Unlocking Access and Cost Savings with AI-Powered Healthcare

Welcome to the Chalk Talk Jim Podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I'm your host, Jim Jordan. I want to welcome Dr. Priyanka Mathur to our podcast. She's a physician turned entrepreneur. Her company has two products, one called MediPocket, which gathers prices and discounts from multiple sources and gets those opportunities to patients. And the second is called MediPocket AI, and this is a cross-border platform that goes outside of the United States that helps people get access to second opinions and even can help people with the concierge service to be able to get them to the US to get treated. Doctor, just tell me a little bit about yourself. I'm a mother, a wife, I am from India, so I was born in ..., so kind of covered half of the world doing this journey of medicine and then landed in United States where I started my company, got married, and have kids now. What's your specialty? Cardiology. Do you speak Russian too? I was there for six years, so I was very fluent before, but now it's like my fluency has gone a little down, but I read, write, and understand it well. So how did you start your company? What I see as a clinician, our struggle is that we are clinically limited because physically we can see X number of patients or we can treat X number of patients. Being in LA, close to the Bay Area, there's always this buzzwords about AI technology, health-tech, and all that was like really made me curious, okay, how can use this technology in healthcare and make it available and accessible to people regardless of the time and distance? So with that in mind is how MediPocket was born. It was born very different what it is right now as it is matured. So we started as a prescription company, and then now is more a cross-border care platform. So I remember from my cardiology days at Johnson and Johnson, so this is many years ago, so maybe it's changed, but I remember that cardiologists were always struggling, particularly with their Medicare patients, where they were making decisions to eat or have Plavix. And I don't know if that's part of your motivation, but it always would be a great frustration for a clinician or cardiologist. Yeah. So how did your company evolve? How did you get from prescription to the applying the AI and the machine learning aspects of things? So, you know, the journey started because for the affordability. For me, I think always like people will be ready to try your product or listen about your product, either you give them money, or you save them money. They are the only two ways. So obviously, we cannot give them the money, we're a startup, and we started with the affordability part of it, and that is where we meet prescription medications, transparent with pricing, and affordable. So for that, we use our discount card, which has some codes, and we partnered with 75,000 pharmacies across US, Hawaii, and Puerto Rico. So our members can literally take that discount card to any of the pharmacies and avail the discount on demand. You don't have to worry about your insurance, and if your medication is a brand or a generic medication. You made that sound really easy, but to get 75,000 places that will take your card is a huge effort. So tell me how do you fit in the healthcare system with this card? Because you have the pharmaceutical companies who sell to distributors, who sell to retailers, then you've got pharmacy benefit folks in there, and you've got the insurers on top of that. So how do you navigate those constituencies? So what we do is we work with the pharmacy benefit managers, the PBMs, directly. Okay. They negotiate on our behalf with the pharmaceuticals and pharmacy. We don't include insurance in this chain of ours. Insurance has their own game, but what we work is the pharmaceuticals and pharmacy. Now, when the pharmaceuticals are giving that to the pharmacy, pharmacies always put their own pricing to it when it becomes a retail. So what we ask is the discount, and that discount is passed from the pharmaceutical to pharmacies, and pharmacies pass that discount to our consumers. So this is how we work on the discount side, how we can help them negotiate on the pricing. Now, the discount is not standard. Like, you will always get 80%; you can get 80%, you can get just 10%, you can get 30%, it all depends on two factors, the relationship between pharmaceutical and pharmacies, and then our relationship with that pharmacy. So with these two factors, the discount is decided. And are they somewhat regional, the discounts, also? They're not regionally defined. For our audience, maybe we can work through this together. So pharmacy benefits management companies make money on fees and discounts, they take a piece of it before passing it along. And what they're doing, if I understand it correctly, is they're aggregating bigger demands. So when you came to them and say, I have a card, they'd say, wow, you can provide us guaranteed volume that we can go back and negotiate. So that would make them happy to honor your cards? Yes, quite close. So it's like, it's always about the game volume versus the quality of it. So definitely, the quality is there, but then the volume, so it helps them to adjust the pricing. Also, we help them with the analytics like, okay, this medication is quite in demand, and people do have a struggle affording it, especially if they don't have insurance or they don't have a premium insurance. So we go with that analytics, help them to ground reality, and that is like, okay, there's a volume here, but people have a struggle, and because of this struggle, they go to this instead of this, and you get a clear picture. So they don't get the pinpoint details of the patient, but they do get the analytics, and that's how we are able to get that discount. And for them, when they work with a particular pharmaceutical company, it helps them to get the pharmaceutical company and pharmacies a sense of the ground reality that, why the consumers are going to the other partner more than you because they are not finding the right pricing with you. So that's how we are able to negotiate. So by you partnering