July 8, 2025 • 62 mins
In this episode, we explore the often overlooked issue of medication errors in pediatric care—especially for children with multiple or chronic conditions. These fragile patients face serious risks, and even minor prescription mistakes can have major consequences. With better medication management and expert support, we can create meaningful change for vulnerable children and their families. Like women’s health, pediatrics has long lacked focus in this area—but that’s starting to change.
https://www.perfectingpeds.com/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Alright.
health heads.
Welcome and thank you for checking into this dose of the healthcare uprising.
I'm your producer in the back Jeremy Carr here with your host in the front row HeatherPierce.
So let's tell them what's on the agenda for today Heather.
Today we're chatting with Lyle Miodyszewski who is the president and co founder ofPerfecting
(00:33):
PEDS as in pediatrics.
PEDS.
It's a mission-driven pediatric pharmacy and care coordination organization dedicated toimproving outcomes for medically complex and high-risk children.
This one really hit home for me because I've got some people in my life who categorize asmedically complex and high-risk.
(00:53):
So really, really love what they're doing.
He is a registered nurse with over 20 years of experience in diverse health carecapacities.
operational and strategic domains, but his deep understanding of the healthcare systemcombined with his commitment to innovation and patient-centered care has positioned
Perfecting Peds as a trusted partner to payers, providers, and families nationwide.
(01:17):
He is also, uh he is a co-founder if I didn't mention that, so he is part of the foundingteam.
Cool.
Good stuff.
All right.
We don't, don't get too many episodes that focus on the kids side of healthcare.
So this is a good addition to the lineup here.
So without further ado, here's our conversation with Lyle from Perfecting Peets.
(01:42):
Hi, and welcome to the healthcare uprising podcast.
Today we have Lyle, the president of perfecting.
Peds pediatrics.
We'll save a long form because we want to make sure that that comes out right.
So Lyle, thank you so much for joining us today.
Excited to have you on.
Yeah, thanks for having me.
(02:02):
I'm super excited to chat with you.
Great.
So let's jump in.
And first, we always like to ask, give us a little bit of background about yourexperience, kind of what brought you to this space and addressing pediatric medication
management.
And, um, and then we'll kind of go from there and see where the conversation goes.
Yeah, sure, absolutely.
(02:23):
uh Me personally, I'm a registered nurse originally.
um Been obsessed with healthcare since I could be obsessed with a career.
uh Spent about 10 years bedside, emergency departments, trauma rooms, cardiac cath labs,and electrophysiology.
I got exposed to sales reps in the cath lab.
(02:44):
This is where they do balloon angioplasty and stenting and uh really the plumbing of theheart.
There's a lot of sales reps in that environment and I just, kind of took to theprofession.
I liked the kind of money that they were making, if I'm going to be honest.
um I thought, geez, I think I've got good enough communication skills and I absolutelyhave the patient care experience to be able to do that.
(03:05):
so worked through that, worked oh at a bunch of different companies since then, was in theMedicare Advantage space before founding Perfecting Peds.
And I stumbled across this solution.
Our CEO had been in kind of a proof of concept phase for a number of years.
She was a pediatric clinical pharmacist, still is.
(03:27):
uh noticed that she was getting a bunch of kids into the hospital, into the pediatric ICUin the Philadelphia area and thought, why am I just reactive?
Like my whole profession is in a hospital waiting for kids to get sick.
And then we try to help.
lot of these kids are on.
a number of medications and I think we could do better on the front end and maybe keepthem out of the hospital.
(03:51):
And so she had implemented what's now perfecting PEDs in a pediatric skilled nursingfacility in subacute rehab.
uh Had initial findings of that implementation and they were profound.
I stumbled across the manuscript and her on Y Combinator.
(04:11):
They have like kind of a match.com for founders.
And so we had both entered our profiles.
It's really cool.
Anytime I talk to somebody who's trying to do something different and they've got diverseexperience or they have an idea, I always send them to this because it's kind of a success
story for Jenna and myself.
But she had an idea and was actually already doing it.
(04:33):
I had this set of skills, didn't find that I was applying them well in Medicare Advantageand specifically risk adjustment.
And I really just wanted to get back to the
care delivery side of our ecosystem.
So I got a chance to read her manuscript of the initial outcomes.
uh I'd messaged her and said, if these are real, I'll hop on a plane tomorrow out to NewJersey.
(04:57):
She said they're real and here we are.
Wow, I love that.
And I was going to ask you kind of the origin story of of the company too, as well, whichyou've kind of started sharing a little bit about that.
Can you kind of expand on that a little bit more?
Like obviously the impetus behind it.
We know there are some issues there, right, that you had already already shared.
(05:19):
But and so and also are you are you considered a founder as well or a co-founder?
Yeah, so my equity stake in the company, I guess, makes me co-founder.
It's myself, Jenna, and then we have a huge founding team behind us at this point in justa really short period of time.
But the founding story is really hers, and I'm happy to tell it.
(05:41):
I'm going to steal her thunder a little bit, though, because this is really Jenna's story.
But she was at Children's Hospital of Philadelphia, a pretty well-renowned hospital, andit's an acronym that is CHOP.
uh And then went on to a hospital in Camden, New Jersey called Cooper University.
uh And she just kept noticing the same thing.
This is a typical story in healthcare.
(06:02):
Like you get, and it's horrible.
We say this, but like frequent flyers or frequent utilizers, high utilizers of thehealthcare system, noticed they were coming uh many times from a few distinct facilities
in the area.
So a lot of people aren't going to be familiar with this because it just doesn't exist incertain geographies.
there are skilled nursing facilities for children.
(06:25):
There's uh inpatient rehab centers for kids.
uh Where I'm from originally in Michigan, we don't have any, right?
And so I wasn't familiar with this care setting, but she was, and she was noticing kidscoming in and she was spending more time working on their chronic medication regimen and
tuning and tweaking and correcting things that were not good uh on those kids.
(06:51):
And some of it wasn't even really what they were being admitted to the hospital for.
So she uh went to the CEO of these facilities and said, you guys have a problem and Idon't think you realize it.
And I have a question and that's who the heck's managing the medications here.
(07:12):
And the answer that she got back was a little bit shocking.
uh And for a pediatric pharmacist like,
She didn't really understand one, how limited of a resource she was, how specialized thisgroup of people really are, uh and what's happening outside of acute care, outside of the
hospital.
And the answer to that question was they had a pharmacist that was really just kind ofchecking the regulatory compliance boxes and not working up the patients, right?
(07:42):
And so she said, I'll come in and you can pay me whatever you're paying the other person.
I'm going to open the charts.
I'm going to go in between all of the prescribers and the doctors and the nurses andeverybody here, just like I do in the hospital.
And I'm going to help fine tune these therapies and make sure that patients are gettingthe right, or at least the best therapy for them individually.
(08:04):
uh And so she, she contracted with them.
She did the regulatory compliance checks and she started opening the charts and uh theresults of that work we published about a year ago.
in the journal pediatric pharmacology, but in just a nine month period, she showed uh thatmany of these kids were on medications that were unnecessary.
(08:29):
They were left on after admissions or discharges from the hospital and shouldn't havebeen.
They were on the profile and nobody knew why.
They were on duplicative therapies.
They were on therapies that were unsafe or causing harm or interacting with other drugs.
so...
Probably whether ending up in the ER, right?
a lot and often mislabeled as a new diagnosis and not like the effect of the medication inan adverse drug event.
(08:55):
So she implements this thing, de-prescribes a bunch of unnecessary medications, these kidsin these facilities around an average of 23 meds.
She took them from 23 to 20.
23.
a lot.
I that's a lot for any, any age.
And you think about this in in a kid and, and, then there's a caregiver aspect and, and,then all of these care team members surrounding this person and 24 hours a day, seven days
(09:24):
a week, they have a care team surrounding them and they still had this room forimprovement.
Um, so she does this, she does it for a period of nine months.
The deprescribing is just a small chunk of really what it was.
It was, it was taking a look at the full thing and saying,
Is neurology talking to cardiology when they change neurology meds that affect cardiologyand does cardiology need to do anything about their meds because of this adjustment?
(09:50):
uh And the answer was usually no.
so uh outside of the deprescribing, just the fine tuning of things, they stop admissionsfrom the skilled nursing and subacute rehab into the hospital, which is really important
to the, businesses to keep
(10:10):
patients there and not one they don't nobody wants a kid or any patient to get sick butlike They also want that patient to stay with them And so she kept she kept them from
being admitted to the hospital from benchmark pre implementing the solution to Just ninemonths later.
They had reduced admissions to hospital by 44 percent
(10:32):
That's a huge number.
44%.
And that equates to cost, right?
Which is something we talk about a lot in the healthcare industry is these unnecessaryvisits to like ER, ICU.
So avoiding those, that's a big cost savings as well.
And all the drugs they don't have to take now because they were taking the wrong drugs.
(10:54):
And just healthier, right?
Well, better care for children.
Those are the two
To be clear to you, Lyle, I just want to make sure that like anyone who's listening toyou, when we talk about these kids, these pediatric patients, these are children with like
chronic health conditions, uh multiple disabilities potentially, right?
(11:17):
So hence why they're on so many of these medications.
Yeah, so in the study, some of the most sweet.
So children, medical complexity makeup, uh, somewhere between one and 3 % of all kids.
That just means that they have multiple diseases.
Um, they're usually on some sort of technology, meaning a ventilator, a feeding tube, um,some sort of technology that helps them, um, sustain life.
(11:45):
And so in the study, yeah, these are some of the most complex of the complex.
And the original hypothesis was like,
I don't want to call it low hanging fruit, like that's who needs to help the most.
Right.
So like the, two light bulbs there were one, this reduction in utilization and the twoexactly we just said, Heather is like, there's a cost uh associated with that.
And so we were charging the health plan.
(12:08):
I'm sorry.
We're charging the, um, facility.
They were getting benefit out of it, but like, this was creating a massive cost reductionfor the health plans that have risk on those lives, right?
The Medicaid.
commercial plans that those
care, all that.
So it's evolved since then by way of it, but today, as we talk about this, the idea haschanged a lot.
(12:35):
So 31 % of pediatric prescriptions contain an error.
It's three times the rate of adults, and that's a really good source.
2023 research out of the medication errors report by the US Pharmacopeia states 31%.
We think it might be higher, or at least not optimized prescriptions.
A lot of this is rooted in something as simple and silly as the fact that pediatricmedications are dose based on weight.
(13:05):
And if you're a parent or you've ever seen a prescription or you've taken in a child'sprescription to the pharmacy, guess what's not on that?
The weight.
So we see, you know, in our own kids, my kids, Jenna's kids, our CEO, like,
Oftentimes the indication for the drug does not match up with what the dose was andthere's no check at the pharmacy.
(13:29):
It just gets filled.
ah It just gets filled.
So this goes beyond the special care centers and these, you know, the chronic conditionkind of stuff.
this, this is all kids then, right?
Like, I mean, this is generally just pediatric medicine in general.
It's not just for the hardest cases.
(13:51):
It sounds like.
Yeah, I mean, like, let's be honest, deploying a high touch clinical pharmacy service onyour typically healthy kid that got bronchitis and it got really out of control, it'd
probably help them.
Is it scalable and doable across, you know, 333 million of us in the country?
(14:13):
I don't think so.
The realization though is like, there's a group in between that and
and up to the most extreme medical complexity you can think of that would benefit and likethe cost, the cost arguments there.
And so we're slowly finding that sweet spot.
We're working with health plans to look at their data, oftentimes look at their pediatricdata in a way they haven't before and pull out the same kind of kids that we're starting
(14:45):
to get used to seeing and be like, that's one, there's one that we can help.
this disease state or these drugs, it's not even the most expensive stuff.
Sometimes it's the cheapest stuff that causes harm or just isn't right.
