In this episode, we talk with Cannon Loughry, Chief Operating Officer of TwelveStone Health Partners. Cannon shares how a culture of constant learning and adapting creates a sustainable business that will be around for many years to care for patients.

WeInfuse podcast

Transcript: How to Continuously Learn & Improve Your Center with Cannon Loughry

Amanda Brummitt: WeInfuse podcast, episode number 61. Welcome to the WeInfuse 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 Canon Lowry, chief operating officer of 12 Stone Health Partners. He’s Canon shares how a culture of constant learning and adapting creates a sustainable business that will be around for many years to care for patients. Well, Canon, thank you so much for being on the show today. We’re super happy to have you here. Good

Cannon Loughry: morning. Good to be with you.

Amanda Brummitt: Yeah. So I know some of our guests already, or some of our listeners rather already know you, but I would love for you to start at the beginning and tell us all about your background.

Cannon Loughry: Well, that’s a lot to talk about. I’ll try to keep it short. My name is Ken Lauer. I’m the chief operating officer of 12 stone health partners. I’ve been with 12 stone for 12 years. I spent most of my career in banking. Actually, I’m a 3rd generation banker. So I was chief information officer at a large regional bank. Towards the end of my banking career, I left there in 08 and went to Microsoft and was at Microsoft for several years. And it’s actually at Microsoft where I got into. I didn’t start out in the healthcare segment. I was on the Nissan account doing technology strategy with their CIO. For Nissan Americas and then had an opening in health care. Of course, being here in Nashville, Nashville is the health care center of the United States and a lot of opportunity. So I thought that was a great option to get into such a. interesting industry. So that’s where I got exposed to health care. I was working with our largest for profit providers. In at Microsoft H. C. A. C. H. S. Life Point Vanguard, helping them with technology strategy. And then got 4 kids and was tired of traveling a lot. And 1 of my good friends, Shane Reeves, who’s our CEO asked me if I’d come help them with technology at his company, which was re saying at the time join them in 2012 and started growing. We’re a multi division company. We’ve got. We had retail pharmacy at the time we had durable medical equipment. We had respiratory. We had enterals. We had home infusion. Since that time, we started a specialty pharmacy. We got out of several of those businesses. We started a infusion center division. We started a home health division. We got licensed in all 50 states for our specialty pharmacy and dual credit with URAC and ACHC and brought in private equity in 2015 divested the retail pharmacy. That’s when we changed our name to 12 stone health partners. So, and now we’ve got, we’ll have 20 centers in 4 states at the end of the, at the end of the year. So we’ve been busy over the past 12 years that I’ve been here, but it’s been a lot of fun.

Amanda Brummitt: Wow, that’s incredible. Well, I have a couple more questions about you and then I want to dive into 12 stone in some depth. And love your background in Nashville. I’m alumni here. So always appreciate that. A lot of

Cannon Loughry: those in Nashville, there’s an interesting the National Healthcare Council. I don’t know if you’ve seen it has a chart of all the different companies. That originated and where they originated from, and it’s amazing how many of those health care companies and health care technology companies in Nashville originated, from H. C. A. So what a what a great thing that’s been for, the national marketplace, but United States of the whole great organizations.

Amanda Brummitt: Yeah. Fascinating. We’ll have to go check that out. So let me ask you this. When you were making the decision about making that jump what made you decide to get an infusion industry? What interest interested you about it?

