Dhiren Patel: Vice President of Medical Affairs at Pack Health (Raise the Line)

Hi, I'm Shiva Glan. And today on raise the line, I'm happy to be joined by Dre Patel, who's a Doctor of Pharmacy and Vice President of Medical Affairs at PAC Health.

PAC Health is a leading leading digital health coaching company that helps people with chronic conditions develop self management skills to improve their health.

And it also happens to be a sister company where we share advisors and investors in Ris. We're part of the same Strategic Health Alliance through cos uh So Darren is a faculty member at the Alpert Medical School of of Brown University, as well as at the Massachusetts College of Pharmacy in Boston and he sees patients at the Boston VA.

So I don't know how you do it all. Darren.

Um So pack health has experienced a large spike in demand for its services due to COVID-19 and we're looking forward to learning more about you, the company and the journey you've been on with your teammates.

So thanks for joining us, Darren. Thank you for having me.

So I even though I gave you this uh long intro, I was curious if you could start by telling us a bit more about your background and how you ended up focusing in on chronic disease management.

Sure. Um, so I'm a clinical pharmacist by background.

Um II trained lo locally I in Boston. And one of the areas that I went into was chronic disease and specifically diabetes and endocrine.

Um I have a very strong family history of diabetes and one of the reasons my father has it, grandmother, grandfather. And so something that I was interested in been seeing patients for 12 years, um in a diabetes clinic.

And one thing that was very evident to me is like, I was making impact on my panel, my, you know, census of patients, but, you know, kept repeatedly seeing the same issues surface.

Um, and I'm like, there's got to be a better way to be able to deliver this. And, um, you know, back in 2013, 2414, um I actually met our ceo um Mazzie at a bar in Boston.

This is actually ho how it all got started um, through a friend of mine. And at this point, he had this idea, you know, uh sketched out on a napkin in his, you know, thinking of doing this.

And I'm like, this makes a total sense. I got the pain point because it's something that I was living with every day, you know, can only see 1012 patients and then they're gone for another three months.

And I couldn't really do much to help them. In between their visits.

And so I asked him, I was like, you know, there's a lot of chronic conditions, which condition are you going to be, you know, focusing on or starting with?

And he said diabetes. And I said, you know, why?

And he's like, I did a Google search and I went on CDC and there's a lot of people that have diabetes. I was like, ok, um, and I was like, well, here's how I can help you a a and why and didn't think anything would, you know, would come out of that interaction?

We have, you know, a lot of those type of interactions. And then two weeks later, um him and his co-founder who are not clinicians called and said, all right, we wanna get started.

What do we do? What do we tell these patients?

And so that's kind of how, how it all started and I saw the opportunity to kind of do what I was doing in clinic, have a complementary service to help these, you know, patients um extend their care beyond the four walls of my clinic.

And that's kind of how it all got started. That's awesome.

I actually didn't know that back story having even though I've met you and, and Mozzie multiple times, that's really great to, great to hear.

Yeah. And so, you know, pack health, obviously, you got your start with diabetes.

Um but I know you've expanded quite a bit and uh including multiple sclerosis and, and several other things. Can you tell us more about pack health and what you all actually offer and, and, and um how you see it fitting into the larger healthcare landscape?

Yeah, that, that's a really good question. And II think that's one of the things that it's kind of set us apart from the beginning.

Um, you know, we started it in one condition and we say that, but one of my biggest feedbacks from Ozzie was, is like, listen, I see patients in a diabetes clinic but they have diabetes, but they also have COPD and heart failure and you know, no one just has one condition.

And so at that point, um you know, they had done a market assessment, there were a lot of other, you know, bigger well known companies that, you know, now we call them point solutions, right?

Because they only deal with one condition and that's the early insight and we actually got a lot of advice along the way to not do that.

Everyone thought we weren't, you know, focused and we were all over the place because we were focusing on multiple conditions.

And one thing I told him is is that I can tell you that none of my patients have diabetes. And I'm telling you if you move away from that model, the adoption by providers like myself, the health systems, the payers is not just going to work.

