Reducing Hospital Pharmacy Costs | Kelly Bolhofner, SRG

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

Mike Koelzer, Host: [00:00:00] Well, hello, Kelly. Hi Mike Kelly, introduce yourself. And what we're talking about today, my name is 

Kelly Bolhofner: Kelly Bolhofner, and, uh, I, I work with Ozzie who you spoke to a couple weeks ago, uh, at SRG and I am focused more on the health system side negotiations. I also do some work with a company called ion that sells a product called ANCO bite.

Mike Koelzer, Host: You were with a wholesaler for a while, right? 

Kelly Bolhofner: Like Ozzie. That's where I met Ozzie. We both worked 20 years. I think he was there a little bit longer than me. He was on the Bergen side. I was on the Amerisource 

Mike Koelzer, Host: side. Would you have said you were competitors before that? I mean, not necessarily against each other, but you were Amerisource and Bergen were wholesaler 

Kelly Bolhofner: competitors.

Yes. They were wholesaler competitors. Uh, MEI source got a, a very big, uh, win for, it was basically the Viant contract away from Bergen and in the process. And the two companies ended up merging. So yes, we were competi. They got a win for what? Uh, it was actually Viant the, the group purchasing organization.

Oh, uh, used to be notation. 

Mike Koelzer, Host: That was a purchasing group. Yeah. 

Kelly Bolhofner: That was a group purchasing organization. And you know, that that's, uh, one of the things that makes health systems a lot more, what I would call complex than an independent pharmacy is because of the, the group purchasing organization piece of it.

A group purchasing organization is, is basically, you know, it's like a, a notation or which is now Viant or a premier where it's kind of like a buying group in that, um, you know, they have special pricing and they have certain, certain things, uh, Contract compliance and those type things that they've got to do to, to be members, but it is different in that when they go to say a, a Lily for instance, um, and they want their pro Lily's product on, on their.

Their, uh, contract, they will give Lily certain parameters of, you know, we're, we're gonna have this group of 400 hospitals that are members and, you know, they, they are gonna be purchasing approximately this much of your product. And then that, you know, they give a price based on that. That goes again on the GPO.

That is loaded at the wholesaler. It 

Mike Koelzer, Host: Sounds like what they had was a purchasing organization that actually had some power. Viant they're strong enough to almost shut down Bergen yet. These buying groups in pharmacies. Don't seem strong enough if one of the buying groups only started going with one of the wholesalers.

I'm trying to think if there'd be a case where in retail pharmacy, one of the wholesalers would say that was so bad that we didn't get to contract with this buying group that we're gonna basically shut our wholesaler down like Bergen did, because they didn't get the Viant. Things. So where is the difference there?

Kelly Bolhofner: Um, the difference is, I mean, when you're, when you're looking at say an independent pharmacy it's, or, or even a, even a buying group, you know, it's, they don't have the same, I'll say buying power as, you know, a, a group within the GPO, because a lot of times what, what these hospitals and IDNs will do is they will band together.

And they will form a perfect example of the, uh, Catholic healthcare system. It's a number of Catholic organization, hospitals that have banded together for buying power. So what happens is, you know, instead of that, that. One or two pharmacies going away or, you know, that group of 10 pharmacies going away, you've got, you know, hundreds of millions of dollars that are being lost because.

This certain group has gone 

Mike Koelzer, Host: away in pharmacy. There's probably no buying group that is quite big enough to demand enough. That's part of it, right? Yeah. That's part of it. And they also can pick and choose products and manufacturers a little bit more than pharmacies can cuz pharmacies have to have everything available.

Exactly. Because you can't go into a pharmacy and say, I want this product. I saw it on TV because the hospitals may not care. They just give you what they have. Right. So now let's say. Buying groups from pharmacies come along. Most pharmacies know that they probably don't have to be in any particular buying group because they know that all the buying [00:05:00] groups are gonna get probably a decent price where hospitals probably really try to track down.

The best GPO, because they know they'll get significant discounts, whatever for being in that buying group. And then when there's more reason to be in a group, then that group keeps getting stronger. Right. 

Kelly Bolhofner: Correct. And, you know, and that's. The other piece is, you know, in a buying group, like, just like you said, you know, that that independent pharmacy can decide, okay, I'm, I'm gonna be in, you know, this buying group or that buying group.

And, and it's not, they don't really sign a long term agreement of, Hey, I'm gonna, you know, this is where I'm gonna go. Whereas in a GPO situation, that health system actually signs an agreement with that GPO that they're gonna purchase. So many of their products are on contract and whatever the agreements are.

They actually signed an agreement with that GPO. So they're tying themselves in and that's, you know, when a wholesaler, the example we've been talking about Amerisource, um, gets that specific GPO. You know, they have pretty much the power to go out and start pulling those customers over and converting them to another wholesaler because they are tied into that wholesaler.

