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Mike Koelzer, Host: [00:00:00] Casey and Elma for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today. Well, my
Casey Villhauer, PharmD: name's Casey , I'm a pharmacist and I'm the CEO of VaxiTaxi. My name is Alma Michaelson. I'm a pharmacist as well. I'm a director of pharmacy operations and co-founder at backseat
Casey Villhauer, PharmD: taxi.
Yeah. We'd love to share with you about the start of ACCE taxi, what we're doing and what we feel. Our purpose is.
Mike Koelzer, Host: I've obtained a lot of URLs in my life for a lot of silly ideas I've had for businesses and so on. I keep them for two years or whatever, and then they go off to pasture. When you guys came across vaccine taxi.com and you knew that was available, that had to be a crazy day that you said, I can't believe this is available.
When did you get that? You are.
Casey Villhauer, PharmD: Sure. I'm always in early 20, 20, um, possibly even late 2019 actually, but Mike, we've got a list of URLs that we think are pretty great. So truth be told taxi taxi wasn't even at the top of it now, I can't
Mike Koelzer, Host: believe that. Gimme
Casey Villhauer, PharmD: Nope. Top secret mic, Tufts secret, but they're coming.
You
Mike Koelzer, Host: mean you have ones that are still available?
Casey Villhauer, PharmD: Not anymore. I mean, they were before we
Mike Koelzer, Host: took them. Yeah. And they're better than vaccine taxis, I think. So. Were there some that you tried to get that you thought were better than vaccine taxis and they weren't.
Casey Villhauer, PharmD: Um, not really. We wanted ones that were very clear on what we do and how you do it.
And that's really hard to do with just two words or one title. And so, no, I don't, I don't think there are any that are specific for this business. That there would be better, but we have other projects in the works and those have really great URLs. Maxi
Mike Koelzer, Host: Taxi is so good. It's almost like you look through the internet, URLs available.
You found a cool name and you said, Hey, let's make a business around that. It's just hard for me to believe that in 2020, there will still be a cool name, like Vaxi taxi, which really defines what your business is. What's.
Casey Villhauer, PharmD: Well, I think, you know, that the hard part for me was coming in terms of the fact that this business of what we're doing hadn't been done yet.
So not just the name, but actually what we were doing.
Mike Koelzer, Host: All right. So spill the beans now. Casey, what are we doing? What is a vaccine taxi?
Casey Villhauer, PharmD: Sure. So the best way I can describe it is we are the Uber eats pharmacy. So we have our pharmacists as immunizers and, um, they partner with us and they're independent contractors.
And then we have our pharmacies, which would be like the restaurants and our immunizers. They stop, they pick up their vaccines and they go to patient's homes.
Mike Koelzer, Host: The pharmacists are independent contractors, they're their own thing.
Casey Villhauer, PharmD: So they're just like the drivers for Uber
Mike Koelzer, Host: eats or any of them pharmacy owners, or are they pharmacists,
Casey Villhauer, PharmD: their pharmacist.
And so our job where a vaccine taxi comes in is cause any community pharmacy could send a pharmacist out in about two to give vaccines, but. What we bring to the table. That's good as that, or makes it simpler is that we coordinate all of the scheduling. We have centralized scheduling, centralized clinical consultations, and the pharmacists are then not on the payroll of the stores.
And we do all of their training. So we do everything at home. Training. And we do all of their equipment, things like that. And we provide all the information that they need to go out and do these appointments.
Mike Koelzer, Host: So Elmo was just a coincidence that this happens to fall in when pharmacy vaccinations, arguably with COVID is the hottest thing going to this so happen that it just lined up with you.
During this vaccine
Alma Michelson, PharmD: taxi really started prior to COVID. Um, I, I think what sparked maxi taxi is some changes in Iowa law. Um, and those recent changes were where the pharmacist became the prescriber of vaccines and immunization. That is the new Iowa statewide protocol prior to, and it's been coming for a couple of years is just that, um, you know, chain pharmacies in our, in our state, no one was really ready for it.
No one really thought it would happen. And then it did finally go into effect actually this year, but when the law was written, uh, Casey knew exactly what it meant. So she was able to talk with,
Casey Villhauer, PharmD: uh,
Alma Michelson, PharmD: her husband and some of, some of her friends and discuss this idea that, you know, wouldn't it be great if you can just bring flu shots to our home, where kids are at [00:05:00] home watching TV and you can distract them in that way.
And it would be easy and seamless and paid. And with the new law change of statewide immunization protocol and, uh, Casey's idea of why don't we just bring the vaccines to people's homes. Uh, she finally was able to act on that idea and that's how vaccine taxis came about. So it was prior to COVID. It was, um, Around flu shots and busy families, and being able to provide a service that fits our modern society.
And that is if you need the vaccine, you can get it, uh, with just a phone call and it can come to you.
Mike Koelzer, Host: A previous guest of mine was talking about the news. Ideals. And I'm pretty sure it was Iowa that they took some of the mandates and just by changing a few things, they allowed Iowa pharmacists and pharmacies to do some really cool things.
