Pediatric Pharmacy is More than Niche, It Saves Lives

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today joining our show we have the CEO and founder herself of Perfecting Peds. So excited to get into pediatric pharmacological care and all the different services this growing organization provides today. So Jena, thank you so much for joining our show.

Jena Quinn:

My pleasure. Thank you for having me, Brian.

Brian Urban:

So this is exciting. We've got to know each other here and there in some preparation for the show. But we're really going to get to know more about who Jena Quinn is through opening up really first off the top here. We love to have our audience get to know our guests and what brought you to founding Perfecting Peds, and we'll get into your organization in a moment. You're PharmD trained by background, but what led you to going into pharmacological science?

Jena Quinn:

Yeah. So I'm very much bred in just history and family background. So my grandfather, who was my mentor and best friend, he unfortunately passed a couple of years ago, but he was the reason why I chose to pursue pharmacy. He was brilliant. He practiced his whole life at GlaxoSmithKline, had over 150 patents, wrote ton of books, which I still read and have on my shelf, and he was the reason to why I specifically chose pharmacy. And I really realized early on that I am great at both math and science and that every single other subject is not my strength. So I just really honed in on that.

The other piece of it is why I niched down to pediatrics is actually my sister. So I have a brother and a sister. My sister's 10 years younger than me, so I naturally took on both a caregiver role, whether she wanted that or not, and still do today, as well as the sister role. So she actually had epilepsy growing up. And so from the early age of one, she suffered from epilepsy, and her seizures were very long. They were called grand mal, and she would have them for 30 minutes. And so there was a lot of time during her childhood that I would unfortunately have to see these seizures and then also be part of the team, for lack of a better word, or be the family member that was administering her Diastat, which is a rescue medication for people who have seizures.

But one episode in particular where she was swimming at a pool and I was, oddly enough, the lifeguard on duty and I had to rescue her from drowning was the culminate, I guess, or really the main reason why I decided to not only pursue pharmacy using my grandfather's background, but then also pediatrics. Because that specific episode still to date replays in my mind frequently, just the gratitude that she's okay, what medications have been able to do in her life to live a very normal... There were so many times they told us she wasn't going to have good neurologic function, but she is right now a very successful teacher, an early development teacher, and she got her master's and she's wildly successful. There was such a large role that medication played, which eventually led me to niche down even more into pediatrics.

Brian Urban:

Thank you for taking us through that journey. Obviously, family a big influence on why you got into pharmacy science research and then down into pediatric focus of pharmacy science. And I find that fascinating, because that's a theme we see across a lot of startup healthcare technology, health research firms across the ecosystem, and very much a similar story for yourself, and thank you for sharing that, Dr. Quinn.

Jena Quinn:

Yeah, my pleasure.

Brian Urban:

What I find so interesting about Perfecting Peds is the services you provide in terms of patient safety and also being able to address HEDIS measures as well. So it's interesting, obviously payers and care facilities, I found long-term care facilities and medical daycares to be the most interesting. We're going to get to that in a moment here, but I want to break down Perfecting Peds a little bit more. So young growing company with a very niche value proposition. So can you break us down into the core of Perfecting Peds and what you all do today?

Jena Quinn:

Yeah. So I'm going to make a long story super, super short, but essentially I realized after practicing in the NICU and the PICU for 12 years in surrounding hospitals that specifically children that are deemed medically complex, so two or more chronic disease states or five or more meds. Really obviously, as common sense as it sounds, the more meds there are on a child's profile, the more ways or the more chances of them having a medication error or what we call the need for medication management optimization. So organically over the years, I started actually following these families outpatient, because I knew that they needed an advocate to be the glue or the communication gap, for lack of a better word, and help navigate and be that one person that has all their meds on file.

And so what specifically we do is we provide what's called comprehensive med management. So people who are listening may have heard of MTM, which is medication therapy management. It's very similar, but it's more of a holistic approach, and we do all of it via telemedicine. So some people do it via the telephone. I don't find that as valuable as doing it via telemedicine because even last week, asking parents to show where are you drawing up on the syringe? How are you mixing the meds? We see that, and we... I last week personally identified two huge medication errors a parent was inadvertently making.

So we provide what's called comprehensive med management, which is we have a proprietary 13 step process that we go through, everything you can think of. So first, the basics, obviously. Is the med dose correctly? Is it being given the right way? Does the parent need additional information to give it the right way as far as it's mixing or surrounded by foods? Are there drug interactions? Are there adverse side effects that are occurring? The big one, is it effective? If it's not, should we be giving it? So that's a huge one. We find that a lot of times these parents are giving meds that aren't effective. They either aren't needed or we should be rotating to another drug.