When 

Mike Koelzer, Host: you're with a wholesaler then, and Viant comes to you, you have to give 'em almost everything because you really need them in all their hospitals. I, I 

Kelly Bolhofner: wouldn't say everything. , you know, there are agreements that are. And, you know, there's certain parameters, um, you know, you're gonna put contracts in then, you know, being that, that I worked very closely with a lot of, lot of the GPOs, you know, they would require us to come in and, and talk about the member compliance.

How many of the members that we had, what their contract compliance was, um, how it benchmark against. The other GPOs, obviously, you know, not giving any names, but you know, there were a lot of things involved. I went back and listened to Ozzie's podcast this morning and, you know, he had mentioned, uh, errors or, or mistakes.

Um, and you know, he had mentioned the, um, the net. You know, there's, there's some GPOs that, you know, won't allow net bills that, you know, you've got to apply. So there's, you know, there's a lot of parameters that they put in these GPO agreements. They're all different, you know, and, and again, Some, some have more buying power than others.

And you know, that's, again, what Ozzie and I are trying to do is to help those health systems. Of course, he's helping independent pharmacies, but to help those health systems to not only understand the complexities. Of the GP agreement, which, you know, just the, the questions that you're asking.

I mean, you know how you're understanding how complex it can 

Mike Koelzer, Host: be. Yeah. I'm just a schmuck up here, sitting here, just curious. But these are people that have millions of dollars, you know, behind this, trying to figure this out. Yeah. 

Kelly Bolhofner: It's very complex. 

Mike Koelzer, Host: It proves the need for what you are doing because yeah, exactly.

You would mainly go between the hospital and. The GPO 

Kelly Bolhofner: we've actually structured it where, you know, I could do hospital and GPO, but it's, it's mainly the hospital and the wholesaler and that's, you know, and that, that kind of goes back to those, those agreements that the wholesaler and the GPO has.

There are a lot of times on the grid. That they put in there, you know, a hospital that buys this much, you know gonna get this cost of goods. If they get this many deliveries, then we will, you know, we will take five basis points if, you know, often and so on. So, you know, when you, when you start looking at these grids, you know, a lot of times when a, when the, the wholesaler goes into.

Say hospital prospect a, you know, they're going in there with, okay. Here's what we've agreed upon with the GPO. And they're only offering that piece of it. And a lot of times they don't understand that that's a starting point. That is not where it could be because hospital A and hospital B. Or just that hospital, a and hospital B, have different buying patterns.

They have different specialty drugs that they may buy. [00:10:00] So it may be totally different. And if, if, if they're going in and offering this grid that, you know, calls for all these things, it may be, you know, something. Different that they can negotiate. And that's, that's kind of what Ozzie and I are doing is we are helping with those negotiations because a lot of them don't know that they need us to be honest.

Mike Koelzer, Host: In other words, the hospital's working with you, Kelly, and it's not like they can just go and say, all right, we'll go with Viant versus these other ones because Viant has, and across the board, no questions asked this much better price on. Every product for every quantity and every situation. We're just gonna look at the GPO.

We're not going to look at the wholesaler. It sounds like there's gotta be some conversation still between the hospital and the wholesaler, because this GPO might be good. But it might not because it doesn't cover every situation that you need. You might have different products, you might have different drugs, you need different things like that.

Would that be fair? That the GPO is not just an overall blanket discount. And so don't even talk to the wholesalers because there's enough needs that the wholesalers still kind of goes around the edges of the GPO. That's why even they have to talk together. 

Kelly Bolhofner: Yeah. I think that that would be, that would be fair too.

um, because like I said, there's a number of agreements in play when, you know, when a, when you're negotiating that, that wholesaler. Uh, IDN agreement. I mean, you've got the agreement with the GPO and the, and the wholesaler that, you know, you're gonna do these certain things. You've got an agreement with the IDN and the GPO that they're gonna do certain things.

And then you've got the agreement between the IDN and the wholesaler. the IDN 

Mike Koelzer, Host: is what, what does that stand for? 

Kelly Bolhofner: Integrated delivery network. It's like a health system, but it's where you've got. A group of health systems that have the same owner. You 

Mike Koelzer, Host: might say like a chain pharmacy almost you're 

Kelly Bolhofner: in Michigan, Trinity they're in Michigan.

They're like an IDN or like a, a, a group that has, has banned 

Mike Koelzer, Host: together. It's the group under the heading where you might have some pharmacy, some hospitals, this and that. They're all basically the same. Yes. Corporate. 

Structure. 

Kelly Bolhofner: This is kind of becoming a common thing where, you know, they'll have a one delivery where the wholesaler will deliver to a warehouse.

And then, and then that warehouse will, will distribute out to, you know, they have a courier that goes to hospital, A on hospital, B hospital C. And so they. They have their own warehouse. 

Mike Koelzer, Host: That can be part of the negotiation where they say, we don't wanna deal with that last mile delivery. We want the wholesaler to do that 

Kelly Bolhofner: still.

