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In this episode you’ll discover:

• Why price transparency is important

• How to understand the impact between a $0 option and a $250 option in the moment of decision

• How data transparency impacts patient access and health equity

Keep scrolling for a transcript of this episode.

Key Takeaways

• Moving to a more consumer-directed and consumer-focused model means focusing on creating more transparency on the area of pricing. By bringing this information upstream, we will be able to build trust between the patient and the provider. 

• The difference between a $250 drug and a $0 drug can be meaningful to a lot of people. Providing this option isn’t impossible, it’s only a matter of getting the right answer to the right decision-maker when those things are happening. 

• Consumer-driven healthcare is the most important health equity issue to solve. Half of America can’t incur $1,000 of unexpected expenses without financial ruin. Providing information to the right people can go a long way in contributing to the solution. 

Learn more from Carrie and Rebecca: 

Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)

Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn

Learn More

Website:  https://arrivehealth.com/ 

LinkedIn: https://www.linkedin.com/in/kyle-kiser-68ba218/ 

Read the transcript:

Announcer (00:01):

You're listening to Decoding Healthcare Innovation with Carrie Nixon and Rebecca Gwilt, A podcast for novel and disruptive healthcare business leaders seeking to transform how we receive and experience healthcare.

Rebecca Gwilt (00:16):

Welcome back to Decoding Healthcare Innovation. My name's Rebecca Gwilt and I'm excited to welcome to the show today. Kyle Kiser who is the CEO of Arrive Health. Good afternoon Kyle.

Kyle Kiser (00:30):

Hey there. Glad to be here.

Rebecca Gwilt (00:31):

Wonderful, wonderful. So Arrive Health <inaudible> or Arrive Health provides realtime patient specific insights at points of care throughout a patient's experience. And the mission is to enable better decisions at the point of care. Arrive Health does this by creating data transparency between providers and patients and they're best known for doing so with pharmacy data. So I'm excited to learn a little bit more about how you're expanding beyond that today. So are you ready?

Kyle Kiser (00:59):

Ready.

Rebecca Gwilt (01:00):

All right. So you said in the past that the only way to solve the care access challenge is to connect providers to a network of realtime patient specific information and deliver it within the clinical workflow. And that's sort of when patients and providers most urgently need it and can make the best decisions. My research tells me this is a nut that you've been working on cracking for a while. So how are you approaching this at Arrive Health?

Kyle Kiser (01:25):

Yeah, so one of the things we say often, and we are not the originator of this quote, but it's the decision in our economy where someone else makes purchase on your behalf and you have no idea what it costs until your expected to pay.That, just as a high level goal, seems like an important thing to solve for. It's just bringing that information upstream and accounting for that as part of the decision making process seems important.

(01:51):

If we're going to move to a more consumer directed consumer focused model. I think sort of secondary to that or maybe compliment to it is people want those answers from their doctor. I mean ultimately where the trust resides is between the patient and their provider. It may be a Dr it may be a nurse practitioner, might even be a pharmacist but they seek those things out from their provider and they may tolerate a conversation with their health plan or their pharmacy benefit manager when they have to to get those answers but they really want to go back to the source of the decision maker and have that conversation. And largely today that information is just not often available to those decision makers either during the decision making process or even retrospectively. So our goal is solve both of those problems is to make this part of the way care decisions happen. Make this part of the way onboarding for medications happen and to connect those as tightly as possible and automate some portions of that along the way.

Rebecca Gwilt (02:53):

And is that, I know a lot of the work has been focused on pharmacy data, is it becoming more than that?

Kyle Kiser (02:59):

Yes. I mean it is. It's primarily pharmacy focused. Increasingly specialty meds are well have been a really important part of the pharmacy world for a long time. Many of those are medical benefit related. So we are pursing actively several opportunities that integrate medical benefit information into our existing pharmacy benefit workflows just because they're so often such consequential decisions and those are the things we really need to make sure we're communicating with patients.

Rebecca Gwilt (03:31):

And I know you recently you have a recent acquisition. How is that fitting into this framework?

