Our latest guest on Moving Digital Health was Kyle Kiser, CEO of Arrive Health, discussing how his company is empowering consumers with the information they need to make informed choices about where they purchase medications — and critically — how much they have to pay.
“64% of patients were going to avoid taking their medication or take it differently than prescribed because of cost… it’s a massive impact on a patient’s ability to fill their meds, take their meds to be compliant with that regimen, and treat their condition.” Kyle Kiser
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Read Transcript:
Reuben Hall:
Welcome to the MindSea podcast series, Moving Digital Health.
Our guest today is Kyle Kaiser CEO of Arrive Health, a health tech company that works with hospitals and health systems to surface pricing information on prescription drug transactions in real time, so medical providers can find the best options for their patients.
Thank you for joining us today, Kyle.
Kyle Kiser:
Glad to be here.
Reuben Hall:
So, could you tell us a little bit about your background and how you came to lead Arrive Health?
Kyle Kiser:
Sure. So my background’s primarily have been in health care in the US. I sort of come from an employee benefits perspective. I come out of that world, my family’s business were was in the employee benefits business. So I I literally grew up on that side of it. I was a wholesaler for employee benefits products. I kind of got the bug for startups at at Principal Group which had a health plan and Wellness business. I was a part of that Wellness business that was kind of like an entrepreneurship experience inside of this big, you know, many thousands of people, financial services company. And that led me to, you know, digital health path.
So early employee, well talk early employee, a company called Capital Health and then joined the original team here at what was Arcs Review at the time and recently has been rebranded as Arrive Health.
Reuben Hall:
And how long has Arrive Health been an entity?
Kyle Kiser:
We’re, I’m in year nine, so we’ve been at it quite well.
Reuben Hall:
So maybe you could tell us a little bit about some of the barriers to care that arrive as helping to solve for patients in the US.
Kyle Kiser:
Sure. Yeah. So, you know, fundamentally, the problem we’re trying to solve is that we’re trying to introduce consumer choice into the clinical decision making process and the patient experience. That feels like something that should have already happened, right? When you say that out loud, you go well, of course, there’s consumer choice. We’re the kings of capitalism in the US. Surely there’s consumer choice. But there isn’t.
And you know, what’s happened over the last couple of decades is that we’ve shifted costs onto the backs of patients in the forms of high deductibles. And really hadn’t shown up with the tools to help them, help those same patients make more informed, transparent and consistent decisions around formulary. Pharmacy selection cost, generally affordability and ways to support their ability to pay. And so we’ve built a network that connects to the point of care where those decisions are originating with the provider that drives real time patient specific moment in time specific pricing into the decision making workloads of doctors. And with alternatives of lower cost options to support the patient. And then now are connecting that into the patient experience in a variety of ways. But that’s the network we’ve been building is taking those tools and putting them into the decision making workloads that to sort of matching that specificity of choice with the decisions as they’re happening, be that in the hands of providers, care teams, or patients.
Reuben Hall:
So currently do clinicians have any visibility into cost, like at that moment when they’re making a prescription?
Kyle Kiser:
They do now. They didn’t. And largely, you know, the advent of e-prescribing, which is now 20 years in, actually restricted consumer choice in a lot of ways. Like when you had a paper prescription, you could actually take that paper prescription to multiple pharmacies and understand price. When we started to electronically route prescriptions, it went directly from the EMR system to whatever pharmacy you decided while you’re sitting in that clinician’s room. And that fundamentally limited consumer choice because the price at your retail pharmacy, or your mail order pharmacy, or the one that’s in the network for your health plan may be different. And so the ability to understand those differences at the point of order has really been absent for the life of e-prescribing. And so that’s what we’re bringing into those decision making workflows is the ability to see real time patient specific moment-in-time specific pricing. So that that level of consumer choice can be reintroduced at the outset of that process.
Reuben Hall:
And how does the cost of prescription drugs impact the parents?
Kyle Kiser:
Totally. It’s the primary cause of non adherence is the inability to afford it. We did a survey recently and found that 64% of patients were going to avoid taking the medication, or take it differently than prescribed because of cost. So, you know, it’s a massive impact, on patients ability to fill their meds, take their meds to be compliant with that regimen and treat their condition.