I forget all the details, but it sounds like what we're talking about here.
Alma Michelson, PharmD: Another detail that, um, that is really cool. Recently, maybe this is the law. Um, but you're talking about the wording, um, says that pharmacists can order tests and treatment of COVID flu and strep. That is not here right now, but that wording is in place and, um, companies will be acting on it anytime.
Mike Koelzer, Host: When you guys set this up from the very beginning, you knew you were going to be using it. Not your own employees. Let's put it that way. 10 99 pharmacists. Yeah,
Casey Villhauer, PharmD: absolutely. It was more of a vision of, we know that there are pharmacists that want to do this, but it might not be a full time job. You know, typically 17 weeks out of the year, we're really heavy on, um, flu season and we're giving a lot of pneumonia shots and some back to school shots as well.
But that usually is about 17 weeks out of the year. So. You know, how can we create something for pharmacists to do? Cause they'd be, they'd be great at it that wasn't full time, you know, how do we, how do we pull these people out too. Um, fill those gaps. So, yep, absolutely. From the beginning, it was based on using, um, people that didn't want to do it full time.
And some of that too also goes back to, um, myself and Alma. We're both moms. We both have three young children. You know, there's a retail pharmacy right now. It's hard. It's hard to work a full-time schedule. And so a lot of our friends and colleagues have backed down to like 30 hours a week or part-time, um, things like that.
So this is a perfect job for someone like that. It's perfect for a new grad or someone who's recently retired. So absolutely.
Mike Koelzer, Host: Casey, what were you doing two years ago when this idea came up? Came to
Casey Villhauer, PharmD: you. I was being a mom. I was not in the world of pharmacy. Um, granted my husband is a community pharmacist. And he was in pharmacy, but I was completely removed from the world of pharmacy.
Mike Koelzer, Host: Where you out searching for a business idea now, or was it such a good idea that it came to you that you had to do something about
Casey Villhauer, PharmD: it? I know that the school has tried to teach entrepreneurial mindsets and like everyone's, you know, using those buzzwords and things. But I stand by the fact that it's probably a very unpopular opinion, but you, you, John set out to own a business or start a business.
As your primary goal, you've to fix a problem. And that's what I've always done. Even when I was working in a chain pharmacy, you know, we would have workflow issues. We would have all kinds of issues, patient issues, things like that. Right. Um, nothing irks me more than to solve the same problem twice.
Cause at that point you have a system problem. And so that's what I did. And I would, I was pretty good at these are our resources. How do we completely revamped the pharmacy in order to fix it with no money or no space or, you know, whatever. But that's what I like doing just, that's just my nature. So planning, logistics, fixing.
That's what I do. When
Mike Koelzer, Host: You then had this idea, how did you then test it? Or how much did you build before you tested it and so on? Yeah. So the
Casey Villhauer, PharmD: first fall, which would have been, um, the fall of 2020 was that was the first test. And, you know, it started with all of the things that come to mind originally to every, every pharmacist is, you know, Can you get a license for it?
Can you, you know, make sure that you can have insurance for it? Do you have people to do it? Is there a demand for it? And so we just [00:10:00] started checking off those boxes. I'm like, let's see if we can get a license for it. Let's see if we can, you know, find insurance. And we just, we just worked our way down the line and.
And then we've started there with cash payers. So it was a concierge service geared at pharmacies and cash payers. And when we realized that we could, we could figure out the logistics and how we could scale it and what we needed for software. Um, then we decided now's the time to broaden our scope and find some insurance companies that are willing to pay for this.
Funny turn of events COVID happened and there became a COVID vaccine. And at that point it was, we didn't have to go looking for insurance companies to partner with us. Um, there were patients coming to us, there were payers coming to us and we said, absolutely. Our customer base is a little bit different because we were familiar with the tech savvy online group, but with COVID, um, those patients that we are trying to help and reach that really couldn't get out or were having a lot of, um, access issues.
Um, those patients are not necessarily a tech savvy group. So, you know, extreme pivot on, on what we were doing, um, to, you know, we, at that point we needed. To rely heavily on phones and that wasn't something in our original plan. Luckily we had a little experience on our belts, so we knew how to go about it, but.
To answer your question. It was trial and error and we could've kept planning with the software or we could have just done it. And we went with, let's just try it. What's the worst that could happen
Mike Koelzer, Host: Being that you were able to do some cast stuff first, you were able to have some. Customers, you were able to bounce in and back and forth instead of putting all your eggs in a big basket and having that basket fall, you were able to kind of have some proof of concepts kind of, as you kind of went along almost tit for tat and you were able to build.
Well kind of back and forth, sort
Casey Villhauer, PharmD: of, yeah.
Alma Michelson, PharmD: You know, when I met Casey, actually I should back up. So I started volunteering with her in April. I met her online in November. Um, she opened up Vaxi taxi in July of 2020. And when I started talking to her, you know, it was really to say, Hey, congratulations, this is awesome.
