Episode 65: How We are Better When We Work Together with David Evans, MBA

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Transcript: How We’re Better When We’re Together with David Evans, MBA

Amanda Brummitt: We Infuse podcast, episode number 65. Welcome to the We Infuse podcast. My name is Amanda Bremit. In every episode, we give you a seat at the table as we talk to Infusion Center owners, operators, and experts so you can get the insight you need to run a thriving practice. In this episode, we talk with David Evans, Chief Executive Officer of Texas Neurology and Founder and Chief Executive Officer of Neuronet Group Purchasing Organization. Well, David, thank you so much for being here with us today. I would love for you to start out by sharing with our listeners just your background, who you are personally and professionally.

David Evans: Well, thank you, Amanda. Thank you for having me, today. Really looking forward to today’s discussion. So I serve a couple of roles. I’m, chief executive officer of Texas Neurology. I also co founded and serve as the chief executive officer for Neuronet GPO, which is the country’s largest neurology group purchasing organization. And then I have a couple other hats. I chair, health policy subcommittee for the American Academy of Neurology and also chair their brain health committee. So quite busy and, but I’m really excited to sort of share my background with today’s listeners.

Amanda Brummitt: Incredible. Well, thank you for your work on both Texas Neurology, Neuronet, GPO, and your volunteer work with those organizations. I’m sure the industry much appreciates it. Thank you. So, yeah, so let’s talk about how did you get into either neurology, actually both, into neurology and the infusion industry in the first place?

David Evans: Well, so when I was first, starting my career, I actually worked in primary care and I, At the time Baylor University Medical Center was starting their employed physician model. So I was working with them and helping them Start up primary care groups basically about four primary care getting ready to go and over that time I met a couple neurologists and They had asked me about coming to work there. I loved what I was doing at Baylor. It was really exciting. but as neurology was starting to evolve in not only from the access to medications and imaging and all these exciting things, and I had a deep interest always in, advocating for small practice or community practices, understanding, you know, from the hospital perspective, the challenges is. That come with larger organizations and I also felt like I just thrived more in a community practice So he ended up and moved over to neurology they had just started doing infusion, prior to me starting there and they were doing immune globulin therapy Which was probably all that was around at that time And then I got involved. When biogen was launching, for tice abri And so actually I was hired as a consultant and I used to travel around the country and people to this day I’ll be on elevators or in conferences and people like you’ll you set up my infusion practice. So that was about 25 years ago but it was a nice way for me to connect and sort of how I got known in The neurology community was probably coming in about a two day trip and helping them set up their infusion It was a lot less complex than it is today. but I’m sure we can talk more about that throughout today’s talk.

Amanda Brummitt: Yeah, for sure. What a great way to start out in the industry. So, with that experience and in the last 25 years, what would you say is your main area of expertise and what would you want our listeners to learn from it today?

David Evans: Well, I’ll tell you what I think makes me successful and in turn makes this organization successful is Absolutely collaboration and networking and that includes from not only networking with my colleagues. I’m always looking out for where is my gap in my skill set and how am I going to identify someone to fill that and in turn to return that favor to those that are going to need my assistance. So you know, part of this is not about Neuronet, but part of that was setting up Neuronet for this value add of making this collaborative program. opportunity with people in their same shoes as I am with that said, that’s why we also look at technology and services and really excited to talk about we infused because this was an important technology that was going to aid us to not only provide, you know, comprehensive, you know, processes to our center, but to be able to democratize that across all of our institutions so that what we’re sharing concerns or ideas were on the same platforms were able to communicate. About what we need from that technology. And we infuse has been a great partner from day one and having those conversations to make sure that not only that their service and technology support the community practices, but they’re evolving in that space as well. So we’ve been really excited about the we infuse an RX toolkit partnership and continue to be excited about what they bring to the community neurology and community infusion market.

Amanda Brummitt: Fantastic. And I want to get more into that collaboration in just a second, but I want to circle back to two incredible points that you made that I think a lot of us forget in health care, which is one, what you said, networking, giving back to the community before you go ask the community for something, because when we have a time of need, we want to put some good out there first, but second, when you mentioned your GPO, just because somebody is a competitor on the surface, They are dealing with the exact same things that we are, and there’s enough business for everybody we, you know, are most of our places are in hyper competitive markets like you guys are in. so I love that instead of seeing your competitors just simply as competitors, you go collaborate with them and work through the issues of infusion together. so I guess my question there, it’s not just a comment. My question there is. what led you to take that direction as opposed to just, I’m going to stay over here at Texas neurology and I’m going to take all the information and keep it for us.

