: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host Saul Marquez
Saul Marquez: [00:00:18] Outcomes rocket listeners will come back once again to the outcomes rocket where we interview today’s most inspiring and successful health care leaders. So thankful that you decided to join us again today and please leave a review and rating. When we get a chance it truly makes a difference for us. Just go to outcomesrocket.com/review and you’ll be able to see the apple podcasts pop up there and you’ll be able to do that. So thank you so much. It makes a big difference for the way the show ranks and gives us feedback that we need to make it amazing. So without further ado I want to introduce my guests. Her name is Kristine Ashcraft. She is the CEO at youscript that where they’re catalyzing the adoption of precision medicine. She’s had various roles in healthcare and has provided guidance as the chief executive officer at Gen-X as well and really has a love for healthcare. And I’m so excited to have her on the show today. So Christine thank you so much for being on the podcast
Kristine Ashcraft: [00:01:19] Thank you so much for inviting me. I appreciate it.
Saul Marquez: [00:01:21] Anything that I missed in your intro that maybe you want to add on?
Kristine Ashcraft: [00:01:25] I think the only thing I would add is I have been specifically in the precision medicine space for 17 years long before it became sexy because Obama called it out of the national priority a few years ago when I’m really excited to be in that field at this time because I feel that we’re really at a tipping point where we’re going to see dramatic care improvements and cost reductions based on that technology.
Saul Marquez: [00:01:49] Oh thank you so much for that. You know 17 years even before it was sexy. I mean now it’s it’s got its its debut. So excited for you too, K Kristine. And so why did you decide to get into the medical sector to begin with.
Kristine Ashcraft: [00:02:03] Sure. So I actually studied genetics in college and that was because my grandmother died of cancer when I was in high school and like a lot of people I had big dreams to go and find a cure for cancer when I went to college.
Kristine Ashcraft: [00:02:17] I did not end up doing laboratory work on the bench. I realized I was better suited to actually speaking and working directly with people a lot more but I did really want to continue to do something that I thought could truly impact health care.
Saul Marquez: [00:02:32] It’s a powerful driver for sure. You know the lost of a loved one is definitely never easy and if you have the power to come up with solutions to help others avoid that pain then I think it’s super admirable.
Saul Marquez: [00:02:46] What do you think Kristine is a hot topic that should be on every medical leaders agenda today. And how have you guys and your organization approached it.
Kristine Ashcraft: [00:02:54] Sure. So I think as I alluded to earlier precision medicine really needs to be on the agenda of medical leaders.
Kristine Ashcraft: [00:03:02] I did see a survey across my inbox today and it said that over 70 percent of leaders think precision medicine is a focus but only 30 percent of them have actually allocated money to a procession medicine program. So I think it needs to move up obviously and priority. You can’t make something a priority if you don’t invest some resources into it. But a lot of the focus has been around oncology and doing genetic tests that help determine the best cancer therapy. I think that my advice would be to widen the thought process around precision medicine. We’re really focusing the precision medicine space although we take them into account is not cancer medication so much as the majority of medications that a patient is taking. Right now we really prescribe medications in a one size fits all manner. And about 93 percent of patients have a variation in a gene that impacts their response to at least 10 percent or more of commonly prescribed medications. So kind of broadening that thought hey genetics doesn’t just impact cancer medications. It impacts pain medications, mental health medications cardiology medications, virtually all of these medications. When you think about it, think about it in a larger context. Can this help me improve drug Endo’s selection for patients that are taking a lot of medications for the rest of their life not just as this helping cancer.
Saul Marquez: [00:04:27] Yeah and the thing that comes to mind here Christine is not only improving outcomes but also taking a lot of cost out of the system.
Kristine Ashcraft: [00:04:34] Correct. Correct. Actually I’ve gone through a series of studies to validate that we can both improve care and reduce costs.
