Podcast appearances and mentions of pramod john

Mark Cuban said “If you're using one of the big 3 pharmacy benefit managers, you're getting ripped off. Period.” And then *I* said “Oh, man—we NEED to do an episode on this.” …and then I went and got highly acclaimed #pharmaceutical benefits expert, Pramod John, to come on the show and talk long form about Rx benefits in America, buying Rx, managing Rx plans, Mark Cuban's company and the whooooole ball of wax.About the Show:The H.I.T. Podcast (Powered by Montage Insurance Solutions): A thought leader in the space, curating the top news and information to deliver a brief, high impact overview designed specifically for the Human Resources professional, business person, and company executive.Find out more here: www.hitpodcast.comSpecial thanks to our Platinum Sponsors: TruHu AND Kingdom Legacy Benefits (KLB)! Thank you to our Gold Sponsor: Cigna

For a full transcript of this episode, click here. Here's something Randy Vogenberg, PhD, wrote the other day; and I made some light edits: Research has documented the unintended impacts of poor pharmacy benefit strategy. Examples include increasing costs of care, bankruptcies, and member satisfaction declines. And, yeah … agreed. Also, probably health problems if we're talking about a member unable to access a drug they really need. I heard the other day about how so many patients who have had organ transplants have a hard time getting their transplant rejection meds. What?! I just can't even with that one. On the other hand, you could have a plan that pays for all manner of drugs, cost-effective or not, appropriate or not. And now we have premiums that no one can afford, and everybody loses for the exact opposite reason. These are the downsides that happen when pharmacy purchasing gets itself into a suboptimal place. And this can happen for many reasons, but one of them is when there is not a concerted effort to buy pharmaceuticals in a value-based way. Now, here's some reasons why employers may have a rough time paying for value (ie, paying a fair price for drugs that work). Here's one reason: Most employers do not have the power to influence the price of a medication. So, any given employer could decide, based on some cost-effectiveness analysis, that the price of a drug is too high. But it's not like they can march into Pharma HQ and haggle. It's more of a take-it-or-leave-it kind of thing. Here's a number two reason why value-based pharmacy purchasing can be tough: Pharmacy spend is siloed a lot of times from medical spend. So, the pharmacy vendor is only concerned about cost and denies access to even drugs that are proven to reduce medical spend. Why wouldn't they do that? The PBM (pharmacy benefit manager) was hired to reduce pharmacy spend. The end. Who cares how many ER visits or disease exacerbations transpired? That's the medical director's problem, not theirs. Here's the number three reason why value-based purchasing is rough: The time horizon an employee is with an employer, which is not one day—and it's not a lifetime. Why did I say one day? I have heard more than once that the actuarial time horizon that some pharmacy plans use to determine if a drug is cost-effective is one day. If the drug doesn't accrue any benefits in one day, well then, it's a cost. It's not effective. On the other hand (and also problematic in the real world), sometimes cost-effectiveness analyses are done with a timeframe of the patient's lifetime. And, yeah … there aren't many employers who have employees for a lifetime—like, they're 85 years old and still on the employer's dime—so the time horizon can't be too short. But if it's a really expensive med that will, at most, prevent something that's not gonna happen anytime soon (heart failure, kidney failure, a stroke), these are things that an employer may pay for but likely is never gonna see the cost benefit of because that benefit will happen 30 years from now when the patient is on Medicare. And here's a fourth reason why value-based purchasing is tough: The FDA is approving drugs based on evidence from one study (ie, not a ton of evidence). And these drugs are also really expensive. So, some of the above issues are solvable; some are less solvable. With this in mind, let's tick through some advice that my guest today, Nina Lathia, suggests if you want to offer members a value-based formulary. 1. Have a stated goal. And maybe that stated goal is to meaningfully improve health of plan members while maintaining access, satisfaction, and affordability for said plan members and the plan. 2. Think holistically about healthcare spend, not just pharmacy spend. 3. Know what the value-based price of a drug has been calculated to be. I talked about this at length in the show with Anna Kaltenboeck (EP303). Also, Bryce Platt, PharmD, has written about this a lot. 4. Look into risk-based deals with Pharma and/or installment payments and/or some of these other interesting payment models that are emerging. Luke Prettol linked to one of them the other day. 5. Set good decision-making precedents that include shared decision-making with members/patients. This means communicating with employees and plan members about what you are doing to make good drug purchasing decisions and evaluate the clinical pros and cons of expensive drugs for any given patient. There are genetic tests now that can be done to determine if a drug is ever going to work for a patient, were these tests even done. I mean, from a patient standpoint, some of these drugs have horrible side effects; and they might be being prescribed by a doc who's not an expert in that condition. If I'm a patient and there's a genetic test I could take before I pay a ton of my own money and subject myself to what might be some pretty nasty side effects (you know, all the things that you hear about at the ends of those pharma ads on TV, right?), this could be, in the right hands, a patient benefit. This feels very different from prior auths administered by a vendor doing all kinds of stuff, where it's hard to make any connections to clinical value or patient upside, even if you squint at it sideways and use your imagination. And, yeah … this is easy to say and really hard to do. One definition I want to chuck in here for you: If we're talking about a cost-effectiveness analysis, cost-effectiveness analyses calculate how effective is the drug, minus side effects at diminishing the so-called burden of illness—burden of illness meaning the financial and health costs of the disease itself or its exacerbations. Nina Lathia, my guest today, is a pharmacist by training who has worked in hospital pharmacies. She earned a PhD in health economics. Currently she's doing consulting work, helping purchasers make value-based decisions about pharmacy spend and managing formularies. Specialty Pharmacy Playlist: https://lnns.co/uNZ3moCaQMb Hit the subscribe button to add it to your podcast player. Also mentioned in this episode are Randy Vogenberg, PhD; Anna Kaltenboeck; Bryce Platt, PharmD; Luke Prettol; Olivia Webb; Pramod John, PhD; Scott Haas; Aaron Mitchell, MD, MPH; Keith Hartman, RPh; Erik Davis; Autumn Yongchu; and Berkley Accident and Health.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia, RPh, MSc, PhD, has spent over 15 years helping healthcare payers achieve value on their drug spend. As the chief executive officer of Healthcare Decision Making, Nina works with public and private healthcare payers, helping them to make evidence-based decisions about their pharmaceutical benefits that lead to improved health outcomes and long-term financial sustainability of their health plans. Her focus is on providing independent, actionable advice for healthcare payers on reimbursement decisions related to expensive new drug therapies. Nina is a frequent public speaker and commentator on employer-sponsored pharmacy benefits design, value-based healthcare decision-making, and evidence-based medicine. Nina honed her skills in value-based assessment of drug therapies when she was a senior technical advisor at the National Institute for Health and Care Excellence (NICE) in the United Kingdom from 2014 to 2017. She has also worked as a clinical lecturer at the University of Toronto. Her work has been published in a number of high-impact peer-reviewed journals. Nina holds a master's degree and doctorate in health economics from the University of Toronto.   06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there's only one drug option and the price is too high? 21:20 What's a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying “no” to certain drugs? 25:36 Why is patient engagement key? 28:23 What does “good” look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia discusses #costcontainment and #valuebasedpurchasing in #pharma on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang  

