Exploring Pharmacy Tech and Digital Healthcare | Rick Ratliff, BChE, MBA MedAdvisor Solutions , CEO

This transcript was generated automatically. Its accuracy may vary.

Mike: Rick, introduce yourself to our listeners. 

Rick: Rick Ratliff. I'm the CEO and managing director of MedAdvisor Solutions. I've been in technology and healthcare for well over 30 years. I started my career at IBM. developing, technology enabled solutions for health care and grew into a number of other privately held businesses that were also focused on, delivering technology and health care.

Probably the most

A well known project across my career was the co-founding of a business called sure scripts where we built a. National electronic prescribing network that's really evolved into a health information network

for the United States, connecting primarily

doctors and

pharmacies, but now other parts of the healthcare system.

I've done other projects similar to that. I spent a few years at Accenture, where I ran the digital health care practice globally. So I actually built, Large scale electronic health record platforms in Singapore and Australia and other parts of the world. using technology to help connect the health care system, share information more effectively so that, The right individuals have access to information to provide the best possible care, at any point in time. So I really love technology. I'm a technology guy and love the application of technology in healthcare.

Mike: All right, Rick. So I hear IBM, my brother Pete, used to work for IBM back in the day. , this is golly. 40 years ago. And

Rick: Mm hmm.

Mike: That's kind of when computers were just making their entrance , the PCs and that kind of stuff.

And people would kind of conflate everything and ask Pete about it. programming Computers. Like he knew what the hell he was a sales guy for them. , that's the last

thing he knew about I think people kind of conflate that. But your time at IBM it sounds like you were in the nuts and bolts of this and as I think back to your history, I think you're a chemical. Engineering major.

One of my sons is doing that at Michigan tech. So long question short,

How much were you into the computer side of things back then versus like the direction of the company?

Well, that's a great question because it's really similar to your brother. I was at IBM, actually, the personal computer was announced the first year I went to work for IBM. So that was 1984,

Rick: So I was a graduate from the University of Oklahoma and chemical engineering.

And, at the time, I thought that I was going to go design and build refineries and gas plants. And I actually started in the petroleum industry with IBM. So we were selling computers to oil companies to help them. find oil, do exploration, as well as to automate all of the downstream operations, like at a, at a gas station, as an example.

So, it's how you use the technology that evolved into eventually getting engaged with hospitals and how hospitals would start to use computers. At this time, personal computers and mainframe computers, as we called them at that time

to help automate processes in the hospital. This was before electronic health records or medical records at the time.

And that evolved over time in the early 90s, when the electronic medical records started to become more pervasive. Our focus was on how we could help those software vendors move their software to our computer systems so that we could bring to the hospital and large physician groups, different kinds of electronic medical record technology to automate the clinical processes 

In the hospital as well as in the doctor's practice. So that was the very early days of, uh, IBM. 

Mike: So when you said software, did these people have their own individual, like DOS things? And you were saying, let's bring it all together. So these can be networked more and we can make them all look the same.

Was it software you were bringing in? Was it the records you were bringing in? What were you conglomerating to make sense of it?

Rick: Initially that's a great question. So initially it was how you bring typically third party software. So, similar to what you would know in a pharmacy as a pharmacy management system or the dispense management system, this manages all the backend processes in the pharmacy. In those days, we were actually working with vendors that had software that ran on our computers to allow for nurses to do the intake on the patient, to track the vital signs for the patient, et cetera.

These were standalone computers at that time with a display that was attached to the computer, eventually, as you're pointing out, personal computers became connected through networks, then the software started to be connected right through those networks and available to more individuals.

And as you started to capture the information, you started to create on the back end. in a database, an electronic record for that individual. So initially, it was capturing information just to help manage the clinical processes for an individual coming into the hospital. But, over the long run, it was to create that information and assign it to that individual in an electronic record.

for that individual. So as the very early days in a hospital that moved into the physician's office in, , one of the bigger players today that actually started back in the early eighties. late seventies is a company called Epic. And so Epic is the largest electronic medical record provider at this point in time.

And they've evolved over time, not only in managing all of the clinical information in the hospital, but also eventually in the doctor's office so that everything, when you go to the doctor, Your clinical or your medical information is all captured inside of a computer system. And then over time, you come into the 2000-2010 time frame, the United States starts to talk about health information exchange.

So I can automate all of these clinical processes and capture this information. Now I need to make sure that information flows from my primary care doctor, to my cardiologist, to other doctors, to different parts of the healthcare system, etc.

And so a big part of what I did was not only find ways to use our computers to automate in the early days, but to connect those computers and then over time. Start to share information more effectively through internet kinds of technologies because the internet wasn't even available when I first started 

Mike: Rick, I was just going to say that any young punks that are listening to this, , Right

now, and young punks for me or anybody under 50 now, but you even have to pull it out of your own memory, not you so much because you lived it, but. Back at, at our pharmacy, it was the mid eighties you alluded to the 84, it was the mid eighties when the PCs came out and this kind of stuff.

