Greg Morris, Chief Strategy Officer at CareMetx, joined us to discuss how to streamline operations, how to use hub services, and how to lead change. We also discuss motivating people the right way when offering a new platform that really changes the way people do things.
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Transcript: How to Streamline Your Infusion Practice
Dylan McCabe: We infuse podcast episode number 42. Welcome to the we infused podcast. My name is Dylan McCabe. And in every episode, we give you a seat at the table as we talk with infusion center operators, owners, and industry experts so that you can get the advice and strategies you need to take your own practice to the next level. Now, in this episode, I’m going to speak with Greg Morris. He’s a chief strategy officer with care medics. And we’re going to talk about A couple of important things like how to streamline operations, how to use hub services, and really how to lead change. We’re going to camp out for a little while on how to motivate people the right way or tap into the motivation. When you offer some new system or platform, That really changes the way people do things and could even, make the staff number smaller, which could be scary for some people. So we’re going to talk about that as well. I think you’re going to get a lot out of this. Greg brings a lot to the table and, and looking forward to it. So let’s jump right into this conversation with Craig Morris. All right. As I mentioned, we have special guests on the show today, Greg Morris with care medics. He’s the chief strategy officer, Greg, thank you for joining us.
Greg Morris: Thanks,
Dylan McCabe: Dylan. Glad to be here today. I’m interested in this because care medics does some unique things for payers and patients or connecting payers and connecting patients with the whole process of insurance verifications and really one of the most challenging pieces of the process, I think, especially for people who own and operate infusion centers. So we’re gonna get, we’re gonna get into some of that. We’re gonna glean some wisdom from what you guys have, Seen after, working through this process millions of times And we’re going to talk about a lot more but before we get into all that kind of share with our listeners Who is care medics? What do you guys do?
Greg Morris: Sure. So care medics, company was founded in 2011 We’re about 800 employees We’re in the patient access business. and it’s also called hub services. So we, are paid by specialty pharma, to help patients with affordability issues and access issues and also with adherence and outcomes. But as we think about particularly with the access issues that oftentimes means. Helping their health care provider, through, things like benefit verification. So how is the product covered? Is the product covered? Are there special considerations like a prior authorization that needs to be addressed? and so we’re, really working, with the provider in those situations to help, he or she through that, that, that clearance process of making sure, all the I’s and T’s are dotted and crossed, to get full reimbursement from the insurance companies.
Dylan McCabe: That is I think as a patient that’s one of the scariest things is navigating the whole insurance process. and you guys make that easier for the patient and the practice that’s just so critical.
Greg Morris: Yeah. And for the patient, it’s often, some, handholding. We, typically will have them sign a patient consent form so that we can make, the, offers of, different affordability programs like a co pay program or a foundation program, make them available to them, make them aware of those other sources of funds so that it can minimize their out of pocket for coverage. even if the insurance company is paying 80 or 90 percent, If you have a an infusion treatment that’s 5, 000 a month, that’s a lot of money for a patient, especially if they’re getting it every month. our manufacturers have wonderful copay and assistance programs and we make sure the patients are highly aware of those programs.
Dylan McCabe: That’s wonderful. tell me about your background. Tell our listeners about your background in healthcare and how you came to work with CareMedx.
Greg Morris: Yeah, I always say I got into the patient access business by accident. I, I started off, I’m, an insurance guy, and a serial entrepreneur. So I started, in, at Aon, the, big insurance broker and, worked there for a number of years in the, healthcare business and on the healthcare reinsurance business. I then went on to found one of the early consumer driven health plans. So we’ve run health plans in the past. and then, started off with after, after the, consumer driven health plan side. started a, revenue cycle management business really for providers as we recognize that more and more financial cost shifting was occurring. We wanted to give providers more real time tools to understand how much a patient was going to owe, help them communicate those issues. We always said, it’s better to the patient’s going to owe 500. It’s better to manage their expectations upfront than have them be surprised afterwards. So we created a bunch of tools to enable that to happen. including the payment gateway tools to actually help them collect money. and then, one, one day by, by accident, a manufacturer approached us and said, Hey, we’d like you to, be, able to provide that same type of patient estimate and the financial out of pocket for our specialty products that were, that happened to be a buy in bill. It was, a vaccine at the time, but, so we actually invented a new transaction and that transaction we call a medical electronic benefit verification. it, over the last 10 years has taken off. It, I think I mentioned to you earlier, we do more than a million, medical specialty benefit verifications a year for about 35 brands. and really what it’s all about is making it easy for a provider to understand, take a drug like a Remicade, is that product covered, for Johnny’s Health Insurance with Aetna? yes or no, is there a prior authorization requirements? with that drug right now, it’s a good example because many payers are requiring, biosimilars or at least having, biosimilars be considered or a step at it. So we’re able to return all of that information back very succinctly to, the infusion center. really helping them understand how that, what their different options are and what they need to do to get reimbursed for that, particular product.
