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Beyond Insurance: The Hidden Path to Affordable Healthcare

• Evan Kirstel

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Speaker 1:

Hey everybody, Really big and important topic today in healthcare on helping patients afford their medications, treatments, and more Big problem these days with Shrulik from TaylorMed. Shrulik, how are you?

Speaker 2:

I'm great. It's good to see you, Evan. Thanks for having me.

Speaker 1:

Well, thanks for being here. Maybe start with the big picture introductions to yourself and the big idea behind TaylorMed.

Speaker 2:

Absolutely so. I'm based out of New York. Co-founder of a company with Adam R Cittal, my co-founder in 2018. Now, wow, that flew by.

Speaker 2:

Personally, I came from a med device background in a very different part of healthcare neurostimulation devices for ischemic stroke.

Speaker 2:

What kind of drove me to start thinking about what became TaylorMed is that, but also some personal experiences with family members with cancer and as many founders in digital health.

Speaker 2:

That story created an itch that eventually created a company, and we started back in 2018, realizing that within specific therapeutic areas and we were focused primarily on oncology back then patients are struggling to afford their care Generally speaking, even more so when you think about medication costs, and I think that we know how much in the news medication costs continues to be, and it's unfortunate for a good reason. What we found over the years is that that specific problem is not oncology related or cancer related. It is much more widespread and we've learned that patients, whether they are getting treatment for their chronic conditions, their specialty conditions or just in general like getting care, are burdened by increasing amounts of out-of-pocket costs for medication. So what TaylorMet does is that, in a very, very simple way, we are able to automatically identify those patients when they are prescribed medication that will create a financial barrier for them and then look for third-party assistance that can alleviate that concern for them but also make their provider organization or their dispensing pharmacy financially whole.

Speaker 2:

And we created what became the largest network in the country that connects patients, providers, pharmacies and now also life sciences companies in one digital interconnected network that automates a lot of those processes and reducing the medication affordability barrier for patients.

Speaker 1:

Amazing. So what a transformational vision you have here. So you built something called an affordability network that includes pharma companies, pharmacies, health systems and more.

Speaker 2:

How does that work exactly, and how does it help cover out-of-pocket costs, other costs, yeah, so think about first of all the different examples we have, and then let's put it together as a network.

Speaker 2:

So, at the end of the day, a patient going into a health system or a community practice is prescribed a medication that will be one or more throughout their course of treatment and, based on their insurance coverage, they will probably have anywhere between a few dozen dollars to a few thousand dollars of out-of-pocket costs that they need to pay in order to get that treatment and adhere to it. Cost that they'll need to pay in order to get that treatment and adhere to it. As we all know, many patients can't, and that will result in prescription abandonment or even getting the drug but then not being able to pay a write-off or uncompensated care for their provider. Organization what people don't know is that there is an abundance of assistance out there. Organization what people don't know is that there is an abundance of assistance out there. There are thousands of programs that would be sponsored by pharma companies foundation grants, government subsidies, charity programs that are amounting to about $50 billion of assistance but they're so hard to enroll into and be aware of and navigate towards, and that's what we do. So that patient that went into that health system has their data in the EHR and we have deep integrations to every EHR and at the moment that prescription is written, we pick it up, we screen for available assistance and then we engage either the care team, the pharmacy team or the patient to instruct them as to how to enroll and capture the value of those assistance programs. So that's what we do in every medication encounter that we see, whether it's a small community practice, a large health system, an enormous specialty pharmacy and so forth.

Speaker 2:

But one of the things that happened over the years is that when you start looking at all of those nodes, quote unquote, in this network, there is value of them being part of the same network.