David Evans: You know, that’s a great point. I think part of that was the volunteer work. I started about 15 years ago with the American Academy of Neurology, and I realized quickly on we’re much better when we work together and we collaborate together. and you know, when you remove egos and proprietary things, those all go away when you’re really thinking about ultimately the patient and access. And we are so powerful. There’s not enough neurologists. There’s not enough health care providers in this country to meet all the needs and that the therapeutic advances are evolving so fast and so much effect that we can have positively. We work together. And so early on, I realized that was going to be an important component. And, you know, the not only is the therapeutic market advanced so quickly, the technology has advanced so much. The pair landscape has evolved, and we all need to sort of work together to how we navigate that. and I rely on everyone that’s sort of, you know, behind me, supporting me, and I’ll be right behind them, supporting them throughout that process.

Amanda Brummitt: Incredible. I think that’s a great way to go about it. Well, let’s go back to that collaboration that you mentioned, both with RxToolkit and with WeInfuse. How, do you guys use that in your practice?

David Evans: Well, everyone who will listen to me would get RxToolkit, number one, because I think RxToolkit is hands down, probably the most beneficial thing that we’ve implemented in our group over the last couple of years, but since the beginning of being here. So walking through sort of the traditionally way we used to have to onboard a new medication and, Yeah, the medications we may have, I don’t know, four or five new ones. Now they seem more and more every year and it would take us probably four months to get, you know, just the process, you know, implemented in our organization include from the consents, the education, the protocol, all those kinds of things. It would just take, you know, a group of people, you know, obviously in private practice, you’re limited by doctors availability, probably not a lot of nurses. They’re probably busy seeing patients, and I didn’t rely a lot on colleagues, but obviously they were developing their processes and forms for their practice, and a lot of times if I didn’t have the bandwidth in my organization, I’d rely on them. there’s ones we were doing, of course, we would share, and then we found out about RxToolkit, which basically by the push of a button and how you guys have this stuff available, like the day it gets FDA approved is always amazing. but no, we now not only do we have that readily available, I can launch a product the day of approval if I wanted, I have all the necessary information to make sure that our clinical staff, the prescribers have all the essential information is going to be very important for them to be able to not only be able to communicate a product, to their patients, but to be able to prescribe it and to be able to infuse that product with all the necessary clinical data and compliance information we would need for that product.

Amanda Brummitt: Incredible. It was a great testimony for how the product works. So it sounds like RxToolkit checked a box on challenges that you guys face. What other challenges or what other, what is your biggest challenge you say you faced in infusion practice that hasn’t been solved yet?

David Evans: Yeah. I, you know, there’s still challenges. I think now, so we’re, facing a new era of these incredible medications for Alzheimer’s and this is something we’ve been prepared for the last, you know, four or five years. there’s been a couple products that have been approved that have been. had sort of some limited restrictions put on him so that we’re really not useful for the patients. We do have like Canada now, which is, FDA approved and can be given to, that population. but there’s a lot of oversight with that. I think navigating, you know, between the, you know, the, protocol requirements of the imaging needs to be done at baseline, the confirmation of diagnosis, the labs and imaging that must be done throughout that treatment to monitor any kind of what they call aria Which is amyloid related, imaging Abnormality. So we’re looking for hemorrhaging or a demon. So this has to be monitored because in the studies that did show in a certain population of that. So we have to monitor those closely. So I think just, you know, navigating all of the oversight components. It’s not like you’re just sticking a needle in and the patient leaves. You have all these other complexities. And that’s what I’ve been really, you know, happy with. We infused and we’ve, you know, had that in place now for About six months. We’ve seen such a difference in our ability to not only onboard the patient to therapy quicker, but you know, really support us in that oversight component, the inventory management, which is essential when you’re adding new products in, you’re ensuring that the billing needs to be done correctly. All of those are really important in there. And for a community practice, you know, you want to make sure you have, you know, economic financial state sustainability in your organization that really requires having all the right components and that software has been really essential for us to be able to implement all of those across the board.

Amanda Brummitt: I’m really glad to hear that it’s making that process a little bit easier. So you’ve had a lot of experience in the business so far. what would you say is your biggest light bulb moment in infusion?