Dylan McCabe: That’s so good. So it’s, interesting, you’re, you are a serial entrepreneur and it’s interesting that you guys started the way you did and now you’re working with so many different. Brands and practices around the U. S. To make sure these verifications are running smoothly. So, let’s talk about how that was born. What’s one of the biggest challenges you’ve seen with these practices, especially infusion. Like you said, if it’s if you’re receiving something that’s 5000 a month. And you owe out of pocket that could be catastrophic, especially to somebody that’s on a fixed income. So what’s one of the biggest challenge you’ve seen, you have seen after working with these practices around the U S over and over again, that you guys really address.
Greg Morris: I’d say that there’s two sides to it, right? The first is the affordability issue, right? And, we were engaged by the manufacturers to, be able to help the patient identify sources of funds. Oftentimes the providers, will know about the, a source of fund like a copay program, but if it’s a Medicare patient, as an example, you’re not going to be eligible for those programs. we start with, helping patients identify, do they qualify for low income subsidy, or are they qualified Medicare beneficiary, so that they can receive additional government benefits, or their foundations, other sources of funds, whether they be manufacturer foundations or some of the public foundations that the patient can access, right? So, making sure that, affordability is not an issue towards adherence is a big aspect of what we do. the other side is, We’re trying to change the way hub services are delivered or patient access services are delivered really to the provider. this has historically been a very manual call center oriented support service and we’re trying to change that, right? and it was, if I use Remicade as an example, the practice could reach out to the Janssen call center, and, receive information about that product. But when you want to go to the next brand, you had to call somebody else because it was a different service team, handling that other brand, for that other manufacturer. And really what we’re trying to do is unpack that centralized call center model where, quite frankly, infusion centers, buy and build providers are getting portal fatigue going to one place in another. And we’re trying to take and embed. technology, and we infuse is a great example. We’re incredibly excited about the partnership there where we’re, putting those core patient access services for all brands right into the infusion workflow, right? So instead of calling the payer and documenting and we infuse, you can actually do the self service work. In we infuse, right? And we think that’s a game changer because now everything you do stays in the way infused system. You can access, the goal is going to be can access any brand and get those basic core, access services, whether it’s, the enrollment, the patient consent. the, medical benefit verifications and ultimately that prior authorization, all, all in a streamlined fashion, simplifying, that onboarding process so that you can infuse patient faster. at the same time, we’re also dealing directly with the patient to help them with those same affordability issues, right? and making sure. regardless of the program that, that, that, that patient’s taken care of from, that standpoint.
Dylan McCabe: That’s huge. if you guys can take a process that’s so complex and simplify it, that’s just huge for the people who work at the practice and also the patient. But, I think about, all the infusion centers that I’ve been in personally and seeing, both small and large, the level of complexity when you have so many patients and all the different moving parts of the insurance process, the greater the complexity, the greater the financial risk as well.
Greg Morris: Oh, without a doubt. if you happen to take an MS product like an Ocrevus. If you, administer or infuse that product, and don’t have the appropriate approvals, you could be out tens of thousands of dollars as, a center. and, at the margins in that business, it takes a lot of incremental infusions to make up that lost, that lost, reimbursement. yeah, it’s the primary reason why, our manufacturer clients hire us is to create that reimbursement certainty, so that they know that they’re going to get paid for, the services they perform and, also that their patients can afford it. And, also they’re going to be able to afford it long term and, stay on therapy.
Dylan McCabe: So let’s talk about a real life scenario, if we can, where maybe a practice was going through the process and doing it, in a more manual fashion. And then they start utilizing this technology to streamline the process, the before and after. We don’t have to mention any specific names, but can you share a story of maybe where somebody was trying to go, they were trying to work out the process, just having a really hard time, maybe even made some really costly mistakes, but then started utilizing this platform to, to streamline the process and bring better simplicity and reduce the financial risk.