Vaccine tax is a great idea. I cannot believe it's here in Anne county. And in November, between November and April, what I can tell you about. I could tell Casey was going back and forth between what business model, what her business model would look like. I actually have an inactive, real estate license.
And when she described to me her idea, you know, I said, oh, okay. So it's kind of like a real estate company. You know, you have the broker and all the realtors are. Our independent contractors and they're managing their own transactions. And so to me, that was like, wow, that's amazing. That's awesome.
Pharmacists would be able to, you know, have their own patients and you, um, are in a way a case worker, a case manager, and that was in November. And she was like, yeah, that's, you know, that's exactly it. But then she went back and forth. With, with reason, you know, um, when, when COVID happened and when we had to figure out, um, how you scale up with that type of an idea, how do you keep patient records and billing and, and everything in place.
Mike Koelzer, Host: Do some pharmacists have in their chain employment contract that they can't do this and other ways around. That's
Casey Villhauer, PharmD: a hot topic right now. Um, so what we're really proud of is that we were able to utilize pharmacists that still wanted to have active patient care roles, but they did things like, um, they, one owned a yoga studio.
One was to stay at home. Dad. One was, um, uh, one is strictly like clinical MTM services from a remote location. All of these pharmacists were able to put them in. Place. And therefore, you know, we don't have to pull them out of the workflow in a community pharmacy because right now, more than ever, we need people in those roles.
But we were able to use, um, pharmacists that are qualified, licensed, more than capable and want to do it, um, to bring immunizations and clinical services to patients at home.
Mike Koelzer, Host: There's enough people that have left the chains. I still want to be involved, but in their own way, sort of, it sounds like a great
Casey Villhauer, PharmD: fit.
Yeah, it really is. Um, you know, it's, we, we kick ourselves that we didn't start doing this and by. [00:15:00] I mean three years earlier, because at that point, if, when COVID would have hit, we would have had the network already built out to have access points for all of these patients, like, you know, across Iowa, we would have already had that, that worked out.
And I think, you know, across the country in general, um, like con county health departments are trying to reach these patients. Hadn't necessarily served before and we didn't have a good list of who the homebound patients are. So it definitely, um, there's definitely opportunity.
Mike Koelzer, Host: But I think Casey, that we have to be really careful before we, well, we can think about kicking ourselves, but we have to be really careful before we actually kick ourselves.
Because think back, like it's easy to think. Not that necessarily we needed video conferencing to do this three years ago, but. We tend to forget where things were even three years ago. I mean, right now you think, oh yeah, video conferencing and apple watches and Google pay and this and that, that's all been around forever, but you know, it hasn't.
So three years is a long, long time in a company like yours, which is very. Technology is very communication-based. That's a long time to go back. That's almost like going back to the wagon wheels, you know, so we have to be easy on ourselves. Uh,
Casey Villhauer, PharmD: I appreciate that Mike, but you know, the same thing applies.
There's pharmacists that wanted to do it three years ago. And there's patients that needed it three years ago. It's just covered. For the whole country, uh, cause we're all talking about vaccines, but these are the same patients that didn't have access to vaccines in 2014 when I was working in a retail pharmacy.
Mike Koelzer, Host: So this idea came to you in 2019. Let's go back to 2014. Let's go five years earlier. Why didn't you have the idea then? It was stressful. Was it a young family? What was the reason why you didn't have the idea in your opinion? In 2014?
Casey Villhauer, PharmD: Yeah, it was, it was financial constraints. It was, I relied on my job and it took a life altering situation for me to realize that I did not need that job as badly as I needed to live my life.
And I had a medical condition and I. I thought I was going to die. I did, but I didn't. And so that's wonderful, but at the same time, um, you know, I left my job. I had three young kids. My youngest was six months old at that time and we sold our house and we moved closer to family. We downgraded our lifestyle and I said, for the next few years, I really need to focus on.
What is important. So 2014 was a really hard time. Um, but this, it turned into something better because then for the most recent five years, I haven't been in a pharmacy. I haven't been behind the counter. I have a completely different perspective on what pharmacists can and should offer patients because I was a patient.
I was strictly a patient. I was a mom and I was on the other side of the counter and I knew what I needed to make my life. Easier, better. And I was able to step away from being a pharmacist. And just into that, what do people really want? Mindset
Mike Koelzer, Host: pharmacy with the extended length of school and all these, whatever the hell you calm, all these PG PG stuff.
I don't know what the hell they are. And I'll start with a PG PG one and two, whatever the hell those are. But with that, with the stress, with the debt. Those are not conducive to entrepreneurial ideas, not to mention the follow-through
Casey Villhauer, PharmD: you're absolutely right. And, you know, so it was easier for me to step away or to, or to go into this because I knew my risk was relatively low.
Um, just doing it on a really, really small scale. But in all Ms. Case, you know, she left a really great position too, to join a backseat taxi and. And that's terrifying. And I feel like there's probably a number of pharmacists in that position.
