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Streamlining Pharmacy Benefits

Episode 356

Recommended Books:

The Three-Body Problem

Principles: Life and Work

Best Way to Contact Matt:

care@alto.com

Linkedin

Company Website:

Alto

 

Streamlining Pharmacy Benefits with Mattieu Gamache-Asselin, CEO at Alto | Convert audio-to-text with Sonix

Hey outcomes rocket listeners thanks for tuning into the podcast again. Tired Saul Marquez: of your businesses healthcare costs unpredictably increasing every year? Healthcare costs are typically a business’s second or third line item expense. And if you’re like most employers, it’s an expense that’s growing faster than your revenue. Luckily for employers Noveta Health has the solution. Noveta Health is a full service healthcare consulting firm with proven strategies to lower your healthcare costs by up to 30% or more. They operate on a fee for service model and never mark up any of their medical or pharmaceutical claims. None of your employees have to leave their doctor or pharmacist either. Their health captive and pharmacy benefit manager are the most cost effective and transparent solutions in the whole country. What they do is not magic. It’s just honest. So if you’re tired of over spending on health insurance and want to learn more visit outcomesrocket.health/save for a free spend analysis to see how you too could save by switching to Noveta Health. That’s outcomesrocket.health/save for your free spend analysis outcomesrocket.health/save.

Saul Marquez:
Welcome back to the podcast. Today I have the privilege of hosting Matt Gamache – Asselin. He’s the CEO at Alto. Matt had always dreamed of being a doctor but found his calling in engineering. Little did he know that years later, Alto’s full stack technology platform would have such a profound impact on health outcomes and patient care. Prior to Alto Matt was an early employee at Parse which was later acquired by Facebook. Matt started his career at Adobe and graduated honors from University of Ottawa with degrees in Biomedical Sciences and software engineering. It’s a great combination to take a look at some of the toughest problems in healthcare and start solving them so I’m excited to enter this discussion with Matt here the insights that he asked to offer and some of the interesting work that they have going on at Alt. Matt, I really want to thank you for joining us today.

Mattieu Gamache-Asselin:
Ofcourse, thank you. Great to be here.

Saul Marquez:
Hey. So what did I leave out in the intro that you want to share with the listeners? Anything?

Mattieu Gamache-Asselin:
That was that was pretty good. It’s in my mind so that bio first to use myself.

Saul Marquez:
I’ll email it to you after the interview. Hey so. So what is it that got you into health care in the way that you get into health care?

Mattieu Gamache-Asselin:
Yeah I think similar to what most people that are drawn to health care go through when you have this this interests or this want to help people. In my college years that was sort of looking at I want to be a doctor, to go to medical school. To wanting to point some way to have sort of a social good impact in the world. And I ultimately fell in love with the Silicon Valley and this crazy atmosphere here where people believe they can do anything. Coming from Ottawa which is a very government town, a little bit more on the conservative side of times at least. It was really fast an experience I had, the opportunity to come here to San Francisco for an internship when I was in college and I actually fell in love with the atmosphere here. And after a few years of working in Silicon Valley I became frustrated with really just the lack of amount of companies trying to have a social good impact. There’s a lot of companies that tend to look for something probably to share a common mantra right. So the problem that you have so you understand the problem deeply and I really disagree with that. I felt it was more important to solve the problem I specifically did not have because I’m not the type of person with the most problems and that that’s really what drove me and my co-founder Jamie to force leave the Facebook and the more software world to focus on applying your skill set to the field where we felt we’d be able to have more impact. So we’ve just in general individuals and in health.

Saul Marquez:
I love it. It’s that pulling for us like you said that everybody in health care wants you know the need and the desire to do something impactful for people.

Mattieu Gamache-Asselin:
Exactly. Exactly.

Saul Marquez:
So you guys have put your heads together. You started a company. And so tell us a little bit about Alto but also dive into what you believe is a hot topic that needs to be on every health leaders agenda.