Um We provide digital health coaching and remote patient monitoring for 25/25 plus uh chronic conditions. And if you think about it, if you just offered one, how is you or as a patient gonna be able to have a coach for your heart failure, your COPD for your diabetes or how could you expect a payer or a health system to, you know, then you can imagine that patient member experience just doesn't work, right?

And you need to holistically take care of that patient. And I think that's what we've stayed true to.

And over the years, you know, that's kind of we've been hyper focused on the member. Um you know, I go back and forth between patient and member, but we call them members um and addressing some of these social determinants of health, um because we know that it's not just take your insulin or take your medications.

There's so many other factors that go into maybe why a patient misses their insulin? Is it cost food insecurity?

There, there's so many things. And so our kind of motto is let's be the quarterback for that patient, take care of all of their needs for their chronic conditions.

And as many of the barriers that we can take down is gonna help us move us that patient so much closer to getting to their, you know, clinical outcomes, clinical goals that they have.

That's a, yeah, that's a great insight. I know.

Um oftentimes we hear that we have to stay focused. Uh, you know, if you have more than three priorities, you have no priorities as Jim Collins says.

But yeah, the fact is a lot of these patients and members that you're, you're all treating do have multiple comorbidities.

And uh that's part of why they need that quarterback, as you're saying. So what kind of results do you see, uh, or have you seen with the members to date?

Yeah. So, um across all of our conditions, um we have a, a very academic and research gene and all of the folks in our company.

So we published at all of the major meetings, um the American Diabetes Association meeting. Um, we have um oncology meeting coming up here in, in a few weeks, um consistently and I'll take diabetes as an example since we've been talking about that, we see a decrease in hemoglobin A1C of 1% in 12 weeks.

Um We've actually done longitudinal studies um because early on they're like, this is great. You were able to show this impact in 12 weeks.

Um h how, what, what's the assurance that this is gonna, you know, last and that's, you know, where I always go back and say we wanna teach these patients how to fish so that they can fish on their own.

And we showed uh maintenance in that decrease in A1C up to a year, uh where it comes up a little bit. We're still uh, you know, sitting around 0.9% um, from an initial, uh, decrease of 1% and we're starting off at a baseline of around 8.5% on a patient's A1C.

Wow, that's awesome. So that, that's diabetes is one example.

And have you, um, have you done some research yet in some, some of the other programs that you all offer together? So our other big buckets, um, so cardiometabolic, um II shared that example of diabetes is one.

our oncology is a pretty big offering. Um And then our autoimmune uh is, is another big one across the board.

Um I'll share some cross cutting um measures we use validated um what we call PR O or patient reported outcomes tools to measure this.

And so ones that you're probably familiar with her like P HQ uh for P HQ nine. and we measure these across all of our conditions.

And so that's what we call our cross cutting measures. So we consistently see improvements in stress, anxiety, depression.

And these are all things when you think about chronic conditions that are big contributors to nonadherence. And so when we see improvement in nonadherence, you know, um a variety of clients say, you know, how is it that you're able to improve medication adherence?

Well, if you help uh figure out the underlying issues as to why that patient wasn't taking that medication, it could be that, that they were depressed maybe they didn't have access to transportation, whatever that is um will help with these but consistently across the board.

Um in just a behavioral health mental health standpoint, we're seeing decreases on the validated scales up to 30% um reduction in flares.

Um for ra uh 50% decrease um in, in, in flares. And as you know, um and you guys do a lot of, you know, great content videos around this for chronic conditions, you know, 80% of the things are the same, right?

You know, there's a huge influence of physical activity of what your diet, you know, social factors such as alcohol, smoking.

Um and there's obviously then the condition specific things, but there's a lot of these things for just general health maintenance from a chronic condition standpoint that we should all be doing.

Um And so we try to focus on those and then just get really good at, you know, what that 20% that's different for each condition, uh that, you know, we need to customize, create content around and making sure that our coaches um are advising around.

Yeah, no, totally 100% get that. And so, um you know, a lot of what you focus on is changing member behavior, patient behavior and that's one of the hardest things to do.

So I'm curious like what insights have you all developed um that have made you effective at seeing those results? Yeah, so for us, you know, we're, we're grounded in that behavior change science and it, it's a, a bunch of them that we use more common ones and popular ones that folks are probably aware of.