They didn't have the wiziwig or whatever that you get from Apple and so on, but they look like a computer, I think a lot of people don't understand the internet. Wasn't like till the mid nineties ish. I mean, this is like a good 10 years later.

And for the young punks now they're like, well, how the hell would you have a computer without connection? It was, I mean, we had 10, 12, 15 years of not having the internet and it started off, , gradually with, you might share files and then you'd have the ethernet. Gobbledy gook, which I still don't know how the hell that works. Thank God the internet came along. So I don't have do the right ports and all that kind of stuff, but

people lose sight of that, that it was a good 10 years of having the computer around before the internet was around.

Rick: That's right. What's interesting in those days, I think, was email more than anything driving the connectivity.

So, a lot of what was happening were email systems even before Microsoft's current email systems were Evolving in The only way that you can make those kinds of systems work is to have connectivity.

And so it's not only the connectivity in an office or a hospital or business or the pharmacy using something like you were describing Ethernet. Then if you want to send an email to another pharmacy or to, , a colleague outside of the pharmacy. That's when you need the internet

and at the time that was all dial up connectivity.

So if you wanted to actually send something, it was very difficult to do. One of my clients at IBM in the 90s was an organization called VHA based out of Dallas, Texas. This is a hospital association. They represent a large number of your largest community hospitals even in Michigan as an example.

They helped to bring down the supply costs for the hospitals. They were a group purchasing organization. That was their whole focus. We built a technology division with them. in the late 90s where we were looking to bring down the cost of the internet because at the time Internet connectivity was very expensive.

So we were looking for ways to help not only automate the hospital In the movement of clinical information but creating a national network using Internet technology, so we could share information between the hospitals themselves. And so we were doing that in the late nineties, and that eventually evolved into a separate, early stage technology business that we launched with VHA, and their hospital customers in the late nineties, early 2000 timeframe.

 Looking for innovative ways to use technology to move information.

Mike: boy, we're going through memory lane here, Rick, but back when right about Ben, the early eighties, if someone told us that someday you didn't have to put a quarter in to play a video game, You, you couldn't believe that. Like, you mean you just can play

video games in the same way with the internet, if they said you didn't have to time how long you were on it in the same way with long distance phone calling.

And the list goes on and on. you just couldn't believe that this stuff was, I mean, it costs an arm and a leg, your parents are paying for it, but you just couldn't believe you can do it. You don't have to time yourself on it.

Rick: Yeah, no question. No question. it's evolved into something we don't even think about today.

 You don't think about it at all because, your phones now are more powerful, significantly more powerful than the personal computer that we announced, , 30 plus years ago in the level of connectivity and what you can do with that phone to your point, even with video games and buying and paying for products and services and refilling your prescription.

, , communicating to your pharmacist and, streamlining the whole process for access to pharmacy services and refilling your prescription is something that you couldn't even imagine

20 years ago, much less 30 years ago, 

Mike: Now I gotta pick on Epic. Can I do that? You're not with Epic, right? Can I pick on him? 

All right, here we go. Here we go. Pharmacy, I think pharmacy was Pretty well

advanced with computers. I know we got ours in the mid eighties and you'd still go. And even when my dad, when he passed, let's say the early two thousands, I mean, that's 15 years later, you'd still be in the hospital.

They'd have these eight inch red books with all these doctor scribbles and things. I think the hospital was a little bit behind with EHR records. I blame it on, I don't know what I blame. And I kind of like to say, Oh, a doctor would like to see their scribbles. It kind of gives them some personality, I guess. So then onto Epic. So just like five, 10 years ago, I'm looking at Epic and I'm like, this is the leader in stuff. I mean, they had like, I don't know, maybe I had seen better stuff at the time, but they had like a logo, not logos. What would you call it? Like, icons, , they'd have icons.

It looked like they were about 15 years old. Just bright red stuff. It looked like something someone put together like a high school computer class or something like that. So I know the EHR stuff was a little bit behind. I'm sure it's all cut up now.

Rick: I'm sure things are all pretty and, and, focus now, but took a little bit. It did. It was slow to start in the 80s and picked up some momentum in the 90s. But, in the early 2000 timeframe, that's when things started to accelerate.

And in 2010, the Health Information Technology Act was passed by the U. S. government. And that initiative actually put several billion dollars into the healthcare technology world, which drove the adoption of electronic health records.

So, what was important is that, , this is an alignment of incentives kind of structures. These systems are fairly expensive. and to your point, given the workflow and I need to now be looking at a computer and talking to my patient and going back and forth is the workflow there.

And is the value worth the cost in the cost is a change. And then do I know how to change my workflow

because this is a challenge for pharmacy today? Do I know how to manage my workflow? patients efficiently. And so the incentives started to come into play and this is not only for adoption of electronic health records, but also for sharing information in relation to what we were doing at SureScripts, creating incentives and eventually penalties for writing prescriptions electronically.

