Rich Prest, Senior Executive Vice President, Corporate Strategy at AssistRx

Meet Patients Where They Are At to Improve Outcomes with Rich Prest, Senior Executive Vice President, Corporate Strategy at AssistRx transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez here, and today I have the privilege of hosting the outstanding Rich Prest. He is the Senior Executive Vice President of Corporate Strategy at AssistRX. He’s working to evolve their technology and talent solutions to meet the needs of health care providers and specialty therapy manufacturers as a part of his mission to help people live their healthiest lives. He looks for new ways to provide differentiated value in initiating patients on therapy, increasing visibility to the treatment journey, and improving patient outcomes at directs. He’s responsible for researching market trends and recommending new strategic priorities, developing strategic partnerships and leading execution of strategic projects. He’s a strategy guy. And since moving from the US from Australia in nineteen ninety nine, Rich has grown his expertise in the technology, startup space, pharmaceutical commercialization and digital health. Over the last decade, he’s helped launch nearly two hundred specialty therapies and solutions for manufacturers and service providers. He’s fortunate to live in San Francisco Bay Area, enjoys ultra running podcasts, cooking and spending time with his two kids and two dogs. Obviously an outstanding leader in health care. And I’m tremendously privileged to have him here with all of us listening. Rich, thanks for being with us.

Rich Prest:
Thanks so much Saul. It’s a pleasure to be here.

Saul Marquez:
Absolutely. So you are the brains of the strategy and it’s going to be a really fun podcast to talk about the exciting things you guys are doing in the pharma space, particularly to speed up that life cycle of innovation and bring things to market. But before we dive into that Rich, I love to hear more about you and what inspires your work in health care.

Rich Prest:
Oh, thank you. So, yeah, I think we really don’t value our health until it’s gone. It’s just one of those things like if you’ve ever had an injury or an illness, you suddenly realize how much good health is a valuable thing. And then I think likewise, when you live with the condition for a long time, it’s sometimes difficult to imagine how much better would be if that condition went away. And I think in the US we see so many people suffering from these chronic conditions. And I really want to do what I can to help them get better and enjoy a richer life and beyond the human suffering. I think there’s a tremendous economic cost that the US is struggling with. I was looking at a CDC website and they referenced some studies where 90 percent of a three and a half trillion health care spend is for people with chronic conditions, including mental health sites. If you want to supply that 80 20 principle to how do we make a difference on the on the cost of health care, going after the cost of chronic conditions is not only going to help a tremendous number of people, but it’s also going to help reduce the cost of health care in the country.

Saul Marquez:
And I think that’s a really great call. And and, look, your mission is great and I think it’s the ultimate place to do it. Health care. So talk to us about AssistRX. So what are you guys up to and how you adding value to the ecosystem?

Rich Prest:
Yeah, the way we look at it is this last mile problem with specialty therapies. Just because a specialist writes a prescription for you, it doesn’t mean you just want it in the local Walgreens, CBS and pick that up. I mean, a lot of these are very expensive medications, so that’s just not an option. And so what we do is, in fact, if you look at some of the studies, there’s about 30 percent of prescriptions never get filled for chronic conditions. That number’s even higher up close to the thirty seven percent. That’s about half of patients. Once they get started on a therapy, don’t take the medications as they meant to. And you see all these studies trying to estimate the cost of this and some of the numbers that are around one hundred twenty five thousand avoidable deaths annually. So that’s why we’re looking at coronaviruses. One hundred and fifty thousand. And just to think that this is about one hundred twenty five thousand annual. Yeah. And then the other number I think people are more familiar with is the is the three hundred billion in avoidable health care costs through this non adherence. And then one of the big reasons for this is the out-of-pocket costs. So I think another study referenced was for three quarters of patients receiving a script, the cost of filling it exceeded their expectations and chose not to.

