In this podcast, we meet Tony Paquin, CEO of the iRemedy Healthcare Companies, who shares his expertise in eCommerce for healthcare. Tony is a recognized pioneer and leader in the field of retail healthcare and he makes a compelling case that it can be a win-win for health care providers and patients. We explore how providers are leveraging these platforms to deliver better service and diversify revenue streams and how patients benefit from the convenience and quality of the products on offer. Given his background and experience, it’s no surprise Tony has a great pet-peeve and some very sage advice too.
Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I’m your host Dr. Dave Levin. Today I am talking to Tony Paquin, CEO of the iRemedy Healthcare Companies who developed the first comprehensive ecommerce solution for healthcare. Their turn key platform provides products to doctors and a business to business model and to patients in a business to consumer model. Tony and his team have grown iRemedy into a National Healthcare Technology Company and they are intent on destructing and transforming what they refer to as, ‘The outdated cost-laden US Healthcare supply chain industry’. Tony is a dedicated entrepreneur, industry pioneer, and a nationally renowned healthcare consultant who has served in a variety leadership positions in a career that spans more than three decades. Welcome to 4 x 4 Health.
Tony Paquin: Well Dave, thank you very much. It’s a real pleasure to be here and I’m looking forward to participate on your podcast. It’s certainly a great production that you’re doing.
Dr. Dave Levin: Well, thanks. Let’s go ahead and jump right in then. I’m gonna ask you a series of four questions and you have up to four minuets to answer each one. So, let’s just get started. Let’s begin by having you tell us about yourself and your organization.
Tony: Sure, well thank you again Dave and I appreciate that introduction that you gave me, it’s very helpful. I have in fact been a long time in the Software Industry. So, I probably have been programming and developing and leading software companies for 25 or 30 years. I really started in the Insurance Industry and developed a pretty substantial company and the software part of the insurance industry and ran there for about a decade or so. Actually, after we sold that and operated for CNA and a group of other insurance companies, took a little break and ran for US Congress. That was an interesting experience as you can imagine but it also gave me a little bit of background you know, as a lobbyist and really understanding the political scene and gate exposed to the healthcare industry during that time. We later developed a kind of an early entrant into the web-based medical software, electronic medical record software business. Ended up taking that company public on the Nasdaq and then ultimately did quite a bit of consulting at the hospital level, in the United states which led us to iRemedy Healthcare and as you described, we’re essentially an e-commerce company that’s focused on delivering products within the industry. So, both to the healthcare providers but also to the patients of those providers and that’s what gets me started on you know, issues where I’ve made a comment of the outdated supply chain. I just think that there’s a tremendous amount of opportunity to bring improvements to that part of healthcare and that’s really what iRemedy is focused on. You know, in some ways we’re sort of similar if you will to an Amazon in the sense, they were a technology company but we also distribute products but it’s the power of our technology both today and what we’re looking to do in the future that we think will make the big difference.
Dr. Dave Levin: Well, I know we’re gonna get a little deeper into that in a minute. I did not know that you had run for Congress. We may have to have you back on the show just to talk about that experience, it’s so bad.
Tony: You know, it was a really interesting experience. I had learned a lot. It was a long year, you gain a lot of respect for people in that in that world and you learned quite a bit. So, it was, yeah, people complain about politics but for me it was a pretty good experience and I think I gained a lot of insight into how the world works and you know, when you look at healthcare as an example, public policy really is important. You know, it matters and you know that as a physician and the work that you’ve done in your career and then it also has a lot of effect on the business side of healthcare. By that I mean you know, reimbursements and Medicare and so forth. So, you know, healthcare is unique and that it has a real public policy component and Government can really impact us both at the state and federal level.
Dr. Dave Levin: Oh, I think that’s really true and so much of what I see in healthcare, our barriers tend to be more geopolitical than they tend to be technical or otherwise. The joke I was gonna make is, I have the pleasure of meeting a lot of people that have come into healthcare from other fields and the usual cycle is they are very excited in our healthcare when they first enter it and then they learn how challenging it can be and sometimes you hear some buyer’s remorse but, in your case, if you came here from politics, I’m thinking it probably was a step up either way, so…
Tony: Yeah, exactly. It was really easy, it was easier. You know…, it’s actually a really accurate observation that you make and you know, where I saw that happen quite a bit in the last 20 years because really, I think one of the more unique things about me and my team and our company is we’re a little bit where the technology industry meets the healthcare industry and I like to believe that we understand both sides. In one way we grew up as a West Coast Software Company that you know, ended up having thousand employees and tens of thousands of clients and in another way, we understand healthcare really well and the example you’re describing you know, people coming into the industry, I think that was very true when the Silicon valley, as we say tried to step in and several times over the last say decade. Now, you saw Microsoft got in, they had the health vault, then they kind of got back out and then Google got in and Google got back out, right and what happens is the software industry, you know, they tend to operate a very logical and two plus two equals four kind of approach to the world and they get involved in healthcare and there’s so many things in healthcare that would seem logical but really aren’t, right and that’s why they lead. So, these people are crazy, I gotta get out of here.
