Tech Solutions for Clinical Workflows | Kevin Houlihan, CEO of Workflow Services

Speech to text:

Mike Koelzer: Kevin, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Kevin Houlihan: My name is Kevin Houlihan. I'm the CEO here at this company called Image Mover. We have a technology platform calSpeeSoled Workflow Services that is focused on enabling the pharmacy to become a healthcare hub and really support pharmacists in delivering clinical services in the stores.

What we're really doing is thinking about how protocols and guidelines enable the pharmacist to do more, but we think the technology should be a support to that rather than forcing the pharmacist to really learn all these protocols and guidelines. [00:02:00] So they're there I think to ensure that the pharmacist is, Practicing within the regulations that they are constrained by, but also practicing at the level of their license.

And so a lot of those protocols and guidelines are set out to ensure that the pharmacists can do the maximum that they're allowed to. But it can be really complicated to keep track of what all those rules are for different types of customers and patients. And so, my background is in, software and that is the perfect kind of thing for software to solve, is if there's a decision tree or an algorithm or that sort of thing, that's where we want to be the support structure for both the patients and pharmacists that we help in stores.

Mike Koelzer: It's in that decision where pharmacists could either, well, anybody could get either decision fatigue or not knowing how to answer or what way to go. And I think that all comes down to. Simpleness, but how does your [00:03:00] format help in those decisions?

Kevin Houlihan: Yeah, so let me give you a good example. Many folks don't know that there's a lot of pharmacies in the country that you can go in and get a point of care test, maybe for the flu or strap or COVID. And if you're positive, the pharmacist is able to actually provide treatment. So they're able to write you a prescription, maybe for amoxicillin, if you're positive for strep, then fill that prescription and send you on your way.

But there's rules about the cases in which a pharmacist can do that. So lots of states, you have to be a certain age, four to six years old, something like that, depending on the type of situation. Well, we don't want the pharmacist to necessarily have to remember that all the time, so we do that in a couple ways.

If the patient wants to come into the store and get some treatment, they can check it out at home before they come in or show up in the store and go to a link or scan a QR code and start to pre register themselves. And if they're there with their child on Thursday night at, 5. 45 p. m. and they have two kids, one kid is three and one kid is eight.

We would help the [00:04:00] customer understand that you can get tests and treatment for one of your kids here at the store, the older one, but the other one you might still have to go to the PCP or urgent care or whatever. But then also the same thing for the pharmacist to make it, make sure that they understand, oh, for this kind of test, The person has to be this age for me in order for me to do the test and then maybe do a treatment.

And some treatments are like that too. Many states allow the pharmacist to write a statin prescription for someone who's on diabetes. But you have to check some other health factors, so if a patient gets too complex. then oftentimes the pharmacist is not allowed to continue with the treatment.

So, we help them understand what those factors are you have to check, and what too complex means, and in the case that they're not too complex, we help step them through to make sure that they're checking lab results, or checking blood pressure, or checking any number of things that are required to be compliant with a protocol that allows medical service delivery in the pharmacy.

 That's a huge thing. When you're getting these more complex services and you've got [00:05:00] different employees, And different pharmacists and they have different definitions in their head of complex. And then you also have the state breathing down on them.

Mike Koelzer: I read a report recently. It said that if you have like a traffic violation, you should try to get the judge. To hear your case or whatever, like at 1pm after lunch, instead of like 4. 30pm. And as I think of pharmacists that are busy or, tired or hungry, you don't want the answer at half hour before close to be different than the answer at one o'clock on a nice, relaxing day at the pharmacy or something like that.

So, it seems that, that structure is important. There's so many variables. It seems like something like that is really going to get it on the, straight and narrow as much as it needs to be.

Kevin Houlihan: Yeah. Well, that's kind of the way that the whole industry is set up with this [00:06:00] transition of accessing care in the retail setting, and so the idea is a pharmacist is highly capable and qualified to deliver a lot of different kinds of service, but there is a limit. And so, there's a definition around what are those services.

There's the kinds of services they can deliver and what are those limits where if someone has a blood pressure that's out of range, frankly, the guidance says you should guide that person to go to urgent care or go to the ED or whatever it is. But you as a pharmacist can't continue down a path of offering care because they're just this level of complexity.

And so I think although it can be a challenge, it's also the opportunity that is the structure that kind of everyone is starting to agree on. This is what allows us to. Deliver these certain types of care. And you've seen those things for years. When you go to get a vaccine, they ask you if you've had an allergic reaction before, we might not want someone who's had an allergic reaction in the past to get their vaccine at a pharmacy.

 the vaccines and pharmacies were a huge [00:07:00] accelerant during the pandemic of people for the first time getting access to care in a new setting, but there are limits on that, someone who's had a bunch of reactions. Maybe it's better that they're at a higher complexity care setting so that if there is an adverse reaction, they've got more tools at their disposal, more staff, people with different kind of training that are able to provide care or provide guidance on what alternatives are.

But for a huge segment of the population, it's totally appropriate. The pharmacist is totally capable. It's within their training. And it opens up the opportunity to get access to a lot more kinds of care, faster care, closer care, cheaper care, and really drives some health outcomes that I think are really exciting.

 Is this a SAS program? 

Kevin Houlihan: Yeah, totally hosted, so our customers don't have to buy any equipment 

Our company is called Workflow Services and we're really focused on what is the workflow, and so if a customer walks in and they're interested in getting a service, we allow them to explore services and kind of [00:08:00] pre register on their own phone.

 And so no matter what kind of phone they have, and then a pharmacist can pick that up and continue through the encounter on a tablet and an iPad or an Android tablet, or they can use the benchtop computer there, depending on what kind of setup they have, if they got an encounter room or what kind of technology they have on that encounter room.

