Episode 34: Diversify your infusion center with Mark & Rick, InfuseAble Care

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Transcript: Diversify your Infusion Center

Dylan McCabe: We infuse podcast episode number 34. Welcome to the we infused podcast. My name is Dylan McCabe. And in every episode, we give you a behind the scenes. Look at the infusion industry. As we interview owners and operators of infusion centers and industry experts to give you a seat at the table. So you can learn best practices and strategies from them. And in this episode, I interviewed two co founders of an infusion center called infusible coffee. care. I’m going to talk with Rick and Mark. They’re going to talk about their transition. Rick was a pharmacist. Mark was a nurse. They’re going to talk about their transition from a more hospital based setting to starting their own infusion center and adding some additional services. They’re going to talk about how they do things to differentiate themselves in the market. And they’re also going to talk about how they’ve broadened their scope as far as services they offer and how they plan to scale over the next couple of years to multiple locations. I think you’re going to get a lot out of it. Before you do that, if you’ve been thinking about how to optimize your current infusion center or starting one, you need to take the time to talk with one of our account executives that we infuse. to discover the scope of work that we do when we engage a client for consulting. There’s no need to reinvent the wheel. And I think you’re going to hear a lot of that in this particular episode. So you’re going to get a lot out of this and looking forward to diving in with you. So here is our interview with Rick and Mark from Infusible Care. All right. As I mentioned, I have special guests on the show today, Rick Yerandopoulos and Mark Karufi from Infusible Care. Guys, thanks for being on the show. Thank you. Thanks for having us. And what I like about you guys is you have a background in healthcare, but this is an entrepreneurial journey. You neither, neither one of you have been a manager or owner of an infusion center before. And so you decided to take this entrepreneurial leap. And go into business for yourselves and you started an infusion center. And so before we get into this journey, there’s some really cool things that we’re going to get out of this, but what I’d like to do is just take it, take a minute for you guys to share your background, what’s your background in the industry, and then we’ll move into why you chose to start an infusion center. Yeah, absolutely. So,

Mark Kharoufeh: Rick and I well i’ll start with me mark. Groovy. I’m a nurse by trade. But I have spent the last 10 years really in the executive world overseeing oncology service lines That are tied into infusion centers as well. So the infusion the infusion background is there you know i’ve done oncology for the last 25 years Both pediatric and adult oncology have been involved in the high and the delivery of chemotherapy in terms of the infusion perspective, Rick and I over the last six years have worked together running an oncology service line with 14 different clinics around the the the Arizona Phoenix Valley. And we’re very successful at doing that. And and I tell you, it was we’re both. We both are are very entrepreneurial at heart. And we were on a business trip one night and after dinner and then a couple of glasses of wine we talked and then we said, Hey, why don’t we just go out and start doing this on our own and. Patient centric model that really still captures the medical component of chronic medication delivery and and integrate it with the with the amenities and the safety that we feel all patients really deserve. And one of our, one of our mottos if you will, is is that all patients really should have infusion therapy. In an environment that does not interrupt their daily activities. So that they can carry on if they’re an executive They can stay in one of our suites get their infusion therapy and still work on their laptop and carry on their daily work or if they’re a stay at home mom, they can you know make Appointments, for their children and still you know, navigate their lives if you will so that’s what really You know, triggered Rick and I to get into this world of infusion therapy, and that’s why we’re here. That’s good stuff.

Rick Yerondopoulos: Great summary, Mark, thank you. And this is Rick Urandopoulos by trade. I’m a pharmacist, but as Mark was describing, I too have been in an administrative role for the past many years. And Mark and I were overseeing all of those 14 clinics that are at a larger healthcare organization. Both Mark and I, our background is really in the health system hospital based systems overseeing the outpatient clinics for those hospital based systems. But we started identifying trends in the industry. That were leading towards hospital based clinic denials And we approached our leadership team about this trend, but for a myriad of reasons One of which being three 340b drug pricing and margins. There’s a lot of reasons why the health The hospital systems can’t pursue or mitigate those risks. So that’s when Mark and I were on this business trip and we looked at each other and said, well, this might be our opportunity to satisfy our entrepreneurial itch. We’re not necessarily in competition. With the hospital based clinics. We’re more mostly interested in their denials and as they grow and especially in this industry is just It just continues to grow the drug pipeline for infusion therapy is very robust and continues to grow and almost every google entry that you that you read or come across there’s projections for double digit, compounded annual growth rates, for which For every projection. So we’re certainly in our infancy of the the growth in this industry and Mark and I figured this is a great time to initiate this freestanding clinic.

