Documenting Value | Samm Anderegg, PharmD, CEO at DocStation

Transcript Disclaimer: This transcript is generated using speech-to-text technology and may contain errors or inaccuracies.

Mike Koelzer, Host: [00:00:00] Sam for those who haven't come across you online, introduce yourself and tell the listeners what we might be talking about today. 

Samm Anderegg, PharmD: My name is Samm Anderegg. I'm a pharmacist. I grew up in the Midwest, a small town, Iowa. And I think what would be interesting to talk about is my transition away from practice completely.

And into technology, uh, where I am today, I run a company called DocStation. As I started looking at dock station right before we were talking here, I'm thinking now, wait a minute. There's a few docs involved here. There's the doctor and there's the documents. And I thought about both of those kinds of work. So fill us in what is doc 

Samm Anderegg, PharmD: station?

Yeah. So it's a clinical platform that pharmacists use. To take care of patients and get paid to do that. And so you pointed out something, uh, interesting that, you know, I considered when choosing the name for the company, which was a doc, I think originally was, came from that document when we need to clinical platform to document that the care that we're providing and be able to get reimbursed for it.

But what we're really trying to do is inspire a mindset for pharmacists out there. Um, to really believe that that D behind their name stands for doctor, and we're trying to transition into more of a role in primary care. And so it's, uh, meant to be uplifting and inspiring. Um, and it was, it was for me and it still is.

And it's part of the mission of the company 

Mike Koelzer, Host: years ago. Somebody said that pharmacists do it. Terrible job. Documenting and the story that I was told someone compared it to, like, if you went to a lube and oil shop, you know, those guys get their clipboard out, you know, and they, and they show you the 50 things they did, you know, and, and pharmacists, they do a lot, but they just suck at recording.

It. That's a big part of it. 

Samm Anderegg, PharmD: Right. I think, um, it's an interesting predicament. We found ourselves because. Yeah, the pharmacy business model has evolved over time. And, because it's been so centered around dispensing prescriptions, a lot of the operations in community and retail pharmacies have just been, uh, about how to optimize volume, how to dispense as many prescriptions as possible.

The lowest possible cost. And because of that, any, any, you know, amount of time or extra time that we would have to spend with patients, let alone document our interactions with them, basically doesn't exist. Right? And so we're so busy filling these prescriptions now. 

Mike Koelzer, Host: It was actually cost prohibitive to do that.

I mean, every time you did that, you were falling behind on something else. It's not just that maybe you didn't want to do it or didn't have the skills or something. It was actually a negative issue. I mean, you were, you were losing money doing 

Samm Anderegg, PharmD: it. Right, exactly. Right. And, and now we're in the situation where, you know, we can evolve our business model, uh, the opportunities there, but we're stuck in this chicken or egg situation.

Right. So if we want to get paid, we have to document. Yeah, and we, we just it's, uh, we have a hard time creating that time in order to do it. So it's a barrier to entry to get there. And those are some of the things that we're trying to solve with, with technology, with software, 

Mike Koelzer, Host: You write about the chicken and the egg, because I remember.

Probably 15 years ago, I was sick of the reimbursement coming through. And I think at the time, like the, I dunno, NCPA or something like that, I had this pretty fancy looking three-part form, you know, it was high tech, carbon copies, you know, stuff back then. And I thought, damn it, I'm going to document.

And I probably got back from one. Weekend, not retreat. What do you call them? You know, what do you call the expo ward? You call it MCP 

Samm Anderegg, PharmD: conference 

Mike Koelzer, Host: or whatever. I probably got back from one of the weekend conferences and like, I'm going to do everything. And that probably lasted about 15 minutes, you know, until I got hungry for lunch or something, you know?

Samm Anderegg, PharmD: Exactly. 

Mike Koelzer, Host: Cause it just took too long. You didn't and, and it was the chicken and the egg, you didn't know what you were going to do with the damn thing once you got it done, 

Samm Anderegg, PharmD: right? Yeah. I mean, there's so many different parts of the process to actually, you know, document. and then get paid. I mean, like there's a whole ton of things that need to happen in between and a form's Great. Right. That's the starting point. Those are the building blocks, but how do we turn that into actual revenue and revenue that we can grow and, and build a sustainable business on? So those are the intricacies, the burden, essentially that I've taken on, that we've taken on as a company. You know, bear that burden for pharmacists and just make it easy to take care of patients' documents quickly and get paid.

Mike Koelzer, Host: The second end of the document, which never came to fruition. For me as these things just rotted in a drawer, I probably bought 500 of them. I probably went through about [00:05:00] three of them. So the second end of the documentation, what is that? You have a fancier way to get this in, but where does that go then?

It 

Samm Anderegg, PharmD: depends. So, um, let's compare it to, you know, physicians or nurse practitioner or a PA or a chiropractor, or really any provider listed in the social security act as a, you know, a provider 

Mike Koelzer, Host: which is from 1970. Right. And 

Samm Anderegg, PharmD: we're not. Yeah, exactly. I think it was even before 

Mike Koelzer, Host: that way back, like 50, some years ago, we're not part of it and never 

Samm Anderegg, PharmD: have been, never have been.

Um, and there's a whole bunch of issues and barriers around why that is. They just introduced legislation in the house and the Senate, which is exciting, but the same barriers remain. Um, but let's take that process as we want it to be a physician or a physician extender or a mid-level provider.

Uh, we document that care. Uh, a lot of times in, you know, physician land or nurse practitioner land, it's free, it's still free text notes. Right. I'm writing a soap note. That's how I was trained. And, um, you know, it's like having a word document open and I, I tracked the conversation, uh, add some labs and vital information in there.

My assessment. And on the back end the way it still happens. A lot of it today is you've got a medical coder or someone reading through that note, looking at the documentation that 

Mike Koelzer, Host: was put in by one of these other professions. 