And there's always a backup plan, if you have an older customer come in that doesn't have a smartphone, of course, the pharmacist, we have tools to help them through the pre registration and set up. And so we really focus on. What is the right way to engage with the patient or the pharmacist or the manager based on what the physical workflow is of how they're delivering care?

To streamline it, we know that the pharmacist's time is kind of the most precious thing. So, if we can open an opportunity for a customer to input their symptoms and their address, they know that information, let's not make the pharmacist transcribe it. Let's connect with the customer for that part of the encounter and use the right technology for that piece.

Mike Koelzer: I think the cool [00:09:00] part about being able to have a handheld app is that it forces the maker, it forces you guys to say, this is too many things to write in with your thumb.

And then you say. Well, maybe we don't need it. Maybe we can just depend on this to do it or pull it from this database. And then you're like, well, how are they going to, whatever, add all these things up or choose what radio buttons to press and so on. Yes. And no, it's like, well, maybe we don't do that.

 It's that goal to get it down to a press 

Mike Koelzer: that. Makes this whole thing easier, then you expand back out however you want to do it. 

Kevin Houlihan: That's right And like, there's a whole bunch of other things In life that are like that. I'm getting ready to travel a bunch the next couple of weeks. And so I'm making rental car reservations. Well, I did that in a webpage on my computer, but then I'm going to be at the airport and I'm going to be checking it on the app, and then they're going to send me a text message when it's time to pick up, well, that's all part of a single system for that one rental car company, [00:10:00] but I'm interacting in the place that makes the most sense for the spot that I am as part of that engagement, 

 our company's been around for over a decade and we started ImageMover, really started on optimizing medical imaging experience outside of radiology in health systems. And that was, hey, everyone's walking around with a film studio in their pocket on their phone, right?

You got photos and images and movies and sounds and all that sort of stuff. Yeah. We're able to capture all this different kind of information now, and how do we link that back to the EHR, and link it back to the image archive, and all that sort of stuff. And so that's where the focus came from, is how do we optimize this experience for an unscheduled point of care medical encounter that opens up the way people get access to different kinds of healthcare.

And for us, , a bunch of that is around, I'm mobile, I'm walking around, I'm capturing a picture of a rash, or taking a video of someone's gait study when they're in rehab, and I want to save that [00:11:00] to part of their chart. And a lot of times it makes sense for that to live in an app, on a phone, or on a tablet.

And so that's kind of where we came from, and that's where the story started. But then, Four years ago the opportunity opened to take a lot of this care outside the walls of a hospital and pull together different kinds of systems to continue to enable new types of care in new settings, but supporting the provider to be able to deliver that care.

when I'm in social settings, where I was talking about what we do, and I explain this to them. the solution that we have and how we're helping pharmacies. 

So many folks are not aware the extent to which services are available at their local pharmacy.

So I'm excited. I live in Madison, Wisconsin. The company's based here you know, I have quite a few friends that, whose kids are struggling with flu type symptoms right now. It's kind of unusual, a little bit late in the season, I think. But explaining to them that we have partners in the community and pharmacies they can go to understand what's going on with their kid and maybe get a treatment.

And they say, man, I just spent four hours in urgent care the other night. I [00:12:00] wish I would have known about this. And so the part that's exciting to me is seeing people have the opportunity to get access to care in these new settings. That's so much more close and convenient, but then link all of that back to the rest of their health history.

So that's part of There's really been a growth in the opportunity to kind of link information around and so see what's going on in someone's EHR record and then our system helps share the information about what a pharmacist did to deliver services back to the patient. the person's PCP. And so a part of our philosophy is that when we open a new care setting, we don't want to introduce a chasm between the old traditional care setting and the new care setting.

So we build a bridge there, so we have tools that allow a pharmacist to see what's happened with this patient and their doctors over the past few years. And then after they get service at a pharmacy, we allow the doctors to see what happened with the service that was delivered in the pharmacy.

And I think all of [00:13:00] that is exciting. It's just this new way to get access to health care and having it delivered in a way that feels sort of intuitive . But it's all linked together so the person gets a comprehensive, picture of what their history is after leaving the new setting.

Mike Koelzer: I had a guest on some time ago and unfortunately, it's sad to say that we were talking about how we as pharmacists can dig down into those third pages of, all the gobbledygook, it's not coding or anything, but it's just all the type put together, how the computer pulls it out.

And he was excited that. Pharmacists can finally look through three pages and find the person's blood pressure or something like that, and things go so fast that was a few years ago, but it's sad in this day that all that information's out there and we can't easily get our hands on our someone comes in for a medicine we don't know if it's for a seizure or for nerve [00:14:00] pain or for You know this or that and you can ask the person the doctor can put it on there But why would that not be available for everybody?

It's important stuff.

Kevin Houlihan: Well, and Mike, so that's a really good example. So my history is in, I've been in, I have a mechanical engineering background. I've been in software my entire career. And a lot of that time has been in a product role. And what product means is you kind of figure out how the software works to meet the needs of the market.

And what you described is this classic product issue where you'll get someone who asks for a thing that they're very, That they're very sure that they want, but it's not actually what they need. And so, your example is, they're excited that they could finally get access to these three pages of information and could go find the thing that they were looking for.

What they really want to know is if there's a piece of information in that patient's history that's relevant to the service that they're trying to deliver right now. So let me give you an example of how we handle that. Every pharmacist [00:15:00] in the country can prescribe Paxlivid for someone that has a positive COVID test.

Well, in order to do that, there's a big protocol and algorithm and you have to confirm three lab results. Some liver and kidney function lab results that are part of a normal annual physical. So our system goes out and checks that customer's electronic health record to see if they've had those lab results.

And if they have, we find the right pieces of information in the health records, so those lab results, we pull them in and then we grade them based on whether or not those lab results make the patient eligible to get a Paxlivid prescription in the pharmacy. So we've taken it from, Oh, yeah, it's super cool because we go get the whole EHR history and then you can go find the lab result. We tell you what the lab result says and whether or not that indicates eligibility for more service in the pharmacy. And so that's an example where if you listen to what the real need is your [00:16:00] result of what you're offering is going to be different than what the ask is. But that's the magic, right?

