TRANSCRIPT: Episode 4 of "The Front Porch," featuring George Lazenby

The following is a transcript of the fourth episode of ScriptDrop's podcast The Front Porch: Where Pharmacy and Healthcare Access Meet.

LAUREN: Welcome to "The Front Porch: Where Pharmacy and Healthcare Access Meet," presented by ScriptDrop. Today, Perry Lewis will be talking to ScriptDrop's newest advisory board member, George Lazenby. George is CEO and co-founder of OrderInsite.

But first, if you're new to the podcast, ScriptDrop is the only healthcare IT company specializing in prescription access that serves patients in all fifty states. Since 2016, ScriptDrop has been improving drug adherence by delivering medication access opportunities through a robust platform, long-term data storage, multiple service levels, and first-class customer service.

I'm Lauren Carpenter, the writer/ researcher here at ScriptDrop. In case you didn't tune in to our previous episodes, let me introduce the one and only Perry Lewis, as well as today's guest. Perry is ScriptDrop's industry relations consultant. Perry has worked in the pharmacy industry for over thirty-five years, was on the NCPDP board for twelve years, and served as chair of the NCPDP board for four years. Since "retiring," Perry has worked as a consultant for healthcare technology startups like local Columbus unicorn CoverMyMeds and now for ScriptDrop. George Lazenby is our guest today. As previously mentioned, George is the CEO and co-founder of OrderInsite. Prior to that, he was CEO of a health information company called Emdeon, which went public in 2009. He's done a few things in between there, but George also runs a healthcare investment company and serves on several healthcare tech company boards. In short, George is a busy guy who knows a lot about the health tech space and we are thrilled to chat with him today. All right, Perry, let's get started.

PERRY: All right, well George, thanks for meeting with me on this episode of the Front Porch. Since we both live in Nashville, we probably could have sat on a front porch for – I have one – if we had both been in town at the same time, and if the rain had stopped. We've had so much rain this spring. But anyway, well um, we'll have to meet at some point. I noticed you are a University of Alabama grad so, in the spirit of full disclosure, my wife is a University of Georgia grad.

GEORGE: Oh, no.

PERRY: Yeah, but I'm sure that's not gonna affect the outcome, especially for this past year, of our discussion.

GEORGE: You know, at the end of the day, most Alabama fans have a soft spot in their heart for Kirby Smart. So we begrudgingly support his success, although we don't want him to be as successful as he was last year, too often.

PERRY: That's true. But we both had – both teams had a really good year last year.


PERRY: So before we dive into specific questions, can you provide us with a fun fact or something that we can get to know you a little bit better? For example, like, I don't know, do you love to run marathons, travel, you’re a chef – anything that we would find pretty interesting?

GEORGE: Well, I do love the outdoors. So most of my habits or hobbies are outdoor related. I particularly love trail running. So couple times a year I'll do – I don't do marathons because they're on the pavement, but we do – the equivalent in the trail running world is a 50K, it’s a thirty-one mile race, and I'll do a couple of year. My next one – I'm injured right now, a little injury, not significant, but it's preventing me from training. So my next one will probably be October in Montana.

PERRY: Oh, that would be beautiful. Oh my goodness. Well that's interesting, I'm preparing for a half marathon just within the next few weeks and it's been a little grueling, but I'm going to do it, going to give it one more shot.

GEORGE: [Laughs] Well, the key thing when you reach my age, I'm fifty-three now, is to stretch. So hopefully you're doing plenty of that or you're going to hurt yourself.

PERRY: Well, I am and I'm, uh, beyond that age, so you can guarantee that I'm doing more than that. Anyway… Well, I'm sure somewhere within our careers our paths have met, especially since I began my career with National Data Corporation [NDC] back in the early 80s and I've spent time with WebMD, I negotiated with MedImpact… I just think there's some synergies there that, you know, we've got some connections, we just can't remember them right off hand.

GEORGE: Absolutely, I mean, my background – I'm a CPA or an account but I got involved with a small technology company in the 90s called Medifax, which is in the hospital revenue cycle, and that company competed with both Envoy and NDC at the time, and then was ultimately acquired by WebMD, which had acquired Envoy prior to that.

PERRY: Right.

GEORGE: So that's how I got involved with those companies, and that would have been in the sort of early 2000s. And then ultimately we restructured that company, as you may remember, and took WebMD public, the portal that we all know, and the remainder of the company I took private and in a series of transactions and then in 2009 took that company public, which was Emdeon. Now it's Change Healthcare. Um, you know… Been in and around the healthcare technology sectors for – since the mid 90s, ‘95, ‘96 time frame.