Samm Anderegg, PharmD: Exactly. Yeah. And, and that's just a side effect of where the technology was, uh, at the time when we shifted to electronic records.

So you've got an entire army or department of medical coders who read through those free text notes that were captured, um, either during or after the visit. And. Turn it into, um, discrete data or billing codes, for example, and lots of different other types of codes, but essentially in a format that can be sent to a health insurance company or a payer, the 

Mike Koelzer, Host: physician.

PA nurse practitioner. They're not necessarily finding the codes, then they're kind of writing out what happened. And then the billing company, which are the billers, the coders who are either working for the office, or probably hired out, they're taking these notes and putting them into coded information.

Samm Anderegg, PharmD: Yeah, absolutely. I mean, it's funny. Can you trip up right there? Easy. You said billers and then you walked it back and said coders. Yeah. We haven't even gotten to the billers yet. The 

Mike Koelzer, Host: coder send it out for these people that are used to getting paid for then what 

Samm Anderegg, PharmD: happens. Yeah. And then it goes over to the billing department and that's when, um, it gets packaged up and actually sent to the.

Uh, health plan, you know, the Aetna's Cigna's blue crosses of the world, and then there's an entire process to track that and make sure that it gets submitted appropriately and it's not denied. And if it's denied, you've got another department of people that are working denials and going back to the providers to update documentation because it's incomplete.

And so the whole process. Incredibly inefficient. And you wonder why, you know, why you stopped at the form. Right? Right. Yeah. It makes sense. There's just, the barrier to entry is just too great. Um, for anyone to just pick it up and start doing it, especially pharmacists who have, you know, they don't have the EHR, they don't have money to fund growing departments.

So huge barrier 

Mike Koelzer, Host: to entry. I'm assuming that your product is going to make all that smoother, but still at the end. Who does a biller send it to? It's just not going to get denied because they say, well, is just a pharmacist. And I only say just a pharmacist because I'm referring back to the document from 50 years ago that says, they're just pharmacists.

We're not going to pay him for that. So where's the magic Sam. 

Samm Anderegg, PharmD: Well, here's the interesting thing. Um, you know, it's really hard to change social security. Uh, and it's really hard to, uh, pass a policy that, you know, the congressional budget office, uh, estimates that billions of dollars added to, uh, you know, CMS has a budget.

Um, but where the action really occurs at the state level. And so there've been states that have passed policy that it is now law. Health plans are required to pay pharmacists really at, or just below the rate of, uh, of a physician. Um, as long as what they're billing is within their scope of practice, they are required by law.

Is that right? That makes it interesting. 

Mike Koelzer, Host: I just talked to a gentleman. Last week I recorded a show and he was telling me that Idaho is one of the leaders in that they're introducing a lot of areas where the scope of practice is pertinent to the pharmacist. And then they're kind of rewriting the laws to say, well, anything that then falls into a similar test or a similar product is also going to be covered now because that's kind of in the scope.

They don't have to reinvent the wheel on all of these. [00:10:00] So, right. How many are we seeing then? I mean, when you, when you say a state, is this happening then? 

Samm Anderegg, PharmD: Or? Yeah. Well, the example that you used for Idaho, I think it's important to point out that there's one piece of moving the profession forward and innovating the descope of practice.

Right? What pharmacists. Able to do with patients, um, and removing those barriers. So prescribing, you know, administering all types of vaccines to any type of patient, you know, the list goes on and then there's a separate piece that. Getting the pharmacist or requiring health plans to pay the pharmacist for those activities.

So you have to focus on both 

Mike Koelzer, Host: being able to do it and getting paid for it. 

Samm Anderegg, PharmD: Exactly. Right. Idaho's done a really great job of writing these things in a way that allows, you know, as you mentioned, you know, the ability to kind of update them, uh, without a whole bunch of. Uh, technical, uh, updates to regulations in the law and such, but yeah, Idaho being one, that's definitely advancing in scope of practice and, uh, has some, uh, payment opportunities there as well.

I think it's more focused on the Medicaid side. Um, and then you've got, you know, a handful is going on 10 now probably. Um, payment parody, which essentially just means pharmacists have to get paid if they bill for something in that say, so we're talking about a good chunk of states. I mean maybe getting up too close to 20 or so why don't 

Mike Koelzer, Host: Do they need the federal law to change in order for the states to do this?

Is there an opposition or opposing sides or if the state approves it, then that's 

Samm Anderegg, PharmD: fine. Yeah. So the state essentially governs anyone doing. Business within their borders. Right? So insurance providers who are offering, you know, commercial insurance or employer sponsored plans. So they've got the jurisdiction essentially to create their own rules right now on the, on the federal side, as you mentioned, um, social security act, I mean, that, that reference basically applies to if.

And the pharmacist taking care of a patient down here in Texas, and they've got traditional Medicare, you know, the red, white, and blue card. Uh, I can't bill Medicare directly for those services. And in fact, I think it's against the law for me to do so because it creates administrative burden, fraud, waste, and abuse.

Mike Koelzer, Host: Like my kid came to me and said, mom said this where mom didn't really say it. 

Samm Anderegg, PharmD: Exactly. Yeah. And how most of healthcare works is, you know, it comes from the top and then it trickles down, you know, Medicare will make a move or implement a policy and then everyone else will adopt it. Well, in this case, We have a grassroots approach going on where the states are taking action into their own hands, passing these laws.

And now we're going back to Medicare to say, Hey, look at every state that is passing this. Why don't you guys get on board? Um, it's a really an interesting play in terms of how we're, how we're attacking policy this time around and 

Mike Koelzer, Host: whatever percent are already paying for it. It's like your Medicare, you're only this percent, but why don't you get on board?

Whatever 80% is already doing it or whatever. I'm on non-Medicare. 

Samm Anderegg, PharmD: Exactly right. Yep. 

Mike Koelzer, Host: What stands in the way of just everybody doing this tomorrow? Is there anything standing in the way? 

