Using Software to Improve Medication Adherence with Shields Health Solutions

Episode 109 · 40:02 · SRT · archive.org · all Tanzu Talk

Hi, everyone. Welcome to Pivotal Conversations. I'm Jeff Kelly, and this week, Dormain Draywitz and I welcome Dan Stevenson and Brandon Zahara from Shields Health Solutions. Shields is a maker of software solutions for specialty pharmacies. Dan and Brandon talk about the challenges of developing and running a specialty pharmacy, how Shields' software helps ensure patients are taking their medications as directed, and how and why Shields adopted cloud-native software development to build and evolve its flagship product, TelemetryRx. Enjoy. So welcome, guys, to the podcast. Thanks for having us. Great to be here. Absolutely. Since we've got a bigger crowd than normal today, so why don't we start with some introductions? Why don't you guys introduce yourselves to our audience, and then we'll dive right in. Yeah. Hello. My name is Dan Stevenson. I'm the Vice President of Business Analytics and Insights at Shields Health Solutions. And I'm Brandon Zahara. I'm the Director of Business Optimization at Shields Health Solutions and work a lot with Dan and our TelemetryRx team. So before we dive into what TelemetryRx is, maybe you can give us a little bit of background on Shields and, you know, what business you've been operating in for the last however many odd years? Yeah. So Shields Health Solutions was created roughly six years ago. We partner with academic medical centers to help them be able to operate and grow their specialty pharmacy programs within their hospital. And specialty pharma for folks who, you know, are kind of of the, of the lay woman variety, just saying, not speaking about myself. What is specialty pharma? Great question. When we think about specialty pharmacy, we really think about the sickest of the sickest patients in the health system. And these patients are typically patients who

are on complex medications that have, you know, very adverse drug interactions that can be difficult to administer. Most of us are, unfortunately, have been witness to, you know, whether it's family members or friends who have been impacted by these, these types of diseases. So whether it's, again, oncology, multiple sclerosis, you know, rheumatology, et cetera. Now, these patients really have a difficult time accessing these medications and staying on these medications because they're not, they're not available at your typical retail pharmacy. So you can't walk down the street and pick up these medications. Gotcha. Okay. Yeah. So this is kind of the stuff that they don't just have on the shelf at your, your corner drugstore and sure, come back in an hour, we'll have it filled. And this is, this is the exotic stuff, if you will. Yeah. These are very complex medications that, again, require a very high touch type of care model. I'm really making sure that there's a big focus on their medication therapy management. You know, as with specialty pharmacy, most of these medications are treating diseases as a, as opposed to treating symptoms. So making sure that these patients are able to get on medication quickly and stay on medication or stay on their medication is truly vital to not only the quality of life, but sometimes their life. So again, being able to help a hospital take those medications and provide it to their patient population is, is really of the utmost importance and focus for SHIELDS. You know, a note that I always like to throw out there is that, you know, these patients that, that we're referring to, although only a really small subset of the patients that are going to be seen at a hospital, they actually make up roughly 35% of the total healthcare spend. So being able to proactively treat these patients and making sure that we're improving outcomes is not only helping

that patient in the short term, but it's also helping the hospital and really the healthcare landscape as we shift from kind of fee-based reimbursement to value-based reimbursement. That's a great description. Um, and I would imagine that it's, it's really important to have good coordination between the clinicians and the physicians and, uh, the pharmacy and the patient even more so than in, I guess, your more traditional pharmacy, uh, situation because you're dealing with such, uh, serious illnesses. Yeah. You mentioned that, you know, the SHIELDS has been doing this for six plus years helping hospitals manage and operate these specialty pharmas. So, you know, inside the hospital when there's, there's a pharmacy inside, um, has it always, has software been a big part of delivering that, um, value back out to the, the, the hospitals and the, um, you know, the academic hospitals that you work with? Uh, absolutely. I think, you know, I think in our, our infancy, right, it was really more about building software to, to collect data. And, and that really allowed us to be able to provide actionable insights, you know, as, as part of our care model, uh, you know, when I mentioned the high touch, you know, we actually put, uh, what we call specialty pharmacy liaisons in each of the disease clinics. So if you are a, um, you know, oncology patient at a certain medical center, um, you always have the same, uh, liaison that you can go to and he or she will support you. And they're really an extension of the, the clinical care team. So, you know, they're frontward facing people who are working with these patients, uh, could be daily, could be weekly, could be monthly. So making sure that we're, we were able to capture, you know, the appropriate information, uh, distill it, and then provide them actionable insights back really is, is a key part of providing better patient care and freeing up the care team, uh, to be able to do just that.