And it's crazy when we go into health plans and they're like, oh, this sounds kind of likea Medicaid thing or this population or that population.
(15:06):
We're like, well, let's see your data.
Let us show it back to you with our filters and our knowledge on it.
And they're always shocked.
So it's super prevalent.
Yeah.
So actually, this is a great opportunity to maybe share a little bit more.
You've already kind of teed this up a little bit.
You work with health plans.
So what does it look like with you guys?
(15:27):
How do you kind of show up?
How do you enter into this kind of ecosystem, working with the kids, the families, theproviders, right?
Because of these care teams.
I know you and I, when we did our prep call, I shared that my nephew has multiple chronicconditions.
He's not on 23 meds, but he's on a lot because he's got epilepsy, he's got CP, he's gotautism, he's got braces, right?
(15:52):
Because of the CP and so, and he goes to a special school and he's always at PhoenixChildren's and it's, had brain surgery.
I mean, I could just keep going on and on about all the things that he's dealt with.
And I have seen from my own personal experience, helping to care for him, the changing ofthe meds for him and how you change one thing and what it does to the other.
(16:13):
Now he's not on feeding tubes or anything like that.
So it's not quite as extreme, but anyhow, could just from talking to you, could, canunderstand like how, what, what you could do, the impact, but share with us kind of like
how you show up, like how do you kind of get into the space and work with those, thosefamilies?
So the health guys became attractive after the, we were like, okay, we've got somethinghere clinically.
(16:37):
We think that the solution is long-term relationships with patients proactively andreactively.
How the heck are we going to get to them?
Again, Michigan, no facility for me to go knock on the door of, they're at home.
um Most providers we were talking to, so we would go to,
(16:59):
a regular clinic or like the first one we talked to was a neurology clinic in Minneapolis.
And they're like, yeah, we would love this support.
get it when our patients are in the hospital.
Soon as they're discharged, we don't have any help.
How are we going to get to them?
And so the first thing we thought was obviously like the risk bearer, the insurancecompany has
(17:25):
the margin to make on any savings that we could create.
But they also have a familiarity with medication management and a little bit of adifferent regard and a mandate to do it.
So in Medicare Advantage, which is kind of the privatized market of Medicare, you get achoice when you turn 65 for people who don't know this in this country, right?
(17:47):
You get to choose, do I want to stay on what's called fee for service where I can go toany doctor I want.
Any specialist, uh have a 20 % co-pay or co-insurance with that care, but I've got kind offreedom.
There's not a narrow network of providers or prior authorizations per se like there is inprivatized Medicare.
(18:12):
More than 50 % of our country is now on a Medicare advantage where it's managed by aninsurance company.
uh In Medicare,
Since the early 2000s, it doesn't matter which side of that you pick, there's somethingcalled medication therapy management or ACRONIZE that's MTM.
(18:32):
MTM, I know that acronym.
uh
All right.
So we knew people were familiar with that.
We knew that there were it's kind of commoditized at this point.
Some people in health plans kind of think of it as a four letter word.
It's it's it can be good, but it's also been abused.
Like there's been companies that have done it and just check the box.
(18:54):
It's very focused on a transactional basis with a patient.
It's brief.
It's drug focused.
But we knew that that existed.
We knew that it was a regulatory mandate for Medicare beneficiaries.
And so we started going to the people that manage those programs and the buyers of thoseprograms at Health Plans and said, what are you guys doing for kids?
(19:15):
You have to do this for adults.
The polypharmacy exists over here in this population too.
It's even more complex because of the dynamic nature of like disease progression in kids.
the growth progression and just like the off-label use of drugs in pediatrics, it's reallyprevalent.
(19:37):
What are you doing for kids?
the first health plan was like, nothing, where have you been?
We've been looking for you.
so that was another moment where we were like, okay, okay, this is probably the place weneed to go.
We just need to like let them understand that we're not gonna lower our standard of care.
(19:57):
But we'll come in underneath the guise of any program just to get this thing going to kindof prove out that we can do this at the population health level.
that gives you an idea you're on the right track when the first people you go to with yourproduct are like, where have you been our whole life?
Yeah, that's got a, a needed niche right there.
When that happened, have a question about the health plans too, to understand, you know, II've worked in the healthcare industry for a long time, Medicaid, Medicare commercial,
(20:26):
right?
Kind of been everywhere.
Do you find that most of these
pediatric patients, are they on Medicare?
Are they on long-term care plans?
Are they on commercial plans?
Is it kind of like all over the place?
I'm just kind of curious in terms of like, where do they actually show up?
Because I immediately think Medicaid long-term care plans.
But I don't think that's not necessarily where they all are, right?
(20:49):
Or maybe even the majority are.
So it kind of depends on how you segment uh who can use the help.
If you think about the, again, the most complex of the complex, typically on CHIP,Medicaid, uh the facility residents for sure are on those types of plans.
(21:10):
Again, when we started looking at this and saying, the first threshold for us was any kidwho's on five or more medications at a time.
and like their state in growth and their unique pathophysiology and their disease state,like they're an N of one in the world, okay?
Just five factors on the medication side.
(21:30):
uh we set the threshold there.
When we started going to the health plans, we anticipated all Medicaid.
uh What we've received is not.
So some of this is just by like,
where we're networked and who we knew and what health plans signed up first and theirproduct mix or their lines of business.
(21:54):
uh But the other portion is that like there's tons of pediatric patients that are on five,10, 15 medications that are commercially insured.
They're buying plans off the healthcare exchange.
They're uh insured by self-insured employers.
(22:14):
uh And so,
The first health plan we worked with was Medicaid, administrative services only foremployer groups and commercially insured lives, which was a complete surprise to us.
And today our patient mix is, it's the same.
It's, uh we have all of it.
Whenever we go into health plan, usually someone wants to push us over to the Medicaidfolks and we're like, Hey, just let, can we just look at like.
(22:38):
data.
Yeah, they're probably there, right?
And you always find them, right?
Always.
Yeah.
And always more than they ever thought.
Okay.
So like employer provided health, right?
So like me getting my insurance through my employer.
If I have a child who falls in that category, they could be on a plan like that.
And you could also be on Medicaid and you could be on all the other things, right?
(23:02):
So.
Sure.
Like, okay, Heather, your, your nephew is one example, but another one, the number of kidsthat are on multiple behavioral health medications, three, four medications, they're,
they're not even considered medically complex, but they're being treated with a number ofpsychotropics or your type one diabetics that also have asthma.
(23:25):
Like these are the kinds of combinations or epileptic patients who have, you know,something else going on.
even when they exacerbate within that single disease state.
So they get COVID on top of their epilepsy.
Like there are things that have to happen and considerations that need to be made andextra labs that need to be checked that aren't the case for a typically healthy kid.
(23:48):
And so that expands the population that we think needs the extra attention.
Maybe it's not as frequent in a proactive fashion, but should we be looking for the risingrisk?
Should we be looking for concerning prescriptions?
admissions to the hospital to say, okay, now's the time we jump in, try to see if we cando something.
And maybe they're not our long-term patient, but there's probably something to be done forthat kind of a kid.
(24:13):
And like you pointed out how every combination of drugs is a very unique, you know, uh,effect on the person, especially since all our physiologies are different.
How do you actually track all this?
Like it, do you guys have like an AI system set up to actually correlate all this data andkeep compiling and all that sort of thing?
(24:35):
Cause it just seems like infinitely complex.
This problem you're trying to solve for.
Yeah, it totally is.
First of all, there is no robust data set.
We're running in a capitalistic healthcare society that's driven by profits, right?
And very little research and development is gone, goes in on the front end, goes intopharmacotherapies for kids, very, very little.
(25:06):
And so if you talk to,
anybody who prescribes in the space, a lot of it's based off experience still and whatthey've seen or single case reports or drawing conclusions from adult studies and then
writing for off-label indications of drugs.
uh Slowly here, we're compiling what works.
(25:31):
So we're absolutely filing clinical guidelines that are set by the medical institutions.
we're filing the standard of care if it's been established somewhere, but the uniquecombinations that you just referenced, there's not a big database of those to put an LLM
over the top of.
We think we're gonna have one and we'll probably have a good one.
(25:53):
We probably do right now to start putting that over, but we're recognizing the patternsand then we're creating the clinical pathways and decision trees of if you look like this,
in our experience, we should probably try
you know, XYZ next, whatever that is.
You're doing it.
You're like doing the work that maybe should have been done like that.
(26:13):
It's like live R &D.
It seems like in the actual actions and the execution of the work that you're doing withthese families and these children.
And it's very individual, case by case kind of process.
Yeah, they that's a subjective component of it.
(26:33):
Like when I was talking about the medic medication therapy management, like our firstthing is to get on with a patient and say like, Hey, how are you feeling?
How are you toileting?
How are you sleeping?
How are you eating?
Tell me about this drug.
Does it is it working for you?
How does it how does it make you feel?
And it's it's it's very dialed into the exact feelings and the signs and the symptoms ofthat patient.
(26:59):
So that comes by way of a subjective assessment and interviewing somebody just like thison a Zoom telehealth call.
It comes from gathering clinical data from anywhere we can grab it.
You know, we're getting better at that as slow as the progression's been with um clinicaldata and electronic health records and stuff.
um to answer your question a little bit more directly, we shopped for some sort ofsoftware to do this.
(27:25):
m Because of the nuances of
pediatrics, we couldn't find it.
We looked at the medication therapy management platforms that are out there.
We looked at the EHRs that are in hospitals and doctor's offices today.
We looked at care management platforms and nothing really fit this weird thing we'redoing.
And so we started to build it on our own.
(27:47):
We've been doing that since October of last year at a very fast pace.
um
And it's all being done internally today.
Wow.
That's crazy.
Talk about like filling a gap, right?
And a need that is...
(28:07):
Building from scratch on this one.
Yeah.
You know, sometimes you just have to build it yourself.
so kind of staying in that, obviously you're getting some clinical data by literallymeeting with these families, getting some of the data that you're seeing from these health
plans.
Can you share kind of, so...
You're into the door at the health plans.
(28:28):
giving you, they're giving you the, maybe the claims data, whatever kind of, whateverthey're, they're, letting you see you're identifying these, we'll say opportunities,
right?
Uh, patients essentially that you're like, okay, they need our help.
They need our help.
Now we've got this list of people.
What happens next?
Like, how do you, how do you get in touch with these people?
(28:50):
How do you get connected with them?
And then how do you help them?
And like, what are some like the immediate benefits that
that they see and how quickly does that happen.
Those are awesome questions.
Okay.
I wish health plans would
questions, I'm sorry, I just threw three at you here.
I wrote one down because I don't want to forget the last one because I think that's themost important question, but
(29:13):
Agreed.
So yeah, you kind of laid it out right how we get to a patient list.
We agree with the health plan.
Here's our list of people.
We're going to go and we're going to try to get them engaged.
I think one of the values is like, there's a lot of money in innovation in software andhealthcare and digital solutions that somebody else needs to go and do it.
(29:38):
And so that's a hard sale.
That's hard to actually get outcomes on.
everybody's already overburdened.
So one of the other things we say is like, we'll do the identification with you.
Like this is a process.
A lot of companies, they're making their entire revenue stream just off doing that.
So we do that as a sales activity.
(29:58):
We don't charge for it to kind of prove like, hey, we're in this with you.
We're going to look and show you what we think we can do before we ever do anything orcharge you.
uh And if we do this, you can't charge the patient.
They have to be
uh, able to be enrolled into it.
they're, we, we, we determine who's eligible, but no copays, no co-insurance, nodeductible, no out of pocket maximum, no bills, no balance billing, none of it.
(30:24):
Cause it's already hard enough sale.
So get the panel.
Um, and then we start, we just start cold calling typically moms and dads, caretakers,foster parents, guardians, whoever is the responsible party.
they're under 18 or over and they have that.
authority, or the patient themselves, we see patients up to the age of 24.