Dylan McCabe: I love that’s just such a great setting for the story here as you guys started this business venture But with your background in health care and you like like you said you’re you guys are both entrepreneurial You wanted to make that shift going from working with, like people like to say, more of a steady environment, a steady paycheck and so forth, to jumping off on your own, where you’re really betting on yourself, what, how did you do that? How did you do your due diligence? How did you, tap the available resources to to make sure that you’re making a smart decisions and headed in the right direction.

Mark Kharoufeh: That’s a great question. When Rick and I first decided that we were going to start going down this journey of of going into business for ourselves we knew From an operational perspective, how to run infusion centers boy we were not prepared for, all of the other diligence that comes along with starting your own business and having to get other things that other components that really keep your business going and that you have to have so we reached out to, we infuse and and I tell you, it was. Probably the best thing that we’ve done during this journey, because while we know the operational perspective, we’ve learned a lot from recent and the team that we infuse and really they helped us put it all together, connected us with the appropriate people and have already built long lasting professional relationships with several of those those people. And, so it’s been a journey. There’s still a lot of a lot of obstacles on a daily basis. But, to your point, going from that steady job and knowing where your paycheck is coming from every week to the uncertainty is. Honestly been a welcome to stress. It’s something that it’s something that we’re enjoying. And we know that we have a service that We feel that is incomparable in the valley and a model that is very unique as we are not just an infusion therapy center for chronic disease management We’re also an immediate care center And that was really based on on or built on the premise of being an oncology immediate care, urgent care site because of our background in oncology. There’s a lot of patients that that that, well, at the end of the day, no one wants to visit an an emergency department especially a patient that is going through chemotherapy, radiation therapy. So we are that that patient. One and only place in the phoenix valley that is open seven days a week long hours to help triage oncology patients as well So it you know that combined with the infusion piece has just been very rewarding and and we know that and we’ve already seen it in the works So we’ve been open for five or six weeks now and our patients are thanking us and it’s both from the chronic disease management side of infusion therapy And also on the immediate care side rick Is there anything to add there

Rick Yerondopoulos: that? The only thing that i’ll add is in regards to when dylan was asking about our due diligence of taking the leap one thing that We were scared of and that’s this is one of the reasons why we engaged we infused very early in the process of thinking about this Is we were scared of the drug pricing in my background is in the hospital setting where we have 340b drug costs and Get drugs for some drugs or even one cent and other drugs are discounted by 20 percent etc and Leaving that environment. That was really one of the key questions is You Is it profitable if you leave the 340 B environment? And so we infuse help, certainly helped navigate through those questions and helped craft some of our performa in order to make the decision of, okay this is, this can be worthwhile. Let’s go ahead and make the leap.

Dylan McCabe: That’s so good. Yeah it’s priceless to have somebody looking over your shoulder who’s an expert in the industry who’s already done it before. It’s just hard to put a price tag on that. There’s no need to reinvent the wheel. And I think the thing that comes out of that, like you guys have already brought to light is even just highlighting issues that you didn’t even know were an issue. And helping you to see things that, you know looking at your blind side, protecting your blind side to make sure that your journey is as smooth as possible, but there’s still challenges you have to face, but at least you have somebody along the journey with you. And so you guys are in North Scottsdale, Arizona you brought another component to this that I don’t typically hear, which is. You’re not just an infusion center. So what was your reasoning behind that? Because that’s not typical. I think a lot of people listening to this, if they own infusion centers, think, Oh, that’s interesting. Maybe I should think about that.