Kristine Ashcraft: [00:04:43] One of the big questions that we got from physicians and pharmacists over the years are I’ve I’ve heard is well how do we know who to test and then how do we know how to act on it. So we’ve gone through a series of studies that validate our ability to do that in real time in a clinical workflow. So step one how do we know who to test. We provided an unrestricted grant to the University of Utah’s pharmaco economics department and they actually got a very large claims and clinical data point database from Unova line of several hundred thousand patients that were over 65 taking several medication and they ran those against genetic risk score. So we have a patent pending score where I can essentially say hey saw based on the medications you’re taking there’s a 70 percent chance that if I do this genetic testing I’m going to recommend an evidence based drug or dose change to one of your doctors when the results come back. So to validate that they ran all these patients against a genetic risk or and what we saw as as the genetic risk percentage increased so did the likelihood that that patient ended up in the hospital or the emergency room. What was really cool about that increase is that they somehow made these patients otherwise equal by age, gender, race, disease, state, and the known drug drug interactions we currently flagged for. So a very clear signal that hey this appears to be causing more emergency room visits and hospitalizations.
Kristine Ashcraft: [00:06:10] So we followed that up with a study in which we provided information on how to optimize drug and dose response based on the use script clinical decision support and analytics framework and about several outpatient clinics around the United States. And what we saw compared to past historic control was a 39 percent reduction in hospitalizations and 71 percent reduction in emergency department visits in just four months with an estimated savings of about 11 32 per patient prior to the cost of intervention. Big pushback on that was not the gold standard the gold standard as a prospective randomized control trial. So followed that up with just a few months ago published a study in home health. So in this particular program there were pharmacists that were actively managing medications for patients that were at very high risk of being readmitted to the hospital. And we flagged them for genetic risk and they were either put in the control or the intervention and in the intervention arm the pharmacists had access to youscript and appropriate genetic testing. And what we saw in just 60 days was a 52 percent reduction in readmissions 42 percent reduction in emergency room visits saved over 43 hundred dollars a patient in just 60 days. I mean it wasn’t one of the endpoints of the study but we did also see a statistically significant 85 percent reduction in mortality which certainly merits looking into further.
Saul Marquez: [00:07:35] That is fascinating, Kristine. And so you guys have done the studies you’ve done the prospective you’ve done the retrospective in this number of preventable deaths is really fascinating to me. I heard 440000 preventable deaths per year and you’re able to reduce such a large number I think that’s super interesting and merits a look at what. Like you said you know broaden the perspective or the scope that you can apply precision medicine to.
Kristine Ashcraft: [00:08:04] I certainly think so I think one of the things that you script really does is it enables providers to treat polypharmacy taking multiple medications as if it were a disease state in and of itself.
Kristine Ashcraft: [00:08:16] So what we have going on and everybody knows this is we tend to treat patients in different silos. Here’s the cardiology silo and here is the mental health silo and here is the pain silo and the issue is all of those drugs interact with each other and the genetics impacts that. And you really need a tool. And I would say a pharmacist care manager ideally that’s proactively managing that.
Saul Marquez: [00:08:39] Now that’s fascinating, Kristine. Can you give us an example of a time where you also had a setback and what you learned from that.
Kristine Ashcraft: [00:08:48] Sure.
Kristine Ashcraft: [00:08:48] So when I first started talking to health systems and hospitals about youscript and targeted pharmaco genetic testing I didn’t do enough homework in advance and I was talking to a hospital system.
Kristine Ashcraft: [00:09:04] And at the end of the meeting one of the CMO looked over at me and he was like I want to say something. I said OK. He’s like I just want you to know this is great technology. And we certainly apologize.
Kristine Ashcraft: [00:09:18] There’s a siren going by I can’t control at all. Anyway the CMO is sitting across the table for me like, Kristine I want you to know this is amazing technology I really think that it can help.
Kristine Ashcraft: [00:09:29] And it’s not that we don’t want to do something like this it’s just you have to understand there is a really big technology agenda that we need to act upon. We need to achieve all these things for meaningful use. And he said you’re you’re essentially coming in here and saying hey we have these amazing solar panels we can install them and you’ll never have an electricity bill at your hospital into the end of time if there’s ever any kind of natural disaster you’re still going to have electricity which sounds amazing but are super effective. And so you know I realized I had to be more targeted in the health system that I was reaching out to. And so I started just focusing on the ones that are Stage 6 or 7 for health care I.T. adoption that are really ready to start integrating additional innovations into their workflow. But I definitely spun my wheels for a while now. Not tightening that net.