(30:49):
And between that age, like graduating from pediatrics to adult medicine, especially whenyou have medical conditions is really, there's really kind of a tough period of life.
uh So we reach out cold, we the health plan usually uh co markets and co brand some snailmail emails, we can do text.
uh But imagine like you're
(31:11):
You're the recipient of this thing.
You've never heard of it.
It takes some experience.
real, right?
Is that like the first way I would imagine like, this is too good to be true, right?
Well, it's either that or like, you're a scam.
validate you're real.
not giving you any health information, right?
(31:32):
So it's usually one of those extremes.
Like, thank God you called or this sounds good, but I'm going to go back and call BlueCross or whoever.
Yeah, yeah, is this legit?
So then they work with you.
it's cold calling telling somebody that you have their information.
They look like somebody who needs help medically and you want to help in a way thatthey've probably never heard of, right?
(31:58):
Like I can say telehealth, most people will be all right with that, but like we startedtalking about clinical pharmacy.
If you haven't worked in a hospital, what's your definition of a pharmacist?
Their main job is dispensing meds, not making therapy decisions.
Right.
They're not, they're not putting the care plans together or anything like that.
(32:20):
They're just executing.
They're being told, right?
Essentially.
Yeah.
filing orders, validating prescriptions, making sure they're safe from like an allergyperspective or drug to drug interaction perspective.
But it kind of ends like, I'm sure there's more to it and uh please don't hate on me.
The hundreds of thousands of community pharmacists out there, because you're doing greatwork too.
(32:41):
We're just doing something different, right?
And so when I cold call, it's a sale, right?
We're selling something, it's free to them.
Um, it's on behalf of their health plan.
It's a benefit that their health plan probably didn't tell them about when they enrolled,but they have available now.
(33:04):
we have to reset that what, what their uh concept of pharmacy is comprehensively, and thenget them to agree to meet with us the next time we have a call, um, and put them on video
and align them to a single pediatric pharmacist and.
the nurses and technicians that we have supporting that role.
(33:26):
Do you have your own clinical staff, like pharmacists and clinical staff, that umcommunicate with these families, that essentially join those calls and help kind of
understand, like, what are all the things that your kid's on?
OK, this is right.
This is wrong.
This could be better.
Does it work kind of like that?
(33:47):
OK.
Yeah.
So uh we, our intent was not to become a technology company.
It still, it still isn't.
We're developing a technology to, be able to do the thing.
And for us, the thing is clinical care.
It's, it's attributing a single pharmacist that meets with them every time we see them umand a nursing team.
(34:08):
So yeah, they're all employees here at Perfecting Peds.
um We have a pharmacist team, have a nursing care management team, and we have atechnician team that are all working on these patients together.
Yeah, I always like to say innovation shows up in really different ways.
It can be a person, it can be a program, it can be building a relationship and that likeconsultative support that you're providing that is in turn changing and impacting these
(34:35):
people's lives, right?
Because you're, you're plugging into a system that hasn't been looking out for them.
And that is an innovation.
That's innovation.
Innovation doesn't have to be technology.
So I love that.
Yeah.
I think so.
I, my brain is still lingering on that 44 % reduction in ER visits or whatever it was likethat right there tells you you're doing something right.
(34:59):
Right.
That's a big number.
It's a hard sell, right?
Because it's not uh hard cost.
The deep rescribing thing, nobody's gonna argue that.
If somebody's on something and then we take them off because they didn't need to be on itand that thing cost a dollar, you saved a dollar.
(35:21):
There's no way to predict how many times Jeremy and Heather go to the hospital, but we canmake inference and say,
for what you look like, your utilization rate is this.
based on the type of interventions that we're doing, and we do about 13 on average perpatient, the cost savings of that looks like this.
(35:48):
It was real easy to do in a facility when we knew what the admission rates were for thosepatients as a group before we came in.
At the POP Health level, uh we've got to convince payers to give us all their data, whichwe haven't done yet.
Mm hmm.
Yeah, that's the hard part.
I feel your pain.
I get it.
As much as our data is everywhere already, people really don't like giving it out.
(36:10):
Yeah.
Yeah.
Especially.
Yeah.
With HIPAA and privacy.
Like the health plans are competitive with each other.
Even health plans under the same franchise.
You think about like Blue Cross Blue Shield, they're all competing with each other.
They have competitive bid process on government contracts.
They don't always want to give away their sauce or where they're saving or where they'renot.
(36:32):
Yeah.
So where the big question, the most important question, what is the immediate benefit forthese folks, for these families when you get in there and you work with them and they say,
yeah, like I'm ready.
Come on in and help us out.
What do you see?
I wrote down the third question and I never answered it, I?
(36:52):
I know I want to make sure you got weak.
is this is literally the reason we're here now.
I think is like, how are you changing lives?
Because that's what you're doing in my opinion.
Um, so the first interaction is this like pretty big assessment.
do a decent amount of work before we ever see the patient.
Soon as they say, yep, sign me up.
We're pulling in as much information as we can.
(37:14):
So we're looking at, uh the, there's a good aggregation of pharmacy data at, at the pointof sale through, um, a company called Sure Scripts.
We'll start to look at what's been ordered, what's been picked up and what's been leftthere.
uh We'll connect to health information exchanges and the national networks that house lotsof clinical data through what's called a QHIN.
(37:39):
uh There was recent legislation passed over the last few years to make access to treatmentinformation a little bit more easy for us providers.
We leverage all of those new regulations through this QHIN and an act called TEFCA.
to get as much as we can beforehand.
And we've got a good idea of where we might start to make adjustments based on thesubjective assessment and kind of what we get from the patient before we ever meet with
(38:04):
them.
But the immediate thing, I think, for patients and parents is a resource.
uh So when they end up in the ER that night unexpectedly or...
They've got a cold, something, you know, they've got all these other things going on andthey're in the middle of the aisle at CVS or Walgreens.
(38:27):
They've got somebody to reach out to and be like, Hey, what do I do?
You know, the, the, the person behind the counter there might be able to make somesuggestions.
Less than a half a percent of all pharmacists have pediatric training.
If they call here, they know they're going to get an expert in whatever they have goingon.
Um, but we immediately start looking at.
(38:48):
What are the indications for the drugs you're on?
Does everyone know why you're on the things that you are?
And if we can't get a good explanation of that from you or your providers, there'ssomething wrong.
em Are your blood levels of your drugs at the point where they're actually doing somethingor are they too high and toxic and we need to bring them down?
And have we been monitoring for adverse reactions every time you bring a new drug onto theprofile?
(39:14):
This is something that like the lay person doesn't think or talk about like.
you're introducing chemicals into your body.
They're interacting with your cells and the other drugs in there.
And oftentimes through the research that's been done before that drug came to market, weknow that, this, this psych, this psych med can delay some of the conduction in the heart.
(39:34):
When's the last time we looked at an EKG and made sure that, you know, there's nothing badhappening from what we're doing.
That's worse than just dealing with the issue or using a different therapy instead of thisone.
So
Those are just a couple of examples of what we'll take a look at right off the bat, butit's comprehensive medication management, we're comprehensive right from the start.
Wow.
And like, what's their reaction to these folks that actually end up working with you?
(39:59):
Are they just like, thank you.
Where have you been all my life?
Or I've got somebody I can depend on and it sounds like they can reach out to you prettymuch anytime.
Is that like a 24 seven kind of call us when you need us sort of thing?
um We're not at 24 seven yet.
I think we will be there soon.
(40:19):
But anyway, they want to get ahold of us.
They can call email text.
um All compliant and protected.
I'm sorry, the first part of your question.
But what has been the reaction just in general from the people that you're you're servingand working with these families?
(40:40):
Um, it's been overwhelming to, to like see it.
I, I, I'm really fortunate.
Like today, my kids are generally healthy.
Like we've got some allergies and whatnot, but like, um, it's been profound.
Google us, take a look at our Google reviews.
Some of them, I mean, I'll cry when I read it, I don't want to talk right now.
Um, but it seems like it's a breath of fresh air.
(41:03):
It seems like we've got a lot of time compared to.
You know, if you go into your primary care, they're really on a fixed schedule andpayment.
um They don't get to negotiate typically, especially in pediatrics with health plans onhow much they're paid.
So they've got a certain amount of time that they can spend with a given patient.
(41:26):
We have the luxury of being able to sit there the first time we meet them for an hour, puta bunch of work on the front end of it, put nurses on the back end of it, and then meet
them again the next month to carry that care plan forward.
and then the next month and the next month for extended periods of time.
And so we can listen, we can spend a lot more time listening.
And I think when people want to be heard, the longer we hear them, the more of a picturewe can get, and then we can start to make better adjustments or at least recommendations
(41:54):
to make those adjustments.
I think, you know, I'm a little biased in my response to this question, but I think we'reproviding a pretty decent.
value back and it's recognized and the only objective way to prove that is in retention.
So very few patients unenroll from the service, very few.
(42:18):
It's like there's churn in eligibility because of a health plan, but I can count on onehand how many patients have after they had just one visit have not come back and continued
on service.
Wow.
I mean, who doesn't want help?
And sometimes it's like, you don't know what you need until you have it.
And then when you have it, you don't want to lose it.
(42:39):
healthcare is complex.
And then you're dealing with these very fragile scenarios, right?
And that's a scary place to be.
The parents of the kids that we're working with, if the kid is, even if they're a fewyears old, they've been through a lot.
(43:01):
They're typically reluctant to let somebody new or something new onto the care team,right?
And so in these initial outreach calls, we get a lot of objections.
There's like, hey, we've got everything under control.
I've been doing this for 12 years with my son, right?
Like, I don't need this.
I've got it.
(43:22):
uh
Oftentimes we'll have to say something like, will you just give us a shot?
Can you show up on video for five minutes?
And if you don't think that it's going to provide anything for you, go ahead and hang up.
Like you don't have to do this.
It's your health plan.
This isn't a check for prior authorizations with your health plan.
Like we're actually, we're going to work on your behalf and really just try to help youclinically.
(43:45):
If you don't find that, then you don't have to come back.
And a lot of times that works in, um, and
You know, we've had one, we had one mom who was like, you've got 15 minutes to impress meor I'm hanging up.
Like said that to the pharmacist.
right then.
Challenge accepted.
Let's go.
Did she sign up with you guys?
(44:08):
She did and then she brought her other two kids and then she ended up working here.
Wow, there you go.
Well, if that isn't a success story, as a marketer, I'm like, I would use that.
We should talk after we stop the podcast.
So I like to look at the big picture things a lot.
(44:28):
I'm a philosopher by nature.
So I have a big picture question for you.
I you said you don't have any intention of becoming a full on tech company, but with whatyou do, if you compile all of these relationships of all these different drugs being taken
by these different people with these different conditions, ultimately over time, mean, youcould, is that a database that could actually like lead to, you, you're
(44:53):
You know, this gender and this age and you have these underlying conditions, you needthese meds and like actually streamline it to the point where you could almost, you know,
it's a plug and play, uh, you know, medicine situation where you really can just like,this is my physiology, this is my problems.
What do I take?
(45:13):
And it will have that information.
Do you see that as a possibility or is it just too complex because of the individualactual like
physiologies, like the patient themselves are just too different.
This is like predictive modeling is what is sticking out of the head from.
Like, that a potential for this that you see?
For sure.
Given the way that we're doing this remotely and then across diverse geographies andpatient populations, I anticipate we will have probably the largest aggregation of rare
(45:45):
disease data in pediatric lives at some point.
There's really long-standing institutions in this country, Children's National in DC andall over.
They've got a lot of information.
The way that we're gathering, the way that it's related to
pharmacotherapies is probably unique.
I anticipate that for sure.