Yeah. We want the wholesaler to go, you know, to this one delivery. If it's just that one delivery, obviously that's gonna affect how much the wholesaler's gonna have to pay to go. You know, to hold, you know, to all of the hospitals, they're delivering to one place and they're taking possession of it and delivering it from there.

Mike Koelzer, Host: Give me an example then of who would come to you. It's gonna be someone at the hospital. Correct. And what level of a person is this going to be? Is it gonna be like the pharmacy manager or higher up higher up, right. 

Kelly Bolhofner: Actually within a health system, it would be higher up. It would be more of a CFO CEO, C.

Kind of, uh, coming to us a lot of times, the supply chain manager or VP of supply chain, pharmacy manager, they are, are put in charge sometimes of, of looking at, you know, the, the agreements and, but. The thing about that is we do a line by line analysis, you know, and, and a lot of these supply chain, people, even the CFO, a lot of times, or the, you know, pharmacy manager, they don't have the knowledge or the expertise and they certainly

They certainly don't have the time. So, you know, they're just going, based on what the wholesaler's giving them. and, you know, it goes back to, like Ozzie said, the piece of paper, you know, we're gonna save you this amount of money. Well, okay. But if you've done a line by line analysis, no. And so, you know, that's where again, we come in. Nobody does what we do by going into that detail and, and looking at, you know, the Nu, the amount of specialty that they buy, you know, how many products or, you know, what their contract compliance actually would be.

How many generics they have. And, you know, [00:15:00] looking at, at every piece of it and what cost of goods would be applied for that certain category and giving a more holistic rather than just a here's what we can 

Mike Koelzer, Host: save you. If you were in the picture, are these guys from the C-suite talking to the wholesalers or are they talking mainly to the GPOs?

Kelly Bolhofner: Or both. I mean, it could be both mainly, mainly the wholesaler, because, you know, again, you've got these, these contracts that they've signed with the GP GPO, for instance, that are used. Oh yeah. And, you know, and then they may have a separate agreement with the wholesaler that, you know, maybe a three year or, you know, so.

It's mainly talking with the wholesalers, not necessarily, you know, they're not necessarily talking to the GPO. They may, um, just figure out what's gonna be the best GPO for them. Normally when a health system or IDN signs up for, you know, a certain GPO. Nine times outta 10, they're not gonna change.

Mm. It's just their, you know, their agreement that they've, they've got with that certain GPO and it, it just becomes a longstanding relationship. 

Mike Koelzer, Host: Does a GPO let's see, would they always have just one of the wholesalers? Would they ever have a couple different ones? 

Kelly Bolhofner: um, actually they, there are a lot of the GPO agreements that will only allow.

One GPO. They can have. Wholesaler one and wholesaler two, this one's primary, this one's secondary. So, you know, they can add the GPO contracts to both of 'em. So they could be with two of the, the big 

Mike Koelzer, Host: Three seems just a lot like a pharmacy. It's like they make this thing complicated on purpose just to screw with people.

I think smoke and mirrors. 

Kelly Bolhofner: It's very complex. Exactly. 

Mike Koelzer, Host: Would you say that smoking mirrors? Yeah. Smoking mirrors where there's mystery there's margin, that kind of thing. I would say 

Kelly Bolhofner: that that sucks. Oh yeah. Oh yeah. And yeah. And you know, the thing about it is, um, you know, Ozzie had talked about the cost of goods, uh, applying differently for, for different types of drugs.

Like for a specialty drug, it'd be different for a brand drug. It might be different for a. Smaller margin drug. It might be different. And you know, in the past, you know, wholesalers weren't necessarily forthcoming with that. And, you know, and, and, you know, it was one of those hidden things. You know, one of those things that was in the fine print, there goes my, my air quotes.

Um, but you know, now they're, they're starting to, you know, they put it out there, but again, when they give you that, Hey, we can save you this much. They haven't done it. They haven't done a line by 

Mike Koelzer, Host: line when you're dealing with these hospitals. People are there any of 'em that are a real pain in the, as they start getting up to the higher levels, you're a sweet.

And I'm sure you get along with everybody and you, you would never see anything bad about anybody like me, but are there any personalities that you come across in general dealing with either wholesalers, hospitals or the GPOs? That you say of these three in general, it's tougher to deal with leaders of this because of the type of people they are or because of the nature of the business.

And I know that these are potential customers of yours, so you don't wanna go on air and lay into 'em, but are there any that rub the wrong way in general?

Kelly Bolhofner: You are right. I do get along pretty much with everybody. Of course, you know, I think it's my Southern charm, but, and you got 

Mike Koelzer, Host: cool leopard print shirt 

Kelly Bolhofner: on, um, I, I know , but I think that when you start dealing with C-suites, uh, you do it, it is a lot more difficult cuz you're, you're dealing with somebody like that.

Has a bottom line in mind and they have, uh, a lot of, they have a lot of dollars that, that go through, you know, go through their, their, uh, what they're over. And, you know, when you're talking two basis points, You know, you're, you're talking a lot of money that, you know, that they're, they're throwing out the window and, you know, so I, I get that, you know, that that's, that they're, they're a little bit more harder to deal with.