Mike Koelzer, Host: Elmo. What trait did you have that, have you sitting there now versus someone else that just looked at Casey from a distance?
Casey Villhauer, PharmD: If she doesn't answer this question correctly, I'm going to, I'm going to buzz in. There's a lot of pressure
Alma Michelson, PharmD: in Casey's words. I am her problem solver. That is in her words. You know, she, uh, as I was telling my family, right, Hey, I met this [00:20:00] person, Casey, she's got this awesome idea. And you know, my sister she's like, oh my gosh, this sounds like a storm of ideas.
It sounds like chaos. And you want to go into that? You want to work with that? And I was like, yeah, yes I do. And so I was talking to Casey and she said, you know, you just really helped me. Ground all of these ideas and, and they're all up here and they're all up in space, but you helped me make that one decision.
That's going to really bring that idea down and solidify it. So I would say, I think I'm, I'm a problem solver. And, um, as Casey said, I'm, uh, a natural processor.
Mike Koelzer, Host: I know you mentioned earlier, you said I couldn't believe it. It was like being in the same town. Right? How far would you have reached out? Would you have done this?
An hour away, like three hours away. We talked about changing communication. Given the new world of video conferencing, would you have offered your services if Casey was across the country, how much did being close to her have its end effect of you being with. Um, did it give you the confidence to reach out?
Like you had a common denominator? It
Alma Michelson, PharmD: definitely helped. I'm a mom of three kids as well. And so, you know, if this company was in New York, I don't think I would leave my three kids and fly to volunteer for them. For a clinic vaccination clinic. And so with her being this close, it certainly was helpful. It was right here in Iowa and it was current.
It was related, uh, to the new laws that were being passed in the state and what the profession is doing. So it definitely helped with her being close.
Mike Koelzer, Host: It's kind of like. The Beatles. I mean, they might've joined each other. If they ran into each other at a music festival, somewhere three hours away from Liverpool and some other place in Europe, wherever the hell.
I don't know. I don't know what else I don't know, I don't know the pharmacist PGU stuff and I don't know my way around Europe, but I know Liverpool, but if they were from different areas, it wouldn't have happened. They had a lot in common. And so I imagine you had. Age, your kids. You're both from Iowa.
You're 20 minutes apart. I imagine that helped to make that original contact that you made with Casey. I would
Casey Villhauer, PharmD: say, well, first of all, I want to back up and say what Alma brings to the table as she is fearless. That is a really good way to describe her. And I think it is great that we were close. Um, but I had a really hard time putting into words what I needed for my next.
Person, right. Like who is going to actually help me do this at the next level. It was hard for me to put that into words. And then how do you, how do you advertise that necessarily, right when you're still kind of trying to develop that role and, um, Alma, just like she checked all those boxes. So I think one of our first meetings was we were actually doing appointments together.
And, um, it was, I had meetings like on a zoom in like the back of my car. And she was like, give me the steering wheel, give me the stuff I'm doing all of it. And those kinds of things. So it was great because I was like, this is, you just need people that are gonna. Do it. And I think what Alma brings to the table is, like I said, she's, she's fearless.
And she compliments very well. All of the things that catch me or hold me up, um, in making decisions or finding direction and on top of. One day. She said, you know, I feel like this isn't just a job. I feel like it's a movement. And, and I told her, I was like, that's probably, and that's how I know that you really understand what we're doing.
Um, I mean, that, that says it all. I never would have said that, but that just perfectly describes how I want. Our company culture is developing. And I believe that she, I mean, I know for a fact that she believes in what we're doing and we just make it a good fit that way.
Mike Koelzer, Host: When you say she compliments you, is that sufficient or.
Does she change you at all? And do you need to be changed at
Casey Villhauer, PharmD: all? Well, I think we've gotten to a point where we have so much on our plate and we have so many ideas for growth and we're going in a million different directions that, um, You know, we, we each have our, our skills that we're good at. And so she is definitely much better at certain things.
And I can kind of say true to what I am good at or what I think I'm good at, and we can move on and we can make bigger progress.
Alma Michelson, PharmD: One time [00:25:00] Casey used the term you're creating and I'm editing. So she's, she's an editor. And I, I really feel comfortable in referring to our dynamic in such a way, because if I, you know, if Casey has an idea and I bring that idea and I create something out of it and, and show her a product she's really good at.
Improving it and making improvements that take that idea or that creation and just make it better. Um, half of it is because she was out of the pharmacy world for five years, that all of a sudden she sees things a little bit differently than I do, who was, you know, working, um, while I still work PRN for our retail pharmacy.
Um, And so I think our relationship of being a creator, being an editor, uh, really
Mike Koelzer, Host: works. You're kind of the break and the gas and sometimes that switches. Yeah,
Casey Villhauer, PharmD: That's great.
Mike Koelzer, Host: That's a nice mix. I like seeing companies when you've got two people involved where you're able to see right away that there's a good reason for two people involved instead of having two people that are.