David Evans: Wow. I think that’s a really good one, but what I would say is. Always make sure you’re focused on your patient and I think ultimately we’re here for our patients and you know, I, you know, my, I always, you know, tell everyone that will listen that, you know, any kind of challenges we have, we, we want to make sure we’re dealing with all those before that patient or after that patient, we’re not, you know, putting that anxiety or burden on the patient. So when you’re in front of that patient. Making sure that they absolutely relying on the confidence of the nurse the support and infrastructure and so really making sure I’m constantly thinking about how do I, in my role and in collaboration with the prescribers, the nurses, the accounting department, what are we doing to make sure that ultimately that patient nurse centric experience is primary to everything else? And it’s more to that because it’s all those layers that exist beyond it. it’s how you use your inventory management how you’re making sure that patient’s bill is appropriate and they’re not getting over under billed And making sure that ultimately their experience is focused solely on Their clinical needs during that infusion immediately after and so I just continue to thrive to be able to do that and support the organization throughout that process

Amanda Brummitt: is really, good advice and such a good reminder for us because there are so many things going on in the background that the patient doesn’t need to know about, nor do we want them to know about that way all they focus on is getting well, So, yeah, that’s a great reminder.

I feel like every Monday morning we just need to queue this little segment up and have you say that to everybody. Okay.

David Evans: Yeah.

Amanda Brummitt: So, David, what are you most excited about right now? and give me both on the neurology side and the infusion industry.

David Evans: Yeah. So obviously neurology, we have had so many incredible advances in therapeutics, specifically for infusion, for diseases that were no, there were no treatments. And so these patients. You know had really limited hope and so they’re you know, the advances in like myasthenia gravis and nmo neuromidas, myelitis optica, which is Very debilitating and potentially to blindness and paralysis and so these great therapies and then now these alzheimer’s market so such significant advances that you know, we’re really excited about what that future would hold You with the broader market, I think it’s just the overall, you know, I think really navigating, an understanding, you know, from the pharmaceutical or from development side because there’s so many drugs now in the infusion. Is we already know from the pipeline that there’ll be a significant amount of drugs that will be starting delivered differently so specifically subcutaneously and i’ve heard from colleagues about concern or threat to their models. I don’t take that same position i’ve been able to i’ve been lucky enough to Interact with large organizations through my work with the american academy neurology and talk to them about other Specialties that have already seen a major conversion over subcutane Canius models and how they implemented things like a rapid clinic and how they’ve incorporated these hybrid models. And actually, successfully, we’re seeing, you know, incredible, economic, valuable return and incredible acclimation to these new therapeutics. So I don’t see it as a threat. I think it’s see it as an opportunity to continue to give advances to these therapeutics to patient, in a potential hybrid model and, get them in and out quicker with the same efficacy of, the, resub Q, formulations. And so I think it’s an opportunity for us to think about the future and how we. Need to rethink sort of our models and how we’re applying our staff in regard to these new therapeutics and you know, like rheumatology has seen a quicker advancement to these but we’re seeing them rapidly now in neurology, we already have a couple new ones that are hitting the market lots of successes from the patients that have been both on the, the pre just the infusion delivery one versus the sub queue. They’ve done incredibly well. So we’re happy with that. And it’s just an opportunity for us to, you know, have that staff, you know, available for other patients. There’s never going to be, you know, a lack of patience, and for us is trying to, you know, keep staff focused on the exciting part of these advances in therapeutics and the ability to reach more patients, with, these therapeutics. And some of them, you know, it’d be very limiting for them to be able to spend four to six hours in the office. And if that can be done in 30 minutes, that’s pretty remarkable. We’re reaching a whole new population there. So I just say, it could be an exciting opportunity to look at this in a whole new lens.

Amanda Brummitt: Yeah, absolutely. I mean, this industry constantly is evolving and adapting and, back to use your words, always make sure you’re focused on the patients. If we, pay attention to what’s good for our patients, usually The financials will follow. and it sounds like in that example that they do. So David, if you had to give one last piece of advice to infusion center owners and operators, what would that be?