And then, you know, I've really not in my career, had any GPOs, that was what I would say hard to deal with. Um, you know, there was a, uh, Uh, one, one [00:20:00] person at a GPO. I was probably the only person he got along with. And so the VP that worked with that GPO. And every time he went in there to talk to him, he would be sure and take me with him because he knew that, you know, he would not.

Lay into us or, you know, talk, you know, talk to us and, well, y'all, aren't doing anything for us and you know, of course he's since retired, but, um, but yeah, I mean, I it's, it's really just, just, you know, uh, I'm not gonna, I'm not gonna be mean to anybody. You know, I, I, I might, uh, tell 'em how nice, which, you know, in, in Southern that's, uh, not, not very nice, but, uh, but yeah, I mean, it's, it is difficult to deal with some of 'em sometimes, but again, you're dealing with millions of dollars.

So I. 

Mike Koelzer, Host: Well, I imagine that when you're dealing with community pharmacy versus hospital, and so on a lot of times you're dealing with the owner who, for sure doesn't want to give away basis points, but in their head, they're also thinking, okay, there's basis points, but there's also decisions that are. Maybe not down to personalities, but maybe almost.

I know that the driver from this company has a good reputation and he's early. And I know that it's a pain in the ass dealing with this wholesaler as far as returns go. And this and that, it's kind of on a personal level. Still. Not that you want to give away basis points for that, but you might say, you know, I'm only giving up some bucks a year for this kind of service, something like that.

Mm-hmm whereas you start probably going up the chain of command. Executives at a healthcare organization, IDN or whatever. They're not seeing people quite as much. They might get some of the pharmacy staff bitching at 'em once a quarter during a meeting or something like that. But the bottom line becomes a lot more important.

And I guess maybe that's why, you know, they say customer service goes down as your company starts getting bigger, unless you have a very tight schedule. Control of it, or it's part of your organization, you know, Amazon or Zs or any of those kind of things, but, you know, money talks a 

Kelly Bolhofner: A lot. Oh yeah. Money does talk and, and that's, that's the other thing that makes the health system different is, you know, a lot of times, like with Ozzie, with the independent pharmacies or the, the pharmacy groups, you, you are dealing with an.

You're dealing with somebody that, you know, it's, it's their, their money. Whereas, you know, when you're dealing with a health system, you're, you're not dealing with an owner, you know, there you're dealing with, with somebody that answers to a corporation that, that, you know, that, that, again, it becomes a lot bigger.

Dollar amount. And you know, those dollars mean a lot. And I mean, not that it doesn't mean a lot to the independent pharmacy, but you know, they've got shareholders that they've got to, you know, that they've got to answer to and, you know, they have so many other people that they've got to 

Mike Koelzer, Host: answer to the owner, the money's important, but the buck stops here.

The owner can decide whether that money is more important or less important. And so on. For the executive guy. It's like, it's always there. 

Kelly Bolhofner: Yeah. Yeah. And it, you know, and, and again, you know, when you're, when you're talking about millions of dollars, two basis points makes difference and, you know, and, and if that's.

Where, you know, we're important because of that, you know, finding those dollars. 

Mike Koelzer, Host: So to speak as far as GPOs, how many are you dealing with? Are there a big three or a big one or big six or. 

Kelly Bolhofner: There's been some purchasing here and there, like, um, you know, notation bought me assets. Um, and I think a Marinette changed names.

You know, there's been a lot of movement the last few years, but, um, you know, if, if you're looking at, at a. GPO, probably the, you know, the bigger ones you've got, uh, probably about four you've got H PPG, which is, which is a health trust, a purchasing group. You've got premier, you've got notation and then inter layer or Marinette is kind of a smaller one.

But, um, but yeah, I mean, you're, you're probably looking at probably four to five actual big GPOs. 

Mike Koelzer, Host: I don't know a damn thing about the only thing I know about hospitals is When I worked an internship, my coworkers were a lot more grumpy in general. 

And maybe that's a good thing because you've got people that are their true self, you know, they're genuine self or they come to mourn and if they're grumpy, they're grumpy and at least you get their true self instead of fakeness, but there.

were [00:25:00] some Grumpy ass workers when I was in, when I was in pharmacy. Cause they can just come and be grumpy all day with retail. You might be grumpy, but at least some, well, maybe even more grumpy sometimes with grumpy customers, but it's almost like. Life happens. And you kind of get drawn out of your grumpiness but there are just some grumpy people in, in hospital pharmacy.

Kelly Bolhofner: Well, they're 

stuck in those little bitty rooms. 

Mike Koelzer, Host: Is that right? 

Kelly Bolhofner: You know? Yeah. I mean, you're looking at an inpatient pharmacy, you know, I. 

Mike Koelzer, Host: I've gone in inpatient pharmacies that are, 

Kelly Bolhofner: you know, 

Mike Koelzer, Host: no bigger than my closet, you know? 