Mattieu Gamache-Asselin:
Well yeah a lot to that question. We started really, our an initial thesis was usually if you would talk to pharmacies today it’s kind of this abandoned ignored chunk of health care and it kind of makes sense right. Overall it’s not a massive cost driver. It’s sort of on the news a lot today with drug prices. And happy to talk more about that piece of it. But really remain sort of less than 15 percent usually a real health care cost or any given payer. And so it hasn’t been the main focal point. Maybe it tends to be a little bit less sexy as well. But what we found fascinating about pharmacy was this kind of apparent paradox that it’s simultaneously an experience that is generally very disliked what most people don’t like their pharmacies you know outside of the handful of people that love their dependent pharmacists or their community pharmacy. And you also on the other side you have this like why are you just doing like an e-commerce pharmacy. It wouldn’t not just solve all your problems from the outside it seemed that way and we assumed that we were missing something right otherwise it was an easy fix to create a great pharmacy experience somebody would have done it right. One of the big incumbents with all the money would have done it. And so we said well we want to know what we’re missing. What does the space know that we don’t. And we usually end up buying this small little mom and pop shop here in San Francisco. That whole team is still with us. And they were great to just learn from it and try to discover what it was about pharmacy that made it so different from your average retail store. But that’s my naivete there come. We quickly discovered that it’s nothing like your typical corner store where despite you know maybe some pharmacy selling some greeting cards and sodas and such. The pharmacy part of it is really a completely different beast. It’s it’s really not a store right. You all is a pharmacy isn’t it to sell something to a patient or a customer. Regular your you’re having this doctor here on the one side ordering something for the patient you have insurance on the other side that is paying, kind of deciding what you’re going to get to the end of the day and then you as the patient trying to make a decision based on all this information but not quite able to put it all together and the role of the pharmacy as we see it is this coordination between everyone. No unfortunately when the word everyone doesn’t get their way though to play bus as the pharmacy. But what’s really been fortunate is over time as the economics of pharmacy changed and as the complexity of processing and coordination have increased. You’ve had this gap where now the patients are stuck having to try and fill it. Instead of having this partner or this entity able to help you make those decisions and balance those for you. I think that was really the inception of the company. It’s still look what if we were able to do this coordination really, really well. What would that do, right? You think of sure maybe only 50 percent of cost is in pharmacy but what impact would pharmacy have on patients? We see patients more often than most doctors. We talk to them. We collaborate with them, interact with them. Most patients typically go to the pharmacy every month. There’s a real opportunity there to leverage these highly skilled professionals the pharmacists to do more than just fill descriptions in the dispensing machine and to us that’s really the overlooked part of health care. I’m seeing more and more in the press today and is more attention right now on this piece of pharmacy. But you just look at adherence rates in the US are terrible. People are trying to solve this in a variety of different ways than are takers just like practically. It’s not that hard right. When you start digging into why it’s so difficult to get your medications today. What if you just make that easier, is that going to help? There’s just so much cost savings and health benefit from just basic improvements there. But that’s really where we focus.

Saul Marquez:
I love it Matt. So give us an example. I’d love to hear how Alto is is doing things differently.

Mattieu Gamache-Asselin:
Yeah. So when we think of this kind of structure who’s involved in a transaction for pharmacy, or the doctor, the insurance, the patient and the pharmacy. We decided really early on that we didn’t want to be just this software company for others to you. We’re going to have direct impact on people. And that mean we had to be one of those for not being the patient one of those three. And we just like to be the actual pharmacy. So today I mean we run everything in-house, so we have our own pharmacy, pharmacist, teams, technicians etc.. All that is OK and I’m sorry. Well the physician side, it’s such an important component. When working so closely together and yet most interactions with them are rushed phone calls or faxes back and forth that aren’t very in-depth and there’s no feedback mechanism between the two of us. And so we started just really deeply partnering with physicians and even building software for should we have a protocol Alto and D. And we’re now doing some EMR integrations as well for that product but it allows us to have a really, really tight connection with the physician so that if we need to collaborate on prescription change it to power authorizations, substitutions, clarification, all these back and forth we can do a really really tight way and we can also share data back like this patient isn’t interested in their man just so you know way if there’s anything you need to do that. This patient is having a hard time with these symptoms, it’s medication. What can we do? And it allows us to have this really interesting collaboration. We really see physicians and hospital systems and clinics that we work with us to partner. On the other side of that, there’s insurance component and that’s a difficult one to solve but we’ve built a lot of automation around the insurance company is trying to tell you don’t use this drug so I’m going to charge 100 dollars for it. Use this one it’s free and the funds are like OK well we don’t have all this information all time. So how can we try to paint a picture so we can share that picture with all the other relevant parties. So we take a lot of internal software just to paint that picture and figure out what’s covered what’s not covered and what’s the best co-pay. Where are the differences between different medications. Is the doctor okay with a different medication that’s covered? How do you see more and more trying to understand the cost the insurance is trying to communicate to me to share that with the patient? And so that meant that all of the software running our pharmacy today from what touches the doctor to the insurance even our own stock is all built and helps and there’s been a massive undertaking. But it’s really the key to our ability to start impacting some of the obstacles that come in between patients that medications and of course we have free delivery and that’s really a suitable place to go the hundreds of retail stores and that’s always an obstacle right removed to come to the pharmacy not being homebound.