That's where the magic happens

Mike Koelzer: It reminds me of the story of they're talking about Steve Jobs, and none of us came from records or cassette tapes to say, we want to have 4, 000 or now unlimited songs on, something the size of a deck of cards if you asked anybody what they would want back then, they would say, I want an unscratchable record, or I want this record to be smaller, or I don't want the record to skip, those kind of things. When in fact, you don't know what you want. And yours was a great example there, that we pharmacists, let's say, have been scanning through three pages, you're happy that you can find it when you want it, but you guys come along and say, You do want this.

Here it is. It's in front of you. And in fact, maybe you don't even want that. You want to know the next step of whether they can do this or that with that [00:17:00] information.

Kevin Houlihan: Well, I mean, the classic example of that is Henry Ford, there's the, I don't know if it's true, he said, If I would have built what the customers asked, I would have made a faster horse. 

Mike Koelzer: Exactly it.

Kevin Houlihan: So that's the part that I like. That's the engineer in me. We have, these strong Midwestern worth work ethics at our company, which is about being a great partner to our customers and really listening and understanding their business and knowing that the way that we win as a partner is when they win.

And in these cases it's, let's not force you to go look through transcribed data to understand if something exists and if it does what it is, and if it is, then if it fits in, let's just tell you whether or not it fits in and say, Hey, like for this patient, you just can't go any farther. They've got some unusual kidney lab results that you're going to have to go see their doctor, but that's a good outcome for the patient.

And it puts the pharmacist in a position where they can continue to be this. trusted healthcare advisor in first stop, they're going to come back to the pharmacist next time to know that [00:18:00] they're going to guide them in the right direction. Maybe they can help them and deliver services right there, or maybe they're going to tell them that, hey, you're, you've got a little bit of a different situation.

You could go see another kind of healthcare provider.

Mike Koelzer: Years ago, we don't do it anymore. Medical equipment at the store. It wasn't profitable enough for all the trouble that was put into it. But years ago we made our pharmacy we Remodeling. We bought an old hardware store next door and instead of the steps being four feet wide, they were six feet wide.

And instead of having this corner, we had this corner. And all of a sudden all this stuff comes to you like, Hey, I want to start carrying lift chairs, or I want to carry a hospital bed. Pragmatically, I you could say, okay, it can fit here and so on.

But even without thinking that, your mind just opens up more because the first step is not so onerous that your mind doesn't even go there. And I think about your stuff here is, if you can make those first ones, whether it's the Pax Lovid prescription, or [00:19:00] Narcan, these or that, or, whatever. You start making that easy, or use that as an intro, everything kind of blooms from there. You don't have something easy, the first one you come across, you're like, this is a pain in the ass, I'm not doing it anymore.

 It's a big hurdle that you get over with that. Intuitive software.

Kevin Houlihan: Well, and I think it's about finding out what is a relatable experience to help The pharmacy C. So, we go to conferences and talk to folks and they'll come by our booth or talking to them at lunch or whatever and say, Hey, do you deliver medical services in the store? And a lot of them will say, no, we don't yet. Okay. Why is that? Well, I don't have the time. Do you do vaccines? Oh yeah, we do vaccines. Well, that's a medical service, do you ever that a customer who's getting an antibiotic filled goes over to the cooler and gets a probiotic? Cause they're going to start to feel better. Kind of upset stomach.

Yeah, do that. Well there that's health care advice that is delivering care of a certain type to folks in the [00:20:00] community And I think that's one one area where you help them open up and say hey Like that is worth recognizing and then I speak to the time issue. It's not that they don't have time It's a matter of helping them get compensated to spend the time to deliver that healthcare, right?

And we saw that with some of our great partners during the pandemic, where they leaned in heavy on, on vaccines and testing, and they hire dozens of TEMP employees to be able to help manage all that, because they knew that they were going to be able to generate the revenue. So, With the opportunity to generate revenue comes the opportunity to hire more people to make the time, And so I think when it's a common theme you hear. Well, what about this transition of medical service delivery to the pharmacy? The pharmacies are already slammed already. There's not enough people. I think that's all true, but can really change the calculus. If you do a better job recognizing the pharmacist and provider and allowing them to bill [00:21:00] insurance or charge cash or whatever the case may be, allow them to generate revenue for the services they're delivering because then it allows them to expand the team in the store and grow in a scalable, robust way.

And I think that's where the change comes from.

Mike Koelzer: Yeah, it's kind of the chicken and the egg 

 you take the barriers down on one side, well then you, start there and come in the back end on the other side, something like that. I can see that really helping a lot.

Kevin Houlihan: Yeah. Well, and it's what we're excited about. I mean, part of the way Part of the challenge in this space right now is that it's different from state to state, and so one of the first things that we do when we talk to prospects and customers and new partners is say, what state are you in? And then let's take a look at what's allowed in that state.

And then we try to be the trusted advisor on here's what we recommend. Here's where we recommend you start expanding your services because from a legislative perspective, it's easy to do in your state. And from a reimbursement perspective, we think you'll have success over here and that can look different in one [00:22:00] state versus another state.

And I think that consolidate and will be more uniformity as we move forward. In some ways it's going incredibly fast and then in other ways it's going so frustratingly slow,

Mike Koelzer: Kevin, as I think about a hurdle my hurdle I think would be, Is is great over here, but this is my system here. They don't necessarily have to be tying, but it seems you'd want to tie some of the POS and then things like that. Is that all API stuff is there a challenge on that?

And how's that going for you guys?

