Fixing The potential snafu between your physician and pharmacy

When your doctor prescribes a new medicine, there’s a pretty good chance that some snafu will crop up before you get it filled. Either your pharmacy doesn’t carry it, or your insurance provider won’t cover it, or they’ll say you need “prior authorization,” or your out-of-pocket cost will be sky-high. The basic problem is that the electronic health record systems and e-prescribing systems at your doctor’s office don’t include price and benefit information for prescription drugs. All of that information lives on separate systems at your insurance company and your health plan’s pharmacy benefit manager, or PBM. And that’s the gap that a company called RxRevu is trying to fix. Harry’s guest on today’s show RxRevu CEO Kyle Kiser, who explains the work the company has done to bring EHR makers, insurers, and PBMs together to make drug cost and coverage information available at the point of care, so doctors and patients can shop together for the best drug at the best price.

Please rate and review The Harry Glorikian Show on Apple Podcasts! Here’s how to do that from an iPhone, iPad, or iPod touch:

1. Open the Podcasts app on your iPhone, iPad, or Mac.

2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you’ll have to go to the series page which shows all the episodes, not just the page for a single episode.

3. Scroll down to find the subhead titled “Ratings & Reviews.”

4. Under one of the highlighted reviews, select “Write a Review.”

5. Next, select a star rating at the top — you have the option of choosing between one and five stars.

6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.

7. Once you’ve finished, select “Send” or “Save” in the top-right corner.

8. If you’ve never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out.

9. After selecting a nickname, tap OK. Your review may not be immediately visible.

That’s it! Thanks so much.

Transcript

Harry Glorikian: Hello. I’m Harry Glorikian, and this is The Harry Glorikian Show, where we explore how technology is changing everything we know about healthcare.

If you live in the United States and you’ve ever had your doctor prescribe a new medication, you’ve probably had the following experience.

You drive from the doctor’s office to the pharmacy.

And when you get there, you find out that the pharmacy doesn’t carry that particular drug.

Or that they do carry it, but your insurance provider doesn’t cover it.

Or your insurance does cover it, but they require prior authorization.

Which means you have to get back in touch with your doctor and ask them to tell the insurance company that you really do need the medicine.

Or you already have prior authorization, but you haven’t met your annual deductible yet, so your out-of-pocket cost is much more than you expected.

If any one of these problems crops up, the chances that you’ll actually get your prescription filled on the day you need it go way down.

And it’s not uncommon for several of these snafus to happen all at once.

Fundamentallythat’s because the electronic health record systems and the electronic prescribing systems at your doctor’s office don’t include price and benefit information for prescription drugs.

All of that information lives on separate systems at your insurance company and your health plan’s pharmacy benefit manager, or PBM.

And that’s the gap that a company called RxRevu is trying to fix.

My guest on today’s show is the CEO of RxRevu, Kyle Kiser.

We talked about the software they’ve built to make drug cost and coverage information available within the major EHR systems

When doctors can see in real time which drugs are covered, at what price, for a specific patient, it    obviously solves a huge pain point for patients, because it means they’re more likely to get the drugs they need at an affordable price.

But it also solves a big problem for doctors. Because, fairly or not, they’re the ones who usually shoulder the blame when it turns out the medication they just prescribed is too expensive or isn’t available.

The kind of information RxRevu provides is going to be more and more important as the U.S. enters into an era of far greater price transparency, as mandated by the federal No Surprises Act, which went into effect on January 1 of this year.

RxRevu is based in Denver, Colorado, and I reached Kyle Kiser at his home in Seattle, Washington. Here’s our full conversation.

Harry Glorikian: Kyle, welcome to the show.

Kyle Kiser: Thanks, Harry. Happy to be here.

Harry Glorikian: So, you know, we were just talking. You’re in Seattle and I’m in Boston. I don’t think we could be much farther apart when it comes to this particular country. So but let’s start with a little bit of background, right. So. You’re the CEO of RxRevu. And can you tell us a little bit about sort of the origin story about how you got started here? I mean, I understand your co-founder, Dr. Kevin O’Brien, had an interesting experience trying to get prescriptions filled for his mother, Lucy, but. What’s the rest of that story? What did that story reveal to you about what’s broken or missing in the way that doctors prescribes medicines or, you know, where the way that maybe payers approve prescription?

Kyle Kiser: Yeah, absolutely. So a little background on Kevin’s story. Kevin was initially inspired to do this because he wanted to solve a problem for his mom. She had an outsized out-of-pocket spend for meds. Like any good son, he wanted to help solve a problem for his mom. He used his expertise to find sort of ways to save on those medications, and that inspired him to start doing that in his clinic for his patients more comprehensively. So he was, you know, way ahead of his time and putting in all of this extra effort to really help find prescription options for patients that they could afford more easily. And that was the initial inspiration for what we’ve done today, which is connecting the point of care and clinical decision making with costs and coverage information that’s real time and patient specific and location specific and moment in time specific, because all those things matter as inputs into a price.

Kyle Kiser: So, you know, really the challenge we’ve been focused on is, is largely that, you know, the clinical decision making process has been pretty, pretty much disconnected, right, from marketplace information. So, you know, anything that impacts the purchasing of that care. And that was okay in a world where deductibles were low, formularies were relatively inexpensive and simple. But that world has changed dramatically over the last 10 to 20 years, right, as consumer driven healthcare has become the way of the world. And first dollar risk is now at the feet of the patient. It’s that patients are now demanding that providers can consider not just what’s best from a clinical perspective, but also set expectations around costs, set expectations around any restrictions that exist, and be an advocate for access to care. And the problem we’re solving. We’re building an access network. And within that access network, we help drive affordability and speed to care for patients. And we’re doing that with a number of stakeholders. But at a high level, that’s what we’re trying to accomplish.

Harry Glorikian: Well, you know, it’s interesting, right? You know, entrepreneurship 101, solve a real need, right? So that there’s a market there because everybody wants it. But so, I mean, look, I think everyone in the United States has probably had experiences similar to Dr. O’Brien’s mom. I mean, you get to the pharmacy, you find out that the medication your doctor prescribed isn’t covered by your plan, or you find out that the co-pay is outrageously high. But behind their personal experiences, I bet most people don’t have a concept of how big and widespread this problem is. You know, you have any maybe some statistics that might illustrate the scale of the problem or how much money is wasted in the medical system because of these disconnects. I mean, I’m wondering how many prescriptions get abandoned or how many patients don’t get the meds they need.