with the pharmacy benefit groups, did you avoid having to go talk to all the insurance companies? Did you have to go do that yourself? Oh, we don't have to work with insurance companies. So we are separate from insurance. And so you have a prescription from your doctor, and that prescription is not covered by insurance company because it's a brand or other factors, you don't have to submit to insurance company at all. It will just, you use that discount card, the pharmacy will check the discount and say, okay, you get 20%. There's no authorization needed, not from the PBMs, not from anybody, there's no authorization needed. It would be the savings right there, and then. So if I have insurance that say, covers 70% of a particular drug, and you can get me a discount of 20, the insurance company isn't involved, then how do I get my 70% coverage, or do I have to pay cash for the difference? So there is no double discount. So we can't do the double discount, so if the insurance is covering it, then the card cannot apply to it. Only in the cases where you don't have an insurance or your insurance is not covering, or your copay is higher than what the discount you're getting. So in that case, you can make a very clear decision. For example, with your coverage, your copay is coming out to be $20, whereas if you're using a card, the medicine is coming $15. It's more out of the pocket cost that you get a discount on. I know you have an app. Does the app do that math for me to tell me if it makes sense to pay myself or go through my insurance company? Exactly. So app gives you three pricing. It gives you the retail price, gives you your insurance price, also gives you the discounted price. So you can make a very clear decision which pharmacy, and then if you would like to go through insurance or out of pocket. How does the insurance information get into your system? Does the patient put it in? Right, they have an option. So again, it's not mandatory, it's all optional. If they want, then they put that insurance detail. They don't have to put the complete details of their insurance. What they tell us is the copay that they pay. They put that information, and the system calculates for them. So it's not necessarily the patient have to completely give their whole insurance information. Given this model, what challenges is your organization facing in matching how healthcare is changing? So I think the main challenge is awareness. Is, we make people aware that such things are available. What happens is generally, in the medicine, if your medication is not covered by insurance, then the next thing happens is you change your medication. I want to share a real-life example with our audience on the value of this product to patients. I was having a conversation a couple of months back with the neurologist who was talking about the challenge of getting branded drugs to his Parkinson's disease patient because they weren't on the formulary. And he had a young woman who was still working and raising a family, and the second choice of drugs left her with tremors, and she couldn't work. Now, fortunately, the sales rep for this drug company was able to do a one-time program that could help this woman for a couple of years. But unfortunately, when that program was up, the patient went back on the formulary product, and the tremors started again. And on my last conversation with this doctor who said the drug company couldn't figure out a good mechanism to help this patient. And it seems to me this type of product could not only help drug companies, so with enough of a discount, it could certainly be in this patient's interest to purchase this drug outside of insurance. So, again, why it's a second line, because that is a second choice for your doctor's choice. So we are trying to solve that. You don't have to compromise on quality of that. Why don't you do the out-of-pocket, which is not going to hurt the pocket? But see, so that is the awareness that we have to spread around. People are not aware about ... specially people, and that is a struggle. How to reach to more and more people the solution? And are most of your patients having multiple chronic diseases? Yes, they do the chronic, but at the same time it is used for conditions like infection, which is not a chronic either. It sometimes even helps for the patients which having a cosmetic condition. As long as they can get their medication, even if it's over-the-counter, but if it gets on the ... doctor, you can avail a discount on it. So that's another ... the discount can be applied. Do you have to tie your system into the e-script system also? We haven't done that because of a few reasons, but we don't have to tie it with the e.script. Okay, so when I show up at the retail place, and I want to use my discount card, then it's the retailer that's responsible for matching the prescription, and they're just honoring your card. Yes, the pharmacy. So you can literally either show the physical card or on the app. Now, once, if it's your regular pharmacy, you can ask them to store that to your account. So not every time you have to show the card, every time you just say like, can you compare with MedioPocket and my insurance? And they can do it as a part of your account on their system. How old is this discount card with the AI attached to it, or are you bringing AI to this category? The AI that we are applying is, when we have the patient's information, especially the medication that they're using, and a little more details of their analytics. We apply AI to that by giving them, when they're using this medication, when how often they are using, very simple is like, okay, the reminders, which is very easy, right? The refill reminders. If the patient provides us more information, which is MediPocket health, and that is where you put your medical information. If, once we get that medical information, plus the use of the medications on a regular basis, the AI is applied to it, to give more analytics, how is it affecting your body now, and what are you looking for the future, what you should be aware about? Okay, based on this, you should do this, or you should be going to this screening. So that is