Kevin Houlihan: Yeah. I mean, there's a whole bunch of ways to approach it. You're right, sometimes it is API and. And we've been doing that for ages. And so we can take that approach. Other times, like you can leverage some older technology that's out there. Like you can fax data around and then, in other ways, like in some cases, the easiest way to integrate is to follow the process that's in place, which might be, There's a piece of paper that comes out of the workflow at the end that gets scanned in.[00:23:00] 

It's, like, I think it's kind of a crazy way to do it in that, like, you go from our digital platform to an analog document, scanned back into another digital platform, but that's a zero effort process. Right. Because all of those steps are in place. And so the reason we would approach something like that is if you want to do it in phases to say like, look, 

you, maybe you need a tech team to enable an API on your side, and that's three months out.

So for the next three months, let's just. Let's just integrate in the way that you integrate together today, which is scanning a piece of paper, not long term, but like, we can get you up and running, you're providing services, you're generating revenue, you're providing care in your community, like day number one.

And then, three months from now, we've got an API integration and we get rid of that paper. But again, that comes back to understanding what this the setting is out there today, and then finding the connection points. And a series of connection points that might change over time to make it as easy to [00:24:00] support the behavior changes you can,

Mike Koelzer: It kind of makes me think of the whole electric car, well, self driving car versus personal driving car, and you think about, American, I'm gonna say guy, an American guy, who's got Corvette pictures on his wall and things like that, he ain't given driving license until he's one hundred ten. So now you're all 80 years And so, yeah, that's important. There's so many things in healthcare that you've got different offices doing different things. And I imagine as a company, it might be nice to have everybody just scanning a QR code or something like that.

But reality is you've got to, integrate that as they come, because not everybody's in the same position.

Kevin Houlihan: I mean, I don't know if this totally continues down the right analogy, but I heard I think it was a quote from Jay Leno, decades ago probably , if folks are not familiar with his extraordinary depth of knowledge about cars and motorcycles, it's really impressive, right?

He said, everyone looks at me and says [00:25:00] I'm this big car guy and they automatically assume that I'd be against EVs and that like, I'm a big petrol head and he's like, I'm all for EVs. I want to save all the oil we can from my old, 67 Shelby Mustang. The new car can be electric, that's super cool.

I might want to drive the old muscle cars too. But I think that's an interesting idea, it's like two things can be true at the same time where I like it. I like an old muscle car that runs on gas, but looking into the future, it doesn't continue to have to be that way. 

Mike Koelzer: All right, Kevin, I can focus on all the wonderful things about what we've been talking about. what comes to mind about somebody not wanting to do this? And I'm not talking maybe from a philosophical thing about what pharmacists should be doing or not doing.

What are the barriers you come across from the people that you're talking to at the health? Fairs that are, like, naysayers. What are they coming up 

Kevin Houlihan: Well, it's almost like [00:26:00] anything else. It's hard to get started with anything new. And it's hard to know where to start. It's one of those things where once you start something, it's way easier to keep going. Right. So, we try and take advantage of that and help our customers get started.

Say, here's something that's familiar, we can do a little bit more there. Here's something that is new, but we can help you get, get rolling with it. Maybe you want to start doing a strep test to treat. Program. Well, here's a wide range of different kinds of point of care tests that you might consider and we've got a protocol that works in your state so we can step you through this and, here's a, someone else that might be in your regional pharmacy association that's had some experience and you can see how it's gone for them.

And so, I mean, that's the biggest thing. It's like, with any change, it takes some, coefficient of static friction to overcome, which it's harder to get started than it is to keep moving. And so that's how we approach it is like, that's the hesitancy because a lot of it is confusing and hard.

And it's true that if you try to start [00:27:00] with a harder thing, you might end up with a poor experience and 

not want to continue, 

Mike Koelzer: if they're already doing something, you might take that and Put that into something. And it might be small. It might be, hey, instead of bringing this paper from here across the store, let's start out by scanning this and then pulling it up on this over there.

Something small to say, you know, let's say, 20 steps out of that. Now, what's the next step 

Kevin Houlihan: So the way that we actually started in pharmacy was it's kind of hard to remember back in the pandemic early on before there were vaccines and before there were at home tests there were these, point of care tests. You remember going to a community center or the pharmacy to get your COVID test and then you'd wait and then see what it said and then you'd stay away from people for a couple days so you could see your

parents that weekend or whatever. There was a bunch of regulation that still exists actually around the test administers having to report those tests, those COVID test results to the CDC. And it was just a [00:28:00] super burdensome process. It was folks were going onto these web pages and typing every single test results in, and it was like 38 data elements and it just took

forever.

And so we said, Hey, I think we can make that way better than you using an Excel sheet on your laptop or a legal pad. Hiring a bunch of people to stay up all night and rekey these results. And so that's an example of, yeah, so, I have figured out how to administer a point of care test, but, man, the friction that's involved in it is high.

Well, let's just reduce that friction so you can focus on lifting your head up and having an interaction with the customer that's there instead of data entry or whatever, 

Mike Koelzer: Going back to the thought about what would someone have if they could dream? What would their druthers be if they could have it like they wanted? Boy, that's a rough system. The whole health thing, go sit in a hospital emergency room for five hours.

And it used to be you couldn't have your phone. Now I think they say it's better to find out a blood type than worry about [00:29:00] it. Some computer's going to get a wrong cell signal or something like that. 

 There's so much room for improvement. But like you say, you want to sometimes say, well, if we made the waiting room, this, it's like, well, what waiting room? Let's start by not having that

Kevin Houlihan: right. Yeah. I mean, I, for me, I experienced getting healthcare for the first time during the pandemic. I got a vaccine sitting in the driver's seat of the car with the window rolled down in the parking lot. They came out, I don't think that kind of thing is happening as much anymore, but it was just like, what a crazy different experience than trying to get an appointment with your PCP and having to get there early.