Mark Kharoufeh: Yeah. It truly, when you think about the infusion piece we really. We know that there’s other entities out there, there’s a, our partners in the community that are running freestanding infusion centers and then even the hospital infusion centers. So when we talked about the infusion piece we focused on the safety and the amenities of the components of that business and we, private suites every patient that comes in for an infusion at our facility. It’s a private suite that has a recliner for the patient and a recliner for the their guests and really just the state of our amenities we are we are we didn’t hold anything back from an amenity perspective on the flip side. From an immediate care perspective we really Rick and I just really just knew that there was a need in the community to provide immediate care triage services, not just for the oncology world but for anyone so when you think about it, it’s like an urgent care or or even a a minute clinic, if you will, however the twist is we’re all cancer specialists so we we we are nurse navigators. We are physicians and nurse practitioners that are generally only done oncology for the last 20 years. And and with our expertise, we brought it in all together. We help navigate patients in their oncology journey during, really post chemotherapy symptom management. That’s really what it is. So we’ll treat the nausea and the vomiting, we’ll treat the pain, we’ll treat the dehydration, or the fever, or the neutropenia, and we can do that all in house. So it’ll save patients the trip to the emergency department it’ll, it’s much lower out of pocket costs the risk for infection is better. Much more minimal than in a hospital setting and and and then all and then after that, you know with that we can funnel those patients into the infusion center as well to help You know, not just from a business perspective, but from an ultimate care under one roof concept We have a lab We have an infusion center and we have an immediate care center all under the same roof where we can result labs without having to send them out and we can see patients and then we can send them over to the infusion side if they need hydration or medication management. And that’s really. turned out to be a very unique model. There is nothing like that in the state of Arizona. Most unfortunately, there’s nothing like that in the state of Arizona. So most most providers are sending their patients to the E. D. S. But we’re now starting to get a lot of those patients filtering in through us. We also do blood transfusions so we are anything infusion anything injection, as well and and that’s really turning out to be very promising for us And the community

Dylan McCabe: well, I love that for two reasons one as a business owner You diversified your offering a little bit But for a patient you are taking steps out of the process for the patient And that’s, you guys are going to, that’s a huge differentiating factor in the marketplace because the patient can find what they need from you and not have to go down the street for something else. That’s just great. Dylan it’s a

Mark Kharoufeh: very true statement. When Rick and I. When we built infusible care we surveyed patients, and it’s come with years and years of hearing the same story from patients over and over again from the hospital world, right? I wish I didn’t have to park in a parking garage. I wish we had curbside parking. I wish there was no associated facility fees. And Rick and I, we just put it all together. We put it all together and there’s no facility fees when you come to our clinic. There is curbside parking. We will greet you in in the on the curb and we’ll help you into the clinic. And and you’re not rubbing elbows with your neighbor. Most infusion centers that you see are either, You’re either face to face with your with your counterpart that’s having an infusion and it’s hard to maintain your privacy Or even have a private conversation on the phone and then you know the infection control piece is now a huge component of that, right? So, it is, everything that you said really it hits the heart because we really approached her from a genuine perspective,

Dylan McCabe: i’ve seen it all I’ll tell you what as a former account executive with we infuse i’ve seen Really nice infusion centers like you’re describing which is basically like taking a patient to a first class. They’re flying first class. They’re comfortable they’re they feel like they’re being so well taken care of like you said it’s The least disruptive experience to their everyday lifestyle and i’ve seen the opposite end of the spectrum where you’ve got 10 chairs in a Very crowded space with a refrigerator in there and you can’t even open the refrigerator door because it would hit somebody’s feet right it’s just you know, it’s hard to believe but like you said, I love all of those things are going to do two things. They’re going to give the patient a great experience, but they’re also going to give you guys, it’s just, all it does is underpin your success strategy, where you want long term relationships, you want referral business, you want physicians to be able to refer to you. I just love that. So, so these are the things you guys are doing at the time of the recording of this podcast. You guys launched November 16th of 2020. So this is all very new at the time of the recording of this podcast. We’re a couple of months into this, essentially, what would you say have been a couple of your biggest challenges? Moving into this space the things that you wake up at 2 a. m For whatever reason and this is what’s running non stop in your brain. You mean you mean

Mark Kharoufeh: not sleeping at all at 2 a. m yeah, i’m gonna let rip take this because this is what’s Made Rick a little a little less hair on his head.