Kyle Kiser: Yeah, I mean, at a. A macro level, you know, the prescription drug market makes just over makes up, you know, just over a half a trillion. Right. And, you know, estimates are that a third, even as much as half of that is waste and waste in the form of, you know, medications that aren’t taken as prescribed or aren’t delivering the right outcomes. I don’t it’s hard to find actually a a stakeholder in the supply chain that’s delivered more value than meds themselves. I mean, if you think about, you know, the innovation in that world over the last 30 years, it’s second to none. But the, you know, the supply chain within which they exist is complicated and it’s hard to navigate. And the consequences of that is waste. And, you know, a ton of administrivia and friction. And frankly, patients bear the brunt of that. Ultimately, it’s health plans and PBMs and risk bearing entities making rules on one end. It’s providers and care teams making clinical decisions on the other end. And both of those processes are largely disconnected. And the only way that that gets harmonized in any way is a patient advocating for themselves. And we just fundamentally don’t believe it should happen that way. What we’re building is the connectivity between those stakeholders so that whether it’s a provider at the point of care making the decision, whether it’s a care team member trying to help you overcome a prior, or whether it’s a patient trying to advocate for themselves using their own technology, we want to put real time, patient-specific, moment in time specific information in their hands to drive affordability and speed to care for that patient, no matter where they are in the care continuum.

Harry Glorikian: Yeah. I mean, so this lack of prescription cost data, I mean at the point of care feels like a real canonical example of deep systemic problems with the with origins that are buried like deep in at least three of these complex organizations. Providers, payers and EHR makers. I mean, once you guys decided what the problem you wanted to fix was, how the hell did you figure out where to like — okay, let’s start here and let’s move forward, right? Because.

Kyle Kiser: Yeah.

Harry Glorikian: Not trivial.

Kyle Kiser: No, it’s exactly the right observation because ultimately what we’re building is a multi-sided network. And what’s difficult about building a multi-sided network is, you know, users on one end, in this case, providers, aren’t going to engage if it doesn’t have the appropriate information in it. And the data sources, the ability to capture that appropriate information, they don’t want to provide that data to you unless you have the appropriate users. So you get stuck in this chicken or the egg problem. And that’s job one in growing this business, is to overcome that chicken or the egg problem. And the way we went about that was we worked really closely with health systems, with provider organizations, primarily because that’s where the trust exists, is that ultimately patients seek out their provider and their care team to answer these questions. And so we worked closely with them as strategic partners and brought some of them in as investors in the company and aggregated a group of meaningful collaborators on the health system side, which then helped us bring PBMs and payers to the table to say, how do we solve these problems together? And that’s that’s sort of how we got out of the gate.

Harry Glorikian: So I mean, tell me if we could dig a little into I think the product is called SwiftRx, if I remember correctly, but at a high level. You know, if you could describe for listeners, what is it? How does it work? And. Where does it fit in relation to the overall system?

Kyle Kiser: Sure. Yes. So SwiftRx Direct is the product you’re describing. What it provides is, is that real time, patient specific, location specific, moment in time specific information in the provider’s native ordering workflow. So we are a data network that’s powering a native feature inside the EMR that provides that insight while providers are selecting medications. So a typical flow would look like, a provider selects a medication. They then place that into a pending status in the software that they use. When that happens, we’re able to gain visibility to that choice. We send that transaction out to our network of data sources, payers, PBMs, etc.. And what we get back is the price that is patient specific. We have formulary insights, so prior auth, quantity, limit, step therapy, those sorts of things. Those are also patient specific. And then most importantly, we get back alternatives. And those alternatives come in two forms. They’re either a lower cost medication or a lower cost pharmacy where the patient can fulfill that medication. And that’s sort of the core information that we then render back into the e-prescribing workflow. And we only interrupt those providers’ workflows, or we and our partners only interrupt those providers workflows, when there’s relevant information to consider. Because as I’m sure, you know, being deep in this world, provider engagement stuff — you really have to be thoughtful about when, when is the appropriate time to intervene and when, when do we want to sort of get out of the way and make sure that when we are intervening, it’s meaningful and understood to be meaningful?

Harry Glorikian: Yeah. So I’m going to I mean, I heard a lot of what you said. I’m I want to maybe summarize all the. A few of these areas that people run into problems. But to try to understand sort of what are the big problems you had to solve to get it to really work? Because I’m just trying to get my head around the magnitude of the data headache here. Right. So if if you’ll allow me, I’ll just try to break it down into parts and then you can tell me how you’re bridging all of these. So for one thing, there’s the patient specific data about what kind of insurance each patient has and what level of benefits they have. And none of that is stored in the EHR at the clinic. As far as I know, typically the EHR would only list the patient’s group number, subscription number or maybe the RxBin number. And then separate from all that, every insurance has a formula of drugs that will cover and sometimes a, you know, a schedule of different copay amounts for those drugs. And those formularies change every year and even more often. Right. And then there’s a patient’s actual prescription data which may live in their EMR or may live in a different system at the pharmacy. And then on top of that, there’s this obscure black box system of prior authorization criteria that insurers may use to deny a prescription if they don’t feel like paying for it. So the fact that the system is so fragmented is a familiar story to anybody who listens to this show. But tell me, you know, how on earth you were able to sort of get all this data under one roof, so to speak? You know, is there a specific architecture of the Swift system that makes you good at collecting all of this changing data and presenting it to the providers in real time?

Kyle Kiser: Yeah. The only other element I’d add to your complexity salad is also benefit design, right. Is that yeah, the, the out-of-pocket cost can be and is dramatically different based on where you are in your coverage. If you’re a commercial member with a high deductible, you’re bearing the, you know, the in-network negotiated rate inside that deductible. And that changes pretty dramatically once you reach a deductible. Or if you’re a Medicare member, there’s the donut hole. And all of those things are also inputs and complexity to add to this. So to answer your question, it’s really working closely with the stakeholders that control those, that are the source of that data. Right. You really can’t get to an accurate price without working with those with those data sources specifically. So we work closely with the PBM, with the payer, and we do more or less a mock adjudication. So the same type of adjudication activity that happens on their end when a patient arrives at the point of sale is happening when a provider is making a prescribing decision in this case.