Dr. Dave Levin: Yeah, it’s so true, it’s been interesting to me. This has been a theme in these podcast interviews, this sort of mash-up of old ideas and new ideas and at least an optimism that out of that will come something better. To that end, tell us what’s the most important or interesting thing that you’ve been working on recently?
Tony: Well, you know, you kind of touched on it. I actually think we were living in a very exciting time and I think that there, from a technology development perspective and look, if I go all the way back to, I hate to admit it, it was so long ago. You know, when I went to college for Computer Programming, they had cards that hey put in Computers.
Dr. Dave Levin: Me too, Tony…
Tony: That’s what I’m talking about, hard disk. So, yeah, it’s been a long time but what is happening now that I think is absolutely fascinating. I think there’s two big generational changes if you will they have occurred and you’re absolutely involved of course at Sansoro, right in a key one of those and that is the EHR, you know. Accomplice, I call it the accomplishment. You know, the fact that EHR now has been implemented, that was expensive and challenging and you know, a lot of people think it was great and others don’t think it as so great and it was very expensive but in fact it got done and now as a result, we have the power of that data for the first time in the history of the world. I think that is transformational and really, really interesting and it’s going to have a big impact. So, that’s one thing that we’re working on is the connection of that EHR data into the supply chain and you know, so when you think of supply chain management, most supply chains in other industries, let’s take for example the automotive industry or the aerospace industry or some aspects of defense manufacturing. The supply chain is demand-driven, in other words, Ford Motor Company will buy steel and glass and rubber and oil based upon the order of trucks coming in, if they get an order for a thousand pickup trucks, then that tells them exactly or what supplies they need to manufacture those trucks and that’s fairly typical. It’s demand-driven, sometimes known as Material Requirements Planning or MRP. On healthcare, you can never really do that because you couldn’t wrap your arms around demand because frankly it was on paper charts and there was no way to manage that information. So, now for the first time, we have that data and we are really excited and very interested in that we are working on a project with Sansoro and Epic and others and how we can pull that data in and do really intelligent things with that EHR data. So, in the one application that we are deploying now is we use the EHR, the patient record and for medical treatment record information to actually recommend appropriate healthcare products for that patient. So, that’s a really exciting area. Second and associated with that is we move been into the big supply chain and that is medical supplies used within the provider industry. So, in the hospital, in post-acute care, you know, and so forth. Independent medical practices and other places, this is a massive industries, several hundred billion dollars. So, on the one hand, we’ve got the EHR data, that’s extremely valuable. We have the supply chain data. We know what products are being consumed at what locations. Connecting the two together isn’t so simple. Once again because healthcare is exceedingly complicated and complex. So, in order to deal with that, what we are applying now is artificial intelligence and machine learning. See, I think that, that’s what transformational, EHR data in AI. Two things a that didn’t even exist ten years ago.
Dr. Dave Levin: That’s very exciting and I, my sense and I’m not a supply chain expert but I’m aware as most 21st Century inhabitants are that supply chain has really changed. It’s become more of a just-in-time thing and a lot of industries have really benefited by extracting a lot more efficiency out of supply chain management. I would guess healthcare is ripe for that as well.
Tony: Well, absolutely. Yeah, the supply chain in healthcare is the number two expense in healthcare in the United States right behind payroll.
Dr. Dave Levin: It’s really interesting…
Tony: And so, you know, there’s a lot of dollars there.
Dr. Dave Levin: Yeah, the other aspect of this though that as a clinician that I find really interesting is the benefit to patients and you know, as you and I have talked about this topic before, there’s obvious benefits to a health system or a provider group in terms of diversifying revenue stream and providing a service that will be pleasing to patients. I think it probably has real clinical implications to patients getting the right supplies at the right time is often a huge challenge when they transition from care. So, part of what I love about the work that you and your team are doing is it just seems like a win-win-win to me that there’s a revenue opportunity, there’s a quality opportunity, there’s a satisfaction opportunity and they are all really nicely aligned. I’m sorry, I got up on the soapbox there, I didn’t mean to write it out for you but I’m excited about the potential of all of this.