Speaker 2:

That value is because we can now come to some of those program sponsors and say we see a meaningful volume of your patients, let's make it easier for them and let's integrate directly to your programs and achieve a single click enrollment which would otherwise be a manual, e-fax form, portal experience. That's one thing. That is the value of being part of this network. The second thing the network is learning and growing. Someone detects a new community program, we add it to our database. Everybody benefits. You can start thinking about patients who are prescribing one organization and dispensing another pharmacy within the same network and you can start seeing a consistent experience for patients within the network, because we have so many partners at the moment. So I think it's only the tip of the iceberg, and the network effect is the one that we're very excited about, because you are able to bring more value to end users and then to the organizations and vice versa.

Speaker 1:

Amazing. So give us a sense of the scale of your network at the moment and how fast it's growing. I mean, how many organizations are part of the network? How many patients have you been able to support today? And obviously you're on a journey.

Speaker 2:

We are and it's humbling to see how we started a few years ago with one small cancer center in northern Michigan and we are now deployed with our technology across around 900 hospitals, 3,000 clinics and about 1,500 pharmacies, of which some of the largest in the country and I think we currently have about four out of the six largest specialty pharmacies also part of our network.

Speaker 2:

That translates into millions of patients a year that we're able to view and get access to their prescriptions and, when relevant, engage with them and their care teams to make sure that we're creating that opportunity for access and affordability programs. We crossed the $5 billion of assistance secured last year and we are on a journey to double that in the next couple of years as well. But if you think about the scale of the network and the pace that we're able to expand that, that also is expedited because of that network and the pace that we're able to expand that, that also is expedited because of that network effect I spoke about before. Because when you think about a new health system that clearly doesn't have anything, it is a very manual process and if they can look at a solution like ours that benefits from the fact that we have so many others participating in this network. We have an unfair advantage because we have those touch points with the program sponsors, with pharma, to have automatic enrollments and we're able to add more and more health systems, practices, pharmacies, every week.

Speaker 1:

Wonderful. So as someone who has good health care like myself and resources, I can only imagine the financial assistance nightmare, the journey that exists today. Describe that for patients who don't have access to a solution like TaylorMed. What's that situation like for them? For?

Speaker 2:

many of them solution like TaylorMed. What's that situation like for them, for many of them, happy to, and I'll also say that it is confusing because people would think that this is something that would be only for the uninsured or the indigent. But if you think about us, hopefully with decent coverage and with our health, knock on wood, it would not be an easy event if we would be surprised quote unquote by a $5,000 a month drug.

Speaker 2:

Or even like hundreds of dollars a week if it's a chronic condition. What currently happens? I'll give you two examples. Like I had a small hospitalization event a couple of years ago and I was prescribed an anticoagulation drug that doesn't cost a lot I could afford it it was $75 a field and I came to the pharmacy. Nobody offered me assistance. Knowing what I know, I went to our app. I put my details in and it surfaced a copy card that lowers my out-of-pocket costs a month from $75 to $5. Many patients don't know that.

Speaker 2:

Think about what happens if it's a chronic condition, but also what happens if it's a specialty, life-threatening condition. Let's say it's multiple sclerosis or rheumatoid arthritis or cancer. God forbid. You are going into your oncologist visit. You leave with a lot of questions and a ton of anxiety and now you are realizing that you need to pay $3,000 next time you come in for an infusion visit.

Speaker 2:

What currently happens is that provider teams are doing beautiful work and trying to help patients, but they're understaffed, as we know, and they're Googling or having some cheat sheets or spare cheats or Post-its which will help them do great if there is one patient or five patients, but in a big practice there could be hundreds of patients a given day that will need that assistance. That's what happens today and it's very manual, it's decentralized and unfortunately, many opportunities go without being utilized and what we do is that we try to change that from a reactive, passive process to a much more data-driven, proactive one. So instead of me thinking about it or a care team trying to allocate time for it, we are surfacing those opportunities for patients proactively, for their care teams, so they can take action in advance of the surprise bill, in advance of that anxiety or even like in advance of that difficult decision should I take my treatment or pay my bills? So I think it's a big change and technology can support it.

