A Healthcare App Startup | Robert Longyear, Montuno's Dosecast

This transcript was generated automatically. Its accuracy may vary.

[00:00:12] Robert Longyear: Well, Robert, hi, Mike, 

[00:00:13] Mike Koelzer, Host: how are you? Hey, I'm doing well. Thank you. Thanks for joining the program, the business of pharmacy podcast, where is our crossover between the cool stuff you do and the business of pharmacy? Uh, I'm 

[00:00:25] Robert Longyear: director of product management at a startup software company called Mancino software, um, which has been around since 2010.

Um, the company was originally started by, um, some software engineers, um, that affiliated with, uh, you know, MIT, Google 'em at different parts of their career. And the company, uh, actually was founded around a mobile application that helps patients manage their meds. It's a pharmacy medication reminder app called dose cast.

Um, it's available on all the app stores and really what they were attempting to go out to solve was making the management for patients managing their complex medication regimens easier. So, um, patients that take three plus medications throughout the day, um, it's, it's difficult for them to remember. And so the app is more flexible for them to be able to schedule their medications.

Um, and it does push notifications. It works with apple watches. It really solves that, you know, 40% of the issue of medication non-adherence, uh, being forgetfulness. So, um, it really helps with that. And then it logs all the history. So when patients take their drugs on time, if they relate, um, they can add a little bit of subjective health and some symptom information as well when they take their medications.

And so it creates a nice log that can then be emailed, shared with family members and doctors. Um, so that's kind of the. You know, consumer applications and that's why I saw it. This would be a good fit. Uh, so digital health, the digital health space is trying to really, um, solve a lot of the problems around pharmacy and the healthcare system in general.

Um, and we know that, you know, pharmacy is, is a, is a key area for, for treating any chronic conditions, which make up 75% of the U S healthcare costs. So, you know, that's, that's why I thought we had a pretty good fit to have a conversation. 

[00:02:06] Mike Koelzer, Host: Give me that number. You mentioned 40% noncompliance, would you say define that?

What does that mean? This is coming from a 

[00:02:13] Robert Longyear: large systematic review of sharing. A lot of studies of, of non-adherence non-compliance, uh, for patients with their treatment regimens and their medication non-adherence they found that about 40% of, of non-adherence cases, um, are related to forgetfulness. Um, so patients just simply forget to take their medication.

And so 

[00:02:30] Mike Koelzer, Host: not adherence. That would be like finding, let's say you're supposed to take a tablet 30 days in a row. If you don't do that every day, then you're non-addictive. And 40% of the prescriptions would fall into that category of not taking it the way the doctor ordered 

[00:02:48] Robert Longyear: it. Right. So let's put it this way.

So, uh, generally the number that's thrown around in the academic literature is about 50% of patients are non adherent to their treatment medication. So if you were to have 10 patients in a coffee shop and you pulled out five of them, those are the ones that are likely to be that's. How many are like, would it be not here into their, or non-compliant to their, their treatment regimen?

Um, now there's a lot of reasons why that happens. Um, a lot of times it can be distrust of the medical system. It can be, um, cost related issues. Um, it can be forgetfulness. So 40% of those have the wide variety of issues that cause patients to be noncompliant, um, is linked to sort of just forgetting. So going about once daily routine and just not remembering taking medications.

[00:03:29] Mike Koelzer, Host: So 40% of the 50% is forgetfulness, or you just are not doing it. Yup. Yup. Wow. That's huge. I think I was talking to a veterinarian. Or somebody on animals. And they said, it's a lot better with animals. You know, people don't want to forget their animals taking the medicine, but, but with humans it's like, I dunno, like a third don't even get it filled.

And then like you're saying half don't, so it's a, it's a huge, huge number. Yeah. 

[00:03:56] Robert Longyear: Yeah, absolutely. Um, so, you know, when, when we think about things like, uh, hot topics in health policy or the social determinants of health, um, you know, a couple of those are access to transportation or, you know, for people who have low income, not being able to afford medication and not being able to actually get to a pharmacy to pick up their, their medications is a major barrier.

Um, so those are also barriers to medication non-adherence, um, from the systems perspective. Um, but again, the general number that I've seen, um, is about 40% is not adherence, uh, as is forgetfulness, I should say. Um, and that's where we kind of fit in. Um, with the, with the mobile app from the start. Um, now we're definitely moving towards more of a chronic disease management, uh, application, so centered around pharmacies centered around medications, but also providing, you know, you know, diagnostic information.

So when patients have a blood glucose meter at home, they can enter their blood glucose on a daily basis with their medications. And then it all goes into that nice report. That's available to physicians to be able to sort of remotely manage patients in real time. Um, so that's where we're moving towards, but we kind of came from this forgetfulness, helping patients just remember to manage no one refills or up, um, kind of everything about them, their medications on their, on their smartphone.

[00:05:09] Mike Koelzer, Host: Right. All right. So Robert Rooney, get back to that. We got a backup here. Your LinkedIn is a really interesting journey that I, that I went through and a few things I got to talk to you about. We gotta get down to business here. Washington DC. Are you there? I know you went to college around there and you live there.

Are you there for a political reason or are you in order to make changes with the government and so on? Or is that just, you ended up there or you grew up there. That's where I'm 

[00:05:40] Robert Longyear: from. I'm from Atlanta, Georgia. Your accent is gone if you had one. Yeah, so my parents are from Delaware, so I have that really for mid Atlantic, uh, you know, no accent.

Um, but I went to wake forest university for my first year of undergrad and wanted to go there. It's in North Carolina, North Carolina. Yep. I wanted to go to medical school. I was, you know, studying pre-med there. I was taking all the chemistry, biochem, all those classes. Um, but halfway through that time, I got really interested in the sort of larger healthcare systems.

So, um, I decided to transfer to Georgetown University in Washington, DC to study healthcare management and policy. That's kind of how I ended up. Um, I worked in a couple of healthcare organizations with research and policy and delivery system managed care related, um, during my time in DC. And, uh, I got offered this job with this, uh, digital health tech startup.

So I'm, I'm here for the reason that's where the company is. 

[00:06:35] Mike Koelzer, Host: Well, let's say this company could move anywhere. Do you think Washington's a good fit or would you be in, you know, Silicon valley or something like that, or do you think Washington's a good fit for medical slash tech saw? 

[00:06:51] Robert Longyear: Yeah. So, you know, so typically San Francisco, Silicon valley, you know, those are the hotspots for digital health innovation right now, and generally any tech startups, and that's where the capital is located.

That's where a lot of the talent's located in DC is, has a growing startup scene, a growing tech scene. Um, Amazon's headquarters is moving out here to Northern Virginia, and there's a lot of cloud-based computing centers, um, out here to service the federal government. So there's a lot of talent in DC actually.

So the startup scene, particularly in healthcare as well as is growing substantially. Um, so when you think about a New York, San Francisco, Silicon valley are typically the places that you see these types of startups popping up, um, and, and Boston, as well is sort of the healthcare, um, Mecca in the United States, if you will, in DC, there's a lot of it's where all the federal health programs are administered typically.

So Medicare and Medicaid, uh, most of the policy and a lot of the funding allocations are here. Um, any federal grants for research and development are located here at national institutes of health. Like I said, there's a growing tech talent in Northern France. Um, a lot of government contractors. So, you know, it's actually a growing space for government tech, um, and, and health tech companies as well.

Um, taking advantage of a lot of the large organizations that they sell to. Um, so all the major health insurance companies, all the major, um, sort of, uh, pharmaceutical companies have a presence in DC for political reasons and for, um, policy reasons. But, um, that gives you access to a lot of the sort of national level leaders as well.

So it's a good place to be. There's a lot of conferences here. Um, a lot of different things. 

[00:08:22] Mike Koelzer, Host: Now you mentioned Amazon, they built there, they're doing some headquarters. You said they're a tech thing. Or 

[00:08:28] Robert Longyear: if you keep on top of Amazon news, um, for about a year and a half or so, they, um, had this big, we're searching for our HQ two.

Yeah. 

[00:08:36] Mike Koelzer, Host: Grand Rapids was one of them. They, they, you know, are, you know, at least people said they were in the running. 

[00:08:41] Robert Longyear: Yeah, there are a lot of them. So Atlanta was in the running for a while. People were expecting Atlanta to be up there, but they really came down. They made the decision, they were going to split it between New York city and Northern France.

Um, crystal city, Northern Virginia, New York, if you remember, um, w AOC who was recently elected into Congress. Yeah, she said that she said she doesn't want them maybe became sort of a, um, a political, um, I want to say firestorm for Amazon. And they decided to not go to New York city and move the whole, um, HQ to Northern Virginia.

So Amazon is currently recruiting pretty heavily in the area and they already have a presence here. They have had one here for a while and in some, in Northern Virginia, because they do have their, some of their cloud headquarters, their, um, their cloud centers, uh, their big data centers. 

[00:09:26] Mike Koelzer, Host: You guys are trying to find out if you can cast absentee ballots from Virginia for AOC to do her, do her part for him in New York still.