Harry Glorikian: I mean, I can tell you, like the last time I had to sit and choose an insurer, and you would think that I’d be better at this than most, I remember having to take two Tylenol, because when I got done, because I thought my head was going to explode. And I could honestly not say to you I made the best choice. It was at the end, it was almost like a Hail Mary, I guess with all the complexity. And the other thing that I keep thinking about is when I used to watch, I think if you have kids, you’ve watched The Incredibles and there’s a point in the show where the manager says they’re penetrating inside of our systems to understand how to get how to get the system to pay them or whatever. It feels like it’s that level of complexity. And you really need a sophisticated system to sort of bring all that information together to make sense of it all.

Kyle Kiser: Yeah, that’s true. And it is it is dynamic, it is highly variable and it’s very different from administrator to administrator. Right. And a specific example of that, right, is that responses we get back are not across the board consistent, that here’s an error and here’s what that error means. And that error message is consistent from health plan to health plan. That’s just not the way the world works, right. The error messages are specific to those claim systems because ultimately on the other side of the fence, these are mainframe systems in some cases that were designed decades ago that they’ve then created a layer to expose to the outside world, in this case us. And, you know, it’s not simple work for us or for them. So I think the thing also to point out here is that there’s a lot of effort from the payer- rrPBM community to make this accessible and to sort of change the way they’re doing business and to change the way their technology works to enable some of these things, which is which is progress and should be commended for sure.

[musical interlude]

Harry Glorikian: Let’s pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that’s leave a rating and a review for the show on Apple Podcasts.

All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments.

It’ll only take a minute, but you’ll be doing a lot to help other listeners discover the show.

And one more thing. If you like the interviews we do here on the show I know you’ll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.

It’s a friendly and accessible tour of all the ways today’s information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.

The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.

And now, back to the show.

[musical interlude]

Harry Glorikian: Interesting. So if I’m not mistaken, both Epic and Cerner have made it possible for providers to embed SwiftRx into their EHR. So if I understand it correctly, it even comes as a standard part of Cerner now. So those are two of the biggest EHR providers in the US.

Kyle Kiser: And Athena.

Harry Glorikian: And Athena, so question: how did you make that happen?

Kyle Kiser: Well, you know, we’ve got a great team and the team executed ultimately. We worked really hard on those relationships. And I think it’s both working with the right customers in small ways in the early days that leads to working with these types of partners and bigger ways. And frankly, some of the open programs at some of these places led to this. So early days, we were working in kind of the more open developer type programs with these EMR partners. We were working closely with some of their customers. Banner was one of our first customers. UC Health was one of our first customers, both a Cerner and an Epic user respectively, and, you know, is working in small ways to solve these problems together with those health systems that led us both to interacting with PBMs and ultimately building these enterprise level relationships with the EMR. It’s, you know, it’s, it’s earning the trust, it’s delivering for these customers and then earning the right to do this at scale. And we’re to a point now where we’ll do almost 100 million of these transactions this year. And it’s you know, it’s grown fast.

Harry Glorikian: Yeah, that’s a lot of that’s a lot of data flowing back and forth. But so let’s ask the money question, like, what’s the business model? Who ends up paying you? Is it the provider buying SwiftRx as an add on to the existing EHR or how does that work?

Kyle Kiser: It’s the risk bearing entity ultimately. So think about that as payer and PBM. In most cases, there are cases where we work with health systems and there are some things we do that that are either channel related or related to specific needs that they have when they’re that risk bearing entity. But at a high level, we follow the risk and we want to work with the customer that is bearing that risk because ultimately they’re the ones that stand to benefit from an optimized prescription choice.

Harry Glorikian: Okay. So that everybody gets a clear idea of like, can you give me a before and after picture at a clinic that brings SwiftRx into their EHR?

Kyle Kiser: Sure. Yeah. So. You know, this is probably an experience many of many of the listeners have had. Right. Is that. Before such acts you interact with your physician, they diagnose you with whatever condition they’ve perceived. They select a medication. They route it to the pharmacy. You go to the pharmacy and cross your fingers that all of the requirements have been met. And that is at a price that you can afford if there is a prior or if that’s too expensive. When you arrive at that site of fulfillment, you discover that, right, if there’s a prior that’s not been completed, then you’ve got to go through that prior authorization process and you’re not picking up that prescription today. If it’s a price you can’t afford, you got to figure out how to pay for it. And there’s a variety of ways that that happens. But ultimately, it’s up to the patient to figure those things out. In a world where SwiftRx is installed, the difference is, as that prescription decision is happening, we notify the prescriber of the patient’s out-of-pocket cost. In some cases, even the plan cost associated with that choice. Any restrictions that exist like prior or quantity limit or step therapy. And we also notify them of any lower cost alternatives. So in many cases, simple changes make big differences in in the out-of-pocket cost. And it might even be something as simple as, time release metformin can be hundreds if not $1,000, and regular old metformin is four bucks and has been four bucks for decades.

Kyle Kiser: So it’s some of those almost unintentional, I hesitate to call them errors on the provider side. It’s just they’re making choices based on their own sort of clinical expertise. But they don’t they don’t know these things, right? They don’t know how a time release metformin might be reimbursed for one of the ten or 12 payers that they may see in a given clinic day. So it’s just providing that insight upfront so that they can make those decisions and understand the trade offs. Is time release really important or is this patient going to be fine? And is that out-of-pocket costs for a med going to prevent them from being able to actually take that medication? And as a result, they’re not going to receive any of the clinical benefit. So ultimately, the $4 option is probably better. So it’s really connecting that clinical decision making process with all of the complexity that exists on the payer and PBM end so that we can get the decision right the first time. And when the patient shows up at the pharmacy, they know how much is going to cost, they feel comfortable that they can pay for it and they’re either aware of the prior auth and have already completed the requirements or have some, some level of expectations set to how to complete those requirements.