So again, we have this 13 step program that we do for these medically-complex children, and it allows us to identify pretty life-changing quality improvement of life issues that can be alleviated. Like I said, from drug/drug interactions being rectified or a side effect that's occurring from the med, but either the caregiver or the parents/providers haven't tied that side effect to the med. So that's really what we do. And then we niche down even further, as you say, depending on who we're servicing. For example, long-term care, we have additional services that provide really antibiotic stewardship. We drive site grounds, and then we work via what's called collaborative practices with the physicians and the providers, NPs, PAs, in that long-term care facility to make sure that all of our clinical interventions not only being relate to the providers, but also implement it via a collaborative practice agreement.

And then just like you said for insurance companies, we're gearing it a little bit different. We understand that each insurance company is actually different in the metrics that they are honing in on for that year, for that quarter. And so we really focus on certain HEDIS gaps. There's actually 17 that we can help close. And so based on that insurance company, that payer, we work with them collaboratively to identify how can we help them meet the HEDIS gap closures that they're trying to strive for that quarter of that year.

Brian Urban:

So fascinating, and I really appreciate you breaking that down into the different stakeholders that you serve and then the services that you provide in specific. Let's dive a little bit deeper into the HEDIS. Our audience mainly filled with those touching payers or inside a health plan themselves or servicing them in various ways. So for that audience, and I'll say maybe the healthcare side as well, let's dive into some really specific examples here. So you mentioned your 13 step clinical pharmacist program. That's your propriety set of steps to go through with servicing individuals. There's something that you listed very interesting on your site, aside from some updates and also some statistics around spend reduction, patient safety. You talked a lot about hemoglobin A1C levels, statin use and kidney health evaluations for diabetic patients.

In terms of population, very big population, very long curve in terms of chronic condition management and also spend associated with that. So aside from really the experience engagement part of the patient, help us understand how you're addressing those HEDIS measures through your program that I think our payer audience would be really interested in.

Jena Quinn:

So yeah, I would love to answer that question, Brian. So we have, like we said, 17 specific measures that we can work with the payer to close. And what we're realizing is we'll take essentially the unattributed members if they're... It's rare, but there are some states that have pharmacists, pediatric pharmacists working, doing MTM. The only one we've been able to find, of course, are the one we're launching in, which is Minnesota. But essentially we'll take the unattributed members and what we'll do is specifically, like you said, the diabetes. That's one that we can easily help the provider. They found that when pharmacists intervene in what's called CMM, that because with the help of the provider, we can actually meet with them a little bit more frequently in the beginning via telemedicine and help drive quicker insulin changes.

When you think of a type 1 diabetic, quicker insulin changes that result in a faster and more efficient lowering of the A1C. So just by naturally having those touchpoints and being able to make insulin med adjustments, especially if we're in a collaborative practice with the provider. If not, then of course, we'll be communicating back and forth to their caregiver to say, "Okay, this is what I recommend as far as the dose adjustment or the insulin," with their endocrinologist. As long as they approve, then we make those adjustments. And then you have all those amazing things that are available now to patients with the continuous glucose monitoring that can be fed back to the professionals, which is huge too, because we can use those type of monitoring tools to then obviously be a tool, for lack of a better word, to make those medication changes.

So for asthma, we have a lot of... I find specifically with caregivers, there's a lot of caregiver education surrounding it, because sometimes they don't realize that the inhaled steroid that you're asking them to give twice a day is actually going to be what's going to save this child's life. So what I would see a lot of times when I worked in the ICU is that these parents didn't really understand the severity until their child was intubated in an ICU setting unfortunately. And so I would work bedside, and now it's even better, because I can work in the outpatient setting to really make sure that we prevent that hospital admission by just simply showing them and talking to them just real humans. And very simply putting that and showing how important that this inhaled corticosteroid is. Sometimes it's just an issue of them not understanding how important that is as a lifesaving med for their child, that giving it consistently every day is what's actually going to prevent them to be admitted in the hospital.