(46:06):
If nothing else, like one of the audacious goals is we want to validate prescriptions atthe point of sale and the point of dispensing because it's not being done today in a way
that we think is the best way that could be done.
And so I think some of that plays into it.
Like there's gotta be a database of historical outcomes and to infer from.
(46:30):
So I think we're I think yeah, I think by accident we're building that.
Like, give it 20 years, right?
Then you're going to have it, whether you're trying to or not at a certain point, right?
As long as you just compile that data.
think so.
Yeah, we'll have to hire another guy to go sell it, I'm really into the care delivery.
But no, you're right.
(46:51):
You're right.
Cool.
Yeah, that also happened.
But you are, yeah, your care delivery first, right?
That's care delivery, care consultation, right?
Medication management.
I mean, to have a partner or somebody that you can rely on, right?
It's to provide guidance and advice and kind of decision-making that I'm not gonna be inthe hospital again where I might have ended up there without you.
(47:18):
Sure.
So.
Yeah, or like, again, how much time does the doctor have?
So I get I get written for the new new drug ABC.
Do I feel confident that when I got home, like, can I call somebody else to learn a littlebit more?
Make sure it's driving with everything else that's going on?
Yeah, I think that's it.
And the real people I think of are these kids who's, you know, these kids who have enoughproblems to begin with and then their medications actually are making it worse instead of
(47:46):
better in some cases.
Fixing that problem right there is a big deal all by itself.
And that's just a little piece of what you guys are doing.
Yeah, like our CEO tells this story, the kid that broke her was just labeled with allthese diagnoses in the hospital.
And I'm not getting too dorky on it.
(48:09):
The nephrologist, the kid had kidney stones, the kid had urinary retention, getting self,was getting catheterized for urine six times a day, was labeled with kidney disease.
had some other things going on where they were using drugs to drive secretions because thekid was on a ventilator and you have a lot of secretions then, but the effects of that
(48:31):
drug slowed down the digestive system.
And so he was constipated and then they were treating that constipation with uh stoolsofteners and other, like another bowel regimen and a bunch of this stuff.
And I'm doing it a really bad job at giving a clinical justice, but like a bunch of thisstuff was by way of that.
was the inner.
causes another causes another causes another that you have to medicate.
(48:55):
then you've got.
Medicating the med.
Side effects from one drug and right.
I've seen that with my nephew.
Yeah.
The kid was on a drug for seven years that was prescribed seven years previously.
No one really caught that.
They pulled him off the drug.
It wasn't even necessary anymore.
spontaneously urinating, not being catheterized, pulled off other medications and just theurine part alone.
(49:23):
That is profound.
That's huge.
To not have to be hooked up to a catheter, like the freedom that that gives somebody.
all because of the meds they were it wasn't even it wasn't a disease like it was
The poor kid could have been off that catheter for probably years.
ah
(49:45):
was like, Heather, this wasn't a catheter that state, it wasn't an indwelling catheter.
Like, you just get tortured every day, like straight catheterized.
Sorry with the hand gesture, but I just, yeah, it it'll break your heart thinking aboutthat.
It does.
Yeah, that's that's rough.
That's rough.
That poor kid.
ah
I think that's why we're here though, that happened.
(50:07):
He was like, oh my gosh, this is like, I got to do something about this.
it's cool part.
Okay, so anyone listening right now, I'm going to say this, who has a child or knowssomebody who has a child that is on multiple medications, has multiple chronic conditions,
has multiple disabilities.
(50:27):
You need to call these guys or find out if you can, you're eligible through your healthplan, like go right now.
Yeah, please do.
like, please go on, bring it on.
We want to help people and change lives.
This is actually I've gotten really good at these segues.
Jeremy, this is how I start to end and wind down the show without without saying thatthat's what we're doing.
(50:48):
But really, this is a really great note to end on.
Very meta moment right there.
Thank you.
Very I know I'm really good at this.
I'm telling you, I was made for this.
You gotta do this by yourself.
Yeah, exactly.
I feel good about this work.
But um seriously, run to your health plan and find out if perfecting.
(51:10):
Peds is with your health plan, and if not, like go to your website, right?
So with that, like kind of what's next, how do we find you?
How does somebody get to find out if they are eligible through their health plan?
Give us all the ways to to locate you online and find out.
Yep.
Um, if you're in Minnesota, New York, New Jersey, Pennsylvania, Florida, South Carolina,you can check with your health plan.
(51:37):
There's more health plans coming on board here soon.
We're really easy to miss today.
We're trying to find somewhere to cross that river.
Um, but if not go to your health plan and ask them for the benefit that we, we gotcontracted with a health plan in, Pennsylvania because a parent went and said,
I've been paying for this out of pocket and I want you to cover it and they called us andthey did.
(51:59):
em And it provided the benefit for thousands of others after that one parent called.
em Otherwise they can go to our website and we can enroll them directly.
And we pretty much do that at cost if they pay private.
Okay.
So that is an option.
Is it just perfectingpedes.com?
PerfectingPets.com
Amazing.
(52:20):
ah We'll put it in the show notes as well.
You can just go click on it in the show notes if you want.
Yeah, awesome.
And I think too, this one thing I want to say, and this comes up a lot, and this is ah Ithink just an important part of healthcare is that we have to advocate for ourselves and
our loved ones that we care for.
um Not, you know, these, the doctors and the providers and the good nurses of theuniverse, and there's so many of them out there.
(52:46):
They are stretched thin, they are overburdened, they can't give each one of us, umprobably the dedicated attention that they want to.
um But we have to be our best advocates and so go fight.
if you don't say anything, it won't happen.
you know, we've got to use our voices.
It's one of my favorite sayings.
(53:07):
I said the squeaky wheel gets the grease.
Yes, it does.
But yeah, if you're in a state that he did not say this is available and yet start makingphone calls.
Yep.
Cause like you just said about Pennsylvania, you know, you got a couple of people fromthat state calling and poking at them to be like, Hey, get on this thing now.
There you go.
soon you'll be.
(53:28):
that where it works?
Yep.
So that's our action item for the day.
If you're listening, feel some social media posts coming from Heather on that.
yeah.
For sure.
Well, while this has been amazing, um, I love what you're doing.
This hits close to home for me.
Um, being I'm the legal guardian of my niece Shannon in New Jersey, who I, know Imentioned to you, who's in a really wonderful program there.
(53:52):
And then of course my nephew, um, who I play very big role in his life as well.
Not quite as,
you know, extreme probably as some of the families that you do help, but definitely prettyclose and probably falls into those categories every once in a while.
And I could just see where this would be uh a godsend to have you at our side, their side,everyone's side, who's dealing with this.
(54:17):
So, yeah.
Get to Arizona.
Yep.
Arizona.
We'll get you to Arizona real quick.
Yeah.
So with that, thank you so much for coming on and sharing.
your story and what you're doing to just make your impact in that one little, one littlepart of our healthcare universe.
So yeah, great.
for having me.
appreciate it.
(54:37):
Thanks for giving me the time.
And there you go.
Our conversation with Lyle from Perfecting Peds.
Very cool stuff.
Very cool.
But I'm going to let you take it up here first.
Heather, what's our main takeaway is there?
Well, I think about this a little bit like how this comes up on the show quite a bit.
(55:01):
Women's health issues have been largely ignored and now there's a lot of a lot oftechnology and companies that are solving for it.
What I didn't realize is how much pediatric medication management for like complex
you know, kids with complex needs, you know, high risk, all the things had been so underserved, um, unaddressed, like huge, huge gap that they're solving for.
(55:27):
Um, very niche, right?
But when you talk about the smallest percentage of, of people, of patients always have thehighest percentage of cost.
And so that is where typically, you know, a lot of focus is put.
but there was nobody focusing on this.
And so they're doing it and it's just been a huge gap.
(55:50):
So I think it's just really cool to see them kind of plugging themselves into that spaceand, and, getting to work with these very vulnerable, fragile children and their families
to do something that no one's ever done for them before.
And that the health plans are like, where have you been?
Yeah.
Right.
And it's like such an obvious need that nobody was taking the time to take care of.
(56:13):
I mean, he told us that one story, but that kid just take them off that one med.
ah And years of suffering could have been avoided if they had just taken them off that onemedicine at the right time and not left them on it for years needlessly causing all those
problems.
It's such a sad thing that, you know, that's just allowed to happen because it's literallyjust lack of attention to the problem.
(56:39):
So it's awesome that these guys
stepped up and like, we're going to be the ones to pay attention to this because thesekids need help.
Yeah.
I loved how, um, almost emotional he was about it too.
That like, that just shows you how, uh, just, you know, how committed, how dedicated theyare.
This is something that's really personal to, to the perfecting Peds team, Peds team, youknow, everybody, the founders, their clinical teams and, know, and not to mention
(57:10):
Like when you have a lot of like issues, like, and this comes up again, like manydifferent episodes, like people with chronic conditions, people with comorbidities, people
with, you know, whatever, like cancer, like it is a scary, scary thing, whether it is likea short-term thing or a long-term thing or forever thing to have somebody that you can
rely on, like a guide, a consultant, uh somebody who can, you can trust to walk youthrough these parts of.
(57:38):
your healthcare journey and your, your, uh you know, your, these systems that are sooverwhelming and you don't know, cause you're not a doctor.
Right.
I mean, to have that, that type of support is it's a gift and sometimes people don't knowthat they need it until they have it.
You you don't know what's missing until you, until you find it.
Yeah.
(57:59):
I love that part.
I actually, my favorite part was that
they're very specifically not looking to be a tech company.
They want to, they're very patient oriented.
They are a medicine company.
are not a tech company, but long-term the tech database they could build off of whatthey're doing with the medicines could be a very important piece of medical tech in the,
(58:22):
in the future realms.
Because of those correlations between the different conditions, the different sets ofmedicines, the way all these medicines
interact with each other and different physiologies and whatnot.
And it's going to take a lot of data and some pretty serious AI software, right.
And probably to really utilize it that way.
(58:43):
But he was like, yeah, I mean, it's going to happen inherently as long as they keep trackof all their data.
Innovation shows up in lots of different ways.
and I feel so much better about AI since we started this podcast.
I don't feel like it's going to destroy us anymore.
It's going to.
It's just a tool that if you use it right, could be amazing.
(59:04):
Yeah.
Can you enjoy?
things for all of us early in the end.
yeah.
Okay.
So yeah, there you go.
If you like what you hear, if you want to keep track of all the new stuff we're going tobe talking about in the future, make sure to hit the, all those happy little fun buttons,
the likes and subscribes, the share with a friend, uh hit that auto download.
(59:24):
You'll never miss a beat.
We are on all the major listening platforms.
We were on YouTube if you want to see us on video We are also on patreon video style IIwhere you can support the uprising for as little as a dollar a month ah You know, we're
need some money eventually on this it's not why we're here But it would help so we wouldmuch appreciate anything you could throw our way I don't know.
(59:46):
Where else are we Heather?
You can find us online at healthcare uprising?
Dot-com as well as all the social media platforms like blue sky linkedin instagram andfacebook be
post out there a lot when our episodes drop and share a lot of our past guests and futureguests posts, especially on LinkedIn.
So lots of good happening out there.
So we'll keep you updated if you're into that.
(01:00:09):
So let's see what else.
I'm blanking.
I'm looking for people.
I'm looking for people.
on the podcast.
Give me a call.
Shoot us an email.
Are you a founder?
Are you, are you working for a company that's doing something innovative?
Are you a person with a with the human story?
Have you had some crazy health care story that you want to come on and share?
(01:00:32):
Give us a shout at our email at healthcare uprising at gmail dot com and reach out.
And I'd love to speak with you and see about having you come on the show and share yourstory.
So always look always looking for those stories.
So in the personal stories get to be bonus episodes, which make them even better.
That is for that is our priorities.
Yeah.
So bring it on.