Pramod John, CEO of VIVIO Health, discusses issues with drug pricing and competition in the pharmaceutical industry. He talks about how the current system incentivizes higher spending on healthcare rather than better outcomes, and how lack of transparency and access to data prevents true competition. [00:00:15] Introduces VIVIO Health mission [00:02:07] Background and improving healthcare [00:05:40] US overspends on drugs [00:08:39] Public benefit corporation [00:12:11] Rebates misalign incentives [00:17:29] FDA approves ineffective drugs [00:24:15] FDA efficacy vs. effectiveness [00:29:47] Health insurance exchanges [00:33:03] Humira lacks competition [00:40:51] Lower cost Humira biosimilars [00:44:38] Employers overpay despite alternatives [00:47:53] Consultants have misaligned incentives [00:51:46] Importance of fiduciary duty [00:53:39] Data access drives competition [00:55:33] Similar issues in other industries [00:57:31] Ask doctors for data on treatments Learn more: https://www.viviohealth.com The Business of Pharmacy Podcast™ offers in-depth, candid conversations with pharmacy business leaders. Hosted by pharmacist Mike Koelzer, each episode covers new topics relevant to pharmacists and pharmacy owners. Listen to a new episode every Monday morning.

I hope you enjoy this encore episode of one of the most popular shows in the last 12 months. One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal. During this conversation today with Scott Haas about PBMs (pharmacy benefit managers), that quote was playing in my head like an earworm. I'm henceforth gonna struggle with the term rebate to define dollars that the PBM gets back from Pharma, because, according to my guest in this healthcare podcast Scott Haas, it turns out “rebates” comprise only about 40% of those back-end dollars that some PBMs manage to score from pharma manufacturers. I don't have any insight really into this, but Scott Haas certainly does—and this is the average that he has seen in his work and that we're going to dig into today. But in sum … wow! Let me just repeat that a mere 40 cents on the dollar of the gross amount that PBMs take in “rebates” from Pharma these days winds up going back to plan sponsors, even plan sponsors who are getting “100% of the rebates.” If you didn't understand what I just said, no worries. I'm gonna explain it right now. If you did and you know the why behind all of this also, you could probably skip ahead about five minutes. Here's the backstory on this whole rebate fandango. Let's start with part one of what is a two-part transaction. So, part one: the deal between pharma manufacturers and PBMs. In general, a pharma manufacturer signs a deal with a PBM to give back whatever percentage of their gross sales revenue to the PBM at the end of the year, say. It's along the same lines as a cash-back coupon for the PBM. Why would a pharma company be up for giving cash back like this? Well, to get on a PBM's formulary, giving cash back is like the price of admission. PBMs have a lot of leverage, after all—at least the big ones. They control access to millions and millions of patient lives. So, if Pharma wants their drug to be accessible to those millions and millions of lives, they have to play the cash-back game, otherwise known as the rebate game. They have to agree to give back to the PBM a certain amount of cash on the back end. So, PBM pays Pharma's list price up front—that's the gross amount paid, based on the list price of the drug—and then after all the cash back gets toted up at the end of the year, there'll be a net price. List price or gross price minus the cash back equals net price. It's this net price that's the true kind of final price which the pharma company gets paid per script by said PBM at the end of the day. These days, most everybody pretty much knows that PBMs are getting these so-called rebates—this cash back from pharma companies that I just explained. And it's pretty common knowledge the so-called gross-to-net bubble (the gross-to-net dollar amount) is pretty huge, meaning the rebate or cash-back amount is pretty huge. And many have also noticed that the gross-to-net dollar amounts seem to be growing bigger and bigger every year. I mean, for one insulin manufacturer, consider this: Their list price, their gross price, is $350 per script. And their net price after cash back/rebates was $52 this past year. Wait ... what? After all the cash back to the PBM, the insulin manufacturer got paid 86% less than their list price—$350 went down to $52 per prescription. The PBM vacuumed up 86% of the dough for every script written for this particular brand of insulin. Okay … so, say Pharma gives $100 back to the PBM based on the terms of their deal. Call that part one of this example transaction. Here's part two: the deal between PBMs and health plans or self-insured employers. Health plans and self-insured employers are customers of the PBM. They hire PBMs to manage the pharmacy benefits for their members or employees. So, because everybody knows this whole rebate thing is going on, as part of the contracts that the PBMs put in place with their customers (meaning the health plans or employers), the PBMs tell their customers that they're going to give 100% of the rebates back to the plan/employer. So, you'd think that if the pharma manufacturer paid $100 to the PBM, that the customers of the PBM (the plan sponsors) would get the $100 back then, right? The PBM would pass on 100% of the savings, as it were, if they're saying that they're gonna give 100% of the rebates. I mean, if this is actually true, that $100 in and $100 out, then the PBM is potentially performing a useful service, right? They're lowering drug costs for their customer, the plan sponsors for their members and employees. Except … turns out, not so much. Because what is a rebate, really? A rebate can be anything the PBM defines as a rebate. And it turns out that, on average, as I said before, according to those in the know, something like $60 of that $100 is not a rebate. It's an administration fee. Or a data fee. Or an education fee. A clinical program fee. Some other name that is not rebate. As my guest Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean. It's like inconceivable from The Princess Bride. I do not think that word rebate means what you think it means. Now it is a tangled web we weave here, and for more on why I say