Enabling Lower-Cost Prescribing at the Point-of-Care with Kyle Kiser, CEO at RxRevu: Audio automatically transcribed by Sonix
Enabling Lower-Cost Prescribing at the Point-of-Care with Kyle Kiser, CEO at RxRevu: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Kyle Wildnauer-Haigney:
Hey, everyone! Welcome back to the Outcomes Rocket Pharma podcast. I’m your host, Kyle Wildnauer-Haigney. Today I have the privilege of welcoming Kyle Kiser to the Show. Kyle Kiser is CEO at RxRevu, where he leads an agile team in developing innovative solutions that improve patient access to care. At RxRevu, Kyle has helped create the nation’s largest cost and coverage network between payers, PBMs, providers, and EHR vendors. His focus on interoperability has allowed partners to lower the cost of care, streamline administrative workflows, improve health outcomes and enable clinically and financially aware prescribing. Prior to joining RxRevu, Kyle developed incentive strategies for the country’s most innovative employers and led product launches with the nation’s largest payers. He was an early employee at Well Talk and Catapult Health, as well as a senior leader at Principal Wellness Company. Well, Kyle, welcome to the show.
Kyle Kiser:
Glad to be here.
Kyle Wildnauer-Haigney:
So maybe to kick things off, you could tell me about yourself what drew you to working in the pharmaceutical value chain?
Kyle Kiser:
Man, I think health care was the draw generally. So I grew up in the health insurance and employee benefits business literally grew up in it. So my family’s business was a benefits brokerage. I got in trouble in middle school and had to go home and stuff enrollment packets. So that kind of world. And so it’s just, you know, I didn’t stand a chance. I was going to be in health care. And I think there was a hope and expectation to be in the family business. But as I learn more about it or participate more in it, it was kind of disappointing to see how little there was to do about controlling costs. Basically, the only trend at the time and even now has been just shifting costs more onto the member and just felt really compelled to find ways to make that difference for the patient. Like how do we help them understand the choices better or how do we help them be more empowered to take control of their own health? And so that led me down a corporate wellness path and spent a lot of time in the corporate wellness world doing points-based incentives with employer-based health care. Spent some time on-site in employer-based preventive care and ended up in RxRevu. After that, just I wanted to go earlier. I participated in a few as an early employee in a few startups and just wanted to go earlier and earlier. And that’s where we met. And Pharmacy has been an interesting deep dive, even within health care. So at the time, living in Denver and we had a friend in the neighborhood. She also happened to be the lady that cut my hair. Just like hard-working, worked her tail off as a sole proprietor, entrepreneur, type of woman. Right when I was meeting Carm calm and starting to get involved in this business or even considering getting involved with this business, she was diagnosed with psoriatic arthritis and went on first-line therapy, which usually methotrexate and it just wrecked her, you know, just as it does a lot of people and moved beyond that to one of the branded therapies in that category, might have been something else and was under or uninsured at the time and got a $50000 bill and had no idea it was coming. It just felt like if that can be a surprise to somebody that’s so engaged in their health, engaged in their own life, trying to advocate for themselves, then just what does that do for people who aren’t as actualized and felt like this is a problem I wanted to work on after that experience? Honestly, just because, you know, it took a bunch of time and cycles out of her life and as a sole proprietor and trying to operate a small business, that stuff can be really consequential to your life and your ability to earn a living and all those things. And so seeing that firsthand with somebody I cared about just made me want to try and help make that difference. So we’ve been on that journey ever since.
Kyle Kiser:
Yeah, maybe for the listeners, too. I think that story grounded in a personal experience is so important, right? And so many of us are consumers of health care are impacted by the health care ecosystem, and we’re also working to try to solve that. But maybe for the audience, start with a little bit of an overview of what RxRevu does and what excites you about what it is that you do.