Kelly Bolhofner: And , and they're, 

Mike Koelzer, Host: and they're crammed in there. And, 

Kelly Bolhofner: you know, 

Mike Koelzer, Host: they got this little desk 

Kelly Bolhofner: that, that, 

Mike Koelzer, Host: that they're having to, you know, do their orders 

Kelly Bolhofner: and, 

Mike Koelzer, Host: and stuff.

And yeah, I could see where it'd make you grumpy. 

the listeners. They're gonna say no, we have a good time. You know, we have our donut days and we do this and I I'm sure it is. Oh, They probably thought I was grumpy. So what, 

Kelly Bolhofner: yeah, they may have 

Mike Koelzer, Host: All right. 

Kelly Bolhofner: No, they wouldn't think you were grumpy 

Mike Koelzer, Host: I'm sure they would be right. So anyways, back in the hospital, it's not like they ship elephants to these people. This stuff is coming in like totes, right? Yeah. During the day hospitals just get a crap load of totes. Right? Exactly. And like you said, sometimes they have last mile delivery somewhere else. And then I imagine that in a big organization like that, you've got totes going to the pharmacy in the pharmacy.

People might be calling the wholesaler. Ozzie was part of the customer service 

Kelly Bolhofner: I was as well. Boy. Yeah. I was as well. You were too. Oh yeah. Oh yeah. It TAed you 

Mike Koelzer, Host: things. You know, when they talk about hell, they talk about the fires of Gehenna and stuff like that. And I'm like, all right, maybe symbolism. I'm glad I didn't put customer service in there.

You know? I'd be a Saint right now. If they said hell was going to work customer service. Is that a pain in the ass? Yeah. Oh yes. 

Kelly Bolhofner: Oh yes. People don't 

Mike Koelzer, Host: call you Kelly and say, Hey, just so you, what kind of day you're having? Oh, no, 

Kelly Bolhofner: right. No, they don't. They don't, there was this one, one customer. He was an independent pharmacy owner.

Every time he called, you know, you would tell him something and he would go unbelievable. 

Mike Koelzer, Host: he'd say 

Kelly Bolhofner: that every time. Uh, yeah, he would say it every time and, and, you know, he'd keep on blah, blah, blah. And then he'd, you know, and then he'd again, you'd get unbelievable. And so when, when he called in, we would make sure that we.

Real loudly. Well, Hey John, how are you doing? And so that everybody in the room would know that we had 'em and every time he said, unbelievable, we'd raise our hand. 

Mike Koelzer, Host: You mean he'd be incredulous? Like, I can't believe that this is happening to me. Oh yeah. Yeah, that's bad when you're known for that.

Cuz then it's a, it's a broken record. You don't listen as closely to 'em. 

Kelly Bolhofner: Yeah, definitely not. Especially when you start raising your hand every time he says it, 

Mike Koelzer, Host: unbelievable. 

Kelly Bolhofner: Sometimes in these agreements, what, what I, it would be what I call value ads, where, you know, you've got a wholesaler that, that does.

Consulting where, you know, they consult on a specialty firm, opening a specialty pharmacy, or a three 40 B audit, or you know it, and they will, they will add these in there to the agreement as, Hey, we'll give you so many dollars to, you know, for consulting. And, again, it goes back to hospital A and hospital B. You know, hospital A is totally different from hospital B.

You've got these value ads added in there. They really don't need to. Right. And you know, you're, you're gonna base the cost of goods on that. So again, that's, you know, that's something that, that we look at along with, you know, the pieces of how everything fits together, the line by line analysis. But also, are you gonna get, actually get something out of this value add, is it gonna be something that's gonna be valuable to.

Mike Koelzer, Host: Yeah, you gotta be careful when you're a company and you give a value, add to a company. That's just gonna say, well, I'm not doing that. You know, it's like with the wholesalers, they may be used to say, well, we also have free access to, you know, diabetes, this that it's like, well, I might do that a couple years from now, but I'm not, I know I'm not gonna do it soon.

So that, that just doesn't do anything for me. And I'm probably paying for it somehow. Exactly. And 

Kelly Bolhofner: that, and that's. Again, where, where our expertise comes in, in, you know, reading, evaluating, interpreting these, these prime vendor agreements that most, most pharmacies and health systems, they don't know, they just, oh, okay.

You know, here's my price. And you know, it looks good. I'm gonna make this savings. Okay. I'll renew or I'll sign. And. You know, that's not always a good thing to 

Mike Koelzer, Host: do. Well, that brings up a point about the value ads. Because if anything, that's a negotiating thing, you know, you can say, look, there's 10 value ads on here.

If you think these are important. And I don't, you know, there is money going to these, so what else can I get back if I'm not doing that? Exactly. So Kelly, this is for the whole hospital. So is this like gloves and all the supplies for everything? Or what kind of things did this [00:30:00] wholesalers do? Supply actually, um, 

Kelly Bolhofner: the wholesaler supply, mainly drugs.