that, listen to the episode with Chris Sloan (Encore! EP216) entitled “How Medicare Part D Plans Became Addicted to Drug Rebates.” There's also a show with Pramod John, PhD (EP353) where we dig into, specifically, specialty drugs and rebating and so-called rebate walls. But net net, all of this probably myopic focus on rebates means that you have to keep an eagle eye out for so-called exclusions in contracts if you are a plan sponsor. So, what are exclusions? This is that whole thing where some cheap generic is excluded from a PBM formulary while some expensive brand for the same condition is on formulary. Why would a cheap generic be excluded from a PBM formulary? Simple. Cheap generics don't have rebates. PBMs lose a lot of money when some high-priced specialty drug, for example, goes generic. They might have made thousands of dollars per script on that high-priced brand by collecting its rebate. Think about that insulin example. The rebate is 86% of the cost of the drug. And everybody wonders why some cheap generic insulin or biosimilar or whatever isn't on formulary. It is not a mystery when you're dealing with for-profit enterprises built around a model of revenue maximization. So, given all this, what's my guest Scott Haas's bottom-line advice in this whole thing? If you're a health plan or employer and you're trying to negotiate a PBM contract where your spend is predictable and your contracted price promises have any meaning whatsoever, Scott Haas's advice is, you have to ensure that the contract defines the actual prices for the drugs in the contract. With absolute numbers. Not percentages off or weird formulas or the empty promise of getting an AWP or a WAC (which means average wholesale price or wholesale acquisition cost) or any of the other various acronyms for some drug pricing schema. All of these are basically shorthand for “this price could change at any moment.” There's a reason in-the-know people say AWP stands for “Ain't what's paid,” meaning ain't what's ultimately going to be paid by plan sponsors. What is necessary in PBM contracts is the final price—that number. Some digits with a dollar sign in front of them and a “per unit” after them. No acronyms and no percentage signs. Whoever gets to define the terms ultimately controls the price. So, get the price up front. As mentioned several times already, I am talking to Scott Haas, who is a senior VP over at USI Insurance Services. He's speaking today from the perspective of a plan sponsor, meaning from the point of view of a health plan, including those health plans managed by and paid for by a self-insured employer and their employees. For more information on PBMs and how drugs get adjudicated, listen to the show with AJ Loiacono (Encore! EP231), which was one of the most popular episodes over here at Relentless Health Value. Somebody on a LinkedIn post the other day commented on how much she appreciated AJ Loiacono's frank assessment of things and how she would love to go to a meeting with more people similarly telling it like it is. That's pretty much what we aim to do at every episode over here at Relentless Health Value, and AJ nails it on that objective for sure in this episode. One last thing, also on the show: Scott Haas brings up GPOs that the Big Three PBMs have been spinning up to aggregate and maximize all of those rebates that we just talked about. I discuss this exact topic at some length in another incredibly popular episode with Mike Schneider (Encore! EP288).   You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.   Scott Haas has over 38 years of employee benefits experience. His background includes the development and validation of care management programs; prescription benefit management solutions; provider network evaluation, valuation, and negotiation; and underwriting. Scott started and operationalized a third-party administrator (TPA) and a pharmacy benefit manager platform from scratch. He has worked in the arena of alternative funding for most of his career. Scott's primary focus is in the area of alternative delivery and financing of healthcare other than fee for service, along with prescription benefit and healthcare risk management consulting. Scott has held officer-level positions within Blues plans and TPAs as vice president of sales and marketing, vice president of underwriting, and president. Scott has also served as a trustee for both union and non-union health and welfare and pension plans. Scott frequently shares his consulting expertise speaking at national events hosted by organizations such as Health Rosetta, the International Foundation of Employee Benefits, the Health and Welfare Plan Management Conference, the Western Pension and Benefits Conference, and the Self-Insurance Institute of America (SIIA). Scott has authored and coauthored articles on various topics over his career. Scott earned his bachelor's degree in business administration and economics from the University of Nebraska at Kearney. Scott also holds Chartered Life Underwriter (CLU) and Registered Health Underwriter (RHU) designations.   10:34 What's the major flaw with the buyer-seller relationship between plan sponsors and PBMs? 12:08 What are the five things that need to be considered in order to get a fair price from a PBM? 13:21 Why does using average wholesale price cause problems for plan sponsors? 15:10 What does it mean to put the network risk on the PBM? 17:15 What's happening with drugs moving from specialty brand to specialty generic? 19:19 “A generic is a generic; in our world, it's binary.” 23:36 “The term 100% of rebates is really irrelevant.” 23:59 What does it mean to have a minimum guarantee in drug rebates? 26:43 “When you do a line-item assessment … is it producing an optimal result in comparison to competitively achieved … pricing for generics … and for specialty?” 27:57 “Plan sponsors need to grow a backbone.” 28:40 EP342 with Christin Deacon. 29:10 Why do you need to understand your consultant's process as a plan sponsor? 29:36 Why do you need to understand formulary exclusions as a plan sponsor? 29:46 Why is it important to create a more equal PBM contract? 30:57 “Rebates inure to the benefit of the plan sponsor; they don't necessarily benefit the consumer.” 31:50 What does Scott do at USI?   You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.   Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400)  