Samm Anderegg, PharmD: No, nothing standing in the way actually like activating it and actually doing it is different from the ability to do it.

Right. Spread that 

Mike Koelzer, Host: out. What do you mean by that? 

Samm Anderegg, PharmD: All pharmacists, all pharmacists in the appropriate states are able to do this. Tomorrow they're able to do it. 

Mike Koelzer, Host: What do you mean by appropriate states? Is it a state that has said the scope of a pharmacist can do this and then there's some proof they'll get paid for it.

What do you mean by ones that are able? Yeah. If we're 

Samm Anderegg, PharmD: talking about medical billing in particular, I mentioned earlier when you asked, where does that data go? And I refine that to a specific use case. Well, that's because there's like five different use cases. Right? And you start understanding the complexity of.

Of this problem and why it's so hard to solve and why we haven't solved it yet. So I would say a majority of pharmacists in the United States are able to get paid for services. Right? You can do that through, you know, a lot of the MTM programs that are out there today, like in people aren't doing it 

Mike Koelzer, Host: today.

Gotcha. There's probably not a state that says a pharmacist is not allowed to get paid for something that they're allowed 

Samm Anderegg, PharmD: to do. Right. Yeah. Uh, and you can get creative with that. Right. It's not illegal for me to get paid for, to provide patient care. Uh, there's just not a mandate in every state saying that if I do build that in, I have to get sure.

Mike Koelzer, Host: All right. So if every pharmacist in every state is allowed to bill for something, all of them are your potential customers, but you're just saying that some may not get paid or do you walk your first day men back and say, yes, everybody can use this now. 

Samm Anderegg, PharmD: I think because. The landscape is so complex and there are so many use cases.

It comes down to focus at the beginning. So what's the very first way we're going to get pharmacists paid for services. 

Mike Koelzer, Host: There's gotta be enough success there for pharmacists to buy [00:15:00] into it. 

Samm Anderegg, PharmD: Exactly. We've got to provide value in some sort of. For pharmacists to buy into it. 

Mike Koelzer, Host: Yeah. You don't want to have a, whatever, the fees for this, a monthly fee or the program fee or something, and then have them be pulling teeth and then maybe get a buck or something down the road because they build the right peep.

They've got to 

Samm Anderegg, PharmD: feel success. Exactly. Right. And sometimes it is intuition, you know, especially when you're working with an entrepreneur pharmacist running their own farm. Uh, they get it. They know when they see something that they like, and they know that, you know, these are good people that I'm working with and there's a return on investment here and others, you know, they want to get an Excel spreadsheet out and run a, you know, a time study, uh, type of motion study and see if the actual minutes down to the minute, uh, that I'm investing pharmacist's time into are going to return my investment.

So we've done, we've done both of those things and. And, uh, we're getting some, some success, at least in this first payment model that we have with pharmacists today. 

Mike Koelzer, Host: Yeah. Because there's costs involved with the pharmacist's time, the learning curve, which you've made smaller, but your program, just the hassle factor, all the stuff that goes into starting a new program, some pharmacists are just jumping in, in summary.

Let's spread this out, but even with that, you've shown success even for the people that just their whole, heart's not into, they're looking at numbers and there's well, there's success 

Samm Anderegg, PharmD: there. Right. And I think that's, you know, one of the things I'm most proud about is that, you know, we do have to earn trust, earn respect, and, and when these, when these folks over, when my colleagues over it's, it's a good thing.

Uh, and it makes us work hard to do the right thing. They can build a really great product. 

Mike Koelzer, Host: Yeah. There's probably been enough pharmacists that have been like me that have been screwed over the years. And so you've got to come at it with a great product, but also great success to get pharmacists on board. 

Samm Anderegg, PharmD: Right.

And I think when you, you know, you have your initial user base or your initial kind of, um, innovators, I would call them the ones that are willing to try things that are new and willing to risk that time. And. You know, once you go a couple of those folks over, they start saying good things about you and telling their friends about you.

Like, Hey, this is, this is what I'm getting out of them. I really think these are pretty good guys, really good products. You should check them out. So yeah, that feels natural. You know, that feels like, um, the type of culture we want to build the company, 

Mike Koelzer, Host: Let's say that a pharmacist knows they're going to get paid.

They know the numbers are. It's not a huge cost of entry for some pharmacists. Where would that stumbling block be? Still, if you could say, Hey, this is going to make financial sense. Whereas the stumbling blocks still, I 

Samm Anderegg, PharmD: think it, it goes with scaling it. Any pharmacy can dedicate, you know, 15 minutes or a half hour to document patient care, uh, to get paid.

But how do we take that too? Um, 40 hours, right? One full-time FTE full-time position. 

Mike Koelzer, Host: You got to the owner or someone else that maybe has, well, we'll give you 5%. We'll give you a couple of hours a week to this thing, but all of a sudden, they say, well, to make this work, we probably have to do it, get to 40 and how's that going to happen?

Samm Anderegg, PharmD: Right. How do we invest in, you know, a pharmacist salary ahead of them bringing this revenue? It's. Insurmountable in terms of overcoming that barrier, but it's, um, you know, it takes a, uh, it might take some lobbying, you know, to, to the owner or the manager of the business. It might take some operational changes and that all comes down to running a business.

So, um, It's our job to bring as many opportunities as possible at the highest ROI possible to pharmacies and, uh, leave it up to them to decide how they want to operationalize it, how they want to scale it. And, you know, I believe in them, they're, you know, independent pharmacies, especially, um, they're entrepreneurs from the get go they're already creative and, uh, you know, they're going to figure it out.

We don't need to tell them how they should. If someone's like, 

Mike Koelzer, Host: Well, I'll give it a try, but I agree with Mike though. Damn farms were a pain in the ass and you know, I don't want to do that again, but I'll give it some time. Sam, I'll let you prove me wrong. How much time would they have to invest in this?

