Q&A with Josh Benner, President and Co-Founder, RxAnte

Coming off the heels of RxAnte's recent acquisition by Millennium Laboratories, Oxeon Director Tim Gordon spent time with founder and President Josh Benner to discuss the company's unique approach to improving medication use, their rapid growth since inception three years ago, and how he envisions their trajectory moving forward. RxAnte, a portfolio company of Oxeon Partners LLC, counted Aberdare Ventures and West Health Investment Fund among its investors. [dropcap]Q:[/dropcap] What was the inspiration behind launching RxAnte and how did the company get its start?

[dropcap]A:[/dropcap] We are a very mission-oriented group of health care guys with long histories in the fields of advanced analytics, medication use, health IT, quality improvement, and health policy. The co-founders knew each other from prior relationships and got together to tackle what we all agreed is the biggest opportunity in the health care system: the problem of misused prescription drugs. The statistic that continues to baffle me is that the U.S. is going to spend $325 billion this year on prescription drugs and we’re also going to spend almost exactly the same amount on hospitalizations, doctor visits, lab tests, and disability caused by the misuse of those medications. To say that more simply, we’re spending equivalent amounts of money on drugs as we do to clean up the problems that the misuse of those drugs causes. If you look at that figure in the grand scheme of things, it’s between a quarter and a third of all preventable costs in the health care system, and many of those preventable costs like hospital readmissions root back to how people do or don’t use their medication correctly. So there’s a huge ROI to the biggest players in the health care system if we can solve the problems of underuse, overuse, and mis-prescribing of prescription drugs. That’s an intensely motivating problem for us, we have backgrounds in the space, and we set out to build some unique tools and solutions to help organizations improve the use of medications in their populations.

[dropcap]Q:[/dropcap] Can you talk about RxAnte’s approach to medication adherence, and the kind of impact you’re ultimately looking to drive with this solution?

[dropcap]A:[/dropcap] For contrast, let me first explain the typical approach. Big health care organizations that are trying to support better use of prescription drugs have a number of available tools in their toolboxes. Those include things like sending refill reminder letters to patients who are late to fill their medicines, using automated phone calls, and most of them have some live care management call centers staffed by nurses or pharmacists who can also do case management with selected cases. They choose these activities because, due to cost, that’s all they can scale over millions of lives taking these medications. Unfortunately, these are the things that are often less effective.

The business problem we wanted to fix was to help these organizations do two things differently. First, we wanted to enable our clients to do more of what works which is engaging patients’ own health care providers in the process of managing their medication outcomes. We do this using advanced analytics to identify and target those patients who will most benefit from outreach from health care providers. And second, we want to get ahead of the problem and prevent the misuse of prescription drugs before it happens because then it’s too late. RxAnte treats medication misuse as a prevention problem by identifying who’s at risk of stopping their medicines too early, or of overusing certain classes of medications, and heading it off before it actually happens. And if you take that approach, you find yourself talking to smaller groups of patients and you can afford to do the things that really work best for those at-risk patients.

[dropcap]Q:[/dropcap] Can you talk a bit about certain goals you’ve had in mind when you set out on this path, how you’re doing against those goals, and some key milestones that you’ve achieved?

[dropcap]A:[/dropcap] We’re making great progress overall, but we’re far from done. We are the first company to deliver an accurate, scalable cross-therapy-area, patient stratification tool that runs on ordinary data that every big health care organization already has. We can predict the medication adherence of patients as early as the first time they fill a prescription in any chronic therapy area today. That’s a big achievement not just for us, but for the field of drug therapy management.

I’d say the next step is to take that knowledge and use it to change the future. We can take accurate predictions and what we know about how different patients respond to different interventions, and match patients to the intervention most likely to benefit them, or most likely to achieve a health plan’s needs or a provider’s needs. It’s pretty exciting that our decision support guides not only specific interventions for each patient, but timing as well.

Our newest offering, which we built in the second half of 2013, is a product called RxEffect™, which allows us to help an organization reach out and activate a patient’s own health care providers, their own doctors, their own nurses, their own pharmacists, to actually better manage their medication outcomes. It involves sophisticated analytics and real-time cloud-based tools for those practices or those pharmacies, identifying which of their patients need support and when. The outcomes that we’ve seen so far are better adherence at a lower cost, and include the associated improvements you would expect in terms of utilization of health care services. We’re really creating value for customers, and I’m excited about that. One nice capstone statistic is that because those tools work, we’re managing the medication use of about 8 million patients today, and that’s another big accomplishment. We have nationally recognized customers using these tools to manage millions of lives, and we can see that it’s making a difference in the right direction.

