Welcome to Thriving Practice, the podcast for healthcare provider owners looking to excel in the ever-evolving world of healthcare. I'm your host, Tracy Trepesky, and today we have a special guest with us, Kyle Kaiser from Arrive Health, formerly known as RxReview. Arrive Health is on a mission to revolutionize the way providers and patients access vital healthcare information, specifically when it comes to pharmaceutical medicines.
In today's healthcare landscape, many Americans are faced with a difficult choice, managing their health or meeting their basic needs. Patients yearn for transparency and understanding the true out-of-pocket costs of their treatments, while providers often find themselves making critical decisions in the dark, without clear and accurate data. Arrive Health bridges that gap.
During my conversation with Kyle, we dove into the heart of their mission at Arrive Health, which is something bigger than the individual. Arrive Health's goal is clear, to provide affordable and accessible medications to those in need. Kyle is passionate about solving impactful problems and creating change that makes healthcare work better for people.
He shares the tools that providers should be using to make informed care decisions and deliver the most effective treatment, ultimately saving time and reducing provider burnout. But the question is, how do they do that? Arrive Health employs technology solutions that seamlessly integrate with existing EMR interfaces, ensuring that providers have simplified and accessible information right at their fingertips.
They provide details about medications, offer alternative options, and demystify insurance coverage, making informed decisions a reality instead of what used to feel like a pipe dream. The story behind Arrive Health is truly inspiring. It was founded within the University of Colorado Healthcare System by physician Kevin O'Brien, really driven by his mother Lucy's questions and challenges related to her medications.
Dr. O'Brien's journey from tracking information to implementing what he learned in his clinic is a testament to the power of innovation in healthcare. At the end of our conversation, Kyle leaves us with a valuable piece of wisdom for you, our dear listeners. He reminds you not to lose sight of the bigger picture. Amidst the daily details and challenges, it's essential to reconnect with the passion and drive that led you to become a healthcare provider in the first place.
So stay tuned as we dive deeper into the world of healthcare business. Join me and Kyle Kaiser as we explore how Arrive Health is shaping the future of healthcare for providers and patients. You know what to do, grab a beverage or a snack and something to write with, and listen to this incredible conversation with Kyle Kaiser. Hey Kyle, thanks for coming on today. Glad to be here.
I'm so happy to have you on the show as we were warming up in the green room, I was just thinking a lot about like the benefits of what you bring and how this kind of the work that you do, that your company does, the meaningful solutions are very appreciated and very necessary. And from my perspective, and I'm looking forward to learning more about what you do, but from my perspective, I really see it as like a very well-rounded solution where everybody wins.
So I'm really excited to hear more about what you do and we'll go from there, but yeah. Yeah. I'm glad to hear that. I'm glad it looks that way from the outside because that's absolutely the intent. Yeah. You know, sometimes it can be challenging to get that through and copy, but it very much comes through on your website and so yeah, well done. You've got people who are doing the good stuff.
So before we dive in and hear about the company and what drove you to be here, I would love to just let our listeners know where you're located. Oh, sure. Yeah. We are. I'm sitting currently in Edmonds, Washington, just outside of Seattle, but we're a Denver-based company, but we're all over. We've got folks in Pittsburgh, Ohio, Colorado, California, Texas, and Washington.
Nice. You may have missed a state or two, but we're relatively national, grew the company in the midst of COVID and virtual work and have continued to double down on all that. Wonderful. And as we were saying when we were just chatting before coming in, being able to do more remote work, it really opens up the field for bringing in the people who really fit rather than being confined to logistics and location and all that. So I think that's awesome.
Yeah. We've benefited from that and not just finding the right skill sets and the right folks that understand pharmacy and data, but also being able to be very selective around mission alignment and have a team that's uncompromising on our mission and trying to get things done that are important and meaningful and bigger than themselves. So that's been a benefit on two sides of that. There's a lot to be said for being mission-focused business.
