Danielle and Cam speak with Varun Goyal, CEO of Illuminate Health. Varun talks about how better medication management via tele-pharmacy decreases adverse reactions to medications, the future of tele-pharmacy, and the applications of Artificial Intelligence in the field.

“I think in terms of the future of telehealth it is going to be the mix of a hybrid care model based on preferences on the provider and patient side, clinical protocols, insurance companies, and reimbursement of course will have a role there. But talking about the future can’t be truly complete without mentioning AI. How do we customize the time with a pharmacist? How do we let technology make the first pass and have pharmacists really focus on what needs to be done?”

I think in terms.

The future of telehealth it's gonna be a mix of the, hybrid care models based on

preferences on provider, patient side, clinical protocols, insurance companies

and reimbursement will have a role there.

And then of course this conversation would be incomplete without mentioning

AI How do we optimize the time of a pharmacist ? How do we let technology

take a first pass and have pharmacists really focus in on what needs to be done.

Welcome to a virtual view where we talk about tele-health

healthcare and everything in between.

we're joined today by Varon Goyle the CEO and co-founder of

illuminate health to discuss telepharmacy and medication management platforms.

Thank you so much for joining us today.

You bet, Daniel, thanks for having me on.

Yeah.

Could you give us a quick overview of your background?

Absolutely.

Yeah I'm an engineer by background and, just spent a large amount of my career in

designing software solutions for different companies and in various industries.

And gravitated towards healthcare over time, just given how complex

it is and, seemed to be behind the tech adoption curve if you will.

So yeah, we're no business school for healthcare and been working in healthcare,

starting out with a role with a company called Hillrom in Ville, Indiana.

Did that for a couple of years in medical devices and then moved

up to working close to Carmel at a company called avail in revenue cycle.

Management and really understanding the reimbursement side of healthcare

from a provider perspective, as well as a health plan perspective.

And that's when we had some personal experiences with the medication

errors that led us to start thinking about med management and how can

we offer a better experience.

So that's a little bit about my background.

Did that naturally lead into telehealth or was that something you

specifically knew that you wanted to bring the medication management into.

So really, the piece that was interesting to me is that in this day

and age, we were having an experience like this, where, we were getting

prescribed the wrong medication or.

Being prescribed a medication despite documented side effects to

a medication or allergic reactions.

We started looking at tools on the market that consumers like us could

use, and didn't find anything with, I'll call it clinical intelligence

or true value if you will.

And and so around that time, I met my co-founder Kal.

Looking at my background, he started talking to me about all his issues,

managing his own meds and unexpected side effects and this and that.

So we had this meeting of the minds where we said, we've talked to enough people.

We've seen the statistics out there around what's called adverse drug events.

Where it's either a medication error or other reason.

And a lot of them are preventable.

And so we need to do something about this, so that's how we started thinking about.

And really focusing in on the medication safety piece, but then

the confusion piece even for someone like me, I was taking an antibiotic.

I think it was CIN where, because I was researching this project, I

sat and read through the pamphlet that comes from the pharmacy.

Which most people don't it's full of medical jargon.

I also needed a magnifying lens to read the small font.

But I realized that I should not be taking the medication within

two hours of having a meal.

Otherwise it makes the medicine less effective and I'm like,

why would no one tell me that?

Stuff like that gets to me.

And of course, we've all seen our.

Parents and grandparents age and struggle with, managing the 10 meds.

And everyone's confused when and how do I take these 10 meds?

Do I have to take today?

So that's the way we came to where we are because , over time, we started

relying on our neighborhood pharmacist.

To be honest with you.

And so that's how the thesis came together.

We said, okay, it'd be satisfying for us.

If we could use technology to simplify med management for the average, Joe.

And put the pharmacist at the helm of driving that patient care,

because, there's such a medication expert and quite the underutilized

resource underrecognized.

Pharmacists are frequently overlooked as a healthcare professional.

And I think that's very interesting how you took your own personal

experiences, as well as just looking at the needs of what was out there and

then moving forward with this project.

