David 0:00

Everybody agrees when it comes to talking about pharma that the holy grail is to reduce costs, but not in a vacuum. It's to reduce costs while improving quality of care. Now that's a tall order, but thankfully there are organizations that are working on exactly that problem. And one of them is Profero Team. And we've asked their CEO, Mark Sweeney, to join us today to talk about how some of those things are working.

Announcer 0:24

Change either paralyzes or energizes. The choice is yours. You're listening to the Shift Shapers podcast. You're about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change you want to see. This episode is brought to you by Shift Shaper Strategies. In sales, if you confuse, you lose. Clarify your message so you win more clients, crush your sales goals, and build your practice. Learn more at ShiftShaper Strategies.com. And now, here's your host, Story Brand Certified Guide and Chief Transformation Strategist at Shift Shaper Strategies, David Saltzman.

David 1:16

Welcome, Mark. Good morning. How are you? I'm fine, thank you. Let's start with a little bit about your background. How did you get to be doing what you're doing?

SPEAKER_00 1:23

Sure. So I'm a pharmacist by training. I've been in pharmacy for about 30 years, and I've had a number of experiences throughout the years, including, you know, 20 plus years in academia. And within that context, I learned that there was a lot of opportunity to utilize our knowledge to improve care and reduce cost. So about 10 years ago, started to do some consulting with some employers when I recognized that rising costs were leading to reductions in workforce. They were laying off individual employees. And I thought, well, I could probably help them out. Well, it ended up just scaling. And over the course of 10 years, what started as just simply a little bit of a side gig to help people turned into something that we're actually doing full time now.

David 2:09

Well, that's great because that's a passion project, and there's nothing better than working in an area where you think you can give back and you can improve stuff. Let's level set for the audience. What is the scope of the problem? What are we dealing with here? And more to the point, what are you guys dealing with?

SPEAKER_00 2:23

That's a great question. So in the industry, and you've probably even had guests on your show talk about some of the challenges with rising drug cost, pharmacy benefits, and in the industry and health benefits, a lot of health insurance companies for a number of years have contracted with pharmacy benefit managers or PBMs, and they were originally put in place to help mitigate the cost. But over time, a lot of PBMs have gone the route of essentially increasing their profitability through various tactics, which ultimately lead to increased drug cost. Now that's one piece of the puzzle. But the other piece is it's not always simply about a particular drug cost, it's also about getting patients or members on a health plan on the right medications. So my standard line is that it's getting the best price on the wrong drug is still not a good deal. And so what we want to do is make sure that patients are on the best drug or medication for the greatest value. And so consequently, it's not just about drug prices. And if and a lot of companies focus predominantly on reducing drug costs by just getting the best price. But as a pharmacist, I would tell you if I had five drugs in a category, all things given equal, I would want to make sure that the patient was on the most effective drug. Because the cheapest drug that lends to increased physician visits or increased hospitalizations, I mean, that's not a good deal for the patient. So we want to make sure that for the most part, that patients are taking the right medications at the best cost.

David 3:59

Well, but in terms of trying to deal with the problem, that's a whole order, as you point out, it's a whole order of magnitude different than just picking the least expensive drug. I mean, you know, one of the examples that we talked about off-air was mental health. And right now in this country, you know, the mental health need is through the roof. And you hear stories from friends or others who who are taking some kind of medication to help with that problem. And they talk about, you know, the doctor saying, or the therapist saying, well, we'll try this. And if that doesn't work, then we'll try the next one. And if that doesn't work, we'll try the third one. And nine months down the road, they're still suffering with the same problems. How do you find the right drug for the right person?

SPEAKER_00 4:36

That's a great question. And again, there's so much evolving data and research coming out in these particular areas. So historically speaking, you're exactly right. The approach has been to essentially utilize a trial and error approach to managing patients in that particular disease category. Now, the great thing is we've kind of had an evolving science in the area of genetics or genomics. And I stop and pause and say, when I say the word genetics or genomics, there's probably a lot of thoughts or opinions about that. There's there's companies that advertised on TV about their, you know, and we're not talking about genetic test to identify your ancestry. We're not talking about genetic test even to identify disease. We're talking about a genetic test that we call a pharmacogenomic test or a pharmacogenetic test. And what that means is we can actually do a cheek swab, get some saliva, run a test, and now we can take those results and determine how a medication might be metabolized in your body. And what I mean by metabolism, I mean in other words, how does the body handle that medication? And we can tell ahead of time which drugs specifically to stay away from, or even in some cases, how to dose those drugs based upon that genetic test result. So to your point, the opportunity exists to minimize cost by not utilizing the trial and error method. And another part to that, you know, on average, the average patient in the United States that has depression will be tried on two and a half medications before they over a period of six to nine months before they actually get to a therapeutic outpoint. We can minimize a lot of that by running a genetic test, figure out which drugs to avoid and start a patient on a drug that we think is going to bring the most impact with the least side effects in the shortest amount of time. So that's a cost mitigation strategy.