Greg Morris: Yeah, I would say the end to end manual process for an infusion center. probably takes somewhere between one to three hours done manually, right? And that would be everything from, filling out an enrollment form, calling the payer, getting the benefit verifications, capturing the consent for the patient so that they can, enroll in the copay program with the manufacturer. working through the prior authorization issues. and then, of course, if they’re faxing that prior authorization, it may take a week or even two weeks to, to get that approval back before you can actually infuse patient and treat. what we see with the technology is that a couple hour process is reduced to, I’ll call it 10 to 15 minutes, which is a big time savings from that standpoint. but I think even more important than the upfront time savings, because of the processes, particularly around the prior auth, we’ll probably get 70 percent of the prior authorizations, for the national payers completed within 24 hours. the, ability to streamline the decision process from the payer, and really bring that forward for the, practice and the patient is, it’s a game changer because it can mean getting onto therapy a week or two faster.
Dylan McCabe: It really is. It’s a total change in direction for somebody who’s managing an infusion practice to take that cumbersome process and narrow the time like that. That’s just so, after, you you mentioned doing over a million, verifications and working with all the brands you work with, what’s the best advice you would give to these infusion practices after, seeing, the operations of so many?
Greg Morris: I guess I’d start with and embrace some of the technology, and understand that not all the processes are going to be perfect. the, reality is what we’re, doing is not easy. It’s difficult. every health plan wants to do something a little bit different, and we’re here to try to help normalize that and create a consistent experience for the provider. but there will be bumps in the road. We always don’t go down the happy path. but I encourage you to stay with the technology communicate with us. we love feedback from users on how we can improve our services. and, generally we’re pretty good at it and we are consistently innovating. and I think, the other pieces. anytime you’re dealing with technology, if you make it voluntary, not all your staff are going to want to do it. and we see frequently that, Mary and Susie will use the technology, but Bobby and Jane won’t, and it causes, a bit of a dislocation within the practice. So having consistent, policies and standard operating procedures across the staff, have having them use the technology the right way. again, use us as a resource. and, what we’re really trying to do is to provide a consistent service across all brands. and, we’re working to get there. We’re not at all brands. when, when we launched the service here with, we infused, not every brand is going to be supported, but, shortly afterwards, they will, we’re going to continue to bring up more and more brands until we’ve got, 30 or so available. and again, these are predominantly the specialty brands. So we’re not, really thinking through like the, the, some of the generics, the, very low cost products that don’t have prior OS that you don’t have reimbursement issues on. we’re really there for the more complex. Products is where your outliers are, right? And, and, getting approvals. that’s where we want to help and help you, focus the energies and hopefully where we can add some value and again, speed up time to therapy.
Dylan McCabe: So let’s go back to something you said, if, make great use of the technology, but not everybody’s going to be excited about making that change. And so if you’ve got one staff member who wants to use it and then you’ve got one that’s indifferent and then one that is just being a stick in the mud. Let’s unpack that a little bit because you’re the chief strategy officer so you’re naturally you’re you are wired to think about the best way to get from point A to point B, how to streamline things how to think about the road, the path to get there. What are some tips for, somebody listening to this may think I have an infusion practice and you’re right, I’d like to implement this, but that’s going to mean more change. So now I’ve got to go to my, my, my nurses. I got to go to my office manager. I got to go my, three or four people working in the insurance process. I got to go to my two financial people. I got to, do all this stuff. What are some tips you have for implementing that change?