This is the BJ fog model, you know, um, the transtheoretical model we use like reflective listening, motivational, uh interviewing and, you know, we try to deliver what we call digital empathy, that's kind of our, our goal.

Um And so we have all of the, you know, stages of behavior change and we try to factor in all of that. Um But the big thing is, is you gotta meet the patients where they're at.

Um And the high touch, um you know, model that we have is we're engaging with the patient five times in a given week. So it's three text messages, one email and one phone call.

So if you think about it, we're in that patient's pocket and it, you don't require an app or a portal or a log in. If you think about how we engage with our friends and family, you take out your phone, you send an email, you send a text message and a phone call.

That is literally how you engage with us. There is no user name, it's the same phone number and you and that patient can talk to their health advisor as many times as they want.

It's not like I'll schedule it like we don't schedule, you know, meetings with our friends. We text them when we need to and it should be no difference accessing, you know, uh you know, coaching and, and so we've made it that simple.

Um everything on our back end is collected and tracked and, you know, we have the ability to look at it, but we wanted to put all of the technology on our side and not complicate it for the patients because if it, if it was going to be another app that was on the sixth page of their phone, it it wasn't gonna get utilized, right?

And so we made that engagement um friction list for them. Yeah, that, that's fantastic.

I mean, uh I we when we were starting osmosis leverage the BJ fog B equals M at to try making things more frictionless. And so even though we do have an app, people can then access videos and get push notifications or questions, the original was we would actually just send text messages to our uh friends and family or friends and me other medical students questions uh to get them, you know, learning and reviewing.

So that's a super smart insight and I'll and I'll add to that. I mean, in your case, the app makes total sense and it is very necessary and we have one, right?

But we don't require it for engagement like you do, right? Where some companies are built solely on, on that.

Um where this is a tool if you want to use it, we certainly have the option. But if you don't have a smart phone life will still continue it and it's not gonna be like, well, we can't do anything with.

You. Got it makes sense.

So you had mentioned earlier about um you know, improvements in reducing patients, stress, anxiety and depression. Uh you know, the last few weeks, uh have probably led to a lot more stress, anxiety and depression than we've seen in a while because of COVID-19.

Yeah. Can you talk to us a bit more about what you and PAC health are doing and, and how it's COVID-19 has affected the business.

Yeah, so we kind of went through like three phases there. The first, this is kind of what I'm calling like the stabilization phase because when no one really knew what to do, um we made sure that our front line and, and those are our health advisors like they were, they were safe, they had all the tools that they needed because we knew that in every article that you and I have read and you guys have done some other amazing, you know, podcast is like everything that you heard was like folks with underlying conditions, that was all of our patients, right?

So we needed to make sure that our frontline folks which are our health advisors were protected, they were able to work from home and continue to engage these patients that were at the highest risk.

And so we did that pretty quickly. Um And you know, we've been remote since then.

The second was the the surge in he a healthcare utilization or the capacity that needed to be created. So what started happening with, you know, clients of ours is patients that had COPD or heart failure that were in the hospitals were being discharged early to create capacity for the COVID patients that were gonna be coming in and or um they wanted to make sure that the patient that wasn't infected was safe because they were at high risk.

And so either way, um they needed to get them out of the hospital, but at the same token, their COPD or their heart failure, exacerbation didn't go away.

So we were helping to remotely monitor these patients. And so that if something were to happen, we can care, coordinate and care escalate back to that system, the other and a smaller cohort of it were those patients that did have COVID that just needed to be remotely monitored.

And so we picked up those patients that could care for themselves and recover at home. But um someone wanted to make sure that, you know, they were keeping a close eye on them in case things did go south.

Um And so, you know, we served a role there and now I think the bigger, you know, and I'm thinking about the next phase of it is, is, you know, as we come out of this, even though we're not really out of it, America and we've all now kind of decided that we've kind of had enough of this quarantine and things are starting to pick back up here.

So, you know, what does that new normal look like? Um, and I think, you know, your model, our model, um, II think some of these things are here to stay and now you talk to patients and they don't necessarily want to come in for a visit because they just got a taste of tele whatever, right?