Rick Yerondopoulos: Because then we knew this going into it was about the payer contracting process being very slow Again, we were warned but we are still disappointed At the slowness of getting the delay in getting the payer contracting. We do have Medicare to start with. We just recently were received a counter signature on our agreement for Aetna. We the consultant that we’re working with is very hopeful for additional commercial contracts coming in the next few weeks. But we just, it’s a hurry up and wait. setting. And it’s very disappointing. And especially since our business model is predicated on the fact of site of service optimization and patients getting denied from the hospital setting for their commercial payer is saying, No, you can’t go to the hospital based clinic. You have to go to an independent freestanding clinic. Well, here we are wanting to take care of them. But We don’t yet have the contract

Mark Kharoufeh: And getting the referrals and we are getting those referrals. So that’s very promising. Yeah

Rick Yerondopoulos: So that’s really been one sticky point But we do we are hopeful that there’s light at the end of the tunnel. It’s just a matter of time

Dylan McCabe: So let’s talk about that for a minute for other people other owners of infusion centers who are listening to that. They think you know That’s been our biggest headache too. What’s one piece of advice based on what you’ve learned to help move that process along?

Rick Yerondopoulos: Well, we have engaged we’ve changed courses with our consulting our payer consultants a couple of times and our latest consultant that we’re working with his strategy in the interest of efficiency of getting these contracts is to try to Be a primary care clinic so that as to not confuse the application process a lot of Apparently a lot of these commercial payers do not fully understand the concept of infusion centers yet And as such if you enter into a contract for infusion center, you might get put into a bucket Of specialty pharmacy or home infusion or some other bucket where then there’s just more inherent delays There’s more inherent questions so that our latest consultant that we’ve been working with is has helped streamline that process and try to Jump those hurdles a little bit

Dylan McCabe: That’s so interesting. So, you would think that a company that’s paying out billions of dollars toward healthcare costs would know what they’re doing. But that’s the way it goes. We hear that over and over again, that confusion between, A specialty pharmacy and an ambulatory infusion center and so forth. So, all right. So payer contracting is definitely an area of struggle with any infusion center owner operator, what would you say has been the next biggest challenge you guys have faced getting into this space?

Rick Yerondopoulos: Well, I certainly can answer this one, as a pharmacist my background has Traditionally been in the hospital based systems and as such you have access to the entire drug catalogs at your fingertips You can order drugs for er or even an outpatient clinic And so the entire drug catalog is available going into the Transitioning from a hospital based, system. I You I guess maybe it’s just being naive, but I thought I took for granted that is how the world works. Like Amazon. You have the entire drug catalog at your fingertips and you get to pick and choose what drugs you want to order. Going into this community based setting it’s a little bit different, or I should say it’s a lot different. It’s a lot more fragmented, I’m finding. There is, there are some distributors in GPOs that are specific. To the monoclonal antibodies which are very helpful for our core infusion business But as mark described we also have immediate care services So I need some of the other drugs on hand such as some antibiotics and some premeds and other supportive care medications And so I have to get a different Distributor and a different gpo in order to obtain to get my hands on those Then i’m also finding out that There are especially in the oncology world since we are heavily focused with our immediate care service on the oncology world apparently oncology has its own gpos So i’ll give you just one example just recently with with one particular medication. We have a referral from a physician for treating a patient with Zarzio, which happens to be a biosimilar of phil graston the medicare Reimbursement is at about 140 for a 300 microgram syringe. The distributors that I have access to, they are charging me significantly more, upwards of close to 200 percent of that. So I would be grossly under water. On those charges, now having said that upon my investigation i’ve learned that if I were to to join an oncology Specific gpl. Well, then I would get pricing that is advantageous and more based on asp rather than being based on whack Pricing and it’s just very convoluted. It’s just very fragmented. I guess is the word that I would say

Dylan McCabe: So how have you had to adapt your operations to accommodate that challenge? There’s people listening that’s going, yeah, it’s a headache. I can’t stand that. And I’m sure some people listening would love to hear what have you done to streamline that process?