What have you seen change in, in the last six years, possibly from a technology landscape or just from a requirement standpoint that has caused you to take a different approach and, and kind of begin the, the, the work that we're going to sort of dig into today. So one of the, the main trends we've seen is hospitals and more generally, generally health system providers across the, the healthcare landscape, look at what are the different technology and software solutions that can help solve some of the very complex problems that they face. So one that enable one trend that enables, uh, a lot more flexibility in the technology space is the, the move to, uh, cloud delivery of, uh, software services. And that's really one that allows us as a, uh, a software provider to scale, uh, a lot of the great solutions that we've built across a vast number of, of hospitals, uh, in a very efficient, um, manner. So is telemetry RX a new solution that you've built, or is this something that, um, you've kind of been offering for a long time and has kind of iterated in a new way? So the first version of telemetry RX has been around for about three and a half years. Um, you know, it's really been kind of a cornerstone of what we do as an organization. And it's really around again, being able to take it, take data and be able to provide insights into those folks that we have in the clinics to be able to help them, um, identify, you know, which patients are the patients in the most need of care, uh, and being able to go and proactively have conversations with those patients. And if, you know, if those patients do decide to end up filling with the hospital specialty pharmacy, this tool also allows, um, for that patient to have a better opportunity and a better chance to stay on their therapy, uh, due to our retention, uh, workflows that we have built in. So it's really around trying to, at the end of the day, create an end to end specialty pharmacy solution that's going

to allow hospitals to operate a specialty pharmacy program based on the best practices that we've learned in a very easy, simplified user interface software solution. Okay. So if I, you know, I just, I was just at the doctor, you know, at the hospital, just got diagnosed with some kind of chronic condition, my head spinning, right. Cause I'm like, oh gosh, what, what's the rest of my life going to be like? And they're like, oh yeah, by the way, you're going to have to go get a bunch of, uh, medication for this. And here it's like, okay, I can just go to the hospital. You know, I can't go to the corner drugstore, but right here in the hospital, I can go to the specialty pharmacy department. And what happens as a result of that pharmacy department, um, using telemetry Rx. Yeah. So it really, again, it really, it does a few things, right? So, um, I think of it as, as kind of being able to identify and attract patients to the specialty pharmacy, um, process patients, again, you know, these, as you mentioned, with these medications, not being available at your, at your local, uh, you know, um, corner pharmacy, you know, there's a lot of, you know, administrative work that's, that's required before a patient can even go on these medications. So, you know, things like prior authorizations, uh, we're also very proactive with helping patients with financial assistance. As you can imagine, these are high cost medications. Um, so really being able to, um, you know, make sure that patient can, can get on therapy. And then again, the last piece is, is really helping them to, to stay on therapy and improve their quality of life. And really the goal of that is again, you know, right now there's so much administrative work that's being done by these hospitals to be able to get these patients on service, that our solution allows for not only automation, but scale so that, you know, physicians, nurse

practitioners, you know, nurses, et cetera, don't have to worry about the administrative work. And they can really focus on doing what they do best. And that's caring for patients. I'm, I'm hearing parallels, Dormain, between, uh, what, uh, what Shields does and what Pivotal does in terms of our platform, which is about taking care of a lot of the operational, uh, operational concerns of building and running software and letting the developers really focus on what they do best, which is build software that was, that was certainly not lost on us. Uh, when we were in our evaluation process of who to partner with, I actually use that, that's that same analogy quite often. Smart people think alike. I like it. Um, so let's talk, let's talk a little bit about the architecture. So, and, and, and the approach to building software at Shields, you know, was there a moment when either because of, you know, technology trends that are happening, feedback from your customers, where Shields kind of had a moment where they said, look, we need to think about modernizing the way we, we approach building this software. Was there an aha moment and maybe help us understand the old way and compare it to the new way. And we can, can dig into that a little more. Yeah, absolutely. You know, I think there was an aha moment and I think that it was, there was really two major factors to that. Um, you know, one of it, one of them is, is really just the, the success and the growth that Shields has had, uh, in this space. So again, as we've talked about, uh, you know, originally kind of being founded as a healthcare services company, as we've started to scale or grow and expand our national footprint, um, you know, being able to have, uh, standardization is, is obviously of the utmost importance because that's the, the core of the care model. Uh, I would say the other part is that, you know, it's becoming more and more difficult, uh, as you know, insurers and pharmacy benefit managers are getting more and more pressure around costs, um, to be able to effectively and efficiently get these patients on therapy. Uh, so that was another big, uh, driving force behind us realizing that, you know, just the barrier to get into the market, the barrier to, to entry, uh, was, was growing every single year.