Kyle Wildnauer-Haigney:
Yeah. So RxRevu is focused on providing real-time, patient-specific, location-specific, and moment-in-time specific insights into prescription decisioning and even increasingly expanding beyond prescription benefit. So up until very recent history, the way those decisions happened were largely in the dark. Doctors chose medications that didn’t understand the cost impact. That information really wasn’t available to them and absolutely wasn’t available to them in a patient-specified way. And what we’ve done is we’ve created direct relationships with the payer and PBM community, where we can exchange real-time transactions about a specific moment, member, and pharmacy, so that we need real-time price, coverage restrictions, and any relevant alternatives back. We insert that into the e-prescribing workflows. So this is the last thing that a prescriber sees before they sign the order. And the goal is where possible, we help prescribers choose lower-cost drugs or lower cost pharmacies for these patients in alignment with their benefits.
Kyle Kiser:
Oh, and so really empowering the physician or the doctor to prescribe individuals with all the information they need to make the appropriate decision, is that right?
Kyle Wildnauer-Haigney:
That’s right. And hopefully the first time, right, the decades-long battle between prescriber choice and health plan formulary is really left to the patient as the one to hold the bag. We were left as patients to have to go to the pharmacy counter, see the claims denied and see you can’t get it and you have to go figure it out for yourself. And our goal is to bring that information upstream, empower the physicians with it, and primarily because the trust is between the patient and the provider. Right? That’s the most leveraged relationship in the supply chain. People seek out conversations with their prescribers. They tolerate conversations with their health plan. And that’s just reality. I don’t think there’s a helpline plan executive that would argue that. And so our goal is to take the quality information, the formulary information, the right side of care type insights, empower that provider with that information so they can make the right choice the first time. Patient benefits, provider benefits, health plan ultimately benefits because we’re lowering costs and improving adherence.
Kyle Wildnauer-Haigney:
Yeah, and it’s easier for the patients. They get the right treatment and they get to take control of their health quicker.
Kyle Kiser:
That’s right.
Kyle Wildnauer-Haigney:
That’s admirable. And so what is it that RxRevu does that’s different from other companies in the space?
Kyle Kiser:
First and I think most importantly, is alignment. There are incumbents that have sort of been in the e-prescribing business where the electronic prior business and they are affiliated with pharmacies or PBMs or they have skin in the game, I guess, is the point of where the prescription is going to end up or how that decision is going to be made. So first for us is neutrality. We’ve actually gone a long way to make sure that we maintain that, that we’re constantly advocating for patients first, for prioritizing the patient interest, always and partnering with providers to accomplish that. And it’s because of that trust issue. I’ve already mentioned. It’s that that’s the most powerful relationship in the supply chain. And so that’s key and important. We’re the only ones that have that orientation in the market. Everybody else has an opinion about where that prescription goes and honestly, that matters. Second, we’ve treated it like software. Like we’ve listened to users, we studied users. We understand why it fails and when it fails and we’ve improved over time. So what that has allowed us to do is there’s a lot of really nuanced in-the-weeds descriptions of why transactions fail. A lot of them are around quantity or a lot of them around sort of NDC complexities and as a percentage of transactions, those are huge, but often those are really expensive medications. Those are self injectables inhalers, creams, insulins, places where they’re really expensive, high-cost brands or specialty meds, and our competitors don’t handle those transactions well. When those transactions fail, you miss the opportunity to make a lower-cost choice. So we’ve gone to extraordinary lengths to make sure that we’re expanding our opportunities as much as possible so that we always have those opportunities to intervene.
Kyle Wildnauer-Haigney:
And it’s almost where the pharmacy value chain is in a lot of those reasons that the claim fails. You know, it’s almost like a step before where transparency brings up. Many individuals don’t even know what are the variables that could cause a claim to fail, why they missed that opportunity. And you are defining those variables and also actually fulfilling those with discrete values and saying this is why it failed. Let’s fix this. And I think that’s a really key point.
Kyle Kiser:
Yeah, absolutely. And so things take pressure off, for example, that is the universally hated thing for a patient, but universally necessary. It’s the only lever that a lot of health clients have to manage cost and drive quality. So what we can create with our solution, Citrix Direct, which is our point of care price transparency solution, is the opportunity to avoid those, and being able to process them electronically is a good thing. What’s better is being able to make the choice that doesn’t involve the prior person or the choice that even if it does involve the prior office, the one that’s likely to be cleared so that, you know, to your point, we can do those things as far upstream as possible. The better experience is for the patient, the better the whole plan is from a risk perspective. And honestly, it’s quite a bit less hassle for the provider and their care team.