Reuben Hall:
And so what is, some of that patient behavior like, do they think? Oh, I’ll, you know, spread out this medication I won’t take as much or what’s the psychology behind their thinking of how to deal with that situation?
Kyle Kiser:
It’s, it’s sort of generally skip or delay are kind of the two things that were characterized in our research. You know, anecdotally, think of this scenario where medications prescribed you go to the pharmacy and you don’t know that, that you don’t know the cost of that until you arrive at the pharmacy counter to pay for it. And so at that point, you either find out a prior authorization was required, you can’t fill it, or you find out that the price is something that you can’t pay. And either of those things cause walkaway, just, they don’t come back. So those are risks to delivering better care because we just, you know, patients met with that friction often just don’t come back
Reuben Hall:
Right. They just get that sticker shock and be like, oh, I had no idea it was gonna cost that much. So I guess I can’t take this treatment. So what are some of the common reasons providers don’t talk with patients about how to save money on their prescriptions?
Kyle Kiser:
Largely it’s been just because they didn’t have the information available to them. So before a network like ours serving providers, they just didn’t have visibility to that information. So the information that was available inside of the EMR system were largely flat files that gave an indication of kind of a group and a plan level insight into benefit design but not any specificity around price, or alternatives, or medications that that would be suitable alternatives based on price, or pharmacies that would be suitable alternatives based on price. It just wasn’t there. I don’t think it’s been an unwillingness for providers, to want to engage in that type of conversation. I think that providers have been largely trained that, that information is not available. And so now it’s our burden to bear to say no, it’s here now and, and present that in ways that beneficial to their decision making process and their workflow.
Reuben Hall:
And what are some of the other factors, aside from price, that might influence a clinician’s prescription of which prescription to fill for =that specific patient.
Kyle Kiser:
Largely training. So there was, there has been some research that could tie back sort of the training program that a provider participated in based on prescribing patterns. So that’s one. Believe it or not, there’s no spell check in an EMR. So it’s a lot of times it’s what they can remember and what they can spell is a huge influence on because they’re, you know, you have to be able to actually type in the first several letters to get an auto populate screen to select a medication. So those are both huge factors that influence decision making.
Reuben Hall:
And so what about the data side of drug pricing? Where does that, all that information come from in the EMR to help make that decision
Kyle Kiser:
We’re connecting directly to health plans and pharmacy benefit managers who are the the source of that information, in words, adjudicating that claim, which is how we’re getting a real time patient specific moment in time specific insight into, into that price.
Reuben Hall:
So from a software development background. So at MindSea we deal with a lot of integrations with different health data and providers. I know that sounds like it must have taken a long time to get that right. Do you have any insight into what that process is like to connect the the dots there?
Kyle Kiser:
It’s more a business problem than a technical problem. Not to deemphasize the technical work. The integration work is tough. But really the hard thing with building a multi sided network is that on one side of your network, the supply side inventory of that network doesn’t want to commit to integrating until you have providers that are using the tool that are delivering value to them. The providers on the other side of the network don’t want to use a network that doesn’t have relevant data in it. So you’re sort of stuck with this chicken or the egg problem where you’re building these things from a cold start.
Reuben Hall:
Very, very familiar with this problem!
Kyle Kiser:
Yeah. So that’s the hardest thing to overcome is, is that first initial gaining significant scale on both ends of the network so that you have something that’s relevant. Once that’s achieved, there’s still a lot of complexity in those integrations and not a lot of consistency today from one to the next. But that’s changing.
And the standards body for e-prescribing NCPDP is making progress and developing a standard and adopting a standard CMS is mandating now that if you’re a part D plan, so a, a Medicare supplement plan that provides outpatient drug coverage, you must have the ability to integrate with real time benefit tools which are the types of things we do. And so there’s a lot of good things happening from a regulatory perspective to bring more consistency and drive more adoption of these types of tools. But there’s still a long way to go.
Reuben Hall:
And in that process, did you have resistance from some manufacturers to take part in a marketplace like this at all.