Kyle Kiser (03:38):

Yeah, so we longtime customer of ours is UPMC, University of Pittsburgh Medical Center. They're obviously a very well regarded and respected medical center. They also have a very capable and innovative group called UPMC Enterprises. So they'd incubated within UMPC Enterprises, a AI powered virtual pharmacy assistant goal of this is really to create kind of continuous care experience beyond the pharmacy's decisions. So via SMS we can interact with patients. We can understand adherence issues, side effect issues, portability issues. And the goal is to really tie that tightly into the care teams that are trying to serve those patients within our health systems customers. So inside of every health systems there's likely a group of pharmacy techs or access team trying to solve prior authorization issues or even pharmacists in some cases that are trying reach patients. This automates much of that outreach creates some ongoing consistent engagement patients so that we can help prioritize the work of those teams and really get the human to human connection happening when it's a complicated, probably expensive, important high consequence decision and where it's things that we can automate, we should automate.

Rebecca Gwilt (04:59):

So say more about that because I've been diving pretty deep my team and I on these large language models and these AI chat bots and we have seen some pretty powerful things out there. Is this, what is the new system meant to play a role in answering questions or is it summarizing? Is it translating things? What's the efficiency that it's netting?

Kyle Kiser (05:26):

Two things. One, there are of it that is answering questions around the pharmacy experience and providing responses. I think more importantly we are automating the outreach and engagement with pharmacy patients and pharmacist. So if you're a health system and you get a network with a payer in your market, there's more often than not depending on those payer agreements, network agreements, there's going to be requirements of how often you reach out to high risk patients. Right now that happens just through manual phone calls. This system allows us to trigger things through the, e-prescribing flow that'll create continuous engagement with that patient so that we are satisfying some of those requirements. Also creating a work queue sort of engaged a group of patients that need to actually talk to the pharmacist so that the ones that have the higher needs and the more complex scenarios actually get to engage with those pharmacists and the health system is not spending time paying a pharmacy tech or a pharmacist or an access team to just make phone calls. We can start to automate some of that outreach.

Rebecca Gwilt (06:38):

I'd love to hear because a lot of this is sort of tech focus and process focus and I know that the purpose behind this is more than just efficiency, certainly in improving outcomes. What have been some successes? What's an example of a time you knew that that house was doing the job that it was meant to do?

Kyle Kiser (07:02):

We have a great collection of health systems that we work really closely with some of those are investors. One of those is in Presbyterian New Mexico and Presbyterian an amazing place because New Mexico has a population, is a really unique insured population. It's really high Medicaid, it's a complicated place to try and manage cost and drive quality. They're a world of experts in that. And they have a provider there who's one of our biggest advocates, super user I think is how we would all describe him, and he told a story of a patient who was in his clinic and I think albuterol was the med and I'll apologize if I got that wrong. But within albuterol there's an inhaled steroid. There's probably several different ways that you could actually administer that med. It could be inhaler, it could be a nebulizer, whatever it may be and usually your payer has a preference that one of those methods is $0, the rest of them are usually quite expensive. It can be much as $250 bucks. And this had a patient in his clinic had exactly that problem. Kids needed some albuterol to get better. if you've got kids you know those are stressful moments and he was able to say this one is $0 and this one is $250 and I could care less which one you choose. And we had him come in and tell this story to our whole team and he said the mom was in tears, the difference between a $250 drug and a $0 drug is really meaningful for a lot of people and you can see right through the complexity and get the right answer. So as a matter of fact we just released something today we've been working on for a while of just how prevalent $0 options are and it's just a matter of getting the right answer to the right decision maker when those things are actually happening. The benefit designs are hard to navigate sometimes, even for providers, especially for the providers, so to bring that stuff to the fingertips of the individuals who are making those decisions is really important work.

Rebecca Gwilt (09:16):

As a patient work in this, I work in this space so it's not surprising to me but my guess is as a patient most people would be shocked that that's even a thing that happens. Most people would be shocked that their doctor wouldn't automatically know that they would prefer a $0 drug over overnight if there weren't any sort of large clinical differences. And it seems a simple problem to solve. I'm assuming that that's not the case.

