, and I think that's such a great quote and I think about that often because this is so much, I think the, you know, 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, you know, we think the market's going overall.

Yeah. What really resonates with me, my, so my, for the first time in six months, my wife actually, and. I cared for her father, and he take, he has his morning pills, his, his dinner pills, and then he has his, before he goes to bed, pills and I, it's probably about 12 pills. 10 to 12 pills and each, not all of em, but a significant number of those are prescribed, and that's.

Uh, between, between caring for him and trying to pick the right plan and all that stuff, and, and talking to my parents and, and, and learning all these, these, the new terminology and the things my mom says to me all the time. Oh, I'm in the donut hole. I'm in the donut hole. Well, I'm like, I mean, it's, this really matters to somebody who's on income.

The amount they're spending on their meds is significant, significant. Of, uh, stress for them and a significant amount of, uh, trust they have to place into that position to, to help them. So, uh, having that information at the point of care is just, is so critical. It's such great service. Yeah, I mean, I couldn't agree more.

I mean, if you look at, I think 70 and old over on typically seven or eight, seven or more medications, uh, that's at least the stat I have in my head ar around.

How, how many medications there 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 gonna 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 point, right? Medicare part D plan or whatever it may be. That's supporting the cost side of it and then rationalizing, well, is this the most cost effective and is, can they afford it? And, 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 all the options.

We've analyzed the clinical effective we, the cost and the convenience for the the patient. And here's the best 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, you know, recommendations. I. To, to what would be the best choice? No different than a shopping experience that we have online today where we get really good recommendations and we that narrow our, our list, we can filter, we can do all sorts of stuff to get and 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. Great solution. I'm glad you're still around after eight years, even after, as you say, picking ups early. I appreciate Have thanks. I appreciate. Yeah. Thanks for having me, bill. It's been great.

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