Samm Anderegg, PharmD: I'll be safe and say one hour, really one hour, because we know that time is a big barrier to entry. We know that pharmacists are. Grinding day in and day out, they're using eight or nine different software platforms. They've got patients coming up to the counter, answering phone calls. They're going to the drive-through window.

It is chaotic. I don't, you don't have a whole lot of time to spend, so you've got to make a good first impression. So if you can spend an hour with [00:20:00] for 20 minutes, maybe. On a live demo or learning how to use the software, or maybe less than that. And put in another half hour of time with patients, we'll get, you paid at least some amount at the end of that month and we'll deposit it directly in your bank account, 

Mike Koelzer, Host: no matter what state they're in or some states you can't make this guarantee to, 

Samm Anderegg, PharmD: we can guarantee it in every state.

We just need more time. 

Mike Koelzer, Host: You get funding from Techstars. 

Samm Anderegg, PharmD: Our first major funding came from Techstars. What does that mean? So Techstars is a technology accelerator. It's a, you know, a thousand companies apply to be a part of an accelerator program. Um, I think 1% gets selected, uh, and it's a three-month program that you and, uh, nine other companies.

Uh, go through and meet a whole bunch of different mentors investors, um, get education on essentially how to start and scale. Uh, technology company quickly, what's in it for those, uh, they get a percentage of equity in the company for signing up. They're 

Mike Koelzer, Host: only choosing those that they think are going to be the most successful or are they picking people that have like a great story in that kind of 

Samm Anderegg, PharmD: stuff?

You know, these are for very, very early stage companies. And when we went through it, we were, you know, and so I think, uh, every managing director or the person really in charge of the accelerator has done it. Philosophies on how to select companies. And I think that, you know, it's, it's, it can be fluid as well.

It might be a really great market. It might be a really great product or it might be a really great founder. And so kind of a combination of those things, I'd say, 

Mike Koelzer, Host: Well, they believe in and they think, well, maybe this isn't quite it, but something might be, or whatever they want to see at work. That's my beef about shark tanks.

You walk in there and these people have great ideas and they're like, well, have you sold. 5 million of these products yet. And they're like, no, we've only sold a million and they're like off with your head. Get outta here. We only want you if you've sold this. And I'm like, if I had sold that amount of money, I probably wouldn't need a shark tank.

It's not for small companies, but this, it sounds like that was. The tech starter, it sounds like that's for smaller, almost like ideas, right? 

Samm Anderegg, PharmD: Yeah. It could be an ideal stage, uh, for us, we were kind of on the brink of closing our first major customer. Um, and I think, you know, the shark tank thing is it's a lot of theatrics.

I think the reality to that though is, uh, every investor is different and, and each one cares about different things or interested in different things and knows more about particular subjects than others. While one might see, you know, straight up finances in growth in sales and you know, those types of KPI metrics, uh, another might see, you know, potential and like a limited market.

And, you know, might think that, that, you know, it would be really hard to scale or operationalize that scale. Um, you really got to F you know, get mashed up with the people that yeah. You know, see, see the world the way you see it and see a future that you see, 

Mike Koelzer, Host: you're a pharmacist at one point a practicing pharmacist.

What did it feel like to go from there to all of a sudden having your idea funded incredibly 

Samm Anderegg, PharmD: exciting and scary at the same time? I think when you start something new, And you mentioned a little bit earlier, you know, pharmacists can be jaded because we've been at this for so long and telling the same story to ourselves for a hundred years and have been burned multiple times as well.

You know, I mean, that's kind of ingrained in me a little bit too. And so when someone comes in and they've got no money that they want to give you. You kind of were like, well, what's the catch, you know? Yeah. So there's those types of emotions going on as well. But ultimately, you know, it was exciting to have someone believe in you when really, uh, Josh, my co-founder and I, uh, at the time or knocking on a lot of doors, telling a lot of stories and a lot of people telling us it was going to be hard and, uh, you know, probably not going to work out.

And so we had to power through all that. And Techstars was really the first. Group to say, you know, I believe in you guys and, uh, let's do this 

Mike Koelzer, Host: and you told them basically the same story you're telling me now. Was there anything else you added to that? No, 

Samm Anderegg, PharmD: my story has been refined extremely so. Oh 

Mike Koelzer, Host: yeah. It was a little bit more muddy back then with what you guys 

Samm Anderegg, PharmD: we're going to do it.

Oh yeah, totally. I just came in hot, like a lot of fire and I was just extremely passionate and believed in the idea of believing. You know, pharmacists and our ability to impact patient care. I just came in, you know, a little bit all over the place, but the passion was there. The fire was [00:25:00] there. And I think, you know, having, uh, having a subject matter expert coming from the field, trying to fix a problem is that benefited me and it helped us, you know, get selected.

Mike Koelzer, Host: So, but the nuts of it still back then was we're trying to get pharmacists paid for services, and we're going to find an easy way to do 

Samm Anderegg, PharmD: it. 

Mike Koelzer, Host: What happens after Techstars, then that was 

Samm Anderegg, PharmD: more during, than after we did close our first customer, right. When we got accepted for that program. So really, yeah, we were heading into it three months of an intense amount of work through the program, the Techstars program, and also, uh, trying to operationalize our, our first contract with a major health plan.

Are you working 

Mike Koelzer, Host: as a pharmacist 

Samm Anderegg, PharmD: at the time? No, I, I, I. The hospital that I was working at previously 12 months prior to that, and had essentially ceased all, uh, consulting work that I was doing to pay the bills at the time and was, was just full-time uh, working on the idea of working on the company, 

Mike Koelzer, Host: You stopped your own income for this.

This was going to go, 

Samm Anderegg, PharmD: yeah, it was, it was the only choice at the time. I just, I needed more time and just made kind of a calculation and said, if we're really gonna make this work. You know, when this customer, I got to give it everything I 

Mike Koelzer, Host: got before you got this customer though, had you already stopped work?