David Evans: I visited so many that I think the one thing that always concerns me is not having rigorous processes. not having, contingencies or staff, you know, processes that person may be out a day and That often will delay, you know, a patient from getting therapy because we, only have one person trained in that specific process. so I think, you know, just making sure we’re, you know, And I totally get it. You know, we’re all very protective of our positions, but I think to make sure that all of the staff are aware that, you know, cross training is essential to be able to ensure that we’re able to have people step in and support us, but also provides a perspective in the process. So I often like when people can come in and go to an apartment, you know, for even if it’s one day a week and say, Hey, I see some opportunities here and have that sort of open. Availability. also not knowing the economics around infusion and these could be challenging to navigate. You know, I’ll go into practices where, you know, they’ll switch everything over to specialty because, you know, they may be under March underwater or something for that quarter, or they’re only looking at things by the quarter. I tend to not look at them that way. It’s number one. It’s a lot of time to be able to do that. I look more. at a longer period, I look typically around three quarters myself. And obviously, if you’re seeing a trend that’s worrying or if it’s, you know, a big number, of course, do we need to do? But we’ve done a lot of, you know, time studies and moving a patient over to specialty and looked at, you know, patient comments and things like that. I don’t know that we’re serving the interests of the patients in that regard. And I don’t know that it’s necessarily saving money by doing that back and forth. And the challenges we’re putting on patients for them to navigate From buy and build the specialty and having them navigate that every quarter And I think as an organization we have to be better Thinking about the long term process and not trying to target every little thing. I mean, obviously we have to be fiscally responsible, but I also think fiscally responsible is understanding all the costs associated and not just the margin as the one identifier for whether or not you’re going to do specialty or not. I think it’s much more nuanced than that.

Amanda Brummitt: Yeah, that is fantastic advice. So looking at that as a whole, the processes, those contingencies, you talked about cross training, knowing the economics around infusion, Are there any resources that you recommend to infusion centers?

David Evans: Well, always NICA. I mean, I think NICA is by far the leader in infusion. I, you know, my career, I’ve gone to more conferences than I want to even imagine. And the one challenge I always have is, You know, trying to find the course that’s applicable to my life and that’s why, you know, I’ve always focused on, you know, networking and socializing with people that are in my same position and why I got involved with the American Academy of Neurology. But when I went to my first conference, I was like, Oh, my gosh, these people get it. And I wanted to attend every session. I didn’t like that. They had breakouts because they’re like, I’m gonna miss something. And I don’t, it was like the first time I really felt like there was an absolute, focus on a service that is so essential to health care and specifically to neurology for us. but all the therapeutics are available in there. And so I just can’t imagine another resource. other than them. I mean, of course, with Neuronet, we’re actively trying to support it. Neurology members in that same regard, and being available and we work a lot with centers that are either transitioning from, you know, a management company and want to come out of it or a group that’s wanting to start infusion and helping them through that process. But even with them, the, you know, the first thing I say to them is become a member of NICA. Get your infusion center listed and network, because we’re just, you know, one group. You really need a village in this, area. so, you know, again, I, think that would be the primary resource for me.

Amanda Brummitt: Excellent resources. Well, David, you have been an absolute wealth of information. Any, last thing you want to share with our listeners?

David Evans: I would you know, just on the we infuse product itself I think you know one of the things I was we’ve been challenged with some claim denials and we’ve went back Just this happened recently and so i’ll just i’ll share this incident But it was I was looking at some of the notes that we had in our ehr side And really challenging to be able to tell what was being done or whatever and then I said go Let me see the we infused note and it was concise It was easy to read and you know, and it turned out our staff was sending the ehr note when they were getting denials versus the The we infused note and what we found is when we started sending just the we infused note we were getting them overturned immediately, so just great job. I think just make sure you know You on that process on the, you know, after the claim gets submitted, that’s still use something, you know, importantly, we got to manage, make sure you know what your staff are sending in far as a, response. I always like to look, maybe have a second step before they submit, just throw a bunch of medical records at the payer. I try to make it as easy as possible, direct them quickly to their questions, highlight as much as possible. but you know, it’s, We have to have sort of, you know, very focused processes and small practice and, we have to wear multiple hats, but yeah, no, I hope there was a couple pearls in there that you were able to, get from the audience.

Amanda Brummitt: Oh, for sure. The cross training piece alone is worth an entire episode. So yes. Well, thank you for your leadership in the industry and thank you for taking time out of your very busy day to be on the podcast and we sincerely appreciate you.

David Evans: I appreciate it. Thank you, Amanda.

Amanda Brummitt: Well, that was really great information from David Evans about networking and collaborating across the industry, inventory management, staying focused on patients, having rigorous processes, cross training and contingencies for staffing, and adapting as treatments evolve, and finally understanding the economics around infusion. If you aren’t already familiar with the WeInfuse software platform and RxToolkit’s web based resources, I’m guessing David has talked you into checking them out. Take a test drive to see how these tools can save you time and money in your practice while making infusion safer for patients and caregivers. My name is Amanda Bremit and we’ll catch you in the next episode.

Guest Speakers:

David Evans, MBA, CEO of Texas Neurology.