Greg Morris: Yeah, no, it’s a great plan. change is hard, right? And if it were easy, we’d all be changing all the time. I, think as you, one of the things to think about when, we’ve worked with lots and lots of, practices, whether they be infusion centers or, just practices that do a lot of buy and build work, room providers and things of that nature. they’ll have a big office, right? Think about the motivation of those individuals. if, Mary doesn’t want it, but Mary’s managing a staff of nine people, it may be because she’s realizing that if we fully adopt this technology, we only need three people, not nine. And my job’s going to get less important, right? maybe helping Mary understand that going from nine to three is a good thing. And maybe we can Keep three more people on to be redeployed to do higher value services than the administrative tasks they’re doing today. Maybe we can redeploy them to do things that have more meaningful impact either to the practice or to, to the patients, right? motivations are a, a very strong thing for individuals. So understanding what you’re asking them to do and how it impacts, their perception of their job is a, is an important one, right? We, dealt with the same thing. the, I was the founder of the company that, that created these transactions and we were actually bought by Carematics, my, my current employer. And it was, As a business care medics was in place and their revenue model was, put butts in a call center seat and pharma pays you for it. And what we were actually doing is automating that process, getting paid less by pharma. But, Mark Hanson, our CEO knew that was absolutely the right thing to do for our customers. And if you’re not laser focused on improving services for your customer, you’re not going to be there long term. as a company we had to innovate, we had to understand the motivations of many of our call center supervisors who were going to go for, from managing hundreds of people down to managing dozens of people. Because technology like this does have that dramatic an impact on staffing and efficiencies in time to therapy. we had to think long and hard about how we were going to motivate our team to make some of those same changes. And, it has been a process and yeah, like all change there’s, bumps in the road. That’s why I said, you just got to continue to adjust and adapt and, and also, the reality is the technology won’t always be perfect the first time.
Dylan McCabe: So what’s, one piece of advice you would give to the physician or the infusion center owner or operator who is saying, okay, we’ve been experiencing this pain point. It is a manual, pretty manual process. We love, we infuse, we’re excited about this feature. but maybe they’re thinking to themselves, that is my biggest fear is that key person is, Is going to be anxious about this change for maybe some of the reasons you listed. What’s just one piece of advice about how to start that conversation or cast that vision to this key, key team member?
Greg Morris: Yeah. and I think maybe before we even answer that, so the other motivation that you’ll see, and, just, for those owners, I want them to understand this motivation as well, is that. That person we’ll call it Bob, the office admin, we’ll call him Bobby, right? Bobby probably also has a belief that he can do it better than anybody else. and when he calls United, he’s going to get the right answer, and no one is going to get the right answer more often than him, right? and if you automate a process and it’s wrong, are we out 10, 000, and is that going to be my fault? and, so that, that’s another big issue. And, most of the manufacturers will put in place when we provide services, they’re going to put in place some protections if, we give you the wrong answers and those sorts of things that there may be a, a vial replacement program or, something of that nature. but that’s a, it’s another key motivation, for individuals is I can do it better. And what we’ve seen time and time again. Happens to be the opposite, right? The technology is going to be more consistent, deliver better quality and more accurate results. They had a phone call, right? Because unfortunately the phone call, you’re only as good as the call center operator on the other side at United, which may be a temporary employee based offshore, right? At different times of the year. so, the norm, normally what happens is the technology does Proved to be more accurate over time. but, I think going back to your initial question, how do you approach it? yeah, I, think a lot of it’s probably common sense. Understand, first understand the motivations, and, ask what their motivations are. Why don’t you want to use this technology? Maybe they think the user interface is terrible. And, and if we’re not, saving that individual time or making it more convenient or reducing errors, we probably shouldn’t be using the technology, right? but, I, think if they understand it, give it a chance, you, you will see, some combination of time savings, cost savings, accuracy improvements. the nice thing with we infuse is we’re going to be eliminating lots of duplicate data entry and things of that nature that, they’re having to do today, that they don’t have to do. And, as we all know, everybody can fact key, particularly a member ID number, right? so, eliminating a lot of that stuff makes, makes a big, difference, but, having open and honest conversations with that, employee, their motivation is probably one that is pure and what they believe to be best for the practice. but, sometimes not, but I think more often than not, it’s, always a good motivation, but with an open conversation, you can probably convince them otherwise.