Cannon Loughry: Well, here it well, re saying when I joined Shane Reeves back in 2012, like I was saying, we have multiple different divisions. I think in health care, there’s constantly new things that are coming on the market. They plateau and then they fall off. So retail pharmacy was great for years. We’ve been, we had a retail pharmacy. Shane’s dad started in 1980. But, retail pharmacy is not where you want to be anymore. Durable medical equipment used to be great. And you don’t want to be in that anymore. We divested that respiratory used to be great. So, the hot new thing now is infusion centers. And we started that division and that’s our main growth area, especially pharmacy has been a good growth area for us. Really the way we got into infusion centers was one of our clients, Vanderbilt medical center said, Hey, we’ve got a lot of. A lot of patients that were infusing, but they don’t want to drive all the way to downtown Nashville and fight the hour and a half to two hour traffic. It takes to go that 32 miles. Have y’all ever thought of opening an infusion center? One of our sales reps came back and gave us this Intel and we’re like, well, that’s great. We’ve never done that before, but let’s try it. So that’s how we got into the infusion industry. So, one of the things I like about 12 stone is that I feel like we’re constantly in startup mode. And we’re always starting new businesses, maintaining businesses and exiting businesses to stay on that forefront of the healthcare wave.

Amanda Brummitt: Yeah. So would you say that with your banking background, you sound like you’re very strategic and very intentional about what you do, when to get in, when to get out, would you say that’s really your area of expertise?

Cannon Loughry: I’m not a clinician, so I’ll say that 1st of all, we’ve got a very talented chief clinical officer, Lee Golden, who we work very closely with who I work very closely with and, our theory or our strategy is, you can go too much too far on the side of fiscal responsibility. And go out of business, or you can go too far on the patient side. And go out of business, and Lee tends to lean towards patient and patient experience and patient service. I tend to lean more towards the operational efficiency and fiscal responsibility. And we work very well together to balance each other and end up somewhere in the middle. So, I think, really, my area of expertise is. It’s technology and software and operational efficiency. And that’s a constant challenge. When you have multiple divisions like we do, we run four pharmacy management systems across the company, which we’re hoping our relationship with we infuse will help eliminate some of those over time. And I think one of the main areas. That I’ve learned from my expertise of implementing software is and I’ve learned this from my time at Microsoft. And from my here, we’ve done several software implementations during my 12 years here at 12 stone is that a lot of times the mistake companies will make when they try to bring in new software is that they will try to take existing processes. And fit those into new software. And a lot of times that’s like trying to put a square peg in a round hole. Really what you need to do is when you choose new software is to really rebuild and re engineer that workflow process to fit the way the software was designed.

Amanda Brummitt: That makes a ton of sense. And I love what you said about, we can lean too far towards fiscal responsibility or too far towards. Patients and either way, we’re going to go out of business. We’ve got to have that balance. And that is such a good reminder for all of us as we’re thinking through everything we do strategically, especially software, because if we don’t stay in business, we’re not going to be here to take care of all these patients that need us.

Cannon Loughry: That’s right. Yeah.

Amanda Brummitt: So let’s get a little bit into 12 stone and how you’re set up. As I understand you, you partner with other providers, especially for post acute care. Sounds like you guys are a little bit unique. Can you tell us about your model?

Cannon Loughry: Yeah. So, there’s several things that I feel like make us unique here at 12 stone. One of those is that we believe that pharmacy. Yeah. Has an important purpose in these workflows that we’ve established. I know a lot of the traditional we infuse clients are just started as medical provider based infusion centers and don’t really have pharmacy involved in the process. Of course, like I told you before, Shane’s a third generation pharmacist and and believes heavily in the purpose of pharmacy in the care continuum. And so we’ve worked hard to include pharmacy in our infusion center division as we started it. And I think that makes us unique. I think another thing that makes us unique is we have a medical provider based entity, 12 state infusion centers that is a traditional buy and build medical practice infusion center. But we also have a specialty pharmacy that I talked about earlier that’s licensed in all 50 states. Dual accredited with URAC and ACHC and that gives us access to a lot of these specialty provider networks that give us the ability to either buy and build a drug or to provide drug from our specialty pharmacy and ship that into one of our infusion centers or ship it directly to one of the specialists. That we work with we also have a home health division. So we have the ability to send nurses into the home and infuse that from our home infusion division as well, or from our specialty pharmacy. So, I think that gives us maximum flexibility because at the end of the day our customer. While the patient is a customer, our ultimate customer really is that specialist that is referring those scripts to us, referring their patients to us in trusting us to care for their patients the way that they do. And we need to give flexibility. To that provider to serve them in any way they see works best for their patient. And then we also need to take great care of our mutual customer, which is the patient and their caregivers.

