Reintroducing Consumer Choice in Prescription Decisions with Kyle Kiser, CEO of Arrive Health

[00:00:02] Hey, everyone. Welcome back to the Outcomes Rocket Founder Stories. I am so excited to have you all tune back in. Today, I've got the privilege of having Kyle Kiser on the podcast with us once again. He's the CEO of Arrive Health. They're an industry-leading provider of data-driven insights to points of care. And as a thought leader in health technology and a diligent student of the complex healthcare value chain, he's been at the forefront of the podcast.

[00:00:32] Some of healthcare's most transformative initiatives. I'm excited for him to just kind of talk to us about what they're doing for their aspirational vision around consumer choice. So with that, I want to welcome him to the podcast. Kyle, thank you so much for joining us again.

[00:00:48] Glad to be here, Saul. Thanks.

[00:00:50] My pleasure to have you back. So look, you know, you guys sort of did a rebrand. Now you're here with the new company. Talk to us a little bit about that.

[00:01:00] And then, you know, let's build in a little bit about you for those that haven't gotten a chance to meet you. What is it that drives your work in entrepreneurship and healthcare?

[00:01:09] Sure. Yeah. I think a little bit of our company founding story is probably important.

[00:01:16] So one of our co-founders is a guy named Kevin O'Brien in Denver. He's still a doc, practicing physician. And so this thing is really all was inspired by Kevin's interest in helping his mom.

[00:01:27] So Kevin's mom came to him with this out-of-pocket spin for her meds that was unmanageable. He was able, you know, as a physician, able to do, you know, what any good skillset would do, which is find lower-cost alternatives, find other ways to save on medications.

[00:01:43] And he reduced her spend by about half. And that inspired him to do what came this work in his clinic. So he started to build this big database around ways to save your medication.

[00:01:52] He was doing this in his clinic, not necessarily because he was getting paid for it. He wasn't getting, you know, this was not a part of a value-based agreement.

[00:01:59] This was just a doctor that saw that, you know, the only meds at work are the ones that people can afford.

[00:02:04] And so really that's the origin from which we come. And that's really informed a lot of who we are as a business.

[00:02:10] We first come from this philosophy that the right steward for this type of work, which is the doctor and the patient relationship, right?

[00:02:18] It's like the most powerful leverage point. And if we can get the right information in the hands of the prescriber when they're making those decisions, we're going to set off a lot of downstream benefits.

[00:02:26] So that's sort of thing one. And the thing two is we've also gone at this strategically from a provider-aligned perspective.

[00:02:33] So we work really closely with health systems like UDMC and Providence and UC Health, among others, and have come at the problem from a physician user perspective.

[00:02:42] Because ultimately, I think that's one in our sort of e-prescribing role that's been absent.

[00:02:46] And all of that comes back to Kevin Wendell's mom, right? It's like his inspiration as a physician of, gosh, I wish I had this information to help with patients.

[00:02:53] So that's the foundation. We even have a mantra in the business called Lucy Up.

[00:02:58] Yeah, I see the poster on your wall.

[00:02:59] Oh, yeah, there it is.

[00:03:00] What does that mean? I was going to ask you about that.

[00:03:03] Yeah, we give Lucy Up a word every month. Kevin's mom's name is Lucy.

[00:03:06] Love it.

[00:03:07] And, you know, this is the inspiration for what we all do. Everybody's either, you know, you might have been to Lucy.

[00:03:11] You may have a Lucy in your life, but everybody's got somebody in their life that's had this experience with the health care system that they couldn't afford or didn't make sense or was frustrating or confusing.

[00:03:19] And that's why we show up every day. So then that all comes from that original spark of Kevin's service patients in Denver.

[00:03:25] So that's one family story that's really important.

[00:03:27] I think separate from that or a parallel to that, in my own interest is I grew up in the health insurance business and literally grew up in the health insurance business.

[00:03:38] Like my family was a benefits broker, you know, when I got in trouble in school, I got sent home and had to go stuff enrollment packets.

[00:03:45] I grew up in the health insurance business.

