Bringing Efficiency to the Prescription Process for Providers and Patients - Deepak Thomas, Co-Founder of Phil, Inc.

Michael Carrese: Hi, everybody. I'm Michael Carrese. It's estimated that 50% of treatment failures and 25% of hospitalizations in the United States can be attributed to one factor: people failing to take their prescriptions. The reasons for this, of course, are many, including cognitive problems, cost, confusion over insurance coverage, and more. And if you have a complex condition requiring specialty medications, you can add several other obstacles to that list. 

Well, we're going to learn more about this problem and ways to solve it today from Deepak Thomas, the co-founder and CEO of Phil, a patient access platform designed to reduce friction and remove barriers to people starting and continuing their prescriptions. He started the company based in part on his own experience dealing with a chronic medical condition and drew on many years of experience working for leading tech companies such as Oracle, eBay, and Shutterfly to build the solution. 

Thanks very much for joining us today. 

Deepak Thomas: Thank you, Michael. Thank you for having me. 

Michael Carrese: We always start with learning more about our guests and what first got them interested in their career. So what's your story about getting into the tech sector?

Deepak Thomas: So, as a college senior in the late 90s, I remember seeing Mark Andresen -- and I'm dating myself by bringing up Mark Andresen references -- but he's the founder of Netscape, and he pretty much invented the modern internet browser. I remember seeing a picture of him on the cover of the Timemagazine. He was sitting on a throne barefoot, and as a college senior, it occurred to me that here was someone changing how we live with little more than a computer connected to the Internet. 

I was not trained to be a computer science engineer but ended up being a self-taught one. Since then, I've always believed that technology is one of the most democratized and easily accessible means for a lot of us to create the change in the world that we hope to see. It was not a very set path getting into technology. It was more meandering, but I find a lot of purpose in it. I feel like it gives you the tools that you could use to see the change through the world that you hope to see. 

Michael Carrese: Yeah, and it's not possible to get bored either. 

Deepak Thomas: It's a deep enough rabbit hole that there's little risk of that happening.

Michael Carrese: Yes. So, as I mentioned, you worked for some pretty big tech companies, and that helped when you were getting Phil started, but you also had this personal reason for heading down the path in the first place. Tell us about that. 

Deepak Thomas: I used to work for Oracle in India, and they transferred me out here to the San Francisco Bay Area when I was in my 20’s. Shortly after I moved over, within a month or so, hiking up in Warren County -- for those of us who are familiar with this neck of the woods it's north of the Golden Gate Bridge -- I ended up picking up a tick and was diagnosed with chronic Lyme disease and treated for it for the next six-plus years. I was fortunate to be under the care of some very efficient prescribers, doctors, and pretty much shook it off entirely after six years or so of therapy. But it was also a very ringside view of how healthcare worked in the most prosperous nation on the planet. 

It was, in some ways, discombobulating because I remember buying my first car...I did the research online and drove it off the lot the very same day that I went to see a dealer. But when it came to accessing medications that could keep me healthy and keep me well and eventually kick this condition, I found myself making three to four trips to the pharmacy every week, despite being covered by one of the most generous plans. My employer at the time, Oracle, had exceptionally generous healthcare benefits, and they probably still do.

That was a head-scratcher. I considered myself always an outsider to healthcare. So, the fact that our day-to-day experiences when it comes to buying everything other than healthcare

is so orthogonal to buying services that fall under the umbrella of healthcare and how those are sort of disjoined, it's worth exploring not just as a society, but as someone who wants to use technology to remove friction from day-to-day consumer experiences. 

So, in a way, it was sort of a coming together of a very personal experience and all of the things that you pick up by way of professional skills as you progress in your career. 

Michael Carrese: As you started looking into it, were you surprised at the causes of that friction or the range of the frictions and barriers? 