Amanda Brummitt: Yeah, that’s brilliant. I love what you said about making pharmacy part of the process in the care continuum. I think that we really miss out on a lot of brilliance and Great patient care and such a good resource. If pharmacy is an afterthought. So I think that’s a great way to set up your model on the front end. I’m really smart and all of that flexibility and the ways you care for specialists and. Their customer and your customer, the patients such a good model. Wow, we could talk all day. Just how does 12 stone do all that?

Cannon Loughry: Excellent. Absolutely. Absolutely.

Amanda Brummitt: Yeah, for sure. So I understand that you’re also part of the infusion technology advisory council for we infuse. Can you tell us what that entails and what you do there and how you bring your software expertise into that?

Cannon Loughry: Absolutely. Yeah, I was really honored to get asked to serve on the attack. I’ve got a great group of board members that have been asked to volunteer their time to help provide industry expertise. To make we infuse better and, of the things that I mentioned before is that we’re currently using multiple pharmacy management systems across our divisions. And that creates challenges and training and flexibility for staff. And in a lot of areas, we’ve had to create dedicated teams for different divisions, because it’s just so difficult to be processing and multiple systems as you’re trying to. Efficiently operate on a day to day basis. So, we would really like to eventually get not only our infusion center division, which is currently migrating that we infuse. We’d like to eventually get our specialty pharmacy and home infusion divisions onto a similar platform. If and I know that 1 of the things that I attack is working with, we infuse on is. What is necessary to have for a system to process, especially pharmacy fills and what is required for a software to process home infusion fills. And, of course, that’s a big topic of discussion in the industry right now, because 1 of the major players, well, Scott CPR plus system, which we are currently on today has announced into life. So several customers like us are having to make decisions on what are we going to go to for the different divisions that are currently running on CPR plus. So we’re in the process of evaluating that for specialty pharmacy and for home infusion in the future. So, on the board, we provide our experiences and say, this is what’s important to us. And this is the direction we feel like. You should go in. To serve infusion centers, especially pharmacies have infusion pharmacies.

Amanda Brummitt: Fantastic. And just for our listeners that aren’t super familiar with the specialty pharmacy side, any you mentioned some uniqueness is there in their technology needs any. Big things you can point out there.

Cannon Loughry: Well, the funny thing is in the industry, when you talk about specialty pharmacy, it’s a gray area. Everybody’s got their own definition, especially pharmacy and really just means really expensive drugs. There’s a lot of, there’s a lot of debate on what does expensive mean to, some people will tell you it’s over 500. Some people tell you it’s over a thousand, there’s no hard and fast. This is especially medication. And the interesting thing about that is especially pharmacy is not that much different than retail pharmacy. Really? You’re taping, taking a product off the shelf. You’re putting a label on it and you’re sending that to, the physician’s practice or to the patient or to 1 or our infusion centers. The difference is that, these are drugs that could be anywhere in the 50 to 300, 000 a dose medication. So it’s really important that there be strong processes in the workflow. For those and, margins are pretty tight in that business as well, in the single digits. And so you just got to be very careful about way in which you process specialty pharmacy. And then, like I said before, there’s some different regulations there, too, from the payers and being in networks for those, because, of course, they want to make sure, because of the cost and the importance of those drugs that you have firm, good processes in place.

Amanda Brummitt: Yeah, that makes sense. And that actually ties so well to what you talked about earlier on taking great care of the patients, but we also have to stay in business while we do it. So those patients with those critical needs. Yeah, we’ve got to take care of that. Right. So you have, it sounds like a ton of experience and we all run through challenges as we’re growing and learning. What would you say has been your biggest challenge so far in infusion practice? And if you can maybe give us a sort of a behind the scenes look at that experience.