So the only way you can write a prescription electronically is to either have a standalone system or electronic health record.

And if you're going to maximize your returns as a doctor or a practice in relation to seeing Medicare patients, as an example, then you're going to be automating as much of your clinical processes as possible.

And writing your prescriptions electronically. And so what's interesting is that the writing of prescriptions electronically was somewhat driven by the government around Medicare. But you don't want to write just your Medicare prescriptions electronically and then everything else on paper.

You want to do everything.

So it did help drive adoption. we started 2002 time frame, and it's ramped up, but it really started in 2008 when first real incentives started to come into play, and then 2010 when there was a hockey stick effect,

and today in the United States. Most doctors use some type of an electronic medical record system.

All hospitals do. And almost 100 percent of prescriptions flow electronically.

And that's not the case in most other countries, by the way. 

Mike: Rick, is it fair to say that? And give me the honest truth here. Is there something in the doctor's psyche? Like they didn't want to go electronic. And I know you mentioned, of course, it's a change and I've heard it before and you alluded to it where, , it might be where if you're writing a prescription, you're looking at the patient and maybe if not, you're looking at a screen and the patient's talking is not as personal and things like that, was there any pride or any, , like. separateness of saying we're physicians and we're gonna, we're gonna, , write it out. And we just, , was there anything like that? What was the slowness or maybe wasn't there a slowness of physicians, but it, was it something like we're not going to do this?

Rick: I don't know that it was as much we're not gonna do this as it was trying to understand now I've got a, , again, this goes back to connectivity that we were talking about earlier and networking and I'll go and see the patient. And I write everything down on a paper and then it's got to get entered into a system if I don't have the right systems in place.

So there was a gap in time where, , there was one or two personal computers or, or maybe even displays. Inside of the practice and then nurse would have to take and translate everything into the computer And so the question is is the ease of use because the doctor has on average probably 10 to 15 minutes per patient And so they're seeing so many patients they need to document the use of what they're doing But what's interesting is is they have to document what they're doing in such a way that they'll get paid

because the patient doesn't pay the doctor,

the health plan pays the doctor, and the health plan determines how you code, etc.

So as coding of visits became more standardized, and as the documentation became more streamlined, and as computers started to be in the actual exam room, the connectivity was there, they were easier to use.

And there were incentives because now I can get paid faster

And I might be able to get paid a little more because i've documented More appropriately,

So there's a lot of that, some of the other hesitancy though. Which this is probably typical across the healthcare system is am I actually entering this information for the benefit of my patients and my practice?

or for the administration

Of the hospital.

And so it is, , my documenting it particularly today because a lot of the structures are changing as far as doctors employed by the hospital systems, et cetera, there are people looking at, , did you prescribe that medication for the right reasons?

Did you document correctly?

Did you get to the specialist to manage the referral? Most efficiently now you're looked at and you've got documentation to determine your level of performance. Thank you very much.

Or at least there's a perception of that and there may be some truth to that.

I'm not a doctor, but I do know some doctors. 

Mike: So Rick, so you say you're one of the founders of SureScript. What was in you too. Leave there. What, what was your exit from there?

So in relation to SureScripts, , SureScripts is probably one of the most exciting parts of my career and, really proud of what we were able to do because we started a business with the National Association of Chain Drug Stores and the National Community Pharmacy Association.

Rick: their leadership in the leadership of the entities that we're participating in really were the drivers of the startup. Sure. Scripts and I had the privilege. I'm working with a friend of mine from IBM, actually, to start SureScripts in the 2001 2000 timeframe, we built a business plan, we built the network, and we took it from, no pharmacies, no doctors, and no revenue.

To the 2010 time frame where we had, , a significant number of physicians. The majority of electronic medical record systems were connected. Almost 100 percent of pharmacies were connected both chain pharmacies and independents by that point in time. And we were quickly moving towards it. 50 percent of prescriptions flowing electronically, , even about that point in time.

Now, I'm a technology guy, and the business has started. In 2001, the timeframe was privately held. The two primary owners were NCPA and N-A-C-D-S. In 2008, we merged that business. with a business called RxHub. I was the CEO at that time of SureScripts. We merged with RxHub, which was owned by, at the time, Caremark, Express Scripts, and MedCup.

So the three major PBMs.

We merged the business. That became the new SureScripts. The CEO of RxHub and I became co CEOs. Of a privately held business, 50 percent of the board was pharmacy in a CDS and in CPA. So independent pharmacies and chain pharmacies. There was a chain pharmacy that didn't know if they wanted to be a chain pharmacy or they wanted to be a PVM. That was CVS. So CVS had merged with Caremark. And so CVS was involved within a CDS, but was also an owner on the other side as a part of CareMart. So we're a privately held company. I'm the co CEO and for about a year or so, I remained the co CEO with my partner and then they brought in a new CEO and I worked with him for about a year, 

And I enjoyed it very, very much. I helped build it, built the base platform, base business, merged it with our number one competitor to create an integrated set of services across pharmacy and PBMs, et cetera. However, it didn't appear. That, , it was going to move much from where it was at that point in time, and the governance structure of the new business created some challenges on innovation.