So along those lines, tell us a little bit about the company and your mission and vision and what brought you into this field. Yeah. So Arrive Health was once called RX Review. We went through a rebrand about 18 months ago and throughout our history, we've been focused on driving more informed decision-making to avoid care around cost coverage and affordability for patients. That has taken the form of what's called real-time benefit.
That's now an industry term for a data exchange that happens between patient PBMs and providers who are trying to make prescribing decisions. And what it does is we deliver real-time, patient-specific, moment-in-time specific insight into the cost of medications, any alternatives that might be relevant for those medications. And those alternatives come in a couple of different forms.
It could be a lower-cost medication, it could be a lower-cost pharmacy, but all with the goal of more affordable and accessible choices the first time, not reworked after a denied claim, not reworked after a note. So we're in the process, but can we pull this as far upstream as possible and inform the patient and provider encounter? I would imagine that that resolves or avoids a lot of headaches, both for providers and for patients. It does.
And frankly, it's just where that work should happen, right? Think about, as a patient, the place that you think to go for those answers is almost always your provider, right? People seek out conversations with their providers and care teams. They tolerate conversations with their health plan and PBM. And so it ends up creating this kind of misaligned process where patients are coming back to the provider and the care team for those answers to help resolve the friction.
And it creates extra work for the practice. But also, more often than not, the answers aren't there, right? They're actually at the payer of PBM. So one of the great successes of real-time benefit generally in the network we've built is that it really empowers that relationship. And ultimately, that's what delivers behavior change. It's the patient and provider encounter. And that sacred encounter is what we're trying to get right the first time.
And help providers operate more in that top-of-their-license-type experience and not on the phone with pharmacies or health plans or PBMs trying to get through the administrivia. Right. Yeah, because it's kind of a hot mess. It's the only part of our economy where someone else is making a purchasing decision on your behalf, and neither of you know what it costs until you're asked to pay for it. Right.
And, you know, when you put it in those terms, you go, wow, how did we ever think to do it this way? This is kind of the only example where technology reduced consumer choice the first time around. So when we went from paper scripts to e-prescribing in the early 2000s, you went from something that you could shop at in many pharmacies to that prescription being routed specifically from the point of care, specifically to a pharmacy you selected without knowledge of anything else.
And so it's kind of the only example I know of where technology constrained consumer choices. Yeah. And and so what we're doing with Real-Time Benefit is actually reintroducing consumer choice into that clinical decision-making process and then throughout the patient journey as it continues from that moment. Really interesting. So do in that process, are you does your technology find the best price at another pharmacy or how does that work? Best price can be very subjective.
So the first thing we do is we take the patient's preferred pharmacy and the medication that the provider intends to choose. And before that's ever signed, while it's in a pending status, we work with the associated health plan and PBM in real time, sub-second transaction, and get a response back that says for that drug at their preferred pharmacy, here's how much it would cost.
And then we work with the PBM and health plan to put forward medication alternatives or pharmacy alternatives that will be better aligned with either the plan design to improve patient out-of-pocket cost or lower cost of care generally. But but the alternatives themselves are generated in collaboration with the plan sponsor, the risk-bearing entity, because ultimately, more often than not, the right answer is there.
We find that almost 80% of the time, the lowest cost option is the insurance option. And I think that's good news generally for insurance benefits. And then there are scenarios where we look outside of those specific insurance benefits to find other ways to pay other pharmacies that might be a good fit for a number of reasons. But the core is how do we understand insurance price based on preferred pharmacy and optimize from there?
So for the patient, that makes the experience a lot smoother, particularly, I'm thinking particularly for someone who might be overwhelmed with a scary diagnosis and like a large treatment plan, a very comprehensive plan or something like that, that that makes it much better for the patient. And I would imagine for the provider, it takes a lot of the administrative, extra administrative tasks that might come with that right off their plate.
Yes. And frankly, it just takes some of the things that feel nonsensical out of the mix. Right. So even outside of that, what you described is entirely accurate, right? The more complex, the more difficult, but even the simple stuff, inhaled steroids, there might be a disc, an inhaler, and that nebulized form, all these different ways that you could get albuterol. And a health plan may have a specific preference as to which one of those forms has been negotiated as the best price.
