Scaling up Pharmacist-Patient Relationships | Tony Willoughby, Stellus Rx

Transcript Disclaimer: This transcript is generated using speech-to-text technology and is intended to capture the essence of the conversation. However, please note that it may contain multiple spelling errors and inaccuracies. It should not be relied upon as an exact or comprehensive record of the discussion.

[00:00:15] Mike Koelzer, Host: Tony, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

[00:00:23] Tony Willoughby: I'm Tony Willoughby, I'm founder and CEO of Stellus Rx. I'm a pharmacist by training. Been practicing for a lot of years now and have grown up in different strategic operations roles across my career. And about seven years ago, I decided I really wanted to focus on how to change the patient journey that I felt was being mismanaged.

Today what I wanna focus on is just sharing our story and the evolution of what we've done well, what we've learned along the way, and what we continue to strive to improve.

[00:00:52] Mike Koelzer, Host: You've been in the dirt with a lot of employees in the past, meaning not up in the clouds. You come from a position of knowing what needs to be fixed instead of some of these new handheld apps that pop up and people think that pharmacists are a bunch of idiots and we're gonna show 'em how it's done.

And they raise a billion in capital, then they go down to zero. But you've been there. You've 

been there.

[00:01:17] Tony Willoughby: there. As we started at Stellus, one of the things that I did is when we first opened, I was a pharmacist behind the first counter.

And then when we first went into the exam room, I played the role of pharmacists in the exam room. When we packed our first patient, they didn't let me do that anymore 'cause I'm not any good at it. But I packed. Some of the first patients because there's authenticity. Mike, that's really important.

This conversation is not a prepped confidence monitor conversation. I always think to show up authentic for a patient, for a stakeholder is really important, and it's hard to show up authentic if you're 180 degrees away from what's actually happening.

And so that's always been really important to me.

And I think sometimes, as a business founder, you spend a lot of time thinking, what if I would've started earlier? And then I go, no, there's a right time for everything. Because all those experiences shaped the purpose of the journey that Stellus is on.

[00:02:18] Mike Koelzer, Host: Tony, I know You've got some standing pharmacies. I think you do some things at a distance. What's your percentage basically of each of those 

[00:02:29] Tony Willoughby: we have two core products. So let me start there and then I'll get to that.

 So one product that we have is the medication adherence monitoring service, we work with medical groups that are in risk contracts and we ingest claims data in a star Medicare stars reporting data. And then we scale the primary care clinic, the risk bearing medical group by reaching out to patients that help discover what's causing the gap in adherence and close that gap.

In that product, we're not dispensing Our other product is our engaged product. This is where we work alongside the physician to co-manage the patient with chronic disease states. We dispense in that model and we have retail locations that are the service locations for those clinics.

And then we have a central fill from a scaling mechanism. To help back office, some of the work for those smaller retail locations. And then those locations are the point of sale, if you will, either through pickup or we do a lot of courier work as

well. 

[00:03:40] Mike Koelzer, Host: On the side of your business that you're filling,

 How far do you go?

[00:03:47] Tony Willoughby: As we speak today. That's in Texas and Oklahoma.

 As we grow, we will expand that. Up until last year we were a captive service, if you will, where we were supporting one primary large a c o medical group.

 After we had performed, we had done a proof of concept with another medical group within the state.

We recreated the same results. Did really well, had a lot of folks say you might consider expanding this. And that's when we rebranded and started moving out nationally. And we started with our adherence product because it's simpler to scale and it's less change management for the physician groups.

And then a fast follow is our engaged product today. Again, that's Texas, Oklahoma. Over the next six to eight months, we'll probably be in about 30, 30 states and continuing to grow. 

[00:04:42] Mike Koelzer, Host: Tony, revenue split. What percent of revenue are you in the first part of your business versus the other side of your business?

The second part, roughly.

[00:04:55] Tony Willoughby: Yeah, from a services revenue, it's probably 70-30 product one versus product two. Once you add dispensing in that because of the unit economics of the dispensing, that changes that,

That mix. We see ourselves as a tech enabled service business with [00:05:15] dispensing as a component of one of those services.

we have the ability, you mentioned this earlier in, in your lead in, We have the ability with the products where we could be a SaaS-based entity. I just don't think SaaS-based groups are the answer right now because we continue to put SaaS-based point solutions in the marketplace and they don't perform the same way they perform when this.

The services provided along with the tech. So I think that is a path. It was a frothy market for quite some time for those applications, but right now we've, we think of ourselves as a value-based care services business that uses tech to enable the patient experience and scale.

[00:05:59] Mike Koelzer, Host: Yeah. And just for any listeners that are less informed than I am, I doubt it, but just in case. So the SAS is an online program. Then you can do it from the computer and your handheld and things like that. And what I was referencing early, Tony, as you and I nodded an agreement, is there's these companies now, you'll see 'em and they'll have a handheld app that will be something like delivery or something that your local pharmacy's doing, and they've got like a billion dollars in funding.