So I had an opportunity to become a partner with Accenture, which is a global, systems integration consulting firm and build out their digital health practice. I'd never worked outside of the United States. So I had a team that worked in Australia, as well as in Europe, different parts of Europe, South America, and the United States.

So it was a great opportunity to go, get some additional experience in working and building health technology companies outside of the United States. So while it was , it was hard to leave SureScripts, that was, those were some of the reasons.

Mike: You said it was hard to leave. What were your emotions along with that? there, was there anxiety that you had done this? Now you're off somewhere else. Was there pride looking back? Was there excitement going forward? 

If you think back to that time, what, what were you feeling during that transition?

Rick: That's a great question. There were many emotions at that point in time, because I was with the small team. There were Four or five of us that started the company in the 2001, 2000 timeframe. So it's your baby to a great extent. you help build the business. And as you would know, particularly, having a community pharmacy, having a small business technology business like that and growing from the ground up, you know, everyone,, and you know, their families. We built a really, really good business. It was evolving to a new level. and it needed to go to a new level, which was perfectly fine. however, , when you built it and it might not be going quite the direction that you would like to,

can create emotions.

And so it was emotional.

There was definitely some pride but as I said, I was very fortunate to have the opportunity to go to Accenture and my experience at Accenture, Accenture is an amazing company, but it's a company it's, you know, it's a 400, 000 person company. I was a partner with Accenture and I had phenomenal experience, but leaving SureScripts to your question was definitely an emotional time for me.

Mike: And you had mentioned Singapore, were you doing any stuff over in Asia yourself? 

Rick: Well, I never moved, actually moved, outside of the United States, but I did have a team in Singapore. and a couple of key individuals on that team actually did move from the Washington, D. C. area to Singapore and move their families and run the business. We had a large contract with the government where we built what they call their national electronic health record, which is basically a.

data platform where we connect the healthcare, the hospitals, and the doctors, and other information, could be even imaging sources, so we could create a medical record for each citizen in Singapore,

and that your information Would follow you from different parts of the healthcare system so that whoever's providing the care has better access to information to make better clinical decisions.

Mike: My wife and I just watched crazy rich Asians last night. Have you seen that? 

Rick: Yeah. So seeing Singapore's a

Mike: Did you come across some of those crazy rich Asians over there?

Rick: Well, I tell you, it's interesting, in Singapore, at the time, so this was probably about 10 years ago, so it's probably even more now, but at the time, it cost 80, 000 just to have a license to buy a car. So it costs you 80, 000 just to have the right to buy a car.

Mike: Hmm. 

Rick: The cars themselves were fairly expensive.

and Singapore is an island, but what's interesting is, The number of Ferraris and Lamborghinis that are being driven around by very young people from different parts of Asia. definitely a lot of money flowing around , but an unbelievable culture and very clean.

very high tech, in the end, but it's a much different part of the world. That's for sure.

But I enjoyed it. It was very nice.

Mike: growing up. I don't know how much you experienced this, but growing up, , like when I was 10 was the bicentennial when we grew up, I mean, America was like, I thought America was like number one in everything.

I thought everybody else was poor.

I thought nobody could have as good of healthcare or technology or cars. That's all we knew. And. to our credit at the time, I mean, Rick, we had, , three TV stations, , the press and

things that your parents and principal at your school told you. And once in a while you might come across a time magazine.

We didn't know anything. And then I guess

it wasn't until maybe even, I don't know, 20 years ago, you start seeing stuff like, oh, . America's number 30 in this and we're number 25 in this. And it's like, , I mean, I love America, but I didn't realize that there could be somebody that had something better than there was in the U S or more advanced.

Rick: That's a very good point. No, I grew up in Oklahoma and have a very similar kind of understanding of the world. And so as you get out in the world, it is interesting because what we view as history is nothing compared to other parts of the world. But in other parts of the world, the way they've invested in certain things has created advantages, but we do have some amazing capabilities.

are not as prevalent. It's not that they're not there, but they're probably not as pervasive as they are here.

but I spent a great deal of time. Our business, MedAdvisor Solutions, is actually based out of Melbourne, Australia.

we're also publicly traded on the Australia Stock Exchange. So, which makes us very interested. we're a smaller business, we're what they consider a micro cap business, but we are traded on the Australia Stock Exchange.

