Season 3: Episode #71

Podcast with Colin Banas, MD, Chief Medical Officer, DrFirst

"Solutions that meet patients, where they are and where they want to be, has tremendous legs in 2021 and going forward."

paddy Hosted by Paddy Padmanabhan

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In this episode, Dr. Colin Banas discusses how they are uniting different stakeholders in the healthcare space through their concept – HealthiverseTM – and providing actionable solutions for a better healthcare experience and outcome to all.

According to Dr. Banas, the overall spend in the U.S. healthcare market in medication management and adherence space rose from 10 percent to 20 percent over the last few decades. In future, the opportunity lies in the solutions that meet patients’ needs wherever they are and where they want to be.

DrFirst serves hospitals and health systems, individual clinics, offer e-prescribing platforms, provide patient-focused price transparency solutions, and much more. Take a listen.

Our Podcast Partner:

PP: [00:01:02] Hello again, everyone. Welcome back to the podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Dr. Colin Banas, Chief Medical Officer of Dr. First Colin. Thank you so much for setting aside the time. And welcome to the show.

CB: [00:01:20] Thank you for having me. I’m honored to be here.

PP: [00:01:23] You’re most welcome. Thank you so much for that. So, let’s get started.

PP: [00:01:26] Tell us a little bit about Dr. First and the market need that the company is trying to address.

CB: [00:01:33] Yeah. So, Dr. First is a pioneering health technology company that’s been around for over two decades. In fact, we just hit our twenty first birthday on January 1st. And what started as an e-prescribing company, a medication management company, has morphed and evolved over these decades to include more and more solutions. And what we’re trying to do is unite all the different players in the health care space and break down the silos. So, we have this concept of the healthy verse. This is because there are so many different players in the health care universe that we’ve coined the term, the healthy verse. And we like to put the information in an actionable way in front of the key players at the moment of care so that we can provide better outcomes and better experiences for all of them.

PP: [00:02:27] So would you then call yourself a more of a data management and a data services company? Or are you offering solutions that use the data? Which side of the aisle would you see yourself more in?

CB: [00:02:45] Yeah, I love the word solutions and we are a solutions company, so putting actionable solutions in front of those key players is really where we sit.

PP: [00:02:54] You mentioned that the company’s origins are a prescription medication management that I imagine continues to be at the core of what you do.

PP: [00:03:04] So let’s talk a little bit about what are the biggest gaps that you see in this market today as you try to unite the data sources using the Healthworks concept that you talked about? And what really is the size of this opportunity? What are we talking about here?

CB: [00:03:20] Yeah, so I’ll start with the size question. I think it’s an interesting question, depending on how you define the medication management space and all of the various pieces and parts.

CB: [00:03:31] But what I’m reminded of is, if you look at the overall spend in health care in the United States a few decades ago, the medication management in its totality was probably 10 percent of the spend. And of course, the rest of it was 90. And over the course of these decades, it has inched up to the point where medication spend and all things related to it is closer to 20 percent now.

CB: [00:04:01] And so depending on how you want to visualize the pie of opportunity, it could be quite sizable. And when I think of medication management, I think of the lifecycle of the prescription from soup to nuts. The decision to initiate therapy and write the prescription all the way to getting it filled at the pharmacy to adjudicating the potential claim all the way to medication history services. So, when you’re seeing the patient back in the clinic or back in the ER or for an admission and trying to figure out patient adherence at that time. So, here’s really a whole lot of those places where our solutions intersect and can provide value.

PP: [00:04:45] Yeah, I’m familiar with the medication management and the medication adherence problems, and it’s a multibillion-dollar opportunity or a problem depending on how you want to define it.

PP: [00:04:56] And I imagine that, among other things, the life sciences companies, the pharma companies in particular are very interested in how to address those gaps because there’s some real revenue implications for them. So, who are your primary target markets for this? Are you serving life sciences companies? You’re selling providers. Who are your target clients?

CB: [00:05:19] Yes, to all of the above but really, I think the biggest opportunity and our biggest success stories are in the clinical space, health systems, hospitals, individual clinics and the solutions that again, surface robust medication histories. Price transparency could talk on about that and solutions that are patient focused and centered around patient activation. And so those are the things that really get me excited about the work that Dr. First is doing. We do have relationships with the payer community as well and trying to bring meaningful data from them into the workflow for our clinicians.

PP: [00:06:00] So, let’s pick any one of these constitutionalists, say health systems, for instance, how are they using your solutions? And then you walk us through maybe an example of how they use it and how the values created and abstracted. In other words, you’ve got a solution that helps them address their medication and hear those gaps. How are they using it? Are they using it for population health management as an example? How do they justify the investment in the solution? Is that a reimbursement component or Is the whole economics involved? Could you walk us through maybe an example using one of your prime journeys?

CB: [00:06:39] Sure. One of the ones with the most legs would be in that medication history, medication reconciliation space. So, we actually have a solution. And then layered on top of that is a patented AI and LP engine that we affectionately call smart. And I’ll tell you how this works. And so, we’re able to provide our clients with a robust medication history.