 And some of them then just flop. And it just amazes me, I think that these Investors come in and they think we're all out of, Mayberry or something without being part of the business. And even as you're saying, Tony, deeper into the relationships, it falls apart.

[00:06:51] Tony Willoughby: Yeah, I think what you saw in a lot of those spaces is there just wasn't a full understanding of the pharmacy business by the marketplace. The pharmacy business has not been one fast to iterate. Most definitely. The unit economics on the traditional, what I'll call count, stick, lick, and pour has been degrading for years.

And so folks are looking at how to drive top line revenue. And capture market share without a clear understanding of the economics below.

What has been really important to us is how do we use technology to gain intimacy at scale? How do you scale relationships? Because ultimately what drives patients' decisions or behaviors or changes in how they approach their health or what makes them their own superhero because they feel like they've got the answers that they need is trust,

Right?

And trust is built over time through a one-to-one relationship. It's not a one 800 dial a pharmacist or log into a pharmacist or chat a pharmacist or a technician, right? It's gotta be more longitudinal in 

nature. And so that's where we've tried to differentiate at Stellus, is on the patient experience and then measure ourselves with outcomes Being a captive service.

For five years, five or six years of our existence, we were able to build a lot of stories. 

And story is what humans run on, right? We were able to create success stories, compendiums of success, stories of patients having a better experience, a better quality of life, clinical improvement, and ultimately total cost of care improvement.

Because if your employer's spending less on your healthcare, they can pay the employee more. If the patient's spending less on their healthcare they're happier because they're spending less and they've got dollars to invest in other parts of wellness or total health, right? And so I just think a lot of the early pioneers and kudos to them for taking value attempts out there.

So I don't critique that. I just think there's a, obviously we feel there's a better way to use technology to enable relationships compared to some of what the early digital marketplace attempts have been.

[00:09:19] Mike Koelzer, Host: Whenever you hear of mail order, I know that's a small part of your business and you do it in order to keep the relationships going. But the old answers that pharmacists gave off, mail order, terrible Because you can't do this, and this, which you can in a store.

But unfortunately, that gets to be a little bit like a blockbusters method of saying people love it this way. But it seems what you've done, Tony, is you've put to bed that easy excuse to say, we're in person and online stuff is no good.

You've molded that together so you're not throwing out the baby with the bath water 

[00:10:02] Tony Willoughby: Yeah. A couple thoughts that come to mind. One, I wouldn't classify us as mail order because we deliver to our patients versus carrier mailing to patients. 

[00:10:13] Mike Koelzer, Host: But Will, that change though, when you're [00:10:15] in 30 states?

[00:10:16] Tony Willoughby: not necessarily, we will expand our retail footprint as well 

as we go. And, and we've net networked with the right partners so we can courier

[00:10:28] Mike Koelzer, Host: I gotcha. I gotcha. Very good.

[00:10:31] Tony Willoughby: But then digging into the relationship of why we can't and mail order isn't relational, and I would say most mail order call centers are not relational.

 I won't fight that. When we first started you talked about humble beginnings. We had a business proposal that was five PowerPoint slides. We bought a pharmacy and we took the pharmacist who'd been in this clinic, pharmacy in this practice for three or four years, still with us, seven years later, who is now our director of clinical practice.

Awesome lady. And because we're really great to our team members, we said, here's our business plan. I need you to go sit in this sample closet in the practice and talk to patients after the doc finishes with them. Groundbreaking. And so we started early on where we had pharmacists embedded in the practices.

And that works in large practices. Think about academic teaching centers or large, multi multi-discipline practices. But as you start growing in a centric circle way, and you've got one or two docs or one or two providers, that gets really hard to scale.

So we ran a test to centralize it and start doing that relational handoff virtually.

And we were scared that because our purpose is so ingrained in relationship and to your point, we've got the relationship at the 

counter. I can talk to people face-to-face and know the T-ball teams and what the soccer team's doing and really relational care. We were worried that it would erode the relationship

And we found out that it didn't. It's less about standing across 18 inches of counter and more about. The depth of the conversation

 and the consistency of the conversation. ' I would argue that many times in that 18 inch relationship across the counter that the relationships aren't deep

 and the pharmacist is being pulled so many different ways and just distracted that in that moment that they are with that patient, how present are they?

And what we found is we've got relationships even when this is not what most pharmacies try to do in their business, but we try to get patients off their medication over time. We have patients that no longer take medications but still call their pharmacist each month.

Because they've become a trusted advisor, because they've taken the time and created the space.