As a result, I spend a fair amount of time in Australia. So I'm there three to four times a year. I've been the CEO of Medivisor Solutions since mid 2022, , we are very focused on how we can affect, to your question you were asking a minute ago, pharmacy services. In Australia it is in Australia.

while it's a very, very large country geographically, it's about a 10th of the U S population. So it's about 25 million people. our software actually runs in 95 percent of the pharmacies in Australia.

And for Australia, there's 6, 000. So, if you look at, , some of the chains in the United States, they're larger than, , the 6, 000.

But all pharmacies, as you would appreciate, all pharmacies in Australia are independent pharmacies. A pharmacy has to be owned by a pharmacist, and a pharmacist is not supposed to own more than five pharmacies.

Now, pharmacies do get organized in groups, so similar to what we would know as a franchise in the U.

S., they have several, large groups that aggregate around 500 to 700 pharmacies each to help bring organization and branding and services to those pharmacies in the market. But that's our core business in Australia. 

Mike: Rick, before we get a little bit more into MedAdvisor solutions, which is your current thing, you're in Australia. 

around there? That's what I want to know.

Rick: Sydney and Melbourne, um, and, uh, Brisbane and several, you know, many of the cities are all around, you know, the edges of Australia.

They're all coastal cities , they're large cities, very similar to cities in the U. S. similar to New York City or Chicago, et cetera. Melbourne's probably a little more European than Sydney is, but you're not going to see kangaroos until you get out of the city. I have seen kangaroos, but you do have to go somewhat seek them,

uh, out into the outer edges outside of the cities.

Mike: And Grand Rapids, Michigan, where I live, we have about, I think we're two hundred thousand , our population, something like that. 

Rick: Mm

Mike: 40 chain pharmacies within 10 miles of me. So we're pretty populated

I will probably see it on the way home. I probably see the evening, probably six, eight deer, a night driving home, even in this population. so it sounds like the kangaroos aren't quiet. dense, you have to go out a little bit further for those.

Rick: Yeah, you would have to go out a little bit further for

bit more than just around

this

the

yeah, because it's, it's, That's funny you mention that, because here in, I live just north of Charlotte, but I live in a suburb,

kind of like the Grand Rapids in some way, not as big as the Grand Rapids, but I do live in an area close to a lake, and so I will see deer fairly frequently,

Mike: And you

wouldn't get that as much, not with the kangaroos as much as that. 

Rick: not until unless you get out.

Mike: there.

Rick: So you get out and there's some communities along. 1 area I did see a number of kangaroos was a golf course actually, 

It's in a little bit more of a rural area.

Rick: You might expect to see Deere too, right?

Mike: Rick,

Rick: Mm-hmm

Mike: Solutions, So give us kind of that tagline and then for the average, let's say independent pharmacy owner or hospital or a chain person, what is your company doing for us, let's say. 

Rick: Great question. So Medi Advisor solutions at the highest level is focused on pharmacy led

patient engagement. So Medi Advisor solutions at the top, highest level is focused on. engaging the pharmacy and helping the pharmacy use technology to engage their customers or patients.

So it's a pharmacy led patient engagement strategy. So our focus is really how we can help you as a pharmacy owner evolve. engagement with your patients such that it can improve patients loyalty, improve their engagement with your pharmacy and help to offload to a great extent.

some types of work that you have to do yourself today or offload phone calls that are coming into the pharmacy using digital technologies. Now in the United States, We have a network of over 30, 000 pharmacies. The majority are through relationships we have with chain pharmacies. There are some independent pharmacies we get through software vendors.

So our relationship isn't directly with the pharmacy, but with the software vendor. Now what we do, though, is we work with pharmaceutical manufacturers. So our focus is how we can help the pharmaceutical manufacturer to target individuals that are engaged with the pharmacy

with information to either help them be adherent to the medication that's been prescribed and is now being filled at the pharmacy or help them to become aware of alternatives where it's appropriate.

help them to understand that, they might be of the category that's a target for a vaccine. So it could be a pneumococcal vaccine. You're over 50, maybe it's a shingles vaccine, et cetera. So this company we call Medivisor Solutions has historically been known as Adheris Health.

So Adheris Health is actually a 30 year old business. It was acquired by MedAdvisor in Australia in 2020. Adheris Health actually started out working with pharmacies to do pharmaceutical brand sponsored direct mail. So back in the day of Lipitor, Pfizer might create a direct mail campaign so that when you fill Lipitor and your patient goes home, you want to make sure they understand the importance of a statin and take it appropriately, et cetera, which works to their advantage.

It works to your advantage, because hopefully they'll come to refill the medication, and it works to the pharmaceutical manufacturer's advantage because they're, they're seeing the appropriate, appropriate volume. That direct mail evolved into, an acquisition Adheris did that of a business that had direct integration into your pharmacy system for printing information that was attached to the prescription bag.

We actually have relationships with a large number of pharmacies and the software vendors where when you print the information on the prescription, could include the med guide and other regulatory related information, there's space on the printout to print information you were just prescribed Lipitor.

