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Accelerating Patient-Centric Care in Pharmacy and Beyond with Carly Rodriguez, Pharmacy Director of Clinical Innovation for Moda Health
Episode

Carly Rodriguez, Pharmacy Director of Clinical Innovation for Moda Health

Accelerating Patient-Centric Care in Pharmacy and Beyond

In this Outcomes Rocket Pharma episode, we are excited to feature the amazing Carly Rodrigues, Pharmacy Director of Clinical Innovation for Moda Health, a health insurance company that is making an impact far beyond providing and paying a medical claim. 

Carly explains how her work has an opportunity to improve patient experience on many levels.

She highlights some of the changes happening in terms of patient care in the pharma space like the move towards holistic, patient-centered care and partnerships with innovation organizations to meet customer needs. She also talks about some of the programs of Moda Health in supporting communities, therapeutic advancements made, the biggest challenges facing the pharma industry, and more.  

This is a great conversation on patient-centric care in the Pharma space, so please tune in!

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Accelerating Patient-Centric Care in Pharmacy and Beyond with Carly Rodriguez, Pharmacy Director of Clinical Innovation for Moda Health

About Carly Rodriguez

Carly Rodriguez is Pharmacy Director at Moda Health where she provides strategic leadership for clinical initiatives, operations, innovation, and the integration of medication management across pharmacy and medical benefits.

Her areas of expertise include formulary management, cost savings, and utilization management strategies, specialty drug management, benefit design, and medical pharmacy. She has presented to a variety of audiences on important topics in managed care, such as specialty pharmacy, medical pharmacy, gene and cell therapies, data integration, the opioid epidemic, and trend management. 

Carly earned her PharmD from the University of Washington and resides in Oregon with her husband, five-year-old son, and twin three-year-old daughters.

Accelerating Patient-Centric Care in Pharmacy and Beyond with Carly Rodriguez, Pharmacy Director of Clinical Innovation for Moda Health: Audio automatically transcribed by Sonix

Accelerating Patient-Centric Care in Pharmacy and Beyond with Carly Rodriguez, Pharmacy Director of Clinical Innovation for Moda Health: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kyle Wildnauer-Haigney:
Welcome everyone to the Outcomes Rocket Pharma Podcast. This is your host, Kyle Wildnauer-Haigney, and today I have the distinct pleasure of hosting the fantastic Carly Rodriguez. Carly is the Pharmacy Director of Clinical Innovation for Moda Health. In this role, she provides strategic leadership for clinical initiatives, operations, innovation, and the clinical and management of medications across pharmacy and medical benefits. Her areas of expertise include formulary management, cost savings, and utilization management strategies, specialty drug management, benefit design, and medical pharmacy. She has presented to a variety of audiences on important topics in managed care, such as specialty pharmacy, medical pharmacy, gene and cell therapies, data integration, the opioid epidemic, and trend management. She resides in Oregon with her husband, five-year-old son, and twin three-year-old daughters. Welcome, Carly to the show.

Carly Rodriguez:
Thanks so much for having me, Kyle.

Kyle Wildnauer-Haigney:
Well, maybe just to kick things off, could you share your background and what drew you to working in the pharmaceutical value chain?

Carly Rodriguez:
Yeah, absolutely. I think my journey into pharmacy really started pretty early when I was very young. I think back even to my very first job. I worked in a retirement home, so I worked with a lot of seniors and I developed pretty close personal relationships with a lot of them in pharmacy and medication is something that came up over and over again in my conversations with seniors at that time. And at that time, I was kind of figuring out what I wanted to go to college for, and I was leaning towards biochem, chemistry. And so as I moved into my undergrad studies, those two kinds of worlds collided a little bit for me. And I decided to pursue pharmacy school as graduate education. And as I progressed, I guess in my pharmacy education, I learned pretty quickly that I wanted to go somewhere that would impact medication management or pharmacy on a macro scale. And actually, I thought initially that I would end up working in the pharmaceutical industry and maybe even doing bench science. But over time I found managed care as a path, and that’s kind of how I landed here.