Tony: Well, I think that you really do hit the nail on the head with those comments though. See, as you know for example, we’ve known for a long time in the pharmacy world that there’s a real compliance problem, right. We would write prescriptions to patients and we know that at least 25% of those prescriptions are never even picked up much less refilled or fall due to their appropriate completion. So, in years past, we addressed that by building pharmacies inside of hospitals and my team has done many of those pharmacies and they’re very successful. It drives to the point of you know, the compliance and satisfaction issue. Well, now this healthcare as you’ve all been you know, there’s becoming a products component into many different treatment scenarios, right. You know, I was working with a vendor the other day who has a deep vein thrombosis product line that they are now using in surgery centers and in the hospital but they also have essentially a Home DBT product that they distribute. Any, it’s just an example of there’s all these post-care because as the length of stay in the hospital and shortening, you know, everybody’s always amazed, right. I go there, you know, I go to the hospital, I’m in for the air too, they put in some stents. I mean, you are getting such major surgeries that are happening in one to two days. You’re in the hospital, you are out of the hospital. Well, that because first off, we’re getting better at that acute-care treatment but also we’re getting better at home based you know, support and that means having products available that can move into that home and I put to your point, there’s a real challenge around compliance and appropriateness and you know, everybody talks about the great success of Amazon but as I often tell people, you don’t really want to go there to purchase your healthcare critical supplies and there’s a reason why but essentially that retail supply chain you know, is not compliant. You don’t know where that product came from, you don’t know what model to get, you don’t know what size to get. So, it’s important that you get exactly the right product at exactly the right time and that’s where I think we’re already seeing it today but we’ll continue to see a mega trend of healthcare providers being more involved with putting the right product in the hands of their patients at the right time.
Dr. Dave Levin: I think that’s right and we’ve struggled with provisioning outside the hospital pretty much my whole career and as you know, more and more care is shifting to outpatient as it should and so those provisioning challenges are just gonna get greater. One last question about all of this, we’ve been focused on products. What’s your take on services, offering services through these kinds of portals?
Tony: Well, you know, it goes a little bit back to what you’ve just mentioned and that is so much of the services. I’m moving me you know, into an outpatient type of organization. So, it might be outpatient ambulatory, it might be in the home and in these you know, retail clinic type of solutions. We saw this happening as Walmart started moving into the retail clinic business and Walgreens and CBS and the Minute Clinics and all those profiles were changing and becoming more retail directed and it’s what consumers are expecting. While we all want the hospitals who are really the best qualified providers of those for your services to be left out of that opportunity. You know, that’s a shortcoming to the market. You know, we are not doing a great service to the patient if we allow that to occur. So, we’re definitely seeing and yeah, another example would be telemedicine, right. So, we see those type of services being offered via things like e-commerce and others outreach solutions to the patients from the hospitals. It’s funny you know, we often talk about hospitals but really their healthcare systems. I mean, no hospital today is really just a hospital. They’ve got imaging centers, they have you know, urgent care facilities, they of course have outpatient, they may have medical spas, retail, DME stores, pharmacies, fitness centers, right. Their enterprises that provide comprehensive services to the patient or people in their community and as a result, they need to operate and think a little bit more of like retail thinkers and in today’s world, that means e-commerce and data and that’s why we are so focused on e-commerce solutions connected back to an epic for other each aren’t type system.
Dr. Dave Levin: Well, we could go on for a long time on this topic and I sense already, we’re gonna have you back for another episode in the future. I want to take you to our next question and this is the point where I usually remind my guests that this is a family show, so please keep it PG-13 but what’s your pet peeve or favorite rant right now?
Tony: Well, you know, I definitely can go off sign a few things but you know, I remember at my core, I still have a little bit of that political gene and then some probably more diplomatic and then…
Dr. Dave Levin: Hahaha, [Laughing].
Tony: You know, but I think that like there’s always to me better problem that we’re very focused on, it’s very frustrating and it is in the medical supply business. What you have been supplying, a very large vendors, three or four or five absolutely dominate this industry. Now, on the one hand you can argue that there’s a reason for that. A, we need a great big supply chain that’s reliable. I mean, it’s practically a National asset to have that, the ability to you know, meet the needs of our, of the population. So, it drives and you know, their devices. So, there’s a very important need here but the result has been a lack of transparency, a lack of mobility of the ability for you know, the clients to move from one supplier to another and as a result, we’ve lost our competitive edge and the part of it that really aggravates me is the independent medical practice part of the market. They you know, come up short. You know, they are the small business provider within the healthcare arena so to speak and they don’t have the large procurement offices and the negotiating power but I really think you know, Dave, in the end, healthcare comes down to a patient and a provider in a room and maybe it’s a virtual room in the form of telemedicine but more often than not, it’s an exam room in some doctor’s office on Main Street, America and I really come back to the idea that we’ve got to protect the viability of these physicians. I know right now there’s this movement of acquisition and by the way we saw this happen about ten years ago with healthcare systems acquiring medical practices and you know, that was a trend and then that trend reversed and now we are seeing that trend again and it may stick a little more of this time and it may be good value in that but there is still a very substantial part of healthcare in America which is essentially a small business and independent medical practice. I think it’s just super critical that we figure out how to provide…, protect the viability of that part of our healthcare system and I think if we fail to do that, it’s gonna be a great loss to the country, really and you know, I see that part of the market being sort of ignored and discounted. I think it’s a very critical part of healthcare and it’s really part of what makes our country unique and great is that we have these hundreds of thousands of independent care providers and I feel like they are just getting the short end of the stick as we say and we have to do something as an industry to you know, really support and protect them and bring them back into a viable way to do business.