David 6:27

Now, you know, when we talk to folks about those kinds of tests, not too many years ago, they were prohibitively expensive. Has the cost come down? I mean, what does it cost if if you've got a self-funded plan and you're an employer and you're looking at claims? What does it cost to do this versus what are the likely savings?

SPEAKER_00 6:41

So, and you're exactly right. The costs initially were pretty significant, but just the advent of technology and as we increase the volume of testing, the price points have come down. Now, I will tell you that it's important to recognize it's not always about the cheapest lab tests. So you want to have a high quality test with high quality results. But in general, you know, you could end up with if you're a self-insured employer, you could have tests that range between four or five hundred dollars as a single test to be able to get those results. And that typically is inclusive of an actual, you know, formalized report that you can send to your physician or give to your physician. And often a consultation with the member or the patient is is included as part of that approach.

David 7:23

So how do you build, do you build that into your plan of benefits? Do you mandate that at a certain cost level? How does the how do the mechanics of that work from the plan side?

SPEAKER_00 7:31

Yeah, so that's what that is kind of evolving as we go. So one of the things that plan sponsor might not want to do is mandate it at this point in time. Now, we may get to a point where that that is an expectation for coverage, but I think just because of how new this all is, it's predominantly been utilized in a recommended fashion or in a voluntary fashion. So members are educated about the opportunity to get a genetic test, its value, and then it's often then covered in the plan. Now it could be covered in a lot of different ways. It could be fully covered by the plan, it could be covered through a health savings account, it could be set up in a way that there's a cost sharing. But at the end of the day, you know, the overall value is pretty significant for both the plan and the member. So it makes some sense for the plan to fully cover that test.

David 8:19

These days, is it mostly targeting specialty drugs?

SPEAKER_00 8:23

So today, that so specialty drugs are expanding. And because, as you know, the cost of specialty drugs continue to rise and people are looking for opportunities to cost mitigate that. It is starting to be utilized to cost mitigate in specialty drugs. I would say that's very early right now. There's still not a lot of data to that. However, the primary areas that it's being used right now would be more mental behavioral health, cardiovascular, and also pain management. Those are kind of the bigger three categories that we're seeing it utilized. And by the way, in terms of cost reduction, there's some self-insured employer data out there to suggest that you could see a reduction in overall cost, both on pharmacy and medical, by using genomic tests, somewhere in the range of five to one to eight to one in terms of overall cost. And there's a whole host, you gotta have well-designed studies to look at that. But at the end of the day, when you look at the impact, you know, you're hopefully reducing urgent care ED visits, physician visits, while you're also minimizing the trial and error of medications. You're also minimizing unnecessary visits related to adverse drug events. So there's a whole host of ways in which you can get benefit, but it is a once-in-a-lifetime test. You don't have to be retested, it's a one-time for members or patients.

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David 10:40

I'll ask you to kind of put on your soothseer hat. Are there folks working on the inverse of that where they do a genetic test and then craft a drug that works specifically for that individual? Or is that still science fiction?

SPEAKER_00 10:52

So pretty funny that you asked me that because I'm actually working on a project right now related to that, which is pretty exciting because if you think about it, you know, they have the genetic test, and then to customize the actual formulation of the drug to the patient, I go so far as to say, what if we go ahead and not only potentially compound, but what if we 3D print the medication specific to the genetic test? So that's you know, you mentioned about being science fiction. I know for a fact that's being worked on right now.

David 11:23

That'd be huge. And then I guess is there still public pushback to saying, you know, we want to do a swab and test your genetic makeup, even if somebody's facing down some pretty large copays or out of pockets on a drug. Are people still kind of nervous about doing that?

SPEAKER_00 11:38

I think it's on both sides. There's certain people we talk to and they're very excited about getting the test because they want to know that information. There are others that are a little bit fearful, and I think partly because there have been some negative media releases, press releases on situations where maybe someone feels like their genetic information was sold or utilized in a harmful way. And even though those are very, very minimal, the reality is people remember those types of things and it makes them nervous. And I understand that. But in general, I look at this test as simply a standard lab test. I mean, we obtain a lab test before we put a patient on a medication that goes through our kidneys. So we'll do a lab test to make sure the kidneys are running and functioning appropriately before we put them on that medication. This is very similar. We're basically making sure that your liver is able to metabolize the drug appropriately, and that genetic test would tell us that. So again, if a patient is educated appropriately on what we're testing and how it would be used, I think most people were very interested in it. And I think as time has gone on, fewer and fewer people are nervous about it than they were maybe five years ago.