[dropcap]Q:[/dropcap] As a first-time CEO, what has surprised you most through RxAnte’s first few years?

[dropcap]A:[/dropcap] There’s this perception out there that it’s very hard to engage and help big health care organizations innovate and change their processes of care or population care management. I was quite convinced from listening to others that it would take years to work our way into a trusting relationship with those big organizations. I think the surprise was that the macro trends in health care are making those big organizations really receptive right now to creative ideas, and they’re actively seeking new tools and innovative ways of taking care of their patients or their members. It was a pleasant surprise to find people really embracing the ideas we brought, testing new products, and then buying them in multi-year contracts as they proved their value. I think it’s a myth that you can’t turn these big battleship health care organizations, and I think we’ve proven that it’s possible.

[dropcap]Q:[/dropcap] How have you approached building your team and can you describe the importance of culture to the organization? What impact has this had on RxAnte’s growth?

[dropcap]A:[/dropcap] Hands down, there’s absolutely nothing more important than team. The team has to share a common vision and has to have a track record of both success and failure to have taught them how to succeed against headwinds. And the team has to ultimately be capable of achieving and executing on the vision. We built the founding team for the most part from people whom I had worked with in one capacity or another previously and who were nationally renowned experts in the space and then there were still gaps. To fill the gaps we looked for the best fit in terms of a recruiter who got what we were trying to do and could represent it well to people who were happy in their jobs and then recruit them anyway. That was Oxeon and Trevor and I think you guys have worked out great.

[dropcap]Q:[/dropcap] The terms “big data” and “analytics” are thrown around the health care industry perpetually at this point. How is RxAnte different?

[dropcap]A:[/dropcap] That’s a great question and it’s really important. Data are ubiquitous— everyone has big data. Everyone has big data and small data. Everyone probably has people who can run statistical software to calculate rates, proportions, and statistics. It makes it seem like the barriers to entry in this field are very low. The reality is big data and analytics are tools for creating value and improving outcomes in the health care system. What I think has differentiated us is that perspective. We look at big data and analytics not as the offering and not as the solution, but as tools to achieve the goal, which is better outcomes, better quality scores, and lower costs. So yes, we do predictive analytics, and we do a lot of advanced analytics measuring programs’ performance, but the most important thing we do is take everything we’re learning from that and build solutions that help these organizations do things like engage providers to work better with their patients. That’s what moves the needle on the most important things: the outcomes and the cost savings and the goals of the client. Our mantra is “Know the future. Then change it.” It’s that second half that really differentiates us.

[dropcap]Q:[/dropcap] How does RxAnte fit into the broader population health management discussion and the shift from fee-for-service to value-based care?

[dropcap]A:[/dropcap] We’re enabling it. More and more organizations are now at risk for the outcomes of patients’ prescription drug use. That means more health plans, more PBMs, more pharmacy chains, more physician groups, and more hospitals now have an interest in making sure patients take their medicines the right way and get the best possible outcomes. And as those organizations have become more accountable economically, they need tools to help manage that process in a very efficient way. They can’t deliver the most effective intervention to every patient in their population. It’s not sustainable; it’s not affordable. What they need are the tools to know which patients are at risk, what to do about those patients who are at risk, and how to solve the problem so that those patients take their medications as appropriately as possible. That’s the solution that we’ve built and I think, in many ways, it’s made us a partner to these accountable care organizations today.

[dropcap]Q:[/dropcap] You have had some big news recently with the recent acquisition by Millennium Labs! Can you talk a bit about this and the long-term vision for RxAnte moving forward?

[dropcap]A:[/dropcap] We’re really excited about our partnership with Millennium. I hate the term “congratulations on the exit” because this is not an exit for anyone here, this is just the end of the beginning and we’re moving on to the next chapter of RxAnte’s development. We still have big goals for our customers and the evolution of our products. We will continue to move on the same trajectory with rapid growth, very customer focused innovation, and a high degree of customer service. So it’s business as usual for me and the management team and the people here at RxAnte going forward. Over the longer term, we will explore with Millennium some interesting opportunities that are created by the coupling of our businesses. Millennium in many ways focuses on that same problem of the cost of misused prescription drugs, but they address it as a lab testing company that enables more personalized treatment plans based on pharmacogenetic testing and drug therapy monitoring with other forms of testing. We approach that same problem by guiding the delivery of personalized care management programs. Together there will be some very interesting synergies, and we’re aiming to explore those over the next couple of years while making sure that first and foremost, our core businesses remain healthy and growing.