Let me tell you about Lipitor or point you to a website. where you can learn more about Lipitor or your just prescribed trilogy. So let me go tell you a little bit more about COPD and how to manage your inhaler or point you to other online information that can help you to support that. Or it could be, which 1s are one thing that's kind of an interesting category.

Maybe you're new to Ozempic and there's a co-pay program to help lower the cost of the first bill of Ozempic at your pharmacy. So we work with the manufacturers to create programs that we can target through the pharmacies. But we partner with the pharmacies. So the pharmacies have the ability to decide they want to run certain programs and not others.

and then when they do run the programs, we share a percentage of the revenue that we receive from the pharmaceutical manufacturer with the pharmacy or the software vendor. Depends on where that relationship is, but that's in return for. The support because we have to have the information, , the data from your systems to be able to know how to target the information and do it appropriately around HIPAA related regulations, et cetera.

But our business is about communicating, pharmacy branded information, to the patient through the pharmacy.

Mike: And Rick, I don't know if you alluded to this, but then are you also throwing in competition to that? Like, Hey, you got this. Have you thought about this one or haven't you? I remember that was always with, I don't know. You'd go to like, uh, Oh, basically the grocery store.

Rick: You'd buy some yogurt. And then on the back of your thing, they'd have a receipt for a different brand of yogurt. Do you do that or not? 

We do that where it's appropriate. So, if there's a therapeutic alternative, and you would appreciate this more than me, because I'm not a pharmacist, but, 

Mike: Some people say I'm

not either though.

Rick: But where there is an alternative, and it is appropriate to suggest that, if this particular medication is not effective, you might talk to your doctor.

So you never make a recommendation, right? But you might say, you might talk to your doctor, particularly if you were on metformin, as an example. So I'm on a generic medication. If it's not, effective in managing your diabetes, you might consider Jardians, or you might consider, , some other

Mike: Interesting.

Rick: or whatever that might be, 

Mike: And then Rick, what is the revenue divide of your company? Not dollars, but I mean, what is the divide? Is it a hundred percent manufacturers that is that where you make your revenue from or how

Rick: In the United States, the business has been designed and it is 100 percent pharmaceutical manufacturers. About 30 to 40 percent of our business is related to communications around vaccines.

Mike: Oh

Rick: So one of the important points, given how our business has evolved, is that, particularly now, because many vaccines are actually administered in the pharmacy, we can communicate to individuals as they're picking up their prescriptions.

Or with text messaging, we can actually communicate to the individual before they come to pick up their prescription.

Mike: hmm.

Rick: might want to schedule into the pharmacy, a vaccine for flu shot, COVID, RSV. Pneumococcal, etc.

Mike: In our software vendor, I don't feel prescriptions myself. And I don't say that for pride. Like I'm above it. I just don't know what the hell's going on in how the system works sometimes. But with

Rick: yeah.

Mike: Once in a while, I'll have to run something through. All of a sudden I get something blocked from my pharmacy.

It's like, Hey, you've got to ask this person this question and then fill this in on the screen before you do this or that. And I'm like, what the hell? I didn't sign up for this. I mean, figuratively and literally I didn't sign up for this. And then I go in and it says, you can remove this by checking this, that you don't want to be part of this and that.

And it's like, Oh, whatever. It's like, don't do that to me. And maybe I signed up for something. I don't even know I did. But you had mentioned yours is more paper based. Is it on the screen stuff too, where you have the pharmacist do stuff or it's all just on the, paper based receipts and

so on?

Rick: So it's, it's either paper or it can be, we're evolving. This is the reason I'm here, is we need to evolve it to digital. And so, digital communications to the extent you can do digital communications via HIPAA. Because HIPAA and other regulations require certain kinds of consents in order for certain information to be shared.

So we do digital as well. But relative to the print, there's no, you as a pharmacist don't have, or even the digital actually. you don't have to get involved. What you're talking about is actually some of the administrative headaches I was talking about on EHRs. In this case, it's most likely related to requirements from the PBM relative to, making sure that it's covered or that you have covered a prior authorization.

Or, starting the process to do a prior authorization, maybe.

That's a different thing.

Mike: There's a lot of that, but it seems like once every like I've only come up with a couple of them, like once a year, it pops up like 

More than just stuff back on the claims from the insurance, I think it's something that our pharmacy software company, I imagine they make some money off of. If, if this thing pops up and it's not an ad, it's not just like an ad, it's

Rick: Yeah.

Mike: The pharmacist has to do it. Clearing something, I think it's some program, but I'm happy to know that I'm not looking at the guy that made that little thing difficult for me.

This is all

Rick: No. No.

Mike: patient receipt. And then the digital thing, which would get to them, maybe looking at HIPAA, but maybe through email or. Texting or

Rick: could, could be email. Most right now is via texting. So where the patient, again, has opted in via texting. There's a little more, starting to happen through the patient's pharmacy app. So particularly with the larger chain drug stores or your pharmacy software vendor, if they've enabled you to, deliver a mobile experience via an app of some form, those apps are a great way to get patients to opt into communications and then you can communicate to them via the app, via text messaging, email, et cetera.