Saul Marquez:
For sure.

Mattieu Gamache-Asselin:
Then we also have smart packs. We package the drugs in these unit dose packets and that helps patients five-six months to know what to take plan and organize them so easily.

Saul Marquez:
That’s fascinating Matt. Now are you guys mainly working with patients or are you working with insurance companies or providers it sounds like who would you say your main customers is?

Mattieu Gamache-Asselin:
Well we have we have one of our primary company values as patients come first. So for us we’ll always do what’s best for the patient always with the patient wants with push way. That’s always possible but what is best for the patient. But that’s how we set primary customer but we really as a company focused on physicians as an equal customer where we work deeply with their clinics and recommend also to their patients. And that’s how we can complete that loop the insurance companies. It’s mostly sort of electronic or digital shift if you will just as matter of being contracted with them.

Saul Marquez:
Got it makes a lot of sense and today it seems like it is you know every insurance company now has an arm of Pharmacy. Whether it be scripts or CBS. You name it. Everybody seems to be affiliated vertically nowadays. I think it’s interesting that you guys are taking this this approach and very very rewarding from what it sounds like. So tell us about some of the setbacks you guys have had and what you’ve learned from them to make you better.

Mattieu Gamache-Asselin:
Oh there is no shortage.

Saul Marquez:
It’s a hairy industry.

Mattieu Gamache-Asselin:
It really is and you know I think as someone who is not hasn’t grown up in me not even the US level, the U.S. health care system it’s been a fascinating journey of learning and discovering all the nuances of it. And it really is a complex system along the way we’ve made plenty of bad decisions on what our software should be. What an experience should be and we’ve had to retry to redo it many many times over and I think really my biggest learning through building Alto to where we are today and where we hope we’d be in the future has been to be a lot more humble toward the space than I think the tech sector tends to be. So many times I hear the hospital is broken, the system’s broken and like sure like that that may be the case but it’s not particularly helpful right. It’s it’s not like tomorrow some company is going to start and rebuild the entire system from scratch.

Saul Marquez:
Right.

Mattieu Gamache-Asselin:
This is very unlikely. Four trillion dollar industry. What we found really helpful is say well what does the industry do today. And so industry is really good at doing what they do. They did squeeze every bit of margin they could out of their current operating practices. And so you’re probably not into everything completely differently. That’s OK right. Where should you change things. Where should you try to innovate and where do we have the most impact? It seems like a lot of these entities these companies been doing this for a hundred years like you probably know figure two what can we learn from them. I mean we try to learn from Walgreens all the time. Plenty of things to do really well and we try to say that these are areas where we can change the model. We can add more value to patients and more value to position but I don’t think it’s ever healthy to say everyone in history is not as good as we are. We’ll make it so much better. Pushing for that too many times from especially tech companies. So we really try to stay humble toward our incumbent competitors.

Saul Marquez:
Yeah. No I think that’s a very healthy approach because, you’re right. I mean you know these players happen in the market for a while. There are things that are working and you know when you blame the system you’re not taking accountability for a decision you made which is playing this field. And so I think that’s a really great great approach that you guys have there, Matt. A very seasoned and mature decision and vision. Tell us a little bit about your your proudest moment.