Oh, mainly 

Mike Koelzer, Host: drugs. Okay. Or mainly drugs. It's not really those, the supplies necessarily 

Kelly Bolhofner: not necessarily. I mean, you do, you do have some of the wholesalers that, you know, like AmerisourceBergen for instance, that we worked out, you know, they carry a certain amount of gloves and, and things, you know, and, and things like that.

But, you know, most of those are handled by the supply chain. Agreements and the supply chain rather than the pharmacy agreements. Whereas, you know, they may have, uh, a different, different, uh, company that actually supplies 

Mike Koelzer, Host: Those once in a while I'd be in a hospital and I would see something, you know, either a Cardinal mm-hmm , whatever it was, a thermometer, you know, whatever.

So most of these hospitals they're getting all of their. Gauze. And obviously they're utensils for the surgeries and all that. They're getting these from a different hospital to the supplier. Usually 

Kelly Bolhofner: I know Cardinal has a certain. Branch is what I'll call it. That, that sells those types, uh, supplies. But you know, not all the wholesalers do that.

I mean, they focus more on pharmaceuticals. What actually comes. Through the pharmacy rather than supply chain stuff like supplies, like GS, they 

Mike Koelzer, Host: focus on actually what physically might go through the pharmacy. Exactly. Gotcha. So those crates are not going off to all these other parts physically of the building.

They're mainly going to the, to the pharmacy for 

Kelly Bolhofner: those. I mean, you may have, if, say they have, we touched on retail pharmacy, you know, if, if they've got a retail pharmacy in there. Their lobby, you know, you'll, you'll have some totes that will go to them and then you'll have some totes that will go, you know, to the inpatient pharmacy.

Sometimes they have it delivered all to the inpatient pharmacy and they take care of getting it out to the cancer center or whatever, but gotcha. But it's mainly just going to that, that pharmacy. But I 

Mike Koelzer, Host: imagine you have connections at these places. Yeah. Not a connection, like a sweetheart connection, but I just mean a connection, like you know who to talk to for these.

So the variable there is usually the hospital. That's the person you don't know. So well, normally, right. I mean, you get to know them, but they're not people that you're dealing with year after year. They might be a newer 

Kelly Bolhofner: relationship in what we're doing. Yes. But of course, you know, Ozzie and I both being that we've, we've been doing this for a cent, you know, quarter of a century here.

Um, collectively, I guess you started when you were four. Exactly. I was four years old. I didn't know. 

Mike Koelzer, Host: They, yeah, , that's probably why you didn't do too well in customer service could be people chewing your ass out as a four year old. 

Kelly Bolhofner: So, you know, we've, we've certainly got, got relationships with, with customers that we've built throughout the years.

I 

Mike Koelzer, Host: Oh customers too. Yeah, the hospitals and that. Gotcha. 

Kelly Bolhofner: Yeah. So I mean, we have had those relationships. Uh, I worked not only with pharmacy directors, but you know, I worked with some C suites and, and some of the roles that I had throughout the years. So, so we've, we've got relationships in there that, you know, can.

Mike Koelzer, Host: When finally the signing goes down, you know, at one of these things, I mean, in our pharmacy, when I finally sign one of these, it's like, you've already seen this. You're just signing it. But when actually these go into effect, and is this like a DocuSign kind of thing? Or are you sitting down like this?

Eight people in person to sign one of these things for a hospital, some are bigger, some are smaller. 

Kelly Bolhofner: You mean the actual, the actual prime vendor agreement? 

Mike Koelzer, Host: Yeah. The actual agreement. Is it just someone signing off on it or is it more of a, is it almost like a closing on a house kind of thing? It's not that big of a deal where you have attorneys for both sides and all that crap, right?

No, it's, it's smaller than that. Yeah. 

Kelly Bolhofner: Yeah. I mean, it's like a DocuSign. I mean, I mean, it's, it would probably be pretty much like, you know, what an independent pharmacy would do. The only thing is the owner is not signing it. You know, you might have a CFO or a CEO that's 

Mike Koelzer, Host: that signed it. It's not a huge thing.

Not like closing on a house. It's not like clothing in a house. No oncology. Did you do any of that at the wholesalers? 

Kelly Bolhofner: Um, I didn't, I didn't necessarily focus on oncology because at the wholesaler, you know, it's. Holistic. Um, I did work very closely with, uh, and with the, uh, the oncology team and, and Dothan that, that, that, uh, mayor Schwar had.

And, you know, I worked a little bit with them, just, you know, bringing them into certain situations within a health system, but, you know, I didn't specifically focus on anything oncology. So 

Mike Koelzer, Host: Who do you sell to with your oncology Nutri? 

Kelly Bolhofner: Mainly [00:35:00] oncologists. How 

Mike Koelzer, Host: Does that make your life different from what you've done?

I mean, you've always kinda worked backgrounds. I worked in sales. Oh, you did? What are you doing? Calling them on the phone. 