where the AI comes in. Right now, it's in a limited application because still gathering the medical information from the patient is a little challenging. Who do you deem your competition to be? In the part of the ... ... is close competition, but they only focus on the discount, whereas MediPocket is full suite service. So we have a discount and we have MediPocket Health, which is also your health pocket, we call it, or the pocket for your patient health record. So that will be your own pocket, instead of EHR that's your PHR to you. So we're trying to put it a whole suite primary care, which is accessibility to your medical information to your doctor plus your affordability. So ... side, ... is a good discount. In the long run, our focus is with this cross-border care, where we are connecting patients around the world to the US healthcare system. What is cross-border care? Let's say a patient sitting in anywhere in the world suffering from cancer, and they are going for a procedure and they are being advised either to go for chemo, radio, or the surgical procedure and they're confused. Now US is considered to be the top when it comes to the medical care or the medical advancement, but not everybody around the world can access it, not everybody can just fly here and navigate the system. So what MediPocket helps them is provide a platform, by being in your country, you can still get connected to the specialists and hospitals like Mayo Clinic, MD. Anderson, our partners, and can get ... with the second opinion. First, you get a second opinion on your disease and then if it looks like a good fit, then we also help them to come here for a treatment. So we started as a second-opinion global company, added to it is the service of treatment in United States. Can you tell me a time where you've had to adapt or shift your strategy quickly? And given that I imagine your fundraising, there's a lot of that going on in your life right now. Yeah, so, you know, during COVID, the pandemic time is where we started with this global platform, because what we realized, when you can't go to the healthcare, the healthcare system has to come to you, and that can come only digitally. Now, a lot of international patients were hugely affected because there was no way for them to come. The whole system was like, you know, shut down so people cannot travel, and that affected especially when you are in a speciality care need. So we saw that space and was like, okay, we understand digital, we understand healthcare, but we have done only locally, we haven't done the cross-border part of it. So we picked a country, which I understand very well, the healthcare system and culture, which is India and Russia, the two countries, and we started our program with these two countries cross-border. So that was, I think, adaptation, you can say, pivoting a little bit, you can say that we had to do it during the pandemic. So how do you keep current with all that you have going on between business and being in cardiology? So I have to choose. So I had to make a decision, so I am not clinically working right now, so I'm not practicing, and I'm full-time with MediPocket where I'm not clinically helping, but digitally helping patients. So how long have you been doing that full-time? Almost one and a half years. How was that transition for you? I think more than me, it was people around me were shocked to see that, because, I mean the family and friends, for them, it's like, why? The big question was like, why you are in such a comfort. You are in a safe zone, as we say it, why you want to go into something which is like unknown territory and all that? So yeah, I think the struggle was more from outside than from my own. I enjoy it. I like when every day you get up and there's a new set of challenges. Your team comes to you, the interesting part, I think when you start any venture as a founder team is going to come to you with problems, right? Questions, not say problem, but questions, and it comes to your part to find the answers for it. You have to work with them to find the answers, and I really like that. Like, okay, unknown, but I have to work to get the answers and solve everyday problem. Well, ... is from being a physician as a resident at midnight when no one's around and you have to make your decision, right? It's a bit like that. So what are the resources you are using now in the space? So you've turned from physician to business person. Where are you getting your information from? Who are you watching, who are you following? I mean, everything available. I'm a person, I think, I learn a lot from online. I do follow a lot of masterclass, if you know that. So I do like, I pick my topic and I try to learn from the people, especially who have very successfully proven it. Y Combinator has a Y school, which is a free platform, but it has a very good amount of resources and knowledge there. Those are my go-to places which I just pick. And then again, when I need very concrete advice, then I look into for my advisors. I have people who have done the business and successfully like, you know, serial entrepreneur. Then the healthcare side have very senior doctors that can really understand that channel. They can say, yes, this is how physician will feel when you put this very technical solution in front of them or how the patients react. So I think those set of people are very important to give you how the reality or a practical use of would be. So that's how like just juggle where to go ... That’s hard. Resources. So where's the funding coming from at this point in time? You self-funding, or have you raised funding yet? We have raised for the ..., we did the seed funding. For the cross-border care, the global one, we have not raised, for now the revenue is supporting it, so not for this one. And so for the artificial intelligence and the technology, do you have people that you fold into your company? Where did you get your talent from? Yeah, so lucky, I had my siblings, so they are techies. So one of them is in data science. So he very well understands this area, and then he was able to bring the right resources through his contacts who understand the space, the