Kyle Kiser (09:44):

Yeah, well it's, it's not mal intent on any stakeholders part. It's the health plan trying to do their best to negotiate a good deal for their plan's sponsor. It's patient trying to understand, how to solve whatever problem they have be it for them rather it be for the patient or their kids. Those stakeholders are communicating in real time.

Rebecca Gwilt (10:13):

It's the age old healthcare story, the silos.

Kyle Kiser (10:16):

That's right. And if you about a clinical day for a provider, you see 25-30 patients in a day, depending on your market. You're in central Virginia that's a fairly fragmented health plan market, so 25-30 patients could be seven or eight different health plans plans. Many of those health plans might have carved out some complexity and different plan designs. So it's just not a solvable human problem. It's something the machine could be doing for us and now it is.

Rebecca Gwilt (10:45):

So awesome. Okay, so you've found success in has been driving decision making to the point of care and lots of companies are trying to do this in one form or another with the goals that we've talked about improving care and care outcomes and reducing healthcare costs. That good old, true lame, Donnie Burwick who I have a professional crush on coined the term back in 2008. But since then and since my time in government we've added two more aims and now we have the quintuple aim and that includes both provider wellness and health equity. I want to explore a little bit about how you're thinking about these two additional arms at Arrive Health. We're all more aware than ever that care providers are burning out left and it's use every day ultimately. Absolutely. We're building a tool for use by clinical staff, which any additional tool might equate to additional burden. How do you make sure that your tool doesn't, that it mitigates or at least doesn an add to sort of burden on providers?

Kyle Kiser (11:55):

Yeah, well we have a, we're incubated with the University of Colorado, UC Health has the care center existing workflow and making things easier, not harder was a big part of what we've learned from and team. And so that LED tool, something outside workflow powering the OEM experience of e-prescribing And so we've really focused heavily on building close relationships with our EMR partners, with our provider partners to make sure we're this data into appropriate em, have the experience, the data in the background, it's making these things happen. So that's one is just an intense focus on provider experience. A lot of sensitivity to how much we're asking of providers generally now job that is make it, how

Rebecca Gwilt (13:09):

Important do you think it was or how big of an influence do you think it had? It was on the trajectory of the company that you were incubated in a system that was actually going to be using this tool to solve a problem?

Kyle Kiser (13:22):

Oh, huge. It is not even just that we were incubated there, it's actually the origin of the company. So co-founders Dr in Denver named Kevin O'Brien he is still practicing there still involved with the company. Kevin actually started doing all of this work in his own clinic and was just trying to help people solve their medication spend problem. For those that were just walking in the door for his clinic built this massive spreadsheet of sort ways, save medication, that he was trying to serve his patients with that was all inspired by him trying to help is mom. So his mom his mom came and said, hey I got a out of control monthly spend on drugs how can you help? Like any good son with skills, he said this is a brand drug and we can break it off into generic parts. Here's the equivalent. And so from the very beginning company we've been inspiring providers helping solve those problem for their patients is where that work should happen. We actually even have mantra around the company called Lucy up. And it's sort our way of saying to each other in moments of intensity or moments of great focus on the next deal or the next feature or the next work that needs to be done, Lucy up is our way to lift our eyes to the mission. And it's cause Kevin's moms named Lucy and everybody's got a Lucy in their life or they've been the Lucy themselves experience healthcare system that just didn't make any sense. So that was a tangent to say origin of this has always been provider is the right stakeholder to help be a steward of this information. The experience at UC Health was incredibly important. Understanding the provider hassle map was really, really important And we even took that further and really specifically pursued health systems as investors and really brought those folks in as kind of a living laboratory for us to make sure we're consistently as we build new things, as we try new things, we're doing that with a provider focus. Because that's ultimately the stakeholder that has the most opportunity.

Rebecca Gwilt (15:28):

Yeah, I mean it sounds like an intense provider focus solving a problem that exists because of that provider focus and also paying attention to the end user, the patient who's ultimately going to be the beneficiary of, that's the more real time information. And speaking of the beneficiary, right, we're going to talk about health equity. Tell me how you think about the potential of your tool to help with patient access. How are you when and measuring your wins on patient affordability and access?