Kelly Bolhofner: Yeah. Yeah. Calling them on the phone, sending them information, calling, uh, sending them emails. Um, and actually we just signed an agreement with Texas oncology and, uh, us oncology, which us oncology is actually the.

McKesson GPO for oncologists. It's kinda like the eye. So we just signed an agreement with them that we will, will actually have them adjust their protocols within each of their practices that will have onco bites as part of it. But they will also have access within their, their actual practices for ACO bites and they will be able to get, uh, pricing a special price from their, uh, their wholesaler from us 

Mike Koelzer, Host: oncology.

They would order it just through their wholesaler. Yeah. Sales, I mean, I don't know. Pharmacists. Aren't really good at talking to doctors. It's just like this, this thing, you know, and even if they think they're doing well, then one doctor kind of slaps their hand and then they kind of go back in their shell with that.

Do you catch these people during surgeries? And it's like, Hey doc, Uh, I know you're replacing this guy's , you know, liver, but Kelly's on the phone. I mean, how do you, when you say you're talking to him, you're actually like chit-chatting with the doctor. I don't wanna make it sound like it's a, uh, a movie star you're trying to get a hold of.

I just mean, it seems like I assume it's on the phone. You're not probably going around to these 

Kelly Bolhofner: places. Well, of course right now I'm not. Yeah. But, uh, but yeah, I mean, and it's, it's mostly. Talking to, you know, their nurses, their nutrition. Gotcha. Okay. Yeah. Um, and, and, and, you know, building those relationships with them.

Yeah. And, you know, I have, um, The company I worked for after leaving AmerisourceBergen, we did a lot of, uh, multi-channel engagement, understanding how oncologists engage with their patients or not their patients, but their, uh, sales executives and stuff. And, you know, and a lot of it was through podcasts through oh, okay.

Um, you know, through just reaching out emails, those type things. Yeah. So, you know, as far as, as a doctor, You know, it's, , it is kind of like getting in with a, with a, a rock star. Uh, it does have its challenges, but, um, it's more of talking to the nutritionist. 

Mike Koelzer, Host: If you're not having those conversations with the doctors, the doctors probably aren't having those with the patient, it's gonna be the nutritionist and things like that.

Right. 

Kelly Bolhofner: It's gonna be the people that actually work with that doctor that, you know, like you said, the nutritionist. For, you know, the nurses and, you know, obviously the doctors have to have a buy-in as well. Yeah. And, you know, and that's, that's when the inservices we have, with every single, you know, with all of our, our, uh, customers and talk about here's, how to introduce bites.

And then we, we also have, you know, a number of things. Like popup tents or, you know, whether it be a, a brochure or whatever that the patients can pick up while they're there and they can actually ask for it. Um, and then of course, you know, we do a lot of social media and stuff like that. Recently.

Mike Koelzer, Host: I just heard this, that the world revolves around money. I never knew that before really. I imagine that if the doctors can bring some of this back into their group with the Al bites, they can say, look now your patient's number one. They don't have to go out and pick this stuff up somewhere at one of the grocery stores.

They don't have to have the trouble of doing that, but also this money can stay in your. System B and then, and then you have a little bit more control of actually what they're getting. If there's a new product or something that's gonna help them more, it's gonna be more beneficial. So it's kind of a win, win, win for everybody.

Oh 

Kelly Bolhofner: Yeah, definitely. Definitely. And, and especially with the agreement that we just did with Texas oncology, where they will actually physically have it in. Their practice. Oh, they will. Yeah. They will actually have it in their practice. They'll have, uh, where they can give it to their patients, whether it be a sample for them to take home, see how they like it.

Which of course, you know, we've gotten enormous feedback right now. It goes based on taste sensitivities because you know, that's another thing when you, when you're going through chemotherapy, you have different taste sensitivities right now, the product is, is, uh, that's out is focused on the spice. Taste sensitivity.

We've got one coming out. That's a peanut butter chocolate chip in, uh, Q1. So it should be coming out any time. That is for the sweet. And then later on in the year, there will be one that is a lemon tart. That'll be that [00:40:00] sour sensitivity, but. They will actually physically have these within, within the, the practice that the patient can get them there.

They'll be able to get it on the practitioner's website. Uh, the practitioner will be able to get it from. The wholesaler from us oncology. And of course, you know, that price is not just, you know, the US oncology deal. Um, it, you know, is open to all of us oncology members. So it's not, it's not just Texas oncology.

It's just that we've got this specific agreement with Texas oncology right now that, you know, and of course we're working on it for, for a number of. Customers as well. 

Mike Koelzer, Host: Yeah, my mother-in-law said if I ever get this breast cancer again, I'm just, I'm not gonna go through with it cuz she's, you know, now it's, it wouldn't be worth the payoff probably with the pain versus the extension of life.

But oh, if I ever got cancer, it's like the one thing that would be a big decision factor would be frankly, my mouth. I mean cuz pain. Kind of control. You can try to control, but eating and throwing up and the taste of stuff. Yeah. And that taste in your mouth and all that. If you can solve some of that, that's a pretty cool thing.