Kyle Wildnauer-Haigney:
That’s awesome. So it’s the first experience in a retirement home that really gave you that insight in the first introduction.

Carly Rodriguez:
Yeah, and interestingly, here I am probably 20 years later at least. And unfortunately, not not a whole lot has changed in terms of seniors’ challenges and struggles with medication management and affordability. And so in your job today in this purview that you have, what excites you most about the work that you do?

Kyle Wildnauer-Haigney:
I think what excites me the most about what I do is that the opportunities are the possibilities are really endless. This particular area of pharmacy is so fast-paced and diverse and there’s really an opportunity to impact the patient experience on so many different levels. And I guess if I had to pinpoint one thing that excites me is the concept of moving beyond just the benefits, thinking about pharmacy benefits in a silo and moving more towards a holistic, like medication management approach, looking at the patient or the consumer as a whole, rather than saying, here’s a benefit and we’re going to manage that.

Kyle Wildnauer-Haigney:
Interesting. Yeah, it’s a theme that I keep on hearing in the pharmacy space today. It’s really looking and orienting the care around the individual, around the patient, and using a pharmacy in conjunction with the broader medical benefit to really drive outcomes.

Carly Rodriguez:
Yeah, absolutely. And I guess the other thing that I would say that’s really exciting in that space is just the opportunity to partner with other innovative organizations and form these kinds of synergistic partnerships that lead to exciting and beneficial programs for members as well. So I think that finally in the health care space where we’re understanding that we have consumers and consumers have demands and we have to meet those demands. So I’d say that’s been fun, really.

Kyle Wildnauer-Haigney:
And so tell me about Moda Health and with your kind of experience there and caring for those members, what is it that Moda does differently than other insurers out there?

Carly Rodriguez:
Yeah, Moda is a really fun and exciting and innovative company to work for. I’ve been here for about five years now and I think what really strikes me about Moda is just our presence in the community. It’s that we are a health plan. We are an insurer, but we’re making an impact so far beyond just providing/paying a medical claim or paying a pharmacy claim. We have a lot of partnerships in the geography that we’re presenting in the Northwest and we do things really to benefit the communities that we serve. So we have a partnership with the Portland Trailblazers called the Moda Assist Program. And through that program, we raise funds and then partner with communities and sometimes liberal, sometimes inner-city neighborhoods to build fallibilities, playgrounds, things like that are just they make you proud to work for an organization that’s really giving back to their community. But I think more so thinking on the health plan or insurer side, I think that we do a lot of really innovative things with providers, with other health and wellness companies, with technology companies. And really we push the envelope. And the Medicaid space is a really good example. But these partnerships that we form are really to benefit, again, our communities and members. And so that’s something that really it makes you excited to come to work every day.

Kyle Wildnauer-Haigney:
Yeah, it sounds like you’re really trying to support your community rather than just being a quote-unquote payer of claims and really supporting the members and their health and kind of benefiting their lifestyle.

Carly Rodriguez:
Yeah, absolutely. It is really about meeting patients, meeting members where they are in their health care journey, and acknowledging that sometimes the most beneficial thing that can be done to benefit somebody’s health is not about getting medication or getting a doctor’s appointment. It’s about food insecurity or just being able to get to an appointment. Things like that that I think have been long overlooked as far as barriers to accessing appropriate health care.

Kyle Wildnauer-Haigney:
You know that broad bucket of social determinants of health where it has become. I think there’s definitely a trend going on right now where it’s at the top of everyone’s mind, and rightfully so. And it’s so much more than just health factors that play into the health of an individual that’s fantastic to hear. And so maybe just kind of thinking more broadly, what excites you about where the pharmacy is today? So kind of outside of the work that you’re doing to help in some of the work that you’re doing with AMC, what gets you really excited for the future?

