DrFirst: Value-Based Care Ups The Ante For AI-Powered Prescription Management ‘Healthiverse’

The best way to improve a fragmented industry, to take far-flung stakeholders and create an ecosystem, is through a digital front door, a single point of access that gets everyone working together.

We’re seeing it in commerce, to be sure, but the connectivity that is fostered through artificial intelligence (AI) and real-time data information sharing can transform any vertical.

Nowhere is the need more apparent than with healthcare, where — well before the pandemic hit — U.S. healthcare spending hit roughly 17 percent of gross domestic product (GDP), accounting for more than $11,500 per person, per the Centers for Medicare and Medicaid Services.

Within those eye-popping stats lies a lot of inefficiency, where people are re-admitted for costly treatments, where simply getting medication to people at the critical moments and making sure they take it when necessary (after care is delivered), could do much to improve costs, yes, but the quality of care, too.

Moving To Value-Based Care

To that end, in an interview with Karen Webster, DrFirst Founder and CEO James (Jim) Chen and President G. Cameron (Cam) Deemer said creating a “Healthiverse” — think of it as a connected healthcare economy — can improve medication management, with positive ripple effects throughout the entire healthcare system.

At a high level, said Deemer, provider organizations are going to have to come to grips with the fact “value-based care is going to be the wave of the future.” Providers will no longer be able to sit back and rely on the processes that existed before the digital age, where prescriptions were (and are) being written, handed to patients, and then they didn’t follow directions or take the meds at all.

“It’s just too expensive,” he said.

The inefficiencies tied to tracking medications and who’s taking them (or not) are resulting in patients’ repeat visits to providers (including emergency rooms).

At the same time, he said, the U.S. healthcare system has been shifting to a model in which patients have been taking on more financial responsibility for their treatment and, in a sense, are juggling more aspects of their care than ever before. Rising co-pays and deductibles mean that care is getting more expensive, not less. Repeat visits to providers add costs and layers of treatments, all tied to lack of coordination between patients and doctors.

Individuals and families, Deemer said, “need better tools to even be able to understand healthcare.” That’s a challenge given the episodic nature of healthcare itself, something that we grapple with only when we need it and often in an emergency setting.

As Webster noted, too, moving toward value-based care, focusing on outcomes, is no easy shift for an industry that is worth trillions of dollars of GDP. There’s a need for financial incentives to spur various stakeholders to “opt in” to connecting to each other, to allow data to flow freely. For the patient, the financial incentive is tied to lower healthcare costs (and medicines); for the provider the incentives are tied to better results (which also help with costs).

Improving The Workflows

DrFirst, as Deemer explained, is focused on improving workflows so that the healthcare system can have better patient outcomes — addressing the frictions that materialize the moment a patient enters the continuum of healthcare services.

Picture, then, the individual who is admitted to the hospital, as Deemer related.

“The first thing they are going to do after they establish you can pay is they will want to know what medications you are on,” he said.

The patient may — or may not — be able to answer the question well on their own. The hospital (or for that matter, any provider), will typically access an industry standard medication history that is available to hospitals.

The Data That Goes Missing

But in one dirty little secret in the industry, he said, the database is not very good, and in fact it’s only 70 percent complete. As to what goes missing in the information gaps: records from pharmacies, which meds were picked up, or how often they were refilled, or how many pills were taken daily. In fact, about 25 percent of patients never pick up their prescriptions (sticker shock plays a role), which means that the medicines are never taken.

If the hospital doesn’t have that information at its fingertips, it’s going to call the pharmacy or the patient’s primary care doctor, a process that will take a lot of time. And in emergency care, time is of the essence. Danger lurks, too, as data may be mismatched depending on the databases or coding, with potentially disastrous impact to the patient. Beyond the admission and the prescription, said Deemer, the monitoring part of the equation is a “black hole” for doctors.

Moving Toward Interoperability

“Nobody thinks about the fact that interoperability is a lot more than just, ‘I can send a record to you,’” said Deemer. “It also means you have to be able to interpret and use the record once you get it.”

DrFirst applies machine learning (ML) and AI to these problems, filling in the blanks of what is missing, Deemer said. DrFirst brings the pharmacies and payers into the ecosystem to contribute data and matches up language to make sure that the data presented is uniform, complete and easily followed, leading to better treatment outcomes.

Drilling a bit deeper, DrFirst’s offerings are embedded in providers’ electronic health record (HER) systems, platforms within platforms across more than 320,000 healthcare professionals and tens of thousands of pharmacies.

After the scrips are written, he said, (DrFirst’s connections touch 120 million prescriptions annually, the company has estimated), the company will send reminders to the patient detailing what’s been prescribed, why and how much it will cost (which avoids sticker shock). DrFirst might suggest cheaper (or generic) alternatives and get the patient over the “financial and learning hurdles” that might stand in the way of them picking up and taking those medications.

Welcome To The Healthiverse

That data flow, the interplay between providers and patients, helps cement the Healthiverse, where everyone is connected in real time, he said. The connection has the doctor at the apex of what might be termed a triangle of care, with the hospital and pharmacies at the other corners and the patient in the center.

“Everybody in that triangle is trying to work for the good of that patient … this big cloud of other interested parties want their message to get into the triangle,” said Deemer.

DrFirst has also been focusing on taking information from payers related to medical procedures and making that data available to providers as they make treatment decisions, he said.

As he told Webster, “we’re heavily focused on medication, but we also take a broader collaborative view.” Advanced tech-enabled collaboration tools make it possible for all parties to collaborate with one another, and with the patient. The company has debuted an app called Huddle, which helps patients and caregivers share, store and track healthcare information.

What results from that “closed loop” of collaboration, said CEO Chen, is productivity, which can increase by several multiples.

Funding The Expansion

DrFirst said Wednesday (May 12) that it has closed a $50 million follow-on equity investment from Sixth Street Growth, the growth investing platform of investment firm Sixth Street. That brings the total to date invested in the company, including a $50 million investment from Goldman Sachs Growth, to $135 million.

Deemer and Chen said the funding comes at a time when the company has the opportunity to grow more rapidly than ever before with a focus on patient outcomes and collaboration.

“We’ll make the supply and demand balance out as we start solving big problems in a small way,” Chen said.

Asked about measuring success, Deemer said that, for the company itself, increasing reach (and touching more patients) is important, especially in terms of making sure that they are picking up drugs and reducing hospital admissions.

“Can we cut seconds out of pharmacist data entry every time on every prescription” while avoiding adverse drug events, he asked, rhetorically.

Those are concrete measures of success, he said.

As he told Webster, “the Healthiverse, for us, is everyone connecting in the cloud, where we’re making it possible for them to collaborate together on patient care.”