[00:09:36] Robert Longyear: Yeah. Yeah, yeah. We're definitely. Yeah, glad that that's happening from our business perspective, 

[00:09:43] Mike Koelzer, Host: there'll be on the two coasts and Amazon 

[00:09:45] Robert Longyear: will they have Northern Virginia? And, uh, I guess they're in Seattle, 

[00:09:50] Mike Koelzer, Host: Seattle. I think they are. Yeah. Yeah. Um, take me through your couple of college degrees then.

Robert. So you had two bachelor's I think. Is that what you went to school here? The wake forest. And then, and then you went to George Washington, Georgetown. Oh, Georgetown, Georgetown. Where's Georgetown? Then I forget 

[00:10:12] Robert Longyear: Georgetown is in Washington, DC. Um, we're like a, I don't know, uh, about a mile from George Washington.

Um, but Georgetown is, you know, home to, uh, you know, basketball in the eighties when it was really good. Um, and not so great since then. Um, Patrick Ewing is now our back. He's our new basketball coach actually. So he came back to Georgetown. Yep. Um, yep, absolutely. Um, bill Clinton is a, is a Georgetown graduate, um, and, uh, So that that's kind of a summary there, but 

[00:10:47] Mike Koelzer, Host: yeah, it was kind of from my, I think he was mid, I dunno, was the mid eighties or something when he played or should be about when I graduated from high 

[00:10:53] Robert Longyear: school back?

So, so yeah, he was, uh, I believe the eighties, he was there, it was a big rivalry and, you know, Georgetown was playing really good basketball. Um, it was Georgetown St. John's university and, um, Marquette and all those schools back when that was that, that was a vacay day for the, that, uh, conference for basketball.

I'm not a big basketball person, so I'm kind of stumbling over my words here, but, um, I always 

[00:11:16] Mike Koelzer, Host: says in the pharmacy it would be, I don't know, maybe. Kind of before the internet, I guess this is like 10 years ago before I would go work in the, uh, and the pharmacy I'd have, I'd have to ask one of my sons to give me like a one minute rundown on the sports going on that day.

Just so when people came in, I knew I was in the right season at least. 

[00:11:36] Robert Longyear: Yeah, yeah, absolutely. Yeah. I definitely have had some situations like that before. Um, I I'm, I'm definitely a tried and true, uh, healthcare system, health policy, uh, you know, nerd, if you will. So, um, that's what I studied at Georgetown.

Um, I graduated with a degree in healthcare management and policy, healthcare 

[00:11:55] Mike Koelzer, Host: management and policy. So that's taking the step. Some people might not like the word above, but it's taken a step beyond the practitioners into managing what they're doing and so on. Yep, absolutely. When you went into that program, what was either your dream or your knowledge of.

What you'd be doing five or 10 years out from graduating. What were your thoughts at that 

[00:12:22] Robert Longyear: time? When I first got there and started studying that, um, I still wanted to go to medical school. So I, I, I kind of intended on going the clinical route and then being able to have a, just a bigger view of, of what was going on in the nation to be able to be a part of that, that conversation be able to do research, um, and, you know, ultimately perhaps be able to manage my own practice.

Um, they don't, they don't teach you that in medical school. So I was, I was blind to be able to, um, sort of have a holistic understanding of, you know, uh, of the healthcare business of, of the healthcare system and healthcare policy is along with sort of a clinical background, but I decided not to go that route.

I, I fell in love with, uh, How policy and, you know, the health system, um, I really found that, you know, the clinicians do a really good job. Um, they're all really well-trained, um, pharmacists, clinical, pharmacists physicians, nurse practitioners, nurses, they know what they're doing. Those sciences are pretty far along.

Um, there's, there's always work to be done, but, um, the real problem is, is, is the system itself. So being able to actually deliver the care that can be provided by a physician, to patients most efficiently, um, at a, at a reasonable cost and effectively, um, to make sure that patients are their care is coordinated between their different practitioners to make sure that, um, they're receiving the right care that they need.

That's, that's not wasteful and that's effective for their condition. So, um, we, this, the system I guess, um, has a long way to go. Um, I know that cost is a big issue. We know that, um, you know, the United States is far, far behind other, uh, you know, similar countries with, um, their, their quality outcomes. And, you know, I saw that as a problem that I was much more interested in being involved in and, um, going to medical school and doing a really good job for my patients.

I'm interested in sort of, um, you know, being a part of the conversation to help a lot more 

[00:14:10] Mike Koelzer, Host: patients. Let me backup just a bit. So wake forest, you took science classes there, right? And then how long were you there before you went to Georgetown? I was there 

[00:14:22] Robert Longyear: for a year, so I finished my first year there.

And 

[00:14:25] Mike Koelzer, Host: Then if you would have taken that year and then let's say you took the management at Georgetown, could you have, if you still loved the medical field? More than what you were studying. Could you still have reversed course? Can you take the M cats, whatever they're called, you don't really need a defined bachelor's for that.

Right. You just have to have enough to pass it, or how does that work 

[00:14:52] Robert Longyear: out? Right. So I, um, you take a, a set of, of science, of course, that science courses, it's typically about two years of chemistry, a year of biology that your physics and those are sort of the prereqs for medical school. 

[00:15:04] Mike Koelzer, Host: It's not a ton.

It's a 

[00:15:06] Robert Longyear: year or two. Yeah. So I actually completed pre-med so I definitely could have gone if I chose to 

[00:15:10] Mike Koelzer, Host: you completed that at wake forest. I 

[00:15:13] Robert Longyear: competed at both at Wake Forest in Georgetown. So I was able to get all those required courses done and gotcha. I could have gone if I chose to, and then 

[00:15:20] Mike Koelzer, Host: you needed a bachelor.

Into it. And so you're like, Hey, I already got this. I might as well get something that's interesting and 

[00:15:27] Robert Longyear: so on. Yeah, absolutely. Yeah. So, um, a lot of people you don't necessarily have to do a typical like biology or human science major to be able to go to medical school. There's a lot of people that apply from, from a lot of different places.

The disciplines, um, which I think really does make a stronger, um, more holistic clinician. So, um, I agree. 

[00:15:47] Mike Koelzer, Host: Yep. I agree. All right. So back to the question that I've interrupted you on, when you're in school five to 10 years out, what are people telling you? It's like, well, Robert, you can do this and you can do that.

Or you're saying to yourself, I can do this and I can do that. What were those things that were on your mind at that time? When you graduated, what was your thought process? Yeah. 

[00:16:07] Robert Longyear: So when I, when I made the decision to go more of the healthcare management policy route, um, and I, I can tell you that I still don't really know what I want to do.

Join the club, 

[00:16:17] Mike Koelzer, Host: and I got a lot more gray hair than you 

[00:16:19] Robert Longyear: do. So, yeah. So, um, you know, there's a lot of people I'll just tell you, a lot of people go into a sort of healthcare consulting. They'll go to sort of big four consulting firms. A lot of people will go to more hospital related functions. So they'll go to, you know, get into a practice management role or a fellowship at a hospital system and be in that role.

Um, I know people doing that. Um, I I'm, I was going to go into consulting actually, but I got this job offer with this health tech startup. So I, I actually was kind of, I've been interested in sort of healthcare, innovation and building. Um, you know, I guess technology has to be able to help patients. And so I jumped at that opportunity and so, you know, I'm, I'm here.

Um, and so I have some friends that are in sort of more strategy consulting roles for the healthcare industry. Um, I have a lot of friends that are actually, um, you know, going to nursing school. So they decided they wanted to go back to a clinical route and apply their management work as a nurse, uh, administrator.

So, um, and then I have a lot of friends that are in policy roles. So I'm in Washington, DC working for trade associations and working for research institutes. And 

[00:17:28] Mike Koelzer, Host: how long between graduation and this 

job, 

[00:17:31] Robert Longyear: Then this job came to me. So I was supposed to join a consulting firm in July, uh, after I graduated.

Um, and then I got this job offer, uh, slightly before that. So I've been consulting for the company for a couple of weeks, a couple of months, I should say. Um, and a couple other digital health technology companies and they made me a job offer. And, uh, it was, it was a good time for me to be able to take the risk and jump at the opportunity for sure.

I decided it was, uh, it was best for me. And, uh, it's been, it's been a great learning experience so far. And then how 

[00:18:03] Mike Koelzer, Host: long have you been in this company? Uh, about eight. Eight months a lot happened in an, in a, in a short time there. 

[00:18:10] Robert Longyear: Oh, definitely. Yeah. I, uh, I was, uh, before I joined this company and before I was supposed to go to the consulting firm, I was working for the Institute for Medicaid innovation.

Um, it's a non-profit research Institute that works, um, with the Medicaid health plans, um, across the country. So all the, all the big names you can think of that have medical health plans. Um, we did research, um, for them and with them. And 

[00:18:33] Mike Koelzer, Host: That was sort of while you were finishing school, basically. Yep.