CB: [00:07:03] We give them a feed of the medications that were prescribed in the medications that are filled. And we actually fill in the gaps, perhaps, of what you may be lacking from our traditional medication history feed. Because we’ve been able to create relationships with independent pharmacies and payers and pharmacy vendor software systems. And so, we were able to augment the existing feed that you may have. And then we take it a step further and we use this AI engine smart to clean up that data, to duplicate it, to prioritize it etc. And then we can actually bring it into the electronic medical record structured. And then we can land it in the appropriate fields without having the clinician, whether it be the farmer or the nurse or the physician who is doing this interview to gather the medication history. We can land it in the appropriate fields so that you don’t have to re-input things. Believe it or not, even though we have all of these mandates for structure and for codify data when we’re transmitting prescriptions. A lot of times when we bring it back into systems, it comes in as free text. So, we’re actually able to solve the data cleanliness problem in a variety of venues. And what we’ve seen is by doing that, you can make the clinicians a whole lot more efficient. And so, we’ve seen client examples gaining efficiency from fifteen to twenty five percent in terms of the number of medication histories and medication reconciliation’s they’re able to get in a particular shift. And more importantly, the data they’re bringing in is accurate and actionable. And so, you can imagine that not only efficiency is important to whomever you’re talking to, but me wearing my safety hat, I actually like to think that the safety side of the equation is even more important. The fact that you’re not having to re-enter data that should flow seamlessly and potentially fact fingering some of those values can really help improve the safety side of the equation. One of our success stories and Covenant Health were in that 15 percent improvement in terms of efficiency. They saw a massive increase in the accuracy of the medication lists on the order of like thirty five percent improved accuracy. And by their own math, maybe we were able to claim a savings ROI of six hundred and fifty thousand dollars in a year. And that’s just one success story from one small piece of our solution set. So, you can imagine as I get the opportunity to describe other solutions and layer them all together, you can get this synergistic effect of improvements in the health care outcomes and the return on investment.

PP: [00:09:50] So that’s helpful to know if you put a number on the benefits system.

PP: [00:09:54] Twenty thousand dollars a year is a sizable number, I imagine, for how sustainable the other side is that you’re talking about.

PP: [00:10:05] When they approach this kind of situation, do you provide any commitments or assurances to them that they are going to achieve a certain threshold level of returns? Or how do you help them really make the decision? What conceptually it’s very straightforward that, yes, if we can improve medication, adherence and manage accuracy and medication and saw the benefits are obvious, it’s fairly straightforward.

PP: [00:10:29] But putting that into action and really helping your clients, specifically clinicians, pharmacists, to sell the idea internally and to gain approvals for budgets and so on and so forth is important. So, hoes it work today?

PP: [00:10:46] And what is one of the top things that they look for in order to feel reassured that this is actually going to deliver?

CB: [00:10:54] Yeah, it’s a great question and it’s become even more relevant in the current era that a return on investment wasn’t always top of mind when trying to pitch these solutions. But even more so now, things like automation and ease of implementation as well as return on investment have become increasingly important. So, one of the things we’re able to do with the solution I just outlined is we have a pretty robust return on investment calculator. And that calculator is based not only on industry standards, industry publications, but also success stories that we’ve been able to see with existing clients. And so, it’s an ever-evolving calculator that we’re able to provide and walk our health care partners through as these are the things you can expect to see. We also have a pretty robust applied clinical research arm at Dr. First. I’m happy to have that up with one of my colleagues. And, we’re constantly looking for partners who are wanting to study those things, just like you said, in order to as twofold. One, we want to give back to the research domain. We want to be able to show positive impact with the things that we’re providing. And then two, we would like to be able to tell those success stories to other partners and other potential partners out there. So, we do have a sort of a one to approach being able to help clients and potential clients with that return on investment.

CB: [00:12:21] So there’s other solutions in the medication management space, things like price transparency tools. So, showing the doctor what the co-pay will be for the patient at the time of writing the prescription so that you can make a more informed decision. Also, maybe, you can even select an alternative. Yet another one being able to provide patients after the moment of prescribing actionable text messages that can show them coupon cards or the prices that they can expect to pay again, as well as education. And so those things were also able to show our clients just through raw data. You know, this is the utilization that you’re getting from these particular solutions. And in the example of that patient facing solution, we’re also able to study adherence rates. And so, we know that when you get an engaged patient who is able to get those secure texts, we know that there are twenty five percent more likely to go pick up that prescription. And so that’s the kind of data that we can feedback. And ultimately, as you pointed out, these are the things that help build the case so that you can continue to layer on solutions with your partners or go extend solutions to new partners.

PP: [00:13:38] You mentioned depending on the focus on the ROI has become even more intense than it was before. Has the pandemic impacted the demand environment in any way, positively or negatively? Can you talk to what has changed for your company as a result of the pandemic?

CB: [00:14:03] Yeah, a couple of things. So, one, our own internal data shows us on the medication management space that adherence took a dip during the pandemic. Possibly due to cost concerns or patients losing their employment and thus their insurance status, perhaps.