[00:03:48] That's awesome.

[00:03:50] So it's, you know, it's a little bit of a piece of work.

[00:03:53] But then when you become a mission, you start to go, well, why didn't, you know, it becomes, even if you lived in it and swam in it your whole life, it's hard to navigate.

[00:04:00] It's hard to sort of understand as a patient.

[00:04:04] And that became life more clear to me working in it.

[00:04:07] And then eventually as a patient of it.

[00:04:09] And that was one of those things where do you want to really, you know, do you want to continue to participate in how things are?

[00:04:15] Or do you want to find a way to sort of drive some different outcome?

[00:04:19] And that was my path.

[00:04:20] It's just let's find a way to do something different.

[00:04:23] That's awesome, man.

[00:04:23] Really great to hear that.

[00:04:25] I love the Lucy up because we all have a Lucy in our lives, whether it's us or somebody that we love or somebody that we care for, right, as a provider.

[00:04:35] So it's certainly interesting to hear that.

[00:04:37] It's also cool to hear about your background in the benefit space and sort of how you really do have an appreciation for both sides of the coin and understanding the importance of the best medication is one that people can afford.

[00:04:51] So love that all.

[00:04:53] Kyle, talk to us a little bit about what you guys are doing for the health care ecosystem.

[00:04:59] How is it all translating to value?

[00:05:01] Yeah, for sure.

[00:05:02] And so it's a little bit of context.

[00:05:04] What we do is we bring real time, patient specific, moment in time specific pricing and alternatives into the ordering workflows at Docs.

[00:05:12] So we work with leading EOR systems.

[00:05:14] We work with leading health plans and PBMs.

[00:05:16] And we inject that information into the ordering workflows so that they can make the right decision the first time.

[00:05:22] So as a broad context, that's what we're up to.

[00:05:25] And really, from my perspective, that's about consumer choice.

[00:05:28] It's how do we introduce consumer choice into this electronic process?

[00:05:33] Again, to my knowledge, this is the only time in human history.

[00:05:36] E-prescribing is the only time in human history where we adopted an electronic process and consumer choice was constrained.

[00:05:42] When you had a paper script, it didn't go wherever you wanted.

[00:05:44] When we got an electronic script in the early 2000s, it went from being erotic from an EMR to a pharmacy without the ability to understand options.

[00:05:52] But it really, you know, the first time you understood what it was going to cost is when you showed up and asked to pay for it.

[00:05:57] So, you know, you and your provider were making a purchasing decision with no knowledge of the consequences of it.

[00:06:02] And our goal is to reintroduce consumer choice into that process.

[00:06:07] And now we're doing that at pretty significant scale.

[00:06:09] We're doing, you know, 15 million of those transactions a month.

[00:06:12] We'll do 20 million a month by the end of the year.

[00:06:13] And it's really about understanding the insurance benefits, understanding the alternatives that are appropriate based on your insurance benefits, and then solving a problem downstream from that.

[00:06:23] That problem might be a prior health that you need to overcome.

[00:06:26] That might be an affordability issue that you need to overcome in a variety of ways.

[00:06:30] That might just be being able to communicate with your care team that you're not tolerating them at well or that you're experiencing side effects or just a reminder, get a read bill.

[00:06:39] But all that has to be an integrated part of care delivery and not happening outside of care delivery in our view.

[00:06:45] So we agree directly to the ER system to do these real-time benefit checks, to do EPA processing, and even ongoing in the ERs work in a lot of cases.

[00:06:55] That's awesome, man.

[00:06:56] It sounds very comprehensive.

[00:06:57] And yeah, you know, all of this stuff should be part of the patient journey, should be consolidated.

[00:07:04] And it sounds like you guys are doing just that from, you know, best price drugs to prior off.

[00:07:10] There's a lot of gaps that happen and a lot of care that gets missed.

[00:07:14] And so it sounds like you guys are doing big plays here to make a difference.

[00:07:19] If you were kind of thinking about as the business, you know, you're building the business, what's a setback that comes to mind and a key learning that came from that?

[00:07:29] We've built a multi-sided network, right?