Really what we are trying to do is provide medication management

as a service led by pharmacists, but enabled by technology.

And that's where that telehealth piece comes in, where, we want

everyone to have easy access.

To, to the right information at the right time.

Not just digital resources, but then, the consults, the interventions that a

pharmacist can do the education piece.

So that's how we've been thinking about it and we started out more

on the patient side, looking at the challenges they have as we discussed.

Our recent focus given that, we are connecting the pharmacist with patient.

Has been on the pharmacist tools as well.

How do we make it easy for pharmacists to really focus on, patient care

Exactly.

So we talked a little bit about the risks and benefits, but are there specific

risks that exist in maybe a traditional healthcare setting that doing this

through telehealth sort of mitigates.

which is what they're passionate about doing?

Absolutely.

So the obvious benefit of telehealth is the access, right?

The convenience, the ease of being able to consult with a healthcare professional

cost also, comes into play in terms of having that access as well as timing, so

with telehealth, you can, potentially even just talk to your provider right away.

And so that's.

The a similar benefit from our perspective, in terms of more of that

pharmacy care management side of things that it's just accessing timely help.

And is this something where having this information more

readily available to patients?

Is that something that impacts health literacy at all?

Oh, absolutely.

Yeah.

And in fact that's a huge reason.

Why we designed our solution this way.

We wanted to take some of that work off self care, off the plate

of either the patient themselves or maybe the family . Caregiver.

And as I shared recently, even the pharmacist and so a lot of the way

we've designed our, tech platform.

And approach is to improve health literacy because as majority of Americans,

do not have the health literacy.

I think the last statistic I read was was it 80% do not or

something drastic like that.

We focus a lot on, when is the right time to take a given medication?

And how do you take the medication and so on.

So that's a big aspect of improving that.

Let's call it medication literacy, and then, we can we configure the daily

routine and care plan if you will specific to the patient's condition.

So that's where some of the disease education comes in as well.

And hence, all of it goes hand in terms of increasing health literacy.

Cuz now they've got the educational references and the mobile app for

the patient or the family caregiver, prompting them, educating them,

engaging them while also providing easy access to a pharmacist.

When they have a question apart from the scenarios where pharmacists

would proactively reach out to.

I do think it's interesting that you mentioned like family caregivers, cuz

I know that a population that is very dependent on medication is aging adults.

And that's a population that again, may not have that health literacy.

So I think we talk about involving family caregivers and that kind of stuff.

And is that something that is made easier through a telehealth platform like this.

Absolutely.

You think about, the caregiver burden as it's called of taking care.

Right.

A loved one.

It's real, these people are trying to manage somewhat of a professional life

if it's still possible, along with other aspects of, family home and more.

And our approach is really, how do we simplify?

How do we take something off their plate and just make it super easy

for them to just know that, okay.

Cameron this is the pill you need to give.

Your loved one at this time, and this is what it looks like.

And by the way, give it with a full glass of water.

And just check it off that you gave it.

So it's stuff like that.

And then, if, yeah, if they have a side effect or some question, Cameron

can now just just chat message the question and the pharmacist can

respond in a timely manner as compared to Cameron having to call multiple

places or having the doctor respond within 24 hours and stuff like that.

Yeah.

That's interesting point too, when you're talking about, how can we.

Improve access as well, health literacy, as well as take some of the burden

off of some of the caregivers who are working directly with those patients.

And one of the big barriers with that is, during the COVID 19 pandemic in

telemedicine appointments, providers were able to prescribe directly to patients.

Now we don't have anything set in stone.

However, it seems to be trending back to, once the COVID 19 pandemic ends,

that, the ability to be able to prescribe medication to patients via telemedicine

appointment may be in jeopardy.

From your perspective, and just, working with patients for telepharmacy, what's

some of the benefits of, being able to.

Be prescribed the medication via telemedicine appoint.

You know, back to the point you made earlier, Cameron, I it's more

of the controlled substances, right?

That there, needs to be more scrutiny around because unfortunately there's

the good side and the bad side of it.