PERRY: My claim to fame with WebMD is that I made it through a lot of their ups and downs, but learned an awful lot with that organization. And even NDC was just a great stepping stone for me. But… So let's switch gears to your current endeavor. Can you provide us with OrderInsite’s mission, vision, and solutions?

GEORGE: Yeah, so in 2013, when I stepped down as the CEO of Emdeon, um, I was trying to figure out what I wanted to do and I ended up partnering with a gentleman named Mark Lyle. And Mark and his brother Murray are, I would say, serial pharmacy technology entrepreneurs, and we decided to start OrderInsite. And the goal, when we looked across the industry, retail pharmacy industry anyway, we saw the continued pressure on margins in that space while at the same time recognized they were delivering a very valuable service to our health care ecosystem. And we created OrderInsite really to help pharmacies better manage their most significant investment outside of their people, which is their prescription drug inventories. So what OrderInsite's goal really is to optimize inventory to demand and also assist pharmacies in purchasing so that they're optimizing their supplier agreement. So the goal is, hey, let's have exactly what we need on the shelf to support our patients, but no more and no less, and let's also make sure that when we purchase items to put on those shelves that we’re purchasing them to optimize the incentives in our agreement. And so then, you know, in our own way, we were trying to help our customer, through technology, make better decisions in an area that affects them the most from a working capital standpoint.

PERRY: Well, I think one thing we saw, also due to the COVID-19 pandemic, is that inventory management is key, but so are the analytics. Clearly, analytics help address supply chain issues now and into the future. So OrderInsite’s pharmacy solutions seem to be up and running within hospital pharmacies as well as independent, small chain pharmacies. As analytics become more important within the supply chain, do you see chain pharmacies, specialty pharmacies and biologic solutions connecting to increase speed to therapy for patients?

GEORGE: Yeah, the – I mean, I think the key, um, barrier there for – that we address is that we help our customers better understand when they need to purchase these biologics and specialty medications based on their patient profile. So you don't have an inventory management suite and intelligent, you know, an intelligent way that leverages machine learning to predict demand, then you're sort of left to purchase these based on any individual’s sort of thought process, which, you know, people get busy and they don't think about it properly. The patient shows up, the drug’s not available, and they're either going to go to another pharmacy or they're going to wait and they potentially miss their therapy.

One of the very, very interesting things about specialty medications is there's only around 30% adherence today, so meaning when a patient is prescribed a specialty medication, only 30% of the time are the patients adherent to the full treatment protocol. And there are a lot of reasons for that. There's the cost of the drug, there's coverage by the insurance company that plays into that cost, but there's also availability. And if you're a pharmacy and you're running on a very thin margin, you know the prospect of purchasing, you know, a multi-thousand dollar drug to support one or two patients is a difficult and daunting question. So having – wrapping intelligence around making that decision for you so that you're more precise when you do that, and the likelihood to patient is going to show when you buy it, increases, then you're more likely to do it. So you're more likely to have the drug available for the patient because your systems are smart enough to know when you should and shouldn't purchase it.

You know, traditional forecasting has always been more trend based forecasting. So, you know, most people understand, like, linear regression or logarithmic or weighted average mean methods to forecasts, which are simply just trying to pattern a trend. Well, in addition to those forecasting methodologies, OrderInsite developed its own just-in-time or – we call – refill-based algorithm. So if it's a high dollar drug and if there are a limited number of patients on that drug in a given pharmacy, we're going to, we're going to drop back from forecasting a trend and we're actually going to begin forecasting the likelihood of the patient arrival. And so when you sorta trigger the purchasing behavior on patient arrival instead of on a particular trend, then the pharmacy doesn't have to hold that drug on their shelf for months at a time and they can buy, you know, two or three days before the patient shows up. And if the patient doesn't show up for some reason, we're going to have analytics that quickly tell them, “Hey, George was on this, you know, specialty med, he was due to show up yesterday and pick the drug up today. He didn't. You might want to give him a week, but then you're probably going to return that back to the supplier. And in the meantime you may want to contact George to see if something changed.”

And so we can't really help with the cost of the drug to the patient. You know, whether the insurance coverage… So what we try to do is focus on admitting, which is, let's make sure that the pharmacy has that drug available for that patient when they're going to arrive, and if the patient changes for some reason or the therapy changes for some reason, we're going to let them know very quickly, “Hey, you've got an expensive drug on your shelf, you need to go ahead and send it back your supply.” So that's – that's the role we play, Perry, and, in that arena. But it is increasingly important, as you point out.

PERRY: You know, a couple things in regards to what you said… I find it very interesting that you said only 30% of patients who require specialty drug are on it. I'm on a specialty med and I know what it, it's gone through when all this started or when I changed health plans, that I've had to go through the entire process with, you know, the health plan, the pharmacy, getting prior authorizations. I felt the frustrations from the patient's perspective, but listening to you, you're trying to fill a need from the pharmacy perspective that you've got these expensive medications on hand when needed for the patient, when the patient needs it. It's – and not floating that huge amount of money that these specialty drugs are are costing for that pharmacy to hold onto it for months at a time, because I don't, I don't know how they would be able to do that because they're so expensive. So –

GEORGE: That’s right.