Um, so we needed to be able to provide, um, that type of solution, uh, as well as, as the reporting requirements, um, that, that are required to be able to, to be in the specialty pharmacy space. Okay. Yeah. I mean, and that's, you know, as you say, like, there's a lot of awareness about the cost of healthcare in general and the cost of medications, but you know, it sort of seems like, yeah, the solution isn't to just not treat all these people. The solution is to become more efficient in all the other places, um, and, and help people manage their chronic diseases more effectively because what gets so expensive about chronic diseases is when they're not being managed effectively. Um, so that makes a ton of sense. So that's kind of like the catalyst moment is we've, we're growing and we need to be able to grow more efficiently. And at the same time, we have an opportunity to kind of make the whole industry more efficient. So, um, how did you get started? What was kind of the, what was the first steps that you were taking? Yeah, I think, you know, the first step was obviously getting consensus across the stakeholders of the organization. Um, as I mentioned, being a healthcare services company and trying to pitch the idea of, uh, becoming a software company or at least having, uh, you know, a much larger software presence, um, and portfolio, um, that can always be a challenging task. And, uh, it was, it was certainly, I think kind of the, the first step in the process. You know, I think that again, as we, as we talked about with our previous version of telemetry OX, I think the results were there enough that we were able to, to convince the stakeholders, um, to, to allow us to proceed with this, um, which really kind of kicked off our search, you know, knowing that we've kind of been a small internal team that has supported a services company, you know, to really go out and find a partner who was going to teach us really the best practices about building an enterprise level software solution, not just something internal. So, uh, you know, when we found, uh, pivotal,

we really focused on, you know, how do we build up, uh, and adopt some of the agile software development practices that some of the best startups, whether it be in, in healthcare or across the, the broader software ecosystem we're, uh, adopting and really through our, our partnership and building up our internal software development team, making sure our, our folks were understanding a lot of these best practices and then building, uh, a great software platform in telemetry RX that is able to, uh, you know, continually grow and help our organization progress as hospitals continue to focus on, uh, you know, the answering the question, what is the technology that can help me be more efficient, that can help me be more effective in, uh, treating patients, uh, with chronic or, or specialty diseases. And when you talk about best practices, uh, I, I think you're referring to things like, um, some of the agile development, best practices, some of the things we preach here at pivotal pair programming, um, uh, test-driven development. Absolutely. Yeah. And, and for, for, I know for some of our customers, that can be a real culture shock, uh, when we, when that's introduced, what was it like at your organization? You mentioned you had a relatively small team, I think before, you know, engaging with pivotal and making this transformation. Um, so I imagine you had two, two challenges, one to introduce some of these new best practices and new ways of working at the same time, grow the team. Yeah. You know, I would say that again, we, you know, as Brandon mentioned, we were very diligent about selecting a partner that, that we thought was going to, um, put us in a position to, to succeed and, and looking at the different styles in which people promote development. Um, you know, I think when it came to make the choice of partnering with pivotal and really that kind of first step, uh, quite honestly, um, you know, I think one of the beauties of being a, um, at the time, you know, somewhat of a startup company is you've got a lot of really entrepreneurial minded, uh, hungry people.

Uh, so we just dove in head first, you know, the, the team was completely on board. Um, you know, we've got a, we've got a great product team, uh, that's willing to, to, to, you know, work as, as hard as possible to make this product, um, come to, come to fruition in a reality. Um, Yeah. And I think one of the things that was great as we were basically taking a, an idea and a proof of concept and building up a team and ultimately a business line around it was we were able to adopt a lot of those agile software development practices into our development culture from day one and then continue to build a team along those lines. So we really have that, that kernel of the culture that we were able to build a team around rather than a lot of bigger companies sort of face the challenge of having an existing culture that they have to then, you know, layer over some of the agile software development practices that may be foreign to many of their team members. Yeah. Yeah. That can definitely be a benefit. Um, and, and, and related to that on the business side, uh, a challenge can be, uh, when you think about budgeting for new products and things, the old way is very much, Oh, give me a, give me this, you know, this large document with all the requirements and we'll figure out exactly how much it's going to cost. And we'll budget that over a two year period. And, you know, in two years, maybe we will, maybe we won't have the solution, but it's, it's kind of the known model, whereas with developing in an iterative way, it's a little bit more challenging because you don't necessarily know what to tell your business stakeholders, what you're going to have at the end. We know we're, we're iterating based on what our customers want and that's going to take the shape that it takes. And so that can introduce some challenges in both getting business buy-in, but also in terms of how you budget and things like that. Were there any challenges on, I guess, the business side of adopting this new way? Uh, yeah, certainly. You know, I, I think you really kind of hit the nail on the head there, right? I think that, you know, it's always a challenge and it, you know, any, any software development, you know, is a challenge. And certainly with kind of the iterative, um, you know, constant deployment, uh, approach that, that we've learned, um, you know, the best practice from,