Built out of the same mold. It's like why? You know, and to have two people that have very nice complementing skills. That's a good
Casey Villhauer, PharmD: thing. Yeah. I think about it every day. How lucky I am that we were able to connect and. And all with Alma, but also like our immediate circle, a pharmacist that we first, our first team of immunizers acting as independent contractors.
It just, it brought a lot of really cool. Providers into our
Mike Koelzer, Host: circles. We talked about the independent contractors of the pharmacists. What about the actual business? I'm thinking that I'm looking at maybe the two full-time employees and what do you have part-time and what do you have for independent contractors?
And what kinds of things do they do? I'm not talking about the boring pharmacy stuff. I'm talking about business stuff.
Casey Villhauer, PharmD: Right. Um, so you know, the boring pharmacy staff, that still is our bread and butter Mike. So we, we spend, you know, a lot of time and energy and funds on, on
Mike Koelzer, Host: that. The actual, like medical pharmacy talking about best of RA that's for some other boring podcasts.
Come on, we're going to talk about the business stuff.
Casey Villhauer, PharmD: Yeah. So, the sexy side of our business, right, is that you're going to talk about that's great. So, you know, like every startup, we have a conglomeration of, of people. So, you know, fractional CFO, we have our per diem marketing. We have, um, people to step in.
We have someone else managing our website and I know a part-time IT developer and. Uh, part-time COO. So like all of these people, um, we've, we've found them, we've brought them on as you know, independent contractors as well, um, for the services when we need them. Um, it also opens the door for if it's going really well.
We have the opportunity to hire them.
Mike Koelzer, Host: Are any of them remote
Casey Villhauer, PharmD: or are they all local? They're local, but we have never met them. Oh, that's interesting. That's not true. That's not true. No, that's not true. We have met with our marketing team.
Mike Koelzer, Host: That's interesting. They're local, but because of that, I guess you could blame it on COVID at first that you haven't sat down and.
Well, you didn't have the initial thing. Probably wasn't, uh, a warm in-person meeting and then it probably just continued that way, even though their local,
Casey Villhauer, PharmD: I think it's out of, it was structured out of efficiency
Mike Koelzer, Host: even without COVID you
Casey Villhauer, PharmD: would've done it this way. Yep. Absolutely covered. Is that. It opened a lot of opportunities for us, I guess, um, for talking with people and meeting with people that otherwise would have required a flight right at a hotel stay and a plane ride somewhere.
But when meeting. Over zoom became the standard. Um, we didn't, we no longer lacked access to all of these individuals. So like players, right. And other startups or other parts of the industry,
Mike Koelzer, Host: you're saying that you're local you're, part-time COO and CFO and all these people they're local, but you have. I met them in person, in person.
Yeah. You've done it through video
Casey Villhauer, PharmD: and we talk a lot over texts and phone. So
Mike Koelzer, Host: COVID, didn't prevent you from meeting them, but because of COVID and because the new norm was saying it's okay. And maybe even preferred for a little bit there to do things through zoom, you haven't had to jump on a plane to do things with some of [00:30:00] your players and things like that.
But your local people, you probably would have had more lunches and more in-person stuff. Pre COVID, just because it wasn't polite. And the normal. To meet someone who was five miles away to do it through video, but now it
Casey Villhauer, PharmD: is right. And it was easier to connect with multiple different marketing firms, for example, or marketing agencies to, you know, we could interview four of them in a day because we're on zoom.
Whereas that would have probably taken three days.
Mike Koelzer, Host: Otherwise, it's amazing. My brother has a marketing for mountain California and breaking down that barrier of not having to hop on a flight for a three-day trip for a half hour meeting is really something else. And I think it took something as big as a pandemic to.
Have everybody agree to that standard at the same
Casey Villhauer, PharmD: time. I agree. And then, you know, our whole goal was to remain really light, really mobile. And so that the provider, the contractor, and the pharmacist, don't need a lot of equipment right at home. They don't need us, the goal is to be able to have a very small footprint for all of our contractors and the company in general.
You know, so as great as it was to be able to do all of these things remotely from the start as we were starting to scale, um, we quickly realized we needed a headquarters. We need a central office. We need to bring it all back. Um, to a central location, because there are some things, you know, training, hiring, onboarding, company discussions, you know, meetings.
There are just some that it has to be in person. It just, it functions better. We do our brainstorming sessions in person. Um, we, things like that.
Mike Koelzer, Host: It's so cool. What's gonna end up and I don't think anybody knows. It's so cool to find out what's going to end up having to be in person. And what's going to be able to be online.
And I don't think anybody really knows that yet, but I think it's going to be a universal feeling that multiple people are going to come up with the same answers, because I think a lot of it's human nature, you know, brainstorming maybe. Better in person where the details of those sessions are the fallout of different things.
Maybe not, you know, I don't think anybody knows that, but I think it's going to be universal.
Casey Villhauer, PharmD: I agree. I think, um, you know, we can have brainstorming sessions and, and it all remains very positive and very like, um, all for the purpose of growing, because when you're in person. Um, and you get to know each other in the office.