Before I get into the show today, let me just remind everybody about our mailing list, which you can sign up for on our Web site, relentlesshealthvalue.com. You might follow Relentless Health Value on LinkedIn or Twitter, which is a great option, for sure; but I wanted to point out that what you see there is abridged at some level. Meanwhile, if you subscribe to our mailing list directly (again, by going to our Web site, relentlesshealthvalue.com—it's over on the right sidebar where you can sign up for the mailing list), if you subscribe that way, each week you'll get an email with a full transcription of the whole introduction of the show with timed show notes. Also, we don't send out literally anything else beyond what I just described on a weekly basis. Also, you can unsubscribe easily and anytime you want. You just hit the unsubscribe in the email. Also, we don't share our list with anybody. We barely have time to look at it ourselves, so if you have any concerns there in that regard, please don't.  Last week's show (EP359) was with Dan O'Neill, and he talked about the four gradations of value-based payments, from paying purely for volume on one end of the continuum to paying purely for value on the other. When you have a moment (not now, but when you can), go back and listen to that show, as it adds some color to what we talk about in this healthcare podcast.  But in the meantime, one of the points that Dan O'Neill makes is that patients in this country won't gain the benefits of value-based care unless commercial insurers pay for value, for reals. After all, value-based payments are payments that incentivize value-based care. Without value-based payments, how does anyone expect to get value-based care? To belabor this point momentarily, a provider is not gonna switch up their FFS business model when insurers, especially commercial insurers, pay whatever for whatever with no reward going to providers who spend time and effort to create value and/or better outcomes for patients. I'm being super cynical here, I will grant you. But in this day and age of private equity and record profits by a consolidated healthcare industry, if I'm in charge of a provider organization just realistically here, Pramod John, PhD, says this really well in EP352. He's talking about drug development in that episode, but same thing here is true for medical care. If you indiscriminately pay Ferrari prices for Hyundais, you're gonna get a Hyundai for the price of a Ferrari.   To add insult to injury—and this is just one important reason why providers aren't really willing to invest in lifting outcomes—any value that they would manage to create is gonna be realized by the insurers. It's gonna go right back into insurers' pockets. Steve Schutzer, MD, talks about this in his episode (Encore! EP294) about the why and how to create a center of excellence. If, as a provider in a pure volume contract which is FFS, I work really hard to save downstream costs and complications for patients, some carrier is gonna bank the difference.   It's go time, all you self-insured employers out there. Pay for high quality. Make the carrot an orange-colored stick, as they say. Patients will benefit. Probably doctors and other clinicians, too, honestly: less moral injury and crappy workflows. In this healthcare podcast, I am talking with Jeb Dunkelberger. Jeb Dunkelberger is the CEO of Sutter Health | Aetna, which is a payvider. Payviders, by Jeb's definition, take on full risk. They have a full-risk insurance product, meaning they must switch up their business model and how they deliver care so that it works in a total capitation payment situation. We go deep on payviders the last time Jeb was on the show (EP348). But in this relatively short conversation, I wanted to talk to Jeb about the operational imperatives of moving to value-based care, moving to a care model that is aligned with value-based payments—what needs to switch up in the day-to-day to ensure that patients don't have care gaps that cause expensive trouble downstream, or patients at rising risk get taken care of promptly before something avoidable and/or acute (ie, expensive) happens.   There are three main things that Jeb talks about: Fixing up the clinical workflow Having care navigators Aligning physician comp to organizational goals Let me dig into each one of them briefly. 1. Fixing up the clinical workflow. There's basically five aspects to that: Ensuring that the right data is in the clinical workflow. Let's talk about this data for just one sec and we'll find actually one more reason that payers and purchasers need to get kinda engaged in this making sure members get care thing. Because data—data that payers have that is needed at the point of care. Like claims data. Please provide it to providers and actually insist that it gets used by clinicians making clinical decisions at the point of care. Ensuring that there are pick lists of drugs, with generic drugs first Making sure it's easy to get to pended orders that close care gaps right within the clinical workflow Empowering medical assistants and holding them responsible to create value for members Building referral management into the clinical workflow in pursuit of a nonfragmented patient journey 2. Having care navigators. I just want to remind everyone: This is even more important if the EHR doesn't support referral navigation. Also, Liliana Petrova talks about this extensively, the need for care navigators, in EP357. She's talking about it relative to telehealth, and she makes a really important point: If you want to ensure that the right patients are getting telehealth and also taking advantage of it to streamline their longitudinal care and make it less fragmented, you have to have navigators involved in scheduling. Otherwise, how's a patient supposed to know whether to go in person or telehealth or even that telehealth is available?  3. Aligning physician comp to organizational goals. We definitely get into this in some detail. We cover these three top-line operational must-haves in this episode, and you'll hear about them right from a CEO who is doing them right now. Besides this conversation, another resource I would highly recommend checking out is a recent article in Nature entitled “Deploying Digital Health Tools Within Large, Complex Health Systems.” While this article is about digital health tools (obviously by its title), 80% of the article is pertinent to deploying pretty much anything in a big provider organization, including an upgrade to value-based care delivery—and/or probably digital health tools are pretty requisite in any attempt to effectively remodel the clinical workflow in this way in 2022, so there's that, too.   For additional Relentless Health Value episodes on this topic of how to build an operational model that fulfills value-based care objectives, I'd listen to the show with Shawn Rhodes on the essentials for clinical integration (EP354)—also the show with Lisa Trumble (EP349) on what that clinical integration looks like from a care perspective. I am also going to refer you to the episode next week (EP361) with Carly Eckert, MD, MPH. So, check that out for sure. We talk about care gaps.  You can learn more at sutterhealthaetna.com.   You can also connect with Jeb on LinkedIn and follow him on Twitter.   Jeb Dunkelberger, MSc, MHCI, currently serves as CEO of Sutter Health | Aetna (SH|A), a commercial insurance plan serving Northern California. The health plan aims to combine the value of retail, provider, and payer via its partnerships with CVS, Sutter Health, and Aetna. Prior to SH|A, Jeb led growth for two bay-area healthcare start-ups: Cricket Health and Notable Health. Jeb has also held executive roles at Highmark, McKesson, and EY. Jeb holds healthcare-related degrees from Virginia Tech, The London School of Economics, Cornell University, and University of Pennsylvania. 08:36 What must a provider organization consider operationally when incorporating value-based care and value-based payments? 09:44 How can you use perverse incentives to encourage people to do the right thing? 12:25 How should clinical workflows operate to incorporate value-based care? 14:10 “How do you align patients?” 15:52 How should the EHR operate to maximize value-based workflow? 16:52 Why is taking action on claims data and clinical data together important? 20:26 “Have they actually solved the last mile of integrations?” 21:15 “Changing the behavior of a provider is an absolute art and science.” 22:57 “We have to do more.” 27:09 “That administrative headache … doesn't just end with the insurer.” You can learn more at sutterhealthaetna.com.   You can also connect with Jeb on LinkedIn and follow him on Twitter.   @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs What must a provider organization consider operationally when incorporating value-based care and value-based payments? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How can you use perverse incentives to encourage people to do the right thing? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How should clinical workflows operate to incorporate value-based care? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “How do you align patients?” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs How should the EHR operate to maximize value-based workflow? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs Why is taking action on claims data and clinical data together important? @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “Have they actually solved the last mile of integrations?” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “Changing the behavior of a provider is an absolute art and science.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “We have to do more.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs “That administrative headache … doesn't just end with the insurer.” @Jeb_Dunk discusses #valuebased #clinicalworkflows in this week's #healthcarepodcast. #healthcare #podcast #vbc #valuebasedcare #ffs Recent past interviews: Click a guest's name for their latest RHV episode! Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb  