And you park in the parking structure and you wait around, like, Just it opens your eyes to how things could be and so then like you're saying Mike it's what else could we change this much and like this and Accommodate the way life really happens, and at the same time, I think there's a bunch of there's a little bit of there's chatter out there around well, like what about the doctors?

It's impossible to get in to see your doctor, let's let's enable them to [00:30:00] take the most complex cases, let's Offload some of this super easy stuff and there's a nursing shortage and a physician shortage and let's leverage the folks that we have that are capable in the community to deliver health care,

Mike Koelzer: I saw your comment on one of your, linkedIn posts You were responding to an article that was something like are doctors mad that pharmacists are, taking their patient appointments or something like that?

don't look at it that way. It's not like an either or these people are not being served by those doctors. a, primary care deserts and all that kind of stuff. And it's like, that's the wrong question. It's like, how can all this be improved and not worrying about business going somewhere else, but there is no somewhere else in a lot of these places.

Kevin Houlihan: Well, I mean everyone's heard this statistic that like 95 percent of people in the u. s Live within five miles of a pharmacy if you go to five miles of primary care, it's down in like the 60s I think 60%, so, that's 30 percent of the population, [00:31:00] like, has a pharmacy accessible but not primary care.

Well, like you were saying, there's a lot of folks who, it's not, am I going to take my business away from my doctor and go over to the pharmacy? It's, am I going to get care at the pharmacy or am I not going to get care? Or am I going to get care today or not until Monday, three days from now, 

Mike Koelzer: What I think is interesting is, we hear so much about in the cloud versus real life.

And some stuff has maybe gone that way, starting with Amazon Books and music and that kind of stuff. And the talk is always about, telemedicine and things like that. But the interesting thing about healthcare is especially service healthcare, not so much maybe medicine that maybe can make its way good or bad through the mail but the stuff that you're talking about here, the services.

It has to be a blend of the online versus real life because you [00:32:00] can't get a, a shot or a test or a blood thing or something, online. And if you did, it might be a week delay . So there's a nice interplay of timing and people leading it at a certain point and all that kind of stuff.

You're always going to have that physical and in cloud stuff at the same time, it seems.

Kevin Houlihan: Yeah. That's exactly right. There's some stuff that you just can't replace with a telemedicine visit. Some stuff is a great fit for a telemedicine visit, but others is not. I think one of the most interesting things about The pharmacist as a provider in particular is the frequency which people are visiting their pharmacist.

So there's tens of millions in this of people in the country that just don't really have a meaningful relationship with the PCP. They might have insurance, they're just not going to see them. I oftentimes have been guilty of some of that. But folks are going in to see their pharmacist once or twice a month maybe, right?

And so in addition to getting the services that you have to be in real life for. There's an [00:33:00] opportunity for the pharmacy to provide other kinds of care or other sort of motivation to drive positive health outcomes just because they've got the opportunity to have an interaction. We have a cool program going on right now where we are focused on opening access to at home colorectal cancer screening.

And what we're doing is we're leveraging the role of the pharmacist in the community to just raise awareness. A lot of people don't know that once you're 45, guidelines, start that you should start getting screened and they also don't know that there are ways to achieve that screening other than a colonoscopy and they don't know how to access and get that, And so the pharmacist is having conversations with people about their health. If they're aware that, this is a part of the guideline it's one of those things where they can encourage people to Maybe it's, manage their blood pressure better, or if they're filling a blood pressure medication, or take advantage of this at home screener, all those different sorts [00:34:00] of things.

So, can you achieve that through a phone call or a telemedicine visit? Maybe, but the pharmacist is in the community, there's someone that you know and trust and see and interact with , and so they've got a great opportunity to help influence positive behavior and outcomes. And that's something that the data proves is just not possible to replicate at the same level remotely. 

Mike Koelzer: I'm kind of a fatty. 

I like

my bowls of cereal at night.

Mike Koelzer: one Thing I do for the last two and a half years now, I walk between 12 and 15 miles a week. So I walk three miles four days a week or five days And there's so many people that it's like, and I'm not a picture of health, but there's so many people that if you could tie in that somehow it's, the walking and that kind of stuff. And it just doesn't happen with the doctors when you see them [00:35:00] once a year, you might get fired up to. Do something the week after you go and maybe three weeks ahead of time you cut back on your cereal cause you don't want your fatty acids too high and things like that.

 Touch points of pharmacists, they say, 12 to 24 a year or something that. And all of that tied in somehow because our, wishes are not as strong as our reality.

Kevin Houlihan: yeah.

you're talking about is the, like, that's the future. That's the creativity. That's where is it going to go, what do you do with those touch points? What do you do with that interaction? When you achieve a lot of the things that we're working on today, what else can you do with that, I think it's a thing where the pharmacist is also well positioned to be the The practical advice giver where it goes back to, for you it's if you wanted to develop a program about using the pharmacist to get people to walk more, how do you do that? I don't know the answer to that, but like, that's an interesting idea, right?

And what are all those sorts of things that you can do to help folks [00:36:00] manage their health and turn the pharmacy into a health hub because of that interaction, 

Mike Koelzer: you think about this stuff, it's like, okay who does that? What company out there helps people walk four or five times a week, not really there. Here's my problem though, Kevin, I would be promoting this and they'd come in and take a look at me and they'd be like, you know, what other program do you have?

I, it's stuff like that. It's like, gets me thinking, of the, the value of that, because we all have good intentions.

Kevin Houlihan: Yeah, well, and sometimes you just need a little bit of help to get started, right?

Mike Koelzer: Like there's the alcoholics 12 steps, and You go to a meeting every, night or something like that. but going to a gym, even with friends is not the same as committing to that. And I think of Weight Watchers.

That's a tough stop right now. Weight Watchers. Cause Oprah bailed on them. I think she said it cause she wanted to promote the shots and That'd be a tough sell right now.