[00:18:36] Robert Longyear: That was before, while I was finishing school. Um, and then a little bit afterwards, I was finishing up some, um, some policy and issue briefs on, uh, high-risk care coordination and social determinants of health data collection. Yeah. 

[00:18:48] Mike Koelzer, Host: Yep. Tell me about your personal branding. Because when I look at your information on the internet, I'm seeing stuff like your little bit of consulting, a little bit of speaking, I'm seeing a book in the works and so on that kind of shouts to me in a great way, kind of a personal branding.

And it was that sort of preparation for when I'm going to be graduating. And I got to get kind of my name out to the world, or is that a current pursuit on top of where you are now? Yeah, 

[00:19:26] Robert Longyear: I would say it's a, what, what you're seeing a lot of is just my just genuine, true interest in the healthcare system. Um, Uh, it's, it's something I'm very, very interested in.

I spent a lot of time doing it. I do have a book. Um, that's been approved for publishing a new degree press. It'll be coming out in April, 2020. Um, it's about the intersection of, uh, sort of payment reform and health technology. So it's, it's kind of, uh, I, during my time studying healthcare, I've, I've seen that the policy people who are working on payment reform, um, and then the technology people are not often in the same room together.

So, um, it really brings together those two, you know, big drivers of change and transformation in the country's healthcare system. Um, but the branding is, I would say mostly a reflection of my just I've I've done a lot of things cause I'm just interested in healthcare. Um, But, you know, I have a really big passion for it.

Um, when I was, uh, a sophomore in high school, um, I lost my mom to chronic myeloid leukemia. 

[00:20:30] Mike Koelzer, Host: I'm sorry. That's where your speaking and fundraising comes in for that. I was going to ask you about that. Oh my sympathies. 

[00:20:36] Robert Longyear: Thank you. Um, it was, it was the best, um, you know, educational experience, um, of the healthcare system.

So, you know, I was, I was really in and out of, of clinics and inpatient units with her, um, managing, you know, 15 to 20 medications at a time. Uh, on a daily basis and, you know, it was, it was extremely difficult situation, but it's now a big driver for, you know, knowing very concretely, um, having experienced it, what we can do in the health system to really improve, uh, both care and the experience for patients, um, as they, as they navigate through their, their different healthcare 

[00:21:13] Mike Koelzer, Host: providers.

I've always said that the smartest people that walk into our pharmacy are people that have either used a drug for a reason. If someone's, you know, on Accutane for acne, or they need something for something else or their family members on. And it's like, they know a ton more than me or the doctors just because their, their heart has to be down into it, you know?

[00:21:36] Robert Longyear: Yep. Absolutely. So everything that I do, um, you know, from that point on was really related to, um, you know, getting to a position where I can learn as much as I can about the current system. Um, and then being able to, you know, just have conversations and start working towards being able to improve a lot of the, um, the issues that come from, um, patients that are seriously sick, um, and have difficulty, you know, navigating the health system, managing conditions, and now with my current role managing their medications.

Um, right. So that's kind of the, I guess what you're seeing as well. Um, and I, and some of my online presence. 

[00:22:16] Mike Koelzer, Host: To me, like the three legs of the stool that I'm hearing from you would be your current product and then the payers of medicine and so on. And then I guess the government, the policies and Medicaid and Medicare and so on.

I know you've had quite a bit of interaction. It seems with those three, do any of those then end. Somehow in this company or your product that you're doing, is that somehow do those morph into making a dent on all three? Or is that something that no, yours is your product is more off on its own as just a, a very good product for non 

[00:23:04] Robert Longyear: adherence.

Um, so I, I, it really does fit in, in all three of those areas. So we have the current product, which is a digital health product. It's technology, it's the information system. We have the, the payment, the payer side, be it government payers, Medicare, Medicaid, or sort of the private insurance companies.

Um, and then, you know, this really does affect sort of the larger policy conversation as well. And I'll, I'll kind of walk through that a little bit. So let's go through that. Um, we know that, you know, the big drivers of cost in the US healthcare system, um, seventy-five percent of costs come from chronic diseases like diabetes, like congestive heart failure or other heart diseases.

Um, as. These are the things that cause people to, um, a, have a lot of prescriptions because they take, you know, medications daily to manage these chronic conditions. Um, and we know that, you know, if not managed properly, they end up going to the emergency department, which is extremely expensive. We know they ended up going to the inpatient units, which, you know, being hospitalized is extremely expensive.

Um, and we know that going to have to see specialists when, when something goes wrong is extremely expensive. So those are the big drivers of, of that 75% of costs to the U S healthcare system. Um, one in $4, um, on the most recent estimates I've seen is spent on diabetes related care. Um, and so. The way that our app really fits into this situation.

And the reason why non-adherence is important is that when patients aren't adherent to their medications, then they're, they're not managing their conditions and they're at higher risk for deterioration. So then they're at higher risk to end up in the emergency department, end up being hospitalized or end up having to see more specialist visits.

And so, you know, that big medication adherence problem, um, is estimated to be a $300 billion problem to the U S healthcare system, um, indirect costs. So, um, being able to, you know, make a dent in that, um, really does help the overall healthcare system from a large government policy perspective. Um, and then the, the ultimate goal is, you know, keeping people healthy.

So, you know, We definitely are able, if we're able to prevent some of these costly points of care, um, then you know, it's good for the health insurance companies. It's good for the government payers. It's good for, uh, hypothetically if that, that savings gets passed on to, uh, patients with, you know, lower premiums than, um, that's.

That's great. Um, yeah, but you know, we also like to think about the fact that, you know, we're helping patients maintain their health, um, being able to get to, um, you know, a child's wedding being able to, um, you know, have a couple more years, um, to see a grandchild, um, being able to have a better quality of life, um, during years where people are typically sicker, um, simply through just making sure that patients take their medications that we know really does drive these outcomes.

We know that it makes people healthier. Um, yeah. And so that's kind of where the technology fits in being able to take the mobile app and then build a larger product where we're able to feed this real-time data. The patient's medication adherence percentage, their real-time medication lists into, um, physician's offices into hospitals and into insurance company care managers.

So that they can see, Hey, this patient's not taking their meds right now. We should give them a phone call. We should send them to a doctor. We should send somebody out to their house even, um, to make sure that they're receiving that they don't have any problems or they're able to get back on track with their medications.

And there's a really good return on investment for that, um, for companies to be able to invest in technologies where instead of waiting for a patient to end up at the ER, or to end up, um, you know, starting to get sick or with a condition, they're able to be more proactive about that. Um, and this is what sort of the core focus of my book is actually it's the technology provides the data and insights to the system, to the physicians, to the clinicians, to be able to do this more effectively, um, to be able to do it right now, as opposed to, oh, picking something up at a yearly physical when it might be too late.

Um, or when somebody ends up at the emergency department, it's too late to get them to take their medications again. That is sort of the core focus of our product. Um, it's providing real-time data and insights to really amplify and enhance what the health system can do already. So we're not, we're not a silver bullet, we're not here to solve the full medication adherence problem.

Um, we're really here to help patients have reminders on their phone. Um, and then in the event that, you know, there is a problem they're not using it properly, or they're not taking their medications or they report, um, they self-report that, um, they have some symptoms that are worrisome or they're not doing too well, that the health system can step in to support them.

Um, and that's the ultimate goal here. We know we don't, we don't want any sort of, uh, big brother it's is not, we're not trying to be like sort of a, a big privacy issue here, which is, you know, a big, hot topic in healthcare data, but it's really to provide clinicians, trusted clinicians, um, with the information to be able to support patients.

Um, you know, have difficulty with taking their medications or who may start to deteriorate, uh, ahead of time. Um, so that's sort of where, where our medicine and the health system is going. Um, we're one company that's working towards that. Um, right now, um, one of the big trends is tele-health. So being able to have, um, a physician do a video chat, um, and, you know, have an office visit like that, um, is a big trend, but being able to have that data about patient health, um, their self-reported health status and their, their medication adherence, which we know are really big predictors of, of deterioration or predictors of, of likelihood to go to the emergency department or inpatient unit.

[00:28:40] Mike Koelzer, Host: Now, where's the money coming in that you're solving a problem. I know a lot of places, the money doesn't come yet, but where in theory does the money come from or where's it going to come from for our 

[00:28:50] Robert Longyear: company? Um, we are focused on a couple of different, um, sectors of the healthcare system. One is sort of government payers.

So Medicare fee for service and, um, state Medicaid programs, um, where we can actually sell the product to the, to the government payers. And they can promote using that amongst, uh, those beneficiaries are. People who are eligible for those programs. Um, and then, you know, that's a, that's a federal contract and we're able to provide the technology to, to those systems to be able to use.

Um, we're also looking at health insurance companies as well. So managed care, both Medicare advantage plans and, um, Medicaid managed care companies, um, which are all the big name insurance companies that you're aware of. Um, they're just working in these specific programs. They have whole offices full of nurses and social workers that actually reach out to their high risk patients, um, and try and coordinate their care.