David 12:44

Now, you know, I'm familiar with the term pharmacogenomics, but you mentioned something in our pre-interview, which is neutrogenomics. And I had not heard of that before. What is that and and how does that impact the kind of work that you guys do and the kind of work that patients need?

SPEAKER_00 12:58

So, again, a great question. And and in the neutrogenomics space, what essentially that is is very similar to pharmacogenomics, and this is something that our company does, which has been growing in interest as well. So, what we would do is offer it, and this is more specifically to direct to patients themselves. However, I personally believe health plans could embrace this as well. So you could actually do again a genetic test on how your body not only handles drugs, but how it handles foods. So you may have five people all trying the same diet, but all five people respond differently. Well, the reason why is because of how genetically they handle those foods. We actually had a situation, we had an HR director who got one of our nutrigenomic tests. We did a consult, and she almost was in tears because she realized how unsuccessful she's been over the years because she had tried a number of diets, and she found after we did this test, it gave a tremendous amount of insight on what would work. And it's how your body handles foods, how your body absorbs foods. And again, the science is evolving. So I don't want to say that that this is you know something that's foundational to healthcare, but with this kind of evolving science, there's an opportunity to enhance not only improved diets, but improved performance. We've actually had conversations with sports teams that are looking for their athletes to improve their performance. So we can tell through genetic tests when you should exercise during the day based upon your genetic makeup. Some people were more impactful, exercise is more impactful in the morning, some people it's more impactful in the evening. And even people probably out there who are hearing this know for themselves that that they are more effective at exercise during certain parts of the day. We can also look at how their body handles caffeine. For some people, caffeine is a non-issue, for other people, it's a huge issue, but it's all based upon your genetic makeup. And having that intel is incredibly powerful. And so I've I've had my own genetic test. And when I read the report and looked through this, boy, it gave me a lot of intel on things that I never realized about myself and what foods I should eat or not eat. And I learned really quickly that there were foods that were actually draining me of my energy, and that was insightful just because now I understood that I was going to eat to energize myself. And again, it fits in with traditional thinking in terms of healthy eating. But within the food pyramid, there are certain foods that maybe certain people should eat more of than others. And so we could talk a long time about this, but it's an exciting area for sure.

David 15:31

Well, it's it's fascinating because you know, we oftentimes when we seek to involve to invoke programs for folks, we look at smoking cessation, we look at diabetes. What we haven't been able to look at effectively for a long time is is the obesity. And in this country, especially, that's a huge problem. And so, you know, maybe this is a way to prevent disease in the first place so you don't need the meds down the road.

SPEAKER_00 15:53

Yeah, that's exactly it. So even though I am a pharmacist, I'd rather use my knowledge to have patients or people be on fewer medications, not more. And when we look at if you have to be on a medication, let's use it correctly and appropriately. Let's make sure we identify the right medication at the right dose. But if we can put in strategies to prevent you from going on medications from the start, that's even better. And that's really the more impactful way to reduce healthcare costs, is if people have that intel, have that understanding, they can create lifestyles specifically to their genetic makeup that foster disease prevention over time. Now, there's not data out there to support that. That's theoretical at this moment, but I think philosophically we could draw those those conclusions that it's simply if we have an understanding of how to live and eat better specific to our genetic makeup, that it would likely lend to a lot of disease prevention. Now, there's other variables, there's there's external variables and there's lifestyle choices that that will make it more complex to predict some of those things out. But just philosophically, it is a really nice direction to go when it when we think of health and wellness.

David 16:59

Well, but you know, maybe at the end of the day, it that's a blessing in disguise because if you go at it with patients from a or with members of a plan from a quality of life standpoint before you go at it from a disease standpoint, it's easier for them to see what's in it for them. And, you know, maybe you drive better adoption that way. You know, any thoughts around the psychology of that?