Mark Kharoufeh: It’s really, it’s truly all about navigating, right? And knowing your business. And we’ve done a good job. Rick is a pharmacist. He tends to be very passionate in that regard. And I feel it too. I tell you, when we say that we can offer some treatment for patients and When they do come calling and it’s unfortunate that we don’t have a certain drug here because of some of these, obstacles it’s you know, it’s disheartening it’s it’s it’s you know It weighs in on us because we really want to be able to provide that service to the community I tell you our partners, with our gpos And and the connect and the connections that we infuse have really established for us has really been very helpful in navigating us through some of these some of these bottlenecks. And, it’s already paid off, there’s, we’ve already made leaps and bounds over the last couple of days and even weeks in regards to how we are managing that. And then we’re, again, this is the fun stress about owning your own your own business. Yeah, you get to. You get to understand some of these nuances and try and figure it out. And when you do it’s it’s like a little celebration, right? Because yeah, you’re winning and you’re doing that for your own team, but you’re also winning for the patients that are out there that are needing your

Dylan McCabe: service. It’s so true. It’s a challenge, to be a business owner and it, you get, your metal gets tested and no matter what. Experience you had before, what knowledge you had before, you’re going to hit a ceiling with experience and knowledge, and that’s where this stuff comes up, and it sounds like you guys are really learning how to, like you said, address bottlenecks, learning how to overcome these challenges you are adapting, and that’s what people need to hear about, because it’s not just start this thing and then you’re Everybody congratulates you and rolls out the red carpet and says, here’s the path to success. I love, so, so I love that. And I really appreciate you guys being candid about those challenges that you face. So let’s go from there and go into, where do you guys hope to take this thing? Where are you headed with this? You have really good reasons for why you got in this space. You’re offering an exceptional experience for your patients. Where do you hope to be five years from now?

Mark Kharoufeh: So we I’ll never forget. It was over about 15 months ago was our initial conversation with Reese and the team over at William fuse. And I’ll never forget the comment that Reese made because we were both very we were very comfortable in positions that we had at our previous jobs, right? And Reese said, Hey, look if you want to just get into an open one clinic yeah, you probably want to just stay in your current positions because it’s a lot less stressful and where you’re, where your check’s coming from. But if you really want to satisfy that entrepreneurial itch and be able to provide what you all feel, is a unique model to millions of. Lives that are out there that are needing these services then that’s then you need to jump right in. And it’s very true. We’ve been open six weeks roughly five or six weeks. And I will tell you that we’re ready to open our second and our third clinic. Now we’ve we’ve gone down that road. We’ve started to engage. In fact, we’ve. Already had multiple conversations and and it’s sticking the conversations that we’re having with people and potential investors and pri and and private equity is quite honestly very encouraging. When we talk about our model eyes start to open a little wider and and it’s something that we want to do. And, Rick and I are impatient by nature. Because we’re just so passionate about making sure that everyone really understands what our model is And we chose originally north scottsdale to open our first clinic And that was really based on the relationships that we have here in the valley We you know, we’ve been around the valley for quite a while and over those years We’ve built a lot of good solid relationships with physicians providers nurses and anyone in healthcare and and it’s proven to be the right decision but it’s funny when I go to visit practices now the what I’m hearing is, when are you going to put something in, in in this part of the valley, or when are you going to put something over in this area and we’re doing it we’re doing it we have already started that that process and we’re hoping to have another two clinics open here in the next five to

Dylan McCabe: six months. That is such a great story. I love the passion. It comes through in our conversation now, but it’s very clear because of the steps you guys have taken to provide that unique patient experience, to diversify your offering and to do something unique and beginning with the end in mind. You guys, one of you must be a strong visionary where you’re thinking, Hey, this is where we could go five, 10 years from now. And one or both of you obviously are strong integrators. Bringing that vision down to the ground on a weekly, quarterly, annual basis. And then the last thing is I know that if you engage, we infuse, one of the reasons you engage, we infuse was to streamline the operations and have solid processes in place, and that’s what makes it repeatable and that’s what I hear you speaking to now. You guys must have very solid systems and processes and the way we do things around here that is nailed down, otherwise you wouldn’t be able to go to second, third, fourth locations.