Mattieu Gamache-Asselin:
Well there’smany as well you know. There’s another company value we have, we leave no patient behind. It sounds kind of obvious when you look at at first glance the testing really means not focusing on creating these amazing experiences here and there but just really ruthlessly focusing on the worst experiences. Right. Maybe counterintuitively trying to make those really bad experiences better instead of making the average experience better. That approach I think it is not as important if you’re maybe a retailer and e-commerce store. It’s OK if every now and then a shipment goes awry and it gets lost. It’s a different story in healthcare. Your margin of error is very very small. Us making mistakes can cost someone their life right. We take that extremely seriously and there’s so many fascinating stories from our patients where our team just intuitively went so far above and beyond to just die. Our pharmacist was closed on a Sunday night. It was like hey sorry you need to lock up Matt. I was working with Sunday and I had to go over this prescription on my way home because it came after a cut off their deliveries and I went back to the station to take care of it. Stories like that that really make me feel good about what we’re building. With feedback we get from our patients and there’s a woman ones that send us a review. Just a note to add to our team and say thank you so much because of Alto I was able to move out of my daughter’s house for the first time in a decade and live on my own because we both feel really comfortable that you know my doctor and my pharmacy are working closely up together and organizing my prescriptions and taking care of me that I don’t need my daughter to do all that for me and it’s something I’ve been wanting to do for years and that really really keeps me going in a tough time.

Saul Marquez:
That’s awesome. Yeah. That’s that’s for sure. I mean patient mobility is a huge challenge. I mean getting to appointments picking up meds and if you could give people their independence back. I mean that’s a pretty big deal.

Mattieu Gamache-Asselin:
Exactly. Exactly.

Saul Marquez:
So tell us about an exciting project that you’re focused on today.

Mattieu Gamache-Asselin:
Yeah, something really exciting or silly I’m really excited for that. It isn’t in beta right now. We will launch it soon. It won’t sort of give too much details but I was in partnership with an institution working on a lot of information about your prescriptions right. So as a pharmacy, we’re looking for ways to know outside of our interactions as a pharmacy. I give you your medications every month, every three months, whatever it may be. How can we interact a few more often every day. A steep part of your life and your needs to take medications every day. There’s so much we can do around personalizing messaging to use a patient based on the drugs you’re on. The needs you have. Now imagine if, this really simple example let’s say you’re you’re taking birth control not a complicated medication. You one every day but the question got really early on. That always stuck with me. Somebody was just starting on birth control and she was asking well like when does it work. I’ve never seen this before do I take one pill and I’m good to go. Does it take a month, that week a day. And I feel like I will be. That’s true. Right. Like how would you know unless you ask for Doctor s requirements. How can we use with specific interesting information about specific drugs to help patients as they’re taking it both to remind them to take it and when to take it. We know all that just from prescription information but also like hey you know. How’s your joint paint today Well you know it’s still pretty bad. You know I’m only two days in. Okay that’s normal real take x number of days before it really becomes effective and you start seeing the results so we can help patients through the nuances of certain drugs so that they’re not saying look I just hope this doesn’t work for me. Super expensive. Like I just won’t take this anymore. With this abandonment piece that we see pretty often the patients. So this is a whole arm of our patient facing software that we’re building right now that I’m super excited for because it goes to above and beyond what we can really interact with patients as a pharmacy and hopefully the launch of the next sort of couple of months.

That’s definitely exciting Matt. I mean today we’re more in the Information Age and it’s no longer about solely the physical products. It’s about educating it’s about providing service. It’s about thinking what these customers want. And you guys are certainly playing a role in this shift that’s happening and medicine I mean we’re definitely in the process of consumerism and you guys are taking it head on on the pharmacy side. So kudos to you. Definitely. I’m excited to hear how this rollout goes. Part of the interview here Matt is a lightning round so I’ve got a couple questions for you quick responses followed by a book that you recommend to the listeners. You ready.

Mattieu Gamache-Asselin:
Sounds good.

Saul Marquez:
All right. What’s the best way to improve health care outcomes?