[00:07:31] And those are hard in every industry, but they're really hard in healthcare.

[00:07:34] And so part of why that's true is you think about as a provider user, the tools are irrelevant until you get the right data sources into it, meeting all of the health plans and PBMs and their pricing data.

[00:07:46] And the PBMs and health plans are necessary.

[00:07:49] You're not relevant to them until you get the positions in.

[00:07:51] So you're facing this chicken-of-the-egg problem from the outset.

[00:07:54] And until you overcome that chicken-of-the-egg problem, then it's almost impossible.

[00:07:59] You have to be able to cross that chasm to get to any level of value.

[00:08:04] And, you know, we took a bunch of swings at that.

[00:08:07] And one of them finally worked.

[00:08:09] I mean, I think the biggest lesson was how important it is to be a directly integrated component of the existing workloads of providers and care teams.

[00:08:18] Is that, you know, you ask them to move even a half a step out of those workloads and engagement's not going to happen.

[00:08:25] And maybe even you end up building something that is adjacent or competitive with some of the existing tools, which is a risk in and of itself.

[00:08:32] And so I think our biggest learning there was just to understand that user experience really well, understand what both sides of that network are trying to accomplish and then help enable that was ultimately what sort of ended up making the difference for us.

[00:08:47] That's great, Kyle.

[00:08:47] Appreciate the summary there.

[00:08:48] As you think about, like, all right, you know, in the health system, how you guys position the solution, the providers paying for it?

[00:08:57] Free to the provider.

[00:08:58] It's free to the provider.

[00:09:00] So then, like, who ends up paying?

[00:09:01] That's always interesting to me.

[00:09:04] We think about it in terms of supply and demand, right?

[00:09:06] So as a network, there's a supply side of the network, which is content that is hosted on the network to drive engagement with users.

[00:09:14] So demand is the user and supply is the connectivity end.

[00:09:17] Sure.

[00:09:17] And so supply side for us is a right.

[00:09:19] It's, you know, PBMs and pairs, it's cash programs and it's other forms of affordability content on the supply side.

[00:09:26] And then demand side is provider and care to immunization.

[00:09:29] And so there are scenarios where the health system becomes a part of that supply side because they're a pharmacy or because they have some other adherence need.

[00:09:37] But ultimately, the user at the end of the day is not who we're charging.

[00:09:40] We're charging the supply side.

[00:09:42] Okay.

[00:09:42] Got it.

[00:09:43] Got it.

[00:09:43] So you guys are a marketplace.

[00:09:45] The supply side pays for positioning on there.

[00:09:48] And in the end, on the provider side, you end up getting transparency and the best fit for your benefits.

[00:09:56] And ultimately, I mean, think about what we're actually trading on.

[00:09:59] It's behavior change.

[00:10:00] It is.

[00:10:00] I don't know about that.

[00:10:01] Just delivering the data to a provider is where the value is derived, right?

[00:10:05] Like if you're only, say, pay the GLB once a thousand dollars, and you aren't then redirecting that to the lower cost side of care or redirecting that to the lower cost choice from the outset, then you aren't delivering any value.

[00:10:16] And so part of what we see is our differentiator is that we're delivering twice the behavior change when we engage those users with data.

[00:10:24] So that all comes down to a bunch of really specific data exchange things that we do.

[00:10:31] But ultimately, what we're trading on is we know how to engage that provider.

[00:10:35] We know how to build trust in that transaction.

[00:10:38] And as a result of building the trust in that transaction, they accept the recommendations for lower cost alternatives that we provide.

[00:10:44] Because you get about three chances with a clinical user.

[00:10:48] And if it doesn't work three times in a row, then they're never coming back.

[00:10:51] And so we've gone to great lengths to make sure that the data quality is high so that the engagement with that data is high so that we can then engage them with lower cost choices and drive value for a customer.

[00:11:02] Super cool.

[00:11:03] I love that.

[00:11:04] And it's like a recommendation engine that has like some built-in nudges that helps them make the best choice for the patient and benefit, but also cost.

