Chris Cook, Vice President of Specialty Pharmacy and Jay Patel, Founder and CEO of Ivira Health share insights on patient experience, care coordination, revenue cycle management, working with payors, creating a company culture and contributing to the community.

WeInfuse podcast

Transcript: How to Create a Frictionless Patient Experience and More

Amanda Brummitt: We Infuse podcast, episode number 45. Welcome to the We Infuse podcast. My name is Amanda Brummett. In every episode, we give you a seat at the table as we talk to Infusion Center owners, operators, and experts so that you can get the insight you need to run a thriving practice. In this episode, we talk with Chris Cook, Vice President of Specialty Pharmacy with Avera Health, and Jay Patel, Founder and CEO of Avera Health. Chris and Jay are both pharmacists, And have a ton of great information to share about patient experience, working with payers, resources, and lessons they’ve learned along the way. So, as I said, I’m here today with Jay and Chris from Ivera Health, and we are super excited to have them on the We Infuse podcast. Thanks for being here, guys.

Chris Cook: Thank you for having us. Thanks for having us.

Amanda Brummitt: Yeah. So I’ve told the audience a little bit about you formally, but I would love for you to share with us your background and how you both got into the infusion industry.

Jay Patel: Absolutely. so my name is Jay Patel. I’m the founder and CEO of Ibera Health, formerly known as Green Hill Pharmacy. I was a young pharmacist at age 26 that, wanted to start an independent pharmacy here in, the Delaware area. And we started this, in this industry, healthcare industry, wanting to just, have an impact in the community pharmacy space. However, as we grew throughout the months and years, we learned that, there was a greater gap in care that needed to be served. And, over time we found more and more opportunities where our, community focused, service was more and more needed. And so we grew from just a small independent pharmacy, to, multiple independent pharmacies throughout Pennsylvania and New Jersey, Pennsylvania, Delaware area in, into, the care coordination business, as well as the infusion space as well. and I’ll let Chris introduce himself.

Chris Cook: Hi, my name’s Chris Cook. I’m the Vice President of Specialty Pharmacy Services for Ivera Health. And, like Jay, I started out in community pharmacy. I started out, roughly about 17 years ago. Started with, being a retail pharmacist, a floating pharmacist coming out of school, with Walgreens. And then I got myself into management. dabbled around in understanding and getting experience with managing people and understanding how the business worked a little bit from that perspective. And then I got into a role as a specialty pharmacist with Walgreens local specialty division. and that was really where I got a lot of my experience and understanding the industry where it sits today. if we look at today where we’re at with pharmacy, a lot of what’s focused on his specialty pharmacy from a variety of elements. And so I got my legs, from that experience with Walgreens. I got an understanding of how certain, certain people in different areas of the healthcare spectrum, look at what the industry is holding, what challenges they have from a hospital perspective, from a provider perspective, and from a pharma perspective, and even an insurance perspective. So I got really good experience, from being in that side of things. And then Jay had a mutual colleague that we teamed up and he said, Hey, look, I need somebody to get me involved with specialty pharmacy. So I joined his team back in 2017. I’ve been helping, grow the business, since then. And we really got into infusion just a couple of years ago. We, it fell into our laps. we met, recent Brian, out at the NHIA in March of 2019. I believe we started having conversation about what it looked like to get into home infusion. They said. No, let’s get it. Let’s get you thinking about, alternate side of care or ambulatory infusion. And for their, from there, the rest is history. we’ve, we started, with, consulting with them and establishing our business. And here we are today with a pretty, well established growing business of IVR infusions.

Amanda Brummitt: Cool story. I love your background and, how you got into it. And my favorite part is that you’re a pharmacist. I love that you look through things, through that lens. Can you talk how that has shaped your journey, both into infusions and how it affects your business decisions that you make every day when you’re thinking about what to do for your patients?