Cannon Loughry: Absolutely. I think our biggest challenge. And of course, this is coming from a pharmacy that got into medical provider based infusion centers. So some of the Other customers that have historically been medical practices are a lot more versed in this than we are. But from a pharmacy standpoint, scheduling patients was a whole new world for us. That’s not something we had to do as a home infusion pharmacy, as a retail pharmacy as a specialty pharmacy, you’re bringing in scripts, you’re filling the scripts and you’re shipping them out. When you start infusion centers, scheduling becomes critically important. And it’s a complex it’s much more complex than we probably thought it was going to be when we first started out because you’re you have the aspect of you’ve got to ensure that your drug is there before the patient is there to be infused. You’ve got to make sure that you’ve got adequate authorizations in place. You’ve got to make sure that you’ve got chair space. You’ve got to make sure that you’ve got adequate time. These infusions could be anywhere from 30 minutes to 6 hours. You’ve got to make sure that you have an N. P. if it’s required for billing, you’ve got to make sure that you have an R.N. there to work the chair. You can’t start. Multiple patients at the same time that 1 nurse is working, that nurse can only work 1 patient at a time. And. And then you get into other complexities. Like you’ve got patients that like a room with a window, you’ve got patients that like a room without a window. So I think as we, you get cancellations and when you cancel, a lot of these infusion appointments aren’t, they’re infused once a week or once every other week or once every six months. So when you cancel one appointment, then you have to cancel the whole series and reset the whole series. And you got to track, why were they canceled? And, were they rescheduled? So, scheduling has become a really big complex process and probably doctors are and, you deal with people, not no shows and people that have been in the medical practice for a long time are probably saying, yeah no, duh. But that’s something that’s new to us, and it’s been a real challenge and, trying to find the right package. When we 1st started using our software package, it didn’t do scheduling very well. So we had to bring in a dedicated scheduling package and. That’s one thing we’re excited about with we infuse is having the scheduling tied to the inventory and the orders in the pharmacy management system. Today are scheduling product is separate from our pharmacy management system, which creates some complexity there as well. But Yeah, really, that’s been our biggest challenge and I would say we hadn’t 100 percent solve that yet either. We’ve been historically we’ve done scheduling in the individual centers. We’re working now to try to centralize scheduling to provide a more consistent experience and also give patients flexibility on, which center they go to. We’ve started partnering with Lyft to work with patients that have. Challenges getting to their appointments. So, yeah, that’s been our biggest challenge. It’s just something we didn’t have experience with. And I don’t think we fully appreciated the complexity and it’s still a work in progress for us.

Amanda Brummitt: Yeah, I suspected is for many centers, because even when you’ve got a well oiled process to your point, you’re still going to have no shows. You’re still going to have cancellations. And I love that. You guys are utilizing software to help. Improve that and hopefully smooth that out. Keep us posted as you come up with more solutions there. So what about light bulb moments? What have you learned along the way that, that you’d want to share with our listeners?

Cannon Loughry: Well, I think I alluded to this earlier in our model that gives us flexibility on both the medical bond and especially pharmacy side. Know a lot of our friends in the industry have started infusion centers just as part of their pharmacy and then you’ve got other people that. Just started infusion centers as a medical provider based infusion center and you got docs. Doctors offices that have their own infusion area there within their own offices. I think, when we 1st started down this path, Lee and I, and the rest of the executive team had never done this before. So we just started doing it the best way possible. And recent Brian, we infuse for instrumental that we actually were on. We infuse when we 1st started. The infusion center division, and they helped us get it started and we made the decision to create a separate entity. That was a medical provider based infusion center. And then we started the work on building that specialty pharmacy and getting license and all 50 states and door credited. And I think having that dual capability is somewhat unique in the industry and gives us. Flexibility, so I don’t know, we fully realized the benefits of doing that early on, but I think. As we got into it, we’re like, wow, okay. That, that really is a model that works very well and gives us flexibility that others don’t always have.