Kyle Kiser (16:07):

This may or may not be sort way health equity is l categorized, but I think about consumer driven healthcare as the most important health equity issue to solve. Because we for the last 25 years have been making those transitions from low deductibles, low co-pays, simple formularies to high deductibles, high co-pays co-insurance and complex formularies. And that's already happened. Over half the health plans right now are high deductible health plans in one form or another or have some significant out pocket spending for the patient and we haven't provided the tools to make those decisions as quickly as those things have been adopted. So I think the most important health equity issue solve is half of America can't incur a $1000 unexpected expense without financial ruin. And half of America also has a multiple thousands of dollars deductible and those two things are incongruent. So how do we provide the tools to help make those decisions a little more palatable? So that's squarely where I focus around health equity. I think there's clearly a lot of factors beyond that, but I think that's the one where we have the most opportunity to make an impact.

Rebecca Gwilt (17:19):

Yeah, I think it's one of those aims that's a tough KPI to collect data on. Are we moving the needle on health equity because one company can't, and certainly one component of the healthcare spectrum can't unilaterally make a difference in a person's equitable access to care. That's true. But the story that you told I think was pretty impactful. If the difference between you can rest easy because your child has asthma medication that is saving and you can also buy groceries that week or not just because the information wasn't there. I mean that seems very tangible in terms of impact.

Kyle Kiser (18:10):

Absolutely. Yeah, there's lots of reasons it would be somet application stakes.

Rebecca Gwilt (18:27):

Yeah

Kyle Kiser (18:27):

That's a big enough problem to solve.

Rebecca Gwilt (18:29):

Yeah. Although I'm a hundred percent here to talk about chap gpt,

Kyle Kiser (18:32):

I'm going to be able to add very little value to that conversation.

Rebecca Gwilt (18:37):

Okay. So you said last year at Startup Health on a podcast or at a startup health podcast that opportunities in pharmacy tech and price, transparency tech are just getting started. And then now I know you sort of made this acquisition. Is this still true for you? What's the next mountain decline for you and your competitors in the space?

Kyle Kiser (18:55):

Yeah, absolutely. So a couple of things. One couple of years ago CMS made real time benefit a requirement for part B plan. So we conduct realtime benefit checks, that's one our features. That means it's the realtime patient specific location, specific moment in time, specific insight into cost. So now you're a Medicare plan that provides part B coverage. You got to have one of those. So that's great tailwinds. About a year after that they made that requirement for patients to provide access to information directly to patients. So both at the point of care and for patients those to me are the ingredients of a better system for patients. And we just need to go execute on the right use cases to do that. So we've made the choice to come alongside providers to do that but there are others that are skinning that cat in different ways but, it's pharmacy data is more discrete. It is more often in structured forms inside of the systems that is used across the industry the data's becoming more liquid. It's been limited in a lot of ways over the years. So it's just got all the ingredients of it's time to do big and important work in pharmacy. So our focus is really provider care team patient and connecting those stakeholders as possible in a continuous care experience so that better decisions get made at every step along the journey, both moment of prescribing and throughout the onboard process. We don't have to do all of that work directly but I think we have an opportunity to be a steward of whatever resources need bring to solve that patient's problem. Benefit pricing is hugely important part of that prioritization is a big important part of that. All of the work that health systems do every day for 100% of those scripts that leave their system even when they're not the ones that get to fill that prescriptions, that solving that problem, the body of work is largely untenable in a lot of cases. Cause prior office is now so ubiquitous. So to me the opportunities are just starting to emerge.

Rebecca Gwilt (21:03):

Well I wish you all the best of luck in that I, like I said, as a patient, these seem like, this seems like table stakes. Let us know, know what this is going to cost us. So exactly. I think folks outside of this industry and probably be surprised to hear, but of course, that's just now sort of being solved. Okay, so the last thing is, I have been there alongside you and well watching as you have been on the rollercoaster of the last two years, you and your digital health colleagues, so many solutions, so much money, crazy valuations, lots of froth, and then sort of the shock of the system when people started noticing it to, it's slowing down a bit. There are disagreements on what the slowdown actually is, if there is one, how bad it is, et cetera. But I'm interested in whether you see the sort of changing landscape around health tech, a challenge or an opportunity. Are you thinking differently about your business now that investment and purchasing seems to be contracting a bit? There's just a lot of discussion around this right now. I'm super interested in your take.