Kevin Houlihan: Yeah, well, it's an interesting thing. I read something [00:37:00] where the most effective thing you can do to get yourself to exercise more in the morning is get your exercise clothes ready to go the night before. So you wake up and you don't have to figure out what to wear or where to get it or that sort of thing.

And so that comes back to like, What are the practical levers that you can activate to change and positively influence behavior,

Mike Koelzer: See, here's mine, Kevin. This is true embarrassingly, but I go out and walk in my pajama pants because I'm not in the summer, but in the winter, 

 I'm out in the dark. No one really sees me because it's still, you know, they get mixed up with daylight savings time. But I go out in my PJs and people that are paying attention, they either get to see the orange checkerboard or.

Mike Koelzer: Some football ones or something like that and I'm the biggest critic I see some people out I see like this old guy jogging all the time and I'm like that guy's crazy. He must be What do you call that he must be an [00:38:00] introvert, you know that doesn't really know how to talk I mean I put all these feelings into someone People must think that about me, but one step further because I'm in my pajama pants.

Kevin Houlihan: Well, you've hacked it instead of just getting your and well You didn't just get your exercise outfit ready to go the next morning. You put it on the night before

You got it's I'm in bed the night before

Mike Koelzer: in it. I'm in it. 

Kevin Houlihan: Well, I hope you're not sleeping with your shoes on. 

Mike Koelzer: I've got some old Reeboks, I'm looking at them right now, they're Reeboks, and they're nice and comfortable, and my wife doesn't like them because she thinks it puts me in the category of the uh, and in fact I had white socks, I think, with them, so I'm in the category of the um, metal finder guys that are on the beach, 

Kevin Houlihan: I

don't know, it's all coming back around. Isn't everyone wearing dad's

shoes 

now? 

Mike Koelzer: told my wife, I said, ever let me buy one of those metal finders because I'm going to look like one of those old farts on the beach.

And then like three years later, I'm like, Hey, honey, remember, I told you [00:39:00] not to give me a metal finder. I think I kind of want one. And she wouldn't do it. And finally I got one for Christmas four or five years ago, but I haven't made it to the beach and I don't plan to do that.

Kevin Houlihan: Well, you don't plan now, but fanny packs are back. You get a fanny pack and put the stuff you find on the beach from the metal finder. Now you're set, right?

Mike Koelzer: We talked about the question was not philosophical. Reasons why a pharmacist doesn't pick up on it more actual reasons you come across at these shows For example, you come across any? philosophical views that are Against something you get any pharmacist naysayers and things or don't people share that with you so much?

Kevin Houlihan: No. I mean, I think the one that I have heard, it's not that common, but it's probably the most common is folks feel like, hey, is the pharmacist really capable of providing these services? And it's an interesting thing. [00:40:00] My perspective and our perspective as a company at Workflow Services is that's not our decision to make.

Frankly, there's protocols and laws and legislation out there that determines that. we're not deciding. But, those rules and regulations are in place and say that yes, the pharmacist is capable. I think if you ask most folks, I mean, you hear stories all the time about, Someone goes into their pharmacist with some prescriptions and the pharmacist will say, Whoa, hold on.

Like, I don't, this doesn't seem right to me. And they'll engage with the doctor to 

adjust things. 

And we're not, we're not talking about a CT scan and IL4 here. Right. We're talking about, several dozen fairly low acuity things. And broadly there's really strong agreement that pharmacists are capable, but the pushback you get sometimes is. And this I think was pushed back years ago. Well, you could have an adverse reaction to a vaccine. And if you administer that in a pharmacy, then what [00:41:00] happens? It's like, well, I mean, we put some guides in place to make sure that you're only given the vaccines to the right people, but also like what's the alternative, a whole bunch of folks that don't have access to the vaccine.

Is that better? And so I think if you really start to peel that onion, that's where it usually shakes out is what we're doing is we're increasing access. And that goes back to the protocols. And that's where we want to help is like, let's get you set up. Our technology system is sort of the support, it's the support net and the guardrails to help you stay on track here.

And when you have a challenge, we'll get you going back in the right direction.

Mike Koelzer: Well, I'll throw my hat in the ring of answering that question for myself. And first of all, like you say, you have the parameters and you've got the rules for the states and obviously people are already using it. My thoughts on the matter are, I think that pharmacists are overtrained in the [00:42:00] community

 And I think that pharmacists should have two years of well, let me back that up. If I had my druthers, the first two years of college would be eliminated. Because, think that's a money grab , because, the kids are learning the same damn thing. They're taking English and art history and all the things that they should have cleared up at a good high school.

Then what I would do is I would make pharmacy like a two year degree. I mean, let's say all colleges degrees go down to two years. Across the board, because you've taken off two years. in pharmacy, two, three year degree total. So you're out as a pharmacist when you're 20, 21.

 Kevin you were talking earlier about, well, you don't need a faster horse. So, so if you break that up. Then I think a good argument for pharmacy, and this has been sort of my argument is. Well, [00:43:00] pharmacists are drug people. we help with drugs. We're drug information, things like that. So, it's diluting our degree by being, primary caregivers.

Mm my thought is, well, how's that going for you? did the supply and demand skip from pharmacists being compounders back in the day when they rolled pills, and they're meant to be, Information, interaction, caregivers, and so on.

But how's that going for you? How much are you getting paid for that? And have we missed the mark? So my thought would be take pharmacy, make it a shorter degree. A year on drugs and a year on some of that primary care stuff, the drug slash patient care where you can touch them and feel for a lump here or that very minimal. So I think your stuff is right online and I could see where a purist pharmacist would say, we're pharmacists and we've got the drug knowledge and we should get paid for that. It's like, well, how's it going? 

So I,

I'm right in [00:44:00] line with your stuff.

Kevin Houlihan: I mean, that's the other big sentiment that we hear in the market is just margins on prescription fills are just crushed, and so it's how do I it's kind of like the movie theater model or the gas station model. They're not making money on movies and gas anymore.