Amanda Brummitt: Yeah, that makes a lot of sense. So it sounds like throughout here, I hear a theme of process optimization and maximizing organization’s efficiency and that you sound like you learn quickly and adapt as needed. Any specific tips in that realm for infusion center operators?

Cannon Loughry: This is a hard question because this is definitely not something I think opt organizational efficiency is a constant battle and it’s challenging and it’s hard and we don’t do it any better than anybody else does. It’s just it’s really difficult. 1 thing I will say, or 2 things that I’ll say, however, that I do think benefits us is I’m a big believer in iterative steps. I think a lot of people, when they’re making changes, try to get to 100 percent solution before they move forward. And I think a lot of times you don’t know what you don’t know. And until you start doing it, you really don’t know. And so I’m a big believer in iterative steps. Let’s get in there. Let’s start doing it. Let’s fail fast and change things as we go versus trying to do everything right on the front end. And our infusion center division looks significantly different than it did back in 2016. started it. We, to my point, I’m trying to include pharmacy in the workflows. We actually put a hood in our very 1st infusion center, which is what traditionally pharmacy would do. But that’s not something traditional medical provider. Infusion centers, do they just mix on the counter? So, there, there were things we tried and said, okay, well, that didn’t work. Great. So we’ll try it this way. We’ve constantly refined our infusion center design and how we lay them out. And so I think that’s my biggest thing is just doing iterative steps and constantly evolving. But again, something we’re perfect at as we’re going through this, we infuse migration. Like I said earlier, we’re doing a full breakdown and re, engineering of the workflow and and I’m sure. 6 months from now, 12 months, 3 years from now, it’ll look different than this initial workflow. We’ve decided to go with on on our 1st center that we put on the way and use

Amanda Brummitt: well, you said that was a hard question. But that was a great answer. It was both humble and it sounds like you guys have a culture where you said fail fast and then change. So where you guys are allowed to make mistakes and learn and adapt. That’s fantastic. I’m good. We’re

Cannon Loughry: good at making mistakes

Amanda Brummitt: when we

Cannon Loughry: correct them. My grandfather used to always tell me the only mistake you’ll ever make is the one you don’t correct. So,

Amanda Brummitt: right, right. And would you say that’s throughout the organization? Does that, or does that stay within the C suite? Is that?

Cannon Loughry: What’s

Amanda Brummitt: the permission to fail and

Cannon Loughry: yeah, absolutely. I think our as we’ve evolved and gotten bigger, our director level is really interest mental. They’re the ones who designed the workflow and how things work across the organization. So, I think our whole team is we’re always trying to do what is right for the patient. And a lot of times that means being very flexible and doing things on the fly to make sure that we solve problems and then try to learn from those and how do we improve the processes going forward?

Amanda Brummitt: That’s fantastic. Well, can you now tell our listeners what you’re most excited about in this industry and. I’m going to add to that what you think is next.

Cannon Loughry: One of the things I really like about the infusion center business versus maybe some of our more historical businesses is it’s a much more intimate relationship between our team and the patients because they’re coming into our centers and they’re getting. Touched by our staff and we’re a big believer in healings, not just physical, it’s spiritual as well. And we have a corporate chaplain on staff that calls every patients three days coming after coming on service to check on them and offer prayer with those patients if they so choose. And that’s very impactful to our patients and it’s impactful to our staff. In traditional pharmacy, you’re somewhat removed because you’re shipping that off. into the home or are shipping that to the patient. So that’s been really rewarding. We’ve got some great video testimonials from some of our patients. Howard is one of my favorites videos on our website and just really touching on what this impact of receiving this therapy from our infusion center has meant to him. Having our infusion centers outside of those urban areas closer to where the patients live, provide Great service for them. And then, I think there’s some amazing things happening in with new drugs that are coming out like Alzheimer’s the new Alzheimer’s drug that’s coming out later this year. And I think the sky’s the limit for some of the things we’re going to see in the next 5, 10 years that will be very impactful. A lot of these patients we serve are chronically ill patients. There’s no cure currently, but these drugs can have a significant impact on their quality of life. And that’s very rewarding.