I'd 

Samm Anderegg, PharmD: been consulting. I got 

Mike Koelzer, Host: you. You were still bringing some income in 

Samm Anderegg, PharmD: yeah. TA to basically cover the bills and make sure I had a roof over my head. Yep. 

Mike Koelzer, Host: Then when this customer finally came along, you're like, Hey, this needs time. 

Samm Anderegg, PharmD: Oh, absolutely. Yeah, there was, there was no choice at that point. And I was able to then use a combination of the investment and the initial contract revenue.

At least replace part of that consulting money that I was bringing in. 

Mike Koelzer, Host: What did your days look like then after you got this first customer, what kind of stuff are you doing? 

Samm Anderegg, PharmD: Oh, man. Everything. It's hard to answer that question. We were in the weeds with the product and how we would build it. You know, I'm not, I'm not in there laying down code, but I'm helping, you know, frame out the architecture and you know how we're going to spin up this electric.

My health record. Would you 

Mike Koelzer, Host: say this is app based or is it windows based or what is it? It's 

Samm Anderegg, PharmD: a web based web 

Mike Koelzer, Host: based. You're not actually doing code, but you're setting up little diagrams and saying where you want what to happen after this click basically. And that kind 

Samm Anderegg, PharmD: of stuff. Yeah. So like designing and prototyping and then, but also like how's our database going to get set up and what type of data would we need to save and how should that be structured?

And. And how should that be reported out? Did 

Mike Koelzer, Host: You have to hire for all that? You didn't know all this, right. 

Samm Anderegg, PharmD: I knew enough to be dangerous, but you know, my counterpart and co-founder, Josh, was really the perfect compliment for me. He knew all that and he also knew how to translate it for me and educate me so that I could write.

Helpful. Um, as we develop the initial iteration of the platform, because he's not a pharmacist. No, no. He's a software engineer and an artist. 

Mike Koelzer, Host: You brought a ton of reality to things and what's going to fly and what's not going to fly. Yeah. 

Samm Anderegg, PharmD: You learn pretty quick. You know, the idea part in the vision is easy.

Then you got to learn how to execute and. Um, we, it, especially at that stage, you've got to figure out how to make a lot of progress with a limited amount of time and resources, 

Mike Koelzer, Host: because you had to present something to your customer in a certain amount of time, right? 

Samm Anderegg, PharmD: Oh yeah. Yeah. We had deadlines to meet and, you know, people relying on us.

And so at that point, I think we, you know, we didn't outsource anything. Everything's always been done internally, but we have. Uh, really convinced, um, an old coworker of Joshua's to come onto the two. Um, and help us out at that time to help build the program, to launch the initial iteration of, of the platform.

Mike Koelzer, Host: He knew how to do enough coding and stuff to make it work. Yup. So you three are sitting around in your proverbial garage. 

Yeah, 

Samm Anderegg, PharmD: I guess he could think of it like that, but, um, there was no garage, uh, there, you know, home office. For each of us, we've been a remote first company since the beginning. It's where Josh came from.

And the three of you are 

Mike Koelzer, Host: remote from each other. Correct? 

Samm Anderegg, PharmD: Even pre pandemic, you know, we leveraged zoom and slack and that, and that was new for me coming from the hospital health system world, where you do everything in person and at a meeting, but yeah, no, no garage, uh, but same sort of mindset, same sort of a stage in online garage.

Yeah, exactly. Virtual garage. So 

Mike Koelzer, Host: You sold this to the company. Did you have any mock-ups or anything, or was it kind of sold on the idea of what was going to be built? [00:30:00] 

Samm Anderegg, PharmD: The fully functioning version was a prototype and we had been, we've been basically working full time to build that out, um, when they decided to work with us, but we just realized we had to speed that up as much as possible.

So we probably were. I don't over halfway there. 

Mike Koelzer, Host: I'm imagining maybe your database might not have had as much refinement because in your demonstration, maybe you didn't need to go too deep into database stuff or something like that. 

Samm Anderegg, PharmD: Yeah, exactly. Right. And, and that's the rules of the road, especially at the very beginning, because at that point in time, my number one priority was getting the first customer on board.

Right. So all my time I was thinking about marketing. You know who we need to be talking to and what the pitch should be. And once we close that first customer, it completely reverses. I was all about operations and taking care of this one client and getting the platform developed. So. Yeah, 

Mike Koelzer, Host: totally marketing and big vision for the next day.

You're like nose to the grindstone, right. Of getting this 

Samm Anderegg, PharmD: thing done. And that's the way it's been ever since, you know, it's like constantly switching based on what the most important thing is for that moment in time. It's not an easy thing to do. And I don't think I'm, I'm still not very good at it. I don't think so.

But, uh, it's just the nature of the game. How long were you in the pharmacy? Uh, two years of residency. And then about three years, uh, And in practice or, uh, in administration, 

Mike Koelzer, Host: You might have decisions in front of you, but basically you're like for those decisions made, it's like back to the course and you know what you're gonna be doing three days from now.

And three weeks from now, a pharmacy owner, we know it too. We know we're going to make some decisions here and there, but basically we're going to get to the store in the morning. It's going to look about the same. That kind of stuff, but you're flip-flopping from visionary to marketer, to salesperson, to designer to execute or all those kinds of things.

Samm Anderegg, PharmD: Yeah. And I would also compare it to the initial days of opening up that pharmacy. Yeah. I suppose. Right. I'm sure a lot of folks and, you know, uh, perhaps yourself included, can think back to those days where, you know, I gotta, I gotta find. Uh, some brick and mortar and put this business in. I got to file for an LLC.

I've got to tell my friends and family that, you know, to come get their prescriptions filled here. I've got to take an ad out in the, you know, the church newsletter. I've got, uh, all those things. I mean, um, it's very similar to that. Uh, and it just feels like it moves so quickly. It's just, the external forces change, I think, to a very high degree.