Uncle bites, uncle bites. So, Kelly, what kind of people would you ultimately like to have here, and let me ask it a different way. Who would be the main person that would decide to. Call you would be one of those executive peoples or would it be someone in the pharmacy who says, look, if we ever do this again, why don't you call up Kelly?

Because she can make sense of all this pharmacy crap or stuff like that. Who would be good hearing this from you right now? I 

Kelly Bolhofner: think ultimately it would be a CFO or, you know, uh, somebody in the safe suite. However, um, that said, you know, not that the pharmacy director pharmacy has. Say, I mean, I, I know that they have some of the say in, in wholesaler choices, but, um, you know, I think that, that in some cases it, you know, it could be a director pharmacy that that would talk to their CFO that has a good relationship because ultimately, you know, that director, pharmacy answers to them on their pharmacy budget.

So, you know, the fact that we can help. You know that line by line analysis and help them know what, what they would really save, what they could save. And it ultimately comes down to that. That director of pharmacy is directly affected, uh, affected by what their pharmacy spends. So, I mean, obviously he would want to bring down the pharmacy spend.

I 

Mike Koelzer, Host: don't know anything about hospitals, but it seems like the director of pharmacy, you talk about those intangibles. You know, like if the pharmacy director could say, look, yeah, we saved this. We saved a thousand bucks. But if this order comes at 7:30 AM and others come at 10:30 AM, we've just missed the whole thing.

Whatever, you know, mm-hmm, the whole day's cycle of whatever people cycle at a hospital pharmacy, you know, so we could basically, we could reduce the day's inventory, especially if it's Monday morning, if we're able to get this versus Tuesday morning, there's a whole week cycle of. X Y Z or whatever, you know?

So it seems like if there was a decent relationship between the pharmacy manager and the CFO, it seems that there could be some value in that. 

Kelly Bolhofner: Oh yeah, definitely. Definitely. You know, especially when, you know, when you've got these director pharmacies that sometimes they're bonuses or they are directly compensated for the amount of money that they save.

And, and if they're in. In a, um, meeting with the CFO or with the C-suite and, and they're asking them, well, why did you spend this amount of money? We need to, to look, you know, we're looking at another wholesaler or whatever that director pharmacy could say, well, I get that. We need to reduce this. So why don't we look at SRG?

That they, they will evaluate the entire picture and not just look at, you know, not just hands it's a piece of paper and say, okay, well, here's what we can save you, you know, it would benefit the director of pharmacy for us to come in there and, and negotiate that. And you know, you saying the deliveries, that's another piece that a lot of times is.

Negotiated in that, that agreement that they're gonna be there within this certain amount of time. So that's some other pieces that are in those agreements as well, is those delivery pieces. And you know, you're, you're talking about, like you said, days that if, if they're getting their delivery at 10: 30, you've missed a lot of that, sending it out on the floor or whatever.

Mike Koelzer, Host: If I was in an organization, I would [00:45:00] always like, if I could to have someone like you, Kelly, kind of my consultant, because then you help to save the money. You take a percentage of the savings mm-hmm but then. They can blame you for stuff. I mean, like my stuff, I can't really say, well, I had a consultant.

They're like, what? I can have a consultant, you and your buddy that you go to breakfast with. We know what Dave said, you know, this kind of stuff, but you guys, instead of saying, we kind of don't have a real good handle on any of this. We can say, ah, we just hired the wrong person last year. We're gonna do this this year.

You know, it's simple, simple to blame someone. Well, Kelly, it's a pleasure talking to you. Glad we got you on this side and Ozzie, on the other side, talking about SRG, all the good things that you guys are doing there, complexities. Yeah, for sure. It's confusing all over. So yeah, definitely. Let's not incentivize or reward the wholesalers any longer for putting up the smoke and mirrors or whoever's putting the smoke and mirrors up.

Exactly. Those days are done. They are, let's put an end to that and bring some clarity to this. And we've seen it across the world, you know, with what are the different crews? What's that group of, uh, you know, the women in Hollywood. What's that one? The view called now a no, no, not, not those old Farks no, um, what's the one with the, the women that, you know, the, they were abused and oh, the me too move.

me too. Yeah. I mean, me too wouldn't have happened, but without a group of people financing, Hey, we know what's going on. Yeah. We have a bunch of people with phones and communication and things like that. So it's time to step up to the wholesalers, the PBMs, anybody else that thinks they can pull the wool over people's eyes nowadays, you know, this is 2021, you know, and those days are done.

So let's get the word out. Keep clearing this stuff up. The obfuscation that these wholesalers are doing are PBMs. We're not gonna solve that overnight, but at least can pay a small fee to somebody who knows all these tricks and come out ahead. And in the meantime, everybody can help clear this stuff up a little bit.

Yeah, exactly. So exactly. All right, Kelly. Nice talking to you. All right. Nice talking to you. Thanks. Take care. Thanks. Bye-bye bye.