And one of those is zero dollars and every single other one of them is a couple hundred bucks. And so even in this thing that we, as parents, probably have all experienced at one point or another, that you're trying to go get a prescription for your kid because of an acute incident. It's still a head start. It's still a head spinning complex system that just, you know, just because it's not visible to the provider when making those decisions.
So we've got a handful of stories where we've gotten really specific feedback from providers where they're sending from a patient, they spin the screen to their EMR and say, well, and load up all the orders and say, well, this one is zero dollars and this one's 250 bucks. And they actually talk through nice. And and those are, you know, those are some of the things that we're trying to do to make
things. And and those are, you know, I think when we were at the outset, there was a lot of debate over whether or not providers wanted this information or, you know, what, even if they may want it, would they take the time to engage with it? And what we're finding is it's, you know, the provider desire this. They understand that clinical care and great clinical care and cost effectiveness are in today's world entirely linked. Right. Yes. It's the thing you can afford.
Yeah, well, and I would imagine that contributes to behavioral change on the behalf of the patient as well, because there's it feels more collaborative than just a directive. And so even even if there's not like a ton of choice, I would imagine when the patient feels like they're in collaboration with their provider and they feel like they have a choice, it probably makes it a little bit easier in their minds. I'm not a psychologist, but I'm very fascinated by what sparks behavioral change.
I would imagine that that makes it easier for people to get over the hump and be more compliant with their with their treatment plans. Yeah, I think it engenders trust. Right. You can be more transparent with those things, sort of share some of the decision processes that, to your point, it's easier to buy in once that trust has been laid as the groundwork. For sure. Yeah. And I would think at the end of the day, every provider would really prefer that their patients get well.
So so this is key, right? Like sometimes we need pharmaceutical support and other treatment plans to to get there. So, yeah, I think if you if you have an experience with somebody that has multiple chronic disease diseases or multiple chronic conditions of some kind that, you know, a lot of times those folks are experts. They know everything about their meds. They know exactly how they're optimizing themselves because they have to think about the last 20, 25 years.
We've transitioned from, you know, low out-of-pocket costs and deductibles in the hundreds of dollars, relatively simple formularies to high out-of-pocket costs, deductibles in the multiple thousands of dollars. Formularies have four or five, six tiers. Some of those years are co-insurance years. And those are two very different economic forces on patients and patients have adapted. But but we didn't really give them the tools at the outset, right?
Like we put all of the out-of-pocket costs on without giving them the tools to understand exactly what the consequences of those choices were. And so you'll see patients. You know, my 94 year old grandmother is, you know, has all kinds of things going on. She she knows her meds and she knows exactly how much she needs and when she needs them and how much it costs and how if something changes about the cost, she understands it.
And so, you know, these are the types of tools that are just required in the world where consumer driven health care is the norm. Yeah. Yeah. It's it's unfortunate, I think, that it has to be that way, but it is what it is right now. And so we if we want people to if we want patients to get well or stabilize, at the very least, then we need those tools.
And I would imagine for providers to help in many ways with sort of their keeping them on the inside edge of burnout, at least, you know, and feeling like what they're doing is making a difference. I've yet to meet a provider who's like, yeah, I decided to become a doctor because I wanted to be rich. Like, you know, they're usually like they have a story. There's something behind why they chose to go into health care.
And so I would imagine that it helps with that a lot and can lower, you know, a lot of the stressors that are there, way too many unknowns sometimes, you know, and keeps a lot of people from going to the doctor because they don't know what to expect and they don't know what's going to happen. More often than not, the most common thing that happens as a result of a patient encounter is a medication, right?
And if you can inform those more accurately, then practice is going to run smoother if outcomes are going to go up or improve. It's it's definitely an unlock for a better practice overall. I'm curious, does that impact the pharmacies and does it have a positive impact for pharmacists and pharmacies?