[00:11:15] Am I hearing you right?

[00:11:16] Yeah.

[00:11:17] And those are related, right?

[00:11:18] Like the benefit cost is almost always the best option.

[00:11:21] And that's not always the case.

[00:11:22] And where it's not, we can guide to more appropriate choices too.

[00:11:26] But yeah, the goal is high quality care at the lowest possible cost.

[00:11:29] That's great.

[00:11:30] How are you guys leveraging the latest and greatest in Gen.A.I. AI?

[00:11:36] We have a really interesting project around PriorAuth right now.

[00:11:41] And, you know, part of PriorAuth is the way it works today is that by and large, PriorAuth is just to throw everything at the machine and see what sticks.

[00:11:52] And what I'm saying is that as a clinical user, you submit it all.

[00:11:55] And some of it will come back as denials and we'll have to make different choices.

[00:11:58] And those might be cash pay choices or that might be different bet.

[00:12:01] But all of that is retrospective in nature.

[00:12:04] Meaning you made a choice, something you get a no and you start off.

[00:12:07] What we're now doing is starting to build in kind of a guidance tools and decision support tools based on the actual policies of those prior authorization policies.

[00:12:17] Because they're out there, right?

[00:12:18] Like we can go work with, you know, leading health plans and understand the details of those policies, make recommendations and workflow before the Met ever leaves the provider system.

[00:12:28] And take a ton of friction out of the middle of that process.

[00:12:32] And it's not just submitting everything and seeing what we can overcome.

[00:12:36] It's actually driving better decision making on the front end because we can say, based on you and the specific type of patient you are, here's the criteria you're likely to have to meet to get on this Met.

[00:12:45] Get it paid for by your insurance.

[00:12:46] Now, if you don't meet that criteria, now it's conversation about what you need to do differently, right?

[00:12:52] Like you might be a cash-based scenario or we're going down a different path to get access to that Met.

[00:12:57] But we say if the health plan or the BBM, the trouble of having to process that PA, because we save them, you know, $50, $60 for occurrence.

[00:13:05] We save the provider system, all the callbacks and friction and hassle associated with resolving that.

[00:13:09] And we most importantly, get the patient on Met faster and get them care faster.

[00:13:13] So that's squarely where we're focused with J.I. right now.

[00:13:17] And I think it's going to be a highly differentiated solution.

[00:13:20] Yeah, it's a big opportunity there because it is a huge pain point for everyone involved, as you mentioned it.

[00:13:27] Well, Kyle, this has been phenomenal.

[00:13:29] Love hearing the updates from you and the things that you guys have been advancing on.

[00:13:34] Leave us with the closing thought.

[00:13:35] You know, what do people, what do you want people to be thinking about as we close?

[00:13:39] And then what's the best place they could reach out to you and the team to learn more?

[00:13:42] I think the closing thought is kind of the one we started with, which is that we deserve consumer choice in health care.

[00:13:48] Right. How do we start to enable that in every way possible?

[00:13:50] And that's an interoperability question.

[00:13:52] That's a data liquidity question.

[00:13:53] And that's ultimately a price transparency question.

[00:13:56] And those are the things we're both a ton of oil.

[00:13:58] So you can find us, you know, LinkedIn, arrivehealth.com.

[00:14:02] We'll be at health later in the year for those that will attend those types of things.

[00:14:06] We'll look forward to seeing you on the road.

[00:14:08] Amazing, Kyle.

[00:14:08] Well, yeah, we'll be at health as well.

[00:14:10] So I look forward to seeing you there.

[00:14:12] And for anybody that wants to connect with Kyle and his team at Arrive Health, make sure you check out the show notes.

[00:14:19] We'll put all the ways that Kyle just shared to get in touch with him.

[00:14:23] The time is now.

[00:14:24] You know, we've got to make a difference in the way that we're delivering care.

[00:14:28] And a big part of that is giving consumers choice and making medications affordable.

[00:14:33] Kyle, thanks so much for being with us.

[00:14:35] This has been a real pleasure.

[00:14:36] Thank you, Saul.