Jay Patel: I think we’re talking from two different perspectives, me from the patient angle, Chris, from the, the payer angle, honestly. and I, think, both of us bring, two different, very important pieces to the puzzle, honestly, right? So for, for me, From when I opened, my first pharmacy to when we opened the infusion center to, care coordination, the patient experience was the most important thing, right? Where, having a good experience. frictionless patient experience was the most important thing, right? And whether that mean, whether that meant, ease of scheduling appointments, whether that meant, communication between providers, whether that meant, access to, their clinicians. that was the most important. thing from, my angle as, the CEO and, when we opened our first infusion center, it was always making sure that the patient had, access to whoever and whatever it was that they needed, right? small things like, I, I don’t ever like to say that we’re a large corporation, but, oh, sorry. I don’t ever like to say that we’re a large corporation, but things like making sure we answer phone calls within like a couple of rings, right? it means something, right? And it’s not, it’s not a metric that we’re trying to sit here and measure, because we’re a small organization and we have no way to measure it really, but, it’s more, having. that patient have a seamless experience in dealing with us, right? Everywhere else in the healthcare journey, they’re used to press one for x, press two for y. Everywhere else, they’re used to being put on hold. Everywhere else, they’re used to waiting. here, They should not have that experience. Right. And, for us, it was making sure that patient experience was seamless was smooth, making sure a lot of ambulatory infusion centers are, beautiful spaces. IVX infusion, we have Sage infusion, we have Kelly Kane out in Arizona where their, their infusion centers are the most beautiful places. And like that, we wanted them. Make sure that we offered places like that as well for patients to go where it wasn’t a tight cramped room. It wasn’t a room place with a lot of people. It was a very smooth, relaxed environment where people were able to feel comfortable, even if they were on, end stage treatment, whether they were on chronic conditions that were going to be placed on lifelong, where their experience was, yeah. a blissful experience, really. And those are the things that we focused on early on with our business experience for patients, honestly. but I know Chris, had,

Chris Cook: a lot of other, I have some things that I can share. So from, my, perspective, gaining the understanding of the specialty, Pharmacy, from a self managed perspective, gave me a lot of tools to bring to infusion. So, I own and operate our specialty pharmacy side of the business, but that allows, that allowed me to bring some experience that we have now with that to infusion. So there’s some similarities and some striking similarities with, the operation. A prior authorization is needed for a lot of these expensive biologics or infusible therapies. And so that is, is, it’s something that is, where, staff have to understand that there might be step therapy or they have to understand a medical policy and how it relates to their clinical condition. there’s also financial assistance component. there’s similarities to that from a self managed perspective to infusion. So. that piece of it is baked into our operation and infusion side. So our staff understands how to do prior authorizations. Our staff knows that if there is an out of pocket, that might be something that prohibits the patient to getting access to treatment. They know the resources that are necessary to get them financial assistance. So, this is just little things, but that helps us to, to move that piece of business. It’s a service essentially, right? So, that helps us to move that piece into infusion. And I think that Providers like the fact that we do all these things for them. Patients are satisfied knowing that they have an opportunity to get access to a treatment that might, be a life altering or lifesaving. And, this is where we’re at. And some of the things that I’ve learned along the way helped us to grow that piece.

Amanda Brummitt: It’s actually a brilliant marriage to put together patient experience with the payer side, because both of them ultimately affect the experience. And I love that you guys look at it that way. We. I think a lot of us forget that nobody ever wants to see any of us. They don’t want our services. they are sick or hurting or probably scared. And so creating that frictionless experience, both on the, beautiful and aesthetic side, making sure the phone’s answered, but also helping them navigate that financial piece. It’s huge. they’re scared, they’re hurting. And the last thing they want to do is find out they have a massive bill or, can’t get anybody to answer the phone.

Jay Patel: I think one other thing that is nice is our care coordination building, our business is actually in the same building as our infusion center and our care coordination business. What it does is it provides a disease education, to, a basic standpoint, right. For a lot of primary care patients, for a lot of specialists, patients. And, the cool thing is, these patients that are coming in, sometimes they’re, patients that are just really dumbfounded as to how, how the heck am I diagnosed with UC? I’m healthy. I don’t do drugs. I don’t smoke. I don’t drink. Like, how do I end up with this condition, right? Or, some, unfortunate, individuals that are young that, end up with MS and that are just really it. confused and dumbfounded with how they get their condition. But because the care coordination business is so nearby for us, we’re actually able to have a pharmacist come in while these patients are getting their infusion and have the pharmacist go through what is the disease state? What’s the background of the condition? what are, some of the things that the patient can do to, better manage the condition? how did they can manage it with diet exercise, help prevent the, Progress of the condition, honestly. And, those are some of the things that I think, are unique to our specific situation, honestly, that are beneficial.