So they make sure they're filling their prescriptions. They make sure that their, their, their primary care doctor knows that they saw a cardiologist. Um, last week they make sure that they have, uh, transportation to their, their, um, their office visits because, um, You know, they know that if patients get the right care at the right time, um, then they're not going to end up paying for these really costly points of care, like the emergency room and hospitalizations.

[00:30:11] Mike Koelzer, Host: How do you survive in the meantime? Because right now you've got a great product in dos cast, but it's free, which a lot of them are. And so how are you funded now? And then when does that transition happen? 

[00:30:26] Robert Longyear: It is free, we have a freemium model on the app stores. You can download it for free, but there are certain features that you can upgrade.

Oh, I see. Gotcha. Actually pay for it, so it's $2 99 a month. Um, and so that's sort of one revenue stream on the sort of consumer side, 

[00:30:42] Mike Koelzer, Host: Wayne, that to the listeners. When you say freemium, I explain what 

[00:30:46] Robert Longyear: they mean. Um, those are a couple of different ways that it works. Um, you know, people have definitely experienced this if you have a smartphone, um, but you download the app for free and you have access to some features, some core features so that you can keep.

Um, so some companies will run ads on the free version. Um, so that will be how they sort of fund that. Um, but for our app, um, one of our main features is something called cloud sync. Um, so if you want access to cloud sync, you have to pay $2 99 a month. But what, but what it does is it lets you remotely monitor a family member.

So, um, I can monitor my grandma who lives in Delaware. Um, he takes a couple of medications and I'm able to, um, see that she took her medications today or in approaching there from my own device. Um, and so those types of features, um, are available for, for an upgrade cost, 

[00:31:36] Mike Koelzer, Host: essentially. That's huge. Let me backup a little bit.

Cause right now I still own my own pharmacy, but some years I may not. And I was thinking to myself, what would I do? You know, what could I really do? Paid for right out of the shoot. And I was talking to my wife and one of my kids, and I thought, you know, one thing I could get paid for is going to doctor's appointments with elderly people, just driving them, being in there, listening to the doctor, and then.

Setting up their medicine, kind of keeping track of it and reporting them to a family member who was maybe a, a son or a daughter, a hundred miles away who maybe comes in once a once, every couple of weeks to see their mom or dad. But every time they're coming in, they're not having to see this. Uh, hurricane of medicine all over the place because they weren't taking it.

Right. And of course not getting the right benefit. So I guess I've just been replaced by your product. So now I gotta find something else. Well, but that's fascinating, that's a great, great thing. 

[00:32:46] Robert Longyear: What's really interesting, like is that there's a, there's a lot of investment right now in direct to consumer pharmacist consults.

Um, and so, you know, this, this might be something you could do afterwards, but, um, there's, there's a couple of companies right now that are, uh, that partner with physician's offices and they do over the phone pharmacy consultations. Um, medication therapy management is how they can be reimbursed for it through Medicare.

Um, and so it's, uh, it really does help, um, patients improve outcomes and reduce their pharmacy costs. And it helps them sort of manage their complex medication regimens. 

[00:33:23] Mike Koelzer, Host: I had a guest on last week, he said, okay, Basically Uber for pharmacists or doctors where this, this company through the phone is putting together just like a driver and a passenger they're putting together a healthcare worker and a, a patient who needs it, but it's an Uber model.

Yeah, absolutely. 

[00:33:43] Robert Longyear: So, um, but the, the next thing that is, is, is happening in the industry. Um, and, and I think this is one of the most fascinating things. So when I was in the hospital with, um, with my mom, um, one of the things that was really revealing was the fact that when the oncologist was doing rounds, um, there was a clinical oncology pharmacist with him.

Um, and so they, the, the amount of meds that have come out in the past, you know, 10, 20 years, um, has far surpassed what physicians were able to really learn. So pharmacy. You know, and, um, I'm sure you're very aware of this, but the clinical pharmacists have become, you know, it's its own medical specialty to be able to manage medications.

So, um, it's becoming so complicated that there's a market for helping physicians in private practice, being able to kind of have this, um, consultation ability, but also directly to patients who might see. And one of the core issues of the healthcare system, um, is, is this, this fragmentation where, you know, you go to a private cardiologist, you go to a private endocrinologist and they prescribed different meds, but they don't know what the other one prescribed.

And so, you know, having that central pharmacist in there and that central authority to be able to review the whole lists that the patient's taking and say, Hey, these two drugs can't be taken together. They're contraindicated. Um, so, you know, that's, that's something that we know is a huge problem. Um, And even though I experienced this when I was, I was going through the experience with my mom during her treatment.

Um, you know, that she was on a leukemia medication that is called Tirosint kinase inhibitor. And. The gastroenterologists at the time prescribed a medication that actually affects the efficacy of the leukemia drug, which is really the biggest issue that we're dealing with. So, um, you know, the, they didn't, he didn't know that, um, you know, this, they, there, she was on this drug and they were contraindicated.

And so I checked all the med lists after things were prescribed and I found this contraindication. I called Pfizer, um, and talked to them on the phone. Um, and I called the pharmacist at the oncology clinic and I was like, look, these two drugs can't be taken together. We gotta figure out what we can do with this.

And they were like, yeah, do not give her that drug. Um, and so for patients then, you know, I have a little bit of clinical background. I was an EMT, a certified EMT for three years. Um, not a great clinical background, but, um, you know, enough. And I worked in an oncology lab for about a year and a half. And so, um, you know, I work in healthcare.

I kind of understand these things a little bit. Um, but for most patients who don't, who don't even know to look for that, um, you know, I, I, there's a lot of bad outcomes that can occur. So, um, this is a really important space to be innovating in. Um, and so pharmacist consultations can really improve safety and can really improve clinical outcomes, um, for the health system as a whole.

Um, but also it can reduce costs for patients. 

[00:36:36] Mike Koelzer, Host: The pharmacist likes it or not the pharmacist is dispensers, there's going to be better ways to do that. Whether it's, you know, physically with the medicine, whether it's drones or, you know, vending machines and so on, and why not, let's get rid of that. Then the second one would be through information and there is a lot of information, more information than any of us can do in our head.

And that's from their handheld, their, their phone that they're getting that from. So, that's out. But I think the key is the word that you used is, well, let's figure this out. You know, you came Robert and you from practically, maybe not back then, but now on your phone, you're finding out that these two meds don't go together where the expertise comes in, where the value comes in is in that keyword.

All right. Well, we know this. Who's going to figure this out. Who's. Answer to this. We've got the drug, you know, we got that from the robot. We've got the information. How are we going to figure this out now, down the road, maybe 10 or 20 years, it's AI that might be doing a better job figuring this out. But right now that figuring out part is not there.

And that's where I think that pharmacists have to do their job. But the great thing that your company is doing is giving enough information to allow. The experts then figure that out instead of a junior in high school being, having to sit there and tell the doctor there's a drug interaction. 

[00:38:12] Robert Longyear: Yeah.

Yeah. The, the thing is, is, is like, you know, being able to provide that real-time information to, to the people who, who are experts in the specific space is, is what needs to happen. And, you know, in, in my book, I, I really focus on, you know, I, I distinguish between the institution of medicine, um, which a lot of people view as the healthcare system.

Um, it's, it is it, medicine is the research and the physicians and the, and the nurse practitioners and the nurses and the, they have really developed a good understanding of the human body, how to treat diseases in the human. Um, but the healthcare system itself, which is where I kind of see, you know, my education, healthcare management and policy needs to do a better job of actually delivering that expertise in an efficient and, um, you know, logical way to improve patient care.

So, you know, the, the, the different cardiologists and endocrinologists who have different offices across the city, or caring for one patient, um, is not a good way to make sure that that patient is receiving holistic care. And so the system and through technology, um, and then through payment incentives needs to be able to.

You know, really coordinate that better, um, provide the information to the people that need the information at their, at the right time. Um, and that's sort of where things are going. That's how we add montuno, kind of see ourselves fitting into, um, sort of the, the larger healthcare ecosystem. Um, we were actually in the process of working through a tech bill to be able to start offering, um, pharmacy pharmacist consultations to patients through their mobile device.

Um, so we're in the process of working through that process. You know, we also submitted a grants to the national institutes on aging, uh, at national institutes of health, um, here to be able to develop our, our artificial intelligence and machine learning into, to take leverage our mobile medication adherence data, um, and some of our self-reported health data to be able to predict patient deterioration, to be able to predict medication nonadherence and.

To look at the drug interactions more holistically. So we work with, um, uh, a, the director of, uh, a polypharmacy center at the university of Louisville. Um, and we are working on sort of developing that, assuming the grant comes through. So, um, we have a lot of big plans in the works to be able to really provide that information, not, not using the information as a, as a silver bullet, like I said, but to really connect the health system, the expertise that exists and, and provide them with the information, they need to be able to really care for patients right now, as opposed to, like I said, waiting until, you know, we're dealing with people when they're sick, we want to, we want to reach out as soon as possible to be able to try and get the best outcomes 

[00:40:53] Mike Koelzer, Host: yeah.