You can, in our model, you can create 30, 45 minutes and you can have the time to listen about the wedding they're trying to make it to, and the graduation that's important to them because there's not another prescription

waiting, there's not somebody dropping their keys on the counter. Pharmacists will understand that, 

right?

Trying to get your attention because for that moment in time we talk about moments that matter for that moment in time, that patient is the only focal point for that pharmacist and they just, they build robust relationships through that. And so we were pleasantly surprised and emboldened by that.

And we've done video chat. Video chat does personalize it because you can see body language and. Sometimes people want to talk to you on Friday morning before they comb their hair and they'd rather just talk on the phone or a asynchronously chat back and forth and you can build relationships,

[00:14:04] Mike Koelzer, Host: And you have all those options, Tony people will be able to video or whatever.

[00:14:08] Tony Willoughby: Correct. Yes. And then we also found that during covid it was a step function change in the attitude of the patient. Because here to four, they were seeing their medical provider in a brick and mortar

and then interacting with us in a different channel, in a virtual channel. But all of a sudden when they started seeing their medical provider in a virtual channel, it became, okay, this isn't different.

This is the same. And so now if you think about the virtualization of medicine, there's a laying on of hands and there's a hybrid approach to that. But most pharmacies I go in, other than giving vaccinations, we don't do a lot of laying out of hands. We've seen strong success in building long enduring relationships with patients in virtual formats.

[00:14:57] Mike Koelzer, Host: if you do virtual right, by its nature, you have a longer lifespan because you've got people that are, moving 20 miles away or they can no longer get to the pharmacy, or, the [00:15:15] pharmacist who's there is moving 30 miles away somewhere else and those relationships, potentially.

In a perfect situation, potentially somebody sitting there with you might be better . That might not last time-wise because of just the changes in people's lives.

[00:15:31] Tony Willoughby: I've been married 27 years. Got married very young. I'm from Kentucky. It's allowed there. But I can remember my first date with my wife, but I also remember that first phone call

that lasted two or three hours 

and how the relationship changed on that, because neither one of us was nervous if we had food in our teeth or if we were looking each other in the eye, and just the vulnerability and the openness.

And so we talk a lot about the first phone call with our patients and truly just listen. It's not about proximity, it's about listening, hearing people, understanding their beliefs, what's important to them. You don't have to touch one another.

To build depth

there. And so we find that is so true in the initiation of the relationship of how do you show up and listen,

 hear what's important to the new relationship, help them solve something early that they want to solve, not that the textbook wants to solve. That's what we see as foundational and launching relationships.

[00:16:39] Mike Koelzer, Host: I've got a guy in my business, he's my right hand guy, and we are sometimes working in a room apart from each other. And more often than not, 80% of the time, I am sending him a Google Chat. It gets my thoughts together.

I spent a minute writing 10 words. It gets my thoughts together and I'm not interrupting him, which often decreases their acceptance of it. He's looking at my chat when he's ready and open to accept it, and so I would argue we have better communication with this Google Chat going back and forth.

Then I would if we stood face to face, because I might be looking at him and he might be looking at me, but they have no idea where our minds are.

[00:17:35] Tony Willoughby: It's context, right? And people need time to process context

and so, so we find that our initial conversation, we do some pre-work before our initial conversation to allow. Context to build. All of our teams are fully integrated into the E M R of the practices that they serve. So before we reach out to patients, we're going and looking at the patient's history and background because we want to show up and make the patient feel known.

You know how frustrated you get when you go to the physician's office and you're filling out the same paperwork all the

time? You spend 90% of your appointments repeating the past history that you've already repeated to somebody else versus getting to the new thing you want to

discuss. So we spend a lot of energy on preparing before the initial consultation to get to contact. Then we have that, and then there are some people who do really well with asynchronous chat to continue the communication because some folks. That's how they process best. They want a moment. And that's not in judgment of processing speed, it's just we do better sometimes when we have a second to be thoughtful

So if you think about the typical patient experience when you go to the doctor, if you're a chronic condition, patient, diabetic, patient, hypertension you're a little anxious before you go because you may be getting updated labs, something new is bothering you.

You get to the practice 30 minutes before you get roomed, maybe within 10 to 20 minutes, and then the MA asks you some questions. And then the physician comes in and you may have 15 minutes with that physician asking you a few questions, validating what the man did, some laying on of hands. And then in about the last 90 seconds of the appointment, here's the plan, here's what we're gonna agree to do.

And for those patients, it usually includes changes in medications or new 

medications. And invariably the last question that the physician will ask is, do you have any questions?

And my hypothesis is, 90 odd percent of patients say no

, they can't process. I can't process it. I tell this story all the time, and then I find myself at the physician's office and they ask that I'll get to that point.

1. And I'll just start dying to laughing. I'll go, no,

Because there's just so much that's been onboarded and, but then by the time I check out and I get to my car, I've got a [00:20:15] cascade of questions right? Then you start Googling, right? You start Googling and you're scared to death at that point.