Dylan McCabe: That’s really good. I think when you lead a practice, or a business and you are both obviously, you leading that change is, is hard when you know it’s something that’s important, but you have people that are setting their ways. There’s a book that we used to have to, we, it was required, when I was with, we infused as an account executive and the book we read, it was called, switch. Yeah. By Chip Heath and Dan Heath. And the tagline is how to create, how to change things when change is hard. because we thought about, when you, go to offer, we infuse as an opportunity for an office, you’re really offering a pretty big change. And they’re the way they operate. And so switch is such an interesting book because it talks about exactly what you were talking about. Motivation. How are people really motivated and what’s the fear factor involved in bringing about change? But I think it’s, I think it’s tricky for somebody, leading a practice, running that business, the business side of things too. but casting that vision to help people understand this is really so much better. Then what we’re doing now, and here’s how it makes your life better. Here’s how it makes the patient life better. and I’m involved in another business where we put CEOs together in peer groups. And one of the things we go over is even, if it’s writing down a few bullet points to yourself as the leader, to give you some rails, as you communicate that and cast that vision and the word picture we use is it’s the difference between telling people to fill bags of sand. Just cause that’s just what they should do. Fill bags with sand. That’s the way you got to do it. And this is why this is, we’re just going to do it because I’m the leader versus fill these bags with sand, because we’re building a dike to save a city. And there’s a storm coming. You’re going to have two totally different outcomes as how far, whether people are motivated or not, whether they have meaning in their work or not. And so I think for the leaders listening to this, it really is important to address that motivation question. I’m really glad you brought that up.
Greg Morris: Yeah. and as one of the things that I love about we infuse and the value proposition that they’re bringing to the table is, before you buy a solution like that, you’ve probably got a bunch of processes, but they’re all disjointed. And, we infuse is really a holistic way to, to manage your, overall infusion practice and, our technology embedded into that. Yeah. is just another example of how, we infuse is looking to become that holistic solution for that practice. Because Now, instead of having to leave their system, call United or call a hub to understand how coverage is done, you’re able to do that workflow all within WeInfuse, right? and that just makes, I think, the system all the more valuable, of a, turnkey solution to, to help an infusion center, ultimately, hit, their business objectives, which You know, which are probably a combination of financial, but also, the delivering high levels of quality care to patients.
Dylan McCabe: No, it’s so good. So what’s, after working with all these practices and having a position like you have as chief strategy officer, with care medics and seeing how this platform implements change and makes things easier. What’s something that you’ve seen over and over again, almost a light bulb moment. That you see this and you think, gosh, if providers would just do this one thing, or if, these owner operators would just do this one thing, it would make everybody’s life so much easier.
Greg Morris: I think, the onboarding process, getting all the insurance reimbursements, can oftentimes be. a series of and then what, right? is the patient covered by Aetna? Yes. Great. Oh, and now I have to check and see how is Remicade covered? how is it covered? Are there step edits? Now what do I have to do? I have to do a PA, right? yeah. And it’s, For certain every payer is a little different. Every brand is a little different on those onboarding processes and what you have to do. Sometimes there’s even like in the MS world. There’s first dose observations where you have to do monitoring and those sorts of things. and, I can’t even imagine for an infusion center that may be dealing with 30 different products. how you deal with all those different paths, right? And what we’re trying to do, in conjunction with We Infuse is to really, make that a sequential process that’s logical, right? we, may need a consent for a patient. We may need to get some information from a brand specific enrollment form. But then we know you need a benefit verification back and we’re, pushing that information to you. You don’t have to ask for it. We’re giving you the staff edit requirements. all of those sorts of things. We’re giving you the PA requirements. We’re making it easy for you to submit that PA information. So hopefully within a relatively short period of time. You understand that the system is helping you down, the treatment pathway or the ability to get to the treatment pathway, maybe even is that get you through the patient onboarding process so that you can actually start making an impact on that patient, by, delivering their treatments.
Dylan McCabe: Yeah, it sounds like, if I hear you correctly, it sounds like it’s, the message here is there’s an easier way to do this. Don’t get bogged down by, by, going down so many different rabbit trails when you could be working with a highway and keep it simple.