You, um, you're, you're personable, right? You get to know, you get to hear things that you wouldn't otherwise hear from a remote location. And so you can, uh, you can, you get to know somebody, you connect with them. So then when you're in a brainstorming session and you really, you know, Alma throws out a terrible idea, Um, she doesn't take it personally when I say it.
Right.
Mike Koelzer, Host: You don't take it personally because you have that time to gel with each other more off camera. And I think
Casey Villhauer, PharmD: that's across the board. That's with our, our whole team, including our, uh, clinical part-time pharmacy.
Mike Koelzer, Host: We talked about headquarters. How often do they have to get to the headquarters? I take it.
They probably get some equipment. And the medicine from you is that right?
Alma Michelson, PharmD: We have partners like independent pharmacies where the pharmacist will go and pick up the medications, pick up the order for their route, and we will provide the billing data entry. Uh, training, hiring and, you know, refill packs for, for
Mike Koelzer, Host: their routes.
So you've got a couple partners, you've got the pharmacists and you have independent pharmacies that have come on. They're the pickup spot for the drugs and that kind of stuff. And I, it probably helps to have a license. Behind
Casey Villhauer, PharmD: that. Well,
Alma Michelson, PharmD: We have our own license. We do have the ability still to
get
Casey Villhauer, PharmD: product.
This
Mike Koelzer, Host: is just for convenience factors. They're around the neighborhood and so on.
Alma Michelson, PharmD: Yes. It's for the convenience of being able to bring this to more patients and more.
Mike Koelzer, Host: I ain't no genius, but that right there then allows you to go U S and worldwide, right? Because they're not coming to your headquarters in Iowa for this.
They're going to these pharmacies across the country. You got it. That's right. That's where your growth comes in. That's really cool. What has the reception been from mainly independent pharmacies that are doing this? What's the [00:35:00] reception been?
Alma Michelson, PharmD: You know, they, they love it. We are able to increase their,
Casey Villhauer, PharmD: um,
Alma Michelson, PharmD: their profits by 20%, um, by being, and partnering with them in one county.
And we're doing all the hard work for them and, and they are able to increase immunizations. And their community and those immunization rates may affect their reimbursement that they get on other medications. And so we are an add-on service to them. That's benefiting them, their community, their patients, and our pharmacists.
Love it.
Mike Koelzer, Host: What is the tie in our right? Like our pharmacy doesn't do vaccinations. If, for example, we were one of the partners would somehow supply the vaccine. Even though it's not our employees, I'm taking it somehow that that vaccination would be credited to us that we did the vaccine, or we helped with the vaccine.
Somehow, even though the pharmacist is not our employee,
Casey Villhauer, PharmD: right? So we provide your pharmacy with the pharmacist. So you hire us, we work for you and we bring you trained, equipped.
Mike Koelzer, Host: Oh, so that pharmacist becomes our employee for that.
Casey Villhauer, PharmD: They're still an independent contractor, but we found them for you. We train them, we equip them so that they are not on your payroll.
Mike Koelzer, Host: If that pharmacist was on a top of a mountain and could go either way, are they more hours or more yours, even though. The 10 99 person, I would say
Casey Villhauer, PharmD: they're more yours. They're more ours. Yep. Because they are going to be registered. You are going to maintain the records at your pharmacy for the pharmacist.
But we, our job is to bring them to you and give them all of the scheduling. And mobile equipment that they need and provide the platform that that individual needs to go out and do these appointments. Would it
Mike Koelzer, Host: Be the same as if our pharmacy used temporary pharmacy staffing? They're not really our employees, but they're in our pharmacy.
W would that be the. Yeah,
Casey Villhauer, PharmD: you hire a staffing agency. So they have already vetted that pharmacist that they're sending to you and that pharmacist is theirs. And you hired the company to send someone from a clinical standpoint that the pharmacist is yours, because they're going on your records verifying your prescriptions and taking your orders.
And yeah, but from a business standpoint, they are. Part of the staffing agency. Gotcha. So your pharmacy doesn't do immunizations and how come laziness. I doubt that, but okay. Well
Mike Koelzer, Host: laziness, and also now it is there with COVID, but the reimbursement wasn't adequate either the remuneration wasn't there for
Casey Villhauer, PharmD: you to take on a full-time employee and to do that.
Well, not
Mike Koelzer, Host: Even that, I mean, either. Pharmacists there and either they're there alone and it's not worth the stress on them to have them do it. If they're alone or I'm there. And it's not worth it financially for me to not get paid enough for my time. And. That laziness is a big factor. I mean, when I say lazy, I'm kind of joking, but I mean, I'm doing this for this much money when I could be doing something else for more and maybe that's just not doing it, but that's a
Casey Villhauer, PharmD: reason.