 Then you go to the pharmacy and from the staffing model and the constraints that they have in place, a clerk's gonna come over to you, tell you it wasn't covered, or they haven't gotten it, or it's not ready, or there's a shortage. And if you stick it out, you'll come back and the same clerk will ask you, do you want to talk to the pharmacist?

I also have a hypothesis in my experience is like 5% of the population says yes,

and then if the pharmacist makes it over, and this is a horrible caricature, but it's the reality because of the other constraints and compression. They'll ask if you have any questions and at best they're gonna. Pull out the bottles, turn 'em sideways and read the warning labels to you.

 And then we wonder why people go home and ask their hairdresser if they should take this or not.

 That experience, when I talked earlier in the conversation when we launched about talking about how to improve the patient journey and the journey impact,

That is what I'm talking about. That just seems like we take better care of toothpaste and toothbrushes from Amazon than we do patients' medication journey experience.

And it's not by bad intent. There's no physician that goes to practice. Being a physician that says I want to be on a fee for service treadmill, that gives me less time to be attentive to my patients.

But they have one more exam room to go to and there's no pharmacist I've interviewed. Tens of thousands of pharmacists, and I've never had one tell me, oh, I want to sit at the computer and not talk to anybody all day, or I don't want to 

help patients. I spent eight years of advanced schooling not to talk to patients,

 but yet that's the environment that we create. It's ludicrous. 

[00:22:13] Mike Koelzer, Host: I was thinking when you're talking about the the doc, asking if they have any questions, I once heard that you can tell if somebody's interested in you, if there's like a group of four people is the people that have their feet. Pointed at you are interested. The people that have one foot pointed at the door are not.

So I was just picturing most doctors, have a foot pointed to the door asking If you have any questions, 

[00:22:38] Tony Willoughby: They have to. And that's why we have focused Working with physician physicians in value-based care arrangements because they have better economic opportunity to not just run to the next exam room, The fee for service volume treadmill is diverted into a total care environment and that payment structure it's the payment structure that gave me hope and what drove me to leave a role I thoroughly enjoyed before starting Stellus there wasn't an economic model for pharmacy then when we started, but here's some foundational components that could create an economic model for a different way to approach pharmacy and medicine.

[00:23:26] Mike Koelzer, Host: Tony, the side of the business that you're getting paid for services, how much of that would be cash pay versus insurance pay?

[00:23:37] Tony Willoughby: I would say 90% comes from the risk bearing medical groups 

[00:23:41] Mike Koelzer, Host: So it's from the group. So they might get an insurance payment, but the part you are doing is you're like siphoning some of that payment off from them. So you're not billing the insurance directly, but they're giving you money and the reason they have money to give you is because they've billed an insurance for 

[00:24:03] Tony Willoughby: yeah. So as a captive service, we would go to the payers because I was both representing the medical group

And the service, and so we saw those as holistically. And so in that phase, I would say, It was coming from the insurance as we started to scale.

The pivot that I made is the players are all aware of us. We've got good relationships with the health plans. They see the value in what we're doing, but ultimately they're passing risk on. And so when I think about the activation of the patient and the activation of the physician, I wanted the client to be the one that's ultimately holding the risk

At the end of the day.

And so we pivoted that probably 24 months ago. We do some direct payer business and do some gap closure and so forth when they come to us because they know us and they understand the work that we do. But it just made sense to me and people would disagree that if risk is being delegated and go to the last line of defense where that risk is actually felt to put in solutions.

Call it the medical group or the health center, or the physician network [00:25:15] aggregator. There's a lot of different flavors of that, but ultimately it's that group.

[00:25:20] Mike Koelzer, Host: Basically their risk is how much money the patient's gonna cost them. 

[00:25:25] Tony Willoughby: It's a balance of cost and quality.

Even if a medical group saved millions of dollars on a group of patients, if you're not providing quality, you're not accessing that because that's ra, that's rationing, that's not what you 

[00:25:38] Mike Koelzer, Host: It's the cost in the best sense of the word, whether they're fulfilled and all that. But ultimately if they don't do it right, it's gonna cost them even more money.

[00:25:48] Tony Willoughby: Correct. Yeah. It's gonna cost the government more money, the employer more money, the patient, more money. The big cost driver is acute exacerbation of uncontrolled chronic conditions. 

.

[00:26:03] Tony Willoughby: We believe that medication is a cost effective way to provide cover as patients engaged and empowered behavior

Some medications are long term, but a lot of medications can be used midterm to give patients a sense of accomplishment within their disease status and start changing behaviors and seeing positive reinforcement to those behaviors.

And then ultimately, Use fewer medications.

