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      Healthcare Rethink - Episode 58

      Healthcare Rethink host Brian Urban welcomes Matthew Hoff, CEO of A-S Medication Solutions. The episode delves into the transformative journey of A-S Medication Solutions, a company that has grown to provide point-of-care medication access across 50 states. The discussion covers the company’s history, unique approach to healthcare, and impact on patient experience and medication adherence.



       

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      Brian Urban:
      Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we have a treat, coming to the end of the year here. We have CEO of A-S Medication Solutions, Matt Hoff joining our show here today. So Matt, thank you for joining our show. And I'll say happy holidays at this time of the year in our recording session as well.

      Matt Hoff:
      Happy holidays, Brian. Thank you for having me.

      Brian Urban:
      This is going to be a lot of fun, Matt. We haven't gotten the pleasure of getting to know each other a little bit before the podcast, so we're going to do that on the podcast here, and really talk about ASM, the company the company that you led. It's family grown. You're across 50 states. It's a huge business for point-of-care medication access. So it's going to be so much fun to do all of that in the conversation. We always like to have our audience get familiar with our guests, so let's start from the top, Matt. How did you become the CEO of this amazing point-of-care medication access company? And tell us the family story, I guess. Take us through that. Who is Matt Hoff?

      Matt Hoff:
      Well, I'll do myself first and then go over to A-S Meds, so I'll start with the least interesting of the two. But A-S Meds has been a part of my family since 2008. But I really came into healthcare in a circuitous sort of fashion. I went to West Point, commissioned as an infantry officer, deployed to Iraq with the 82nd Airborne. And that's not typically the background that you see for somebody in healthcare.
      While there's plenty of guys who go and use the Army for medical school, I am not a doctor, not a pharmacist, nothing along those lines. But as I was transitioning out of the Army, I had a holdover or a pit stop in retail. So I was at Home Depot working in their corporate office while I did my MBA at night. And what I found was Home Depot is a great company, but I lacked and was missing a calling. Something that was bigger, something that felt like I was having an impact on the world, that I was having an impact on other people. And there was a family connection. My father was my predecessor as CEO and is part of the ownership team of A-S Meds.
      So the entire time I was doing all of my Military stuff and the entire time I was doing all of my MBA and regular job, he kept trying to woo me in, convert me over, bring me into the business. And it's one of the few things that I swore I would never do, and I couldn't have been more wrong. So been with the company since 2015. Working with family is unique and challenging, but I've honestly loved every minute of it. But yeah, the history of A-S Meds is a little bit more interesting than the history of Matt, so if you don't mind, Brian, I'll jump into that part.
      A-S Meds, until 2008, was actually part of Allstate. So yeah, it was founded in the '80s, 1988, by two doctors. And the story goes, they were on vacation with their wives in Japan. One of the wives got sick, which if you're a doctor and the severity of it, they wound up having to go to a hospital. And just doing that in a foreign country had to be quite challenging, as you could imagine. Then they go and they see what the notes are. So they have this part of the treatment plan, and there's obviously some drugs that they have to navigate the Japanese healthcare system. Now they have to navigate Japan to get to a pharmacy to navigate the Japanese pharmacy system.
      But to their surprise, the doctor handed them a prepackaged bottle of medication. So when they got back to the States, they're both from Chicago, they took a look at what the regulations were there and they founded A-S Meds. What we do is really simple. We make medication that's dispensable by physicians. So it's prepackaged, it eliminates the need for counting, all of the label has all the information on what the patient needs, and there's a software system that ensures 100% accuracy as the meds are dispensed. So it's really an access program.
      But the ownership team, in addition to Walter, was founded by his business partner back in 1968. So Jim was a pharmacist in Vietnam, came back to rural Nebraska, where he was from, and started his business with a mom and pop pharmacy in a relatively small town in central Nebraska. And as a serial entrepreneur, access was always one of the things he really took a lot of pride and focus in, especially in a rural area like Nebraska. You could drive hours just to get to the next town to find a grocery store, let alone a pharmacy.
      So one of the really creative things he did is he was the pioneer in putting pharmacies inside of grocery stores. He created that idea, and it grew and worked so well that eventually the grocery store chains decided that they wanted to do it themselves. But it was always that entrepreneurial spirit that led him to really new and creative things inside of healthcare.
      Then in 2008, Jim, Walter, and the two families wound up buying the medication dispensing business away from Allscripts. Obviously the EMR stayed on as its own company. But at the end of the day, our real focus is access, making it easier for folks to get the medications that they need regardless of where they are or what their circumstances are.