Rich Prest:
So this is sort of the last mile problem, right. Just because pharma got to all the trouble to get that drug approved, convince the doctor of the safety and efficacy, doctor’s written the prescription, but now you actually in order for the patient to get better, they’ve actually got to get the medication by hand and they’ve got to take it as they are supposed to. The guys that founded AssistRX had run specialty pharmacies and they had seen this tremendous difficulty in specialty of getting patients started on specialists. In fact, it’s sort of interesting that with electronic prescriptions, which are now the norm for generic drugs, I think around ninety five percent of the prescriptions are generic and most of those are electronically put in, especially therapy, these high cost biologics, etc. We’re talking around about 15 percent of prescriptions are actually done electronically. Most of it is still done on the table, and so these guys ten years ago actually decide to try to put in place and technology to it to transition from paper to and to make this process easier. And so I was fortunate to run into them a couple of years ago and and join the team. And now the strategy, as you said in the introduction, focusing on how we can use these tech and talent solutions to deliver the next generation of therapy initiation patients.

Saul Marquez:
So it’s about therapy, initiation. It’s that startup Right.. It’s getting getting patients access and getting them to take the medications as prescribed.

Rich Prest:
Yeah, that’s very much one part of it. So it’s amazing what’s happened the last two years. We’ve gone from 170 employees in one location to over five hundred in five locations. A national network of field nurses. And a big transition for us is being actually asked us to take over the patients services. So in addition to the therapy initiation that we’ve been talking about, we also have this patient support services that we provide quite a few manufacturers and that while not just getting started with the software, we talk about us, but also that process of helping patients to stay on therapy. And through the journey from my specialty therapy, manufacturers typically have what’s called a hub or patient services program. And this is really about providing a team of people that will help people to navigate these complex issues of how to actually get insurance approval for this drug and how to take advantage of the manufacturer programs that are available to help make it more affordable for me. And if there’s any other pieces around case management sort of navigating the disease, these are the programs.

Saul Marquez:
And so you guys are now administering these programs as well, making them easier to access and understand.

Rich Prest:
Yeah, exactly. We see lots of opportunities for making the better. The it’s the usual story where there were companies that basically offered offered call and had a model that was essentially the more people that they had on the phones, the more money than that, really. Now we see tremendous opportunities for technology to make that more efficient and effective moment.

Saul Marquez:
Yeah. And and so as we think about this model of, all right, we’re helping get patients to start with their therapies, then assisting the manufacturers to carry forward with some of the best practices can. Do you have any examples of how this is helping improve outcomes or making business model success?

Rich Prest:
Yeah, absolutely. I have to give you a few examples. For this piece of therapy initiation that we talk about. The software we have called isystem that we provide free of charge to providers offices in the case of a multiple sclerosis drug. We were able to reduce the time to therapy versus faxing by 10 days, which was about a forty five percent reduction time until patients got started. And obviously it’s better for the patient and better for the manufacturer if we can get them on drug quicker. So another example is in the area of the first fill abandonment. So we talked about this last mile problem for women’s health care products. They had about 13 percent first of abandonment with enrollments. We bring that down to nearly zero. And then for dermatology product, we were able to reduce that first fill abandonment by about thirty five percent. So a couple of good examples of making a difference there. I have a few more I can dive into, I am.

Saul Marquez:
Sure.You know, I love to hear about those rich and question for you when you first fill abandonment. Is that so? They’ve already gotten the first prescription and this is when they have to go back to refill. Or is this for the first one overall?

Rich Prest:
Yes. For that very first one or the first one? Yeah, often the first one is the most difficult. The refills are much easier.

Saul Marquez:
But what happened with that first one,

Rich Prest:
It really is. A lot of it is the sticker shock. And I think increasingly seeing patients having to carry more and more out of pocket, it’s surprising to manufacturers of these very generous copay offset programs, but often those don’t get applied. And so just something as simple as making sure that the available funds are applied to that script so that the patient has a minimal out of pocket can make a difference in getting a field. And then there’s other stupid stuff like with fact enrollments. We see missing information on about 30 percent of the forms that come in. And a lot of the time it’s a missing signature from the patient or the provider. And then when you reach back out to that patient provider, you can’t actually reach them. And then it just falls by the wayside. And so that’s another area where we’ve been having that exciting piece of technology work going on right now is actually a smart fax form that will look to see if there are any issues and respond straight back to the doctor’s office to let them know that might be the wrong form or they just need to get a signature. And looking to really close that gap with misinformation, wow, that’s crazy, man.