Greg Morris: Yeah, we’re going to be working, it’s going to be a continuous process with the team here. We infused, they’ve got, they got wonderful leadership. We’re going to continue to add, more brands to the portfolio. We’ll get better at doing what we want to, what we’re trying to do. And, one of the other things that I’m excited about, is, we hear so often from referring providers. That, they lose lose track of my patient when I send them to an infusion center. I, I don’t know whether they were treated, what’s happening. and, one of the things that we’re really excited about is, we, deal a lot with those specialists that we’re referring into we infuse. we’re gonna, we’re gonna be working on, some technology that allows them to in some of our other user interfaces to write their work order, send it to we infuse and then start to get status updates back. What’s happening with my patient or the, did what we think was going to happen. Do I have anything I got to worry about or their lab results I need to know about, et cetera. so the more we can keep, the care continuum in the loop, I think that’s a, after we, we first have to make sure we completely nail for, the, infusion centers. All the benefit verification prior off, things that we’re trying to do. But, I think that’s the next big, big opportunity is, to bring that care continuum in, in, into play. And then, and the other thing I’m excited about is. is, we’re unfortunately in the times of Covid. how can and how can infusion centers play a bigger role? Should they be playing a bigger role? How do they do that safely? our manufacturer customers also happen to be both the vaccine makers and the treatment solutions. folks like Regeneron. and and we’re trying to even bring some of their voice and, you mentioned some panels and discussions, we’d love to be, matchmaking, bringing some of the leadership of, the covid vaccines and the treatments, and have them get perspectives from the infusion center operators and vice versa. And how do we, do a better job of. tackling this, this pandemic.
Dylan McCabe: Oh, that’s so good. Yeah. When you bring leaders together and you can leverage that collective wisdom, great things can happen. That’s just great. So really love the fact that you guys are so connected with the practices and the manufacturers. And I love that you’re streamlining. Significantly streamlining the insurance process. It’s so great. So there’s going to be people that listen to this. They’re going to think, I want to learn more about care medics. I want to learn more about Greg. What’s the best way for people to get in touch with you guys?
Greg Morris: certainly your, we infused reps are going to know the functionality that we have available. And I think, for any practices or infusion centers that use we infused, that’s going to be a The best first step, right? if you’re listening this and you’re in another therapeutic class, it’s not an infusion center and you’re just you’re curious or you have a practice in another buy and build therapeutic area, you can certainly reach out to care medics. my, my email easy. It’s just g Morris at care medics. com. anybody’s welcome to reach out to me or go to the website. to learn more. and, I should also mention we also have a whole host of services, on the pharmacy benefit side. And we’re talking mostly about infusions and, buy and build products. But, we’ve got, a non dispensing pharmacy. We, can help with, triage, particularly for, narrow network products to make sure, the script gets to a pharmacy that can actually fill the script many times, and especially, there’s narrow networks either directed by the manufacturer or the health plan. but, yeah, I think that those are all good starts and, welcome all interest. And, I’d say, you’d mentioned, we bring together the manufacturer and the provider. I think, the 3rd wheel in that, or the triangle is the payer. And, one of the things that. That we’re trying to help our manufacturers understand, about we infuse is that from a place of service standpoint, that place of service at the, office of the provider, infusion center. is a much more attractive site of care than the hospital inpatient infusion centers, right? it’s a third of the cost. And, we’re, trying to, our, manufacturer customer, our manufacturers and our payers. They always feel like they should be butting heads, right? And, but, situations like this actually allow them to collaborate. And we’re trying to help them understand that, as we’re putting technology into WeInfuse, it’s a good thing for everybody to, to have patients treated there because they’re lower cost, solutions and sites of care.
Dylan McCabe: That’s so good. Yeah, it’s, hard to argue with the site of care optimization when you compare a hospital versus a standalone infusion center.
Greg Morris: Yep.
Dylan McCabe: Greg, Morris with care medics. Thank you so much for joining us. I know that everybody listening to this got a lot out of it. So thanks for being on the show.
Greg Morris: Thanks for having me appreciate the time today.
Dylan McCabe: All right. Valuable insights there from Greg Morris. And I really like what he said about tapping into people’s motivation. it’s just so critical if we are going to lead change, really thinking back and considering even asking people, why do you do what you do? What’s important to you about it? Or why do you not want to be a part of this change? What are you afraid of really finding that stuff out and making sure people are motivated the right way. I love that. He really unpacked that for us. And, guys, I just want to say, if you haven’t done so already, you can learn more about how we infuse can save you time and money. You can schedule a no obligation discovery call with one of our account executives. I think you’ll be so glad you did if you’re not already using WeInfuse. Okay guys, it’s Dylan McKay with the WeInfuse podcast, and I will catch you in the next episode.
Guest Speaker:
Greg Morris has over 20 years of experience in the healthcare industry. He graduated from Harvard University in 1992, and has held positions as CEO, COO, CCO, and President for various healthcare businesses. Greg currently serves as Chief Strategy Officer at CareMetx, a specialty medication services and technology company that prioritizes patient access to complex therapies.