      Brian Urban:
      Such an interesting story, going back to the birth of the company and all things coming down to a scenario experienced in real life with family. I think a lot of amazing, now tenured, startups have really been out of those types of scenarios. At least that's what we've heard on our little show from a lot of the executives that we've talked to, like yourself. So it's nice that you follow the family lineage. Thank you for your service to our great country.
      That's a unique path. A lot of people do take that GI Bill opportunity to build a lot of education, and even go back as a medical practitioner to servicing the population of veterans or active service. So a very interesting path for you to have served, had your education through that, and then gone into the retail space, and now into a different niche of, really, the retail space in terms of points of care.
      It's amazing to see how fast A-S Medications has grown. You have over 3,500 active contracts with prescribers at points of care in terms of dispensing. That is a huge book to balance. And there's been other competitors that have entered the space. I think PillPack is one of them that got acquired by Whole Foods back in the day, and it shook up a lot of different multi-medication packs. And I'm curious now. It seems like those waters have calmed. There's not been a lot of M&A activity. But am I wrong here? Is there a lot of M&A activity? A lot of innovation in the space? Educate us a little bit more on that.

      Matt Hoff:
      I think what you're seeing in this space more than innovation, unfortunately, and more than M&A activity is pharmacies are really struggling these days. People hear physician dispensing and they think we're anti-pharmacy. And that couldn't be further from the truth. We're pharmacist-founded. One of our owners is a pharmacist. We run a good number of our own pharmacies. But pharmacies in general, especially at the big chains, are just struggling to provide patients with a good experience.
      And when we talk to our clients who run healthcare centers, clinics, and physician's offices, the number one word we always hear is experience. They are hyper-focused on giving patients a great experience. And it's not trying to drive a net provider score, it's not trying to drive up a metric. It's because they know a patient that has a good experience is going to come in for treatment, they're going to see their doctor, and they're going to get the care they need.
      I think pharmacies by and large are not providing a patient-first experience. And that lack of patient focus is making it tougher for folks to go and have a great experience. If it takes 30 minutes to an hour to pick up your medication at most pharmacies, you're not going to have a great time. So what we do, and I think what PillPack and a number of other companies are doing, is recognizing that there's a couple of things in the pharmaceutical space that are really hindering someone's ability to get care.
      I think patient experience and even just basic access. Can they even get to a pharmacy that's open? Those are two huge things. Cost is obviously a major part of that. We've been doing cost-plus pricing since 1988, but that's something that you're hearing more and more: finding the way to get directly to generic and increasingly brand manufacturers, to cut out middlemen, and lower costs. That becomes incredibly important to making sure folks can actually afford their medication.
      But more than anything, it's access and experience. The numbers vary, but it's a surprisingly low percentage of patients will pick up their prescription and stay compliant with the medications. So knowing that, if you're a provider, which are the folks that we're selling to, the doctors, the mid-levels, the companies that run these great health centers, and you find out that only 60-ish percent of your patients are getting the medications that you prescribe, well, how can you get healthy without following the doctor's orders? So access and accessibility, that really becomes the main driving factor. And there's no better way to do that than handing a simple, easy prepackaged bottle of medication to a patient right when you see them.