uh, with, with Pivotal, uh, to your point, it does make, uh, setting deadlines and, um, you know, forecasting budgets and things like that, uh, a little bit trickier. Uh, you know, I think that that's, you know, it's really important at that point, you know, and I think we did a good job in, in the initial phases of really fostering that, that excitement with, with our stakeholders so that they understood, you know, really kind of the journey that we were going on. Um, and so, you know, it's been really, really important to make sure that, um, you know, we, we keep the team, um, you know, the, the, the rest of the stakeholders really kind of involved in, in how we're developing, what we're developing, uh, you know, when we have to pivot for a certain reason, no pun intended. Um, so, you know, I, I think that was really something that allowed us, um, or it has allowed us to kind of continue and use these best practices, um, of, of agile development that, that we've learned at, uh, at Pivotal. Absolutely. And I, I think the other, uh, element I'd like to emphasize is that the user centered design approach, which very much resonates with our executive team here, as well as our specialty care teams at hospitals across the country, you know, we're really putting that, uh, specialty care team user front and center and thinking about, you know, how is our software making their life easier? How are we making the interaction between that care team and the patient easier? And then working backwards such that we're able to build sort of simple purpose-built software that solves those, uh, key sort of patient engagement problems. Yeah. I'm sure that could be pretty refreshing for, you know, folks, uh, you know, we've gotten used to in our consumer apps that the folks building consumer apps are really tuned in to trying to make this something that you're going to want to click. You're going to want to buy, but in so much enterprise software, it's like the user can be such an afterthought and it's like, no, the user will adapt to the software we have built and not the other way around. Um, so I, I, that makes a lot of

sense that, you know, being able to bring in those specialty pharma care folks so that they get to be part of the process, you know, can just have tremendous, both, you know, impact on building better software that that's actually solving their challenges, but also, you know, their psychological buy-in to using the software since you're, you're, you're, what you've described as transitioning from healthcare services company to something that's very technology powered and enabled with the software that's now going to be out there in front of, um, probably your team as well as your customers' teams. So you're, you're helping kind of foster that, that transition and making that transition easier just by bringing them into the process. Am I, am I totally in left field here or? Yeah, no, that, that's exactly right. And it's really about, uh, you know, taking what their goals are, you know, and aligning them with some of the, the business priorities and health systems priorities around giving patients a higher level of care and a higher quality of care and doing that in an efficient manner such that, you know, it's not costing the, the health systems a prohibitive amount to care for the, the thousands or tens of thousands of patients that, that they have to. And really taking that user-centered design approach, uh, enables those frictionless health experiences for the patient because you have a, a specialty care team that is, you know, not worried about administrative burdens of really complex EMRs or other software. You have something that's sort of simple and pleasant to use. So you're, you're reducing the burnout of the care team and they're able to focus on those patient interactions. When you talk about this frictionless, um, care experience, you know, what can you tell us about what it's meant? Um, uh, what kind of results and, and the outcome, like, can you quantify that? How can you demonstrate that it's actually a more

frictionless experience? Yeah, absolutely. So when we think about the metrics, you know, our objectives are fundamentally, you know, improving the care that patients receive and improving the enrollment and expanding access of patients to our higher degree of a specialty pharmacy care. So when we look at the, the care component, you know, we really focus on our medication adherence metrics or PDC proportion of days covered. So that is our patients actually taking their medications and following the regimens that doctors are prescribing to them. Um, and when we look across our network, we do see about a 92% average, uh, medication adherence rate, which is phenomenal compared to the industry averages around 65% or, or even as low as 50% in many estimates. Uh, on the enrollment piece, we really look at how many patients are the, the doctors seeing and writing specialty prescriptions to, and what percentage of, of those patients are actually choosing to fill with the, the hospital specialty pharmacy and receive that higher level of care, really get access to those, uh, best in class care services. And across a lot of our health system network, you see, you know, over 60% of patients are actually choosing to fill with the hospital specialty pharmacy. Whereas, you know, when we, uh, we start with a new client, often that number is, you know, sort of below 3% even. Okay. So that's a big jump. Okay. So yeah. And that's, thank you for walking through those two sort of high level metrics to look at, um, you know, for, for those of us kind of outside the, the industry. Um, I want to also ask, I don't know if it's the S word or the H word. Um, so security, but then your case, since it's, you're talking about healthcare software, HIPAA and HIPAA compliance is kind of, um, you know, uh, another, another important