They're making money on all the other stuff that comes around them.

 Like, that's just the reality.

Kevin Houlihan: But at the same time, people love buying popcorn at movie theaters and the pharmacist is in a great position to be able to help with some of this other healthcare,

Mike Koelzer: I really think it's good. I think it's unfair to the pharmacist to train them for six years, tell them they're gonna go out in the community and use that. They just don't need it. We just don't need it. We need some other care. Because frankly people aren't gonna pay you, I mean some do, but you know, for a brown bag service of going through their medicine, the drugs are a commodity.

And I talked to a guest, he said, thankfully they're a commodity, you know that something [00:45:00] that's labeled as such, it's going to be the same in every bottle across the country. But how much have they been paying us for our pharmacy services?

It's like zero. So are we going to wait around? Or are we going to change the education, get programs like yours in there and fill a need that maybe is not being filled. . Maybe the whole pharmacy profession kind of changes. I'm not for everybody. There's people that are practicing at the top of their degree , but I think it needs to change.

Kevin Houlihan: Yeah. It does. And that's where we want to help, there's a bunch of ancillary things that come in that are hard and complicated, so all of a sudden now I'm going to deliver some low acuity services in the pharmacy and I want to bill. the medical insurance policy for those services.

Well, I haven't had to deal with that before. This is a new kind of policy. And now all of a sudden I'm dealing with 10 codes. And how do I figure out which ones are those to pick based on what happened during the thing? Well, this is where we fit in. If we can help you step through the encounter and make sure that the patient is eligible for the service and help you deliver the [00:46:00] service, guess what?

We know everything that happened. And so we can automate the selection of the insurance billing codes and get that sent to the insurance company and get you paid back. Do you really need to understand the intricacies of how insurance billing works to be able to deliver healthcare to your customer?

No, but I think we're at a time when we can step in. and kind of take that burden off of the pharmacist and enable them to focus on patient care. And so that's how we approach it, is when a pharmacist is ready to trend, like to evolve their business. Here's all the pieces that you, here's how you get set up in the beginning.

And maybe if you want to get some tests, here's what those are. And here's what your protocols are. And here's how you communicate. We have, We have toolkits that help pharmacists communicate out to their community that they offer tests to treat. And at the end of it, we'll build the insurance claim for you and get it submitted and get you paid and take care of all that stuff because pharmacists is just a different kind of business.

It's not as complex and complicated as a [00:47:00] hospital, but it also doesn't need to be. Right.

Cause you're 

not doing surgery in a pharmacy. 

Mike Koelzer: There's a ton of examples. I think of just like website building or something. You don't need to know the HTML. You don't need to know that stuff. Yeah. You pull something up and you drag a box from here to here and you say, that's where I want, or you have a template and pharmacists don't need to go into that data.

 they just need to use it for the patient care. 

Now if they got paid for it, if that was their job to get paid for it, as you alluded to earlier, you'd be happy to do it, but that's not where the focus or the payment's going to be.

Kevin Houlihan: right. Well, and no one wants to pay a pharmacist to do medical billing. They want to pay a pharmacist to deliver care. So, can we streamline medical billing so that the pharmacist is spending their time delivering care? Well, that's, that's our vision 

Mike Koelzer: Do you guys dabble at all with insurances or do you have ideas how to do that? You don't do any contracting with insurances or anything like that, 

Kevin Houlihan: I mean, that's step one. So the one of the [00:48:00] first things that we do for some of our customers, we help get them set up to be recognized as providers by insurance and get a contract to get paid. Yeah.

Um, And then at the end, since we stepped them through the entire clinical service encounter, we build the medical insurance claim.

So we've got all the information, it's all the supporting information. We know what happened. We've got the claim there. And then we facilitate submitting that claim to the insurance company and getting the payment remitted back to the pharmacy. So it is really like whole, it's not where we started, right?

Like I was explaining that we started in managing the encounter, but we were working with these pharmacies and they said, Hey, we really want to get set up to deal with insurance. And we learned over and over that we'd had all these conversations with pharmacies to help them figure it out. And so for us, we'd done it dozens of times, but you talk to a new pharmacy and they've never done it at all.

It's the first time they're ever thinking about it. Well, all of a sudden we have this industry expertise and we have this. This sort of tribal [00:49:00] knowledge and understanding of how these things work. And so part of delivering a service in the store is getting set up to manage insurance. And we've now seen that a bunch of times.

And so we wrap it all together and help our customers get set up in the beginning and manage it on the back end to be the trusted advisor to the pharmacist. 

Mike Koelzer: It's probably more successful in some states than others. Some that have already opened things up and so on.

Kevin Houlihan: For sure. Absolutely. That's another one that's like state by state. And that's what I was mentioning earlier, Mike. You might go to one state and say hey, here's the services we recommend you deliver and bill insurance for. And then you go to a different state and say that's not, don't do those services here, do these other ones here because of 

how it's recognized over here, right?

Like, so the landscape just right now today really does vary from state to state. And if you're a pharmacist in some state, you don't know necessarily how it looks in the rest of your state. We work with a bunch of industry organizations and associations and groups like that where we, that are [00:50:00] also have the same mission to help pharmacies kind of figure out how to transition their business.

And so we're plugged in those spaces, but ultimately we're coming in trying to solve the tech problems and sometimes the business problems too, like here's how you should think about that.

Mike Koelzer: Well, you simplify one thing and sometimes other things kind of fall in line with it. 

Kevin, your company is lucky to have you as a CEO, because if I was in your position and someone said, we want to start getting help 

with the insurances, I would say no.

That would just be my answer.

 You can't give me any help. No,

Kevin Houlihan: It's one of those things where there's 

no way around it, like we all, you look, like I said, you look five years out, that's where it's gonna be. Well, what's that saying about a journey of a thousand miles starts with one step? We gotta start, we gotta start going that direction, and so that's why we started, cause it's like, well, it's clear that's what the destination is.