Amanda Brummitt: Now, what a value add for the patients, and for their referring physicians that you are providing some of that education that complements what they’re probably telling their patients to. That’s awesome. And I love that you do it. While they’re already getting an infusion, they’re not having to make another appointment for something else. they’re sitting there captive and they get a brilliant pharmacist explaining about their condition.

Chris Cook: That’s right.

Amanda Brummitt: Nice. I love that. so one of the things you guys had mentioned to me, that’s been really helpful is a lot of people along the way. It sounds like there’s a lot of folks that you, feel like really helped craft your journey. Can you share a little bit about that?

Chris Cook: yeah, honestly, I would definitely Reese Norris and Brian Johnson. we got it. We got to give them cred for getting us to think about, medication or treatment from this perspective. we, we always, And this is what I liked about Jane. That’s why I signed. I signed on a little while ago was that, we’re always thinking the next step we’re trying to we’re trying to be innovative. We’re trying to be intuitive with our thought process and how we can get how we can get in front of what the how the wave of health care right and what the future brings. And, Part of doing that is building relationships, right? With people that are smart and sometimes smarter than you. And we got, we had a chance to get in front of some really smart guys and Brian and Reese at that conference and just got a different perspective. They shed some light on some things that got our light bulbs turning on. And, I can tell you that without support, without help from others, Really business doesn’t work.

Jay Patel: Yeah. So, it was 2017 NHIA conference. Chris and I, we, we pretty much spent a lot of the year researching home infusion, actually. so I don’t know. so you could see, I don’t know if the viewers could see, but you could see behind us, that’s actually our, sterile compounding lab behind us or USDA lab behind us. and our, specialty pharmacy is focused on home infusion. so we spent a majority of a whole year actually focusing on learning how to do home infusion. We went to the home infusion, NHIA conference. That’s actually where we met Reese and Brian. And it was there that I just, Chris was in one of the more valuable sessions of the NHI conference. I was in, just floating around in one of the other sessions. I, just happened to be in a session where Reese and Brian were talking. And that’s where I, heard their entire session, fell in love with them. thankfully was able to get 30 minutes with them alone, at the conference. And that’s where they got my mind thinking about an ambulatory infusion center in conjunction with doing home infusion. we have, we have a really close, colleague here, that runs biotech remedies. His name’s, Chai Goodday. he’s, CEO, biotech remedies, national home infusion, pharmacy. and he’s a very invaluable resource to us, but we never, in working with Chai, we never even thought about, ambulatory infusion. But in that, 30 minute session that we sat with Reese and Brian, we, we got to learn so much. we engage them in a consulting agreement. We, sign on, we infuse, we infuse again, Shameless plug, by far best EHR we’ve ever worked with, makes things, the most simplest form of what needs to be done. And in working with so many different softwares across so many different businesses, we infuse hands down deserves all the praise. Yeah, it takes the cake for sure.

Amanda Brummitt: Words I rarely hear clinicians say about an EMR.

Chris Cook: we could spend hours on the bad softwares, but.

Jay Patel: too good.

Amanda Brummitt: Awesome. Well, I’m glad that you guys crossed paths. It sounded like it had a big impact on your business and the direction. so, you guys were cracking me up earlier when you’re saying you’ve learned a lot from your failures. I think most of us probably have, which ones can you share with your fellow infusion owners and hopefully help them dodge?

Jay Patel: I think the one that we could share is one that everyone always talks about, but we could probably put a dollar number two. the hurt, is billing. Oh, so our friend Kelly Kane always expressed to us the importance of billing, working with people like Jackie from Pinnacle Infusion that really understand the beauty of billing. infusion billing. Reese stressed to us the beauty of infusion billing. me as an arrogant pharmacist, maybe chose not to listen. I don’t know what it was. however,