(01:00:52):
Give us a call or email.
Other than that, think that's our dose of healthcare for the day.
So with that, keep looking for the good in the world.
Sometimes that's where you least expect it.
(01:02:02):
This has been a Shut Up production.
Alright.
health heads.
Welcome and thank you for checking into this dose of the healthcare uprising.
I'm your producer in the back Jeremy Carr here with your host in the front row HeatherPierce.
So let's tell them what's on the agenda for today Heather.
Today we're chatting with Lyle Miodyszewski who is the president and co founder ofPerfecting
(00:33):
PEDS as in pediatrics.
PEDS.
It's a mission-driven pediatric pharmacy and care coordination organization dedicated toimproving outcomes for medically complex and high-risk children.
This one really hit home for me because I've got some people in my life who categorize asmedically complex and high-risk.
(00:53):
So really, really love what they're doing.
He is a registered nurse with over 20 years of experience in diverse health carecapacities.
operational and strategic domains, but his deep understanding of the healthcare systemcombined with his commitment to innovation and patient-centered care has positioned
Perfecting Peds as a trusted partner to payers, providers, and families nationwide.
(01:17):
He is also, uh he is a co-founder if I didn't mention that, so he is part of the foundingteam.
Cool.
Good stuff.
All right.
We don't, don't get too many episodes that focus on the kids side of healthcare.
So this is a good addition to the lineup here.
So without further ado, here's our conversation with Lyle from Perfecting Peets.
(01:42):
Hi, and welcome to the healthcare uprising podcast.
Today we have Lyle, the president of perfecting.
Peds pediatrics.
We'll save a long form because we want to make sure that that comes out right.
So Lyle, thank you so much for joining us today.
Excited to have you on.
Yeah, thanks for having me.
(02:02):
I'm super excited to chat with you.
Great.
So let's jump in.
And first, we always like to ask, give us a little bit of background about yourexperience, kind of what brought you to this space and addressing pediatric medication
management.
And, um, and then we'll kind of go from there and see where the conversation goes.
Yeah, sure, absolutely.
(02:23):
uh Me personally, I'm a registered nurse originally.
um Been obsessed with healthcare since I could be obsessed with a career.
uh Spent about 10 years bedside, emergency departments, trauma rooms, cardiac cath labs,and electrophysiology.
I got exposed to sales reps in the cath lab.
(02:44):
This is where they do balloon angioplasty and stenting and uh really the plumbing of theheart.
There's a lot of sales reps in that environment and I just, kind of took to theprofession.
I liked the kind of money that they were making, if I'm going to be honest.
um I thought, geez, I think I've got good enough communication skills and I absolutelyhave the patient care experience to be able to do that.
(03:05):
so worked through that, worked oh at a bunch of different companies since then, was in theMedicare Advantage space before founding Perfecting Peds.
And I stumbled across this solution.
Our CEO had been in kind of a proof of concept phase for a number of years.
She was a pediatric clinical pharmacist, still is.
(03:27):
uh noticed that she was getting a bunch of kids into the hospital, into the pediatric ICUin the Philadelphia area and thought, why am I just reactive?
Like my whole profession is in a hospital waiting for kids to get sick.
And then we try to help.
lot of these kids are on.
a number of medications and I think we could do better on the front end and maybe keepthem out of the hospital.
(03:51):
And so she had implemented what's now perfecting PEDs in a pediatric skilled nursingfacility in subacute rehab.
uh Had initial findings of that implementation and they were profound.
I stumbled across the manuscript and her on Y Combinator.
(04:11):
They have like kind of a match.com for founders.
And so we had both entered our profiles.
It's really cool.
Anytime I talk to somebody who's trying to do something different and they've got diverseexperience or they have an idea, I always send them to this because it's kind of a success
story for Jenna and myself.
But she had an idea and was actually already doing it.
(04:33):
I had this set of skills, didn't find that I was applying them well in Medicare Advantageand specifically risk adjustment.
And I really just wanted to get back to the
care delivery side of our ecosystem.
So I got a chance to read her manuscript of the initial outcomes.
uh I'd messaged her and said, if these are real, I'll hop on a plane tomorrow out to NewJersey.
(04:57):
She said they're real and here we are.
Wow, I love that.
And I was going to ask you kind of the origin story of of the company too, as well, whichyou've kind of started sharing a little bit about that.
Can you kind of expand on that a little bit more?
Like obviously the impetus behind it.
We know there are some issues there, right, that you had already already shared.
(05:19):
But and so and also are you are you considered a founder as well or a co-founder?
Yeah, so my equity stake in the company, I guess, makes me co-founder.
It's myself, Jenna, and then we have a huge founding team behind us at this point in justa really short period of time.
But the founding story is really hers, and I'm happy to tell it.
(05:41):
I'm going to steal her thunder a little bit, though, because this is really Jenna's story.
But she was at Children's Hospital of Philadelphia, a pretty well-renowned hospital, andit's an acronym that is CHOP.
uh And then went on to a hospital in Camden, New Jersey called Cooper University.
uh And she just kept noticing the same thing.
This is a typical story in healthcare.
(06:02):
Like you get, and it's horrible.
We say this, but like frequent flyers or frequent utilizers, high utilizers of thehealthcare system, noticed they were coming uh many times from a few distinct facilities
in the area.
So a lot of people aren't going to be familiar with this because it just doesn't exist incertain geographies.
there are skilled nursing facilities for children.
(06:25):
There's uh inpatient rehab centers for kids.
uh Where I'm from originally in Michigan, we don't have any, right?
And so I wasn't familiar with this care setting, but she was, and she was noticing kidscoming in and she was spending more time working on their chronic medication regimen and
tuning and tweaking and correcting things that were not good uh on those kids.
(06:51):
And some of it wasn't even really what they were being admitted to the hospital for.
So she uh went to the CEO of these facilities and said, you guys have a problem and Idon't think you realize it.
And I have a question and that's who the heck's managing the medications here.
(07:12):
And the answer that she got back was a little bit shocking.
uh And for a pediatric pharmacist like,
She didn't really understand one, how limited of a resource she was, how specialized thisgroup of people really are, uh and what's happening outside of acute care, outside of the
hospital.
And the answer to that question was they had a pharmacist that was really just kind ofchecking the regulatory compliance boxes and not working up the patients, right?
(07:42):
And so she said, I'll come in and you can pay me whatever you're paying the other person.
I'm going to open the charts.
I'm going to go in between all of the prescribers and the doctors and the nurses andeverybody here, just like I do in the hospital.
And I'm going to help fine tune these therapies and make sure that patients are gettingthe right, or at least the best therapy for them individually.
(08:04):
uh And so she, she contracted with them.
She did the regulatory compliance checks and she started opening the charts and uh theresults of that work we published about a year ago.
in the journal pediatric pharmacology, but in just a nine month period, she showed uh thatmany of these kids were on medications that were unnecessary.
(08:29):
They were left on after admissions or discharges from the hospital and shouldn't havebeen.
They were on the profile and nobody knew why.
They were on duplicative therapies.
They were on therapies that were unsafe or causing harm or interacting with other drugs.
so...
Probably whether ending up in the ER, right?
a lot and often mislabeled as a new diagnosis and not like the effect of the medication inan adverse drug event.
(08:55):
So she implements this thing, de-prescribes a bunch of unnecessary medications, these kidsin these facilities around an average of 23 meds.
She took them from 23 to 20.
23.
a lot.
I that's a lot for any, any age.
And you think about this in in a kid and, and, then there's a caregiver aspect and, and,then all of these care team members surrounding this person and 24 hours a day, seven days
(09:24):
a week, they have a care team surrounding them and they still had this room forimprovement.
Um, so she does this, she does it for a period of nine months.
The deprescribing is just a small chunk of really what it was.
It was, it was taking a look at the full thing and saying,
Is neurology talking to cardiology when they change neurology meds that affect cardiologyand does cardiology need to do anything about their meds because of this adjustment?
(09:50):
uh And the answer was usually no.
so uh outside of the deprescribing, just the fine tuning of things, they stop admissionsfrom the skilled nursing and subacute rehab into the hospital, which is really important
to the, businesses to keep
(10:10):
patients there and not one they don't nobody wants a kid or any patient to get sick butlike They also want that patient to stay with them And so she kept she kept them from
being admitted to the hospital from benchmark pre implementing the solution to Just ninemonths later.
They had reduced admissions to hospital by 44 percent
(10:32):
That's a huge number.
44%.
And that equates to cost, right?
Which is something we talk about a lot in the healthcare industry is these unnecessaryvisits to like ER, ICU.
So avoiding those, that's a big cost savings as well.
And all the drugs they don't have to take now because they were taking the wrong drugs.
(10:54):
And just healthier, right?
Well, better care for children.
Those are the two
To be clear to you, Lyle, I just want to make sure that like anyone who's listening toyou, when we talk about these kids, these pediatric patients, these are children with like
chronic health conditions, uh multiple disabilities potentially, right?
(11:17):
So hence why they're on so many of these medications.
Yeah, so in the study, some of the most sweet.
So children, medical complexity makeup, uh, somewhere between one and 3 % of all kids.
That just means that they have multiple diseases.
Um, they're usually on some sort of technology, meaning a ventilator, a feeding tube, um,some sort of technology that helps them, um, sustain life.
(11:45):
And so in the study, yeah, these are some of the most complex of the complex.
And the original hypothesis was like,
I don't want to call it low hanging fruit, like that's who needs to help the most.
Right.
So like the, two light bulbs there were one, this reduction in utilization and the twoexactly we just said, Heather is like, there's a cost uh associated with that.
And so we were charging the health plan.
(12:08):
I'm sorry.
We're charging the, um, facility.
They were getting benefit out of it, but like, this was creating a massive cost reductionfor the health plans that have risk on those lives, right?
The Medicaid.
commercial plans that those
care, all that.
So it's evolved since then by way of it, but today, as we talk about this, the idea haschanged a lot.
(12:35):
So 31 % of pediatric prescriptions contain an error.
It's three times the rate of adults, and that's a really good source.
2023 research out of the medication errors report by the US Pharmacopeia states 31%.
We think it might be higher, or at least not optimized prescriptions.
A lot of this is rooted in something as simple and silly as the fact that pediatricmedications are dose based on weight.
(13:05):
And if you're a parent or you've ever seen a prescription or you've taken in a child'sprescription to the pharmacy, guess what's not on that?
The weight.
So we see, you know, in our own kids, my kids, Jenna's kids, our CEO, like,
Oftentimes the indication for the drug does not match up with what the dose was andthere's no check at the pharmacy.
(13:29):
It just gets filled.
ah It just gets filled.
So this goes beyond the special care centers and these, you know, the chronic conditionkind of stuff.
this, this is all kids then, right?
Like, I mean, this is generally just pediatric medicine in general.
It's not just for the hardest cases.
(13:51):
It sounds like.
Yeah, I mean, like, let's be honest, deploying a high touch clinical pharmacy service onyour typically healthy kid that got bronchitis and it got really out of control, it'd
probably help them.
Is it scalable and doable across, you know, 333 million of us in the country?
(14:13):
I don't think so.
The realization though is like, there's a group in between that and
and up to the most extreme medical complexity you can think of that would benefit and likethe cost, the cost arguments there.
And so we're slowly finding that sweet spot.
We're working with health plans to look at their data, oftentimes look at their pediatricdata in a way they haven't before and pull out the same kind of kids that we're starting
(14:45):
to get used to seeing and be like, that's one, there's one that we can help.
this disease state or these drugs, it's not even the most expensive stuff.
Sometimes it's the cheapest stuff that causes harm or just isn't right.
And it's crazy when we go into health plans and they're like, oh, this sounds kind of likea Medicaid thing or this population or that population.
(15:06):
We're like, well, let's see your data.
Let us show it back to you with our filters and our knowledge on it.