So, let's get moving in that direction.

Mike Koelzer: Kevin, what are your thoughts on the [00:51:00] AI that has just kind of come to light for us, normal people, but it's 

been around forever for the engineers and so on.

Kevin Houlihan: Yeah, 

I mean, it's an interesting thing. I spent a bunch of time trying to pay attention to it and trying to stay on top of it, and I think it's at an interesting stage right now where ultimately what 

it is 

is just kind of aggregating information that's already out there, you're taking a bunch of information that's been published and then inferring what would happen based

on that information that's been published.

I don't know that I'm smart enough to tell you where it's going to go from here, but It is interesting today. In my personal life, I use it a little bit for stuff that I always end up checking, so if I'm, trying to write a document and I'm struggling to describe something, I'll ask it, how can you describe this differently?

It never outputs something that you're like, oh, that's it. I'm done. But it gets you over that hump. It's like, oh yeah, that is the right way. And oftentimes, you have to ask it a few times. I [00:52:00] don't know if you've heard of this. This emerging profession called prompt engineering, but it's like the new version of a software

developer writing code you're someone who's skilled at knowing how to ask AI the right questions to

get the result you want, Right. 

Mike Koelzer: Yeah. Just as small as me writing up the social posts for the shows coming out, this is very small scale, but you started off when I came out a few months ago, it's like, write me a release for this. Nah. Now it's like, all right, I want this, but I want this, I want these four things.

I have to mention this and kind of, 

you 

you give it some direction. It really can do a good job. One thing. It's good for me as not to stick my impatient and prideful foot in my mouth when I'm writing uh, Email to some company or something like that because I think I'm so clever and , suddenly blasting them for something.

And it says, well, you can do that, but here's another approach kind of thing. 

Kevin Houlihan: right. 

Mike Koelzer: gives me a check and balance.

Kevin Houlihan: Yeah. I mean, [00:53:00] I it's just a it's a like an assistant That's there really is kind of the way that I've used it so far. I think it's gonna evolve You I don't know, there's a ton of opinions out there about what it's going to turn into.

Um, right now I think it's interesting and it's a productivity enhancer, but 

Mike Koelzer: Yeah,

that the people that use it. So, for example, if I had to explain to somebody the best thing in life for me it's list management. It's a guy called David Allen, he wrote a book called Getting Things Done. It's not so much getting things done, but it's more how to free up time to be creative in other ways and so on.

And you'd think like, If somebody knew what it did for me, you'd think everybody would run up the next day and do this. It's like, it doesn't happen. One in thousand people, things like that. Same with the AI. It's like, it's going to be good for the people that want to use it.

And it'll make its movement behind the scenes. Of course, just like maybe [00:54:00] blockchain, people don't think they're using it, but maybe it's there. But for changing the world, overnight that stuff doesn't happen. There's not enough people that want to adopt it that quickly.

Kevin Houlihan: The area that I think is interesting and I think we're not quite there yet, but when it's like you go to the next level of research sort of, so if you're traveling for work and you're going to be in some new city, And you could ask it, instead of saying, like, what are the restaurants in this

city? You could ask it, suggest a restaurant in this city that I might like, and it knows the kinds of things that you like, and then it can say, like, hey, here's a, more appropriate, informed selection, like, so, is that changing my life? Not yet, at that level, but it's kind of a cool, It's just like a smarter search, sort of, or a more personalized

Mike Koelzer: It's certainly going to change and Google's responding, but it's certainly going to change search. I mean, I'll use it for nearly everything except like [00:55:00] something that I don't think it's maybe caught up quite yet. Like if I need to, don't know, find out how to. Fix a drawer on my refrigerator or something like that there.

I'm gonna look up Kenmore and go to Google look something up from eight years ago that kind of stuff It hasn't caught up all that but for day to day search and stuff. It's like you wonder what it'll do and somehow Google will have to put finances back into that. They'll have to sponsor something but right now 95 percent of the searches I did I've ever seen a person a year ago and saw advertisements or marketing.

I don't see those anymore . I'm not there to see them. I'm in, Chad GPT, and it 

comes up and I don't see it. So somehow, they'll have to figure something out to get back front of people.

Kevin Houlihan: Well, I mean, I think your example is a really interesting one. If search can do a better job of understanding exactly the information about your Kenmore fridge that you need to be able to fix what's going on, which [00:56:00] is a little bit different than a top search result hit,

that's where it starts to become really interesting.

Mike Koelzer: Kevin, Ali, good to have you on. It's always fun to look at the future of what's happening in pharmacy, and those choices aren't easy always.

There's some shifting that has to take place, but certainly technology has to be a huge part of

Kevin Houlihan: Yeah. Thanks for having me here today, Mike. It was great to chat with you and I'm just super excited. We're sitting in such a dynamic time right now with what's going on in pharmacy. But I think pharmacy is at the center of an opportunity to change how access to health care happens in the U. S. And it's hard, a little bit hard to predict the future, but I think there's a ton of different ways that it can be bright and we're excited to be a part of it and Kind of help the industry move along.

Mike Koelzer: Kevin, tell listeners how to find your stuff. Where are they gonna go?

Kevin Houlihan: Yeah. Workflow services. com. You can find us there. You can learn about the [00:57:00] solution. There's an opportunity to reach out and request a demo or get information or connect with our team. But that's the best spot to be. 

Mike Koelzer: Well, Kevin, you're a busy guy. You have a lot stuff going on. I appreciate you spending time with us. Pleasure talking to you.

Kevin Houlihan: You too, Mike. Thanks. Have a great one.

Mike Koelzer: Thank you. 

You've been listening to the Business of Pharmacy podcast with me, your host, Mike Kelser. Please subscribe for all future episodes.