Just like everything else.

I absolutely, otherwise support the the prescribing over telehealth, again, from

the standpoint of ease the convenience, the access but obviously, it's a mix.

Clinical protocols in terms of, does a provider need to actually

examine you physically in order to comfortably prescribe something as

well as, patient preferences now where.

Yeah, let's say that I might be able to get my prescription over telehealth,

but I'm just used to wanting to see the provider face to face in person.

And that's just my comfort level.

So it's, I think we're at that cusp of like you said, where

telehealth's utilization just, skyrocketed early in the pandemic.

And then now it's wanna call it plateaued to some degree or come back to maybe.

Could be the new normal, but I think people are still trying to

figure out what is that right.

Hybrid care model

where,

We've had the most use cases with the most variety of telehealth

services that we've ever had in the past.

And we did that in a panic during the pandemic, cuz that was the only

way we could roll out care to people.

But now we're moving into this stage where.

Does this particular type of service or this particular activity that

we're doing with a patient make sense to do in a virtual format?

Is it better to do in person?

Is it better to do virtual?

Is it okay?

Both ways?

so we're kind of in this weird limbo spot where we're still looking at a lot

of different things to see, what's gonna be the method that makes most sense.

And it's interesting, you brought up patient choice.

I think that's gonna become a much.

Bigger deal with care, that's gonna drive what a lot of change will look like in

either these virtual first, in person or hybrid what are patients choosing?

So if they really want certain services using tele behavioral health, as an

example, To be predominantly virtual.

That's gonna change the landscape of what behavioral healthcare

will look like in the future.

Absolutely.

Yeah.

But if people maybe are seeking out care for a different

condition and they prefer to be seen in person and that's what

majority of the people are doing.

That's also gonna impact that service line.

So it's gonna be interesting to see, how some of those things shake out.

But even within the realm of telepharmacy, what do those protocols look like?

When it comes to prescribing controlled substances to patients and what

would be the most effective approach I think is something that a lot of

people still have on their mind and are trying to figure out, sorry.

So we talk about patient choice and patient preference, and I

think it gets very interesting when we get into the realm of populations that

maybe don't have the same access to services things like rural populations.

We work a lot with those, or like I said, populations that

are aging in place and maybe.

Can't get to a provider.

I think telehealth and medication management platforms could be a very

good sort of avenue for those folks who maybe don't have the luxury of choice

to have access to these services.

Absolutely.

, transport and the distances to your point is such a big challenge.

From that perspective, I think what's been interesting in the last couple

of years is just seeing that tech adoption, if you will, where, up to

a large degree, it's just smartphone access used to be a challenge.

Thankfully the Medicaid plans, states and others have made smart phones available

or tablets in some cases for folks on.

And then even the tech savviness has really come up on the learning

curve over the pandemic, because everyone's had to adopt to zoom or

whatever it might be whether for work or, stay in touch with their family.

And so I think, we've come a long way in terms of that infrastructure

and that digital literacy piece.

Of course, still room to grow, especially in the aging population,

but I think that's where back to.

Conversation about the family caregivers, that becomes more relevant

where, maybe it, it is that grandson or wife or someone who's helping

the the person with technology.

Which of course has, become much more simplified than

what it used to be as well.

So I think that's really the way we see this going in terms of,

the rural populations as well.

And same with the providing value to providers in, in the rural health

setting as well, where, even they don't have the same level of resources.

And how can a service like ours provide value to the provider who's already,

overworked burned out potentially.

Where, we can take on some of the work of med management, medication education

and even some of the care coordination that it's involved in, what's called a

medication reconciliation where, we're trying to verify that this patient who

was just discharged from a hospital back to their home environment,

what is their latest and greatest medication list that they should be.

Because they had meds going into the hospital and then now

they have new meds as well.

And even those aspects so that we can then share an updated medication list

with the provider, with the family, caregiver, and patient just is,

we've heard is tremendously valuable.

Yeah.

yeah, in my own personal experience, I've had family members

with chronic health issues, and I know that even just finding.