Or coming in, like you see in the news a few days later when a. They have a, they call the sheriff for a checkup or something like that. They find someone that's been dead for three days and that kind of stuff hopefully will be monitored and found out, you know? Well, before that, not just days but months before that of something happening, my dad used to get so pissed off when he.

Cancer and ended up passing from that. And there he had bone cancer, it would affect his brain because it would swell up different things in his brain. He couldn't think straight, but he would get so mad because he said, I just told that to the last doctor, you know? Cause every time they come in, they get a guy who can't remember stuff and they're asking him his age and his, all that kind of stuff, you know, and sometimes they say they do that because they're testing and they want to see that they agree with all that stuff.

But I think that's part of an excuse for just saying we don't have it all. I know Google was just in the news yesterday. Cause I remember years ago, like 10 years ago they had that Google health or something they were trying to come out with. And then just yesterday in the paper they got, I didn't read the paper, I'm dating myself yesterday on the phone.

They came out and they said they had a little bit of monkey business going on, coming up with some data that they maybe weren't supposed to have or something like 

[00:42:02] Robert Longyear: that. We track the digital health world pretty closely. Also starting to hear about your dad. Um, Yeah. I mean, it's, it's when I'll kind of address two points in that one is, you know, when, when there's a lot of pressure on physicians to see a whole bunch of patients in a day, um, for, from hospital administrators and from, you know, just in general to try and make a profit, it's kind of conceptually makes sense that they, they're not going to be able to really focus in on a single patient's case as much as they need to.

Um, so being able to simplify and provide the right actionable information to, um, to those physicians, to be able to have that at their fingertips is necessary to really make sure patients are getting the right amount of care and the right amount of tension. And so we can automate a lot of those processes using technology.

We can do a lot of analysis automatically. Um, so the physician doesn't have to sit there and go through their electronic health records so much, and there's a lot of companies working on it. Um, and then Google, you know, there's a lot of interest in health from Google and Amazon. Um, and you know, a lot of large, big tech companies, Facebook just came out with sort of a consumer health app, um, consumer health product as well.

And, you know, Google signed a deal with extension, um, Ascension, which was one of the largest Catholic health systems in the country. Um, they deliver care to a lot of people. It's a typical agreement that occurs, um, with, with tech companies, from, from hospitals to be able to have access to the clinical data.

Um, there's a lot of small companies like mine. Run analytics on, um, on electronic health records and pull out actionable insights, um, to be able to, you know, risk adjusting to patients and treat these patients more priority than this patient and in a whole bunch of different functionalities. Um, so the agreement that they signed, a business associates agreement for, um, you know, health data is pretty common in the industry.

Um, Google is getting a lot of, you know, there's the privacy talk in, in Washington at least about tech privacy and who owns your data is, is huge right now. Um, and so there's a little bit of a firestorm coming out with Google, getting the information from Ascension. Um, but you know, from our perspective, obviously patient privacy and, and data protection is, is really important to make sure that patients trust their care providers and trust the health system.

Um, and it's just, you know, it is their right to have, um, you know, their personal data. And private if they choose to. Um, but the innovation from the tech side from a big company like Google is, is a good thing. In my perspective, from my perspective, um, you know, they have access to tons of money, tons of capital.

They have access to world-leading experts. And so, you know, being able to really innovate and healthcare is going to come from companies like that. Um, there's small companies that can do things quickly. Like hours, but, um, you know, the big companies are really going to be able to do something that's that, that diffuses across the industry pretty quickly.

I agree. 

[00:44:58] Mike Koelzer, Host: And at our pharmacy, I mean, we were HIPAA at our pharmacy before HIPAA was invented. I mean, when I was there, when I was 13 at the store, you know, you're not going to call up someone's friend and tell them they have this disease or send a postcard that says, uh, Hey, do you need help with your hemorrhage?

You know, whatever. We knew that before we're smart enough. So HIPAA came in and made all this stuff official. I heard someone say, um, everybody was afraid of big brother. And now someone says, uh, Hey, big brother, should I wear my rain boots today or not? You know, it's like, so I have to say this for my customers that might be listening.

Yes. I'm all for privacy. And so on. However, with that said, it's like, I don't have anything to hide. You know, if people want. Pictures of me to, and to keep me in line or if they, if they want to know my weight or my what medicine I'm on, I'm probably not on anything too embarrassing or have a disease that may be leaves a bad connotation of who I am, but it's like, bring it on, you know, show me the right ads, show me the right stuff.

And again, I'm for privacy, but I'm for privacy. But personally I think if anybody knows something about me, I'm going to get more refined results and probably get better. Healthcare because of 

[00:46:21] Robert Longyear: it, I guess I think it's a, it's a matter of, and you know, this is a big debate here in DC. You can't walk into a coffee shop without hearing somebody talk about it.

That's what I 

[00:46:30] Mike Koelzer, Host: was talking about DC. You're in the right space, at least a 

[00:46:32] Robert Longyear: year. All those conversations go. Absolutely. You can just sit around and listen and you never know what you're going to hear. Um, but you know, I think that, you know, patients have, have a complete right to be able to require privacy, but you know, generally speaking, a lot of people, you know, and what we've seen in some of the research and what, you know, a lot of us believe in this space is that a lot of people are like, if it gets me better care and it takes care of me better, or if I get a better service out of this, that's okay with me.

Um, it's just, it's just, who has access to it? Do I, can, I can do I have control over? And if I want to, um, and you know, As long as I'm getting a benefit from it, then that's that. Okay. Um, and I think that, I think that we are seeing sort of a trend with that. We see a little bit when we look at a lot of research like sort of digital engagement on smartphones and tablets with seniors in particular, um, people that we would expect to be really against data to be really against tech.

Um, and we know that there's a gap between, you know, they really want to be engaged by, by the healthcare system on their own time, on, on healthcare, on, on their mobile devices, um, to be engaged digitally because it's more convenient and it doesn't disrupt life as much. And so we think that there's a pretty good market for tele-health and for technology in those, in those, in the older generation, um, who typically has a higher rate of disease who typically take more medications, um, we expect that there is a market there.

Um, it's just a matter of. The applications are user-friendly and get the word out. Um, and so we think that there's a lot of benefit to that. Um, and we know that, you know, my generation in particular, I have an apple watch on right now. Um, if, if my doctor wants to be checking my EKG automatically on my app or ECG, that's the German way to do it, the ECG on my, um, on my apple watch, um, or they want to check my heart rate and if something goes wrong, if they want to send me a text message and say, hi, Robert, um, I noticed something wrong on your ECG.

You know, do you want to come in next week? If, if that's going to catch me a problem and keep me out of the hospital, I'm, I'm personally okay with that. Um, and so it's just a matter of, of making sure that from a federal perspective, that the laws and the regulations are in place to make sure that people in large companies aren't allowed to do bad things with the data.

So. 

[00:48:48] Mike Koelzer, Host: I agree. And I think the other thing I suppose has to do with maybe some hiring and firing laws, because there's still stigmas. And for example, I'm not sure where the, well let's pick two let's, let's say the president of the United States, and let's say airline pilots, I'm not sure where the laws stand right now or where even the corporate procedures are.

Are those pilots allowed to say that they're anxious and depressed and they're on a SSRI Prozac or something? Is a president allowed to say that he's on a Xanax when he finds out that the, uh, bunker rate is going to go on against Iraq or something that day. And I forget where some of the stuff is on that, but it seems like it was no shame or legal.

Ability to come down on someone like that. I think everybody's healthier to say, like, if I knew the president was doing something like that, Geez. That's a great lesson for somebody else. Yeah. 

[00:49:53] Robert Longyear: I think, I think there's a lot of debate that still has to occur. Um, which is, you know, most people will think that's all that happens in Washington.

Um, which is, which is a valid concern. Um, I think that, you know, when it comes to privacy, um, you know, we have HIPAA which protects personal health information and a lot more. Um, but I think that the sharing of personal health information is less of a problem. I think it's, we, we certainly need more explicit laws in place and policies in place that prevent discrimination based on, on health status or health information, um, that prevents any sort of retribution for that.

Um, and so once, once those are in place, um, you know, in, in more concrete and more explicit language, um, then you know, the privacy may become less of, less of an issue. Um, and I think. Um, you know, obviously for example, with essential and Google, the business associates agreements that are typically signed for healthcare data are, um, you know, you can only use this for, for reasons that improve clinical care.

You can not share this outside of your organization. These people have access to it. Um, they're really explicit. Um, the, the trust with the trust issue and the reason why this seems like it's a big problem is because Google, Google, the big concern is, you know, they, they, they have a culture there where it's like, we will just do anything to innovate and, you know, break the rules.

And, um, they're concerned about sort of the internal controls and whatnot. Um, but you know, from a, from a privacy perspective, with personal health information, um, the department of health and human services, you know, they handle a lot of the HIPAA compliance issues. And, um, you know, in health companies, you go through a week of HIPAA training when you start, um, yeah.