Pramod John is the CEO of VIVIO, a company that has built an autonomous solution that allows employers and other healthcare payers to take control over their specialty drug spend.   VIVIO is a Public Benefit Corporation that operates with a transparent business model.  Their only form of compensation is an administration fee allowing them to focus just on the question of cost benefit at the individual patient level. We'll hear how VIVIO's approach differs from that of the traditional PBM and the impact this approach has on both health outcomes and costs. Show notes:  Suggested Books:  Talking To Strangers by Malcolm Gladwell; Uncaring: How The Culture Of Medicine Kills Doctors And Patients by Robert Pearl.

This episode is probably a 400-level class in specialty pharmacy rebating. If you want a 45-minute conversation on rebates in all their glory, go back and listen to the conversation with Chris Sloan (Encore! EP216).   But if you're still with me, what's gonna follow is about an eight-minute overview of pharmaceutical rebating, just to make sure we're all on the same page before we get into the show itself. So, if you know all there is to know about pharmaceutical rebating, you can jump ahead about eight minutes and get to the part where I talk with Pramod John.

As a country, we spend approximately $500 billion on prescription drugs. Specialty drugs account for less than 2% of prescriptions but will cost us over $250 billion (that's in 2021)—so, 2% of prescriptions but half the spend. Specialty is the fastest-growing segment of healthcare spend and is a dominant issue that self-funded employers and other purchasers face. But let's dig into that $250 billion being spent on specialty drugs, shall we? I have to say, personally, that if we spent $250 billion but saved more than that in medical costs or if the patient quality of life went up measurably or if life expectancy or overall survival or whatever metric you used to assess quality … if that big spend produced even bigger returns/results, I for one would be like, “OK, trade-offs. Let's discuss.” But the thing is, clinical trials and real-world evidence alike suggest that there's a lot of patients who don't really benefit from the expensive drugs that they are taking or were prescribed, and even those who benefit might not get the results that they're hoping for or even de minimis expecting. In this healthcare podcast, I am talking with Pramod John, CEO of VIVIO Health; and he makes a couple of great points about all of this that I'll repeat here and then he's gonna say them again later in this episode but in context—and probably better. There was some research done that showed for a really popular, really expensive drug, only 2% of patients who took it got the expected, maybe promised, benefits. But 100% of the patients who took that drug got bad, in some cases dangerously bad, diarrhea. This situation is really kind of typical. A drug will work great for some people, mediocre for other people/patients, and not at all for, say, the remaining what might be majority of patients. So, you'll have 2 patients where the results are out of the park, 23 patients where results are pretty darn good, 25 patients reporting meh results but something you can actually still point to, and then maybe 50 patients who see absolutely no improvement in anything. So, here's an important point: Maybe there's, let's just say, 3 drugs or 10 drugs in this therapeutic category, and that same patient distribution is true for all of them—except different drugs may work for different people. So, by enabling access to all the drugs, you can see that patients have a better chance of being in one of those first groups where they actually get results because there's more drugs that they can try and different drugs work differently in different people. But now, let's consider the way that we pay for specialty drugs: One or two of them get on formulary typically, and then all the others are excluded. That said, the purchaser, patient, and/or taxpayer is gonna pay a whole lot of money for those drugs regardless of how well they do or do not work. And with fewer drugs on formulary, there's less of a chance that results gold will be struck. But we're gonna pay a whole lot of money, also in terms of human life, to deal with the direct and cascading side effects of drugs whether they do or don't work. I have to admit, I kind of have a new appreciation for so-called me-too drugs after this conversation. Let me just add that here for the record. My guest today and next week is Pramod John, who is the founder and CEO over at VIVIO Health. VIVIO contracts with self-insured employers and helps their employees/members/patients (whatever you call them) get the right drug. They actually expand access, and the employer saves money. After what I just said, you might be cottoning on to why. The show this week concerns the reality of specialty drugs and what the terms efficacy and effectiveness really mean because they might not mean what you think they mean. As inconceivable as that might feel, I learned something. You might, too. And there are implications—big implications—for all of this for patients/members/employees. Or you and your family. In this episode, we also define and discuss the terms NNT (number needed to treat) and NNH (number needed to harm), which are really important and, in my humble opinion, do not get discussed enough—especially with patients who need to know these things to make informed choices. Next week's show is also with Pramod John, and we get into how what we talk about here intersects with rebates and formularies. Come back for that. It's probably a 400-level class in specialty pharmacy rebating, but some of you will appreciate it. You can learn more at viviohealth.com or by emailing Pramod at pramod@viviohealth.com.   Pramod John, PhD, is the team leader of VIVIO, a public benefit corporation whose mission is to ensure that drugs work in the real world for the people on them and that their costs reflect the value provided. VIVIO's model has improved health outcomes and generated 35% to 40% savings on drug acquisition costs. It accomplishes this by answering three simple questions: (1) Is this the right drug? (2) Is it a fair price? and (3) Is it working for the patient? Before VIVIO, Pramod was founder of Oration PBC (acquired by PokitDok), which gave consumers control over their drug purchasing by capturing the prescription in the physician's office and providing real-time pricing options and automatic routing capabilities. Pramod was also vice president of strategy and innovation at McKesson, the world's largest healthcare company. At McKesson, Pramod helped develop solutions that leveraged advanced technologies and business process improvements to optimize healthcare delivery systems, infrastructure, and supply chains. Earlier, Pramod founded and served as CEO of PacketMotion, Inc, a venture-funded startup in the enterprise network information and policy management industry. VMware later acquired the company. In addition, Pramod founded netExaminer.com, a managed-vulnerability assessment company acquired by SonicWALL. Pramod earned his PhD in electrical engineering from the University of Illinois at Urbana-Champaign. He serves on the board of Wycliffe USA. He also serves on the advisory board of Folia Water and as a mentor at StartX. 