And they're always shocked.
So it's super prevalent.
Yeah.
So actually, this is a great opportunity to maybe share a little bit more.
You've already kind of teed this up a little bit.
You work with health plans.
So what does it look like with you guys?
(15:27):
How do you kind of show up?
How do you enter into this kind of ecosystem, working with the kids, the families, theproviders, right?
Because of these care teams.
I know you and I, when we did our prep call, I shared that my nephew has multiple chronicconditions.
He's not on 23 meds, but he's on a lot because he's got epilepsy, he's got CP, he's gotautism, he's got braces, right?
(15:52):
Because of the CP and so, and he goes to a special school and he's always at PhoenixChildren's and it's, had brain surgery.
I mean, I could just keep going on and on about all the things that he's dealt with.
And I have seen from my own personal experience, helping to care for him, the changing ofthe meds for him and how you change one thing and what it does to the other.
(16:13):
Now he's not on feeding tubes or anything like that.
So it's not quite as extreme, but anyhow, could just from talking to you, could, canunderstand like how, what, what you could do, the impact, but share with us kind of like
how you show up, like how do you kind of get into the space and work with those, thosefamilies?
So the health guys became attractive after the, we were like, okay, we've got somethinghere clinically.
(16:37):
We think that the solution is long-term relationships with patients proactively andreactively.
How the heck are we going to get to them?
Again, Michigan, no facility for me to go knock on the door of, they're at home.
um Most providers we were talking to, so we would go to,
(16:59):
a regular clinic or like the first one we talked to was a neurology clinic in Minneapolis.
And they're like, yeah, we would love this support.
get it when our patients are in the hospital.
Soon as they're discharged, we don't have any help.
How are we going to get to them?
And so the first thing we thought was obviously like the risk bearer, the insurancecompany has
(17:25):
the margin to make on any savings that we could create.
But they also have a familiarity with medication management and a little bit of adifferent regard and a mandate to do it.
So in Medicare Advantage, which is kind of the privatized market of Medicare, you get achoice when you turn 65 for people who don't know this in this country, right?
(17:47):
You get to choose, do I want to stay on what's called fee for service where I can go toany doctor I want.
Any specialist, uh have a 20 % co-pay or co-insurance with that care, but I've got kind offreedom.
There's not a narrow network of providers or prior authorizations per se like there is inprivatized Medicare.
(18:12):
More than 50 % of our country is now on a Medicare advantage where it's managed by aninsurance company.
uh In Medicare,
Since the early 2000s, it doesn't matter which side of that you pick, there's somethingcalled medication therapy management or ACRONIZE that's MTM.
(18:32):
MTM, I know that acronym.
uh
All right.
So we knew people were familiar with that.
We knew that there were it's kind of commoditized at this point.
Some people in health plans kind of think of it as a four letter word.
It's it's it can be good, but it's also been abused.
Like there's been companies that have done it and just check the box.
(18:54):
It's very focused on a transactional basis with a patient.
It's brief.
It's drug focused.
But we knew that that existed.
We knew that it was a regulatory mandate for Medicare beneficiaries.
And so we started going to the people that manage those programs and the buyers of thoseprograms at Health Plans and said, what are you guys doing for kids?
(19:15):
You have to do this for adults.
The polypharmacy exists over here in this population too.
It's even more complex because of the dynamic nature of like disease progression in kids.
the growth progression and just like the off-label use of drugs in pediatrics, it's reallyprevalent.
(19:37):
What are you doing for kids?
the first health plan was like, nothing, where have you been?
We've been looking for you.
so that was another moment where we were like, okay, okay, this is probably the place weneed to go.
We just need to like let them understand that we're not gonna lower our standard of care.
(19:57):
But we'll come in underneath the guise of any program just to get this thing going to kindof prove out that we can do this at the population health level.
that gives you an idea you're on the right track when the first people you go to with yourproduct are like, where have you been our whole life?
Yeah, that's got a, a needed niche right there.
When that happened, have a question about the health plans too, to understand, you know, II've worked in the healthcare industry for a long time, Medicaid, Medicare commercial,
(20:26):
right?
Kind of been everywhere.
Do you find that most of these
pediatric patients, are they on Medicare?
Are they on long-term care plans?
Are they on commercial plans?
Is it kind of like all over the place?
I'm just kind of curious in terms of like, where do they actually show up?
Because I immediately think Medicaid long-term care plans.
But I don't think that's not necessarily where they all are, right?
(20:49):
Or maybe even the majority are.
So it kind of depends on how you segment uh who can use the help.
If you think about the, again, the most complex of the complex, typically on CHIP,Medicaid, uh the facility residents for sure are on those types of plans.
(21:10):
Again, when we started looking at this and saying, the first threshold for us was any kidwho's on five or more medications at a time.
and like their state in growth and their unique pathophysiology and their disease state,like they're an N of one in the world, okay?
Just five factors on the medication side.
(21:30):
uh we set the threshold there.
When we started going to the health plans, we anticipated all Medicaid.
uh What we've received is not.
So some of this is just by like,
where we're networked and who we knew and what health plans signed up first and theirproduct mix or their lines of business.
(21:54):
uh But the other portion is that like there's tons of pediatric patients that are on five,10, 15 medications that are commercially insured.
They're buying plans off the healthcare exchange.
They're uh insured by self-insured employers.
(22:14):
uh And so,
The first health plan we worked with was Medicaid, administrative services only foremployer groups and commercially insured lives, which was a complete surprise to us.
And today our patient mix is, it's the same.
It's, uh we have all of it.
Whenever we go into health plan, usually someone wants to push us over to the Medicaidfolks and we're like, Hey, just let, can we just look at like.
(22:38):
data.
Yeah, they're probably there, right?
And you always find them, right?
Always.
Yeah.
And always more than they ever thought.
Okay.
So like employer provided health, right?
So like me getting my insurance through my employer.
If I have a child who falls in that category, they could be on a plan like that.
And you could also be on Medicaid and you could be on all the other things, right?
(23:02):
So.
Sure.
Like, okay, Heather, your, your nephew is one example, but another one, the number of kidsthat are on multiple behavioral health medications, three, four medications, they're,
they're not even considered medically complex, but they're being treated with a number ofpsychotropics or your type one diabetics that also have asthma.
(23:25):
Like these are the kinds of combinations or epileptic patients who have, you know,something else going on.
even when they exacerbate within that single disease state.
So they get COVID on top of their epilepsy.
Like there are things that have to happen and considerations that need to be made andextra labs that need to be checked that aren't the case for a typically healthy kid.
(23:48):
And so that expands the population that we think needs the extra attention.
Maybe it's not as frequent in a proactive fashion, but should we be looking for the risingrisk?
Should we be looking for concerning prescriptions?
admissions to the hospital to say, okay, now's the time we jump in, try to see if we cando something.
And maybe they're not our long-term patient, but there's probably something to be done forthat kind of a kid.
(24:13):
And like you pointed out how every combination of drugs is a very unique, you know, uh,effect on the person, especially since all our physiologies are different.
How do you actually track all this?
Like it, do you guys have like an AI system set up to actually correlate all this data andkeep compiling and all that sort of thing?
(24:35):
Cause it just seems like infinitely complex.
This problem you're trying to solve for.
Yeah, it totally is.
First of all, there is no robust data set.
We're running in a capitalistic healthcare society that's driven by profits, right?
And very little research and development is gone, goes in on the front end, goes intopharmacotherapies for kids, very, very little.
(25:06):
And so if you talk to,
anybody who prescribes in the space, a lot of it's based off experience still and whatthey've seen or single case reports or drawing conclusions from adult studies and then
writing for off-label indications of drugs.
uh Slowly here, we're compiling what works.
(25:31):
So we're absolutely filing clinical guidelines that are set by the medical institutions.
we're filing the standard of care if it's been established somewhere, but the uniquecombinations that you just referenced, there's not a big database of those to put an LLM
over the top of.
We think we're gonna have one and we'll probably have a good one.
(25:53):
We probably do right now to start putting that over, but we're recognizing the patternsand then we're creating the clinical pathways and decision trees of if you look like this,
in our experience, we should probably try
you know, XYZ next, whatever that is.
You're doing it.
You're like doing the work that maybe should have been done like that.
(26:13):
It's like live R &D.
It seems like in the actual actions and the execution of the work that you're doing withthese families and these children.
And it's very individual, case by case kind of process.
Yeah, they that's a subjective component of it.
(26:33):
Like when I was talking about the medic medication therapy management, like our firstthing is to get on with a patient and say like, Hey, how are you feeling?
How are you toileting?
How are you sleeping?
How are you eating?
Tell me about this drug.
Does it is it working for you?
How does it how does it make you feel?
And it's it's it's very dialed into the exact feelings and the signs and the symptoms ofthat patient.
(26:59):
So that comes by way of a subjective assessment and interviewing somebody just like thison a Zoom telehealth call.
It comes from gathering clinical data from anywhere we can grab it.
You know, we're getting better at that as slow as the progression's been with um clinicaldata and electronic health records and stuff.
um to answer your question a little bit more directly, we shopped for some sort ofsoftware to do this.
(27:25):
m Because of the nuances of
pediatrics, we couldn't find it.
We looked at the medication therapy management platforms that are out there.
We looked at the EHRs that are in hospitals and doctor's offices today.
We looked at care management platforms and nothing really fit this weird thing we'redoing.
And so we started to build it on our own.
(27:47):
We've been doing that since October of last year at a very fast pace.
um
And it's all being done internally today.
Wow.
That's crazy.
Talk about like filling a gap, right?
And a need that is...
(28:07):
Building from scratch on this one.
Yeah.
You know, sometimes you just have to build it yourself.
so kind of staying in that, obviously you're getting some clinical data by literallymeeting with these families, getting some of the data that you're seeing from these health
plans.
Can you share kind of, so...
You're into the door at the health plans.
(28:28):
giving you, they're giving you the, maybe the claims data, whatever kind of, whateverthey're, they're, letting you see you're identifying these, we'll say opportunities,
right?
Uh, patients essentially that you're like, okay, they need our help.
They need our help.
Now we've got this list of people.
What happens next?
Like, how do you, how do you get in touch with these people?
(28:50):
How do you get connected with them?
And then how do you help them?
And like, what are some like the immediate benefits that
that they see and how quickly does that happen.
Those are awesome questions.
Okay.
I wish health plans would
questions, I'm sorry, I just threw three at you here.
I wrote one down because I don't want to forget the last one because I think that's themost important question, but
(29:13):
Agreed.
So yeah, you kind of laid it out right how we get to a patient list.
We agree with the health plan.
Here's our list of people.
We're going to go and we're going to try to get them engaged.
I think one of the values is like, there's a lot of money in innovation in software andhealthcare and digital solutions that somebody else needs to go and do it.
(29:38):
And so that's a hard sale.
That's hard to actually get outcomes on.
everybody's already overburdened.
So one of the other things we say is like, we'll do the identification with you.
Like this is a process.
A lot of companies, they're making their entire revenue stream just off doing that.
So we do that as a sales activity.
(29:58):
We don't charge for it to kind of prove like, hey, we're in this with you.
We're going to look and show you what we think we can do before we ever do anything orcharge you.
uh And if we do this, you can't charge the patient.
They have to be
uh, able to be enrolled into it.
they're, we, we, we determine who's eligible, but no copays, no co-insurance, nodeductible, no out of pocket maximum, no bills, no balance billing, none of it.
(30:24):
Cause it's already hard enough sale.
So get the panel.
Um, and then we start, we just start cold calling typically moms and dads, caretakers,foster parents, guardians, whoever is the responsible party.
they're under 18 or over and they have that.
authority, or the patient themselves, we see patients up to the age of 24.