Saul Marquez:
I mean, it’s just shocking Right. like that. It could be so inefficient.

Rich Prest:
It’s nuts, too. And again, if you think back to the billions of dollars it takes.

Saul Marquez:
billions.

Rich Prest:
Years it takes to get a drug to market and you’ve gone to all that trouble and then you’ve all that cost of putting a field force out there, although, of course, they are having to migrate to video detailing now. But all of that effort and then finally, the doctor uses this drug over all the other competition and then it just gets lost in the process. And you’re like, oh, it’s so close. So just get a little thought about how we get started can make a big difference.

Saul Marquez:
That’s amazing. Thanks for adding that additional detail there. So and what did you say? The percent of first film abandonment was on average and then you had these two applications.

Rich Prest:
What was? It’s not one study had that essentially, but half of patients chose not to fil because of the out-of-pocket costs.

Saul Marquez:
Wow.

Rich Prest:
You know, I think many will have many different numbers, and it varies tremendously from drug to drug, et cetera. But clearly, anything we can do to improve that first feel makes a difference, both in terms of the time it takes and actually making it happen.

Saul Marquez:
Huge. Thanks for indulging us there for for a bit. I just wasn’t sure about that. You were about to mention a couple other ones, so go ahead.

Rich Prest:
Yeah. Yeah. So another big challenge in the specialty space is prior authorization. So because of the tremendous cost of these drugs, we’re seeing drugs now for multiple sclerosis, for example, would we typically in that sort of six, seven thousand a month range for these drugs? So tremendous amount of money. Right. And so the insurance companies want to make absolutely sure that the patients got coverage and especially pharmacies don’t want to dispense the drug unless they know for sure they’re going to get paid back by the insurance company. And so there’s often a prior authorization process to make sure that there’s actually appropriate patient for the drug. These can be quite challenging to get through. And so we have some solutions that help take that process from a manual one to electronic. We can actually, especially in case of pharmacy benefit drug, do the whole process, the prior authorization electronically. And then we’ve been able to improve the conversions from 13 to thirty two percent for one drug while reducing the headcount required to make all those phone calls and run that program by about thirty five. So that’s an example of where technology is making the process better and at the same time more cost effective.

Rich Prest:
Wow. So I mean, taking it from manual to electronic, reducing overhead while increasing the prior authorization. Exactly.

Saul Marquez:
Yeah, exactly. That’s what I’m talking about is pretty cool. Look, I’m all about automation. If there is a way to do it smarter, let’s do it. And so sounds like the team over there came from the old school way and said we could do this better and now they’re doing that. You guys are doing that.

Rich Prest:
You got it. Yeah. And I think ten years ago was probably a little ahead of where the industry was at. But now is the time and we’re certainly seeing a tremendous amount of interest, as I mentioned, some fantastic growth.

Saul Marquez:
Yeah. And so, you know, talk to me about the technology or is it less the technology and more so the strategy and the approach that allows you guys to do what you do?

Rich Prest:
You know, it’s one of the really interesting pieces of health care is just how messy getting things done is. And so one of the things that we found is it’s actually you can never get to a hundred percent with a technology solution that this sort of minimum available product just doesn’t work. If you think of a minimum viable product to health care providers office and they start using it, they’re going to stop because if they can’t trust the information that they’re saying, they’re just going to say, I’d rather go back to paper. And so we’re finding that it’s this combination of technology and talent that’s critical. So you use the technology where you can to get as efficient as you possibly can. But then if there’s a gap, so you’ve got an insurer that’s still completely paper-based and can’t handle electronic enquiries, then have the backup team that can get on the phone with that insurer and close that gap and take it up to percent solution.