05:34 What does a good response mean in pharmaceutical products? 06:06 “Different people get different utility out of something.” 06:31 Why doesn't efficacy mean what you think it means in terms of pharmaceutical products? 08:40 What is the difference between efficacy and effectiveness in Pharma? 09:10 Why aren't drugs' major side effects factored into a drug's efficacy and effectiveness? 10:14 “What's the benefit of this versus what's the harm in this?” 13:35 “Clearly as consumers, we all feel that we're special. But what about physicians?” 14:14 “The benefit itself—what does it have to be?” 15:18 EP334 with Sunita Desai, PhD.17:11 “We tend to think of things as a binary distribution—it works or it doesn't.” 18:22 “The default choice that we start with is often the wrong one.” 20:54 “It doesn't matter why if we can't fix the reason.” 22:02 “At some point, the question becomes, ‘Do we have any information?'” 22:36 Why do other developed countries pay less for their drugs? 24:21 How do we end up with crappy drugs on the market that don't really move the dial? 25:57 EP303 with Anna Kaltenboeck. 27:22 “We can build a better system. And that's what we do every day.” You can learn more at viviohealth.com or by emailing Pramod at pramod@viviohealth.com.   Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs What does a good response mean in pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “Different people get different utility out of something.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why doesn't efficacy mean what you think it means in terms of pharmaceutical products? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs What is the difference between efficacy and effectiveness in Pharma? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why aren't drugs' major side effects factored into a drug's efficacy and effectiveness? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “What's the benefit of this versus what's the harm in this?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “Clearly as consumers, we all feel that we're special. But what about physicians?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “The benefit itself—what does it have to be?” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “We tend to think of things as a binary distribution—it works or it doesn't.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “The default choice that we start with is often the wrong one.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “It doesn't matter why if we can't fix the reason.” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs “At some point, the question becomes, ‘Do we have any information?'” Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs Why do other developed countries pay less for their drugs? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs How do we end up with crappy drugs on the market that don't really move the dial? Pramod John discusses #specialtydrugpricing on our #healthcarepodcast. #healthcare #podcast #pharma #specialtypharma #specialtydrugs   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis

S1E9: Healthcare's Asymmetry of Information with Pramod John, CEO of Vivio Health, and host Dr. Nick. Do you know if the drugs you are prescribed and are taking are actually delivering value? Who has your best interests front and center and you trust to make a determination and guide the clinical decision-making process on what therapy is indicated for the disease in you? If you were leaning on the FDA, recent news and events might give you pause. Recently conditionally approved Aduhelm an Alzheimer treatment by Biogen is controversial and pricey. Medicare premiums at all time high in part from the impact of Aduhelm. So what about the information and data available, the science? Drug pricing is outstripping our ability to pay, and a large portion of these escalating costs is linked to specialty drugs that can account for as much as 50% of costs while only treating a small percentage of patients. Your better pill to swallow, we can no longer accept the value of a treatment based on it being prescribed and our assumption that all the processes in place make this choice the right choice for you since the assumptions are not aligned with yours and in fact may be counter. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play HealthcareNOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Driven by a personal passion to change healthcare and “the obligation to do the right thing for the good of every American,” Pramod John, CEO of Vivio Health, is on a mission to overhaul the specialty drug market. He and the team at Vivio - founded by a leaders previously working in Pharma - want to use data to help people get the right drug, at the right time.  Pramod says medications are the most frequent intervention a physician will make, and that specialty drugs are the fastest growing segment of healthcare globally.  Yet, he also says that many of the drugs aren't widely effective.  The team of Vivio sees opportunity for change and is working to improve things by using and analyzing real-world drug and patient data - analyzed separately from the FDA. Learn more about Vivio Health: https://viviohealth.com  Connect with Pramod: https://www.linkedin.com/in/pramod-john/  Topical time codes: 00:00 - Video starts 00:58 - Creation of Vivio Health 2:28 - Specialty drug market 5:15 - Endorsement of specialty drugs by influencers and celebs 8:04 - Lack of time to analyze drug trial info of every new drug 12:08 - Too much info for physicians to keep up with in practice, no infrastructure to help  14:56 - Using computers to keep up with data doesn't mean human replacement - they're good at different things  17:26 - Switch in thinking to allow change and let people work at their highest level 20:56 - Using technology more often and using it better 23:36 - Personal passion for change