Mark Kharoufeh: Yeah, you’re absolutely right. I think in combination with the relationships that we have with we infuse and our past experience of being really operational based leaders in the ambulatory world has really You know, given this more even more momentum right? So that yeah, it is absolutely proven to be correct in terms of having operations to a point of efficiency where we feel comfortable to go ahead and start hoping

Dylan McCabe: two and

Mark Kharoufeh: three and four

Dylan McCabe: That’s so good. Well, we could go on and talk about this for another hour, but I know you guys have a business to run. I just want to ask a kind of a key question here. What’s a parting piece of advice after everything that you guys have been through? You’re off to the races. You’ve got a really good blueprint you’re working from. What’s one parting piece of advice to other people, other business owners infusion center owners listening to this now? Yeah,

Mark Kharoufeh: And that’s a great question and a question that we are often asking some of our own partners, and colleagues in the community I would think You know, it’s been a journey. It’s been a good 15 months since we’ve put a solid Confirmation that we are going to move forward with this and I would say, you know It’s not it sounds cliche, but you know really You Stick to it. And just and just, grind and grind. If you have a passion and your work ethic is there and you and your, and you have the ability to build really strong teams, the patients and the providers in the community, they see that and it’s. It’s very, it’s been very promising to us because there’s some physicians that, didn’t even know us. And we walked into their offices and they said, stop with the cells type talk, I can see in your eyes and hear in your voice that you really just care about treating patients and you’re the type of, you’re the type of practice and service line that I want to send my patients to and, so again, passion. Stick to it grind, and at the end of the day your goals of delivering your services to patients that need you most is going to come through.

Dylan McCabe: That’s so good. Well, Rick and Mark, co founders of Infusible Care, we really appreciate you being on the show. And obviously, we Infuse appreciates you being a client for consulting, and this is going to be a success story. It already is a success story. And I think it would be really neat to have you guys back on the show in 12 to 18 months and just give us a progress report. How have things been going? Have you been, how are the, is the expansion going and all that stuff? It would be really cool to get you guys looking back on the journey. We would really appreciate

Mark Kharoufeh: that Dylan. And we really appreciate you doing this with us and thank you so much for your time.

Dylan McCabe: All right, that concludes our interview with Rick and Mark. I really like what they’ve done to diversify their offering in the marketplace. They are not just an infusion center, although that’s quite an undertaking in and of itself. They’ve really diversified their offering to make their to give their patients the best experience, but also to have a more robust business model. And they already have plans to scale to four locations. So, wonderful case study in how to start an infusion center effectively. They engaged WeInfuse for consulting. They’re using WeInfuse software. And they also have an exit plan and a blueprint in place. Solid stuff. So, hope you got a lot out of that. And if you haven’t done so already, you’d be Oh, it to yourself to learn how we infuse can save you time and money with we infuse software. It’s the gold standard for infusion center software. You can schedule a free call with one of our account executives and at least take it for a test drive and see what the rage is all about. It’s a phenomenal system. And you, like I said, you owe it to yourself to at least check it out. Okay guys, this is Dylan McKay with the we infuse podcast, and I will catch you in the next episode. Thank you for joining us.

Guest Speakers: Mark Kharoufeh, RN, BSN, MBA and Rick Yerondopoulos, PharmD co-founded InfuseAble Care after recognizing the common patient frustrations in hospital and traditional infusion settings. Prior to opening InfuseAble Care, Mark had an extensive background in pediatrics, specializing in oncology and neurology. Rick is a practiced pharmacist, with over 20 years of experience and a Doctorate from the University of Arizona.