[00:26:36] Mike Koelzer, Host: So let me picture this, Tony. There's a physician's office.

How many physicians are there? Let's say I. Per pharmacist's head. And then tell me again, is that pharmacist at the initial appointment , are they physically in this group of physicians?

[00:26:58] Tony Willoughby: The pharmacists work panels of physicians and they work panels of patients. So once a physician's connected to a pharmacist , that's his or her pharmacist, there's crosscheck training and cost coverage. And then once a patient is connected to a pharmacist, that's his or her pharmacist, so you create this triad of physician, pharmacist, and patient.

And 

 What you get is this trusted advisor.

Interdisciplinary team to use an old term, that knows each other, has trust in each other and it turns into some really beautiful story

creation. So those ratios, not to avert the question, Mike, but they vary. So if I've got a physician that is a heavy utilizer of the service, then that pharmacist can handle more patients because they're only in one E M R, they're with one 

physician. 

So the capacity kind of waxes and wanes based on that. But we have pharmacists that manage upwards of a thousand to 1500 patients.

[00:28:09] Mike Koelzer, Host: Really.

[00:28:10] Tony Willoughby: Yeah.

All our pharmacists are virtual.

[00:28:13] Mike Koelzer, Host: They're all virtual and it's not necessarily a direct handoff. If the patient goes and it's nine o'clock in the morning, it's not like that virtual pharmacist is waiting on the other end of the screen at that point. 

[00:28:30] Tony Willoughby: Sometimes they are. We've gone through a lot of iterations 

of the handoff, right? Because that, that the handoff, the stewardship of that, we call it the transference of trust from the physician to the pharmacist is 

really pivotal.

[00:28:45] Mike Koelzer, Host: Cause you mentioned that earlier.

[00:28:47] Tony Willoughby: yeah. we do have some practices that have what we call kiosks, where they'll bring a digital device into the exam room, and if they want to talk to the pharmacist, they'll hit a button and the pharmacist will pop up on

screen. Yep. That's a quick introduction. We're not doing a complete assessment because you would destroy the physician's workflow and the patient's experience at that point,

[00:29:16] Mike Koelzer, Host: It's a personal handoff, but not necessarily deep, but at least 

it makes that connection.

[00:29:21] Tony Willoughby: Or the physician will introduce because they know who their pharmacist is, and then we will get an alert either through a portal message or by receiving prescriptions that will trigger a real time outreach to the patient, either via text or phone call, etcetera . that sets up a connection point based on the patient's availability to meet that patient where they're at to do our first relationship building activities.

[00:29:48] Mike Koelzer, Host: So not only does the patient have the same doctor and pharmacist, but the doctor usually works with a specific pharmacist.

[00:29:57] Tony Willoughby: Yes. 

[00:29:58] Mike Koelzer, Host: Oh, that's cool.

[00:29:59] Tony Willoughby: Yeah. So that's where you really build trust because now the pharmacist is learning the physician's tendencies. What do they, what's their standards of care? What do they start with? Their new diabetics. They're getting to know each

other, right?

And we all have our [00:30:15] tendencies,

And What we react positively to and what we don't. And so it's like any relationship 

And sometimes there's some grinding of relationships and. We find that later on those become the strongest relationships because they've gone through some adversity or suffering together.

And that triad is one of the core things that we haven't seen done exactly the way we do it in the marketplace. And we think that makes a tremendous difference in the outcomes that we see.

[00:30:47] Mike Koelzer, Host: Almost all the people I've talked to, even if the pharmacist relationship is strong, I haven't come across or I, at least I haven't asked the right questions of having that triad going on.

[00:30:59] Tony Willoughby: Yeah, we see healthcare is a we thing, not an us and 

them. 

How many times have I shot? I've worked in pharmacies my whole life. That patient comes in, they're waiting for a refill. And the pharmacist goes, man, I've tried to get ahold of the doctor 

a bunch. It's their problem. Or how many times has the physician said, I've gotten 14 requests on this, I've sent it.

It must just be getting lost. Both have purity of intent, but it creates an us and them. And the poor human that's in the vice grip of that is the one that should be getting all of our attention, if you will, the patient. And so we try to coordinate to decompress, press the patient, and then I also hold and high stewardship the physician experience, read some of the burnout stats for primary care physicians in this country. It's hard, like this is the cornerstone of healthcare in America.

There was a study that came out last year, and I'm mad at myself for not remembering the Academy of Science that said people live longer who have a primary care relationship like the dad is there. If you have somebody stewarding your health in that position, it is better for you. 

Yet these women and men have been put on a fee for service treadmill with the documentation standards through the roof, and most of them see patients all day and then spend pajama time at night documenting these patients.

And so when there's a pharmacist at Acme Pharmacy that wakes up every morning and hits F 12 on the keyboard to generate the same refill request that goes through a whole process.