The other piece too that we really play a huge factor in on the outpatient's side is that, which happened to me personally, is sometimes you're getting insurance rejections, and these meds are so expensive that especially when you think of health equity or when you think of just economically not viable. For me, I had to call the insurance company. Then ask the physician to change the med to something that was in the same class but was covered under my formulary for my insurance, and then it was finally covered. But when you don't have that health literacy background, you don't know how to navigate that. So you show up at the pharmacy and they say, "It's a couple $100," and you think, "Well, I can't afford this." So at the end of the day, the child's going to suffer.

And so that's a huge communication gap that we help close. We're constantly talking to these... We have very frequent touch points, especially in the beginning. And so when we can ask, we identified either two ways. The caregiver's saying they can't afford it, so then we take the onus on ourselves and do the prior authorization or do the formulary change if it's through a CPA. If it's not, then we just provide call the doctor and give them... Just say, "Hey, can we change this? Here's what is covered."

And then the second thing that we can do, obviously, is just talking, having that constant communication with the caregiver. But the second thing is when we call to do what's called a med rec, we can tell the pharmacy will tell us, "Oh, this patient hasn't picked up their script." And that's another way that we can flag it and do some digging to see, "Okay, what is the problem?" And through that, we can identify, "Well, it's not covered." So there's two different ways that uniquely pharmacists can help close that asthma gap just by nature of our workflow.

The other ones that are very, I don't want to say easy, but come naturally for us to close are specifically those behavioral health measures. It's no secret that with COVID, that it really identified that there's a huge need for behavioral health, mental health advocacy around adolescents, right? So what happened in COVID is that all these adolescents struggled with their mental health during that time. I was actually inpatient in a general peds floor in ICU, and it turned into your traditional ICU general peds into seriously a behavioral health floor. That's how the amount of children that were in crisis. And so we would come in. Adolescents would come in with suicidal ideations or a suicide attempt, and it was alarmingly frequent.

So what that highlighted obviously, is that there's a need for more mental health providers. Primary care doctors, pediatricians, don't always feel comfortable in that mental health space, because they don't have a lot of training behind the pharmacology. Yes, they can screen for anxiety and depression, but then what meds do they select? Also, I think of ADHD, that's another one. So this is where a pharmacist really has a lot of education, knowledge, experience to help the provider use whether they want to or not. I'm a great proponent of pharmacogenomics, but use tools and use our expertise to select that best medication for that patient. Help dose-adjust it as appropriate. Make sure it's effective.

Like I said, make sure it jives with their genes, make sure it doesn't have any other drug interactions. And really, again, constantly talking to the patient, constantly talking to the caregiver. It can be as simple as, "Hey, my daughter started Lexapro. She's nauseous." "Okay, you want to cut that dose in half for two weeks, and then you want to increase it. And that will negate that side effect." So little tips and tricks like that go a long way to increasing compliance. And then also obviously have a life-changing effect on a child that's suffering with anxiety, depression. We also have all those tricks for ADHD as well. So those are HEDIS measures that we can close. And again, like I said, there's a lot surrounding mental health right now that we can hone in on.

Brian Urban:

I love the examples you made, Jena, because it all routes back to meeting those measures and those measures based on quality and how ratings are affected as well. So very helpful I think for our audience that you walk through those very specific examples. And not only do you provide these services, clinics, long-term care facilities, and also working as a navigator in between the patient and the payer as well is critically important, because that can be just a jungle that folks don't want to enter. And then that puts up a big barrier in terms of trust and medication adherence, access, affordability, everything. So I'm really glad to hear that you've taken that responsibility and you've taken it forward. So that's fantastic.

So Jena, I want to flip actually to your personal side here. So just saw that you were at a big summit in Minnesota. You're launching your services in that state, that sub-market there, but you also have three children and you're running this business and you're trying to get it going. For yourself, how do you stay balanced? How do you find the right mix of pushing your work and your message and obviously being present with your family and your health, your personal health too?

Jena Quinn:

Yeah. You're asking that Brian during a tough time. I currently have COVID. I don't know if you-

Brian Urban:

No. Oh, my goodness. You're working through it well. I would've never have told [inaudible 00:20:14].

Jena Quinn:

Oh, good. But that being said, what you saw is me traveling, which is really, really hard for me. I actually have to... So talk about work-life balances. I recently got a partner in business, which has been super exciting, but one of the original conversations I had was around this partnership is, "This is only going to work if we put our family first." So I have a six-year-old who's amazing. She lost her first tooth last night. It was so cute. A four-year-old and a one-year-old. And just like you're saying, what work-life balance looks like to me is not your traditional work schedule. So I work usually from 8:30 to 2:30 or 3:00. And I completely break until 3:00 to 8:00, and I make sure I'm completely present with my family. And then I log back in from 8:00 to 11:00, 8:00 to 11:30.