Yeah.

Mike: So then Rick, you mentioned that you were brought in more for the electronic part of things. Did I get that right? And that's, let's bring Rick in and make this shift.

Rick: Yeah. So, yes, the business, as I said, is a 30 year old business and, commonly, it's the result of a combination of a few different companies. So there is this transition to digital so that we can, we've moved from direct mail to print and the pharmacy that's streamlined. Now it's, how do we make sure we're leveraging the new communications of individuals?

Are mostly engaged in to help create awareness on, , how to make sure you're taking your medication adherence is a significant problem still across the industry. but also, as a way to help. Ensure or encourage the appropriate level of vaccination and other other services. Using communications platform,

Mike: You're not kidding about adherence. It's like I've had a couple of DVTs in my life. So I'm on Eloquist and I'll do just about anything not to take my evening dose. I've got it on my to-do list . It's sitting in my backpack three feet from me and I'll be damned if I, , I'll say to myself, well, I had a couple of Motrin two days ago, so my blood must be thin enough.

I don't. There's just something about me, so here I am with a drug. That's going to save my life. It's two feet from me. I've got all these alarms going off. I'm not busy. I'm just sitting around at night, but like my day just wants to be done. And so I always think

about adherence. It's like, there's more to it.

There's, , belief. I mean, it's not just mathematics. it's.it's belief that this is doing something for you. And I don't have any financial concerns. 

It's a copay thing for me. It's not like this thing that I'm trying to save money on, but it's just amazing what this brain can do if it's just not wanting to do something.

Rick: Well, the range of challenges around adherence are fairly significant, and it is a lot of behavioral.

Well,there is affordability, there is access, there are some education or understanding related gaps that create challenges. What you're describing, , interestingly enough, even with certain types of cancer medications.

there's also, , certain types of adherence challenges.

So it, to your point, it might be, , the difference between life and death.

But, , if I don't feel good, sick of my stomach, if I can't sleep, , the behavioral changes are definitely significant.

We provide one mechanism to help try to move the needle is the way I describe it. , solving the problem or having a significant impact is a significant issue that goes beyond technology. What's interesting though, is I think technology, and this is where people start to get a little hesitant, but.

with artificial intelligence and what you can do to help improve education of individuals and make it more easily accessible to them or target communications that are much more selective, much more intentional, also might. Containing the right content for that kind of an individual because everybody learns differently and reacts differently Artificial intelligence has a significant opportunity to again help move the needle.

Rick: It's not going to solve the problem,

Mike: Well, that's what I say with people with AI. They're like, and I know my listeners hear this ad nauseum, but it's like AI is coming out. Everybody's going to lose their job. It's like, all right. Adherence is like this. Here's the average age of the, uh, male death in the U S here's the cancer rates.

It's like, you're not going to wake up tomorrow and have these things at a hundred percent. it's just a slow process of this stuff.

Rick: It is a slow process And interestingly enough, there is a lot of conversation about people losing their jobs well, what I would say though is there are, , a number of books written on these types of things. But, you look at the industrial revolution or you look at even just, we were talking about the introduction of personal computers, 

Mike: Calculators, all that stuff.

Rick: have automated a lot of things. 

but they create new, new opportunities.

Mike: That's right,

Rick: It's just like you look at drones, everybody worries about drones. Well, drones are creating new opportunities for young people that have grown up with video games to help automate and run home delivery.

via drones, 

Mike: yeah,

Rick: Or emergency operations

Mike: yes,

Rick: defense.

And , the other side of it is back, when I was younger , there wasn't such a thing as a fitness center.

You know, you look at, you

lifestyle kinds of programs. We have gyms and fitness centers and niche programs today that didn't exist.

20-30 years ago.

So there will be new industries created. There'll be new jobs. There'll be, it might require that you have different skills,

but that's not all bad.

Mike: I think back to my dad, like back to his football days, , and they didn't even have to be really uniformed, , they practice on the dirt of the baseball field. And then I look back at my

Rick: mm hmm.

Mike: I was a freshman in high school and I kept some of those papers and it's like, it was mimeograph, , it was, show up August 15th, bring your cleats, , that was, , 40

Rick: Yeah.

Mike: Now it's like.

Rick: Mm-hmm

Mike: all year, all that kind of stuff. 

Rick: it's evolved to that point though, for sports, for young people,

That's a whole industry in and of itself. I mean, my son was a baseball player. We had coaches for him. He went to training, he went to batting training, he went to pitching training. and it is, it was year round and it was very competitive.