And every system did every provider, every patient, all of a sudden in the last two months has now completely understood what telemedicine tele coaching, digital health coaching is.

And, you know, I think there'll be some regression to the mean. I think some folks um you know, um it'll go back but a lot of patients are like this is what's better for me.

II don't wanna drive an hour to come, you know, share my blood sugar readings with you when I can do that remotely and then let's get on the phone and kind of talk about that.

So I think those are the kind of the three phases uh that we had and kind of how we dealt with them. Yeah.

No, it's super, super exciting and I agree like there's um uh a quote I've shared pretty often with the team uh about uh how it was actually lending said, he said uh there are decades where nothing happens and there are weeks where decades happen.

And so some of the things we were looking at from a telehealth perspective, a work from home perspective, online learning, which is our space.

Um, things that we were thinking would take until 2023 2025 to come to fruition. Yeah.

Or coming to fruition now in a matter of weeks or months. Yeah.

Absolutely. And, um, even still teaching.

So II teach in our Digital Health Selective at the Mass College of Pharmacy. And now there's, and I think the, the, the learning piece I is one of those that now everyone, you know, that whole model has been just wrecked, right?

And so I think what you guys were doing um early on now it's totally been cemented and, you know, it, it's unfortunate that it took a pandemic to, you know, prove some of our models including yours.

But, you know, it, there's never been a better time now, you know, for our companies to be moving forward and, you know, delivering um care and learning um in digital virtual models 100%.

Yeah, it's so it's kind of exciting times that, that we're able to actually do things that will make a difference and as we say, raise the line.

Um so speaking of your other hat as a pharmacist uh by training, I'm curious how, how is COVID-19 affecting pharmacist specifically in that, that industry, the whole overall pharmacy industry.

Yeah. I'm actually very proud, um, of our profession and kind of, um, what's happened here.

I mean, um, early on, I think, um, they, they weren't in that front line, you know, a characterization but I think slowly, you know, uh, that has happened and you've seen, you know, the pharmacies are still open, you know, they're still, uh, dispensing drug.

Um, and you've even saw that in some of the legislation, like in the Heroes Act, initially, pharmacists weren't gonna be a part of that.

And then they made that change just recently in California, you saw, they're now part of the folks that can administer um the, the COVID tests.

Um And HHS just came yesterday and kind of clarified that saying that the, our ruling is gonna trump any state requirements that would prohibit me, me from ordering a COVID test.

Um So I'm really proud of kind of, you know, what the profession has stepped up and, and done here because, you know, we're very accessible.

Um You know, one of the most trusted professions year after year, you know, pharmacists are on top of that, the top of that list.

Um And then, um the big one is the fact that we were testing all of these drugs that were off label, right? And so every drug that was being administered, whether early on it was hydroxychloroquine or remdesivir.

Um These were all what we call off label, investigational drugs and so it required a massive response on the folks um in each of these institutions to put together these protocols because they were all being administered under a protocol or emergency use case.

Um And so, you know, the banding of that community to kind of share best practices in saying we've tried this, this didn't work or this worked.

Um Here's what made it better. Um You know, I II think that sometimes doesn't deserve, uh it doesn't get into, you know, the mainstream media, but I think uh the pharmacists have done a, a phenomenal job there.

Yeah, that's, I mean, II, you know, makes sense. Uh now that I think about it, but that's fascinating.

So, you know, so it's actually develop and enforce the protocols that, that required clinical pharmacologists and pharmacists on, on staff, right?

Yeah, absolutely wonderful. So, speaking of uh kind of professions in health care, um you know, I know Pack health also created a, a health coaching institute and we've had the pleasure of talking to Mazzie and Michael and your team about that.

Can you talk more about the health coaching as a profession? Because, uh uh correct me if I'm wrong, you've hired like more, more of your clinical staff or health coaches than, than any other kind of uh clinical staff o on board a pack, right?

Yeah, absolutely. Um And we think that that industry is gonna continue to grow.

Um And if you kinda think about where we've thought medicine is going, you know, we had specialists and then we had primary care doctors and they were like, great.

We have mps and PA S, they're gonna help with that. And now the mps and PA S also want to specialize and, you know, it's just you have pharmacists helping, there's just so many chronic conditions and I always say it takes a village to take care of patients with chronic conditions, um where we need everyone on the team.