Saul Marquez: [00:10:20] You know Christine that’s a great call out you know every everybody every system in health care has different stage of advancement and we have to ask ourselves if we have a technology or piece of equipment that we could use to help them out. It’s not going to help to give them solar panels if there’s sewage has backed up.
Kristine Ashcraft: [00:10:40] You know I think the analogy I had it was a good one it started with me I was like oh that makes a lot of sense.
Saul Marquez: [00:10:46] It makes a lot of sense and so it’s our responsibility as innovators and also just people looking to make outcomes better to ask ourselves what stage in the process are they.
Saul Marquez: [00:10:58] And that’s my solution fet so I think this is a wonderful learning that you’ve shared with us. Christine thank you so much for that.
Kristine Ashcraft: [00:11:04] Thank you.
Saul Marquez: [00:11:05] So what would you say what are your proudest medical leadership experiences you’ve had to date is.
Kristine Ashcraft: [00:11:11] I think that you know it’s really about the patients stories all I’ll share one.
Kristine Ashcraft: [00:11:16] There is a woman that I’m still in contact with. Elise Castleford who raced out because one of her pharmacists had changed her medications based on genetics and she said you know I thought I was in the early stages of Alzheimer’s. I had given up my weekly bridge game and when her medication was changed based on her genetics her memory issues resolved in just a few days.
Saul Marquez: [00:11:37] Wow. Yeah it’s incredible.
Kristine Ashcraft: [00:11:39] But stories like that are not real people where you know you impacted their quality of life in a real way.
Kristine Ashcraft: [00:11:47] That’s what keeps me going.
Saul Marquez: [00:11:48] And that’s such a great great story Christine and you think about it now. I mean to get a genome test done is? What is it a thousand bucks now?.
Kristine Ashcraft: [00:11:57] For genome sequencing which doesn’t include the entire team.
Kristine Ashcraft: [00:12:01] It’s a bit of a misnomer.
Kristine Ashcraft: [00:12:03] It’s coming down it depends where you go and the tests that we operate on are very specifically looking at genes that dictate response to medication. So we don’t focus on disease prediction or anything like that that those tests are just a few hundred dollars so they’re fairly inexpensive and they help patients understand how they’re going to respond to the vast majority of medications they’ll be exposed to in a lifetime.
Saul Marquez: [00:12:27] Really fascinating and I think an area that’s worth devoting some more time listeners. There’s a lot of things that maybe we’re assuming right. Like I just assumed all these tests are a thousand bucks. Kristine what resource would you give to us to further our knowledge and understanding of this precision medicine field.
Kristine Ashcraft: [00:12:46] Sure. I think that it depends who you are but if you’re on the healthcare side and you’re a health care provider I think one thing that people aren’t aware of is there’s actually a clinical pharmacogenetics implementation consortium that’s under the auspices of HHS.
Kristine Ashcraft: [00:13:01] And it is a great group of academics and private companies that have worked together to coalesce guidelines on when you should be taking genetics into account when you’re prescribing different medications and they’ve done a really good job. I think sometimes people don’t realize that there’s a separate group working on this. Again back to the silos people are going to make wait for the cardiologist to tell us which cardiology drugs this applies to. And you know oncologists for the oncology drugs and know there’s actually a group or pharmacogenetics made up of a ton of very smart people in this space and I say if you don’t go anywhere else to go to the CPA website and take a look at those guidelines.
Saul Marquez: [00:13:41] And what’s the website Kristine?.
Kristine Ashcraft: [00:13:42] It says cpicpgx.org.
Saul Marquez: [00:13:46] cpicpgx.org, listeners.
Saul Marquez: [00:13:49] So if you don’t go anywhere else that is the place that you go for information. And what we’ll do is we’ll provide it in the show notes. So if you go to outcomesrocket.com/ashcraft that’s a s h c r a f t Ashcraft. You’ll be able to find the show notes as well as any links to the resources that we addressed today. That’s a great one. Christine I’ll definitely be sure to study that.