 On the physician side, that creates all kinds of workload.

When we first started, we studied that and we looked at patients on, what was it, three or more meds, this was years ago, but three or more meds. And they averaged in this one practice, 17 refill requests across the year,

And each refill request within the practice generated four to five handoffs.

So just think about that compression, there's a lot of large practices that are trying to figure out how do I create a refill center

In a moment where, just as it's hard to hire pharmacy technicians at scale, it's hard to find medical assistants

at scale

Like your hourly technical team members that are so important to the provision of healthcare.

Are in high demand, low supply, and our operating system doesn't make that work any easier.

And so that becomes a churning. But even that example of not having coordination just creates workload on both ecosystems. That's highly inefficient

[00:34:10] Mike Koelzer, Host: How many patients does each physician have with this program?

[00:34:14] Tony Willoughby: Once a physician has eight to 10 patients, They start getting the positive feedback cycle of the patient coming in and saying, thank you. This has made a difference. And so we will have physicians that we'll call engaged that have 10 patients, and then we have a couple physicians that are north of five to 600 patients.

Because once our physicians get engaged and they see the outcomes, they see the standard of care, it becomes like, I don't wanna practice medicine without this.

So on that point then, Tony if a doctor's using 500 patients for this, is it one per one, one pharmacist to a doctor, or is that pharmacist maybe have other doctors also,

have others at that panel size. They would have others as well.

[00:35:05] Mike Koelzer, Host: Tony, so you've got this rolling and usually when it's rolling is a time you think, boy, how can we maybe [00:35:15] duplicate this?

Because there's still headaches, but maybe the big headaches you've gotten through. At what point did you realize that the hurdles were low enough that you could expand?

[00:35:29] Tony Willoughby: Yeah, I would say we've had a lot of visitors over the years that would come in and look at our population health solutions in total beyond pharmacy and go, those are great. You guys are doing a great job, but that pharmacy thing's different. Can you scale it? It's always, that's really cute, but.

Can you scale

it? And so the first thing we had to figure out is could we, if we called our first medical group our lab, could we recreate the same results outside the lab? Every good scientist tries to test that. And so we did some pilots back in 20 and 21, and we proved that we could create the same results.

So that was step one: had you called caught lightning in a bottle and all the stars had lined and all the knowns and unknowns were aligning just the right way to create the results, or was it recruitable? Once we did that, we had to go, okay, how would you take the manual processes and the manual quality checks and the manual workflows and start introducing technology to to scale the sweat?

Grind, if you will, the grit component of your business. And so that's what we've started doing as we looked at those two products that I mentioned earlier, our adherence product and our engagement product. We started first by building our own technology around our adherence product so that we could have multiple medical groups with multiple payers, with multiple files, with a lot of data ingestion in a scalable way.

And then also as we grew that team that you had workflow processes that were sustainable and predictable. And so that was the first proof that you could do it outside the lab, second start building the technology for that tool. The next thing that we had to hurdle is how do you scale dispensing and what has become a commoditized business?

And we broke that last year. We got where it got really hard to hit service delivery times, we did it, but it was through a lot of discretionary effort on behalf of our teams. And so last year, throughout last year, and then the first of this year we launched in partnership. We launched a automated central fill here's where you would think about a central fill for a Costco or a Walmart or something how do you most efficiently from a qua cost and quality and compliance standpoint take things from big bottles to little

bottles, With a high accuracy rate.

So we went through that transition in Q one of of this year full of learnings like any big 

technology transition, both. For our teams, for our patients, for our physician groups. But right now my confidence has never been higher about our ability to get the right drug to the right patient at the right time because of that.

And so now what a lot of our work is done is how do we start building version two of the workflow technology and the patient experience on both of those products. So where the technology not just touches the pharmacist, but where it touches the patient to continue to scale intimacy with that patient.

Because I need the experience to be for 100,000 patients the same that it was for patient one.

And we've changed. And it used to be you called and you asked for me.

And every, every small pharmacy thinks about 

that, right? Like when I was at McKesson Leading Health Mart, a lot of pharmacies didn't want an I V R because they didn't want to, they wanted to be different that way. And so we always stress test what's the right experience for our patient and our physicians, and how do we scale that and meet the patients where they're at.

So it's almost become an iterative process. Not every, a lot of our dollars, we reinvest almost all of our dollars. We reinvest back into our product and technology to help touch that patient efficiently and effectively.

[00:39:52] Mike Koelzer, Host: Tony, 

What is the business structure as far as ownership, as far as investors, that 

kind of thing. 

[00:40:01] Tony Willoughby: We're privately held. 

[00:40:03] Mike Koelzer, Host: what is the ownership? You or

[00:40:06] Tony Willoughby: There's a small group?

Yeah. Of founders that own the business.