Harry Glorikian: So for all the reasons we’ve been discussing, doctors traditionally have been able to stay somewhat separated or maybe called it shielded from discussions about drug prices. I mean, they just prescribe a drug, leave it to their office staff or the patient or their pharmacy to figure out whether it’s covered. But now, for organizations that are using your system that are built into their EHR, a clinical encounter, it can involve essentially going shopping in real time for the best drug at the best price. I mean, in your experience, how do doctors like being pulled into these decisions? I mean, I can see how it be great for patients, but I wonder if doctors are equally excited.

Kyle Kiser: You know, one of the things that’s been the most surprising to us around this subject, specifically patient out-of-pocket cost, is one of the most requested pieces of information in a primary care clinic, because it’s so complex and it creates so many callbacks and it creates so much patient dissatisfaction. Because ultimately the patient’s going to, at some level, hold that prescriber accountable for that decision. And if it’s really expensive med there’s an assumption that the provider knew that already or should have known that, whether that’s true or not. And so what that’s resulted in is primary care providers want this information, they want it. They want to have this at their fingertips when they’re making decisions. It’s the world certainly changed in that way. So I think, you know, it’s becoming a part of the standard of care being able to consider cost. Because to the point earlier, the only medication that works is the one the patient can afford. And so you really have to consider those things because of the way our sort of health care payment infrastructure exists. Right. There’s just, patients are bearing a dramatic portion of that cost these days and got to consider that as a part of the way you deliver care.

Harry Glorikian: I mean, I almost feel like your company is is pushing. These providers and payers and to fix the prescription benefit system or making them more efficient or compatible.

Kyle Kiser: Yeah. I think there is a, I maybe describe it as rationalizing. R I don’t think that a clinical team and a PBM and PNT committee at a health system have dramatically different opinions on what medications should be prescribed, for what conditions. The friction exists in that they’re making those decisions in isolation of one another. So I think I see our role as a connector to help, you know, in a value based world, the incentives start to align between risk bearing entity and health system. And many times the health system becomes the risk bearing entity fully. And so our goal is to empower providers to understand those things in real time, to manage the complexity for them, only engage them with the information that makes a difference in the decision they’re trying to make and ultimately create a better experience for the patient, a better outcome for the patient, and a less burdensome process for the provider organization.

Harry Glorikian: So as we all know, I mean, the American medical system is famous for sending patients surprise bills after clinical encounter or an emergency room visit, right. Where a bandage or an aspirin can carry some crazy prices that I’ve seen. And I’m trying to project onto where you are as a company and where you want to go. I mean, now that you’ve tackled the rrtransparency in drug pricing, which I would honestly like to see everywhere, because I think I’ve heard my wife complain all the time when she encounters some astronomical price. Right. Can you imagine trying to tackle or bring greater transparency to other medical costs, such as maybe a surgical procedure or hospital supplies. I mean, is there anything that you’ve learned about prescription benefits that’s transferable to all these other types of care?

Kyle Kiser: Absolutely. Yeah. We’re already moving beyond prescriptions today and focused on labs, radiology services, generally. And see the dynamics of the payer-PBM end of the market five or six years ago as it relates to pharmacy real time benefit shaping up much in the same way around medical benefits. That payers are thinking about these problems in the same ways and are showing initiative and prioritizing putting this information at the point of care for for all of the reasons that we just described on the drug side are true in many ways on the medical side. So, yes, absolutely. That’s where we’re headed. And the regulatory tailwinds are there in a new way. Right. If you think about in the last 12 months, there’s been more price transparency legislation than in the last 30 years. And that, combined with the no surprise billing legislation, really creates this this kind of pre EOB requirement for each of the stakeholders and they got to solve that problem. And we see ourselves as really well positioned to be a part of that solution.

Harry Glorikian: Yeah. I mean, you know, it there was no way. I mean, the Affordable Care Act got put into place and there were certain things in there that just there was no way that you were going to be able to do that without some level of transparency and understanding what’s going on.

Kyle Kiser: Yeah. Yeah, that’s right. But even further, right, before the end of last year there were price transparency regulations for health systems, for providers, for payers. And then the no surprise billing legislation has in it a component that says, you know, before you deliver care, you got to be able to give an estimation of cost. And so all of those things sort of work together from a regulatory perspective to start to drive the market in that direction. So absolutely, it’s coming everywhere. It’s going to be, it’s going to be a part of the way that every health care decision is made in the future. And it’s just a matter of time before that’s the case.

Harry Glorikian: Yeah. It’s interesting because I have lots of conversations with, you know, lots of different people. And they I don’t think they understand that. If you don’t have that level of transparency, you truly don’t have a competitive environment, right? You can’t make choices because you don’t have the information to be able to make that choice.

Kyle Kiser: That’s exactly right. Without it, there is no marketplace. Right. That’s probably overstated. It’s without it, it’s a dysfunctional marketplace. And with transparency, we will start to see real competitive dynamics emerge. And I’m hopeful for that. Sunlight’s the greatest antiseptic.

Harry Glorikian: Oh, I totally agree. I mean, for me, it’s always been like a walled garden. Like, you know, either you’re here or, you know, you’re out of luck, right? Because you don’t have any information so you can go across the street. So. So. I guess I should be asking. I’ve probably reached the limit of my knowledge on the subject matter, but like, is. Is there anything I haven’t asked you or anything, you know, that you would want to add to the conversation that would be enlightening to the people that are listening?

Kyle Kiser: Yeah, well, the only thing I would sort of make sure we reframe a little bit is that this isn’t necessarily about price transparency. Price transparency is a component of providing access to care for patients, and that’s ultimately what we continually focus on inside of our company, that price is an input. Affordability is an input. Convenience is an input. The ability to actually receive the prescription is an input. We’re ultimately trying to make sure that affordability and speed to care lead to better outcomes. And that’s an access story, not just a price transparency story. And so that’s the only sort of reframe that I’d offer is that ultimately this has to lead to better health, people getting healthier, getting the care they need, being able to afford the medications that they need. And that’s the work. And we’re going to stop at nothing to make sure that that happens.

Harry Glorikian: Excellent. Well, it was great talking to you, Kyle. I wish you great success because, I mean, whenever I talk to anybody, I’m like, I know I could be benefiting from all of this, so I want everybody to be successful.