(30:49):
And between that age, like graduating from pediatrics to adult medicine, especially whenyou have medical conditions is really, there's really kind of a tough period of life.
uh So we reach out cold, we the health plan usually uh co markets and co brand some snailmail emails, we can do text.
uh But imagine like you're
(31:11):
You're the recipient of this thing.
You've never heard of it.
It takes some experience.
real, right?
Is that like the first way I would imagine like, this is too good to be true, right?
Well, it's either that or like, you're a scam.
validate you're real.
not giving you any health information, right?
(31:32):
So it's usually one of those extremes.
Like, thank God you called or this sounds good, but I'm going to go back and call BlueCross or whoever.
Yeah, yeah, is this legit?
So then they work with you.
it's cold calling telling somebody that you have their information.
They look like somebody who needs help medically and you want to help in a way thatthey've probably never heard of, right?
(31:58):
Like I can say telehealth, most people will be all right with that, but like we startedtalking about clinical pharmacy.
If you haven't worked in a hospital, what's your definition of a pharmacist?
Their main job is dispensing meds, not making therapy decisions.
Right.
They're not, they're not putting the care plans together or anything like that.
(32:20):
They're just executing.
They're being told, right?
Essentially.
Yeah.
filing orders, validating prescriptions, making sure they're safe from like an allergyperspective or drug to drug interaction perspective.
But it kind of ends like, I'm sure there's more to it and uh please don't hate on me.
The hundreds of thousands of community pharmacists out there, because you're doing greatwork too.
(32:41):
We're just doing something different, right?
And so when I cold call, it's a sale, right?
We're selling something, it's free to them.
Um, it's on behalf of their health plan.
It's a benefit that their health plan probably didn't tell them about when they enrolled,but they have available now.
(33:04):
we have to reset that what, what their uh concept of pharmacy is comprehensively, and thenget them to agree to meet with us the next time we have a call, um, and put them on video
and align them to a single pediatric pharmacist and.
the nurses and technicians that we have supporting that role.
(33:26):
Do you have your own clinical staff, like pharmacists and clinical staff, that umcommunicate with these families, that essentially join those calls and help kind of
understand, like, what are all the things that your kid's on?
OK, this is right.
This is wrong.
This could be better.
Does it work kind of like that?
(33:47):
OK.
Yeah.
So uh we, our intent was not to become a technology company.
It still, it still isn't.
We're developing a technology to, be able to do the thing.
And for us, the thing is clinical care.
It's, it's attributing a single pharmacist that meets with them every time we see them umand a nursing team.
(34:08):
So yeah, they're all employees here at Perfecting Peds.
um We have a pharmacist team, have a nursing care management team, and we have atechnician team that are all working on these patients together.
Yeah, I always like to say innovation shows up in really different ways.
It can be a person, it can be a program, it can be building a relationship and that likeconsultative support that you're providing that is in turn changing and impacting these
(34:35):
people's lives, right?
Because you're, you're plugging into a system that hasn't been looking out for them.
And that is an innovation.
That's innovation.
Innovation doesn't have to be technology.
So I love that.
Yeah.
I think so.
I, my brain is still lingering on that 44 % reduction in ER visits or whatever it was likethat right there tells you you're doing something right.
(34:59):
Right.
That's a big number.
It's a hard sell, right?
Because it's not uh hard cost.
The deep rescribing thing, nobody's gonna argue that.
If somebody's on something and then we take them off because they didn't need to be on itand that thing cost a dollar, you saved a dollar.
(35:21):
There's no way to predict how many times Jeremy and Heather go to the hospital, but we canmake inference and say,
for what you look like, your utilization rate is this.
based on the type of interventions that we're doing, and we do about 13 on average perpatient, the cost savings of that looks like this.
(35:48):
It was real easy to do in a facility when we knew what the admission rates were for thosepatients as a group before we came in.
At the POP Health level, uh we've got to convince payers to give us all their data, whichwe haven't done yet.
Mm hmm.
Yeah, that's the hard part.
I feel your pain.
I get it.
As much as our data is everywhere already, people really don't like giving it out.
(36:10):
Yeah.
Yeah.
Especially.
Yeah.
With HIPAA and privacy.
Like the health plans are competitive with each other.
Even health plans under the same franchise.
You think about like Blue Cross Blue Shield, they're all competing with each other.
They have competitive bid process on government contracts.
They don't always want to give away their sauce or where they're saving or where they'renot.
(36:32):
Yeah.
So where the big question, the most important question, what is the immediate benefit forthese folks, for these families when you get in there and you work with them and they say,
yeah, like I'm ready.
Come on in and help us out.
What do you see?
I wrote down the third question and I never answered it, I?
(36:52):
I know I want to make sure you got weak.
is this is literally the reason we're here now.
I think is like, how are you changing lives?
Because that's what you're doing in my opinion.
Um, so the first interaction is this like pretty big assessment.
do a decent amount of work before we ever see the patient.
Soon as they say, yep, sign me up.
We're pulling in as much information as we can.
(37:14):
So we're looking at, uh the, there's a good aggregation of pharmacy data at, at the pointof sale through, um, a company called Sure Scripts.
We'll start to look at what's been ordered, what's been picked up and what's been leftthere.
uh We'll connect to health information exchanges and the national networks that house lotsof clinical data through what's called a QHIN.
(37:39):
uh There was recent legislation passed over the last few years to make access to treatmentinformation a little bit more easy for us providers.
We leverage all of those new regulations through this QHIN and an act called TEFCA.
to get as much as we can beforehand.
And we've got a good idea of where we might start to make adjustments based on thesubjective assessment and kind of what we get from the patient before we ever meet with
(38:04):
them.
But the immediate thing, I think, for patients and parents is a resource.
uh So when they end up in the ER that night unexpectedly or...
They've got a cold, something, you know, they've got all these other things going on andthey're in the middle of the aisle at CVS or Walgreens.
(38:27):
They've got somebody to reach out to and be like, Hey, what do I do?
You know, the, the, the person behind the counter there might be able to make somesuggestions.
Less than a half a percent of all pharmacists have pediatric training.
If they call here, they know they're going to get an expert in whatever they have goingon.
Um, but we immediately start looking at.
(38:48):
What are the indications for the drugs you're on?
Does everyone know why you're on the things that you are?
And if we can't get a good explanation of that from you or your providers, there'ssomething wrong.
em Are your blood levels of your drugs at the point where they're actually doing somethingor are they too high and toxic and we need to bring them down?
And have we been monitoring for adverse reactions every time you bring a new drug onto theprofile?
(39:14):
This is something that like the lay person doesn't think or talk about like.
you're introducing chemicals into your body.
They're interacting with your cells and the other drugs in there.
And oftentimes through the research that's been done before that drug came to market, weknow that, this, this psych, this psych med can delay some of the conduction in the heart.
(39:34):
When's the last time we looked at an EKG and made sure that, you know, there's nothing badhappening from what we're doing.
That's worse than just dealing with the issue or using a different therapy instead of thisone.
So
Those are just a couple of examples of what we'll take a look at right off the bat, butit's comprehensive medication management, we're comprehensive right from the start.
Wow.
And like, what's their reaction to these folks that actually end up working with you?
(39:59):
Are they just like, thank you.
Where have you been all my life?
Or I've got somebody I can depend on and it sounds like they can reach out to you prettymuch anytime.
Is that like a 24 seven kind of call us when you need us sort of thing?
um We're not at 24 seven yet.
I think we will be there soon.
(40:19):
But anyway, they want to get ahold of us.
They can call email text.
um All compliant and protected.
I'm sorry, the first part of your question.
But what has been the reaction just in general from the people that you're you're servingand working with these families?
(40:40):
Um, it's been overwhelming to, to like see it.
I, I, I'm really fortunate.
Like today, my kids are generally healthy.
Like we've got some allergies and whatnot, but like, um, it's been profound.
Google us, take a look at our Google reviews.
Some of them, I mean, I'll cry when I read it, I don't want to talk right now.
Um, but it seems like it's a breath of fresh air.
(41:03):
It seems like we've got a lot of time compared to.
You know, if you go into your primary care, they're really on a fixed schedule andpayment.
um They don't get to negotiate typically, especially in pediatrics with health plans onhow much they're paid.
So they've got a certain amount of time that they can spend with a given patient.
(41:26):
We have the luxury of being able to sit there the first time we meet them for an hour, puta bunch of work on the front end of it, put nurses on the back end of it, and then meet
them again the next month to carry that care plan forward.
and then the next month and the next month for extended periods of time.
And so we can listen, we can spend a lot more time listening.
And I think when people want to be heard, the longer we hear them, the more of a picturewe can get, and then we can start to make better adjustments or at least recommendations
(41:54):
to make those adjustments.
I think, you know, I'm a little biased in my response to this question, but I think we'reproviding a pretty decent.
value back and it's recognized and the only objective way to prove that is in retention.
So very few patients unenroll from the service, very few.
(42:18):
It's like there's churn in eligibility because of a health plan, but I can count on onehand how many patients have after they had just one visit have not come back and continued
on service.
Wow.
I mean, who doesn't want help?
And sometimes it's like, you don't know what you need until you have it.
And then when you have it, you don't want to lose it.
(42:39):
healthcare is complex.
And then you're dealing with these very fragile scenarios, right?
And that's a scary place to be.
The parents of the kids that we're working with, if the kid is, even if they're a fewyears old, they've been through a lot.
(43:01):
They're typically reluctant to let somebody new or something new onto the care team,right?
And so in these initial outreach calls, we get a lot of objections.
There's like, hey, we've got everything under control.
I've been doing this for 12 years with my son, right?
Like, I don't need this.
I've got it.
(43:22):
uh
Oftentimes we'll have to say something like, will you just give us a shot?
Can you show up on video for five minutes?
And if you don't think that it's going to provide anything for you, go ahead and hang up.
Like you don't have to do this.
It's your health plan.
This isn't a check for prior authorizations with your health plan.
Like we're actually, we're going to work on your behalf and really just try to help youclinically.
(43:45):
If you don't find that, then you don't have to come back.
And a lot of times that works in, um, and
You know, we've had one, we had one mom who was like, you've got 15 minutes to impress meor I'm hanging up.
Like said that to the pharmacist.
right then.
Challenge accepted.
Let's go.
Did she sign up with you guys?
(44:08):
She did and then she brought her other two kids and then she ended up working here.
Wow, there you go.
Well, if that isn't a success story, as a marketer, I'm like, I would use that.
We should talk after we stop the podcast.
So I like to look at the big picture things a lot.
(44:28):
I'm a philosopher by nature.
So I have a big picture question for you.
I you said you don't have any intention of becoming a full on tech company, but with whatyou do, if you compile all of these relationships of all these different drugs being taken
by these different people with these different conditions, ultimately over time, mean, youcould, is that a database that could actually like lead to, you, you're
(44:53):
You know, this gender and this age and you have these underlying conditions, you needthese meds and like actually streamline it to the point where you could almost, you know,
it's a plug and play, uh, you know, medicine situation where you really can just like,this is my physiology, this is my problems.
What do I take?
(45:13):
And it will have that information.
Do you see that as a possibility or is it just too complex because of the individualactual like
physiologies, like the patient themselves are just too different.
This is like predictive modeling is what is sticking out of the head from.
Like, that a potential for this that you see?
For sure.
Given the way that we're doing this remotely and then across diverse geographies andpatient populations, I anticipate we will have probably the largest aggregation of rare
(45:45):
disease data in pediatric lives at some point.
There's really long-standing institutions in this country, Children's National in DC andall over.
They've got a lot of information.
The way that we're gathering, the way that it's related to
pharmacotherapies is probably unique.
I anticipate that for sure.
(46:06):
If nothing else, like one of the audacious goals is we want to validate prescriptions atthe point of sale and the point of dispensing because it's not being done today in a way
that we think is the best way that could be done.
And so I think some of that plays into it.
Like there's gotta be a database of historical outcomes and to infer from.