[00:40:11] Mike Koelzer, Host: How many.

[00:40:12] Tony Willoughby: Three.

[00:40:13] Mike Koelzer, Host: Three.

[00:40:13] Tony Willoughby: At [00:40:15] this point we haven't taken outside dollars. We've funded the business, bootstrapped the business as we go along. At some point, we'll take on a strategic partner to support the continued scale, but we've been blessed at this point from a performance standpoint to enable us to continue to grow and reinvest in the company.

[00:40:35] Mike Koelzer, Host: Tony, what's your least favorite? 5% of your week, your least favorite two hours.

[00:40:43] Tony Willoughby: Oh, Yeah, there's some polarity in this. if you looked at my Enneagram, I would be an achiever and a pleaser, right? So when I disappoint or when we disappoint, that's really hard. And the polarity in that, and it's some of the most rewarding and ripe opportunities for learning.

So I find myself a lot of times when we disappoint a patient or a physician or a team member and they reach out like the first 90 seconds of that experience.

So if you coalesce, not that we have that many of them, but. That first 90 seconds of that experience, the first reaction is to tense up and go, oh man, why did we do that again? But then when you take a breath and know that growth comes through suffering it becomes part of the best week. I would say those are high tensile

moments. I like to create, and so some of the repetitive

Components can be tasky, 

but 

I think your attitude creates the good and the bad, this has become a mission and a purpose, and so I don't necessarily see it as work. It's a vacation and I love spending time with my teams. I'm a passionate leader. So I can get hyped up sometimes, we do all hands meetings in our company and every time we do an all hands meeting, we do 'em, we do these town halls weekly, but then we bring everybody together once a quarter

And this hybrid, a couple hundred team members and we do panels instead of them just listening to me, preaching if you will, we do panels.

And last month's panel was students that had become team members

And they did a panel, and I loved what one of them said. W we have challenges on a daily basis, but we never have bad days.

And I was like, wow, that is really, it's working. You guys get it. Like the culture's there, right? 

Because that's what you want.

 If you're not having challenges, you're not trying hard

enough. Like when we started this business, there was no infrastructure and no payment mechanism. It was an idea. And we've created a value prop which has turned into a payment mechanism. And we built a ton of infrastructure and still have a lot more to go.

But when you've got a group of humans that take that line of sight, 

you can really push a creative force.

[00:43:26] Mike Koelzer, Host: Tony, what's your structure as far as c e o, and then do you have a number of people that you can say, here's this many people that are directly under you, and so on?

[00:43:37] Tony Willoughby: Yeah. We have an executive team. The things you would think of, we have an operations leader and a technology leader and a product leader and legal and finance and people. So five to seven. And then we start to get product ties after that point. And then you have your two different products and your general operations

leadership, 

and you got a light administrative layer.

We're pretty flat. Just from an efficiency standpoint and size. 

. And then we arrange trying to be client centric. Even in the operations team, we are also aligned by client groups, so that client has account management and operations that are all lined up to take care of the needs of that group.

 I don't know if that's unique, but some organizations they centralize at different cuts and hierarchy and we've tried, we've got some central services and then we quickly get into our products and then quickly get into a client

[00:44:38] Mike Koelzer, Host: Tony

What message would you put out for somebody listening to this and Let's say it's a pharmacist they're hearing this and it's a good feeling they're getting. Do you think there's any life left in this for individual stores or do you think that people have to start looking at a conglomerate of this to be part of something that has gone this far?

[00:45:10] Tony Willoughby: Yeah, I always think there's hope. And I think there's some super [00:45:15] engaging creative pharmacy owners out there doing great things that I think of as role models. And so I think the key is having a creator's mindset and being resolute in what you're trying to achieve. And I do think there's a space.

I think if you're trying to solely survive on drug economics, 

That's really hard.

Really hard. But there's a lot of different ways. And our way isn't the only way to be successful and serve your community. And so I wouldn't push back on the ability for a local, independent owner operator to survive and thrive.

I think that there's less margin for error, 

today than there was five years ago then there was 15 and definitely than 30 years ago.

But I think there's a lot of people in the marketplace that are doing creative things and there needs to be Consolidation, stifles creativity and advancement, right? And so we need competition in the marketplace. We need diversity in the marketplace to continue to push the envelope on what's possible.

[00:46:33] Mike Koelzer, Host: when people get pessimistic, and you're seeing that now with some of the white collars a little afraid of ai, artificial intelligence and some people compare it, the students shouldn't be doing it, and it's My opinion, and it's held by many others, is let's use AI as the calculator as that was back in the, fifties and sixties.

And until people are living to a hundred and until people are walking every day and until people have stopped smoking and until all these things have happened, it's an endless amount of ideas that people can have to improve this. Cancer and heart attacks are still the number one killer and there's a lot of room. You just have to break out of the thought patterns. I think.