A complete list of all of those medications can be a real task.

And even after that of figuring out what the interactions and the different side

effects to be on the lookout for are, can be something that's very difficult without

the aid of some sort of platform or having a pharmacist like readily available.

I think even with that, we've seen some and you can correct

me if I'm wrong, or if I'm making this up, I probably need to go.

Get a patent for this, but uh, I've seen commercials for, this machine where

you can put multiple medications in it and you can put settings so that for

individuals know the particular cadence.

Or time of day that they're supposed to be taking certain medications.

Now, granted, those are helpful and those can be a, something to

use as an assist, but it still doesn't help you with interactions.

I'm.

Pretty sure they don't tell you.

Yeah.

You need to eat before you take this medication and some more of

the specifics with that, and I'm sure the barrier to entry as far as

cost for those are not cheap either.

So we've seen, some of those, that are supplements, but not

really quite a complete solution to really help people with that.

You really do have to have that engage.

With a healthcare professional that knows those medications and can

really educate that patient to really see positive results, long term.

Yeah, that's a great point, Cameron, cuz essentially, what you're

referring to is, is covering sort of one aspect of the challenge, right?

But there's still other aspects, whether it's the consultation with

the pharmacist or closing the loop with your doctor or whatever it might

be where, a lot of us have to work.

Together nicely or so even on our advisory board, we've got Dr.

Aiden Fang who, who actually came from a company that did

those home dispensing devices.

Really Neat looking robotic device and, dispenses medications on time and so on.

And yeah, there's, a couple of others in the market, but yeah, to your point

it provides part of the solution.

And the cost of entry, is huge, which, over time, yeah.

Time will tell, will help plans wanna pay for this, as a standard.

Issue or standard protocol along with then what are the wraparound

services, the actual medications being delivered, so they can be loaded into

the device and, all kinds of these other things that, that go into this.

Yeah.

And we talk about all these different solutions not just the hardware ones,

but all the different software stuff too.

And I know in telehealth as a whole, and I'm sure in telepharmacy there's

an issue with interoperability.

Is that something you ever face in your work?

Absolutely.

The good news is that there's legislation now in terms of, what's being called the

in, information blocking that's, trickling down the pipes and, providers, health

plans are working on making, are, consumer health information available more freely.

So we've got a couple of different approaches.

We essentially try and work with.

Data.

Every time we're starting to work with a health plan, that's our source of truth.

If you will.

Anything we can get from the providers is fantastic.

Along with, whatever the patient might have as their record, if you will.

And that's also the beauty of telehealth because now, the patient can just bring

all their meds from the medicine cabinet.

Put them on the table right now here, and our pharmacist can see on the camera.

Okay.

I see this is what, so I think interoperability is

an interesting one, I think.

Yeah.

Lots to be done there.

But thankfully, again, things are moving the right direction.

But but honestly, I think the value of service like this also.

The fact that you're not just relying on technology so we started a few years

ago with a ton of mobile apps, right?

There's an app for this half for that.

However, engaging you make a kind of freestanding mobile app, people may

continue or may not continue to use it.

Research has shown that if you've got a trusted clinician, monitoring what

you're doing in the mobile app, right?

Are you taking your meds?

Are you reporting on your symptoms and side effects and this and that then

that engagement and that compliance is a lot higher because as you would

expect, it's you know, that, oh, pharmacist, Joe is watching out for

me and taking this into account as part of the care decisions for me.

So I'm gonna be better about, keeping track of these things.

So I think that also to me is a huge value prop for telehealth service.

I feel like with telehealth, we get very caught up in the shiny

new technology aspect of that.

And sometimes forget that there is a lot of value, obviously in

still having medical providers and medical professionals.

Be a part of that and that a great value of telehealth is to just connect

with those folks, not just to have a fancy camera, what have you, but

is to provide those connections and to provide that consistent care?

And I think with

Yeah, for sure.

The additional tools.

So what's that saying, right?

The best technology should not be in, in your environment, it should

just be the background if you will.