modelling, all the ML, and AI, all that. So that's how we have a very small team, because still it's like more in R&D that we are doing, but that is how we, through the contacts, pull the resources. Given these past 18 months, two years, what's the biggest lesson that you've learned? I think the thing is, just keep going. That was my biggest because as you just rightly said, it's a very lonely journey, at least initially. It's very lonely where, you know, people are ready to see your success and hear about it, but they don't want to get bothered about your pains and struggle. So it's a very lonely journey. So one thing I think I learned in my journey of two years is like, push yourself to keep going, and I think you would achieve things when you don't stop. Now, there's no timeline, it could be done in a year, it could be in two years, four years. We have no defined timeline when it would be as we are imagining it, right? Because every entrepreneur is like a next few years IPO exit and all that. When that is going to happen, we really don't know, but that can only happen if we keep going. So I think what I have learned is just don't give up, keep going, learn from your mistakes. Definitely don't just like okay, yeah, I did this, I'll do it again, and somehow it will give me a different result. If I do the same thing, I will get the same result. So every day I have to do something better or different in order to get the result that I desire. And so as you look forward, what do you see as the biggest opportunity for growth or threat in the healthcare system today as you look at it? Because you have two views here, you have it as an entrepreneur, and you also have it as a physician. Yeah, I think healthcare is definitely the people are, or the patients, the consumers, as we can say, are more aware about, and they want to get involved. I think what I see in the past, patients would come to doctor with something and then it's done, they feel like their job is done, whatever the doctor is saying. Now, they want to be involved in their healthcare, and I think, and they want to be informed and involved. That is where I feel like there is a good area for multiple startups can come and take care of that area. How we can get our patients more informed, whether it be their prescription, whether it be their primary care, whether it be the wellness part, and then also how to get them involved. Another thing, I see people around the world, they want the quality. So for them, it's like they don't mind paying for it as long as they can access it easily. So accessibility has become a very important thing in the countries, in Asian countries, where they really want quality and then accessibility. So that is another big area where I can see the growth is. So there's a couple of big things you say there I just want to explore. So there was the time when I look at my grandparents generation, and they saw their health as the doctor's responsibility. One of the things you're bringing forward is that self-responsibility, which I think is critical. And then the other piece was the doctor was never questioned. Is there an age line that you're seeing where both the responsibility and the proactiveness is coming? Is it a younger generation, or what's the line that you're feeling that it's at? Yeah, no, definitely. I think that's more the younger generation where people are open because I think they question everything. So they want to question their doctors. But also what we are doing, if a little older generation, if they are provided information or the fact, they are ready to please go and talk to their doctor, not question them, but at least understand them, raise like, okay, we did this, are we doing this for this reason? So they talk to their doctor, they just don't take it as a dictation. I feel like ... was on the patient side or the doctor side, it's the system itself keeping them both on the same platform where the patient has the complete information, and the doctor was, okay, this all has to be passed to the patient. So I feel like, yes, the younger generation are much faster to adopt this, because for them it's, really give us the information. So on your AI model, are there regulatory concerns that you have to have? Does the FDA have certain rules of validations that need to happen in this space yet? The thing that we have to work on the regulatory side is the efficacy of it. And that is where I think any of the AI when it comes to the healthcare is the efficacy, like how accurate that information that we, the analytics that we are giving. And one of the challenges you will understand for them is the AI models are trained on data, so the bigger the data you give them, the faster and the more accurate they get. Now, being in a young company, you have limited data, good quality data. Now either you have to go out and get the data from the Health Institute, and that's where we are also trying to work, where we can go to these Health Institutes, partner with them, and get access to their data so the machine models can learn faster and get more accurate. Is there anything else you'd like to share or any other topics you'd like to talk about? You know, one topic I would like to talk, and it is a continuation of what we were talking, it's, for patients to get involved. And when I say involved, as long as, even if you get sick, but should, be like that, people should also take healthcare as a part of their wellness, and physical wellness, mental wellness, and this is your complete wellness. Another point I always say in healthcare, we try to use technology on a very, very high level, like we do MRI, sophisticated MRIs. We do drug discovery, which is important, but that is not what day-to-day person uses, right? We don't go and do the imaging every day, or not every person, but day-to-day we do need our primary level. That is where I think we need to just bring the technology to that level, automate it and make it seamless. Thank you so much for your time. I appreciate it. Yeah, it was very, very fun. Thank you. Thanks for tuning in to the Chalk Talk Jim Podcast. For resources, show notes, and ways to get in touch, visit us at ChalkTalkJim.com.