[00:47:25] Tony Willoughby: Yeah, I agree. It goes back to that learner mindset. Everything can be seen as a threat or an opportunity.

And AI's another one of

Those, Our fathers told our generation, watch out for robots. Don't become a robot. Don't become something a robot can do. But, um, you can become a robotics engineer and do really well.

I see AI is the same thing. We use AI in our business. We use AI to write code. So that our engineers can focus on QA automation and scale our engineering applications. We use AI to find gaps in data sets and fill 'em in from a data ingestion standpoint. And we'll use components of AI to drive patient engagement, to get us in context, That'll happen over time. It can be used as an extension of a relationship, not a replacement of a

relationship. Pharmacists and physicians are exception managers. I was trained to find every mistake I can in something,

 You can give me, probably not now, but in the day you could give me any drug study and if you gave me an hour, I could come up with all kinds of reasons to invalidate the

data. You give data, set a performance data set to a physician or a pharmacist or any type of clinician, and the first thing they will do is tell you how the data's wrong.

It's just a mindset, right? And it's not a negative mindset. It's what keeps you safe,

right? It's what enables a pharmacist to check a posi prescription.

It's what enables a physician to really dig in and do the right differential diagnosis 

on a patient. And sometimes it's an inhibitor of creativity. Your opportunity is usually the dark side of your

strength, And so we tend to have, and I lock myself in because I'm still a druggist, that's what I say around my team, and they ask me what a druggist is, and I was like, don't worry about it.

 The first thing is to see why something can't. Work Instead of why something can work. And a lot of times we'll have operational meetings or opportunities and we'll go, we want to try this. And then we go, what happens if one patient has one thing and I was like, yes, keep that rigor and what about the other 999 patients that it could make a difference for?

And so I think Mike, that's what we all have to invite ourselves to because AI is what it is today

and it'll iterate and iterate and yeah, I'm fascinated. Been doing a lot of research on it. Our teams have, like I said, started using machine learning and different applications and generative technologies.

And are [00:50:15] either evolving and growing or you're dying. And so that just goes back to that learning culture that we try to. Have in place. So 

I see it as an opportunity, not a threat.

[00:50:26] Mike Koelzer, Host: Tony, when you talk about all the AI stuff we're talking about now are you digging any deeper or is that since chat, G P T. Rose up, and I know it does all that, the coding and all that, but I also know that people can define AI in different ways. You talking about your coding and stuff, is that since the beginning of when chat g p T came out or were you doing something else before that?

[00:50:52] Tony Willoughby: It was, there was another application that we'd started using prior 

to that uses the same learning concepts. 

Gotcha. 

[00:51:02] Mike Koelzer, Host: But not too long ago, maybe. Within the

[00:51:04] Tony Willoughby: no, within the year we've used a machine learning application to help check prescriptions. As a first check, not a final 

check. 

We've used that's a vendor solution through a partner that we've used 

for four years where it's building images and using files to understand what's supposed to be in the bottle, and then checking against it and kicking out outliers as a checkpoint.

 And then the data integration stuff has been, that's probably been in the last six weeks. it's changing 

So fast.

[00:51:43] Mike Koelzer, Host: Every year they've got the end of year review. You start seeing 'em at the end of December and every year there's something new, it's covid, then this and that. And boy, this is as big as handhelds is as big as the internet.

It comes around like once every 20 years.

I 

[00:52:03] Tony Willoughby: I think that's a great application. So we, have these interactions with patients all the time, 

How could we send a recap of those interactions in a scalable way using that technology? And that's an administrative task, but it's built off and it's gonna catch the themes.

It's gonna be reviewed 

But it's gonna be automated. And so you think about the panel capacity

Of the clinician that's a great use case. And then you can go back and say, Hey, do that in a eighth grade or sixth grade reading

level. 

It's powerful. 

[00:52:41] Mike Koelzer, Host: But here's the bad with the good. We've got this company that we use for some delivery stuff. It's a rather new program. And I'll write their customer service with , here's the problem we had, and I've learned to throw out the first paragraph of it because the AI answer's gonna be in the third paragraph down after the first two paragraphs tell you they understand your feelings, and what you're going through.

It 

gets old you just want a little 

text. 

 Tony, boy, thanks for joining us. It's really fun seeing someone who's put action to their dreams. you've done a great job at that. So keep doing what you're doing.

[00:53:18] Tony Willoughby: Thanks Mike. I appreciate the opportunity to share our story and it's always good to build new relationships and talk to new folks and be able to answer and ask questions and explore together. So thanks for the opportunity today.

[00:53:32] Mike Koelzer, Host: Alright, Tony we'll keep in touch and thanks again.

[00:53:35] Tony Willoughby: Absolutely. Thank you, Mike.