Deepak Thomas: I also have an economics background, academically speaking, so most of the wrinkles or frictions in our consumer experiences can be explained by the underlying incentives. It can also be explained by the extent to which technology has been deployed or not in terms of solving some of the underlying issues. 

When you want to solve for a consumer experience, in my opinion, that should be your North Star, meaning you want the world to look differently tomorrow than it looks today, and that means convenient, affordable access to anything, not just healthcare. But it's not a user interface problem. The user interface is an outcome of solving everything that lies beneath the surface. So, when you look under the surface, you see information asymmetries, which is a fancy way of saying if only the various stakeholders involved in this process of getting the patient on therapy, if only they knew what they needed to know or needed to do at the right points in time, the patients get on therapy. 

The other has to do with workflow automation, meaning there are certain steps that needed to be taken, whether it's the steps that the prescriber needs to take or that the pharmacy needs to take. If those are not transacted in a way where technology has been taken into consideration to automate and create efficiency, that will show up in the user interface. So, that was another observation. 

And then there are financial incentives that are misaligned. What's good for a pharmacy may not necessarily be good for the patient or, you know, the prescriber's incentives may not be entirely aligned with those of the pharmacy. There are a lot of misalignments on those fronts. So, if you fix all of those things that lie beneath the surface, then the user interface comes together. But the user interface is the guiding principle.

By user interface, I mean how close can you approximate the experience of buying something on, say, Amazon, to that of buying healthier services, right? But the way you solve that has to take into account how the system is put together behind the scenes.

Michael Carrese: That's a lot to entangle, obviously. Tell us what your approach to it is. What's your solution to that? 

Deepak Thomas: It's a systemic problem. The way that you buy prescription medications or get access to them has not changed in the last several decades, while everything else that you buy has substantially evolved. You pull out your phone, tap a couple buttons, and have stuff show up at your door. There's an increasing gap between those experiences, and I think that the reason that gap exists is not so much because someone's not invented an app that looks similar to that that they have to buy prescriptions. If that were the case, that would have already been solved, right? 

I think the reason that the gap exists is everything that happens before somebody is able to press that button remains static. When you unpack that, you see a supply chain that has all of the three issues that I alluded to earlier: misaligned economic incentives, poor workflow automation, and information asymmetries. It turns out that these three problems are such that they are amenable to solution through technology. 

We know that tech keeps various people informed. Communication is one of the primary use cases. So, if you were able to keep the patient informed in the same way that they're informed when they order something on Amazon that would be ideal. The two things that, say, a brand like Amazon does exceptionally well is answer the most elementary of questions, such as how much does this cost, am I paying the right price and when will I get it? If you get the answers to those, as simple as those questions might be, the entities that solve it exceptionally well, they serve the customer really well.

In this case, if using technology, we're able to answer those questions really well. When a patient is put on therapy, it’s a point in time when they are dealing with more than usual anxiety because they're going through what is, in many cases, a reckoning with their own mortality if the condition is that grievous. That's when the experience needs to step up and tell them when can they expect to get better. It's really that consequential, right? So, we focus on that. 

Then the next part is the support of the patient, right? We need to be able to tell the patient what to expect. So the systems that we built essentially inform the patient of this new therapy that you've been written, when will we get it and how much would you expect to pay. As simple as the answers might be, the solution leading up to it has to solve for everything behind the scenes, which leads to the prescriber.

Michael Carrese: I was going to ask you, they set the process in motion. What's it like for them? 

Deepak Thomas: Yes. So they are, candidly, they're in that tough spot because the average prescriber's office is understaffed, overworked, and certainly not compensated for all of the workflow that they need to undertake in order to get a specialty medication to meet the bar set by the payer. And the payer, obviously has certain thresholds that need to be met in order for the patient to qualify for that medication. That's well understood and necessary. But you call it a conviction process, meaning these boxes need to be checked, this patient needs to have gone through or needs to be diagnosed with a certain subset of conditions that qualify them for the therapy. But it falls on the prescriber's office to navigate those, they're not set up to do that. They don't have the right tools to go through that process, and there's very little automation.