Chris Cook: yes,

Jay Patel: we can tell you that billing is probably one of the most important things that you can focus on as a practitioner in medical billing, right? to the extent that, I think it was to the bell of, almost 500, 000 that we had, almost as a loss. Thankfully, we were able to work with some very skillful players like Jackie at Pinnacle Infusion that, were able to save us. but billing, honestly, making sure that you understand. The life cycle of, medical billing, understanding that it is not a pharmacy billing where it’s, and this goes out to my pharmacist who are, I personally know, eight to 10 colleagues that I’ve like referred to. we infuse to do an infusion center, right? And, that’s just, eight to ten in my network where they are, pharmacists coming from the pharmacy world who are looking to do, an infusion center to take care of patients and their community, probably in the same situation that we’re in. And, from the pharmacy world, we’re so used to, hey, if you get your, aspirin, if you get your cholesterol medication, if you get your, even your 3, 000 HIV medication, if you bill the insurance today, right now, in less than 10 seconds, you will get an answer whether you are going to get paid. And you will know to a T. Minus D. I. R. Fees. what you’re gonna get paid and how much you’re gonna get paid and that you will guaranteed get a payment in the mail or through E. F. T. In a matter of, 3 to 5 weeks in the medical world. does not exist. The guarantee does not exist. even if you could get someone on the insurance company to say, Hey, this is your reference number still means literally nothing, unfortunately. So, what we’ve learned is, having a robust team that can do your benefits checks, that can do your prior authorizations, that can, Guarantee that you are in network that your par provider make sure your cash flow is able to manage, six to 10 to 12 weeks worth of cash flow. That is probably one of the most important things that I could say to any provider that’s willing to go into this because, In the pharmacy world, 3, 000 drugs, you’re doing them daily, almost sometimes if you’re a specialty pharmacy, and you guarantee payments within a couple of weeks and, it’s okay. It’s easy to manage, but when it comes, 12 weeks and you don’t get a payment when it is 15, 20, 18, six months almost before you get a payment. Can you manage that? And there is no business plan that I have ever formulated in any of the companies that I’ve started since I was 26 that has planned for a 26 week business cashflow. and That is the one thing that I think that we learned the lesson early on, thankfully. and because we learned that lesson early on, we were able to, cut the losses. and implement a very, robust billing team, to make sure that we are guaranteed for success in the future. And again, there’s probably been at least eight other podcasts from We Infuse that have talked about billing and make sure it works out well. Three of the people that I look to as mentors have told me to make sure billing works out well. I don’t know why I did not listen. I don’t know if it was arrogance or just me being dumb coming from the pharmacy world, but, it is what it is, but making sure billing. Is at the forefront of everything that you do, making sure that your cashflow can stay secure is probably one of the most important things you could do. that would be the biggest lesson, honestly, to other pharmacists that are looking to jump into this landscape now.

Amanda Brummitt: Yeah, totally makes sense. my journey was the opposite of you guys. I did business school and then went into healthcare. and we basically start with cash is king, day’s cash on hand. You need six months and, but you’re not alone. I, Rarely talk to anybody that owns any kind of healthcare entity that hasn’t run into the same thing. And, yeah, and it’s tough. So I’m glad that you weathered the storm and, Christiny. Okay.

Chris Cook: I think it falls in line with what Jay was discussing is, at, from an entrepreneur perspective, you really got to do your due diligence and anything you do. and I think that. early in our career, in my experience, being, being with a small company is that we’re really, we’re go getters. So if there’s something, that we, we feel that might, be an opportunity, we’ll go after it. And sometimes it’s taking a risk, right? and not all the time. Does that mean that you’re going to succeed with, with that venture? And so, Part of success is being able to accept failure. And I think that, for all the listeners that are out there, it’s don’t be afraid to take risks and don’t be afraid to, to, go after things that, that might, be on the cusp of we’re counterintuitive. It’s just do your due diligence. and, with that, you may fail, but if you succeed all the more better. Awesome.

Amanda Brummitt: Yeah, that is fantastic advice. I wish everybody got it about six months before they went into business. Okay. So last question. Of all the things that you’ve learned, everything you’ve been through with your different businesses, what is one last piece of advice that each of you would give our listeners?

Chris Cook: I can tell you right now, I think so, is developing a culture, identifying a culture within your organization. it’s probably the most paramount thing, to a company, especially as you grow, you want to establish that because you want people to have the same values or resonate with the same, the values that you have as a company. and that helps you identify the type of talent that you want. and it’s not just. what tangible skills they have, or, this person might be clinically gifted, but, are they self motivated? are, they, willing to wake up in the morning early and do research? Are they willing to put in the sweat equity? So, it’s establishing, those values and creating a culture. And then, hoping that you can bring in people that will mold to that culture. So I think culture is a really big thing that a lot of people don’t, that take for granted, so to speak. and really surrounding yourself with smart people. I can’t say enough about it. I’m not the smartest guy in the room and Jane will tell you the same thing, but I’ll tell you what, we have some really, smart, And talented folks on our team that help us to bring ideas to the table and to shed light on things from a different perspective. And so I think those, all those pieces are important.