PERRY: That is – that is really interesting because I was looking at it from a patient’s perspective. But you're bringing forth a whole new dynamic for the pharmacies that they can manage this benefit without losing their shirts on it.

GEORGE: That's right. And you know, every – all of the problems as the – that the patient encounters, they sort of trickle down to the supply chain and the delivery and the access to that for that drug. To the extent that we can be more sophisticated around helping our customers better understand that patient behavior so that they're not committing themselves financially in a way that could be detrimental, the better off the pharmacy is going to be, the more confident they are going to be sort of making that drug available, and the more likely when you show up they're going to have it.

PERRY: Well, what other challenges do you see in the pharmacy industry and that you might want to tackle through OrderInsite or another endeavor? I mean, it seems like you've had so many different developments and new organizations through your career. Is there anything else outside of what you're doing right now that you feel is really imperative that OrderInsite might be able to address?

GEORGE: Well, where we're focused right now, heavily focused right now, is in the area of analytics, and specifically in support of the opioid monitoring. So, as you guys know, there's the opioid epidemic, has – it's not unlike tobacco legislation in that the state attorney generals and every state are are pursuing all of the stakeholders that contributed to the opioid epidemic. Initially it was the manufacturers, and there's you know, you've seen all the publicity and press around that. Then more recently there's been a settlement with wholesalers and suppliers, some multibillion dollar settlements, and it's going to trickle down to the pharmacies.

And so pharmacies are going to be required to have systems to help them monitor opioid dispensing. And you know, the DEA provides the – their guidance that they've provided the pharmacies around how to monitor is pretty limited. I mean, frankly, it's, it's “Know your customer.” And that doesn't really give anyone specific direction on how do we do this. So if you think about what we have to do at OrderInsite to forecast demand and set inventory levels and understand purchasing behavior and all of that, we can – we can determine with analytics very quickly if a pharmacy is purchasing more opioid, you know, more controlled substances than are necessary to fill actual patient demand. But we've also started doing analytics at the patient and prescriber level to support that forecasting. So we know, if, you know, George is constantly coming in for an early refill, or we know that Dr. George is always prescribing immediate release, these are red flags that pharmacies need to pay attention to. So this is an area where, again, our goal is to provide what I would call affordable software solutions by leveraging the Cloud and current technologies to help our customers use technology to manage these problems rather than having to put people – hire more and more people to help solve all these issues. So OrderInsite’s positioning itself as a leader in this suspicious order monitoring area as well.

PERRY: Wow, that's really interesting, and I'm saying that from two perspectives. One of them is years ago I got involved with NCPDP and we had been going to DC, to the Hill, quite often talking about the opioid epidemic and how can standards play a part of it. And personally, during those particular visits, that's when I let it be known that we had been dealing in our family with addiction and why that was so important that we get a handle on this, this tremendous, you know, epidemic. So –

GEORGE: I mean it's so common, Perry, and everyone has a role in helping control the epidemic.

PERRY: Right.

GEORGE: Of course, any time something like this happens, there's always going to be a reaction and a financial restitution component of it, and that's usually what causes the markets to react. It’s okay, you know, it's beyond getting my hand slapped, I've actually got to write a big check, so I better start doing something about it. And the personal stories are – are just so common, I don't know that there's any family that hasn't been affected by it.

PERRY: Right.

GEORGE: And so how can we have – how can we put – again, affordable technology in place to help our customers, which are primarily pharmacies, help better manage this solution? And what we know, and what you probably know, is that it's the exception that you have bad actors–

PERRY: Right.

GEORGE: – it's not the rule, and so a lot of times the exception is a difficult thing to monitor and it requires a significant amount of energy, or what I like to call horsepower, to apply to something like this. And the, you know, the Cloud and big data analytics and all the advancements that we've made in these areas have really helped us as a community, not just OrderInsite, make better solutions, to help our customers see the problems before they would get bigger. You know, had we had these capabilities when all this started, at least there would have been more indication of the issues that have ultimately presented themselves as an epidemic. It's, you know, our customers really don't want to turn a blind eye to it, but their systems were so bad it was hard for them to take data and do anything with it in a relevant period of time to address an issue. And so, yeah, they could get the data and they could crunch it, but by the time they figured out who the bad actor was, the bad actor had moved on. And so it, you know, at least today we have better solutions to that.