And then, so also with traveling, I told myself I'm not traveling more than three times a year. So I really prioritize. It's something that I don't do well doing. I get anxiety around it. Even when I came back, it was my first time traveling in 18 months. They're like, "Mom, it feels like you've been gone forever." Like I said, three is my max, a couple days. So what I do is I really... This summit was really important for me to be at, because it was like all the innovators in one room. Then other conferences especially then leaning in on my partner, divide and conquer which conferences we're at, because I don't want to be traveling all the time. My family comes first. So that being said, other things that I do is I will intentionally leave my laptop, take off my watch and my phone when all three of my girls are here and just put it in another room.

Brian Urban:

There you go.

Jena Quinn:

Technology free, free days and so... Not days, but hours where I just block it out so that I'm present. And then I do five days a week non-negotiably workout. I have history of anxiety and OCD. I'm very open about it because it's been well controlled forever, but that doesn't mean like any other mental health issues, it could come back. And so, one of the most effective things for me to stay on top of my game as a business owner and as a mom is if I work out. And so that's a non-negotiable for my work-life balance. But yeah, it's a continuous thing. It's not a perfect art by any means, but those are the things that I do that really help keep me in check personally.

And then I have three girls, so it's really important for me to show that you definitely can't have it all. But even simple things like, "Hey, can I ask the babysitter to help me do something?" It sounds so silly, but can I ask her, pay her some small cash to rotate the clothes for a season while I play with them instead of driving myself crazy about going through Benza clothes? So those are also some tools that through... I know we didn't talk about this, but doing multi-level marketing and sales for a little bit during my years has taught me to lean in and ask for help. And then if it's something that absolutely does not provide value to your life, is there any way you can ask somebody to help you out? And so if that equates to time with my kids, my poor babysitter, she's my right-hand woman. So again, any way that I can make more time for my kids to have that quality time is what I focus on as well.

Brian Urban:

That's excellent to hear. Finding ways to be more present and removing the things that are distracting. Jena, I tell you what, I've enjoyed our conversation. We've gotten deep on Perfecting Peds, good background on how you've come to launch this very exciting new venture that's impacting lives in a very unique way through all the different services you provide and partnerships you have with really important big stakeholders in healthcare and payers. So I want to look into the future a little bit here. So let's say you've grown your presence in the niche market here with pediatric pharmacy services, and you're picking up steam. You're making an impact. What will that impact be in the next three years? What's your biggest contribution to the stakeholders in lives that you serve?

Jena Quinn:

Obviously, it goes without saying, these medically complex children. So to date, there's no services like this. So if I think of a patient that my team worked up yesterday, like I said, something so simple, we identified they weren't using fluoride, but their child was three and five. So they would've non-negotiably, if they already don't, unfortunately, that's an easy way to prevent cavities, which makes a huge impact on their life. The mom did not get the communication that she was supposed to increase the seizure medication and the child was having increased seizures. Well, there we go. We made that intervention. She also wasn't told that she had to go get blood work to monitor for or didn't understand because she spoke Somali. So I had to get an interpreter, didn't understand the importance of going to get that blood work. And then the one child was on medication that can cause peripheral blindness. And so I helped her navigate how to make an appointment with an ophthalmologist.

So it really is... I'm just using one example to show hopefully we can take just those couple children. And really my big audacious goal is that in three to five years, that extrapolates to a hundred thousands of children. Because I know there's pediatric training pharmacists that are really itching to get out of the traditional space of hospital and academia. And we have the expertise. We have the whereabout knowledge and the desire to help these kids in an ambulatory care setting. So I hope it goes from almost a thousand to tens or hundreds of thousands, is my big audacious goal. And then really put clinical pediatric pharmacists at the forefront of accessible healthcare to children is my optimal goal in every state.

Brian Urban:

I love that, every state. So that's the vision. We'll be following on closely and cheering on Perfecting Peds and hoping that you continue to do the great work that you're doing, and just growth and impact for all the very complex lives that you help serve that are children now that will be adults soon. So again, Dr. Jena Quinn, thank you so very much for joining our little show. It's been a pleasure learning and hearing what your adventures have been recently.

Jena Quinn:

Thank you so much.

Brian Urban:

And for more exciting excerpts and insights, please visit us at finthrive.com.