The other reality of the prescriber's office is in an environment like the one that I described, there is very little appetite to learn the shiny new app or tool or newfangled piece of technology. So, just like we have to meet the patient where they are in terms of the user experience that they are accustomed to -- which is pulling out the phone and tapping a couple buttons -- you have to meet the prescriber where they are in terms of the user interface that they are willing to adopt. It has to be relatable. So, what we do is we make it much easier for them through automation to meet the payer requirements or to submit the necessary documentation to the payer using tools that they're already familiar with. Most of the automation happens beneath the surface. So, by sort of reducing their workload burden when it comes to meeting payer requirements, we then free them up to deliver care, which is why they signed up for their vocation in the first place.

Michael Carrese: Yeah, you alluded to something there about not having time or inclination to deal with a new shiny object. As you well know, there are all kinds of digital health solutions being developed and presented to providers. So, how do you break through that and get them to pay attention to your product?

Deepak Thomas: We start by not introducing a new tool or a new user interface for them to learn at all. I think that the fallacy has always been that in order to have technology and create an impact in a user's interaction with technology -- that user could be the prescriber or the patient, it doesn't matter -- that you have to build something new and that they have to climb this hill of learning that new technology to get there. You can have the technology work behind the scenes, but the user interface could be something that's already familiar. 

Our observation is that there are three technologies that the prescriber's office is already very familiar with. So, our thought process was rather than build a new interface or put an iPad in front of them or ask them to sign up for a new portal, can we work with their EMR system, their favorite fax machine, and say an electronic prior authorization tool that they're already familiar with, and have all of the automation run behind the scenes? The surface layer is already familiar. There’s nothing new to learn and all the hard work is happening underneath the surface. So, you get the benefits of automation, but you're not having to learn a new set of tools. That has been our breakthrough. The graveyard of digital tools is filled with many a company that has tried to teach the prescriber new tools and failed just because of that...the adoption hurdle.

Michael Carrese: Yeah, that is a great insight. So, you're really needing to get to the IT department and the leadership of these health systems and practices, really, and explain to them what you just said...their providers don't need to learn anything new. We can integrate this into what they've got already. And I'm just guessing that healthcare is the only place still using faxes.

So, as you know, there are existing options for dealing with these problems, specialty pharmacies, patient hubs and so on. What is it about the Phil solution that you think really differentiates it? 

Deepak Thomas: Every couple of decades there is a generational, not incremental, shift in how people do things. We see that around us, right? In the next ten years, we're not going to see as many cars with tailpipes on them. So, that's a generational shift. That's how we see Phil. The next step in patient access solutions is one where technology is what powers patient access -- not call centers or the fax machines that you alluded to. They all have a role. I think there is not a scenario here that's techno utopian when it comes to healthcare. The care part of healthcare assumes that it can only be rendered by another human being, so we absolutely want to keep the human in the loop. 

I sometimes use the distinction between the clinical and the clerical. I think the clinical aspects of healthcare has to be most in instances -- and most likely in the future will continue to be --rendered by caregivers and providers. The clerical aspects of what they do, they didn't train for it. It's very inefficient for them to do it. Those parts need to be handled by technology and they are not today. So, when we replace those parts, the clerical parts, the non-automated parts of technology, that becomes a dramatic shift from how things are done today.

For instance, one comparable here would be there are patient access services out there today. Based on third party estimates, we're probably almost 80 to 90% more efficient in terms of getting patients on therapy using the model that we build in terms of the number of human beings that you need to have in the loop to deliver care. It's a one to thirty ratio compared to a call center-based patient access platform. For every thirty folks that were mostly in a call center who are mostly performing these sort of clerical activities -- even though they might be nurses or pharmacy technicians -- we only have one because everything that's clerical in nature, that's routinized in nature, the technology handles that and people do what they truly do best, which is to be that empathetic voice on the phone, the voice that can deliver the care that the patient deserves. So, I think that's far ahead of what we have by way of a traditional solution today.