Kyle Kiser (22:19):

Yeah, I think my answer to that either or question is yes,

(22:24):

Both challenge and opportunity at a high level win over the last many years, maybe 10, maybe more than that. Effectively capital has been very accessible at a low cost that's changed and that'll change the way people approach these problems to some degree, the sort of classic Silicon Valley go fast as possible methods are probably not going to work anymore because growth is not being rewarded in the same ways that it was. I think the opportunity we'll probably build healthier businesses longterm as a result of that. Even producing businesses that are growing in healthier ways that create more sustainable success. So it's both a challenging opportunity because everybody is trying to make that swing from grow at all cost to growth with the right business mechanics. I think the other opportunity is just there'll be some opportunities for what are complimentary but bespoke companies to start to consolidate into more platform looking things. I think there's likely be much more of that as a result of this just cause some of these companies aren't going to make that turn and they need to consolidate into larger solutions.

Rebecca Gwilt (23:44):

It's been really interesting to see digital health solutions get more and more and more specialized. And I don't think that necessarily will go away, but to your point, taking sort of bespoke and very specialized solutions and not getting rid of them but making sure that they at in their own right are available but possibly through another vehicle. I think it's probably what we're going to see next. Maybe some cool marketplace solutions in the telehealth space. And yeah, I agree. And I think the other thing that I am that I'm watching is just the sheer amount of data being collected and shared and combined and extracted and manipulated. My suspicion is that that has been happening without a lot of people looking in on it, without a lot of people checking in on it. And certainly the responsible, there's responsible companies out there are paying attention. But also I'm also looking toward a ton when there's going to have to be some more organization around who is buying data, who's selling data. I've already seen data sources like big health systems and payers get more strict about this. Have you experienced that at all?

Kyle Kiser (25:13):

I think there's always a lot of caution around data and healthcare for sure. Yeah. And that's true with every stakeholder we work with. And I don't think that'll change. I do think sort of giving consumers or patients more control of that information is a good thing and curious is a good thing ultimately. And all the things that will come downstream the data becoming more liquid is a good thing that combined with a much more digital fluid or native user base. If you think of our population as a country is booming at the seniors end and the Medicare roles are going to grow and the only way to manage that effectively is going to be through tech enabled, technology driven solution. But the good news is it's like the folks that are enrolling those in those plans are not completely without experience with technology's. It's my parents who have had iPads for ten years who understand how to use this stuff. I think there's a sort of data liquidity with some willing and capable users of that could be recipe for some good success.

Rebecca Gwilt (26:20):

Yeah, yeah. Alright, well, so I really, really appreciate you spending time with me today. I'll just ask you one more question and then let you go. I'm curious, what's one piece of advice you'd like to give to Healthcare Innovators to help them supercharge their success?

Kyle Kiser (26:38):

Pay a lot of attention to how your customers make money. Until you understand that really well, it's going to be hard to solve the ecosystem problems. Because everybody's making very rational decisions based on the incentives that are in front of them. So the better you understand those, the more healthy business you'll build.

Rebecca Gwilt (26:57):

Agree, agree, agree. All right. Well thank you so much Kyle. I wish you the best and as you thank continue to grow, Arrive Health, I will be listening and paying attention to what you all have on the horizon. And if people want to get in touch with you, how do they do that?

Kyle Kiser (27:14):

arrivehealth.com is a great site. We're fairly active on LinkedIn as well, so those are good options.

Rebecca Gwilt (27:19):

Perfect. I will drop those in the show notes and thank you again.

Kyle Kiser (27:24):

Appreciate the time. Have a great day. Thanks Rebecca.

Rebecca Gwilt (27:29):

Thank you for listening to Decoding Healthcare Innovation. If you'd like the show, please subscribe, rate and review at Apple Podcast, Spotify, or wherever you get your podcasts. If you'd like to find out more about Carrie, me or Nixon Gwilt Law, go to nixongwiltlaw.com or click the links in the show notes.