      Brian Urban:
      I think it's so interesting that, in preparing for our conversation, Matt, I looked at something that you just mentioned, access and then, as a metric, just looking at it from a perspective of adherence. I was curious of, what are some of the research publications out there talking about medication adherence today? And not all of them really go deep in experience, because I think that requires a very strong qualitative analysis tact that not a lot of researchers have access to get into and interview all the different consumers of retail pharmacies.
      But I looked at a study from 2011 and then I recently looked at a study that was closer to 2019. I thought was really interesting is, in 2011, it talked about medication adherence purely from an access standpoint, a discoordination of efforts, tech, communication, patient and prescriber. And then I looked in 2019 and it was talking all about socioeconomic barriers, really. Not only just the affordability, but people getting there, getting it to their home, the right place. And then for them, from a behavior standpoint, taking it as written without fear, and having trust in healthcare as a system. So these two studies, really only like eight years apart, drastically different, with similar researchers.
      So with that said, Matt, I want to get your perspective on medication adherence. What ASM does, I think, is a huge medication here is play. But also I'm curious of what you're seeing across your 50 states that you're dispensing in as the biggest barriers to adherence or the biggest challenges imposing on adherence. Could you take us through a little bit of that?

      Matt Hoff:
      That's a great question, Brian. When people ask me about, what's the biggest barrier at a client? The response is, if you've seen one, you've seen one. So across different demographics, across different patient populations, across different circumstances, you'll see a number of areas where it's just going to create a big barrier that keeps somebody from getting their meds. So we work in a couple of different marketplaces. Our biggest one is in employer health. These are employer-sponsored health centers that are either on site or near site. And patients can go into there if their employees are dependents. They see their provider and their provider writes them a prescription for their medication. And what's great about them is, usually they give the meds away for free to the patient because they're trying to increase access and lower the overall cost of care. Spend a little bit upfront to prevent a hospitalization in the future.
      It's an ounce of prevention is a pound of cure. And in those circumstances, even meds that would get prescribed outside of the clinic, you're seeing a much higher adherence rate because you've taken that cost factor away. I mentioned we do a cost-plus model, and that obviously brings up cost-plus pharmacy. And I think there's such a big drive towards that, and some of the other things you've seen in the news recently around price, that that has to be the biggest barrier.
      But I don't think access should be taken for granted. Across the country there's been pharmacist walkouts. There have been pharmacies that have had to close down their hours. We partnered with a group of urgent care clinics in the Rocky Mountain area, and they brought in dispensing purely because of the fact that there's only one pharmacy in town and it's only open six hours a day. So someone comes into the urgent care, they broke a bone, they have some sort of issue that requires some sort of care, they couldn't get a pain medication. They might have to wait several hours before the pharmacy even opens. So that just becomes a simple matter of access. So I think when you look at it, of course the financial piece to it is enormous, but just the ability to go get to the medications becomes an even bigger barrier. And if you take that to some of the most disaffected communities, the ones that are generally in the poorer economic areas, access becomes even more challenging for them because they have a very hard time finding pharmacies that are open and accessible to them.

      Brian Urban:
      Yeah. Yeah, that's probably the most, I think, unique barrier that's been popping up more and more. As you talked about the workforce changing, burnout goes across the spectrum of healthcare from a practitioner standpoint. Not just those in urgent emergent care in a hospital setting, but it goes across a lot. So I'm glad you said that, because I think a lot of people forget that. That's quite amazing.
      I think what's really interesting now is the experience being built into or being put back into the retail field. And we've had some amazing folks on the podcast, from leaders in Walgreens, leaders from clinical resource organizations, and they all have said what you've said, but how do we deliver on that, Matt? How do we try and transform the experience of pre-pandemic, of old, we can say, because that being a milestone in our society in a lot of ways for accessing healthcare. Now post-pandemic and going forward, what are some iterations that we need to take as leaders in healthcare to have a better experience for people going into a physical location to pick up medication? And then to your point, the ounce of prevention, it's huge downstream in terms of medication adherence leading to less hospitalizations, less need for healthcare. So how do we build a better experience that we can then measure in the same way going forward? How do we start to do this?

      Matt Hoff:
      My opinion's always been that healthcare needs to come back to a KISS model. The keep it simple, stupid. There's so many smart people in healthcare, much, much smarter than I am, that are always looking for the new, the best, the biggest thing, the next piece of technology, the next process, the next, this, that or the other. All those new great things are just tacking on another solution, another complication. But what people need to realize is, at the end of the day, you have a very overworked medical staff trying to execute on complicated programs that directly affect someone's health. So not only are they working hard, but the consequences if they make a mistake are pretty high.
      You have patients that... nobody ever goes to the doctor with a smile on their face. It has to be one of the scarier things. There's a reason you're going for it. Either you're getting older or you have a condition. So the more we can simplify healthcare, the better off it's going to be. So instead of trying to do more, let's try to do less. What steps can we eliminate? What extra person, what extra process can we take out of the patient's routine so it's easier for them to focus on the most important things?
      And I think when you look at adherence, when we go to conferences and when we talk to suppliers, we see everything from smart bottle caps to 100 other different things that could add a new way of trying to measure something. Well, the simplest way to make sure someone's getting their drugs is you hand it to them. And if they have an issue where, the last time they took it, they had an adverse reaction, or they haven't been taking them because they don't like the way it makes them feel, they'll probably tell you to it when they put the bottle in your hand, versus somebody who, a script gets sent out to a pharmacy and they can say, "Okay, I'll say yes, doc. Sure thing." And then they go and just drive straight home. So it's a little old school. It might not seem very innovative, but you cutting out some steps, some what I view as unnecessary steps, it makes the process easier and more understandable, and friendlier for both the patient and for the provider.

      Brian Urban:
      It's interesting, Matt, because I think the philosophy of getting simple has not been the theme of healthcare in the last, really, 10 years. It's been more faster, more tech, more virtual digital touch. It's been more and more and more. Apps, everything. So it's refreshing to hear that. And also, it creates a leaner playbook. I think you see the retail pharmacies out there needing to cut costs in the next year at these very huge figures. How do you do that? You cut back and invest in the things that are of savings nature or avoidance nature. So I'm curious, a bit of a philosophical question for you here because you've been in the game for a while. You've advanced a family business here to a very high scale.
      I'm curious, are you seeing, across the industry, healthcare, maybe not just in medication access, are you seeing the lack of understanding from healthcare, what they put first, the person or the patient? Is it still a very hard business model for a lot of healthcare institutions that you interact with? Or are they starting to really think about the person, the household, the family? What do you see in the shifting focus, the person versus the patient, in healthcare these days?

      Matt Hoff:
      I definitely think that there's a big shift towards the patient. Now, some of this could just be I have 3,500 really great clients, and they all have a patient-first focus. So I may be a little biased and skewed because, if you're a provider or a clinic operator or a healthcare system and you opt into doing an extra step to make sure patients can get their meds easily and affordably, well, you've already really bought in from the beginning on, I'm providing an exceptional service for my patients.
      So again, I may be a little biased in this, Brian, but I think that I've been seeing a lot of patients and a lot of providers that are really, really focused on driving up that patient interaction.
      And I think that's an absolute difference-maker because it's a competitive landscape for most of my clients. Their patients could go to them or could go someplace else. So providing a better focus for the patient and a better experience helps make sure that they drive up their capture rate, which drives up their adherence and all their other things they're trying to do. Outcomes has always been a buzzword that we hear. And we hear outcomes, probably for the last six years, that's been the major one.
      And I think that recently, especially post-COVID, there's been an understanding that your ability to get outcomes, your technology that's supposed to bring better outcomes, really can't do anything if you can't get the patient in the door, or the virtual door, in the first place. So I think there's been a realization of, they have to go down one step baser to be able to really have the impact, and focus on the patient experience, means that they're able to get those folks in. And then they can go worry about the outcomes, once they're actually in there and seeing their providers.