Yeah, I think so. Well, said differently, the pharmacists were actually this sort of invisible thing happening that just fixed what a bunch of what that resolved a ton of complexity, right, is that orders coming out of EMRs come in a certain form that are totally incompatible in some cases with the way they need to go into the claim system. And those are just things that pharmacists always have done. They just fix those problems for everyone in the system without anyone being particularly
aware of it. So one of the things we had to overcome in pulling this upstream is we had to sort of start to embed the intelligence of the pharmacist into the tool because there's, you know, things an example might be something comes out of the EMR as a something comes out of the EMR as a package size. It needs to go into the claim system as milliliters and it needs to be translated back to successfully transact for us to deliver a price in the first place.
And if we don't deliver a price, then you can't deliver the alternatives that are lower cost options. And so by missing that transaction, you miss the opportunity entirely. So we've we've spent an entire or a ton of resources on kind of a learning model within the tool that allows it to do intelligent interchange and understand that complexity and just in real time make the adjustments necessary because the difference, you know, the scenarios that can make those things fail are wildly variable.
And so it's different for every provider office you walk into or every health system you walk into. So the tool has to be able to adapt and have that sort of intelligence of a pharmacist inside of it. Otherwise, it just won't work, you know, or it'll only work for things that are really simple and low cost and they'll deliver a lot of value.
Whereas the high cost meds are, you know, the inhalers and the self injectables and creams and all these insulins, all these things that are happening in non pills capsule form. And so it's so the pharmacist, I guess, answer a different question, has always played a huge, important role.
We're hopefully virtualizing some of that role into the tool so that clean scripts show up at a pharmacy and the pharmacist can then focus more on that patient encounter and kind of similar story to the provider, right? Pharmacists show up because they care about patients and they want to help help them manage their meds and help them manage their needs and drive a better outcome. Hopefully we're we're clearing the way for that to happen. And in doing so, we're solving problems upstream.
So it's so interesting, we we go to a local sort of small, you know, local pharmacy here and, you know, sometimes we get to talk to Dave, the owner, and he he just started matching like good Rx prices because some purchase and some large sort of monopolizing force or whatever. And he was like, I just didn't want to deal with it anymore. So I just always look up what the good Rx price would be. And I offer that to our clients here at the pharmacy.
And then he went on a little bit of a rant about how frustrating the whole system is. Right. And I was just thinking about that, thinking, wouldn't it be easier if we could just centralize this? And here it is. I mean, in a way, it would be easy if they could just do a flat price. But that's a whole other topic. But to centralize the data and the information and bring that forward for provider and patient and then ultimately, you know, goes over to the pharmacy. That's that's it's cool.
Like I think somewhere on your website or in your in your literature, you talk about being the bridge. And that's definitely how I see it. That would be a good metaphor that I would use. It's definitely a bridge that y'all created. And part of what enables Dave to do that now is there's been a cluster of good legislative changes over the last couple of years. One of them is allowing pharmacists to now discuss different cost alternatives with their
patients. Yeah, that you should be straight up illegal as a part of network agreements. Yeah. So that's been a positive change. One of the things that we've benefited from is real time benefit, which is the name or real time prescription benefit is sort of the name for what we do specifically is now mandated to be included as a part of part D plan. So if you're a party plan, you need to have the capability of integrating with real time benefit tools at the point of care and for patients.
That's all happened in the last couple of years. All all on top of other price transparency legislation for both health plans and providers. And it just you know, there's a lot of good momentum and regulatory tailwinds in the space right now that I think is is going to drive us much closer to what you described is that kind of digitally enabled marketplace that feels like the you know, the Expedia like thing that everybody desires.
Right. It's obviously incredibly complicated to actually execute on that in health care, but we're certainly moving in that direction. I'm glad for it. I think it's there's so many wins, right? Like, I think the pharma companies are doing all right. And so they're good. And I think everybody else is going to win. You know, you can't you can't go wrong with helping people. One of our one of my life mantras, it's always good to help people.
Right. So to be in a position where you can help as many people as you can through this this technology and these technological solutions that you offer, I think is really cool. So, yeah, well, that's so yeah, it is, you know. We behind the scenes, you know, like not on camera, I'll get a lot of grousing, you know, my client not towards me, but my clients will talk about it and some of our some of our listeners will share with us in private messages how frustrating some of the systems are.