(46:30):
So I think we're I think yeah, I think by accident we're building that.
Like, give it 20 years, right?
Then you're going to have it, whether you're trying to or not at a certain point, right?
As long as you just compile that data.
think so.
Yeah, we'll have to hire another guy to go sell it, I'm really into the care delivery.
But no, you're right.
(46:51):
You're right.
Cool.
Yeah, that also happened.
But you are, yeah, your care delivery first, right?
That's care delivery, care consultation, right?
Medication management.
I mean, to have a partner or somebody that you can rely on, right?
It's to provide guidance and advice and kind of decision-making that I'm not gonna be inthe hospital again where I might have ended up there without you.
(47:18):
Sure.
So.
Yeah, or like, again, how much time does the doctor have?
So I get I get written for the new new drug ABC.
Do I feel confident that when I got home, like, can I call somebody else to learn a littlebit more?
Make sure it's driving with everything else that's going on?
Yeah, I think that's it.
And the real people I think of are these kids who's, you know, these kids who have enoughproblems to begin with and then their medications actually are making it worse instead of
(47:46):
better in some cases.
Fixing that problem right there is a big deal all by itself.
And that's just a little piece of what you guys are doing.
Yeah, like our CEO tells this story, the kid that broke her was just labeled with allthese diagnoses in the hospital.
And I'm not getting too dorky on it.
(48:09):
The nephrologist, the kid had kidney stones, the kid had urinary retention, getting self,was getting catheterized for urine six times a day, was labeled with kidney disease.
had some other things going on where they were using drugs to drive secretions because thekid was on a ventilator and you have a lot of secretions then, but the effects of that
(48:31):
drug slowed down the digestive system.
And so he was constipated and then they were treating that constipation with uh stoolsofteners and other, like another bowel regimen and a bunch of this stuff.
And I'm doing it a really bad job at giving a clinical justice, but like a bunch of thisstuff was by way of that.
was the inner.
causes another causes another causes another that you have to medicate.
(48:55):
then you've got.
Medicating the med.
Side effects from one drug and right.
I've seen that with my nephew.
Yeah.
The kid was on a drug for seven years that was prescribed seven years previously.
No one really caught that.
They pulled him off the drug.
It wasn't even necessary anymore.
spontaneously urinating, not being catheterized, pulled off other medications and just theurine part alone.
(49:23):
That is profound.
That's huge.
To not have to be hooked up to a catheter, like the freedom that that gives somebody.
all because of the meds they were it wasn't even it wasn't a disease like it was
The poor kid could have been off that catheter for probably years.
ah
(49:45):
was like, Heather, this wasn't a catheter that state, it wasn't an indwelling catheter.
Like, you just get tortured every day, like straight catheterized.
Sorry with the hand gesture, but I just, yeah, it it'll break your heart thinking aboutthat.
It does.
Yeah, that's that's rough.
That's rough.
That poor kid.
ah
I think that's why we're here though, that happened.
(50:07):
He was like, oh my gosh, this is like, I got to do something about this.
it's cool part.
Okay, so anyone listening right now, I'm going to say this, who has a child or knowssomebody who has a child that is on multiple medications, has multiple chronic conditions,
has multiple disabilities.
(50:27):
You need to call these guys or find out if you can, you're eligible through your healthplan, like go right now.
Yeah, please do.
like, please go on, bring it on.
We want to help people and change lives.
This is actually I've gotten really good at these segues.
Jeremy, this is how I start to end and wind down the show without without saying thatthat's what we're doing.
(50:48):
But really, this is a really great note to end on.
Very meta moment right there.
Thank you.
Very I know I'm really good at this.
I'm telling you, I was made for this.
You gotta do this by yourself.
Yeah, exactly.
I feel good about this work.
But um seriously, run to your health plan and find out if perfecting.
(51:10):
Peds is with your health plan, and if not, like go to your website, right?
So with that, like kind of what's next, how do we find you?
How does somebody get to find out if they are eligible through their health plan?
Give us all the ways to to locate you online and find out.
Yep.
Um, if you're in Minnesota, New York, New Jersey, Pennsylvania, Florida, South Carolina,you can check with your health plan.
(51:37):
There's more health plans coming on board here soon.
We're really easy to miss today.
We're trying to find somewhere to cross that river.
Um, but if not go to your health plan and ask them for the benefit that we, we gotcontracted with a health plan in, Pennsylvania because a parent went and said,
I've been paying for this out of pocket and I want you to cover it and they called us andthey did.
(51:59):
em And it provided the benefit for thousands of others after that one parent called.
em Otherwise they can go to our website and we can enroll them directly.
And we pretty much do that at cost if they pay private.
Okay.
So that is an option.
Is it just perfectingpedes.com?
PerfectingPets.com
Amazing.
(52:20):
ah We'll put it in the show notes as well.
You can just go click on it in the show notes if you want.
Yeah, awesome.
And I think too, this one thing I want to say, and this comes up a lot, and this is ah Ithink just an important part of healthcare is that we have to advocate for ourselves and
our loved ones that we care for.
um Not, you know, these, the doctors and the providers and the good nurses of theuniverse, and there's so many of them out there.
(52:46):
They are stretched thin, they are overburdened, they can't give each one of us, umprobably the dedicated attention that they want to.
um But we have to be our best advocates and so go fight.
if you don't say anything, it won't happen.
you know, we've got to use our voices.
It's one of my favorite sayings.
(53:07):
I said the squeaky wheel gets the grease.
Yes, it does.
But yeah, if you're in a state that he did not say this is available and yet start makingphone calls.
Yep.
Cause like you just said about Pennsylvania, you know, you got a couple of people fromthat state calling and poking at them to be like, Hey, get on this thing now.
There you go.
soon you'll be.
(53:28):
that where it works?
Yep.
So that's our action item for the day.
If you're listening, feel some social media posts coming from Heather on that.
yeah.
For sure.
Well, while this has been amazing, um, I love what you're doing.
This hits close to home for me.
Um, being I'm the legal guardian of my niece Shannon in New Jersey, who I, know Imentioned to you, who's in a really wonderful program there.
(53:52):
And then of course my nephew, um, who I play very big role in his life as well.
Not quite as,
you know, extreme probably as some of the families that you do help, but definitely prettyclose and probably falls into those categories every once in a while.
And I could just see where this would be uh a godsend to have you at our side, their side,everyone's side, who's dealing with this.
(54:17):
So, yeah.
Get to Arizona.
Yep.
Arizona.
We'll get you to Arizona real quick.
Yeah.
So with that, thank you so much for coming on and sharing.
your story and what you're doing to just make your impact in that one little, one littlepart of our healthcare universe.
So yeah, great.
for having me.
appreciate it.
(54:37):
Thanks for giving me the time.
And there you go.
Our conversation with Lyle from Perfecting Peds.
Very cool stuff.
Very cool.
But I'm going to let you take it up here first.
Heather, what's our main takeaway is there?
Well, I think about this a little bit like how this comes up on the show quite a bit.
(55:01):
Women's health issues have been largely ignored and now there's a lot of a lot oftechnology and companies that are solving for it.
What I didn't realize is how much pediatric medication management for like complex
you know, kids with complex needs, you know, high risk, all the things had been so underserved, um, unaddressed, like huge, huge gap that they're solving for.
(55:27):
Um, very niche, right?
But when you talk about the smallest percentage of, of people, of patients always have thehighest percentage of cost.
And so that is where typically, you know, a lot of focus is put.
but there was nobody focusing on this.
And so they're doing it and it's just been a huge gap.
(55:50):
So I think it's just really cool to see them kind of plugging themselves into that spaceand, and, getting to work with these very vulnerable, fragile children and their families
to do something that no one's ever done for them before.
And that the health plans are like, where have you been?
Yeah.
Right.
And it's like such an obvious need that nobody was taking the time to take care of.
(56:13):
I mean, he told us that one story, but that kid just take them off that one med.
ah And years of suffering could have been avoided if they had just taken them off that onemedicine at the right time and not left them on it for years needlessly causing all those
problems.
It's such a sad thing that, you know, that's just allowed to happen because it's literallyjust lack of attention to the problem.
(56:39):
So it's awesome that these guys
stepped up and like, we're going to be the ones to pay attention to this because thesekids need help.
Yeah.
I loved how, um, almost emotional he was about it too.
That like, that just shows you how, uh, just, you know, how committed, how dedicated theyare.
This is something that's really personal to, to the perfecting Peds team, Peds team, youknow, everybody, the founders, their clinical teams and, know, and not to mention
(57:10):
Like when you have a lot of like issues, like, and this comes up again, like manydifferent episodes, like people with chronic conditions, people with comorbidities, people
with, you know, whatever, like cancer, like it is a scary, scary thing, whether it is likea short-term thing or a long-term thing or forever thing to have somebody that you can
rely on, like a guide, a consultant, uh somebody who can, you can trust to walk youthrough these parts of.
(57:38):
your healthcare journey and your, your, uh you know, your, these systems that are sooverwhelming and you don't know, cause you're not a doctor.
Right.
I mean, to have that, that type of support is it's a gift and sometimes people don't knowthat they need it until they have it.
You you don't know what's missing until you, until you find it.
Yeah.
(57:59):
I love that part.
I actually, my favorite part was that
they're very specifically not looking to be a tech company.
They want to, they're very patient oriented.
They are a medicine company.
are not a tech company, but long-term the tech database they could build off of whatthey're doing with the medicines could be a very important piece of medical tech in the,
(58:22):
in the future realms.
Because of those correlations between the different conditions, the different sets ofmedicines, the way all these medicines
interact with each other and different physiologies and whatnot.
And it's going to take a lot of data and some pretty serious AI software, right.
And probably to really utilize it that way.
(58:43):
But he was like, yeah, I mean, it's going to happen inherently as long as they keep trackof all their data.
Innovation shows up in lots of different ways.
and I feel so much better about AI since we started this podcast.
I don't feel like it's going to destroy us anymore.
It's going to.
It's just a tool that if you use it right, could be amazing.
(59:04):
Yeah.
Can you enjoy?
things for all of us early in the end.
yeah.
Okay.
So yeah, there you go.
If you like what you hear, if you want to keep track of all the new stuff we're going tobe talking about in the future, make sure to hit the, all those happy little fun buttons,
the likes and subscribes, the share with a friend, uh hit that auto download.
(59:24):
You'll never miss a beat.
We are on all the major listening platforms.
We were on YouTube if you want to see us on video We are also on patreon video style IIwhere you can support the uprising for as little as a dollar a month ah You know, we're
need some money eventually on this it's not why we're here But it would help so we wouldmuch appreciate anything you could throw our way I don't know.
(59:46):
Where else are we Heather?
You can find us online at healthcare uprising?
Dot-com as well as all the social media platforms like blue sky linkedin instagram andfacebook be
post out there a lot when our episodes drop and share a lot of our past guests and futureguests posts, especially on LinkedIn.
So lots of good happening out there.
So we'll keep you updated if you're into that.
(01:00:09):
So let's see what else.
I'm blanking.
I'm looking for people.
I'm looking for people.
on the podcast.
Give me a call.
Shoot us an email.
Are you a founder?
Are you, are you working for a company that's doing something innovative?
Are you a person with a with the human story?
Have you had some crazy health care story that you want to come on and share?
(01:00:32):
Give us a shout at our email at healthcare uprising at gmail dot com and reach out.
And I'd love to speak with you and see about having you come on the show and share yourstory.
So always look always looking for those stories.
So in the personal stories get to be bonus episodes, which make them even better.
That is for that is our priorities.
Yeah.
So bring it on.
(01:00:52):
Give us a call or email.
Other than that, think that's our dose of healthcare for the day.
So with that, keep looking for the good in the world.
Sometimes that's where you least expect it.
(01:02:02):
This has been a Shut Up production.
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