Kyle Kiser: We appreciate the well-wishes and we’ll be working hard to ensure that that’s the case.

Harry Glorikian: Excellent. Thank you so much.

Kyle Kiser: All right. Thanks, Harry.

Harry Glorikian: Bye bye.

Harry Glorikian: That’s it for this week’s episode.

You can find a full transcript of this episode as well as the full archive of episodes of The Harry Glorikian Show and MoneyBall Medicine at our website. Just go to glorikian.com and click on the tab Podcasts.

I’d like to thank our listeners for boosting The Harry Glorikian Show into the top three percent of global podcasts.

If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit follow or subscribe.

Don’t forget to leave us a rating and review on Apple Podcasts.

And we always love to hear from listeners on Twitter, where you can find me at hglorikian.

Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.

Harry Glorikian: Hello. I’m Harry Glorikian, and this is The Harry Glorikian Show, where we explore how technology is changing everything we know about healthcare.

If you live in the United States and you’ve ever had your doctor prescribe a new medication, you’ve probably had the following experience.

You drive from the doctor’s office to the pharmacy.

And when you get there, you find out that the pharmacy doesn’t carry that particular drug.

Or that they do carry it, but your insurance provider doesn’t cover it.

Or your insurance does cover it, but they require prior authorization.

Which means you have to get back in touch with your doctor and ask them to tell the insurance company that you really do need the medicine.

Or you already have prior authorization, but you haven’t met your annual deductible yet, so your out-of-pocket cost is much more than you expected.

If any one of these problems crops up, the chances that you’ll actually get your prescription filled on the day you need it go way down.

And it’s not uncommon for several of these snafus to happen all at once.

Fundamentallythat’s because the electronic health record systems and the electronic prescribing systems at your doctor’s office don’t include price and benefit information for prescription drugs.

All of that information lives on separate systems at your insurance company and your health plan’s pharmacy benefit manager, or PBM.

And that’s the gap that a company called RxRevu is trying to fix.

My guest on today’s show is the CEO of RxRevu, Kyle Kiser.

We talked about the software they’ve built to make drug cost and coverage information available within the major EHR systems

When doctors can see in real time which drugs are covered, at what price, for a specific patient, it    obviously solves a huge pain point for patients, because it means they’re more likely to get the drugs they need at an affordable price.

But it also solves a big problem for doctors. Because, fairly or not, they’re the ones who usually shoulder the blame when it turns out the medication they just prescribed is too expensive or isn’t available.

The kind of information RxRevu provides is going to be more and more important as the U.S. enters into an era of far greater price transparency, as mandated by the federal No Surprises Act, which went into effect on January 1 of this year.

RxRevu is based in Denver, Colorado, and I reached Kyle Kiser at his home in Seattle, Washington. Here’s our full conversation.

Harry Glorikian: Kyle, welcome to the show.

Kyle Kiser: Thanks, Harry. Happy to be here.

Harry Glorikian: So, you know, we were just talking. You’re in Seattle and I’m in Boston. I don’t think we could be much farther apart when it comes to this particular country. So but let’s start with a little bit of background, right. So. You’re the CEO of RxRevu. And can you tell us a little bit about sort of the origin story about how you got started here? I mean, I understand your co-founder, Dr. Kevin O’Brien, had an interesting experience trying to get prescriptions filled for his mother, Lucy, but. What’s the rest of that story? What did that story reveal to you about what’s broken or missing in the way that doctors prescribes medicines or, you know, where the way that maybe payers approve prescription?

Kyle Kiser: Yeah, absolutely. So a little background on Kevin’s story. Kevin was initially inspired to do this because he wanted to solve a problem for his mom. She had an outsized out-of-pocket spend for meds. Like any good son, he wanted to help solve a problem for his mom. He used his expertise to find sort of ways to save on those medications, and that inspired him to start doing that in his clinic for his patients more comprehensively. So he was, you know, way ahead of his time and putting in all of this extra effort to really help find prescription options for patients that they could afford more easily. And that was the initial inspiration for what we’ve done today, which is connecting the point of care and clinical decision making with costs and coverage information that’s real time and patient specific and location specific and moment in time specific, because all those things matter as inputs into a price.

Kyle Kiser: So, you know, really the challenge we’ve been focused on is, is largely that, you know, the clinical decision making process has been pretty, pretty much disconnected, right, from marketplace information. So, you know, anything that impacts the purchasing of that care. And that was okay in a world where deductibles were low, formularies were relatively inexpensive and simple. But that world has changed dramatically over the last 10 to 20 years, right, as consumer driven healthcare has become the way of the world. And first dollar risk is now at the feet of the patient. It’s that patients are now demanding that providers can consider not just what’s best from a clinical perspective, but also set expectations around costs, set expectations around any restrictions that exist, and be an advocate for access to care. And the problem we’re solving. We’re building an access network. And within that access network, we help drive affordability and speed to care for patients. And we’re doing that with a number of stakeholders. But at a high level, that’s what we’re trying to accomplish.

Harry Glorikian: Well, you know, it’s interesting, right? You know, entrepreneurship 101, solve a real need, right? So that there’s a market there because everybody wants it. But so, I mean, look, I think everyone in the United States has probably had experiences similar to Dr. O’Brien’s mom. I mean, you get to the pharmacy, you find out that the medication your doctor prescribed isn’t covered by your plan, or you find out that the co-pay is outrageously high. But behind their personal experiences, I bet most people don’t have a concept of how big and widespread this problem is. You know, you have any maybe some statistics that might illustrate the scale of the problem or how much money is wasted in the medical system because of these disconnects. I mean, I’m wondering how many prescriptions get abandoned or how many patients don’t get the meds they need.