Uh, sort of your emotions. Yeah. 

Mike Koelzer, Host: What do you mean by external forces? I can imagine that, but give me an example of that. 

Samm Anderegg, PharmD: Well, I think like, you know, when you're, when you're trying to, to sell to large health plans, you know, they're huge, huge customers and incredibly complex organizations, but, you know, one day you might be trying to contact a hundred of them.

In the next week or two weeks or something. And you're trying to get in touch with as many people as possible, cast a wide net, and then eventually you find the match, right? Um, the folks who are looking to do the things that you are talking about, what your product does, right. And when you find that match, you shift all your focus to, you know, um, building trust with that company in that.

And it can be, you know, uh, and the importance of that is, is. You know, it can fund the next six months of your business. Oh yeah. If you win this client, it means so much. And so that that's one example of an external 

Mike Koelzer, Host: force. Yeah. It's okay to cast that net for a while and to throw out feelers and things like that.

But when someone's putting that kind of money into it and that kind of a decision that's going to fund you for six months, you have to give them a lot of TLC to make sure that happens. 

Samm Anderegg, PharmD: Yeah, it's, it's very meaningful for us, uh, at, at the early stages that we were at, but it's also, you know, it's extremely meaningful for them.

Right. You know, they're, they're looking at you and believe what you're saying and believe in you that you're going to be able to deliver for them. You want to, you want to be able to take care of them. Um, 

Mike Koelzer, Host: this is your biggest customer look like, is it a, are they a pharmacist or are they a healthcare company?

Has pharmacists that are going to be using this. 

Samm Anderegg, PharmD: Yeah. They're a health plan. A health plan. So not, not a PBM, a health plan, 

Mike Koelzer, Host: an insurer. Yeah. Who's hiring the PBM and so on. And they're hiring you knowing that they are. Pharmacists will be on it or do I have that backwards? The health plan is a person that is going to see the results of doc station and then pay, 

Samm Anderegg, PharmD: right?

So they're like they hire their PBM to [00:35:00] manage their dispensing pharmacy network. They're hiring us. Ah, I got you to manage their clinical pharmacy network, their providers. I 

Mike Koelzer, Host: have it backwards. We're looking here at the other end at the plan. What are they going to get? Are they going to respond to this?

And then your job I imagine is to then back up. Sell this, and I say selling clothes, it might be financially. It might be sell the idea to pharmacists who then input this and then come back out that first and we're talking about 

Samm Anderegg, PharmD: exactly. And that goes back. It's another chicken and egg, right? Exactly. If, uh, you know, a health plan, um, is, uh, To what you're selling, you have to have something to sell.

So we had to get pharmacists up and using the platform. And in the same regard, you've got to have a, provide some sort of value to pharmacists who want to use your platform. So you're constantly telling different stories, depending on whether it is a chicken and egg who your stakeholder is. And then when you add investors into that mix too, then you get three and you know, some days you don't know where you are or you just do your best to keep your head above.

The first 

Mike Koelzer, Host: thing that you need to sell me. If I'm a plan leader, I'm going to pay for this stuff in the first place. I don't care if it comes to me with a cran on a brown paper bag, you've got to sell me the idea that I'm even going to pay for this. Right. And then you're going to say, well, all right, well, it's chicken and egg again, while yeah.

It's going to be in this kind of format and it's going to come to you on this and you can do this and that, but ultimately they have to agree to pay for in the first place, pay for pharmacists. Professional surface. Right. 

Samm Anderegg, PharmD: Right. And I would say even before that, you've got to sell them on the fact that pharmacists are going to return an ROI.

Like pharmacists are a valuable member of the healthcare team. Gotcha. But once, you know, uh, after awhile I just started getting some experience, started learning more about, you know, sales, especially at an early stage company. Uh, and you realize that you really just need to. Ratchet up your filtering skills.

Right? And so you're trying to find the people that already believe that. And then talk about what you're selling and convince not only them, but maybe the four or five other stakeholders that are involved in the decision. You're selling 

Mike Koelzer, Host: the whole clinical package to these plans. You're selling who the pharmacist is, what they can do, how it's going to save them money, how it's going to improve everybody, blah, blah, blah.

It goes on and 

Samm Anderegg, PharmD: on. Yes, we have to do that because we are essentially selling into a category that we're helping create and evolve. 

Mike Koelzer, Host: You're creating the category, but you guys are actually more focused on the software of this, but the reason you have to extend so far is because you're creating a new 

Samm Anderegg, PharmD: category.

Exactly. Right, exactly. Right. It would be a heck of a lot easier just to build this off. And if 

Mike Koelzer, Host: You could do that, that's what your focus is, but you're building the category because you have to, you're not a full package. You just have to be the full package now because nothing would exist without 

Samm Anderegg, PharmD: you.

Yeah, it's a it's so it's a very heavy, you know, a service component 

Mike Koelzer, Host: to it. Why the hell are you sitting here talking to me? You should get to work. Oh, 

Samm Anderegg, PharmD: believe me, buddy. 

Mike Koelzer, Host: That's a big undertaking. It is. And you're doing it though. 

Samm Anderegg, PharmD: Yeah, because it's the right thing to do. Of course, the right thing to do.

Mike Koelzer, Host: It's an obvious ball that once you get rolling, it's going to keep rolling. It's just that, you know, a lot of work upfront doing it. If you do this legwork outside of the dock station and get this stuff rolling. Does the dock station take over then in terms of. Showing this ROI somehow, does it show this? So you're not back, you know, just knocking on doors a year from now with the same people and showing, see, I told you they can see in this program what's happening then.

Samm Anderegg, PharmD: Correct. So it's about inertia. You know, you really have to put in a lot of legwork upfront and, and find the people that believe in vision. Uh, without any sort of, you know, before we had any sort of customers or any patients on our platform, any pharmacists using the platform, there's no way I can pull out a report on ROI and guarantee anyone that, you know, this is going to be a good idea.