So technology is just the enabler.

It can help prompt it can, help you track, give more insight and do how you're doing.

But it's healthcare.

We need that human touch, that human contact.

So absolutely.

you can.

Catch some of these drug interactions a lot quicker It's

not a one size fits all approach.

Each patient is gonna interact with a drug differently.

That's usually why there's a little bit of trial and error, even when you're trying

a new drug for the first time, you don't know exactly how your body's gonna react.

So being able to have, that open line of communication with a pharmacist to

begin with is gonna be really valuable.

But, for some of our listeners who maybe Aren.

Very knowledgeable about,

what do drug interactions really look like?

So how does that impact a patient?

Or how does that impact their health outcomes if they are having

some of these drug interactions.

Yeah, absolutely.

A drug interaction could present itself as a very mild, let's say symptom like

nausea or stomach upset or something.

But unfortunately some of the severe drug interactions could, lead you

to have to go to the ER right away.

Unfortunately, the debts are also part of the system when it comes to that.

And there's multiple aspects of adverse drug events as they're

called, there's drug interactions.

Yes.

But then there's also.

Is this dosage of medication appropriate, given the patient's,

gender, age, weight, things like that.

Is there a duplication of therapy going on where it's not just the same drug

that's being prescribed twice and being taken twice, but the same category of

drug where maybe the patient is not able to see that, at drug a and drug.

So they're different, but they're the same category.

And so they're still causing that duplication.

So there's multiple aspects of this that, folks have to watch out for, I think

and then there's the allergies, where, I might be allergic to self on drugs

for example, or, whatever it might be.

And then, even food.

Interactions to some degree, grapefruit juice, for example, with a lot of

medications, is suggested not to have, or, definite not to have.

And then, back to your earlier comment, Cameron, I.

Knowing, which medication's gonna work better.

I think especially in behavioral health, is a tough one for prescribers to know,

Hey, which medicine do I start with?

And then there's conditions where you need more frequent sort of monitoring

and tight trading of the medication, so adjusting a dose based on how today

is versus yesterday and so forth.

So hence.

More and more the access we at telehealth and that continued sort of engagement

model versus a once and done, let's say medication consult, if you will.

Makes sense.

And last but not least, I think where, pharmaco genomics now can

play a role as the markers are getting more and more accurate.

Isn't exactly what you said, in informing some of those prescribing decisions.

Which medication is gonna be processed better by patient

Veron versus, Cameron and so on.

So I think yeah, it's an exciting time.

Yeah, and this is, and I'm gonna apologize for my ignorance

with that, but I have heard of.

Being able to test to see, genetically which medications

are gonna be best for you.

I met that with a little bit of skeptic skepticism if I was being honest, but

just curious from your perspective, where are we at when it comes to that

genetic linkage when it comes to certain medications and the effectiveness.

Yeah, no, absolutely.

And I was in the same boat, I wanna say about four years ago, when, one

really started hearing about gen genomics and genetic testing, especially

with 23 NME and others, right?

The consumer facing marketing was big in, back.

Time, if you will.

But but more specifically, the pharmacogenomic side of it has

really come a long way as well.

In, in those years, because not only can your, gen general sort of profile be

valuable for a physician while they're making prescribing decisions or for

a pharmacist when they're helping you optimize your medication therapies.

But then now you can have focus testing from a pharmacogenomic

profile perspective as well.

You.

Focused on a few conditions that, the FDA and CDC have said that yes, these

are, pretty accurate and worth reviewing.

So I would absolutely, recommend that at this point.

Obviously there's a variance in terms of, the vendors that do a good job

with it and who have got a better reputation, more accuracy, this and

that, but I that's with everything else,

yeah, no, that's really interesting.

I had heard of it and I really didn't do a whole lot of digging in it myself

to know, okay, how accurate is this?

Some that feedback, it's come a long way in a very short period of time.

And there's a lot of practical applications with it as well.

Do you see, especially with pharmacists, when you're utilizing some of these

medications and perhaps, maybe you are treating a patient who is

diabetic, and so you're giving them.