Kyle Kiser: Yeah, I mean, at a. A macro level, you know, the prescription drug market makes just over makes up, you know, just over a half a trillion. Right. And, you know, estimates are that a third, even as much as half of that is waste and waste in the form of, you know, medications that aren’t taken as prescribed or aren’t delivering the right outcomes. I don’t it’s hard to find actually a a stakeholder in the supply chain that’s delivered more value than meds themselves. I mean, if you think about, you know, the innovation in that world over the last 30 years, it’s second to none. But the, you know, the supply chain within which they exist is complicated and it’s hard to navigate. And the consequences of that is waste. And, you know, a ton of administrivia and friction. And frankly, patients bear the brunt of that. Ultimately, it’s health plans and PBMs and risk bearing entities making rules on one end. It’s providers and care teams making clinical decisions on the other end. And both of those processes are largely disconnected. And the only way that that gets harmonized in any way is a patient advocating for themselves. And we just fundamentally don’t believe it should happen that way. What we’re building is the connectivity between those stakeholders so that whether it’s a provider at the point of care making the decision, whether it’s a care team member trying to help you overcome a prior, or whether it’s a patient trying to advocate for themselves using their own technology, we want to put real time, patient-specific, moment in time specific information in their hands to drive affordability and speed to care for that patient, no matter where they are in the care continuum.

Harry Glorikian: Yeah. I mean, so this lack of prescription cost data, I mean at the point of care feels like a real canonical example of deep systemic problems with the with origins that are buried like deep in at least three of these complex organizations. Providers, payers and EHR makers. I mean, once you guys decided what the problem you wanted to fix was, how the hell did you figure out where to like — okay, let’s start here and let’s move forward, right? Because.

Kyle Kiser: Yeah.

Harry Glorikian: Not trivial.

Kyle Kiser: No, it’s exactly the right observation because ultimately what we’re building is a multi-sided network. And what’s difficult about building a multi-sided network is, you know, users on one end, in this case, providers, aren’t going to engage if it doesn’t have the appropriate information in it. And the data sources, the ability to capture that appropriate information, they don’t want to provide that data to you unless you have the appropriate users. So you get stuck in this chicken or the egg problem. And that’s job one in growing this business, is to overcome that chicken or the egg problem. And the way we went about that was we worked really closely with health systems, with provider organizations, primarily because that’s where the trust exists, is that ultimately patients seek out their provider and their care team to answer these questions. And so we worked closely with them as strategic partners and brought some of them in as investors in the company and aggregated a group of meaningful collaborators on the health system side, which then helped us bring PBMs and payers to the table to say, how do we solve these problems together? And that’s that’s sort of how we got out of the gate.

Harry Glorikian: So I mean, tell me if we could dig a little into I think the product is called SwiftRx, if I remember correctly, but at a high level. You know, if you could describe for listeners, what is it? How does it work? And. Where does it fit in relation to the overall system?

Kyle Kiser: Sure. Yes. So SwiftRx Direct is the product you’re describing. What it provides is, is that real time, patient specific, location specific, moment in time specific information in the provider’s native ordering workflow. So we are a data network that’s powering a native feature inside the EMR that provides that insight while providers are selecting medications. So a typical flow would look like, a provider selects a medication. They then place that into a pending status in the software that they use. When that happens, we’re able to gain visibility to that choice. We send that transaction out to our network of data sources, payers, PBMs, etc.. And what we get back is the price that is patient specific. We have formulary insights, so prior auth, quantity, limit, step therapy, those sorts of things. Those are also patient specific. And then most importantly, we get back alternatives. And those alternatives come in two forms. They’re either a lower cost medication or a lower cost pharmacy where the patient can fulfill that medication. And that’s sort of the core information that we then render back into the e-prescribing workflow. And we only interrupt those providers’ workflows, or we and our partners only interrupt those providers workflows, when there’s relevant information to consider. Because as I’m sure, you know, being deep in this world, provider engagement stuff — you really have to be thoughtful about when, when is the appropriate time to intervene and when, when do we want to sort of get out of the way and make sure that when we are intervening, it’s meaningful and understood to be meaningful?

Harry Glorikian: Yeah. So I’m going to I mean, I heard a lot of what you said. I’m I want to maybe summarize all the. A few of these areas that people run into problems. But to try to understand sort of what are the big problems you had to solve to get it to really work? Because I’m just trying to get my head around the magnitude of the data headache here. Right. So if if you’ll allow me, I’ll just try to break it down into parts and then you can tell me how you’re bridging all of these. So for one thing, there’s the patient specific data about what kind of insurance each patient has and what level of benefits they have. And none of that is stored in the EHR at the clinic. As far as I know, typically the EHR would only list the patient’s group number, subscription number or maybe the RxBin number. And then separate from all that, every insurance has a formula of drugs that will cover and sometimes a, you know, a schedule of different copay amounts for those drugs. And those formularies change every year and even more often. Right. And then there’s a patient’s actual prescription data which may live in their EMR or may live in a different system at the pharmacy. And then on top of that, there’s this obscure black box system of prior authorization criteria that insurers may use to deny a prescription if they don’t feel like paying for it. So the fact that the system is so fragmented is a familiar story to anybody who listens to this show. But tell me, you know, how on earth you were able to sort of get all this data under one roof, so to speak? You know, is there a specific architecture of the Swift system that makes you good at collecting all of this changing data and presenting it to the providers in real time?

Kyle Kiser: Yeah. The only other element I’d add to your complexity salad is also benefit design, right. Is that yeah, the, the out-of-pocket cost can be and is dramatically different based on where you are in your coverage. If you’re a commercial member with a high deductible, you’re bearing the, you know, the in-network negotiated rate inside that deductible. And that changes pretty dramatically once you reach a deductible. Or if you’re a Medicare member, there’s the donut hole. And all of those things are also inputs and complexity to add to this. So to answer your question, it’s really working closely with the stakeholders that control those, that are the source of that data. Right. You really can’t get to an accurate price without working with those with those data sources specifically. So we work closely with the PBM, with the payer, and we do more or less a mock adjudication. So the same type of adjudication activity that happens on their end when a patient arrives at the point of sale is happening when a provider is making a prescribing decision in this case.

Harry Glorikian: I mean, I can tell you, like the last time I had to sit and choose an insurer, and you would think that I’d be better at this than most, I remember having to take two Tylenol, because when I got done, because I thought my head was going to explode. And I could honestly not say to you I made the best choice. It was at the end, it was almost like a Hail Mary, I guess with all the complexity. And the other thing that I keep thinking about is when I used to watch, I think if you have kids, you’ve watched The Incredibles and there’s a point in the show where the manager says they’re penetrating inside of our systems to understand how to get how to get the system to pay them or whatever. It feels like it’s that level of complexity. And you really need a sophisticated system to sort of bring all that information together to make sense of it all.