You have to find the people that believe in it and are willing to take that risk. So once you have that initial customer, then you get some initial data. You'd say, Hey, this is real. And people are using it. And people are getting what we promised that they would get. And do you start, you know, expands your, your very first market, a little bit more into people that are interested, um, might be early adopters rather than the very front and which are the innovators.

So then once you get that customer, you get some credibility and you can convince some investors who. [00:40:00] Give you a little bit of money, which extends your runway and your timeline to continue doing things. You can't build it all at once. And the thing that we set out to build, you know, we're, we're, we're maybe, you know, the vision is really big, so we might, maybe we're like 10% there.

Um, but we're making progress on the way to do exactly what you just said. You know, we want it to immediately calculate the ROI. Um, and do that in real time. So the health plans can monitor these programs and, and see which pharmacies are the highest performers and make decisions on how they want to manage their member population using our software.

Mike Koelzer, Host: Well, it's that chicken and the egg thing again, because even down the road, though, let's say that you've done all your sales and all that a nurse has started it all. Helps people, if they get a dock station claim, because they know the company has success and they know that something from a pharmacist using a dock station is going to be successful and therefore we want to pay for it kind of thing.

Right. It's the program, but it's so much more than the program, even if you're not selling it anymore, you're not trying to recreate this market. So let's say you created this market and now doc station is the program for it. Then it expands beyond that again, right? It's more of a belief 

Samm Anderegg, PharmD: system.

Credibility. So yeah, once you, uh, you know, like maybe you're working with one blue cross plan and then maybe two and then three and four, and you know, other blue crosses are like, Hey, you know, my friends over there across the country who I know, I see them at conferences are saying, these guys do good work.

And you know, you're getting over that initial level. You know, these guys are new and that scary. Right. And, um, and the snowball gets a little bit bigger. And so maybe your next sale is a little bit bigger. Um, and you can start having conversations with, you know, a United healthcare or, uh, an Aetna, and they know that their competitors are using this platform to activate pharmacy.

To improve outcomes and reduce costs. Well, why aren't we looking into this? 

Mike Koelzer, Host: And there might be a straggling pharmacist on one end of it or this or that, but basically there's success with the dock station. Let's jump in and we'll find all the success points there. Right? 

Samm Anderegg, PharmD: The only way that you can even get to that point.

Is by having a good product, a product that works, a product that provides value that makes it easier for both the health plan and the pharmacist to do their job. And so you're never going to get there unless you build a great product. And, and that's, that's always the number one focus. Where 

Mike Koelzer, Host: does dock station then as a company, where do you, will you make your money 

Samm Anderegg, PharmD: today?

We make our money. Selling our software to health plans. So the health plans are paying fees to use our software and to get connected with all of the pharmacies that are on our platform or will be on our platform. And so we're providing efficiencies for the health plan to leverage a valuable resource, which is the pharmacy.

We are helping connect the pharmacist with the health plan, so that value can be exchanged. We facilitate the payment for services and for outcomes through our platform. And we're charging, you know, a small amount to the health plan, um, to, to do that. So the health plan, you know, the revenue that's coming in from the health plan is subsidizing the cost for the pharmacies to use our software.

Do the 

Mike Koelzer, Host: pharmacists have a fee. 

Samm Anderegg, PharmD: Yeah. Pharmacists use the platform at no cost because of that. And because of that, and we know that that is, you know, money's really hard, especially today, you know, we don't have a whole lot, so, you know, we want to get the tool and get this, get the platform in front of the pharmacist so that they can start taking care of patients, start getting paid for it.

Um, and we only wanna make money when they make money is kind of the idea. There's this other end of the spectrum. Um, when we start billing for services and we don't have a direct relationship or a direct contract with the health plan, um, we've got to find some way to get paid in that scenario as well.

And so in that scenario, we'll, you know, take a portion of the income that we bring to pharmacists from using our technology. So kind of, kind of to say. Business models. 

Mike Koelzer, Host: I wasn't going to ask about the sales function, because it sounds like in the first section, it's like a hundred percent. You want to go to health plans and then it's almost an easy sell to the pharmacy.

It's like, well, it's free. As long as you have some time to do it and you'll learn this, it's like a no-brainer almost [00:45:00] right. But I can see through, when you don't have a plan set up yeah. That you'd have the pharmacists go by. Hopefully the health plan doctors and so on, then they don't even really think, well, is this a one that started from the health plan doc station?

Or is this a dock station coming back in? You know, it just seems like if you have a great name for it, which you do, people won't even really know what's coming or going, and it'll just be the promise of ease. It won't matter who started it, really the chicken and the egg again. 

Samm Anderegg, PharmD: Exactly. Right. And if you believe in the vision and you know, what you're doing is, is the right thing and is going to generate value.

You just have to find a way to make it sustainable, uh, and, and survive. We want to build everything. Of course. What's going to be sustainable for the next 12 months. Like how do we make me shift over time? You know, we first started, it's like, okay, epic and Cerner charged doctors, a monthly subscription fee or annual.

So we tried that, but that didn't work because, you know, if pharmacists don't have a whole lot of extra cash laying around to invest in their ninth platform, and then you say, okay, well, um, you know, let's try health plans. Can we provide enough? To health plans off the get, go to start, um, to get paid that way and give it away for free to the pharmacist.

Okay, great. Oh, that buys us enough time to build out the automation that we need to submit claims to the health plan, uh, and bring in money for pharmacies that way and, and sustain the business that way. And so you're constantly evaluating and figuring out how to. Extend the amount of time we can work on this because I know we've got smart people on the team.

We're going to figure all these things out. We're going to build a great product, great company, but we just need to survive for the time being 

Mike Koelzer, Host: my pharmacy. I'm doing that right now. It's like a cancer diagnosis too. Every time you can stick around for six months, you know, a new medicine comes out and with the pharmacy, you know, I hate to say it, but I mean, I never thought I'd have my hand out to the government, but this PPP and the Eid L's and things like that at hel helpful.