And one of our goals in our company is to help bring down people, our provider owners, stress levels so they can go advocate, so they can go push for these things and and come together and ask for it. So I'm really excited to know that this solution exists and to share this message with our listeners and get this out there, because I think that it's something that every practice might want to have access to.
Yeah, absolutely. And I think the way that could be accessed is I'm sure your listeners have a cats and dogs mixture of electronic health records that they use. Many of the EMRs are starting to integrate these tools pretty broadly. And we we work with some great ones and some really important EMR partners on our end and want to continue to do so. We're always growing those relationships.
So, you know, if you've got an EMR vendor that you work with that you're not experiencing these tools, then we'd love to talk to them, because I think it's these things are not all created equal. And we've spent a lot of time making sure data quality and provider trust is inherent in what we do. And that partially comes from being incubated in a health system. We were you know, we came out of the University of Colorado Health System.
We've sought out providers as investors and collaborators and strategic partners to make the product better over time. And it's really started to bear fruit where we're seeing some market leading results from behavior change perspective, which to me says providers trust the tool. They know they can rely on the tool. They know that the content coming through it is viable and useful. Those may sound like low bars, but they're really complicated to do.
And I think we stand out in our peer group in those ways. Yeah, for sure. And, you know, it's funny you said low bar and I was thinking, no, these are ripples. You know, when you think about the ripples that are created and how much of a difference that can make.
And, you know, considering that you're working with some EMR companies who then are in multiple practices and maybe even in larger health care systems, how many people's lives are being impacted in a positive way, both from the patient perspective and from the provider perspective? I mean, this is mind blowing. Yeah, absolutely. Our goal by year end is we want to inform 150 million transactions. That doesn't exactly line up with a one to one patient encounter, but it's pretty close.
We're estimating now that about 25 percent of e-prescribers are using our tool and we're going to grow that by a third by year end. So, yeah, to your point, we've estimated that total cost of care that represents about twenty six billion dollars that we are seeing flow through the pipes.
And yeah, what a responsibility and kind of sacred opportunity for us to think about is that, you know, those are all people and people that need to be impacted in a positive way, to your point, and providers that are there to help. Yeah, when I think as a data driven company, obviously you're mission driven, but the bones of it rely on data. It's really refreshing to hear you saying how much you bring people back into it.
Right. Because some of the frustrations that patients have and even some of our clients and other providers that we talk to have said, you know, it's just it's so hard to humanize all of this. It's it's a challenge. They have to kind of go up and go down and lift up and go down and kind of go high level and think in terms of data and then attach human beings to that data and then land it again. So this is it's very refreshing to hear that because I think we need it right.
We really, really need it. That's in part due to our origin story. So we were founded by one of one of the co-founders, Kevin O'Brien, and he's a physician in Denver, a practicing physician in Denver. He was actually inspired to start to do this work because his mom approached him and had a high out-of-pocket monthly spend, wanted the help of her doctor son to solve some of those problems that he did. He looked at just simple things.
Can you split these? Can you take this brand and break it into its generic parts? Can you find a therapeutic equivalent that's within the same class, but not necessarily direct generic? And he's got her spend in half by doing that evaluation. So what that inspired him to do is to start doing this in his own clinic. So he was, you know, nobody was paying him anything extra.
He was doing this only for his own purpose, started to track these things in a spreadsheet of sort of ways to save on medication. And so that that at its core is where we've come from. Right. And we still have a mantra in the company called Lucy Up. It's because Kevin's mom's name was Lucy. And, you know, and that's the way to for all of us when we're in the weeds and we're focused on the next thing or the next close the next deal or get the next piece of
out the door. It's a way to lift our eyes and say this is actually about something bigger than us. And everybody's either has a Lucy in their lives or has been the Lucy. You know, everybody's had some experience or someone they love has had an experience with the health care system that's been confusing or frustrating or hard to understand or unaffordable. And so we we keep that front and center. And I think that our team is really focused and inspired by that.