Kyle Kiser: Yeah, that’s true. And it is it is dynamic, it is highly variable and it’s very different from administrator to administrator. Right. And a specific example of that, right, is that responses we get back are not across the board consistent, that here’s an error and here’s what that error means. And that error message is consistent from health plan to health plan. That’s just not the way the world works, right. The error messages are specific to those claim systems because ultimately on the other side of the fence, these are mainframe systems in some cases that were designed decades ago that they’ve then created a layer to expose to the outside world, in this case us. And, you know, it’s not simple work for us or for them. So I think the thing also to point out here is that there’s a lot of effort from the payer- rrPBM community to make this accessible and to sort of change the way they’re doing business and to change the way their technology works to enable some of these things, which is which is progress and should be commended for sure.

[musical interlude]

Harry Glorikian: Let’s pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that’s leave a rating and a review for the show on Apple Podcasts.

All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments.

It’ll only take a minute, but you’ll be doing a lot to help other listeners discover the show.

And one more thing. If you like the interviews we do here on the show I know you’ll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.

It’s a friendly and accessible tour of all the ways today’s information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.

The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.

And now, back to the show.

[musical interlude]

Harry Glorikian: Interesting. So if I’m not mistaken, both Epic and Cerner have made it possible for providers to embed SwiftRx into their EHR. So if I understand it correctly, it even comes as a standard part of Cerner now. So those are two of the biggest EHR providers in the US.

Kyle Kiser: And Athena.

Harry Glorikian: And Athena, so question: how did you make that happen?

Kyle Kiser: Well, you know, we’ve got a great team and the team executed ultimately. We worked really hard on those relationships. And I think it’s both working with the right customers in small ways in the early days that leads to working with these types of partners and bigger ways. And frankly, some of the open programs at some of these places led to this. So early days, we were working in kind of the more open developer type programs with these EMR partners. We were working closely with some of their customers. Banner was one of our first customers. UC Health was one of our first customers, both a Cerner and an Epic user respectively, and, you know, is working in small ways to solve these problems together with those health systems that led us both to interacting with PBMs and ultimately building these enterprise level relationships with the EMR. It’s, you know, it’s, it’s earning the trust, it’s delivering for these customers and then earning the right to do this at scale. And we’re to a point now where we’ll do almost 100 million of these transactions this year. And it’s you know, it’s grown fast.

Harry Glorikian: Yeah, that’s a lot of that’s a lot of data flowing back and forth. But so let’s ask the money question, like, what’s the business model? Who ends up paying you? Is it the provider buying SwiftRx as an add on to the existing EHR or how does that work?

Kyle Kiser: It’s the risk bearing entity ultimately. So think about that as payer and PBM. In most cases, there are cases where we work with health systems and there are some things we do that that are either channel related or related to specific needs that they have when they’re that risk bearing entity. But at a high level, we follow the risk and we want to work with the customer that is bearing that risk because ultimately they’re the ones that stand to benefit from an optimized prescription choice.

Harry Glorikian: Okay. So that everybody gets a clear idea of like, can you give me a before and after picture at a clinic that brings SwiftRx into their EHR?

Kyle Kiser: Sure. Yeah. So. You know, this is probably an experience many of many of the listeners have had. Right. Is that. Before such acts you interact with your physician, they diagnose you with whatever condition they’ve perceived. They select a medication. They route it to the pharmacy. You go to the pharmacy and cross your fingers that all of the requirements have been met. And that is at a price that you can afford if there is a prior or if that’s too expensive. When you arrive at that site of fulfillment, you discover that, right, if there’s a prior that’s not been completed, then you’ve got to go through that prior authorization process and you’re not picking up that prescription today. If it’s a price you can’t afford, you got to figure out how to pay for it. And there’s a variety of ways that that happens. But ultimately, it’s up to the patient to figure those things out. In a world where SwiftRx is installed, the difference is, as that prescription decision is happening, we notify the prescriber of the patient’s out-of-pocket cost. In some cases, even the plan cost associated with that choice. Any restrictions that exist like prior or quantity limit or step therapy. And we also notify them of any lower cost alternatives. So in many cases, simple changes make big differences in in the out-of-pocket cost. And it might even be something as simple as, time release metformin can be hundreds if not $1,000, and regular old metformin is four bucks and has been four bucks for decades.

Kyle Kiser: So it’s some of those almost unintentional, I hesitate to call them errors on the provider side. It’s just they’re making choices based on their own sort of clinical expertise. But they don’t they don’t know these things, right? They don’t know how a time release metformin might be reimbursed for one of the ten or 12 payers that they may see in a given clinic day. So it’s just providing that insight upfront so that they can make those decisions and understand the trade offs. Is time release really important or is this patient going to be fine? And is that out-of-pocket costs for a med going to prevent them from being able to actually take that medication? And as a result, they’re not going to receive any of the clinical benefit. So ultimately, the $4 option is probably better. So it’s really connecting that clinical decision making process with all of the complexity that exists on the payer and PBM end so that we can get the decision right the first time. And when the patient shows up at the pharmacy, they know how much is going to cost, they feel comfortable that they can pay for it and they’re either aware of the prior auth and have already completed the requirements or have some, some level of expectations set to how to complete those requirements.

Harry Glorikian: So for all the reasons we’ve been discussing, doctors traditionally have been able to stay somewhat separated or maybe called it shielded from discussions about drug prices. I mean, they just prescribe a drug, leave it to their office staff or the patient or their pharmacy to figure out whether it’s covered. But now, for organizations that are using your system that are built into their EHR, a clinical encounter, it can involve essentially going shopping in real time for the best drug at the best price. I mean, in your experience, how do doctors like being pulled into these decisions? I mean, I can see how it be great for patients, but I wonder if doctors are equally excited.