Drugs that are gonna help them manage their conditions.

Do you see applications of like remote patient monitoring to where

they're gonna utilize peripheral devices to help, determine what impact

perhaps that medication is having on managing that patient's condition?

Absolutely.

That's definitely a direction we're headed in, as, as that's a direction

where the industry in general is going with the reimbursement code,

of RPM ever since it got available.

And there's so much value in, in getting that data.

The, at home device, if you will.

So blood pressure being the most common one, or checking your glucose readings

and more and now of course, a lot more sophisticated devices with, what's

being called a hospital in the home.

Scenario.

Even for us app, that's an area where we are starting to look at, how do we tie in

the data from, an ongoing diagnostic side of it to marry it up with the medication

management side of it, because then we can have the full picture of, okay,

Cameron, you say you're taking your, blood pressure meds, but your blood pressure

reading does not say the same thing.

Right.

So it's stuff like that.

I think that'll really play an important role bringing it all together.

And part of that is as Danielle was saying before is interoperability and making

sure that all the data can be structured properly and you get the right insights at

the right time and be able to intervene.

That's all really exciting.

And just looking at like the future of telehealth in general,

and telepharmacy specifically.

Do you have any Thoughts about where we might go in the future in

the sort of realm of telepharmacy and medication management platform.

I think there's a lot of room for providing more

access and increasing awareness.

What started out on the Medicare side is MTM medication therapy management,

even the penetration of just MTM is not that great, across the country.

So I think there's need for, more awareness and pushing that

a little bit more so that more people available those services.

But I think in terms.

The future of telehealth as we already discussed.

I think it's gonna be a mix of the, hybrid care models based on preferences

on both provider, patient side, clinical protocols, obviously insurance companies

and reimbursement will have a role there.

I think from a pharmacy care management side, otherwise I think it's.

How do we optimize the time of a pharmacist as well?

So lots going into, how do we let technology take a first pass at,

what should be identified with this patient and have pharmacists really

focus in on what needs to be done.

And then that.

Engagement model, whether it's, for the patient, whether it's a call, it's a text

it's a mobile app, not really tethering ourselves to one versus the other, I think

is gonna be interesting as we go forward.

And then of course this conversation would be incomplete without mentioning

AI and the role of bots going forward.

So the conversational AI, which is the most exciting.

In my mind where, now a bot could be having a conversation,

with you as a human almost.

So it's been interesting to see some of the surveys and studies out there where,

some people enjoy interacting with a text based chat bot versus, a life conversation

and more , so I think those some of the exciting things developing from a

virtual care telehealth perspective.

The mention of AI, we have a colleague who talks

about that quite frequently.

So I do like the idea of taking some of the sort of lower level tasks

that maybe take up a pharmacist's time and delegating those to an AI.

So you have more time to focus on the very important, not that everything

is an important, but the more labor intensive things, the things

that do require human interaction.

And honestly, that's the other aspect of where, I get really excited

because, if over time we can really crowdsource all kinds of these medication.

Prescriptions, the side effects, the experiences people are having and really

use AI again, going back to Cameron, your question about the right prescribing

decisions, off, how did this work for this kind of patient cohort and use

that data as part of it, but also use that data to help guide the patient

on an ongoing basis in terms of just.

Optimizing their medication therapy, simple scenario of, oh yeah.

You're having some nausea today because you started this medication two days ago.

And so this is the typical sort of, curve we see of how it settles in and so forth.

So I think that's definitely the future.

Thank you so much for being here today with us.

I think we had a great conversation.

I really appreciate you taking the time to talk with

You bet really enjoyed the conversation.

Thank you again for having me.

And would love to just use this to get the word out about what we

are trying to do@illuminate.health and uh, you know, all of us have

aging parents and folks who might.

Benefit from the service.

So thank you again.

thanks so much.

Thank you for listening to a virtual view.

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Our podcast series of virtual view is sponsored in part by hearses telehealth

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The content and conclusions of this podcast are those of Cameron hilt of the

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