Kyle Kiser:
We don’t work directly with manufacturers. At the moment we work with the health plans and the PDM’S that the pricing.
Reuben Hall:
Got it. And how about on their side, like, you know, when you were first proposing this model, was it generally everyone was on board or was it you know, difficult to get everyone to participate?
Kyle Kiser:
No, I think there’s a it was one of those ideas whose time had come, right is that there, there’s a lot of benefit to the health plans and the PBM’S to integrating in these types of tools. So ,for example, the opportunity to avoid prior auth altogether has a lot of patient benefit that it drives usually to a lower cost medication that benefits the patient and the health plan and avoids the administrative costs associated with administering a prior auth, which is a huge benefit to the health plan or the PBM depending on who’s doing that work. So, there’s a lot of value to that side of the network. And then on the other side of the network providers, you know, we were hearing in the early days, the number one requested thing from an ambulatory provider was the cost of medications just because all those things we already talked about of the barriers that, that exist for patients if you make these choices and, and a lot of times the choices are not necessarily things that are clinically significant. So, you know, Albuterol is always an easy example because Albuterol comes in a bunch of different forms, inhaler and all kinds of forms and there’s, you know, all the news now about the shortages. But but there’s that there’s health plan preference on which form because they’ve negotiated specifically for a form at lower lowest price. But the didn’t have any visibility to that at all.
So, and that, that answer might be different for each health plan. And so if you see 30 patients in a day and there’s five or six health plans relevant in your market, that there’s this really complex decision criteria to get to the right answer for the right class of drugs for the exact med that that payer may have negotiated best for. Well, this resolves that right on that side and we say specifically you’re trying to take medication A, you’re trying to prescribe medication A, we bring back alternatives of medication B or pharmacy B that are lower cost options for that patient based on our interaction directly with which is a huge benefit to the provider, patient, and creates a system where they’re gonna reduce callbacks, they’re gonna have less friction within those clinics.
Reuben Hall:
So the lowest cost option might actually be different from one patient to the next with the same condition depending on their, their plan and, and the other factors?
Kyle Kiser:
Right. Exactly. Exactly.
Reuben Hall:
And what about the impact of recent state and federal drug pricing transparency laws in the US? How has that impacted the the landscape?
Kyle Kiser:
The, the CMS rule has been beneficial. We’ve seen folks come to the table as a result of that. I think the opportunity right now is that it’s currently only focused on Medicare beneficiaries, you know, part D membership. I think there’s a, a great opportunity to expand that, you know, to regulating Aisa to other federal beneficiaries like Dod and D A and exchange business. So I think expanding the surface area that the government can influence or the adoption of these types of tools is a great opportunity. But it, it has brought people to the table. We’ve been less involved with some of the other price transparency rules around you know, non pharmacy related, things like hospital, price, transparency and health plan, price transparency for procedures, not better world per se. But but on the drug side, we’ve actually seen good adoption. We’ve seen folks come to the table where we’ve got, you know, over 200 million Health Plan lives addressable within the network now and some of that is a result of some of these regulations.
Reuben Hall:
And how big does the Arrive Health network span now? Is that across the US?
Kyle Kiser:
Yeah, yeah. So we’ve got over 300,000 providers connected on the demand side of the network. We’ve got over 200 million Health Plan lives in the network on the supply side of the network. We’re on track do 150 million or so transactions this year. So it’s, it’s reached some significant scale and, and continuing to grow. We’re, we’re looking at, yeah, pretty sizable growth in utilization of the network year over year. Our goals, over 100% growth from a revenue perspective, recurring revenue perspective from January to December. So, we get a lot, a lot of good things out of.
Reuben Hall:
Wow. Yeah, excellent. It seems like you so certainly found that, product market fit there. What does the world look like when more providers start using these tools?
Kyle Kiser:
Well, I think it probably looks a lot less frustrating for patients, right? Like that, that scenario where you show up at the pharmacy blind hopefully starts to go away. I think over time as these, these are more adopted at the point of care as they’re better understood at the point of care than these are conversations that patients can have with their provider, which is ultimately what they want in the first place. Patients seek these answers from their providers, but largely, the providers haven’t had the answers, not because of an unwillingness or lack of effort because the data wasn’t there. So, you know, the, I think the the what the world looks like is that the trust between patient and providers which is inherent is, is enhanced and empowered with information that allows that conversation to happen the first time and not as a consequence of a claim being denied or as a consequence of learning that you can’t afford the medication. But that’s a conversation that a patient or a provider can have in the clinic as that decision is being made.