Terribly boring after the sixth time you've heard it. Um, but you know, if people are companies and people do actually slip up with personal health information, then there are consequences for that. And so the, it, you might say that they're not, they're not strong enough or they're not, um, you know, patients didn't provide consent for, for essential to share that information with Google, which is one of the big topics of discussion.

Like patients can consent to share their data if they choose to. Um, but you know, we'll have to see what, where the discussion goes on this and, and what sort of policies come out, um, in Congress it's gotten a lot of attention recently. Um, and, uh, the federal agencies are very aware. Um, I was actually taught, uh, in my health law class by one of the inspector generals or assistant inspector generals of the department of human health and human services office of the inspector general, um, who investigates, uh, issues with like fraud waste and abuse in the Medicare program, um, and HIPAA related issues as well.

And so, um, you know, they have a really strong, robust ability to regulate and, and to bring consequences and, um, you know, let you feel it would be fine. If, if, if organizations do fail to protect patient data, um, you know, obviously more can be done, but, you know, I think a lot of the health, the health data is pretty well protected.

Um, based on what I've seen, you know, there's been some breaches, but, um, you know, the big concern I think is, is the larger data picture of consumer data with Facebook having so much information and who owns it. Um, and that's kind of spilling over into healthcare a little bit too. Um, you know, in my experience, it's pretty well guarded.

Um, 

[00:53:07] Mike Koelzer, Host: I think so. I think it's pretty well guarded and I guess I'm not in the position where I can't think of a disease right now that I would have, or a medical thing that would prevent me from doing what I do. I suppose there's things out there about, I don't know the rules. Like if you're a, again, I'll go back to an airline pilot, they find out your site's going bad or something and in your eye or you got a cataract or something, what does that do for your job and those kinds of things.

Yeah. Yeah. As a 

[00:53:34] Robert Longyear: person who flies, I would certainly prefer, um, if my pilot can see, um, so I, yeah, generally I think that those types of things are important. I think that, you know, one of the big areas, just to give you a concrete example with some of the data privacy and discrimination is. Um, if it with, with pregnant women, um, if somebody is pregnant and employed, they might go out on maternity leave and there's an opportunity for them to be discriminated against, um, in the workplace there.

So that's an example. Um, I, I think that people who may be of higher risk for healthcare costs, um, who have a genetic history or some sort of disease, um, if that employer finds out about that and they have an employer health insurance plan, um, you know, they may not want to hire that person cause it's going to drive up some of their costs for their, their insurance plan.

Those are very 

[00:54:24] Mike Koelzer, Host: real life examples. 

[00:54:25] Robert Longyear: Yeah. So there is risk there. Um, I do think that there's ways that, um, you know, we can use regulation, we can use policy to really, you know, protect people from that type of discrimination, um, without really preventing the innovation that needs to occur with patient data.

Um, and you know, being able, and this is the example I always give. Um, when you go see your doctor and you want to get diagnosed with something, um, they may have seen. 5,000 cases in their lifetime of your, your condition, if you're, if it's an older doctor, um, but why not have a computer compare your, your profile and your patient data against a million patients that have had a similar condition to you and then determine, Hey, this is most likely the condition that you have, um, based on a million.

So it can really enhance the health system, that data. So, um, you know, that's, that's one area. I think we want to be careful with putting too much regulation on it. We want to, we want to protect patient's privacy and we want to protect people from discrimination, um, based on, on healthcare and certainly other factors as well.

Um, but we also don't want to stymie innovation to be able to truly improve our healthcare. 

[00:55:34] Mike Koelzer, Host: And I think like you said, Robert, I think I heard this, that it may not be so much of the. Information because we do a good job on that, but it's the discrimination. And when you had mentioned that the baby, you know, I was just thinking that it was the same lady that maybe doesn't want the word out to their boss for sure.

Because she is going to get discriminated against five seconds later has just posted to, you know, 5,000 people on Facebook that she's having a baby. So it's like, yeah, it's probably less of that information and more of like what can be done with it. Cause the information seems to be out there anyways, you had mentioned, um, maybe a doctor who has so many patients, but could see, see more.

And that's one of the reasons that I heard is so cool about these, um, self-driving cars, right? And now that there's LG five or whatever out there real quick computers, but they said that, oh, I'll just use this example. You're backing up a driveway with a certain slope to it and you make a turn, but you slide a little bit into your mailbox, you know, the next.

Winter, you might say, ah, I remember that I went down here and slid into the mailbox. So this time I'm going to take a little bit of a wider angle. Yeah. But with the new technology and the artificial intelligence, it's like, when this happens to you, the first time a billion cars are going to know the next day, not to take that angle or it could slide into the mailbox kind of thing.

So it's just, it's on that same thing as a health has just like, so much learning that that can come from. Yeah. 

[00:57:16] Robert Longyear: And, and that's what we're hoping from Google. Um, you know, they're, they're the experts at, at information and, and big information information, and being able to pull it all together, big data, massive data sets to be able to analyze it and pull out really easy, actionable information for what you're looking for.

Um, and that's what, you know, they've announced recently they've done some hiring and their Google health division. Um, and you know, one of the things that came out of it that a lot of people have said is really underwhelming, um, is, is improving searches and electronic health records for physicians to be able to search.

And, you know, while it seems like a pretty trivial thing, it's very complicated because there's a lot of data points and a lot of things. Um, so, you know, I, I expect that to be pretty effective and um, you know, hopefully, you know, we'll be able to start seeing that, you know, the electronic health records are a huge topic of discussion physicians generally don't like.

Um, and it's it. They have a lot of room to be improved. I'm not 

[00:58:14] Mike Koelzer, Host: a huge user right now of voice technology, because I've got this hundred dollar Google. Thing in my kitchen and all as I've asked it so far as what's the temperature going to be tomorrow, you know, it's like, I don't, I haven't delved into it, but they were talking about like, let's say Alexa or Google home or whatever, but they talked about having one of those in the, in the patient's room, let's say, so a doctors making rounds, they come into the room and the doctor doesn't want to mess with the phone and this and that.

And there's nurses that are on and everybody in the patient's there. But the doctor with his voice is able to get a fingerprint access to his voice. And he says something as simple as when was the last time that Mrs. Smith had her legs looked at, you know, whatever, something, something very minor that would be kind of hard to search.

But by having him get that information, he can say, oh, well, I'm seeing a bump here. Well, whatever, whatever the example is, but. Very very seemingly simple question that the doctor can verbally ask. It comes back to him through the speaker or even an earpiece. And that information is worth the life or death for this patient.

And they were talking about Alexa for that. Yeah. And I thought that. 

[00:59:39] Robert Longyear: Yeah. You know, so let's take Alexa as an example here, I have an Alexa, I love my Alexa. You 

[00:59:44] Mike Koelzer, Host: do, do you ask anything more than what you 

[00:59:46] Robert Longyear: should I wear it today? Well, so, you know, I, I, I like, well, I'll tell you a couple of things I use on, and then I'll give you sort of three examples of voice technology, um, in healthcare.

But, um, I personally really liked the scheduling so I can be like, Alexa, remind me, you know, tomorrow at five, I need to do this. And, and, and she'll text me. Um, and you know, that's great for my calendar. Um, I like to ask about the weather in the morning before I go outside. Um, you know, they're, they're simple things, but they fit nicely into your life.

Um, and, and one of the things that I recently discovered is if you're a prime member and you go to whole foods, um, and you pick up a, um, you, you pick up, uh, like one of their pre-packaged meals that you can make a proportion like blue apron or hello, fresh. Um, but you can take it home and Alexa will walk you through the steps.

So I can be like, Alexa, I have, oh, you know, the honey orange chicken today, um, from, uh, can you walk me to the steps? And Alexa would be like, sure, step one. Start chopping their cucumbers. Um, and so like, that's, that's an interesting piece. Um, so I do like my Alexa quite a bit. Um, and so here's three, like quick healthcare things, right?

So one we're working on voice technology, um, for, you know, monitoring patients in the home. So for seniors, it's hard for them to use the mobile device. So, you know, when we want to ask them, you know, how are you feeling today? Tell us a little about your health. They can speak it and we can have that data sent to their physician.

So that's one. Um, so I think the two overarching categories are improving. Um, sort of the physician patient experience. So physicians right now really rail against electronic health records because they sit in the office and they have to sit there and type while they're talking to their patient. Patients don't like it, but now I can face patients and I can be like, I see I'm doing it.

Um, you know, I'm doing an eye exam. I'm looking through here, I'm seeing a little bit of a collusion. Um, I'm going through here. I'm doing a, you know, a knee exam. Yeah. It reflects and looks great and that information can then be taken through voice and structured into an electronic health record for.

[01:01:44] Mike Koelzer, Host: Maybe even some day, it's like how Microsoft did this. They watched people's movements to do the games, you know, like playing ping pong and stuff. And maybe they say, well, when the doctor bends over at this angle and brings both hands up, we're going to record that he looked at the eye or something like that.