Kyle Wildnauer-Haigney:
That makes sense. And so you’re scaling out and thinking about where the pharmaceutical value chain is today. What excites you most about that? What are you seeing kind of in the market today?
Kyle Kiser:
I think there’s an opportunity to move where the work happens. So today, as you know, there’s a lot of work happening in hopes. There’s a lot of work happening in health plans. There’s a lot of work happening inside the provider’s office and much of it is uncoordinated and much of its retrospective so the claim has already been denied. And then the rates start to solve the problem. What I think we have an opportunity to do is move that work so. Whether it’s prior off its enrollment, its medication access barriers, its ways to pay, those are all things that we can start to solve in real-time. We could start to inject into the right places and workflow. We can start to suggest different basically care paths. They’re really not clinical care paths, but their supply chain paths to help get that patient from one place to the next. Really starting to think about ourselves as a router. There’s a lot of cases where our health system is the right place for this prescription to be filled. If we’ve got a complex patient, we’ve got someone that’s Hep C patient, that’s somebody with a bunch of co-morbidities. There’s a great argument to keep that person within that health system to have continuity of care, to have an advocate. We can solve some of those problems and create a frictionless path to get that done. And then that health system can be better positioned to advocate for that patient in some of the same ways that hubs do that today. You know, hubs do a nice job of organizing some of that information through complete brute force and what technology is going to create the opportunity for is for us to move the network into the health system so that the provider care team can start to do those things at their fingertips. And it’s not something that has to happen after the fact. We can start to move that into more of a real-time environment.
Kyle Wildnauer-Haigney:
Yeah, you know, that makes complete sense. It’s the shift from being reactive to proactive and really understanding what the patient needs to ensure that they aren’t left uncovered or left in an exposed position where their health is in jeopardy because the whole system operates in a reactive fashion. Exactly how do you think this is going to play out, though, kind of looking towards the future? What does this mean for the value chain as a whole?
Kyle Kiser:
Well, that’s a big question. I think there are a few things. I think there’s, you know, increasingly health plan and PBM integration is just a reality now. it’s harder and harder to find it within the PBM. So I think there’s a closer alignment between, priorities of the health plan and the implementation of those. I think that’s a good thing. That means patient experience and member experience improve. For some of these higher costs, as you and I have spent way too much time battling back and forth at times. There’s a ton of value in some of these new, extremely expensive specialty therapeutics. But the system is maybe incapable of paying for those in a way that makes sense. And absolutely, I think there’s a lot of opportunity in how we sort of change how payment works in those scenarios, and hopefully not even the simple ways of just creating finance mechanisms for the patient to bear that burden in a different way. I hope there are ways that this evolves into pay per value and different opportunities for manufacturers and payers and providers and patients to collaborate to make sure that if we’re curing a disease or dramatically increasing someone’s quality of life, that there’s a way for the right entities to participate in that and not to leave the patient holding the bag?
Kyle Wildnauer-Haigney:
Absolutely. And so it’s, you know, it sounds like some flavor of value-based contracting two or three-point zero mixed with some sort of consumer engagement financing mechanism. But I think to your point, it’s not just those end solutions solving the payment problems, but a complete paradigm shift of what is paid for, how is valued value accrued and also captured to all the key stakeholders.
Kyle Kiser:
Yeah, absolutely. And then to the ethics review point is that only increases complexity over time. So if we think formularies and utilization management as it exists today is complicated, which it is and it’s an impossible problem for prescribers to solve the 40 patients they see in a day and half a dozen or a dozen permutations of formulary and benefit that each of those patients probably represents. That’s a hard problem today, but as some of those things that we’re talking about become a reality that is not that far away, frankly, tools like ours are going to have to be there to manage that complexity. Right. There’s going to be a trusted technology at the point of care that helps relieve some of the burden and cognitive load that’s going to be created by that complexity. And we’re really only trying to help the prescriber think about the clinical decision only. And then once that clinical decision is assured, we want to be there to manage the complexity associated with that as it relates to the benefits and the benefit design and formulary and price and where to fill and all those things. So is that complexity increases, we’ll be there to meet that need.
Kyle Wildnauer-Haigney:
Absolutely love it. And so you’re kind of thinking about back to where the industry is today. What are some of the biggest challenges that you’re seeing across your partners and really kind of more broadly?