Mattieu Gamache-Asselin:
I found that It’s obvious what you want to focus on patients but the hard part of that is the incentives don’t align and it’s in our view always looking at where is the money flowing and where is the money at. That’s important because if the paper thinks but try to step out of that and say what should we do for patients and how would we then pay for it instead of where is the money and how do we use it to improve patient outcomes. Which tends to be the pitfall people get him to. Will always start with patients. Then think about the flow of cash in and how you pay for it. What’s the biggest mistake or pitfall to avoid. I would say it’s at least if we’re looking at tech companies and then companies trying to change things. It’s not being overly arrogant and staying humble toward best straight.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Mattieu Gamache-Asselin:
I would maybe somewhat kind of truly say not paying too much attention to what everyone else is doing and trying to think from first principles what would work right. What do we thinkwe are all human, we’re patients what do we think would work really well. How do we think the system should work. And again how would you get there instead of this what other people are doing. Let’s do that too. Let’s do that. But a little bit differently. But ignoring the outside world a little bit.

Saul Marquez:
Love it. What’s one area of focus that drives everything in your organization?

Mattieu Gamache-Asselin:
Patients come first. That’s our mantra that we always remember. I use meetings up and try to visualize the patient in the meeting room with us right and say well when I say this if a patient was standing here to sort of keep me accountable to that sort of guiding principle.

Love that. What’s your number one health habit?

Mattieu Gamache-Asselin:
While I eat you keto. My ketogenic diet does this for about six months now. Before that I was on the Paleo diet which isn’t too different but that’s something I try to do to stay healthy.

Saul Marquez:
Love it. How about your number one success habit?

Mattieu Gamache-Asselin:
I think the biggest change in my life for the last few years is starting a company has been meditation. It’s been just a phenomenally powerful habit to deal with the daily stress and anxiety of property company and also to stay focused.

Saul Marquez:
Love that, Matt. Yeah I incorporated that into my routines made a big in and I recently started doing yoga because there’s a lot of breathing and stretching so you kind of get a little bit of both.

Mattieu Gamache-Asselin:
Interesting. This is great. I have never tried yoga but it is definite on the list.

Saul Marquez:
Yeah, and that’s pretty cool man. Yeah meditation is huge and watching what you eat is key. Love that you’ve shared those tips with us. What book would you recommend to the listeners?

Mattieu Gamache-Asselin:
Oh I have so many books and an avid reader under the baby non-business book side of sci fi. My favorite I think sci fi book of all time has been The three body problem by a Chinese author, Cixin Liu, a phenomenal book. On the business side, I recently read that Principles, life and work by Ray Dalio. It’s really really great and the classic called The gold, kind of lean manufacturing book that that’s really helped me think through a complex operation we have here. Those are I mean my main top of mine here.

Saul Marquez:
I love it Matt great recommendations. Listeners, if you want to get these books as well as an entire transcript of our conversation with Matt go to outcomes rocket that health and in the search bar type in Alto, ALTO pharmacy and you’ll see the entire show come up and the show notes as well as a full transcript. Go there or check out alto.com which is Altos Web site where you can learn more about them directly. This has been a true privilege, Matt, really enjoyed our conversation. I’d love if you could just leave us all with a closing thought and then the best place for the listeners could get in touch with you or follow your work.

Mattieu Gamache-Asselin:
Yeah absolutely. Closing thought I find that we as a health care if you don’t don’t try enough new things and rapid to slow to just experiment and I think there’s so much we could do to experiment more and try more and drive innovative change instead of of big massive system changes. And I think often iterative changes are underrated in healthcare. So I feel like we should all try more to just make small little changes here and there to make things better for patient and in touch with me and I’m not a big social media users. There’s not much there but people can feel free to send an email to care@alto.com and I’ll definitely see it. I think my first name @mattieuga on Twitter but I don’t go there much.

Saul Marquez:
So stick with linkedin folks or reach out via care@alto and Matt will certainly connect and find ways collaborate. So it’s been a true pleasure, Matt. I really think that the work you guys are doing here and pharmacy and health care consumerism is making a splash. Keep up the awesome work. And and thanks for carving out some time for us.

Mattieu Gamache-Asselin:
Of course we thank you so much, Saul.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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