And you know, I think coaches are health coaches, uh and health advisors are gonna be a part of that team um to the point where now they've designated a CPT category three for health coaches.

And so CPT category three doesn't allow you to bill, but they're using that for monitoring so that when you do get elevated to the actual CPT codes that physicians, clinicians use and you can get reimbursed for your services.

So that's a pretty big step that you can see is headed in the right direction to the point where there's going to be a reimbursement tied for the services rendered.

That's fascinating. Um So yeah, I think it's, it's really an interesting space to watch.

Um And again, telehealth, I mean, all of this stuff with the Cares Act has catalyzed telehealth. So hopefully health coaching will be part of that too.

Um I know we're coming up on time. So just two more quick questions.

One is you know, as a health professional yourself. Uh do you have any advice to early stage health professionals or even students uh who are members of our audience about uh challenges of the COVID moment and how they should approach the next few years in healthcare.

Yeah. Um and this is something that I've even told, you know, our cohorts.

So we're teaching our institution even at P health. So I have students rotating with me, I have four students that pharmacy students that rotate every six weeks and uh other groups take dietetic interns and behavior, psychology interns.

And I know a lot of people's, you know, graduation plans and things kind of got uprooted and, you know, um it's kind of the message that you, the point that you made earlier, you know, it's ok.

You've been learning for four or five years and been paying to learn. Now, it's your time to go find a job and that will allow you to continue to learn.

And I know there's a lot of hesitation with, you know, some things, classes went online quickly and it wasn't the same experience or the college experience and I say it's ok.

Right. Um You, you missed a half a semester or something, but your learning is just now starting.

So, don't worry about it. Right.

Um You know, follow your passion, follow your dream. Now, just find a job that allow you to learn for another four or five years.

Um, and, you know, your learning is just now starting, um you're getting into that, you know, experiential phase of your life where you're, you know, starting to start now apply things I'd say also keep an open mind.

Um you know, med medication uh or medicine is gonna be, you know, delivered very differently, learning is gonna be very different.

And so embrace some of the new modalities that are now here to stay, you know, such as distance learning, virtual learning, you know, flip classrooms, these are different things that historically, people have been used to just that lecture approach.

Um And I think the skill set that's needed. Um It is very different and I think some of the things that you guys are doing and how education is being delivered, I think is the next kind of wave and my message is, is embrace that wave.

Um You can be a part of that change. Um And I always tell my students, you know, do you want to be the taxi driver or do you want to be the Uber?

Right? And um you can sit there and just, you know, resist um and see what happened, you know, to that industry.

Um And, and so my message is, is, you know, try to be on the, on the disruptive side of any change if you can. That's a, that's a great message.

Thanks for sharing that. So one final question, are there any other comments or thoughts you would like to share before we wrap up.

Yeah, I would. Um, and in terms of just final thoughts, um, you know, I don't think we're out of this pandemic.

Um, you know, if, if there's anything that we realize there's a lot of things that we're gonna have to think through differently.

Um, you know, some of the same points that we just discussed earlier, you know, medicine, learning, travel. I mean, um I was, you know, my message there is, is, you know, we still need to be hypervigilant of what we're doing.

Um We're not in the clear, we're gonna learn a lot, we're gonna make a lot of mistakes. Um but it's, you know, how quickly we, we learn from those mistakes.

Um How quickly we can share data with each other. You know, you have big companies that normally wouldn't work together that are working together, sharing data.

Uh hospitals are sharing and bartering supplies because someone has extra ventilators and doesn't have PPS. And so, um you know, again, that message there is, is just um be prepared uh to live in this new norm, whether it's working from home, learning how medicine is gonna be delivered, practiced.

Um II think um change will be the, the new constant, great, great parting words of wisdom. So thanks so much for taking the time to view with us today, Darren.

Thank you guys uh for the opportunity. And um uh kudos again on on the great work that you are doing to uh you know, keep all the uh higher um in institutions and academic institutions.

Uh still going. Thanks so much.

So, with that, I'm Shivani. Thanks to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line.

We're all in this together. Take care.

Thank you.