Dr. Dave Levin: Boy, we could devote a whole conversation just to that topic as well.
Dr. Dave Levin: I imagine there are many of my colleagues that would agree with what you’ve said and I’m typically a both end kind of a guy. So, I think there’s a place for both. My hope is that as I see some of the emerging technologies and services companies that are actually thinking about this. How do small groups survive and thrive in the emerging new environment gives me a little bit of hope for what you are talking about, that’s terrific. Alright, so our last question today, what’s your most sage advice?
Tony: Well, you know, I have to say Dave, you almost stole my thunder without realizing at the beginning of the podcast but where I’m a bit of a contrarian, you know, we spend a lot of time in today’s world both politically and socially worrying about all the problems that we’re faced with and one of the problems that we talk about almost non-stop, you know, around healthcare, the high cost of healthcare and it is remarkably expensive. You know, if somebody who has employed people, you know, really for 25 years I’ve had you know, I’ve been CEO of companies, I’ve had employees and as part of having employees you have health insurance costs and you watch those costs just go up year after, year after, year just endless increases. So, it has become incredibly expensive and yeah, relating to that thing you have access problems and fairness issues and the arguments over the single payer system and so forth. Having said all that though, I am actually very optimistic about where we are in this, in the industry and I think that you could say, yeah, we’re finally at a place where great things are going to happen. They are going to impact those issues of cost and therefore things like accessibility to go with it. Now, when we talk about the society issues of healthcare and going back to the Affordable Care Act and all the political debate around that, much of that debate is run the payer’s system and you know, should we have single-payer and States rights and private payers and all these issues but in the end really what we have is we have a big old cost problem. It’s a very expensive time in healthcare and what we need to do is attack that cost problem and what I believe you know, we are really looking at right now, I like to think of the EHR industry, the medical record industry that you are so closed to. There were almost in the beginning of a generation too of that industry. So, generation one was building the EHR and that was incredible and as I said earlier, expensive and challenging but it’s more or less done as much as anything’s ever done in the software business but now, we are a generation two where we’re going to be able to finally take advantage of that data and do amazing things. Now, I happen to be focused on the business side, right. So, I want to optimize medical supply for example but there of course as you know, many great clinical things being done and we’re gonna see all these you know, clinical gains as well and if so, you know, it’s a little bit like while when we invented the internet that was an amazing thing but really it was later when we got Amazon and Uber and Airbnb and all these applications that use the internet. They brought great value and modernization to you know, the world. Well, I think it’s the same thing. The EHR industry was sort of like inventing the internet and now we are at the stage where we are gonna invent all these applications and the second thing that’s going along with that, that I think is equally important. It’s talked about a lot but people don’t really understand it and it happens to fascinate me because I’m a software guy but that is machine learning and artificial intelligence and I have a team of people that I work with, involved with iRemedy who are AI type people. Guys, it’s just amazing and fascinating. So, that technology is also going to change things and if by the way it was enabled, it needed the data of the EHR data. So, for me, I think we’re in a really optimistic time. I think great things are going to happen in the next five to ten years and it’s gonna have a really positive impact on the healthcare industry. So, I’m you know, unique in that regard. I think it’s a time to be positive and a time to be excited about the future because I think great things are about to happen.
Dr. Dave Levin: Well, that’s an inspiring message and I agree, I largely agree. I’ve heard it described this way that what we’ve been about in this point was the basic digitizing of healthcare. We’ve put down pens and we started using keyboards. I have a colleague that says we are now ready to harvest the digital dividend and I think that’s you’ve described really very well. Well, that was terrific and I’m leaving this kind of feeling a little inspired Tony, so thank you, I appreciate that.
Tony: Well, it’s my pleasure and thank you for you now, bringing us together today.
Dr. Dave Levin: Great! Well, we’ve been talking today with Tony Paquin, CEO of the iRemedy Healthcare Companies. Tony again, thank you for joining us, we really appreciate your time and your wisdom today.
Tony: My pleasure Dave, thank you.
Dr. Dave Levin: You’ve been listening to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host Dr. Dave Levin, thanks for listening.