This episode of The ShiftShapers Podcast is called "Target and Tame the Drug Spend Monster" with Pramod John, Founder and CEO at VIVIO Health. They discuss the changing nature of specialty drugs as adjuvant therapies and the skyrocketing costs that come with it. Pramod also discusses the case of Humira biosimilars and AbbVie's threat to litigate, resulting in it being unavailable in the US. He further explains the broken system that favors big pharma, its detrimental effect on regular citizens, and what we can do about it. You can find show notes and more information by clicking here: https://bit.ly/2ALItrX

Topics: Pharmacy Benefit Manager (PBM) Misaligned Incentives Price Transparency  Efficacy versus Effectiveness Consumerism Specialty Drugs Drug Waste Drug Manufacturer Rebate Steerage   In this episode, Michael introduces you to Mort Jorgensen, the Co-founder, and CEO of Rx’n Go, Paul Ford, the Founder of OrchestraRx and Pramod John, the CEO of VIVIO Health. Join our round table as we dive into the current state of the Pharmacy Marketplace and ideas to challenge the inefficiencies and problems in traditional Rx purchasing.  Here’s a glance at what we discuss in this episode: The table’s opinion about the current mergers of the largest PBMs with insurance companies and how this could impact the marketplace The complexities and challenges with the current pharmacy purchasing structure  How payors have zero visibility into the pricing for Generics, Brand and Specialty Drugs How current benefit design is a part of the transparency problem  The Pareto Principle, how it relates to drug spend and why employers need to take a more proactive stance on what drugs are allowed to be used if they want to save money How the presence of multiple middlemen in the drug distribution system creates additional cost and inefficiency Why our biggest problem may not be a lack of transparency, but rather an unwillingness for payors to stop doing business with the vendors who profit off of higher drug costs Misconceptions about drug manufacturer rebates and why the impact of rebate driven drug steerage should be a greater concern than how much the drugs cost Understanding which stakeholders benefit from drug manufacturer rebates  Understanding that consumerism doesn’t really work when it comes to drug choice given it is usually a provider who is the one selecting the drug for the patient The differences between efficacy versus effectiveness and why we continue to pay for drugs that do not work How employers can reduce waste within their benefit design How employers can protect themselves from Big Pharma and Specialty Drug costs Why FDA approval of a drug doesn’t necessarily warrant covering it on an employer’s formulary Why paying for bad drugs that don’t work creates a disincentive for Pharma to create drugs that actually work Why employers need to start taking a more proactive role in selecting what drugs they are willing to cover and pay for Questions that an employer should be asking to ensure their pharmacy vendors have aligned incentives  The government’s role in creating policies that address data sharing, drug pricing, and transparency To learn more about Rx’n Go visit: (https://www.rxngo.com/) To learn more about OrchestraRx visit: (https://www.orchestrarx.com/) To learn more about VIVIO Health visit: (https://viviohealth.com/)

Podcast Show Notes Our podcast discussion today between Michael Andrade and  Pramod John, CEO of Vivio Health.  We discuss what Vivio Health does to deliver Precision Care in specialty medication compliance versus the traditional prior authorization process.  You may be surprised to learn some things that are contrary [...]

Specialty drugs represent an ever-growing driver of our overall enormous drug spend. Pramod John, our guest on this episode, is CEO of Vivio Health, which is singularly focused on using outcomes revealed by data and analytics to bend the hockey-stick curve of this spending trend. You can find show notes and more information by clicking here: http://bit.ly/2RJwTQL  

Topics: Specialty Drugs Data Analytics Net Acquisition Cost vs. Discount Pricing Improving Health Outcomes Specialty Drug Waste Prior Authorization Cost Savings Misaligned Incentives In this episode, Michael introduces you to Pramod John, CEO of VIVIO Health. Join us as we discuss how VIVIO Health, a specialty drug platform, utilizes data analytics and outcomes based models to help employers control their specialty drug spend. Here’s a glance at what we discuss in this episode: Pramod John’s software engineering and supply chain background and why he founded VIVIO Health How drugs may be prescribed off-label and physicians prescribing patterns may be influenced by payments from drug manufacturers How misaligned incentives have propelled our healthcare system into a cycle of complacency and how VIVIO Health seeks to break the cycle Why its critical to focus on specialty drugs to contain costs in Rx spending Why the current discount pricing model doesn’t work and leads to higher medical inflation year after year Why a focus on specialty drug discount guarantees in PBM contracts may not be in the best interest of employers and lead to the purchase of higher cost drugs when lower cost drugs are available Why the assumption that smaller companies like VIVIO Health can’t negotiate pricing competitive with Big PBM’s is false Why a stamp of approval from the FDA may not mean a drug is safe or effective The difference between effectiveness of a drug and efficacy and how many drugs on formularies are not impactful for improving clinical conditions they are designed to treat The problems with the traditional prior authorization process and how VIVIO Health has  changed the process to be a data driven approach to determining the optimal therapy for the specific patient How VIVIO Health’s data collection process helps an employer to monitor if the drugs that are being prescribed are actually working and effective The resistance from PBM’s to allow a vendor like VIVIO Health to carve out the administration, procurement and management of the specialty drug component VIVIO Health’s platform and how they are improving the employee experience and helping reduce waste in prescribing practices and employer spend on specialty drugs by 30% to 50% VIVIO Health’s transparent cost structure and typical ROI with current clients Obstacles that VIVIO Health has overcome to implementing their program with employers VIVIO Health’s website and contact information: (http://www.viviohealth.com/) , pramod@viviohealth.com