So somebody brought it to you. Like in our case, we brought it to you and it required no additional payroll. And we brought you the entire system of what you need for ordering, and we brought you the staff, um, to, to provide the immunizations. Is it something? You
Mike Koelzer, Host: would consider that sounds like a no brainer to me because I'm not doing it.
I'm not training for it. It's not disrupting workflow. I don't have to worry about whether some staff may have a moral stance against a certain thing. All that kind of goes out the window. So it's a cool concept and I can see independence really getting behind it. People
Casey Villhauer, PharmD: like me. So back to your original question of, you know, how is it being received?
I think you're, you're one of them. Owners have said to us, it's a no-brainer and we feel good about it too. Um, and I'm not sure if you know your, your area, what it looks like for home health care, but in Iowa, there's a lot of home health agencies that are not doing routine immunizations, um, because of the logistics of, of scheduling it, transporting it, maintaining cold chain, all of those [00:40:00] things.
So, you know, there's a need for it. But it just has never been brought up because home-health hair care is kind of the forgotten child of, of healthcare in general. Um, but those could be, you know, your patients that you wouldn't have had otherwise.
Mike Koelzer, Host: And arguably the people that are asking me for a vaccine still are ones that can easily get to whatever options they currently have in town, for whatever reasons, whether.
Transportation or knowledge or not trusting some, whatever. The reason they're asking me that would be an option. What's the biggest impedance to your growth? I imagine if I'm in your shoes, I want to be in every city in the U S. What's the biggest hurdle in doing that?
Casey Villhauer, PharmD: It's the legal and regulatory between the states.
So what pharmacists can do, um, from state to state there's, you know, it is it, every state is its own animal. So in Iowa, you know, we got lucky, we have the immunization statewide protocol, but you know, we're the only profession facing a negative 3% job. Over the next 10 years. So there's, there's pharmacists out there that are not doing pharmacy that will not be doing pharmacy jobs because outside of this immediate need for COVID, we've got pharmacists that want to do it.
And they would make a huge impact in their communities, but they can't get paid if they don't have provider status.
Mike Koelzer, Host: In Iowa, the pharmacist can kind of decide who's going to get a shot and then off they go, but don't the pharmacies or can't pharmacies. Like when we were doing vaccines a few years ago, we had cooperative practice, the kind of things that can be done in other states.
It
Casey Villhauer, PharmD: can. So it's tricky. So when our immunization statewide protocol went into effect here in Iowa, the sun set on the ability to have a physician signed protocol, which it was, it's a great thing because at that point, if we can no longer have a physician sign protocol, it puts the payers in a position to have to recognize pharmacist as provider.
Otherwise, you're not going to be doing vaccines in your pharmacies anymore. So you know, that was great. However, the players have not been very receptive to it. To recognize pharmacists as providers.
Mike Koelzer, Host: So in other states that already have a cooperative practice going on, but that be okay. Or maybe it's hard for some pharmacies who aren't doing it to get into a practice.
Where's the problem there?
Casey Villhauer, PharmD: Yeah. So having a collaborative practice agreement solves our immediate problems. Need as a profession, that solves our immediate problem, which is getting paid right now for giving vaccines. But when we look five years into the future and we hope at that time, pharmacists can actually get paid for the vaccines that they can order legally.
So if a 16 year old needs a second dose Gardasil vaccine, we can do that. But now we need it to be recognized as we need the prayers to recognize us so that when we are that provider on that order, on that vaccine order that we get paid for it. All right.
Mike Koelzer, Host: But let's say a pharmacy has a collaborative practice.
Sounds like that'd be a good place to. But if you're in a state and you don't have a collaborative practice setup and you don't have provider status, that would be a tough nut to crack, even in
Alma Michelson, PharmD: states where they do have collaborative practice. I think I was looking up the state of Georgia. They do have collaborative practice.
Each one of those doctors does have a limit of how many farmers. They signed with. So that would be another limiting factor of how many pharmacists that doctor can be
Mike Koelzer, Host: overseeing it. So it's not just the pharmacy. It might be the pharmacists. And then you couldn't have Joe's pharmacy having 20 different pharmacists coming from Baxi tech.
Alma Michelson, PharmD: It's the number of pharmacists and the number of pharmacies. I don't know. Yeah, it's both. I don't know which I know there was a number of 10, but I don't know if it was 10 pharmacies. Um, and so it was a lot more pharmacists obviously then. Um, but there is, that is also another limiting factor in the model that has collaborative practice agreement.
Mike Koelzer, Host: Gotcha. It's some magic combination.
Alma Michelson, PharmD: Although in the state of Iowa, right before the [00:45:00] statewide immunization protocol, I don't think we had that as a limitation for collaborative practice agreements. Um, you know, right before pharmacists were their own providers. Um, a lot of pharmacies in Iowa use the state epidemiologist as the.
Protocol provider. And it was a lot of pharmacies and a lot of pharmacists,
Mike Koelzer, Host: I put words in your mouth thinking that would be my goal to go to all these different states. Is that a goal to get into another state? And I know that's bigger, cause right now you're maybe in your city, but once you conquer Iowa, will that be another goal with vaccine taxis?