Jay Patel: I don’t know if Chris was telling me that I’m equally as him. However, I do not disagree with him. I am in the same boat. I do not think that I am the smartest person in the room. Honestly. I don’t know. When I started my first business, I was 25 going on 26. and I was not. The smartest person at all in any means. quit my secure job. I had nothing but debt. I had no house. I had no car. I was just going out of the wild, just saying, YOLO, which, you know, at that point, as a 20, 26 year old going in, it. It seemed like, what’s the worst that could happen. And honestly, that, that was my mentality, right? Like I had, I had a father who was a immigrant to this country who, came here, we had a typical gas station. and he said, what is the worst that can happen to you? Right? Like worst case scenario, you have a doctorate of pharmacy degree, you will go back and you will have a six figure salary. I had, a girlfriend who is now the mother of my two month old daughter, who said, I will be here to support you. What is the worst thing that can happen to you? Right? Like you will, again, right. Go back and go to Walmart and work and get a six figure salary. What is the worst thing that can happen? and so that, that gave me the, that gave me the foolish arrogance of pride to, to trek forward to, want to do something better for the community, right? And in, in doing that for that first year, I learned that the more you give back to the community that you serve, the more. The community will always give back to you, right? Year one, opening a pharmacy, we succeeded, which is rare to say in the industry today. year two, we had our second location. Year three, we had two more locations. Year four, five, six today, where we are now, we are, a, a very large organization serving people. thousands of patients across multiple states, across, pharmacy, infusion, care coordination. And none of that would have been possible without taking the risk of foolishness, right? And, it’s easy to say, let’s take a risk, but it’s hard to know when that risk is a calculated risk versus, that risk is a calculated risk, doing good for the world. And that’s the most important thing, right? where if you know you are doing good, then That risk you should always take because, more often than not, when you’re doing good for the world will always be there to support you, to stand you up, to strong, to hold you up. And I think that is the most important thing that, I’ve always learned that my parents have always taught me. My wife’s always supported me. My partners have always seen in me in that, in the last six years, we’ve, done some foolish things where, we, it may not have always made business sense, but it made sense in, supporting the population that we’re promoting here in our community. It made sense to the patients of the doctors that we support. And, on paper, financially, it may not have made sense, but, in the end, it’s always paid dividends long terms over. And that’s the most important thing that you always see is like, the, more happy your patients are, the more happy your community is, the more happy your providers are. sometimes Those are the risks that are the most worth taking, honestly.

Amanda Brummitt: Yeah, absolutely. I find the same. Whenever you put good out, it comes back to you and we put the patients 1st. It always ends up working out in the end. Well, Jane, Chris, thank you so much for all the information. I love hearing your story. I so appreciate your passion for patients and for sharing your advice with other infusion center owners and just really appreciate your time and love that Avera is doing such amazing things.

Chris Cook: Thank you for having us. Really appreciate it. Amanda.

Amanda Brummitt: Well, there you have it. That’s Chris Cook and Jay Patel of Avira Health. Their passion for putting the patient first is such a good reminder for why we all do what we do. And their advice and experience on the financial side of medicine is certainly one that we can all appreciate. Well, if you haven’t done so already, do yourself a favor and give the WeInfuse software platform a test drive to see how it can save you time and money in your practice. My name is Amanda Brummett, and I’ll catch you in the next episode.

Guest Speakers: Chris Cook, PharmD serves as VP at Ivira Health, a healthcare company that focuses on specialty pharmaceuticals. Chris has over 15 years of experience in the pharmaceuticals industry, and he manages Specialty Pharmacy & Clinical Services at Ivira.

Jay Patel, PharmD is the Founder and CEO at Ivira Health. Jay founded Ivira as a community-focused healthcare company that streamlines medication management by directly contacting practitioners. He has had multiple pharmaceutical works issued in various publications, including Janssen Scientific Affairs, LLC and Mercy Suburban Hospital.