Absolutely. I never thought I would be looking at the government for that. Maybe reduce taxes, but never for a, kind of a handout from them, but I stuck around and you stick around for six more months and that happens. And then some other, you know, law from the, uh, SCOTUS is going to come in, you know, or something like that.

So every six months just hang out that much longer. 

Samm Anderegg, PharmD: Exactly right. Our software company, your pharmacy. I feel like we're really in the same position. What I mean is, is that we're approaching this golden opportunity where the timing's right. You know, we've got an oversupply of pharmacists graduating from pharmacy schools to fill this primary care gap, all these different factors at play.

So if we can just survive. Another six months, 12 months, 18 months, we are going to be in a golden age. I really believe it. We're going to be able to achieve all the things that are promised to us in pharmacy school, all the things that our mentors have been saying for 40 years, uh, and really make the impact on patients that we really want to.

I really think that we're, we're on the brink of something. 

I've got a lot of 

Samm Anderegg, PharmD: my sons, 

may my daughters. They 

Samm Anderegg, PharmD: specialize in procrastinating. 

And there's a certain, 

Samm Anderegg, PharmD: there's a certain value in procrastinating 

though, you know? Yeah. You don't want to procrastinate so much that you shoot yourself in the foot without enough time to do a quality product, but 

Samm Anderegg, PharmD: you wait around and sometimes things come to you that you just didn't think about when you weren't under the gun 

In your case, Sam.

Maybe one company might think you are a little scary or you being a leader, you might think it is a little scary, you know, not knowing where your next six months. Payments are going to come from. There's a beauty in that though of saying you don't know where it's going to come from, because that allows you to be nimble and to shift, and you're not afraid to shift.

In fact, you have to shift every six months, you know? So you're set up to take advantage of that pot at the end of the rainbow, because shifting is part of your DNA basically in your 

Samm Anderegg, PharmD: company. Absolutely. Yeah. It's being patient and being very observant And learning as much as you can. Along the way I procrastinate or at least delay decisions until they have to be made sometimes.

Right? Because you aren't, you're learning things constantly every day or you are going to have a conversation, um, you don't want to make something, you don't want to make a decision. That's going to have a long-term impact. Right. That's where the risk [00:50:00] comes into a long-term impact or. Uh, uh, long-term lock-in to some sort of financial or resource, right.

You don't want to cause it to break yet. Right? The nimbleness is one of the things that is great about a startup that differentiates you or puts you at an actual advantage to a billion dollar company, 

Mike Koelzer, Host: so to speak. Sure. It's like, my wife has like, you know, she'll want the garage clean and it's like, well I could, but maybe I won't make enough room for your 67.

Mustang I might buy. Yeah, 

Samm Anderegg, PharmD: yeah, 

Mike Koelzer, Host: yeah. Coming down from the clouds and what should the pharmacy do right now? Can they help at all? Can they help themselves? Can they help you at all? Which is the same thing. Should they be looking something up? Should they be trying to get in touch with somebody outside of your company, one of the health plans or whatever, what can they do right now?

The 

Samm Anderegg, PharmD: The biggest thing they could do, they do want to help us is sign up. Our software, like I said, no costs, just get on it, pop it open and start using it really. We're we're, we're getting, we're very close to the point where no matter what type of pharmacist you are or where you're located, when you log in, you're going to get some sort of value out of the software.

And we need pharmacists to tell us, Hey, if it is just, if you could just do this. That would make me want to use it. And you know, another pharmacist across the country or an, uh, you know, in Canada, for example, to do the same thing, because that has been kind of one of the most successful things that we've done to date is be really great listeners and understand the problem and then implement things that solve those problems.

So we just want to engage, you know, if you get value out of it, immediately. Um, wonderful. Uh, if not in the first 30 days, tell us what we can do to make it valuable for 

Mike Koelzer, Host: Now will a pharmacist in every state, will some of them just be going on and maybe just checking it out or will they actually do something there?

Can they actually fill something out? And then. Tap a button and say, send this somewhere or not necessarily. Cause you might not have all those connections yet. Yeah, 

Samm Anderegg, PharmD: absolutely. They can log into the platform and uh, import their entire patient base and start managing those patients. I know tracking blood pressure, you know, tracking adherence, you know, communicating with the health plan, running reports, all of these things are things that do provide value to.

Some pharmacist, probably a lot of pharmacists, but not every pharmacist, 

Mike Koelzer, Host: But when they send it to the health plan, they're probably not the health plan that you set up this original one as your first customer, but there could be thousands of plans that will respond with payment from there, sending this to them.

Right, 

Samm Anderegg, PharmD: exactly right. That's cool. Exactly. Because your pharmacy, you might have, you know, there might be eight or 900. Health plans that provide coverage to the patients that are coming into your pharmacy. So we want to be able to have one workflow. You take care of patients, we get the claim submitted and you just get paid.

Yeah. 

Mike Koelzer, Host: Cause right now you haven't even monetized the pharmacist side of it. So they're just going to get a hundred percent paid from that. Well, that's really cool. I might even 

Samm Anderegg, PharmD: do that. We'd 

Mike Koelzer, Host: love to have you, if I get to sit down more and play on the computer, I'll take that over anything.

Samm Anderegg, PharmD: I hear 

Mike Koelzer, Host: ya, Sam, what a pleasure talking to him. I could go on for a long time. That's so interesting. Thanks for spending the time and walking me through that. That's a really cool thing. And I agree. I know we've heard it, but we're right around the corner. There's some really cool stuff coming together 

Samm Anderegg, PharmD: right there.

We've got to keep at it and, and we'll get there. We'll get 

Mike Koelzer, Host: there. All right, Sam, we'll be watching. Thanks for everything. You're doing.