Kyle Kiser: You know, one of the things that’s been the most surprising to us around this subject, specifically patient out-of-pocket cost, is one of the most requested pieces of information in a primary care clinic, because it’s so complex and it creates so many callbacks and it creates so much patient dissatisfaction. Because ultimately the patient’s going to, at some level, hold that prescriber accountable for that decision. And if it’s really expensive med there’s an assumption that the provider knew that already or should have known that, whether that’s true or not. And so what that’s resulted in is primary care providers want this information, they want it. They want to have this at their fingertips when they’re making decisions. It’s the world certainly changed in that way. So I think, you know, it’s becoming a part of the standard of care being able to consider cost. Because to the point earlier, the only medication that works is the one the patient can afford. And so you really have to consider those things because of the way our sort of health care payment infrastructure exists. Right. There’s just, patients are bearing a dramatic portion of that cost these days and got to consider that as a part of the way you deliver care.

Harry Glorikian: I mean, I almost feel like your company is is pushing. These providers and payers and to fix the prescription benefit system or making them more efficient or compatible.

Kyle Kiser: Yeah. I think there is a, I maybe describe it as rationalizing. R I don’t think that a clinical team and a PBM and PNT committee at a health system have dramatically different opinions on what medications should be prescribed, for what conditions. The friction exists in that they’re making those decisions in isolation of one another. So I think I see our role as a connector to help, you know, in a value based world, the incentives start to align between risk bearing entity and health system. And many times the health system becomes the risk bearing entity fully. And so our goal is to empower providers to understand those things in real time, to manage the complexity for them, only engage them with the information that makes a difference in the decision they’re trying to make and ultimately create a better experience for the patient, a better outcome for the patient, and a less burdensome process for the provider organization.

Harry Glorikian: So as we all know, I mean, the American medical system is famous for sending patients surprise bills after clinical encounter or an emergency room visit, right. Where a bandage or an aspirin can carry some crazy prices that I’ve seen. And I’m trying to project onto where you are as a company and where you want to go. I mean, now that you’ve tackled the rrtransparency in drug pricing, which I would honestly like to see everywhere, because I think I’ve heard my wife complain all the time when she encounters some astronomical price. Right. Can you imagine trying to tackle or bring greater transparency to other medical costs, such as maybe a surgical procedure or hospital supplies. I mean, is there anything that you’ve learned about prescription benefits that’s transferable to all these other types of care?

Kyle Kiser: Absolutely. Yeah. We’re already moving beyond prescriptions today and focused on labs, radiology services, generally. And see the dynamics of the payer-PBM end of the market five or six years ago as it relates to pharmacy real time benefit shaping up much in the same way around medical benefits. That payers are thinking about these problems in the same ways and are showing initiative and prioritizing putting this information at the point of care for for all of the reasons that we just described on the drug side are true in many ways on the medical side. So, yes, absolutely. That’s where we’re headed. And the regulatory tailwinds are there in a new way. Right. If you think about in the last 12 months, there’s been more price transparency legislation than in the last 30 years. And that, combined with the no surprise billing legislation, really creates this this kind of pre EOB requirement for each of the stakeholders and they got to solve that problem. And we see ourselves as really well positioned to be a part of that solution.

Harry Glorikian: Yeah. I mean, you know, it there was no way. I mean, the Affordable Care Act got put into place and there were certain things in there that just there was no way that you were going to be able to do that without some level of transparency and understanding what’s going on.

Kyle Kiser: Yeah. Yeah, that’s right. But even further, right, before the end of last year there were price transparency regulations for health systems, for providers, for payers. And then the no surprise billing legislation has in it a component that says, you know, before you deliver care, you got to be able to give an estimation of cost. And so all of those things sort of work together from a regulatory perspective to start to drive the market in that direction. So absolutely, it’s coming everywhere. It’s going to be, it’s going to be a part of the way that every health care decision is made in the future. And it’s just a matter of time before that’s the case.

Harry Glorikian: Yeah. It’s interesting because I have lots of conversations with, you know, lots of different people. And they I don’t think they understand that. If you don’t have that level of transparency, you truly don’t have a competitive environment, right? You can’t make choices because you don’t have the information to be able to make that choice.

Kyle Kiser: That’s exactly right. Without it, there is no marketplace. Right. That’s probably overstated. It’s without it, it’s a dysfunctional marketplace. And with transparency, we will start to see real competitive dynamics emerge. And I’m hopeful for that. Sunlight’s the greatest antiseptic.

Harry Glorikian: Oh, I totally agree. I mean, for me, it’s always been like a walled garden. Like, you know, either you’re here or, you know, you’re out of luck, right? Because you don’t have any information so you can go across the street. So. So. I guess I should be asking. I’ve probably reached the limit of my knowledge on the subject matter, but like, is. Is there anything I haven’t asked you or anything, you know, that you would want to add to the conversation that would be enlightening to the people that are listening?

Kyle Kiser: Yeah, well, the only thing I would sort of make sure we reframe a little bit is that this isn’t necessarily about price transparency. Price transparency is a component of providing access to care for patients, and that’s ultimately what we continually focus on inside of our company, that price is an input. Affordability is an input. Convenience is an input. The ability to actually receive the prescription is an input. We’re ultimately trying to make sure that affordability and speed to care lead to better outcomes. And that’s an access story, not just a price transparency story. And so that’s the only sort of reframe that I’d offer is that ultimately this has to lead to better health, people getting healthier, getting the care they need, being able to afford the medications that they need. And that’s the work. And we’re going to stop at nothing to make sure that that happens.

Harry Glorikian: Excellent. Well, it was great talking to you, Kyle. I wish you great success because, I mean, whenever I talk to anybody, I’m like, I know I could be benefiting from all of this, so I want everybody to be successful.

Kyle Kiser: We appreciate the well-wishes and we’ll be working hard to ensure that that’s the case.

Harry Glorikian: Excellent. Thank you so much.

Kyle Kiser: All right. Thanks, Harry.

Harry Glorikian: Bye bye.

Harry Glorikian: That’s it for this week’s episode.

You can find a full transcript of this episode as well as the full archive of episodes of The Harry Glorikian Show and MoneyBall Medicine at our website. Just go to glorikian.com and click on the tab Podcasts.

I’d like to thank our listeners for boosting The Harry Glorikian Show into the top three percent of global podcasts.

If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit follow or subscribe.

Don’t forget to leave us a rating and review on Apple Podcasts.

And we always love to hear from listeners on Twitter, where you can find me at hglorikian.

Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview