February 2021 - MDisrupt

The Pandemic Fast-forwarded Digital Health. What’s Next?

by Ruby Gadelrab | Feb 25, 2021

The Motley Fool recently interviewed Ruby Gadelrab, MDisrupt’s CEO and founder, about the most important 2021 trends in digital health.

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Motley Fool: Why don’t we start with a brief introduction about you and MDisrupt?

Ruby Gadelrab: I have been in the biotech, healthcare, and digital health industry for about 24 years on the commercial side in various marketing and executive roles. I have worked at some notable companies in the space, including Affymetrix (now part of Thermo Fisher Scientific) and Invitae, a genetic information company. My last employed role was VP of commercial marketing at 23andMe.

Before founding MDisrupt 18 months ago, I consulted for two years for about 25 digital health companies, and I started noticing a pattern. I realized that these companies were seeking experts that understood the healthcare ecosystem. And these experts are hard to find.

MDisrupt is a platform that connects the digital health industry to the scientists and healthcare industry experts that they need to build, commercialize, and scale a health product both quickly and responsibly.

We currently work with a variety of experts including physicians, health system leaders, scientists, health economists, behavioral scientists, and lab operations and commercialization specialists.

Rapid innovation

Motley Fool: Let’s start broadly by looking at the digital health space. What were some of your most interesting observations in this space in 2020?

Ruby Gadelrab: Let’s start by defining what digital health is. Digital health is defined as the use of digital technologies and genomics to solve key problems in healthcare. So think algorithms, AI, data analytics, wearables, apps, telemedicine and virtual care, genetic tests and personalized medicine solutions. Healthcare typically has been slow to adopt digital health. Many of these solutions existed before the pandemic but struggled to get adoption.

So the high-level observations in 2020 as the pandemic hit us are these: The pandemic revealed how unprepared our healthcare system is for an event of such magnitude. The pandemic also revealed many of the inequity and access issues around health and digital health.

BUT there are silver linings. There is a fast forward button pushed on digital health and there are three themes:

Investments – It was the highest-ever year in digital health: According to Rock Health there were $14B of investments in digital health in 2020—an increase of 72% over the previous landmark year of 2018.
Speed of innovation – The FDA has issued over 300 emergency use authorizations for tests and devices during this pandemic. Many digital health companies quickly pivoted to create solutions for COVID-19. One example that’s particularly relevant at this stage of the pandemic is Clear Labs. They developed a fully automated platform that can screen and sequence the SARS-COVID virus in under 24 hours. Now, with the new mutant strains of the virus, this is particularly relevant for epidemiological applications in monitoring and surveillance.
Adoption of telehealth and virtual care – This is an example of a technology that had been around for years but there was a reluctance about adoption—because of privacy issues, and because the Centers for Medicare and Medicaid Services (CMS) was only reimbursing telehealth visits in certain circumstances, for example in rural areas. But the pandemic forced patients, providers, and payors to experience different ways of delivering healthcare. In March of 2020, CMS reported that telehealth visits jumped from 10,000 per week to over 300,000.

Beyond COVID

Motley Fool: How do you expect those trends to evolve in 2021?

Ruby Gadelrab: For telehealth and virtual care, this is just the beginning. Providers and physicians experienced the comfort and convenience of delivering care from their homes. That trend will continue, especially now that CMS has released a policy showing that over 60 new telehealth services will now be reimbursed by Medicare.

Often when we think about telehealth we think of primary care services, but actually I think it will extend into areas of specialized care. One of our clients innovating in this area is Genome Medical. This is a genetics-focused medical practice that’s delivered by telehealth. They are democratizing access to the very limited number of genetics experts in the country.

For sure there will be more COVID solutions. 2020 was about getting tests and vaccines out quickly, but 2021 will be more about back-to-work solutions. For example, Mesa Biotech built a point-of-care system that does rapid PCR of COVID and provides results in about 30 minutes outside of a lab setting. This is important as we consider back-to-work solutions and ways to bring testing closer to the consumer in the workplace or in retail pharmacies, for example. They were actually acquired by ThermoFisher recently for $550M. Many of these companies are thinking about the world beyond COVID. What they can do for COVID they can potentially do for other infectious diseases, too.

There will also be increased demand for at-home testing and monitoring solutions. Throughout the pandemic, we have seen states struggle to deliver COVID-19 testing efficiently. They have faced challenges with test availability and distribution as well as long turnaround times. And as we see new surges in infection rates, these problems have worsened.

Everlywell is one of our clients at MDisrupt and is an interesting example in this category.

Their mission was to democratize and simplify the lab testing process and get high quality lab testing straight into the hands of consumers with applications such as A1c, hormone testing, etc. In May, the FDA issued an emergency use authorization, making Everlywell’s test the first stand-alone at-home sample collection kit for COVID-19 and making them the first digital health company to receive an EUA.

Everlywell has now shipped more than a million COVID-19 test kits, validating both consumer demand for at-home testing and consumer willingness to self-pay for diagnostic testing, In November Everlywell raised $175M to expand its consumer lab testing and digital health offerings and now has a valuation of $1.3 billion.

Delivering better engagement

Motley Fool: You worked at 23andMe in the past and with Everlywell during the pandemic. What’s your future vision for the genetic testing industry? Are we just now seeing the tip of the iceberg on what value can be unlocked with this kind of innovation?

Ruby Gadelrab: What companies like 23andMe and Everlywell have done is demonstrated a few things that are critically important to the future of healthcare as a service:

That consumers and patients can effectively collect a sample at home and ship it back to the lab.
That consumers can accurately report phenotype data.
That a segment of the population wants direct and easy access to its health information and is willing to pay for it.
That they can deliver engaging consumer experiences and engage consumers in conversations around their health before they get sick.

In essence, what they have built is a novel way of delivering healthcare information and patient engagement experiences. And, quite frankly, it’s a much better experience than what we can get from our healthcare system.

So I think the future of this space largely depends on who is willing to pay for this type of access, experience, and convenience. For sure there are segments of consumers who are willing to pay. But if companies like these can generate data to showcase improved outcomes, then there are potentially new stakeholders willing to consider paying for solutions like this, including employers, payors, and some health systems.

An example of this is Renown Health in northern Nevada. They launched the Healthy Nevada project where they offered patients in their system free genetic testing at home. They have had over 50,000 patients from within their system sign up and get access to their genetic test results.

Addressing health disparities

Motley Fool: The pandemic has revealed inequity in every corner of the world and revealed many health disparities. What did the pandemic teach you about the US healthcare system and what solutions might be effective?

Ruby Gadelrab: The pandemic was like putting a magnifying glass over our health system and showcasing the biggest gaps and health disparities. Everything from the most vulnerable populations contracting COVID at a higher rate to vulnerable populations suffering more severe symptoms when they contracted COVID, to who had access to testing if at all.

We saw that Black and minority populations were particularly impacted. And this started the big and tough conversations about ALL the disparities in health.

A couple of examples—most of the largest genetics databases are based on Caucasian populations. These databases are now being used to create diagnostic tests and therapeutics. Some of these innovations just won’t be as effective when you use them on minority populations. Second example—many wearables use a particular type of light to monitor heart rate. This type of light is not as accurate on people with darker skin tones. So when we think about wearables being used in a medical setting to monitor cardiac issues, these are the types of things we have to take into account.

One company innovating in this area is 54gene. They are building the world’s first biobank based on African genomes. Their goal is to close some of these gaps in health disparities by ensuring that people of African descent, globally, will be represented in the next generation of diagnostics and therapeutics.

Of course the discussion about health equity extends beyond race and into many other minority areas. Are we doing enough for women’s health? For eldercare? For the LGBTQ community? Clearly the one-size-fits-all model of healthcare isn’t working. It has to get more personalized and it has to address underserved populations by understanding their needs and their unique challenges.

One positive thing that has come from the pandemic is that there is a renewed focus on this, from investors and digital health innovators alike. We are seeing a new class of investors emerge who want to invest in minority founders building health companies that can address some of these issues.

Key steps for digital health

Motley Fool: A lot of your work with MDisrupt is advising and consulting with digital health startups. What do you tell them about competing with the big tech giants getting involved in healthcare? What competitive edges do smaller health-specific startups have over the Amazons and Microsofts of the world?

Ruby Gadelrab: Building health products that scale is really hard. And it’s hard, it’s expensive and it takes time, for everyone, whether you are a big tech company or a smaller digital health company. This is for a few reasons:

The user, the influencer, the payor, and the consumer of health products are each different stakeholders with different incentives.
Healthcare is highly regulated and the regulations in each country and sometimes in each state are different.
You can’t test and iterate quickly like you can in tech. You need to do the studies to generate evidence to prove that your product is safe, effective, clinically useful, and that the economics work. These studies can often take many years.
You have to find your earliest adopters in the healthcare world. That often involves building expensive specialized sales teams and deploying KOL programs.
You have to get your product reimbursed and engage the medical community and medical societies.

These considerations apply to everyone, whether you are Amazon or Microsoft or smaller companies. So my advice:

Since it’s impossible for one company to solve all of healthcare, pick a specific niche area that you know really well. If you don’t know it through experience, engage healthcare experts. Ideally, hire a chief medical officer (CMO) that really knows the space and the problem you are trying to solve, and engage your target audience early and often.

Figure out early who you expect to be using the product and who is paying for it—because the type of product and commercial strategy you may build if a consumer is paying for it may be vastly different than if you expect it to be used in a healthcare setting.

Do not skimp on regulatory or evidence generation. This is an area where there are no shortcuts. The studies are critically important at every stage of commercialization. You need them to work with regulators, to convince physicians to adopt your solution, to engage medical societies and to build the dossier you need to convince payers to pay for it.

Four ways to improve outcomes

Motley Fool: We’ve seen certain healthtech companies be successful by occupying a niche where there are inefficiencies, and using technology to create value by streamlining or simplifying. What areas in the health space are still ripe for disruption?

Ruby Gadelrab: The $3.5T healthcare industry is ripe for digital disruption. Healthcare is at an inflection point. It’s changing from being transactional when you are sick, into an ongoing service designed to keep you healthy.

The health system of the past 100 years wasn’t about health or care. It’s effectively a sick care system. We need a health system that starts to take care of people before they get sick—outside the walls of a hospital and more in their daily lives, by continually engaging with consumers BEFORE they become patients.

The changes over the next few years will be driven not only by technology but also by how it’s going to get paid for. We are moving from a fee-for service system (where more procedures makes more money) to a value-based care system where health systems and providers are reimbursed by better outcomes.

So for digital health companies to be successful they need to demonstrate that they can improve outcomes. And typically these fall into one of four categories:

Health outcomes—Can we predict and prevent disease or do a better job of managing it outside of the health system if it occurs? Medication compliance?
Patient and physician experience—Are there solutions that improve the experience for both?
Access—Can we simplify access to delivering healthcare for more people when they need it, either inside and outside of a healthcare system?
Reducing costs—Can we create efficiencies in the health system or a clinical workflow that can increase productivity or reduce costs?

At MDisrupt, when we work with digital health companies we encourage them to think about which of these four problems their solution addresses, and how to generate the evidence to showcase this.

The best way for companies to do this, in my opinion, is to ensure that they engage scientists and health industry experts early and often throughout their product development. Clinicians understand the healthcare system, they see the problems and they know what the effective solutions need to be—and they can add tremendous value to digital health companies.

Connecting truth-seekers to talent

Motley Fool: Let’s talk about the medical diligence part of MDisrupt. Diligence is important for investors in any sector, but in healthcare, the stakes can be life and death. Of course, investors can only base their decisions on information the company makes available, and we’ve seen instances of management either withholding certain material info or even outright lying at what its technology is capable of. What have you learned about medical diligence and how can investors have more confidence in a company by harnessing this knowledge?

Ruby Gadelrab: This was a really interesting experience for us when we first founded MDisrupt. Investors weren’t really our first customers.

What we found early on is a breed of digital health companies where the founders were truth seekers and determined to create impactful, responsible health products and get them to market quickly. Many of these founders had business or tech backgrounds. They understood that access to health industry expertise was critical to their success and yet that talent is relatively hard to find. They were asking us for chief medical officers, regulatory experts, health economists, lab scientists, product managers and behavioral scientists.

At the same time, we were inundated with hundreds of messages from scientists, clinicians and other health industry experts asking us how they could get involved in lending their expertise and knowledge to digital health companies. We quickly realized we needed to build a platform that could connect digital health companies to the experts.

I guess like other start-ups in this space, finding true product-market fit is when the market pulls you in a specific direction. So that’s where we focus now, on helping the digital health companies connect to the experts so they can get to market quickly and responsibly.

Of course, if investors want access to our experts to help them diligence their investments for clinical and commercial viability, we are more than happy to help them too.

Ruby Gadelrab: Here are the top trends we see at MDisrupt:

Telemedicine and virtual care
New Covid solutions focused on getting back to work
At-home testing and monitoring solutions
Behavioral and mental health solutions
Femtech
Teams which have a good balance of tech and healthcare folks.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Where is DTC Healthcare Headed? Lessons from 23andMe’s SPAC IPO

by Ruby Gadelrab | Feb 19, 2021

MDisrupt CEO and founder Ruby Gadelrab shares her insights in a recent Clubhouse MedTech interview with Henry Peck. Ruby has worked on the commercial side of biotech, healthcare, and digital health for 24 years. She founded MDisrupt to connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Henry Peck: Let’s talk about 23andMe. What role did you play there and what were the key challenges you were trying to solve for the business?

Ruby Gadelrab: First, some disclaimers—I left 23andMe four years ago. So I’m not speaking on behalf of the company. The opinions are my own as an industry observer.

I was hired at 23andMe just after the FDA had told them they had to temporarily stop selling health products to consumers. My role was to help them figure out some of the non-consumer business models. These included:

23andMe for medical professionals. How do we educate and engage medical professionals on genetics and the reports that 23andMe were providing?
23andMe for educators. Could a genetic test be used to teach university and medical students about genetics, statistics, and ancestry better than a textbook could?
23andMe for research. How could the 23andMe experience be used in a research setting to improve recruitment in population health studies? For example, by giving people interesting data about their ancestry and eventually their health, can we improve recruitment and longer term engagement?

How 23andMe broke new ground

Henry Peck: In your opinion, what makes 23andMe’s product offering so successful and “sticky”?

Ruby Gadelrab: Let’s break this question down into two parts—why is it successful and sticky to consumers, and then secondly why does it have huge potential as a business.

Let’s start with consumer experience. Every aspect of our lives has been digitized through technology. Healthcare is undergoing that same revolution. 23andMe was the first company to work closely with the FDA to create a product that consumers could buy directly themselves that gave them personalized insights from their genetics about their health and ancestry. Over 10 million people bought the product and clearly, ancestry was one of the killer apps, but consumers also had an interest and hunger for health information and trait information.

23andMe made that information really easy and engaging for consumers to understand and interact with. They made the information digestible at an eighth grade literacy level and they explained complex genetics concepts simply enough for people to understand.

23andMe gave consumers the ability to participate in research for causes and diseases that they really care about. During the time I was at 23andMe over 80% of consumers were consenting to research.

Business value

Henry Peck: So what does that mean in terms of value to the business?

Ruby Gadelrab: 23andMe has one of the largest genetic databases in the world, with over 10 million people genotyped and consented to research. An individual genome isn’t really that useful unless it’s paired with phenotype and/or clinical information and aggregated with millions of other genomes so that we can see the patterns and discover new genes that are important for diagnostics and therapeutics.

What’s unique about 23andMe is that the database is recontactable and engaged and the company has the ability to collect additional phenotype data—I believe they currently have over 30K phenotypic surveys completed daily. Effectively, they have built a crowdsourced research platform where you can quickly make novel discoveries which can be applied to building new generations of therapeutics and diagnostics.The value they add to research is clearly recognized by pharma. Drug development is a long and expensive process. That’s because:

It takes 7-10 years to bring a drug to market.
90% of drug candidates fail.
$2.6B is the average cost of getting a drug successfully to market.
It’s incredibly difficult to recruit patients into clinical trials and engage them for the life of the trial.

How do we create efficiencies in this process? The theory is, with the combination of genotype/phenotype data and a recontactable database, can you accelerate the pace of novel drug discovery? Find new drug targets and bring them to market faster? 23andMe has a partnership with GSK where they currently have over 30 therapeutic programs in the areas of oncology, cardiovascular disease, immunology, neurology, and metabolic disease, so clearly pharma sees the potential of such an asset.

4 keys to health product success

Henry Peck: Let’s talk about 23andMe’s recent announcement. How do you think this next step will change the company and their business? Any bold predictions for the future of 23andMe?

Ruby Gadelrab: Despite the numbers, the genetics industry is still in its infancy. And it’s still not a routine part of our healthcare system. Our healthcare system as it stands today is neither about health nor about care—it’s actually a reactive sick care system.

One of the few silver linings of the COVID-19 pandemic is that It showcased the huge gaps in our healthcare system that are ready to be addressed by those who are daring enough to try and disrupt it. Effectively, the pandemic pushed the fast forward button on digital health adoption. And one of the biggest gaps that was revealed is the problem of access.
Everyone from within the health system and outside of it recognizes that it has to change—we have to:

Improve access to health information and health services
Build solutions that can predict and prevent disease before people ever get sick and deliver the right interventions to the highest risk populations at the right time
Have a more holistic view of individuals’ genetics, lifestyle and behavioral data as well as social determinants of health in order to figure out what the right interventions are and who needs them most urgently
Develop tools for individuals to have all their health data consolidated in one place.

At MDisrupt we see many digital health companies trying to address some of these challenges. We work with them to identify which problems they are trying to solve that matter to the current healthcare system. So generally for a health product to be successful and gain widespread adoption it has to improve one or more of these four areas:

Health outcomes
Experience—for patients and for physicians
Access to healthcare products or services
Reducing healthcare costs.

When I think about how companies like 23andMe have played a role in this (beyond therapeutics, which we already talked about), here’s what comes to mind:

23andMe has built a platform that provides easier access for consumers to gain insights about their health.
They have built an experience for consumers to engage in conversations about their health often before they are patients—and this experience is more engaging than what we currently see from our health systems.
The previous generation of genetic tests focused on inherited rare diseases that affect 1% of the population.
The next generation of genetic tests will focus on common chronic diseases that affect many of us, such as diabetes, cardiovascular disease, hypertension, and obesity. 23andMe’s genotype/phenotype database gives them the power to develop this new class of tests known as polygenic risk scores.

One caveat to this is that these types of tests are difficult to get to market as hey require huge datasets, the studies are complex because many of the diseases are impacted by lifestyle and behavioral factors, and how these products will get through regulatory is still to be seen.

Why building health products is a marathon and not a sprint

Henry Peck: 23andMe has been one of the flagship companies in direct to consumer (DTC) healthcare. Talk to me more about this space.

Ruby Gadelrab: Building health products is hard, it’s expensive and it takes time. You have to be in it for the long term. It’s hard for a number of reasons.
In healthcare, the user, the influencer, the payer, and the consumer of the product are often completely different stakeholders with completely different incentives, so that’s a really tough challenge.

It’s a really highly regulated space and the regulation is not just per country, it’s potentially per state as well. When you’re thinking about building a health product, you have to think about the regulatory process countrywide and statewide. Your regulatory strategy also deeply impacts your commercial strategy—the type of product you would build for a DTC market is potentially different to what you would build if you want the healthcare system to adopt it.

Unlike tech, in health, you cannot test and iterate quickly. You need to do the studies to generate the evidence that your product is safe, is effective, is clinically useful, and that its economics work, and these studies can take many, many years.

When you start the commercialization process, you have to find your earliest adopters in the healthcare world, which involves building specialized sales teams and deploying expensive KOL (Key Opinion Leader) programs,
Finally, you have to get your product reimbursed and engage the medical community.

Digital health innovators: Don’t skip these steps

Henry Peck: What are the key challenges in DTC? What do you absolutely HAVE to get right in DTC?

Ruby Gadelrab: These three areas are critical:

Regulatory and Evidence Generation
For ANY health product the two things that are most critical are regulatory and evidence generation. No one should skimp on those. If you really want to disrupt healthcare this is the key differentiator. Quite frankly, there is a lot of nonsense out there disguised as health products and your studies and regulatory strategy is what will differentiate you from the nonsense and stop you getting in trouble. The advice I give all digital health companies is to hire a CMO (Chief Medical Officer) even if part time, because they will help you with the evidence generation and staying on the right side of regulatory.

Understand User Acquisition
People underestimate the cost of user acquisition. It’s very expensive to acquire consumers for health products, especially when most people are used to health products being covered by insurance. To be clear, I am a firm believer that there is a self-pay market for access and convenience, but it’s a subset of the market. I see this a lot where companies start out DTC, then realize how hard and expensive it is, and then want to pivot to B2B2C—where they want to work with health systems, employers, providers etc. So, back to my earlier point—to do that you need to make sure you have the right regulatory strategy and have done the evidence generation to allow you to make that pivot.

Bring Healthcare Providers into the Experience
Many DTC companies are improving the access to and experience of health products—and we love this democratization of health products. HOWEVER, part of the consumer experience has to be bringing healthcare providers into the fold. Think about the scenario where a consumer orders a test at home or uses an app or wearable to track their health data and that consumer takes that report to their physicians who has never seen it, has no idea why they ordered it and they ask the consumer, “What is this crazy thing you ordered off the internet?” That ruins the consumer experience.

The way around this is to engage healthcare professionals early on in your product development, so they can help you build products that are clinically useful even if they are for a consumer market. They will be your advocates later. Then, when your product is on the market, provide education for healthcare providers who may see your consumers. Educate them on your product with data and studies. This will massively help with the consumer experience and you won’t spend ridiculous amounts of money calming the naysayers.

Innovators to watch

Henry Peck: Who are some of the leaders and “up and comers” in the space, in your opinion?

Ruby Gadelrab: It’s companies creating DTC health products that are taking an evidence-based approach that democratize access and improve the experience of healthcare products and services responsibly. And they are even better if they can demonstrate that they can improve health outcomes and reduce healthcare costs.

At-home lab testing. I think Everlywell and Modern Fertility are fascinating in that they massively improve the access to and the experience of a traditionally cumbersome process.
Liquid biopsy for early cancer detection, particularly patient-initiated (not DTC, but easy access). There are so many digital health companies innovating in this area: Grail, Exact Sciences, Guardant Health, Freenome, just to name a few.
Femtech. Women’s health has been neglected for far too long. Everyone thinks Femtech is just about fertility but it goes beyond that into hormone testing, sleep, diet, menopause, endometriosis, and so much more.
Apps and wearables that help with at-home patient monitoring. I like OneDrop. It’s a diabetes product that uses a data-driven approach to measure blood glucose levels with coaching and data.
Mental and behavioral health apps that combine technology with coaching experts.

Henry Peck: What types of technologies/businesses can we expect to see with the rise of DTC?

Ruby Gadelrab: Some products are DTC and some products are easy-access, where a physician network behind the scenes orders the product. Telehealth is the key technology that can power this. Telehealth and virtual care are big areas by themselves but they also power some of these products that appear to be DTC.

Health data analytics companies are generating huge amounts of data. How do we make sense of it all into something that’s clinically useful?

I think there is also potential for a company to create a space for providers and consumers to learn about digital health products and the evidence behind them. This is one of the things we are working on at MDisrupt.

The Future of the Healthcare System

by MDisrupt Guest Author | Feb 12, 2021

Meet Chet Robson, DO, chief clinical officer at Walgreens.

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Beginning as a family practice physician, Robson went on to C-suite positions at health systems and one of the largest health retailers. He was an early adopter of electronic medical records (EMR), educating himself and helping colleagues understand how to use and implement them. He later earned his MBA at Dartmouth in health care delivery science with a focus on how healthcare can be delivered to different populations. At Walgreens, he delivers healthcare directly to the consumer on a national scale—in everyone’s neighborhood.

Listen to the full interview here.

MDisrupt: How do you envision healthcare delivery in the US changing?

Chet Robson: Health care is becoming more home- and consumer-driven. Examples of this include telemedicine for care delivery, oral oncology medications that can be taken at home, home testing (COVID-19 testing, cholesterol and genetic tests), mental health coaching, and health tracking through apps. Hospitals are having to become parts of a system that reach beyond the hospital walls; integrating with retail pharmacies, companies like Uber, and more.

From the pharmacy standpoint, it’s a very similar theme—meeting consumers where they live and making it easy for them to get medications and other health care services. Several retail healthcare venues now have primary care doctors’ offices inside of their pharmacies—an elegant integration of delivery models supplementing the norms of the traditional health care system.

The final piece is the payment models to help facilitate care. It’s not simply about how we pay for a particular diagnosis and treatment , but how we pay for the prevention, the treatment, and the aftercare for the best outcome.

Recently with COVID-19, there’s been a huge evolution of home delivery, medication, and medical goods.

MDisrupt: As a health retailer, how do you evaluate innovative technology for introduction into the retail pharmacy market?

Chet Robson: This is always an exciting challenge because there are so many great ideas at different stages of development. Given this, we have a very formalized approach that we go through. The first thing we evaluate when a company brings something new to us is identifying what problem the technology is trying to solve. We’ve seen things where it’s great technology and an interesting scientific venture, but it doesn’t really solve a problem. Then we dive into the fundamentals around the basic medical science, clinical efficacy, real-world evidence data, multi-population studies, outcomes, and feedback that affects patients around use, price, insurance coverage, and ordering. We really want to understand if the technology actually improves the problem that needs improving.

From a business standpoint, we evaluate if there is a sustainable business model and synergistic fit with our current strategy. There are many times we’ll see products that are really very good, interesting, but it might not really be the exact right fit for what our current strategy is or what we’re trying to achieve.

MDisrupt: Adverse drug reactions are the fourth leading cause of death in the US, but pharmacogenomics is still not a standard of care. How do we reconcile that and where is it going?

Chet Robson: I share that frustration with you because I’m a big believer in pharmacogenomics. It could really become a valuable tool, but we are still along the pathway to integrating it into the standard model of care. First, it’s “newer” science to the general public, regulatory bodies, and legal organizations so there are hurdles around education and defining how to use the information in patient care. Second, we have to become very specific about the benefits, impact, and use cases for pharmacogenomics. Third, there are operational challenges around getting the information into a prescriber’s workflow so that the health care provider, at the point of writing the prescription, has access to drug interaction information. It has to be simple and straightforward. Lastly, the information has to be available to anyone who’s going to interact with it. This includes the healthcare provider and the pharmacist, so they can support each other to ensure that drug interactions are identified and acted on appropriately.

MDisrupt: Do you have an example of a country or health system that’s been successful in implementing a PGx program?

Chet Robson: We’ve implemented a very successful program through Walgreens Boots Alliance and our independent pharmacies in the Netherlands. The health system in the Netherlands is a single payer system, so both the physician and the pharmacists have access to a common EMR. This is critical because the physician or pharmacist can look up a patient’s drug interaction information. The physician can request a pharmacogenomics test, the patient’s results get added to the system, the pharmacist sees the results, and then walks the patient through the information. If there’s an actionable medication, the pharmacist can then connect with the physician to request a change of medication. It’s worked extremely well and we’ve had really good uptake. Even throughout the pandemic we’ve seen the number of pharmacogenomics tests going up greatly because there is a good deal of interest from the patients. The other interesting piece is that the physicians look at the pharmacies now as part of the whole ecosystem. It’s still early and we’ve not even completed a year, but the initial results have been strong.

MDisrupt: What’s the future for pharmacogenomics?

Chet Robson: PGx is beginning to be a part of a bigger picture of understanding a robust genetic overview of an individual. Currently we have an understanding of phenotype through biometric testing, lab testing, and imaging, but we tend not to have a very good genetic view. To be able to fully manage a patient’s health, you have to understand that entire equation including the social determinants of health.

The FDA a year or so ago really pulled back on the pharmacogenomics information that could be released to patients. Currently, they’ve begun to make major strides moving forward by looking much more deeply at the research and working with the Clinical Pharmacogenetics Implementation Consortium (CPIC) and other organizations. A major hurdle to overcome is the FDA becoming more comfortable with what PGx offers. Payors are also doing a lot of different testing in various different forms with pharmacy benefit managers (PBMs), sometimes with their insured populations, and sometimes with particular disease states.

As you begin to make PGx an actionable, value-based test, we’re going to need to become much more refined in our risk stratification of how we use the test. It’s an important piece of the total comprehensive view of the patient.

MDisrupt: What does the pharmacy of the future look like?

Chet Robson: There’s only about four ways to manage health and disease. First, maintain health by exercise and good nutrition. The second is to prevent illness through immunizations, routine testing, continuous health monitoring. Third is medication delivery and education. And fourth are interventions like surgery and radiation. Pharmacists can play an integral role in the first three ways by providing medication and treatment expertise.

Part of the pharmacy of the future is helping pharmacists become integrated in delivering health services rather than simply delivering prescriptions. This can include mail or home delivery, telemedicine, followup care, and clinical services. Pharmacies are already in everybody’s neighborhood and it creates a network of places where people can easily access the health resources they need. Lastly, in the virtual world of health apps tied to medication and health management, digital pharmacy services can play an important part in medication management, providing immunization information, or answering questions around the clock via Ask A Pharmacist chat. Having that virtual, always-ready connection is definitely going to play a critical role in the pharmacy of the future.

The pharmacy of the future is really an expansion of what we do now. It’s about allowing the pharmacist to use their full skills rather than just operational ones, thus allowing people to connect virtually and in-person to their local pharmacy. It’s about an interconnected healthcare ecosystem that meets people where they live and experience health care. A health care system that operates in the continuum of people’s lives—living, working, and virtually.

At MDisrupt we believe the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

If you are building a pharmacogenomics or other health product, MDisrupt can help. Talk to us.