Speaker 1:

That's incredible and given the medical debt snowball that's increasing out there, this is such an important solution. So it wouldn't be a health technology discussion if we didn't talk about AI. How does AI fit into your roadmap and how you're using it, either on the provider or the patient side?

Speaker 2:

Yeah. So I think that maybe oversharing a little bit, if you will we resisted being part of the early days of just like saying we do things with AI until we figured out what AI really means in the context of medication affordability and how it can really drastically drive change in TaylorMade, and I'm glad to say that we're in a transition here. There are three core identified areas where AI is changing the way we work. One is actually maybe less sexy. It's behind the scenes. It's our engineering. Our engineering are able to now scale their work to new velocity and just work with the support of a lot of the new agentic AI tools to be able to do more with the current skill set and talent and bandwidth that we have, and I think it's going to translate into more feature enhancements, more products and product lines to our customers, which I think is something that is not as easy as it sounds when you read it on X or just see some blog posts. There is a lot of engineering I would say design that needs to come into it to actually unlock the value. That's one core area that we are seeing a massive transformation this year. The second one is also around services. We have a team that is able to help patients or health systems or pharmacy, do a lot of that work as a hybrid team, because sometimes there isn't enough staff for a hospital, for example, to have and a lot of our FHC are going there as well we want to make sure that our teams and as a result of that, you know, our care teams are able to reduce a lot of the manual and administrative burden, and AI can play a huge role in that and we're starting to see the early signs of that this year as well.

Speaker 2:

But last but not least, as I said, think about the maze of thousands of programs that one individual needs to navigate. Ai can play a huge role in that. We recently launched a new product called Teammate AI that allows users to chat GPT, quote, unquote with Telomed to ask very simple questions. I have a patient with prostate cancer. Are there any foundations currently open? What would it take to enroll to this different program? And please put a reminder to help me follow up with the patient in a few weeks and instead of like working the same workflow tool, this is a new way to interact. We all know that we all do that, but we want to make sure that the patients are able to leverage that in the context of financial assistance and also our care teams to scale their work as well. So it's a big position here for us, not only across the world, but also for us at TaylorMath, big year indeed, and you know healthcare, as you know better than anyone.

Speaker 1:

Healthcare affordability is such a moving target and you're a bright light in this space. But what are some of the big picture trends? Are we moving in the right direction and what you know? How are you evolving as the landscape changes?

Speaker 2:

Yeah, so I think that you're right. There are a lot of moving pieces, a lot of balls in the air. Some of those are coming from things that started probably in the last two years with the IRA under the previous administration, and those are positive changes, but unfortunately not enough. We're seeing cap put on Medicare Part D plans. We're seeing insulin prices drop to $35. And we are still trying to figure out what would happen under the new administration. We've recently heard about a few executive orders that will have a potential impact on drug prices.

Speaker 2:

But I think that all of those moving pieces and if you also want to throw the dynamics within pharma and payers into the mix, at the end of the day are intensifying the confusion and it's very hard for a patient to navigate. All of those and some of those create, you know, positive impacts, some actually, there is a movement that someone else needs to pay more because Medicare maybe pays less. But all of that eventually puts one most important, I would claim, individual at the center of all of that, which is the patient, and we can help them navigate through those monumental changes or just noise, we never know what would it be the the end result? I think this is where we can, uh, play a big role and continue supporting our patients, our customers, our network with that and obviously do that with. Technology makes it easier because you can scale that automatically.

Speaker 2:

But I think, if you think about the landscape more broadly, when a patient gets to an affordable medication, it's not the end of the challenges that they will face throughout their medication journey. What comes next is how do I get to my appointment, how do I adhere to my treatment, how do I avoid side effects, and so on and so forth. Unfair advantage here at Telomed that we are closing this critical gap so upstream in the patient journey, earning the trust of our partners and patients, that we can start thinking about the next layer and next layer of barriers that will come in and apply the same techniques of a digital, first patient-centric approach, not only to remove affordability barriers, but also access and, later on, adherence. That's definitely where our team is really excited about going and building.