SPEAKER_00 17:18

No, that's a great point. And and I actually I'm a big believer in the psychology of healthcare. So here's my example is you know, a lot of time us healthcare professionals, we like to tell patients, you know, your goal blood pressure should be this, your global goal, cholesterol should be that. And that's not very exciting. If you're walking out of out of uh healthcare professionals practice, a physician practice, and that's the messaging, that's not very exciting. And that does it drive behavioral change. I would say often it does not. However, if we were told or encouraged on how to live healthier, and this is how we're going to feel, we're gonna feel better, we're gonna have a better quality of life. And in some ways, it's I'll use this. So the the Apple iPhone, you know, when the corporation uh goes out and markets their iPhone, it's not based upon their essentially goals in terms of sales and numbers. They come out and say that you should have an iPhone because it'll make your life better. Well, I feel like healthcare could learn a lot from that. We don't want to communicate to the public goals for your cholesterol. We should articulate goals for improved living. And I think that generally is a better message than what we've done traditionally in healthcare.

David 18:28

Well, you know, that's true. And you you cite Apple. In the average Apple event address, the word you is used 16 times more frequently than any other word. And they understand and they have for a long time that they're not selling a product. There are tons of cell phones out there. What they're selling is an experience that makes you feel better, smarter, faster, zippier, you know, whatever. It's interesting because psychologists have known this for a long time. They've used the Prochaska protocols to determine whether somebody's ready for change and willing to undertake a change. And so maybe this is a kind of bass acords way of getting to the same goal. As I said, a blessing in disguise.

SPEAKER_00 19:01

Yes, I would agree with you completely.

David 19:03

So we've got a couple of minutes left. Put on that soothsayer hat again and look at your crystal ball. What do you see coming in the next three, four, five years that is interesting and you know to you in your mission of trying to help people live better lives, get better drugs, and uh, you know, not have those side effects and things?

SPEAKER_00 19:19

I'll be honest, it this is one of the most exciting times in healthcare I've ever seen. And I think it's because the intersection between technology and pharmaceutical drugs and genetic and other lab tests, I mean, it's all converging, in my opinion, to give us more intel and data than we've ever had before about how to live and how to better manage disease. So I see in the future, I see us giving tremendous attention to improved quality of life and healthier living. And I think that as we talked about with nutrigenomics, I think that piece of it is coming. I do believe I referenced the opportunity to utilize, you know, 3D printing for medications. I mean, what if we get to the point where we could do a genetic test, know which medication should we should be on, and then we simply 3D print our medications. You know, in 1975, I actually have references of people stating that there's no reason why any person should have an actual printer in their home. There's no value to that. And then look where we are today in terms of that perspective. I think you could say the same thing. Well, no, someone today could say, well, there's no reason to have a 3D printer in your in your home. But fast forward, maybe we have 3D printers in our homes to 3D print our medications. And again, to do it based upon a genetic test, I think is really a great direction to go. Cost mitigation reduces cost. The other big area that I think that is coming, and it's partly because of the price point. Specialty drugs, you know, are driving cost up for health plans across the board. Two to three percent of your population are driving, you know, 40, 50% of your drug cost. That is going to hit a wall at some point in time. How sustainable is that? So I do believe specialty drug focus, and one thing that we're working on too is what we would call a utilization management program on specialty drugs. So if you're going to have a medication that's literally four, five, six thousand dollars a month or more, let's make sure that it's working, it's effective, let's make sure it's it's the right dose. Let's not overdose, let's make sure we're minimizing side effects, let's make sure that the follow-through on labs and visits are occurring. I'll give you a case example. I called a patient and asked her. This was related to just double checking on her prescription for a specialty drug. I won't go into details there, but I asked her, I said, is this drug working for you? It was for a plaque psoriasis, a psoriasis condition. She said, it's not working. She says, I've been taking this for a year and a half. I don't like to be on it. It doesn't make me feel good. It doesn't work. I'm only taking it because my doctor told me to. So I said, Well, would you mind if I contact your physician and explain this to your physician? And she said, Absolutely. Call him, tell him I'm not interested. So with that one call, I saved the plan and the member literally $100,000 worth of drug treatment that she didn't want to be on in the first place. I think we need to stop putting people into what I want to say, algorithms and automation, but treat people and have conversations with them in such a way. So I'll lend this thought. I spoke to an individual several years ago and he said, you know, if you go back to year 2000, 2005, he said, if you had a smartphone, you were considered to be more affluent. If you fast forward, what's going to ultimately happen is the people that can have actual meaningful relationships with their healthcare providers, those are going to be the affluent ones, and we're going to have healthcare delivered in an automated way through our smartphone technology. And I think we need to find the balance there. We want to optimize technology, but not forsake the relationships that we have to improve overall care.

David 22:46

And that's a great place to end our conversation for today. Mark Sweeney, CEO at Profero Team. Mark, thanks so much for the interview and for sharing your expertise with the audience. I do hope you'll come back as everything plays out.

SPEAKER_00 22:56

Thank you very much. I enjoyed it.

Announcer 22:58

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