Rich Prest:
Yeah, it’s not a one size fits all. You got to do a combo of tech and talent. Absolutely. Yeah, that’s interesting. So as you think about how you guys are improving outcomes and making business better, it’s so clear. Now, I appreciate you walking us through that. What’s one of the biggest setbacks you’ve experienced and a key learning that emerged from that show?

Rich Prest:
I think probably one of the biggest surprises for me was discovering that the biggest competitor we had to adoption was the fax machine, that this idea of a technology that most of us can barely remember. It’s still this favorite communicate technology in health care, and so that was a big surprise and then the other piece was attention. So when we think about the software that we offer to doctors offices, so the specialist writes the prescription and then there’s usually a team of office staff that are involved in processing all of this paperwork to help the patient get started. So we’re really trying to help that team of office staff and those folks so hard working. And you go into one of these offices and even if you’ve got an appointment, because we have a team that was in the field as well as a team on the phone calling on these offices and helping them to get educated about our software and how to use it. And we found that just getting attention is incredibly difficult. And so what we have to do is not just provide a solution that’s going to help them in the long run. It’s got to be immediately apparent to them that it’s going to make life easier.

Rich Prest:
And so we found that once they start using the software and they get it, they love it. In fact, we’ve been doing product market fit surveys and finding a really high percentage of folks to be really disappointed if it was no longer available. So it’s great news. Yes, we know we’ve got the product market fit, but first we’ve got to get on it. And that’s been the challenge. So, for example, we have a what’s called a reverse solution that loads the patient list like a to do list. So this is all of these patients, because typically at the end of the year, you’ve got to go and check everybody’s insurance again. And I think particularly in the current situation as well, we saw many people changing their job. Situation is a constant need to evaluate whether insurance has changed. And so that loading that patient was like a to do list suddenly makes life a lot easier because now you can go, OK, I’ve got to go in and check this out of patients to see whether their insurance has changed. Looking at anything we can do to make it started easier is really the big lesson that’s so interesting.

Saul Marquez:
And so what’s been the key to adoption then?

Rich Prest:
Yeah, really, really. This sort of looking at the redesign. So can we import patient data? Can we look at every aspect of getting started, the log in registration, etc., and just trying to find ways to reduce that amount of effort? Because if it if it looks like it’s going to be harder than scribbling on a piece of paper and faxing it, they’re not going to do it. And so that’s really the challenge is is just continuing to refine that that front end up and and trying to help them to just give it a go so that they can understand how their lives can be a little bit easier and the patients can get better results.

Saul Marquez:
Yeah, that’s a good call. Reducing the friction, thinking about the overall workflow, how can it be easier than scribbling on paper? It’s, um, I do fax through my phone now, like in a rare instance, they’ve got these fax apps now. Yeah. Yeah. And so I’m wondering if you mentioned that fax machines are one of the biggest competitors. Is there a software optimization where you use digital fax technologies to make the overall process simpler?

Rich Prest:
Yeah, and that’s been one area that we’ve been looking at because it’s going to take a while to convert people over from faxes. And so.

Saul Marquez:
That’s really funny, too, by the way. I don’t let me fax Amazon to get whatever I want tomorrow.

Rich Prest:
Yeah. Yeah. So well. And of course, yeah. It’s analogy’s divide between health care and other industries. Right. Imagine calling an airplane, you know, and allied it say can I have a flight tomorrow. And the airline says, well I don’t know and I have no idea how much it’s going to cost.

Saul Marquez:
You guys are looking at it. Digital technology. Yeah.

Rich Prest:
Yeah, especially for retail. Because, know, we talked a little earlier about this problem of some of these forms come in with missing information.

Rich Prest:
So can we can we take those faxes electronically, use optical character recognition to to read the key parts of those forms and load that information in so it makes it easier for our staff, but also if there are any issues we can get on top of straight away and go straight back to the provider’s office and say, hey, we noticed your phone is missing X or Y, can you fill out and send it back?

Saul Marquez:
That’s powerful. And that could be really powerful Right. especially if that is the case. Right. people don’t want to give away the fax machine. Let’s digitize at least.