Kyle Kiser:
I think twofold. One is consistency, I guess incapability. This is true in both pharmacy and medical benefit transactions for us right now is just moving from one payer to the next or some they’re way far ahead. And there’s some of they’re just catching up and there’s some they’re just not compliant yet with the type of data exchanges that are required to achieve this. So that’s going to be a rate limiter, probably even before that, one rate limiter for the whole industry, frankly, is there’s a sole source of eligibility for pharmacy and that’s a chokepoint on innovation in the industry. That’s just a hard stop. That is just true. Think about what has to happen for successful, real-time benefit. We have to know Kyle’s associated with this health plan and this formulary so that we know where to send the transaction. Once we know where to send the transaction, we can have a real-time price delivery, alternative delivery formulary exceptions delivery. Well, if that eligibility date is not available, it’s not possible to send that transaction. So more liquidity in eligibility data, I think, is a really important thing to happen to the industry. And frankly, it’s within the rulemaking capability of CMS as they look to implement the real-time benefit rule that passed one-one. So I think those are probably the two big ones on the payer side. On the provider side, it is largely engagement-related. And I think it’s less sort of a technological implementation and more education and awareness of the prescriber. If you’ve spent 25 years as a provider using an EMR and honestly ignoring the formula of the benefit data that was in there because it hadn’t been in your entire career. And then suddenly we show up with a new price insight and say, Hey, you should pay attention to this. It takes a bit of convincing at times to say, here’s this new insight. Here’s why it’s important. Here’s why it’s better. Here’s why it’s reliable. You can trust it. It’s simple stuff, but I think that re-earning the trust of the provider user as an industry is something that we’ve got to look towards as an opportunity, and we’ve made a lot of progress on that with our users. Also really important as to why we’ve come in alongside providers, as you know, as our investors, as our collaborators is because we want to understand what that takes because ultimately the value only occurs if we can change provider behavior and referral patterns only change if we change provider behavior at the point of care. Otherwise, we’re sort of chasing a rabbit that’s already getting away.
Kyle Wildnauer-Haigney:
Yeah, and I think it’s the earning of trust. But then to your second point, is also building new patterns of behavior, kind of a change management component wrapped around that, for sure. And so maybe to wrap things up if you give the listeners a closing thought and the best place where they can collaborate with you?
Kyle Kiser:
Well, for us, I mean, I think I’ll do a recruiting plug first. We’re growing fast and we’ve got a lot of ambition. So for those that are in the industry and passionate clinical pharmacists that understand data or passionate business development folks that care deeply about the value chain and want to see it be different, we want you on our team. We’ve got a phrase mantra within a company called Lucy up, and this is referencing our physician founder Kevin O’Brien, who’s a physician in Denver. The way this thing started, as I’m sure you remember he was trying to save money for his mom. His mom had a $900 monthly stipend for her for meds, and he said, You can split these into parts. You can do these things differently and these things differently and help cut her prescription spend in half. And that’s the initial inspiration for the company is just, you know, a son trying to help his mom solve a problem so she can manage her care. And her name was Lucy. So Lucy up is our mantra. You’ll see that around our website and our gear and our social media presence. And that’s the thing that’s most exciting to me about this team and the folks I get to work with is that they are entirely uncompromising on purpose. We’re all here because we want to make this better. And so one is shameless plug. We want more of those types of people on the team. And, you know, to find us, we’re increasingly on Zoom like everyone else, but we’re hopeful that that’s changing. But we’re collaborating with providers actively. So it’s spending a lot of time with the academy. And I think we’ve we would love to find these provider-led health plans and leading integrated delivery networks that want to think about things differently. We’re always looking for those types of collaborators, too. So those are my two plugs.
Kyle Wildnauer-Haigney:
I love it and I can confirm our interview is very mission-driven as an organization overall, and you are accepting applications across the board. So hopefully you get a deluge of applicants after this podcast is released.
Kyle Kiser:
That’s true.
Kyle Wildnauer-Haigney:
Kyle Kaiser. I always enjoy chatting with you. It was a pleasure having you on the show and have a wonderful day.
Kyle Kiser:
Right, Kyle. Always a treat.
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