Carly Rodriguez:
Yeah, I think it’s really hard not to be excited about the therapeutic advancements that are being made in pharmacy, thinking about gene therapies. When I started pharmacy school, that’s not something that was even ever on my radar. And while they come with extraordinary price tags, you can’t help but be excited about the science and the potential that these could cure really debilitating and sometimes fatal conditions. I think that’s something that’s certainly exciting. Thinking about the emergence of digital therapeutics, I think we’ve sort of been conditioned as a society to say, oh, I have a chronic condition or I have an illness and there’s a medication that’s going to treat that or a medication that can be paired with that. And digital therapeutics are more so about thinking about behavior modification and other active measures that can be taken to combat the downstream effects of chronic or acute conditions beyond the concept of taking a pill. And I think that’s really, really exciting. I think the other thing I would say is that we’re starting to move along this pay-for-performance continuum and starting to integrate pharmacy into some of those value-based care arrangement discussions, whereas pharmacy has almost always been a fee-for-service kind of transaction. And now we’re starting to move towards more of that, the pay-for-performance seeing providers taking risks in pharmacy costs and trends. And I think that’s a really exciting place to be.

Kyle Wildnauer-Haigney:
How do you think from the health plan perspective, the plan needs to adjust for these pay-for-performance contracts? I mean, there are considerable adjustments that they have to make in order to support them. You talked about that for a little bit.

Carly Rodriguez:
Yeah, I think when we think about pay-for-performance mean there are so many different things that you can think about here. You can think about outcomes-based contracts with manufacturers of pharmaceuticals or biotechnologies. So that’s one area you can think about. You can also think about provider-based value agreements or performance-based agreements where you’re potentially looking at per member per month caps on pharmacy spend or you’re looking at reference-based pricing within therapeutic categories and benchmarking prescribers against those, so there’s a lot of different things you can think about in the pay-for-performance continuum. And I think the biggest change or challenge potentially for payers is the data aspect. If you’re looking at outcomes, you have to be able to collect and aggregate and report the data that’s associated with those outcomes. And I think historically some of that clinical data has been really difficult for payers to get their hands on.

Kyle Wildnauer-Haigney:
Sure. I mean, so much of where health care is today and I know this is a broad generalization, but hinges upon having better data, and data that connects across these disparate systems. And I imagine that as we move towards pay-for-performance contracts, gene therapies, digital therapeutics, understanding the value that it provides, the member and the patient is going to be critical to really control costs. And so is this a good solution for no.

Carly Rodriguez:
Yeah, I think you’ve absolutely hit it on the head there. I think, especially as I think about gene therapies or digital therapeutics, how exciting those are. Of course, employer groups, payers are all going to be concerned with the return on investment particularly with gene therapies, because some of them we’ve seen have two-plus million dollar price tags. And so you have to be able to answer the question as an employee or group or as a payer at any level. You have to be able to answer the question, what am I getting for that investment? And the truth is the answer right now is I don’t know. And it probably is I don’t know for a long time until you see how that particular therapy plays out in an individual or we start to get some broader real-world data. But the other challenge to that is that the gene therapy at least, that are approved today are approved for rare or ultra-rare conditions. And so aggregating data and getting any amount of robust real-world data is a challenge in itself. But we know that there’s gene therapy on the horizon for more common conditions like hemophilia. And so we may start to see some of that data there. But we do have to answer the question. What are we getting for that investment?

Kyle Wildnauer-Haigney:
Yeah, and it sounds like that’s going to be something that Moda Health just to kind of scale back to your current role is going to be developing partnerships with the community and with providers and other innovative companies to really better understand that and get the complete picture.

Carly Rodriguez:
Yeah, absolutely. And I think that’s so important with gene therapy is that it is thinking about, again, the ones that are now for rare and ultra-rare conditions is even in the studies, the clinical trials for these therapies, there’s only a handful of treatment centers in the whole country that even have experience with these therapies and treating these populations. And so it is about identifying those important provider partnerships where you can be assured of the quality of care, but you also have better access to data to understand how the therapies are performing.

Carly Rodriguez:
Sure. And so currently, when you think about today, what are the biggest challenges that you think the industry is facing right now?