PERRY: I find that so interesting because we've known for quite a while, if from the pharmacy perspective, that any time they had to go out of workflow to go into a prescription drug monitoring program within a state, that's time-consuming, you know. So anything that we could do to provide that accurate analytical information to the pharmacist or the provider while it's occurring instead of having to take it out of workflow, I think it's critical. So I really liked what I'm hearing and when it comes to what you guys are doing from the pharmacy perspective, through their systems because it's given them the data they need to deal with it at the time they need to deal with it.

GEORGE: Our approach is kind of what I would call belt and suspenders. So the belt is the analytics, you know, that help identify the areas of concern. The suspenders is our solutions actually won't allow a pharmacy to order the controlled substance at all, won’t even allow them to put it on the shelf, if we suspect something is happening. So we're preventing the order so that the pharmacy can't, you know, participate, you know, in a situation that would cause them to be in trouble. So that's also a very different approach. We're not just showing them, “Hey, Dr. George is a problem here. All of his patients are paying cash, all of his patients are showing up early, all of his patients are on high dose, immediate release.” We're also saying, you know, because Dr. George exists in your pharmacy, you're not going to get to order anything until you resolve that. And it causes an action. Again, most people are not bad actors and want to know the right thing to do, and we're just kind of helping them find it more quickly.

PERRY: Right. Well, it sounds like OrderInsite definitely has some guiding principles, you know, to develop and support solutions for, are truly valuable to pharmacies. So how does that apply also to ScriptDrop in your estimation? Because you've been involved with ScriptDrop quite a while, you know who we are and what we do. How does that fit into the principles of what OrderInsite is working on?

GEORGE: We both are helping our customers provide access, right? So my customer is a retail pharmacy and we're helping them properly stock their shelves so that their patients have the ability to get the treatments that they need. And in how that, in my mind, how that's complementary to what ScriptDrop is doing, ScriptDrop is helping provide a way to have that access for those either out for convenience or out of need.

And I really like – there's a segment of the population, as everybody understands, that are higher usage, they utilize the health care system more than anyone else. There are challenges with that population. I mean we all have the same similar stories about that, and I like the fact that ScriptDrop is addressing a problem in the industry about providing access to prescription medications in a way that's convenient and can support not only those that are challenged in terms of getting to a pharmacy, but also those that – there may be, you know, based on their work schedule, they just don't have – it's just not available. So I really, I think we both, in different ways, support that patient access, which is a critical component ah, to, you know, maintaining therapy and staying healthy.

PERRY: Well, it sounds like we've got a lot of the same mindset, that it's about the patient, making sure they get prescriptions when they need… and I think having you on our Advisory Council is great timing. The amount of experience and knowledge that you bring to this group has really been helpful so far, and it seems like every time we have a call we come out with this brain trust of ideas that we need to be working on. So we really appreciate your participation.

GEORGE: No, it's been terrific and I look forward to our meetings. I'll, you know, it's obvious when the leadership of a company is focused on delivering a solid service that is out there to help move the industry forward, and I, and you know my, my energy is sort of reflective of that. ScriptDrop has a great mission. They have a great team and it's just exciting to be a part of it.

PERRY: Great. We're excited to have you as well and I've learned an awful lot about OrderInsite through this conversation today. Really appreciate your time and I'm going to turn this conversation back over to Lauren and she'll do a recap. But again, thank you, George.

GEORGE: Oh you're welcome. Thank you, guys.

LAUREN: All right, thank you Perry and thank you George! That was a really great conversation.

So to recap, I think the most important points here are that OrderInsite is offering a really important and valuable benefit to pharmacies both large and small, in helping them protect their investment in their prescription inventory, helping them keep a handle on that inventory, help them understand their patients, but they're also helping drive the actual human actions that support adherence, because if a pharmacist knows that they have a patient who takes a specialty med and that patient hasn't come in, that's – that pushes them to reach out to that patient and ensure that they stay adherent. And that simple little process could really save a lot of money and a lot of effort and a lot of suffering on the part of the patient.

Thank you for joining us on the Front Porch. We hope you'll join us for our next episode. If you're a member of the healthcare industry and would like to learn more about ScriptDrop’s solutions, please reach out to us at info@scriptdrop.co. If you're attending NCPDP's annual conference or the Asembia Specialty Pharmacy Summit the first week of May, we will have team members at both events and would love to talk to you.

And finally, if you liked what you heard today, please subscribe on Apple Podcasts, Spotify, Stitcher, TuneIn or wherever you get your podcasts so you'll be sure to catch the next episode.

The Front Porch: Where Pharmacy and Healthcare Access Meet is a healthcare podcast created by the ScriptDrop team. This episode was produced in partnership with Perry Lewis and George Lazenby. Our theme music is “River Meditation” by Jason Shaw, licensed through Creative Commons 3.0.