CB: [00:14:21] And so back to those solutions that can help point out prescription benefits or help to activate patients so that they can see education, coupon cards, costs out of pocket. Those things actually have had a bit of an uptick in terms of interest in adoption. And a couple of things come to mind in terms of the impact on our company and our solutions. One, I even made mention to this a second ago, the ease of the implementation or the size of the lift seems to matter a great deal during the pandemic. And what I mean by that is there isn’t a lot of appetite nor time for multi month implementations that perhaps we had the luxury of before. But a lot of the solutions that we are able to offer up, especially in the medication management space, are very light lift. In fact, they’re often sort of unplug one and plug this one in and you’re good to go. And I think that has benefited us greatly in terms of being able to keep the momentum on a lot of our solution sets. So, we’ve actually some increases in our medication history space, our price transparency. This is again, unplug or perhaps an addition of our service to one you may already have. Go ahead and plug that in. And we’re talking light lifts for these things or under 20 hours for some of them. And that actually seems to be an appetite for that. So, you couple the ROI with the fact that you are not going to engage a whole lot of your internal IT talent. In fact, a lot of the lift is being done by us as the company. This seems to be a winning combination during the pandemic and even more than it was pre pandemic.

PP: [00:16:07] Medication management has been a target for quite a while by a number of different players in the industry.

PP: [00:16:14] And I imagine that the pharma companies obviously are tracking it from the point of view of their own products.

PP: [00:16:21] And I imagine that PBM would be another category that are really looking at the medication out in space and building solutions to create incremental value for their clients.

PP: [00:16:33] You talked a little bit about the competitive landscape. Do you compete with PBM’s, for instance, are you competing with an entirely new class of solution providers?

PP: [00:16:43] You talk a little bit about the competitive landscape.

CB: [00:16:45] I wouldn’t say that we compete with PBM. If anything, I’d rather use the word complement. And so, if you think about the traditional PBM relationships, they function in claims management for the most part. So, they have these relationships with pharmacies, with payers, with health plans. But again, traditionally they’ve had trouble getting upstream in the medication lifecycle to where the actual decision to prescribe something is being made. And that’s where we come in. We are leveraging relationships that we have at the point of care relationships with providers through our e-prescribing platforms, with our price transparency tools. And then also with the patients, again the solution I keep referencing about patient activation and patient engagement is called our e-inform. And it’s pretty revolutionary stuff in terms of being able to activate our patient base. And so again, I like that word complement the PBM’s. In terms of the competitive landscape, I would say there are other players in these spaces who are trying to skate to the same place. Or I can say independent solutions in terms of the ability to show price transparency or other prescription platforms and prescribing platforms, for example. And so I think that’s the competitive space that we’re playing.

PP: [00:18:05] And what do you see as the outlook for 2021? I know you said big technology firms getting into this in a big way. Amazon comes to mind. Obviously, their ambitions in the pharma space are fairly out in the open now.

PP: [00:18:20] What do you see as the demand environment going into 2021?

CB: [00:18:24] Yeah, you know, it’s always been interesting to keep an eye on quote unquote, the big guys for the past few years. In terms of their ambitions, I’m still not sure what to make of the Amazon play. But I do know, and I do think that there’s enough room for all of us. I guess, this is a good way to say it right now. And I do think that the outlook, at least in terms of things that are meeting the patient where they are in the name of consumerism. And I’m not a big fan of the term consumerism when it comes to patients, but I do think it fits. And so, the space to the extent of a solution that meets the patient, where they are, where they want to be, has tremendous legs in 2021 and going forward. And I think that’s the space that we’re filling nicely.

PP: [00:19:12] That’s fantastic. So, I guess we we’ll leave it there.

PP: [00:19:17] That’s a great positive note to end the podcast conversation on that column. Once again, it has been a pleasure having you on the podcast.

PP: [00:19:26] I wish you and Dr. First all the very best going into 2021.

CB: [00:19:30] Oh, again, thank you for having me so much. It really has been an honor.

[00:20:00] We hope you enjoyed this podcast. You can reach us at info@bigunlock.com with your feedback and questions.

[00:19:44] This podcast is brought to you with the support of our partner mailbox and secure email for modern health care right out of the box.

About our guest

collins-bannas-profile-pic

Colin Banas is an Internal Medicine Hospitalist and the former Chief Medical Information Officer for VCU Health System in Richmond, VA prior to stepping down after 15 fulfilling years to pursue consulting. He is proud to have testified before the U.S. Senate and the Office of the National Coordinator (ONC) on the topic of Health IT and the Meaningful Use Program and is a former Health IT Fellow for the ONC.

His interests center the role of big-data and analytics on patient outcomes and on novel forms of Clinical Decision Support, those that are outside of the realm of traditional rules and alerts, and include real-time dashboarding and intuitive usability designs.

He also helped spearhead the VCU effort to participate in the Open Notes initiative, where patients have access to their clinical documentation in real time. In 2017, Dr. Banas was humbled to receive the HIMSS-AMDIS award for Physician Executive of the Year from his peers.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.