      Brian Urban:
      Look, the outcomes will follow if you really address the needs first. Yeah, that totally makes sense. It's good that's this shifted mind focus. I think that the outcome-heavy nature of everything that we talk about from metrics is all, what happened? At the end. Not, what did you do way upstream that contributed toward X, Y, Z? So yeah, I think very insightful to hear that. And I think what's really exciting, it's what's ahead. Matt, you've really taken the business to scale. From an outsider perspective, how much more do you grow? What else do you do for yourself, that does a lot of point of care dispensing, and maybe the rest of the industry? If you want to comment on that. But I'm curious, where do you go from here in terms of innovation or in terms of continuing to establish higher medication rates, better patient experience? Where does ASM go from here over the next few years, Matt?

      Matt Hoff:
      I'll tell you where my big focus has been the last year and a half, Brian, and what I hope to see in the next probably two, three years. Medication dispensing is regulated at a state level, so there's a big issue with equity across states. So if you're a patient in Florida and you walk in to see a provider, provided have all their Is dotted and Ts crossed on their permits and licensure, any patient there can get a medication, whether they're seeing an MD or an NP or a PA. If you have prescriptive authority, you have the ability to dispense. So this isn't anything related to scope. It's if you can prescribe the medication and send it to a pharmacy, you can dispense a prepackaged medication. Well, that's next to impossible in states like Texas and New Jersey.
      I think that that does those states a disservice. I'm in Georgia, and an MD can dispense, but the urgent care down the street for me, their mid-levels can't dispense, even though the mid-levels can prescribe. So again, we're not asking for any scope creep. That's way outside of our pay grade and way outside of what our focus is. But if a prescriber can write the medication, they should be able to dispense it.
      And you look on the employer health marketplace. If you have a company with an office in Texas and an office in Indiana, Indiana patients could get their medications onsite at a $0 copay. Texas patients couldn't. You have a Medicare Advantage group, and those groups really rely on star ratings and are really, really incented for outcomes. And if they have an office in Arizona and an office in Texas, well, the Arizona office is going to do a lot better because they can ensure adherence. That Texas office is going to have a hard time making sure their patients are getting those medications that they need.
      So what we'd really love to see is equity across all 50 states to make sure that patients have access to the care that they need in the pharmaceutical space. We don't see pharmacies opening up new locations. I mentioned earlier that there has been walkouts this year. I don't really see that shifting in the next couple of years because the barriers and the requirements to become a pharmacist are, rightfully so, very tough. You have to be... you're a doctor of pharmacy. No slouches allowed. So the more we can do to make sure prescribers can get medication into patients' hands to free up the pharmacists for the more complicated cases to make it so they have manageable workloads, it's really a balancing act across the whole health ecosystem.
      So this is a great, easily accessible pressure relief valve so that common medications like antibiotics like amoxicillin can be dispensed at a clinic. A patient who's been stabilized on their atorvastatin for years can get it right from their clinic without having to have another body waiting in line, further stressing an already stressed system.

      Brian Urban:
      Wow. The pressure relieving valve analogy you just made there, I think, is very clear for our audience who isn't really deep in this space necessarily but has an understanding from their perspectives. So I think that's extremely helpful. Very helpful for myself, too. So it's interesting. It's not like a policy reform, it's policy transformation. And that's one of the bigger barriers we've seen across, obviously, Medicaid expansion, the benefits and programs associated with those lives across the United States as well.
      So hopefully that type of transformation takes place. I see Matt as a big influencer, having a huge book of very valuable customers that you're dispensing onsite multi medications to the prescriber for the patient, and really hoping to improve experience. I'm excited to see what's next for ASM. And Matt, again, thank you for joining our little show here today. I feel a follow up coming on, so thank you again for your time here today.

      Matt Hoff:
      Absolutely. I'd be happy to join anytime, Brian. I can't thank you enough for having me and I can't thank you enough for pushing what you're pushing in the industry, because it just makes everything better for everybody. It's so multifaceted. I see the world through a straw, which is medication adherence, but there's so many things that affect patients' outcomes, and you're doing a great job of helping drive the world in the right direction.

      Brian Urban:
      Aw, thank you, Matt. You definitely made my day, I'll tell you that. Made my podcast here for the day. And again, thank you, Matt Hoff. CEO, ASM. That is A-S Medication Solutions. And for more exciting excerpts and insights, please visit us at finthrive.com.

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