Um,
Casey Villhauer, PharmD: absolutely. I think, you know, it comes back to how Alma described it as a movement and we have. Pharmacy's all over the country, reaching out to us already. We have pharmacists reaching out to us as well. You know, there's, there's people that want to do it. There's people who want the service and it's our job to connect them.
And I don't really see a market where it doesn't work. You know, I'd, I'd love to be able to help my aunt in California and my. Niece and nephew that live in Chicago. And I think both of those people I know would be very appreciative of the service.
Mike Koelzer, Host: Ladies without giving too much away because we already talked about your cool URLs and Casey, by the way, you sort of told me about these.
I know you're not going to spill them out to me. I'm sorry. My that's where I know you've got something there, but as much as you can tell us about your 10 year goal, and maybe you tie into this a little bit of your vision statement, so I can try to pick that apart somehow, but it sounds like it's bigger than.
Jess vaccines. I don't know if it's bigger than just home visits. Give me something.
Casey Villhauer, PharmD: And I think about all the things that I wish I could have done for patients coming into the pharmacy when I worked in a retail setting and there wasn't enough time, there wasn't enough resources and I can make this list of what I wish I had to do my job.
And that's what we want to provide for pharmacists. Is to give them all the resources they need to do exactly what they want to do to practice. And at the end of the day, it's great patient care. Hm,
Mike Koelzer, Host: It's good. It's good. But here's what I'm hearing. Uber has done different stuff. So what you're going to do, Casey and Elma, is you're going to take a Maxi taxi.
You're going to use one of your new URLs to pull a little bit away from the vaccine part. Still kind of keeping the taxi part and your handheld app is going to be. The pharmacy, not necessarily the drugs, but it's going to be all the pharmacy services in a handheld app. And then you're going to set up the pharmacists and the patients, and it's going to be online visits slash. Let me swing over to the pharmacy that we're a partner with and we'll get that to your house.
So that's your future?
Casey Villhauer, PharmD: Yep. You got it, Mike, you nailed it.
Mike Koelzer, Host: That's something like that, right?
Alma Michelson, PharmD: Right. Yeah. So it's almost as if the pharmacist is a caseworker and is in your home and can actually get paid for all the services they can do in your home. Which is more than a caseworker.
Casey Villhauer, PharmD: Like right now, we're in a, you know, we're in a position right now where we are being invited into homes for whatever reason, whether that is a primary care physician that is sending us there, or a home health agency that's sending us their, or even a payer, um, an insurance company is sending us to someone talk.
And while we're there, we know what else we can do. And we're like, how do pharmacists fit into a home health care space? It's not a space that we are familiar with working in. So there's a lot to be learned and there's a huge opportunity to document what we can do and what patients are needing and where we could provide the most benefit.
I believe that starts with vaccines, but I think there's a huge market for, you know, we walk into somebody's house and they've got a pile of medications that just continues to be shipped from the mail order facility and patients aren't taking them correctly. And you know, there's a lot of people and entities that would benefit from a pharmacist having that consultation in that patient's home.
Mike Koelzer, Host: I know exactly what we're talking about. I mean, we have customers, you talk to them and it's like, you know, they've got nine different medicines or something and [00:50:00] you can talk to them, but it's like, oh, I'd love to be sitting at their counter with them at home and actually touching those bottles and, you know, realizing that something's not right, just because they have some out of reach, you know, and they don't want to get up and get it.
You know, it's as simple as that, but you don't get that till it's in the home. Casey and Elma are very forward thinking. And it's going to bring a lot of the joy in pharmacy back to pharmacists that maybe need to get out of some of that brick and mortar and maybe more so the psychological burden that that brick and mortar brings along with them.
And so I think you're doing some really cool things.
Casey Villhauer, PharmD: It's good for pharmacists. It's good for the pharmacies. And, you know, hopefully we can relieve some of the burden because I know that I used to do home visits after my shifts for patients that couldn't get out, we only delivered to them. We would do their shots.
I would personally do them after my shifts were over in my own free time. And every single pharmacy has those patients. We know this because they've been referring them to us. So we know that. Hopefully we can take some, you know, some burden after the pharmacist and also engage a whole new group of individuals that can do this.
I'm going to look
Mike Koelzer, Host: all over for those URLs.
Casey Villhauer, PharmD: Mike, I got a book, I have a million dollar idea, book idea, and all my has one Q and a lot of these things are not even pharmacy related, but we're excited to move on to those someday. I'm
Mike Koelzer, Host: going to have to sign a non-disclosure agreement and just get on and talk with you guys sometime and just hear them because they sound like they're fun.
Yeah. They sound fun and they sound very interesting. So we'll be watching and waiting for the next time you roll one out. We got to get you back on here for sure.
Casey Villhauer, PharmD: All right. Thanks a lot, Mike. I appreciate it. All right.
Mike Koelzer, Host: Thanks ladies. Such a pleasure. Thank you. Bye.