Speaker 1:

Wonderful. So, speaking of patients, you must have so many stories or anecdotes, feedback from patients. Do you care to share any of those?

Speaker 2:

obviously anonymously, of course, and for those of you who are interested, like check our blogs we're posting those every other week but one that we just you know.

Speaker 2:

I was visiting one of our customers in New Orleans last week and we met and talked about you know the company and our trends and our success together.

Speaker 2:

But one of our team members made a point which I really like, which is, at the end of the day, patient stories kind of get missed with all of these numbers, and she shared a story of a patient that had commercial insurance, turned 65, was on two expensive drugs one infusion, one oral drug and in that transition they lost their access to a manufactured, copious system, which is what a lot of commercially insured patients can get access to.

Speaker 2:

In our team we have a TaylorMet Complete Solutions team and services team was able to get on a call with that patient, navigate them to a free drug program by the manufacturer to make sure that they don't lose treatment, and it helped them reduce their costs from thousands of dollars a month to zero zero until they were able to get on their Medicare program, find a foundation that can support their out-of-pocket costs. And I think that those gaps in care can be life-threatening and this is one of thousands we see a day, but for that specific patient that changed their life, and I think that you know, going back to why we started this company, it makes us, you know, still have the motivation to continue building and reaching more. Oh wonderful.

Speaker 1:

I'm getting goosebumps hearing that story. So, meanwhile, you're investing, you're fundraising in the team and growing. So what are you looking forward to this year in terms of new tools, services, features, other capabilities?

Speaker 2:

Yeah. So I think that we look at like three main themes of our roadmap. One obviously, we have thousands of daily users in our platform. There is so much more we can do for them, so we're constantly adding enhancements, whether it's through AI, through other product integrations, deeper integrations with IT systems. So that's kind of our kind of flagship platform that continues to be enhanced.

Speaker 2:

The big bet that we have this year is patient-facing. We launched last year our first patient-facing tool that basically allows patients to self-serve, completely manage a virtual copy wallet and interact with our team through digital technology, which is just another way to have patients more engaged and, to the extent they can, proactive in their financial journey and also help scale our teams and not require that health systems hire hundreds of employees, because it's not feasible. So that's number two. And number three is our integrations with pharma. We are building more and more programs that we can have that single click and moment experience that we call Expressenal. We're adding more solutions for our brands and manufacturers that translate into like great value to patients and our care teams. That kind of network effect is most felt there. So our customers and patients can expect more express-able brands coming in this year, more capabilities to automate and just make this complicated multi-step, multi-stakeholder process a bit more efficient than automated.

Speaker 1:

Fantastic, and you know looking forward even more beyond this year or next. I mean five years. Where are you hoping the conversation around affordability will be? Policy-wise big picture? What's your longer-term impact? Potentially.

Speaker 2:

So our hopes is that financial barriers to care would be a thing of the past, I think, where policy changes will help great, where technology and other program sponsors can help great as well. But as our company scales, we have two North Stars that we want to make sure that we execute. On One, there is no medication encounter that takes place in the country that we can support a patient if there is a financial barrier and tell them it should be, that go to a trusted source to close that gap. And two, how do we start looking at the next and the next and the next barrier to the example I gave before and really create what at the moment doesn't exist in the space An end-to-end, from prescription to ongoing care platform that removes all of those barriers for patients so they can actually focus on their care, and for their pharmacy and provider teams to focus on delivering care and remove a lot of the administrative burden that they have to go through every day?

Speaker 1:

Well, here's to that vision. We're all rooting for you, and thanks for joining and sharing more about the mission. It's been a pleasure. Thank you for having me. Thank you and thanks everyone for listening and watching and sharing the episode, and be sure to check out our latest TV show, TechImpact TV, now on Bloomberg and Fox Business. Thanks everyone, Take care.