Amanda Brummitt: Yeah, that is a great approach. That the healing isn’t just physical. It’s also spiritual. It seems like that combined with some of these new treatments might actually be able to work ourselves out of jobs at some point, which would be a beautiful thing.

Cannon Loughry: It would be.

Amanda Brummitt: And then we’ll all call you to see what’s next. So Canon, if you had just one last piece of advice for our listeners, what would that be?

Cannon Loughry: Let’s see, as far as infusion center business, I think I don’t know if I can do it in just 1 thing. I think there are more

Amanda Brummitt: than 1. I

Cannon Loughry: think there are 3 main things. If I were to go back and talk to me and Lee in 2016, when we were 1st. Working on the start in the infusion center division. That we probably should have put more time and attention and focus on and not saying we do a horrible job at these things, but we probably could have done a better job over the past several years. I think 1st of all, is purchasing is so complex in this industry and so important. That’s really the name of the game is how do you buy in and starting with that margin is so important on the front end. So we put a lot of time and attention and have a great dedicated purchasing team. But, we’ve learned through mistakes like we were talking about earlier there on things. We’ve done great things. We haven’t been great are really making a lot of movement. There now, but that’s a key piece of this game. I think just maybe more important, but just as important that purchasing is the contracting and that’s challenging. And that’s still an area where I feel like we’re down in the trenches slugging it out. We probably should have put more time and attention on contracting. And we’ve got a dedicated team for that now, but, just as important as how well you purchase is how well you get paid for the work that you do. And that’s all about having great contracts, having access to the contracts and constantly working to get better contracts. And as I told you, a lot of times you have to go through those barriers to entry. Like being in licensed and in all 50 states, like being dual accredited, and those are multi year very expensive processes to get there. So, we’re continuing to work on that. And then I think finally, just billing, billing is very complex, especially when you’re talking about, what is the class of trade and are you going by bill? Are you going pharmacy? And which 1. makes the most sense, not just for us, but which one makes the most sense for the patient. Can they afford it dealing with free drug issues? So I think all three of those things have been major challenges that we probably didn’t put enough time, attention and resources on early on. And we’re really trying to get bond at this point.

Amanda Brummitt: Well, I feel like you brought us full circle that in order to stay in business, we’ve got to do good purchasing, good contracting, and good billing so that we are all around to take care of these patients and deliver great care for them. Well, Canon, thank you for your time. Thank you for the humble, introspective conversation about 12 stone and your career. And we just appreciate you being here today.

Cannon Loughry: Great. I was pleased to be with you and pleased to share our experiences. It’s been a fun ride.

Amanda Brummitt: Well, that was great information from Kanan Lowry of 12 Stone Health Partners. His humble approach to process improvement and optimization creates a culture of continuous learning and a center that takes great care of patients and referring providers. And if you aren’t familiar with the WeInfuse software platform and RxToolkit’s web based resources, I hope after listening to Kannon talk about software and how important it is, you’ll schedule a test drive of these softwares. They can save you time and money in your practice while making infusion safer for patients and for caregivers. My name is Amanda Brummett, and we’ll catch you in the next episode.

Guest Speaker:

Cannon Loughry is the Chief Operating Officer of TwelveStone Health Partners and a member on the Infusion Technology Advisory Council (ITAC). At TwelveStone, he is responsible for developing corporate strategy and encouraging process optimization with the goal of maximizing our organization’s efficiency.

The TwelveStone Health Partners product offering includes every service that patients with chronic, complex and rare diseases require to heal including packaged medications, home infusion, infusion centers and nutrition therapy.