Saul Marquez: [00:14:15] What would you say an exciting project. Obviously what you’re doing overall is exciting but something in particular with what you’re doing that’s exciting today.
Kristine Ashcraft: [00:14:24] Sure I think one of the projects I’m most excited about. We did get Highmark health final innovation grant and they have. Yeah pretty exciting.
Kristine Ashcraft: [00:14:35] So they were so impressed by the results of our studies that they wanted to test it out in some patients. So we did a risk stratification to determine which patients in their Medicare Advantage program had genetic risk and then we integrated youscript right into the clinical workflow and in all scripts ehr for a primary care clinic under Allegheny Health Network and they are getting plaids for the patients coming in for appointments that would benefit from testing and in this particular program they actually have a pharmacist care manager that is talking to the primary care physicians and other physicians both to recommend testing and also to recommend drug or dose changes when the results come back. And that’s live for a few months now and we’re seeing really incredible results. They’re very happy with the integration and the care improvements that they’ve seen so far so very excited about that. We’re not going to see final results for awhile now but I think it’s great when an organization does what Highmark did and actually puts their money where their mouth is in terms of innovation. Think there’s a lot of talk about innovation. But again people haven’t put the resources behind it to make sure that they’re providing a platform for innovation to move forward. So I think they’ve done a really good job.
Saul Marquez: [00:15:51] Now congratulations on that Christine. Sounds like you guys have gotten really exciting and outcomes improving project off the ground over there with high marks so kudos to that partnership that you guys struck and I think it’s a great point.
Saul Marquez: [00:16:05] You know listeners put your money where your mouth is you know that you’re looking to make some meaningful change that improves outcomes invest the money in it try out some pilots that will help you explore these technologies like Kristine is discussing to improve outcomes in your system. Christine let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It’s the 101 course or the ABC of Kristine Ashcraft and so we’re going to write out a syllabus. I’ve got four questions for you that will do in a lightning round fashion and then you will conclude the syllabus with a book you recommend to the listeners. You ready.
Kristine Ashcraft: [00:16:44] I am
Saul Marquez: [00:16:46] Alright. So what is the best way to improve healthcare outcomes.
Kristine Ashcraft: [00:16:49] Well I know the correct answer should probably be precision medicine.
Kristine Ashcraft: [00:16:55] I think that that would be the correct answer though I think one of the things just to take take a step back more globally is that we really need to do a better job understanding the social determinants of health. I heard before that you know where your zip code is more of a determined to termination of how young you’re going to die than pretty much anything else. And I think as a society we need to start creating ways to address that in a more meaningful way. I do also think that personalizing care based on genetics and other factors is key but social determinants of health are really really big thing that we need to look into more.
Saul Marquez: [00:17:34] What does the biggest mistake or pitfall to avoid.
Kristine Ashcraft: [00:17:37] I think that’s a no. We go back and forth about whether Einstein really said this or not but they say the definition of insanity is to do the same things over and over again and expect different results.
Kristine Ashcraft: [00:17:48] And I think one of the biggest mistakes or pitfalls we need to avoid is just tweaking ever so slightly the way that we’ve done things and expect real results. So we’re doing with youscript historically when somebody gets a prescription to run against back and that’s like this binary chassis. It’s kind of like they crucified a paper map Shearmur when we used to look young.
Kristine Ashcraft: [00:18:12] Maybe you don’t remember we used to plan road trips using paper map.
Kristine Ashcraft: [00:18:17] We know we fell out our phone and in real time it takes into account a ton of different factors. And that’s essentially the leap that we’re taking to medication management. But it doesn’t work on a binary chassis. So how do we really make big jumps forward in medicine if we continue to take this binary or a very siloed approach. So I think biggest mistake or pitfall again just trying to make a slight improvement to the things that haven’t worked.
Saul Marquez: [00:18:49] Great message.
Saul Marquez: [00:18:50] How do you stay relevant as an organization.
Saul Marquez: [00:18:53] Despite constant change.