Speaker3:
Yeah, I think the biggest challenge and sadly it’s not a new challenge is really this balance between innovation and affordability. We constantly hear about escalating drug costs and medications not being affordable and gene therapy again as a whole different dimension to that, that challenge with these the price tags that we’ve just never seen before. And so it’s really how do you find the balance between those escalating drug costs that are for innovative therapies, but managing the affordability aspect? Because the reality is those innovations can only be useful if people can access them and they have to be affordable for people to access them. So it’s really striking that balance, I think, as I think about some other challenge beyond that, which is kind of the obvious is, is this a newfound demand for transparency in our industry? And I think that’s a good thing, that there’s a demand for transparency, but the industry as a whole is maybe being too slow to respond to that demand for transparency. And so that’s leading to legislation in all 50 states which is about controlling drug cost or potentially influencing utilization management tools that payers have at their fingertips, and so that can possibly lead to fragmented regulation and sadly even increased cost because of removing some of those utilization management tools that we have available today, but also the administrative cost of fragmented, fragmented regulations. And I guess the last thing I would say about challenges, which I think is also a good thing, is the need to meet each individual consumer where they are. It’s a great thing, right? Health care should be personalized, but it’s a heavy resource investment. And so if we think about communicating to consumers how they want to be communicated to or providing them information in a timely manner and in the way they want it provided to them for delivering services in a more convenient way, like virtual health or home health, mail-order delivery services, those kinds of things. All of those things are great and it’s just a matter of the logistics and the resources to get there. But I’d say those are kind of the three things, the three biggest challenges that I see facing the industry right now.

Kyle Wildnauer-Haigney:
And it’s there’s a lot of investment in this space to its promising, but it will also take some time for these solutions to scale and to really start making a broader impact on the members of the US. It’s exciting, though. Just to close things out. Could you give us a closing thought and the best place that listeners can collaborate with you?

Carly Rodriguez:
Yeah, sure. I think that hopefully, a theme that you’ve seen throughout our conversation today really is around the consumer, the member, the patient, meeting them where they are and delivering innovations that they need and can use. And so I guess from a closing thought perspective, I would just say that innovations in pharmacy and in health care more broadly are only as good as their uptake. So the approach to any new innovation, whether it’s program services, technologies, they have to be patient or consumer-centric, and they have to provide a tangible benefit to those stakeholders in order to influence behavior. And as far as a place to collaborate with me, I think LinkedIn is a great spot for me to collaborate. And I welcome any outreach to further the discussion.

Kyle Wildnauer-Haigney:
Oh, fantastic. Thank you so much Carly for joining me today. There’s a great conversation and I hope you have a wonderful day.

Carly Rodriguez:
Thank you. Thanks for having me. You too.

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Things You’ll Learn

  • Healthcare needs to understand that we have consumers and consumers have demands and we have to meet those demands.
  • Sometimes the most beneficial thing that can be done to benefit somebody’s health is not about getting medication but rather about food security or just getting a doctor’s appointment. 
  • Social determinants of health have been overlooked as far as barriers to accessing appropriate health care.
  • Digital therapeutics is more about thinking behavior modification and other active measures that can be taken to combat the downstream effects of chronic or acute conditions beyond the concept of taking a pill. 
  • Pharmacy has always been a fee-for-service kind of transaction, and now we’re starting to move towards pay-for-performance. 
  • Much of healthcare hinges upon having better data. 
  • The biggest challenge the industry faces is the balance between innovation and affordability. 
  • Health care should be personalized, but it’s a heavy resource investment.
  • Meet patients where they are and deliver innovations that they need and can use.
  • Innovations in pharmacy and healthcare are only as good as their uptake.  So the approach to any new innovation has to be patient or consumer-centric to provide a tangible benefit to stakeholders in order to influence behavior.

 

Resources

LinkedIn: https://www.linkedin.com/in/carly-rodriguez-pharm-d-famcp-552a6b14

Website: https://www.modahealth.com/