Michael Carrese: Yeah, that's a big jump in efficiency. And did you say that with the Phil system you're showing 80 to 90% more compliance? I'm not sure I understood what you just said about that. 

Deepak Thomas: The adherence rates are substantially higher. So in a traditional hub program, 15% to 20% enrollment is considered a victory. If you think about a traditional hub service, the idea is let me help you, the doctor, with all the documentation, but let's start with a four-page form. It's somewhat interesting that that's how that value proposition kicks off. 

In our case, there's nothing new to learn for the prescriber because the prescriber is essentially using their existing system to kick things off with us. The patient, while often sitting in front of the prescriber, gets a text message with a link in it and then they click through, which takes them through the experience. The enrollment rates into the patient access programs offered by the manufacturers are easily 90% on average across all of our programs. So, right there, you have a four and a half times improvement at the top of the process. 

When it comes to adherence rates, yesterday I was on a call with a client of ours here in retail. For a medication that patients typically need to be on for several months in retail, they see patients to be adherent for one and a half months on the average. Whereas patients that we are able to help get on therapies stay on therapy on the average for ten months. So, it's a substantial improvement in outcomes because patients stay and get on therapy faster and more affordably and then stay on therapy a lot longer in accordance with what their prescribers need that to be.

Michael Carrese: Yeah, because the renewal process has been identified as a pain point before. People will start, but then there's problems with insurance or whatever else that gets in the way. So, yeah, very interesting. So, what's next for Phil? What are you working on? 

Deepak Thomas: So, we think in terms of two strategic vectors, if you want to call it that. We think that we’ve barely scratched the surface in terms of the populations we can help. That means we want to partner with other pharma services entities that have the relationships that would help us get our solution in front of more and more prescribers and patients who could benefit from it. So, that's a big focus of ours, and we continue to grow at a pace that reflects that. 

Then the other vector for us really is not resting on our laurels when it comes to the services that we offer, and I think that we just talked through the specialty prescription workflow and how we are able to influence that. But the gamut of pharma services is a lot broader than that, right? There are adherence services. There is clinical support that's offered depending on the therapy, significant gaps in automation exist for these models. So we would love to help on those fronts. But these are adjacent areas. We need to invest in them. 

Michael Carrese: There are plenty of targets as far as bringing efficiency to the healthcare system. So, we just have a minute left. We like to end with having our guests provide some advice to our audience -- which is learners, med students, nursing students, and also early career folks -- about approaching their careers. In your case, you got into tech and probably didn't imagine focusing on healthcare, but here you are. So, what's your go-to advice? 

Deepak Thomas: I've noticed this tendency where the smartest people in healthcare end up crimping their imagination because they can't imagine a tomorrow that's different from yesterday because they have not really thought about it from the patient's perspective. Because of all the time that they spend in learning how the system works, for lack of a better term, it's very discouraging because it almost feels like change is not possible. 

But the minute you're able to view it from the patient's perspective and recognize that the patient is a consumer that has a higher bar in terms of their expectations. This is yet another interaction that they're engaged in, and they know better. So do you. So, how do you bring those two together? Don't be discouraged by looking at the system from the inside. Look at it from the outside. Because ultimately you are exceptionally well qualified to solve for it, especially if you have both perspectives. So, that would be a piece of advice. 

I had the benefit of being an outsider and the disadvantage of not knowing how the system is put together and having to figure it out, whereas many of you folks already know how it's put together. But now you may want to acquire the patient's perspective.

Michael Carrese: That's really interesting. A very valuable perspective shift for our listeners. Appreciate that. And I appreciate you taking the time to be with us today. It's been a pleasure to talk to you. 

Deepak Thomas: Yeah, likewise, Michael. Appreciate the time. 

Michael Carrese: I'm Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.