Rich Prest:
Yeah, yeah. It was funny, this pandemic. I mean, it’s not a obviously it’s a terrible situation, but we’ve had office staff working from their homes and they’ve had no access to a fax so that we see increased interest from providers offices and manufacturers in the software.

Saul Marquez:
Oh my gosh. Wow, amazing. Well, you know what, these things, while very challenging and and painful, also push us to be better and and adapt faster. So, you know, I hope it’s helped you guys. And and so what are you most excited about today, Rich?

Rich Prest:
I would say for me, it’s really this next generation of patient support solutions are continuing to find ways that we can leverage so much amazing innovation happening in digital health. And I think particularly now we’re seeing a lot with virtual health, remote patient monitoring and growing on the back of telehealth. And so that’s one key piece. And I think the other area is really the continuing evolution of iron space and how do we leverage data and get smarter.

Rich Prest:
So when you look at patient support solutions today, it’s been very much a one size fits all approach. Every patient is the same, and I’m just very excited about how we can get smart and say, let’s really assess each patient as a unique individual and Right. size the support they need and monitor how they’re doing and adjust this as we go through that patient journey.

Saul Marquez:
That’s exciting.

Rich Prest:
It is, yeah. I mean, for example, we’re looking at social determinants of health and saying, can we blame that? Typically a welcome call to assess the patient and see what the challenges are. But if we can blend that with data about social determinants of health, we can provide that nurse with even more information about some of the challenges the patient might have with getting started and staying on therapy. And then I think likewise getting smart about communicating with patients. Every every patient is going to have a preference, whether it’s a younger patient that wants texting and doesn’t ever want to get a phone call or a patient that much prefer phone calls over other methods, but really understanding each patient and their unique preferences and then being able to meet them where they’re at and communicate with them the way they want to be communicated with. Yeah, I think with these specialty drugs, it’s key. Exactly.

Rich Prest:
Yes, everyone is unique and I think all of these innovations really give us these opportunities to not just get it right for each person and help them to have better outcomes, but also at the same time do it more efficiently and reduce the costs and that wonderful combinations or the win win of better outcomes for patients and reduce costs in terms of providing that health care to them.

Rich Prest:
It just seems like exactly what we need for dealing with chronic conditions.

Saul Marquez:
Can’t agree with you more, which this has been a really interesting and I’ve enjoyed learning more about assist our folks. You could visit them at assist our X.com. You can also go to the website Outcomes Rocket that health type in, assist our X or type in Rich Prest, and you’ll find our entire interview there with the transcript and show notes and links. So make sure you check it out to learn more. Rich before we conclude, I’d love if you could just give us a closing thought and then the best place for the listeners to get in touch with you to continue the conversation.

Rich Prest:
Oh, it’s been great. Saul, I’ve really took the conversation. I would say that we all realize the pandemic has exposed many of the weaknesses of our health care system and at the same time is providing tremendous acceleration, as we’ve been talking about, to the option of digital technologies. And so anything we can do to make it easier for people to get the care they need by leveraging tech, it’s really going to not just help with this current crisis. I really see it will yield long term benefits and improving outcomes for patients and reducing the cost of the system of it rich.

Saul Marquez:
And for folks to continue the conversation, what would you suggest is the best way?

Rich Prest:
I would tell if anyone wants to connect with me. Just looking at Rich on LinkedIn is probably the best way to get in touch.

Saul Marquez:
They have folks connect with Rich and LinkedIn if you want to keep chatting otherwise rich. Tremendous work in this space. Specialty pharmacy needs help. Patients need help. And getting more efficient about it is critical to reduce that 50 percent. I mean 50 percent first fill abandonment. I’m still going to leave me with that wrench because it’s so crazy, man.

Rich Prest:
It’s nut. Not the numbers go up or down, but it’s it’s way higher than it needs to be. And we need to help more patients get started.

Saul Marquez:
Agreed. Thank you, Rich. Appreciate what you guys are doing.

Rich Prest:
Saul thank you so much. It’s been a great conversation.

Saul Marquez:
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