But same idea though. Okay. So yeah, the doctor can talk it through. Yeah. And so 

[01:02:03] Robert Longyear: Hopefully then we're able to pull it out and do an electronic health record. And then that improves the patient physician experience improves the patient's experience and we're getting that data that we need that really rich data.

Um, and so that's kind of a hope, I think that that might be effective moving forward. Um, and then there's, I think the big one though, Is patient code data collection in the home. Um, giving patients the ability to, um, schedule some of their healthcare stuff through Alexa and being able to collect healthcare related data through Alexa, I think is truly the future.

So, you know, once a day, you, Alexa, Alexa asks you, how are you feeling today? If you say, oh, I have a headache. And my, my, my chest hurts a little bit and, or, you know, I, my it's been sweaty all day. I haven't taken my, my, um, you know, my nitroglycerin for my, my heart condition for a couple of days. Because the prescription didn't get filled.

And then, you know, that's an alert that might say, Hey, this patient might be having a, it may be at risk for a heart attack coming up. And so, you know, or whatever the questions need to be or whatever it gets pulled out of there. And then, you know, clinician, nurse can call and be like, Hey, you're at risk.

Or Alexa could even say, Hey, you might be at risk. You should call your doctor. Um, and that's the type of thing. Um, can can really help the healthcare system sort of become more, more proactive rather than again, waiting to schedule appointments after a patient ends up in the emergency room. So I think that that's a big thing.

Yeah. And 

[01:03:29] Mike Koelzer, Host: it's not asking things like, tell us your temperature and your blood reading. It's saying, are you feeling like you've been sweating a lot of, you know, whatever, whatever, whatever they can put into words, but then the smarts of the internet, you know, they, as they say, puts it together and gives them something for it.

Robert, what is your day like in general? Are you at, uh, are you on the phone? Are you at a computer? Are you in meetings? Are you, what are you, what are you doing? Like generally through the day, where's your body taking you through the day kind of physically on site. 

[01:03:56] Robert Longyear: Yeah. So I said computer a lot. Um, I'm at an early stage startup.

Um, and just to answer your question earlier on the funding, um, it was, it was built and then there was success. So there was, uh, uh, capital to keep operating since 2010. Um, the application was sold to some big healthcare systems and some bigger organizations as well. Um, so it's, it's, if there was a recent cash infusion this past year, so I was able to come onboard and start working full 

[01:04:20] Mike Koelzer, Host: time when they say.

I imagine they give them more access to freemium and so on. And that was part of my question. Well, if it's free for everybody, why have shoved someone by it, but they give them more functions and it's tied in more and all that stuff, I imagine. Yeah. So the 

[01:04:37] Robert Longyear: health, the health insurance companies, or the, or the home health agencies or the health systems will purchase it and they'll pay monthly, it's a SAS model, a software as a service.

So they'll pay a monthly fee for that and they can offer it to any number of patients that they want to have using the functionality. Um, and so that's sort of the business model there. Um, so what I do on a day to day basis, I do a lot of research, um, on, on sort of other products. I do research on sort of health industry trends.

And then I do, I do some sales. So I'm, I'm on the phone. Um, I'm talking to potential customers and clients. Um, I do a lot of talking with some of our partners that go in on federal grants with us. So, um, I, for the month of September and October, I was writing a lot of, uh, I was writing a lot of grants, um, and a lot of contract proposals for federal.

Um, and so it's a mix. Um, I wear a lot of hats and, um, it's, uh, it's, it's been a, it's been a great, great experience so far. Um, and you know, we, we, the, the application has actually been in some, some clinical studies, um, one out of the university of Utah. And so they use it in, uh, young adults with cancer, uh, population.

And so they wanted to see if a mobile first smartphone application that can help patients remember their medications would be accepted by part of that age group. Um, and they think it was helpful. Um, Did show that the people that were included in the study, um, you know, they really did find value in it.

It did help them remember their medications. They did use the app. Um, so the tool is, is, is clinically validated. Um, we're looking to get into some more, um, you know, rigorous, um, academic evaluations of the, of the product, um, going forward. 

[01:06:14] Mike Koelzer, Host: How many people do you like with everyday lakes? Are there a couple of you?

Are there a handful of you? Are there more, how many people are running around the office during the day? 

[01:06:22] Robert Longyear: There were a few of us. Um, so we have, uh, we have some of us work from home every once in a while. Um, and so we have a kind of a shared office space, like we work. Um, and we, you know, I met with our CEO.

We have a, um, a development team that works on the application, um, that we work with. And then. You know, I, I see a lot of other companies in the office as well, so, um, it's a shared workspace, like I said, so, um, there's, there's there's policy, there's nonprofit, there's um, you know, other consultants that are here too.

So, um, it's a, it's a pretty busy office, but we're, uh, we're located at a new development in Washington, DC called the Wharf. Um, so it's right on the water, um, beautiful office space. Um, so, you know, I, I probably say I split my time 50-50 office work from home. Um, but I do a lot of phone calls. They do a lot of networking.

Um, I go to a lot of, uh, meetings with potential customers and potential collaborators as well. 

[01:07:16] Mike Koelzer, Host: Yeah. With the actual app, what are you hearing are like, ah, crap, Google or apple is doing this again. What are the pain in the ass things with dealing with an actual app? You know, it's like, like one, like one question I always had is how long does it take?

Like if you found a problem on your app, how long would it take to. Well, let's not say the fixing part could take a long time, but let's say once you fix something and put it back into like, say, oh, we have, we have a new version. Because we found out this, something was broken. How long does it take before the customer can upload that there's, 

[01:07:54] Robert Longyear: there's frequent app stores.

So both Google, Amazon and apple, um, they, they all require frequent updates. So you can't just write a code for a mobile application and then just stick it on to the app store and then expect it to remain on the app store. So you have to manage it and continually approve it. And so they it's. Frequent, you have to do it so frequently.

Um, you know, with any technology, there's gonna be some bugs that pop up for some users. And so, um, you get data. When, when apple, I recently learned this, when, when apple asks you, do you want to share this data with Microsoft? You want to share this data with apple. Do you want to share this information with, um, you know, anything you're Dell to improve your products?

Um, if you opt into that, the, the, the companies get the data and they say, oh, you know, this, this app is crashing. Um, oh, at four o'clock because there were a whole bunch of users there. Um, and so the developers, the software engineers will sit there and they'll figure out what the issue is. And they'll be able to identify that and rewrite the code.

And then, um, hopefully it, um, you know, makes the app, it fixes the bug and then you just push an update. So you just update the application and does 

[01:09:02] Mike Koelzer, Host: that update re rather quickly then? Yeah. Like if you guys found a problem right now, if you fixed it, like, let's say you push the button to say, all right, this is fixed, go back out.

Would that be up like in five minutes or something? 

[01:09:13] Robert Longyear: Yeah. Yeah. So. It's a matter of rewriting the code. Um, you typically want to warn your typical product management. You typically want to warn your users, Hey, pushing an update on, you know, this day, um, you know, you might see some disruption, you know, please update your app to fix these bugs.

Um, so you want to be transparent about it, but it can be done right away. Yeah. So you just, you know, it's, it's a matter of, of how big the problem is, you know, how much code has to be written to actually fix it. So, I mean, if you're a big company like Facebook, Google, like you can have, you know, your 300 software engineers working on it overnight and have it up.

If it's a big problem, it will happen very quickly. Um, but typically what will happen is you'll kind of rewrite the code, you'll make your fixes of your bugs. And then you'll sort of, you know, upload, and I'm not a software engineer, so I could be misquoting some of this, but you typically upload that, um, that information to, um, you know, basically through the console, the developers console that apple, Google, Amazon provide.

And then the app is then pushed out and available for update on mobile devices. 

[01:10:13] Mike Koelzer, Host: That's interesting. I don't know why I fought longer. I guess I've seen some problems on some apps where, you know, like it resets when you do this. And it seems like maybe they had problems writing the change in the code and so on, but then once it's done, they do it pretty fast.

Any 

[01:10:28] Robert Longyear: number of issues that can come up, uh, they can be related. It can be, you know, somebody could not be working for you anymore. And then you have to have somebody to relearn it. You never, you never know. Sure. A 

[01:10:38] Mike Koelzer, Host: tons of reasons before that. Yeah. It doesn't just happen like that. What's the most frustrating part?

I don't mean your company. We're not gonna talk about the people that sign your check. What's the most frustrating part about your day in jail? Or week or whatever, see here dealing with anybody, 

[01:10:56] Robert Longyear: or, um, I would say, I would say for, for me, somebody who comes from more of a research background, um, who's doing a lot more analysis and a lot more analytics, um, yeah.

I, I, it being an early stage startup, you have to wear a lot of hats and you have to move kind of quickly. Um, so, you know, just by nature of that role, um, you know, you, you don't get to sit there and spend a week developing a really deep amount of knowledge on, on a subject. So you really have to like to do stuff as you go and stay on your feet, um, to be able to, you know, Basically stay operating.

