Beyond the Pill: Technology-Enabled Clinical Pharmacy Services to Improve Medication Access and Use
Recently, I saw that a company that I have been following made a significant announcement regarding a new partnership that I believe should be applauded. The Oklahoma Health Authority recently announced its planned expansion of Arine in order to utilize their medication optimization platform used by clinical pharmacists to address Oklahoma patients' needs.
The results of the initial pilot program are highly promising, with their PR statement that "Interim results from the demonstration project point to significant positive outcomes. These include:
92% of suggested care plan changes generated by the Virtual Pharmacist were implemented by primary care providers and specialists
94% of SoonerCare participants would recommend the program to a friend
40% reduction in hospitalizations."
What is Arine?
Based in San Francisco, Arine is a really different company for me in the health startup space. Per their description:
Arine is a healthcare technology company that combines data science with clinical expertise to ensure that patients are on the safest and most effective medications for their conditions. The company's proprietary platform, the Virtual Pharmacist, aggregates and analyzes clinical and behavioral data to identify gaps in patient care and uses artificial intelligence to address and resolve them on behalf of Arine's partners. The company's platform is being used to optimize treatment plans, monitor medication performance, and improve outcomes for patients on multiple medications by leading healthcare organizations.
Needless to say, the concept of a virtual pharmacist is probably a bit new for most health tech enthusiasts. After all, the tech news was profoundly captivated by the PillPack acquisition by Amazon two years back for ~$750M, and that was just on an upscaled means of packaging and getting drugs to patients. So I often think when people hear a 'Virtual Pharmacist' + data analytics, they are envisioning a mechanism to automate and replace a pharmacist’s role and duties….which is just not right.
I often think the best and worse thing about pharmacists is that no one knows what we do. It's a double-edged sword. On the one hand, most people view pharmacists as a health care team member who only helps to dispense medications from a pharmacy. As such, investors and other tech enthusiasts may be inclined to view different services (e.g., Alto Pharmacy, PillPack, etc.) as viable new iterations and promising investments that can take on the status quo (e.g., CVS, Walgreens, Walmart) in the pharmacy space. Unfortunately, that just reaffirms what the public thinks they know about pharmacists. You see, there's more out there that pharmacists can do, and the contradiction that a pharmacist and the pharmacy are synonymous entities needs to die. Tapping into the clinical knowledge of pharmacists as a novel means to provide services and expand business opportunities is all too often glossed over.
That is why I really like the founders of Arine, Yoona Kim, David De Vries, and Penjit Moorhead. All three have been working in pharma, technology and digital health for years. In particular, Yoona Kim is a pharmacist who understands the nuances of the profession and underutilization of our clinical abilities.
What does Arine Do?
To begin with, let's talk about the significant-tech/digital health investments in the pharmacy space. Most are focused singularly on adherence or a product-based model. This emphasizes the volume of sales and dispensing of medications to the patient, which generates revenue. It can be argued the more adherent a patient, the more script volume you see, the greater the revenue.
Rarely do I see companies tapping into the pharmacist’s professional expertise to elevate the market for clinical services. There are currently several items that pharmacists can bill for to generate revenue, primarily focused on MTM/CMM, and chronic disease care action plans. Most of the time, these services are time-consuming, have complicated prerequisites that are too onerous for most pharmacists to navigate. What the industry lacks is a platform that utilizes technology to empower pharmacists to conduct such clinical services efficiently at scale.
You may say, well, the money is in adherence! It's a $300B problem, and that is where I would say you are wrong, as I have previously written about. Medication optimization is likely a $300-500B problem in the US, and pharmacists are in the best position to deliver on addressing drug-related problems for patient care. The issue is that not much of our current infrastructure is geared to solve this problem. Pharmacies currently focus on inventory, insurance claims, and managing prescriptions. They don't store or help with clinical data. Many people I talk to are surprised to know that a pharmacy does not house data that includes a patient's past medical history, lab data, vitals, etc. Pharmacists remain one of the most highly educated health professionals sidelined by the technology they use.
So then I hear about Arine, a platform that seeks to collate and analyze patient data (that most pharmacists don't have access to) to provide personal insights and guide clinical recommendations for a patient (cutting down the grunt work of MTM/CMM), and loop in both the patient, provider and pharmacy (which is difficult to do due to workflow limitations). Needless to say, I was impressed, and I admired the thought process of bringing together technology that other health professions are seeing (e.g., AI, data analytics, teleservices) to the pharmacy space and pharmacist profession. It comes back to what I said before, most people do not know what pharmacists can do, and we may have to be the innovators for ourselves as outside disruptors do not know us.
I honestly think the missing link to raise awareness of what pharmacists are capable of from a clinical service perspective is the provision of relevant data, time to act on it and implement insights from it into a person’s healthcare experience. We still have a long way to go, but Arine is showing the promise.
Pharmacy Start-Up Investments
Moving beyond the product-based model that most digital health tech investors seem so fascinated with to a clinical-service based model empowered by technology is tough. I've seen other companies try to create data and analytics platforms to usurp MTM services that do not involve a pharmacist (and I find it fascinating that some of these companies don't even have a pharmacist involved) and not gain much traction. For a potential investor looking at Arine or other pharmacist-driven clinical service companies, I can imagine it is something hard to grasp. After all, they probably don't know much about pharmacists aside from when they have stepped into a pharmacy to get a medication. The investments that Arine has obtained to get them to this place are promising, and it shows that that change is afoot, and investors are starting to pay attention to the right things when it comes to our profession.
Investors, both in tech and in healthcare should take time to figure out pharmacy problems beyond the fill, and where pharmacists as highly-specialized clinical professionals can solve those issues. Adherence is just the tip of the iceberg. With all the other drug-related problems causing such incredible medical waste in the US, pharmacists could hold the key to many eventual solutions.