I love that. Yeah. How how do providers get access to this data, like how? How do you get this to them, providers and patients, like is it through do they need to go into the EMR to look this up? Is that kind of how that works? Yeah. So our core, we're data network. So we we don't control a user interface. We are we populate the existing user interfaces inside of EMR. So inside of Epic Center, Athena or any of our other partners, Dospot, those are their e-prescribing tools.
And inside of those e-prescribing tools, they have real time benefit features and we power those real time benefit features. So if you're an EMR user, I mean, as I mentioned, you may have started to already see some of this cost information as a part of the e-prescribing process. So we're just in the background. We're the data network in the background. And what we're doing on the back end is calling out to our network of insurance information, which is primarily health plans and PBMs.
And in real time, bringing back what you pay when you show up at the pharmacy counter at its core and alternatives. But it's it's all data that we're populating inside of an EMR screen, not necessarily us populating our own screens or embedding that
screen into a different place in the EMR. What we found in part of the because of that provider incubation process is that this thing needs to be absolutely in the middle of the existing e-prescribing process and anything that deviates from that is going to hurt engagement and hurt behavior change. Right. It would be it could potentially cause confusion. Right. If I get that. Interesting. That's really, really interesting.
I'm not a real tech person, but I'm always really interested in how like how does that work if you've got this one? It's not the one thing, but this this thing that you bring to the table and it goes into many different systems. So as a non-techie person, I'm very, very intrigued and impressed by that. I think it's something I don't really understand, so it's cool, I guess. Yeah, it's fun to think that this sort of innocuous opportunity inside the EMR.
So we're either rendered as an interruptive alert or populating a card in the screen, or sometimes there's a button, a patient cost estimate button, that to your point behind that is this massive network that's going out to all of these health plans to get the information back. That's so great. Well, this is, this is something that I think our listeners are going to want to know more about if they don't already. So I would love to ask you,
like, how can people, what do you recommend for people who are interested? Should they come and check it out? Should they schedule a conversation with somebody? How should they? Yeah. So ArriveHealth.com is always a good front door. From there, we can get you to the appropriate team member to, to either talk about, you know, your direct needs. If you're an Epic user, for example, we work directly with Epic users, or to help connect into your EMR system. We'd love provider support in doing that.
LinkedIn and all those things are places where everybody's pretty active. And then coming up, we will be at the Oracle Health Conference next week. We'll have a team there. We'll be at Health Evolution Connect in Nashville a couple weeks after that. So those are both opportunities where we'll be on the road and have team members there and eager to meet your
listeners. Perfect. Well, one final question. If you could offer a piece of advice to our listeners who are mostly provider owners, what would that be? Oh, geez. I think, I don't know, usually I answer this question in a more businessy context, but I think the provider owners are such a unique audience. And I think what I most appreciate is that those are, to your point earlier, are folks that got into medicine because they're
passionate about it. And so I think, you know, never forget the human context, right? Like it's so easy inside of this big, complicated, stressful healthcare system to just get caught up in all of the complexity and make the business work. And I think provider owners are inspiring because they more often than not don't lose sight of the patient relationship
because they're seeing it every day. So I think continue inspiring us in that way, because that's an important part of the system that shouldn't be lost. Wonderful. Kyle, thank you so much for coming on today. It's been such a pleasure. Thanks for the invitation. Glad to be here. Thank you so much for listening to this episode of Thriving Practice. I appreciate you. And I have an ask. If you got value from this show, make sure to share it. You can give a shout on
on social media or tell your friends and colleagues about it. You can also subscribe so you never miss a show. To learn more about how we work with practice owners to help them take back their time, head over to tracytrupesky.com. While you're there, sign up for our newsletter, which has tips and tools for your practice success. A special thanks to our incredible team and thanks to you, our dear listener, for sharing the gift of your time and attention.
I wish you so much success as you continue to move forward in your day. If I can be a resource to you, let's schedule a time to talk. You can find the scheduling link on our website.