Kristine Ashcraft: [00:18:54] I think that one of the things that we’ve done a good job of here youscript is written all over we have one of those you know visual boards where you have some huge pictures of things you’re supposed to focus on.
Kristine Ashcraft: [00:19:06] But the number one thing we have on all of our minutes and agendas and everything that kind of circulates internally and some things externally is never losing sight of your mission. At the end of the day as long as that’s first and foremost in your mind. I think that you’re going to change and evolve around it because if that mission is critical you have to adapt in order to achieve that and at you script our mission is to end avoidable adverse event.
Saul Marquez: [00:19:36] What is one area of focus that should drive all else in your company.
Kristine Ashcraft: [00:19:39] So I think the chance of being a bit repetitive it’s it’s once again never losing sight of the mission.
Kristine Ashcraft: [00:19:46] At the end of the day we need to take care of customers and listen to them. But it’s all based around what is it that we’re trying to achieve here. Everything needs to be flowing down from there.
Saul Marquez: [00:19:59] What would you say Christine. The book that you’d add to the syllabus for the listeners.
Kristine Ashcraft: [00:20:04] Okay so this has nothing to do with health care but my favorite book and there are there are some health care there are some health care things in there.
Kristine Ashcraft: [00:20:15] Holographic Universe by Mike Talbott it’s a lot about physics but there’s actual very specific examples in there of mind over matter I think one of the most common ones in healthcare is the placebo effect. So there have been people that have become a lot better when they were given up Sebo that really there was no logical reason for that. They were given a sugar pill. But it’s it’s a very interesting book with a lot of studies that I think put forward some interesting theories on mind over matter and I think anybody would find it an interesting reading.
Saul Marquez: [00:20:49] I love that Kristine and listeners take a note from that. You know it’s you don’t have to get your inspiration from health care based resources. You could get your inspiration from anywhere so long as what you take out is just what gives you that fire that spark that idea to create that change is going to improve outcomes and health care. I love it Kristine. Thanks for going with a not health care book.
Kristine Ashcraft: [00:21:10] You’re welcome.
Kristine Ashcraft: [00:21:11] I’ll say I did pull it up on Amazon to look at some of the people that have commented on it and a lot of them were in health care. I’m not alone in line.
Saul Marquez: [00:21:20] There you go again now.
Saul Marquez: [00:21:23] So listeners go to outcomesrocket.com/ashcraft and you’ll find the link to that book as well as these tidbits of amazing wisdom that Christine has imparted on us. Kristine before we conclude I’d like to ask you to just share one closing thought and then the best place where the listeners could get a hold of you.
Kristine Ashcraft: [00:21:42] Ok. So my my one closing thought I keep talking about the youscript mission of ending avoidable adverse drug events.
Kristine Ashcraft: [00:21:51] So I just want to make sure I stop talking here that people understand how large of a problem this is. One person dies every five minute from adverse reactions to properly prescribed medications. Just to put that in perspective that’s equivalent of a full 747 every 34 hours. We have ended much yeah. We spend as much on average drug offense as we do on the drugs themselves. Half of medications don’t work as intended and are therefore wasted therapies. And this problem is getting worse as we put people on more and more drugs because the genetics is more likely to have an impact. But it’s a huge huge problem and I think people don’t often realize what a big problem it is. So I think the big takeaway is you need to be doing something about this and if you have a loved one or someone you care about or even yourself and you’re taking a lot of medications you should really look into it. There are some resources on our website www.youscript.com and our phone number and email is on there as well.
Saul Marquez: [00:22:52] Wonderful Kristine and listeners do yourself some work and take advantage of the things that we just learned here with Kristine and take a dive into this really impactful problem that that exists and I encourage you to check out the website.
Saul Marquez: [00:23:08] Make sure you access the resources that Kristine shared with us and do your part to improve outcomes by preventing adverse medication events. Christine just want to say thank you so much for being on the show.
Kristine Ashcraft: [00:23:21] Thank you so much for having me on. And best of luck with this it’s a really cool program you put together.
: [00:23:29] Thanks for listening to the outcomes Rockett podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.