Um, and so, you know, I, I will say that, you know, I, I do miss having some time to sit down and really do a thorough literature review and, um, understand where, where the research has come from something and then be able to develop a new analytic framework to evaluate a problem going forward. And then, um, you know, have the luxury of time and, and, the narrow narrowness and your job to be able to really, um, focus on something and really comprehensively sit there and be like, I get this now.

Um, I know what this is. I'm very confident in this. I can go speak to it. Um, there's a lot of that kind of being on your feet, which, which is, is, is interesting. And it's, I do enjoy that. Um, it's been, like I said, a great learning experience, but I definitely, um, you know, I do miss a little bit of having that dedicated time to really hit something really hard.

[01:12:25] Mike Koelzer, Host: Yeah. And if it's your own problem, you can, you can gradually do that. But if someone has asked you about it, then it's like, you're on their timeframe. Robert is someone who said you had to take a sabbatical, uh, away from your book away from the business. What would you do for a year? And they say, we'll see you in 365 days, your jobs here, what would you be doing for 

[01:12:46] Robert Longyear: That year?

It's hard to work full-time and write a book. Um, uh, so if not, I would say if I had time off, I'd focus a little bit more on the book. Um, but if I really had the opportunity to take time off, if I had the financial ability to do it, I would, I would travel quite. Um, yeah, I would really like to do that.

Um, but I, my, my interests really lie in, in research. So what I would tell you is I, I might, I could go back to school. Um, I, I, I would probably try and get some fellowship. Um, I would get research fellowship with a research Institute and, uh, spend some time working on a specific 

issue. 

[01:13:29] Mike Koelzer, Host: Um, that's a good sign.

I mean, it's like, you're not climbing out the walls, trying to get out of what you're doing. You know, it sounds like, it sounds like you're on the right path. 

[01:13:37] Robert Longyear: Am I starting podcasts? Hey, there you go. Yeah. Then, being in DC, you have access to a lot of people. So, um, you know, it, that, that might be something that'd be interesting to do.

I've, I've talked about it, um, a couple of times, but, uh, you know, I, like I said, you can only, you only have so much time in the day, which is something I'm starting to learn a little bit more about, 

[01:13:55] Mike Koelzer, Host: You know, they say now is the time. You know, podcasts, as you know, they've been around for, you know, 10 or 15 years, they say now's the time.

And I don't, I don't know. I believe that, because it seems old to me, but then for pizza, Google just came out with their first podcast app, like a half a year ago or something. So I guess it's 

[01:14:15] Robert Longyear: rather new. They're getting popular. I mean, I really liked them. Um, I'm heading back to Atlanta for Thanksgiving and um, I'm purposely renting a car to drive back instead of flying back to DC because I want dedicated time to listen to all the Freakonomics episodes I've missed.

Um, and, um, I'll, I'll definitely add the business of pharmacy there too. Um, and you know, so I had to bring some stuff back, which is, you know, another driving force, but like I'm sitting here and I'm just like, I'm very excited to have this 10 hours in the car by myself to listen to some podcasts. Um, and you know, I think that it is a big industry that's coming up.

Um, you know, I remember being in school and um, you know, some of the professors actually assigned like do a, do a podcast episode as a, as an assignment. Um, so I think that this type of media. It's becoming more popular to really be able to, you know, actually it's, it's more user-friendly and more mobile than having to sit there and read 

[01:15:13] Mike Koelzer, Host: something.

I've always thought a podcast is like a movie, but you know, not as good as you don't get to see it, but it really, if you compare it to reading, I had heard that, you know, there's some people. Can't read more people can hear than read because of concentration issues and dyslexia, and just, just having the time to sit down and you can't read while you're in the car and those kinds of things.

One interesting thing that I've noticed is two or three podcasts that are the longest have the most listeners. Interesting. I was kind of amazed by that and I've got a theory for it. And my theory is that we are so sick of making decisions. You know, you'd go in and you have a million decisions you have to make.

So my theory is if you can pick a podcast that's an hour or an hour and a half or whatever, it's only one decision where if you have a 10 minute podcast, you have to pick between six and nine podcasts instead of just making the decision to go with one. So, yeah, I 

[01:16:07] Robert Longyear: Think, you know, what, if you think about like 60 minutes, um, you know, that's been around for so long and it's really engaging.

And you think about this as more of a more mobile accessible 60 minutes where you can listen to it when you're commuting. Um, and I really use them for educational purposes. I mean, you get to listen to interviews with people who are working in industry, or like, I like Freakonomics because it's all behavioral economics.

So, yeah, it's very academic focused and, um, you know, I, I, when I get into cars, like, that's, I love sitting there listening to it. That's your time. 

[01:16:39] Mike Koelzer, Host: And I'm purpose, even over, over the, to focus 

[01:16:42] Robert Longyear: on that. I mean, it's a great way to keep learning. So like, I see it as not being at school, being able to stay on top of topics there, basically some of them are like mini lectures.

Um, I listened to a philosophy podcast with a bunch of philosophers from Oxford and Cambridge. What's that called? It's called philosophy bites. Oh yeah. At Georgetown we have to take a lot of philosophy and theology. So, you know, you have a little bit of an understanding. And so it's, it's just an interesting way to think about the world.

And so, um, yeah, I see it as they're there at 30, 40 minute long lectures and you can keep learning. Um, so trying to think that they're, they're great. Uh, I'm a big fan. 

[01:17:18] Mike Koelzer, Host: Yeah. Well, speaking of learning, Robert, I'm so glad you read. For me to do this because I've learned a ton from you, which a lot of the guests, I cleaned up my learning because I had a little bit of knowledge, but on this stuff I had not have as much.

And you've really brought some really interesting stuff to this. So I'm sure the audience is going to love this. It's kind of late in the show to put a plugin, not on the last and the last minute of the, uh, of our episode here, but nonetheless, it was sure a pleasure having you on. Yeah, 

[01:17:47] Robert Longyear: Mike, I really enjoyed the opportunity.

Um, you know, it's, I like to be able to talk about this type of stuff and, uh, especially the work that we're doing at Bon tuna, but, um, you know, the healthcare system in general is it touches all of our lives and, um, you know, it's, it's a big topic of debate for the, um, you know, presidential election. Um, it's, it's a, it's a big.

It's very important. Um, and so, you know, and pharmacy truthfully, um, bringing it back to sort of, you know, the core focus podcast is, is the huge industry, um, both from the research and development for medications and drugs, and, um, actually delivering it to patients. And so, um, you know, it's, it's a huge part of the conversation in the greater health policy world here in Washington.

Um, and sometimes it might get missed in the, in the sort of more public presidential debates, but, um, under Medicare for all, um, under, um, you know, some of these different policies that are being touted, Medicare buy-ins, um, fixing the affordable care act, you know, all of those are going to involve alterations to, to pharmaceutical drug pricing and to, um, you know, managing pharmaceuticals better.

Um, so I mean, extremely relevant podcast, glad to be talking about it. It was a great 

[01:19:03] Mike Koelzer, Host: discussion. I'm always talking to my people at the store about. You know how I never know the future of our little independent corner pharmacy, but you say the top cause of death is cancer and heart disease. You got guys like Steve jobs that had it all, but his health.

Yeah. If they talk about businesses being, uh, problems that you solve, and if you solve them, you get paid for them. There's always going to be a need for health discussions on a, on a smaller level, on your bigger, a policy level and how all that intersects with the technologies and payments and stuff. So I think we're on the right topics.

[01:19:46] Robert Longyear: And you know, when it comes down to. Um, and this is what I talk about in my book as one of the core features. It's like the interaction between any healthcare provider, the health system and the patient is where the magic happens. Um, so anything that happens in the policy arena up top can really influence that.

But truthfully, if you want to improve a patient's healthcare, if you want to actually do what the health care system is meant to do, um, it comes down to where is that patient going to get their medications? Who's talking to them there? Um, you know, and, and who's their physician. And, you know, when it comes down to it, the stuff that happens at the patient level is extremely important to understand.

Um, and, and far too often gets lost in the greater conversation.

[01:20:26] Mike Koelzer, Host: It does. And that's where, um, you can go a long ways, but if you got some stubborn, you know, maybe I'm in, maybe I'm almost that age right now, stubborn old fool that doesn't want to open his mouth to take a medicine because he doesn't believe what his doctor's saying or this or that. That's not 40% of the adherence to forgetfulness or whatever, but it's stubbornness, but that's another topic.

[01:20:49] Robert Longyear: Yeah. Well, it fits into the other 60%. So being stubborn, distrust, um, and you know, you're hearing the same messaging from, from a physician, from, from a pharmacist where you pick your drugs up to that, you know, I don't know this for a fact, but I'm sure it has an effect on patient's willingness to trust the system a little bit more.

Like if you trust your pharmacist and you don't trust your doctor, um, you know, your pharmacist tells you the same thing, maybe it's like, okay, well I guess I can do this. 

[01:21:12] Mike Koelzer, Host: Yeah. Or maybe not. Hey pleasure, Robert. Thank you. All right. We'll talk to you.