And that didn't exist. We just went out and

Mike: No,

had a baseball glove and a bat. So Rick talked about Australia with the kangaroos, and then we had to come to the U S cause that's probably a good portion of our listeners. Back to Australia though. What do you see? Like, for example, I'm on a different continent. What do you see happening there, if anything, versus like the U S and how does that your, your company's approach?

Rick: A great question. well, what's interesting is in Australia, we, I think I mentioned earlier that our software runs in over 95 percent of the pharmacies in Australia. Our software really manages. the clinical workflow. it's a bolt on to the pharmacy management system.

And so we're not running all the back end systems. We're running all of the interaction of the pharmacist with the patient. So helping to refill medications, also helping to schedule vaccines, helping to automate certain types of interactions with the patient, such as, In the United States, we have complex medication reviews, or CMRs.

In Australia, there's something called a meds check, and the government will actually pay the pharmacist for engaging the patient in managing multiple chronic medications. We provide the software to support that. Now, In different states, so there's six states and two territories in Australia. In different states, they've actually passed regulations to allow for pharmacists to deliver certain types of clinical services.

This started initially with women's health kinds of programs, particularly around urinary tract infections. where an individual can come into the pharmacy, she can be diagnosed with a UTI, and the pharmacist can actually prescribe the appropriate antibiotic or other treatment. And so that has evolved into, in Queensland, over 23 categories that a pharmacist can actually manage , a clinical intervention with a patient.

And that requires the pharmacist to go through a certain amount of training. If you go through the training and then they have once they've completed and certified, they're then able to provide these services and our software's evolving to, to enable this more complex workflow and documentation requirements, as well as the ability to write prescriptions electronically and then securely.

Communicate with the general practitioner using software on the actual encounter in the pharmacy so we can create this coordination of care between the pharmacist and the doctors in the community. This is evolving very fast in Australia. This is being driven by the Pharmacy Guild of Australia, which is the counterpart to the National Community Pharmacy Association in the United States.

So actually the CEOs of NCPA. as well as PGA, know each other and interact on what's called the World Pharmacy Council, where there are multiple countries that are represented in that council. So they're making good progress in Australia. The UK is very similar. There are parts of Canada that are actually making good progress on this, and this is really what, as we move into the United States, where we're trying to get CMS to provide some level of provider status to pharmacists to deliver care in the pharmacy.

So that's what's interesting, I think, is this has been a conversation for some time. We talked about SureScripts, starting in 2001, we at that time, we were talking about pharmacists. , actually operating at the top of their license, these types of things. But we're now at a different point in time.

Access to health care is more of a challenge, like it is in Australia, even in the United States. And you have pharmacies, many pharmacies, very close, within five miles, typically, of an individual. And an individual sees their pharmacist probably 10 to 12 times more frequently

than their doctor. So there's a really interesting opportunity there. There's also a lot of complexity to that

because pharmacies are not necessarily designed to be able to have that kind of a clinical encounter.

ability to provide vaccines. And the requirements to have some, some real estate to be able to deliver those kinds of services in private has helped at least move that direction.

But it's a really interesting opportunity, I think, evolving for the US and, , an interesting opportunity for us when we look at our business in Australia and what we might be able to do here in the United States. Right. Right.

Mike: He's a five timer now, but we were talking in the past. It's like he's, he owns an independent pharmacy and it's like it took him, I don't know, he had to dig and dig and dig through all the, You know, , like when you take a picture on Google or something and you hit the eye, you know,, the information that tells you where it was and the latitude and all that kind of on a prescription to, if you go into the depths of the prescription, but he had to go down like 136 lines to find like a blood pressure of somebody, something like that.

So he could then compare it from last time to this time with the EHR stuff. There's a lot of room, , even something as simple as that, just to bring that out to the limelight and, , let's get on the same page here with everybody.

Rick: Right. Make those kinds of tools available to the pharmacist 

Mike: Absolutely.

Rick: is very important. And to, to the point of the complexity of finding the information, you only have so much time

for the interaction. 

Mike: So Rick, someone listening to this, they're just getting done, they're pulling into their store or something. What, what's something they could do in 30 seconds? Could they look up your company? What could they do as the next step after hearing this?

Rick: I would say the easiest thing to do is to go to med advisor solutions. com. And on MedAdvisorSolutions. com, there's information that provides, at a high level, what we do to support pharmaceutical manufacturers, and even more importantly, pharmacies, and probably more important than that, patients.

Mike: huh.

Rick: And so it's at least the high level view and that's probably the best way to learn about what we do. And then, we're always happy to connect. 

Mike: Well, golly, Rick, thanks for your time today. That was fun. All the way from the kangaroos to the important stuff, I guess, very good stuff you're doing.

And in this day and age of all this. information and everything, connecting those dots, is very important. And so you guys are doing cool things with that. So keep it going, but Rick, I know you're busy. Thanks for your time today. I appreciate it. The listeners do. and great talking to you.

Rick: Thank you, Mike. I enjoyed it. It was a great conversation. Thanks for inviting me. 

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