Reuben Hall:
Yeah. And as a patient, you know, you’re gonna feel really good about knowing that you’re getting the best option there.
Kyle Kiser:
That’s right. Exactly.
Reuben Hall:
And so, what’s next for Arrive Health. Aside from this very specific problem that you’ve really been able to come up with a solution for, is there other ways that Arrive Health is thinking about how they could help patients?
Kyle Kiser:
Yeah, I mean, it’s to us, it’s, it’s definitely not stopping at the point of care. Our goal is to create this digitally enabled marketplace that that meets decisions with specific insights around how to drive a, a lower cost, more affordable, more accessible choice. And so what, what that looks like for us is connecting care teams and patients into the process. So today, we’ve built sizable scale at the point of care, we’ve got a network that’s delivering value at the point of care. At the beginning of the year we bought a company from UPMC that’s focused on medication adherence that’s doing AI driven outreach directly to patients and connected with the care team interaction. So that those downstream of that initial decision can do automated outreach and check in around side effects and refills and, and just how things are going from a patient perspective, because pharmacy really starts to, to be an opportunity for continuous care. Because the the pharmaceutical event is the most frequent thing that happens in a patient’s experience more often than not. So what we want to start to drive is that continuous action off of that pharmaceutical event. And what what that will allow us to do is to start to tailor really hyper personalized messages to patients around whatever it is that we learn as a result of that encounter with the provider. So if they’re on a diabetes med, then there’s some really specific things that need to happen if you’re a Medicare member on a diabetes med. So we wanna start to integrate messages from their health plan that, that help them understand gaps in care that may exist, affordability solutions that may be out there ways to overcome prior authorization or other friction in the process. And we don’t want to do that in a connected and automated way from point of care to care team directly to patient and start to create that consistent experience that honestly feels a little bit more like every other e-commerce experience we have in our lives. But sadly, doesn’t happen very often in, in health care.
Reuben Hall:
And in terms of the range… like if we take a specific example of a common medication that prescribed, what can be the difference from the highest cost to a a lower cost version?
Kyle Kiser:
Highly variable based on the condition. But it can be the difference between a $0 option and a hundreds of dollar option. No kidding. I mean, we did the research and found that nearly half of the time there were $0 options available when a patient was prescribed something that was $50 or more. And so it’s really the difference between paying nothing and paying something. A there’s a lot of cases where that’s clinically justified and important. What we’re contending is there’s also a lot of cases where it’s just the visibility of the information is what’s preventing that choice from happening.
Reuben Hall:
And is there value to giving the patients the visibility as well and kind of exposing the you know, that information so they can see it themselves or is that kind of you know, dangerous and has some potential negative impacts?
Kyle Kiser:
Hugely valuable! I think, especially as we’ve shifted benefit design, that the first several $1000’s of care is the patient’s responsibility. It is critical that we now provide the ability for them to understand costs to understand options and understand you know, in many cases, things outside of their own benefits because ultimately, we need them to make more informed consumer centric decisions because they have to, right, like the the price, the cash price or the price through a discount card or the price of your benefits are all things that patients are considering today. It it’s already happening. So we need to ensure that we’re doing that in a connected way withthe provider that’s guiding them around that decision as we mentioned before. That’s the trust, right? Like that’s that’s who patients are seeking those answers from.
Reuben Hall:
Well, thank you for joining me, Kyle. Really I really appreciate your perspectives on this issue and learning more about what Arrive Health does.
Kyle Kiser:
Thanks for the invitation. Enjoyed the conversation.
Reuben Hall:
Thanks. Excellent. Well, and thanks for everyone who is listening and joined us on Moving Digital Health. If you enjoyed the conversation, please go to movingdigitalhealth.com to subscribe to the MindSea newsletter and be notified about future episodes.