Pramod John is team leader of Vivio Health, a company that is reinventing the therapeutic use and supply chain for the specialty drug space. The Vivio Health plan solution is challenging the current framework of efficacy and extending it to true effectiveness in the real world. It also offers significant drug acquisition savings and simplicity for the patient by integrating the supply chain into a unified and data driven process. Prior to Vivio Health, Pramod was founder of Oration PBC (acquired by PokitDok) which was focused on giving back consumers control over their drug purchasing by capturing the prescription in the physician's office and providing real-time pricing options and automatic routing capabilities. Pramod was also VP of Strategy and Innovation at McKesson, the world's largest health care company. At McKesson, Pramod helped develop solutions that leveraged advanced technologies and business process improvements to optimize health care delivery systems, infrastructure, and supply chains. Earlier, Pramod founded and served as CEO of PacketMotion, Inc., a venture-funded startup in the enterprise network information and policy management industry. The company was later acquired by VMware. In addition, Pramod founded netExaminer.com, a managed-vulnerability assessment company acquired by SonicWALL (owned by Dell). Pramod earned his PhD in Electrical Engineering from the University of Illinois at Urbana-Champaign. He serves on the Boards of Mission Aviation Fellowship, a global relief organization, and 3Crosses Church in Castro Valley, CA. He also serves on the advisory board of Folia Water and as a mentor at StartX. 00:00 What aspects of health care that Vivio solves. 02:15 What would care look like by starting with the question, “What outcome do we want to see?” 04:40 Benefit designs. 06:00 Vivio's customers. 06:50 How this works from the patient side. 09:00 How this looks from a clinician standpoint. 13:00 Proactively building clinical models and data collection. 13:30 Results of Vivio's transparency. 14:45 How this comes down to a numbers problem. 15:00 “There's very little clinical to do in a clinical trial.” 17:00 The types of reports that Vivio comes up with, and who they benefit? 19:00 “How do we help people see, ‘Here are the one or two things you need to understand.” 22:30 You can learn more at www.viviohealth.com.

Pramod John is team leader of VIVIO Health, a company that is reinventing the therapeutic use and supply chain for the specialty drug space. VIVIO Health's solution is challenging the current framework of efficacy and extending it to true effectiveness in the real world. It also offers significant drug acquisition savings and simplicity for the patient by integrating the supply chain into a unified and data driven process. Prior to VIVIO Health, Pramod was founder of Oration PBC (acquired by Pokitdok) which was focused on giving back consumers control over their drug purchasing by capturing the prescription in the physician's office and providing real time pricing options and automatic routing capabilities.   Pramod was also VP of Strategy and Innovation at McKesson, the world's largest healthcare company. At McKesson, Pramod helped develop solutions that leveraged advanced technologies and business process improvements to optimize healthcare delivery systems, infrastructure and supply chains. Earlier, Pramod founded and served as CEO of PacketMotion, Inc., a venture-funded startup in the enterprise network information and policy management industry. The company was later acquired by VMWare. In addition, Pramod founded netExaminer.com, a managed-vulnerability assessment company acquired by SonicWALL (owned by Dell). Pramod earned his Ph.D. in Electrical Engineering from the University of Illinois at Urbana-Champaign. He serves on the Boards of Mission Aviation Fellowship, a global relief organization and 3 Crosses Church in Castro Valley, CA. He also serves on the advisory board of Folia Water and as a mentor at StartX. 00:00 Pramod's article on Amazon getting into Pharmacy & Stacey's Inbetweenisode 14. 00:45 The four key structural roadblocks Amazon would have to overcome to get into Pharmacy. 02:20 The issues in the pharmacy space & the hope that a disruptor can come in and fix these issues. 03:50 What Amazon would have to do to overcome the current issues in the drug market. 05:00 What innovation would Amazon have to bring to the market to truly be innovative? 07:00 The unmovable vested interests in the pharma industry. 08:15 The monopoly of the pharma industry on the micro level. 09:45 Why consumers go to Amazon. 10:15 The difference between the health care consumer market and other consumer markets. 11:10 The primary driver for consumers in the drug space. 12:20 The disjointed process of prescriptions and pharmacies. 13:15 What will lead to real disruption in this industry. 15:15 “Amazon doesn't just mean Amazon anymore.” 16:15 The difference Amazon has made in an unregulated market versus a regulated market. 17:00 “What are we going to do about these intermediaries?” 17:30 The economic problem in the pharma market. 17:45 The best strategy to completely change the dynamics of the industry. 18:10 Taking insurance, Getting in Network, E-Prescribing, Buying a PBM. 22:45 “You can't grow demand when three people control 70% of the market.” 28:50 The self-administered space. 30:15 “Disruption is going to come because we're getting ahead of where the money is coming from in the future.” 31:00 You can learn more at www.viviohealth.com.

Pramod John, CEO/Founder of Vivio Health is on All Business this week. Prior to VIVIO Health, Pramod was the founder of Oration PBC which is changing the way consumers purchase prescription medications by capturing the prescription in the physician’s office and providing all the pricing options and routing automatically. This episode is sponsored by Dunkin’ Donuts and Liberty Tax. Learn more about your ad choices. Visit megaphone.fm/adchoices

Pramod John who is the CEO of Vivio Health explains the tremendous challenge of specialty drug costs and how the great people at www.viviohealth.com are solving the problem. www.HealthReformExplained.com