piece of the overall architecture. So can you talk a little bit about how you're able to achieve, um, meeting those kinds of security and compliance challenges with building and I write to describe it as almost like a SAS based software that's getting delivered to, um, the specialty pharma departments? Absolutely. So, uh, you know, when you're delivering a software as a service, you know, sort of via cloud environments at massive scale, you know, making sure you're adhering to the, the highest standards in security and HIPAA compliance is really essential. And when we think of HIPAA compliance, there's really two elements of it. You know, there's the security piece, which I think a lot of people are focused on, particularly in light of the well-publicized data breaches. So really making sure the data is secure and malicious actors don't have access to that data. And that's one key element that we really focus on, uh, through encrypting our data, both in rest, as well as in transit, um, and, uh, a number of other sort of third party systems that we use in order to make sure our data is secure. But the important aspect of HIPAA requirements also mandate that you control the, the access to the data and then that it's being used only by the people who really need to use it. So making sure we have, uh, user-based or role-based user access controls, uh, multi-factor authentication to make sure that if someone is logging into our, uh, software, we know who that is and we're actually controlling what information they can see. It's not just carte blanche to look at all the healthcare data within our software. And does HIPAA require you to also report against that, uh, information? Absolutely. So, uh, logging and auditing are essential when you're, when you're talking about HIPAA compliance. So we've built in on the back end through one of our partners, Sumo Logic, uh, a lot of automated logging, uh, and error reporting to our platform team.

So they can look at, uh, what are the, the security concerns that we may need to look into. And again, that, uh, culture of continuous improvement of our security, such that, uh, you know, we're keeping up with all the potential, um, intrusions, uh, that are out there, uh, across the globe. So stepping back, are you able to comment on how PCF, uh, as sort of the platform on which you're running TelemetryRx has been able to help, um, meet the security piece and the data access piece and the logging piece? Absolutely. So one of the reasons we chose Pivotal Cloud Foundry, um, as our platform is that it has a lot of these really easy to use and easy to develop on top of hooks into some of the, the best in class third-party services like a Sumo Logic, as I mentioned, or like Okta for multi-factor authentication. So it's really easy for our software development team to build in a lot of these security and privacy best practices. I think the, the other element that's really important is the, the automated, uh, views of the cloud infrastructure so that we can understand what is, uh, what users are looking at across our system in a very efficient level. We can make sure we have reliability built in, uh, and we make sure that we have the auditing set up and audit logs are, are being stored at, in the appropriate places, uh, within our, our broader database platform. So, and I'll just add to it, uh, in a very less technical, uh, manner than, than Brandon did. You know, I almost kind of think as of security, kind of the same way that I think about our business, right? Which is the patient is always first. So, you know, really when you think about security, the biggest issue with security is making sure that your patient's information isn't exposed to the public. Uh,

so again, just a, a small little parallel that, that I always think in my mind. And again, when we talk to the platform team and we, the app team, and we talk about security, you know, it's, I think giving that little extra, uh, context really kind of helps them understand, you know, why it is so important, uh, to be compliant, um, to be secure, uh, and to make sure that people aren't accessing this data that that shouldn't be. I was going to try and get more technical right there, but you know, you just, you just took it in a different direction. Um, but yeah, no, yeah, no, I think it's important to also be able to, you know, from a, uh, communication standpoint, when you're trying to explain to the teams, you getting them to care, like that's absolutely the best practice that, you know, I'm, um, I, I've heard, for example, like Molly Crowther and our team, as she's working through, um, raising everyone's security awareness is actually just sitting down and spending the time getting people to, on a human level, wrap their head around why it's important and why they should care. And then from there, they're far more likely to take the steps that they need. Um, especially if you make, you know, doing the secure thing, the easy thing, um, then, then you get a lot more sort of developer compliance with, uh, just security best practices. I think the last thing I was going to ask about was going to be around data and analytics and the role that plays in both the actual product itself, uh, in terms of delivering insights to the users of the product, as well as how you think about using data when you're continuing to develop the product. And we touched on this before, but you know, you want to focus on the user. And so you must be getting a lot of user data. Here's how they're using the platform. Here's our, they're using our solution, which informs how you then develop future features or capabilities. So I wonder if you could just talk a little bit about the role of data, uh, as you see it, uh, in your product and your, your whole approach to the software. Yeah. You know, I think data at the end of the day is really the lifeblood of, of, you know, the software

as well as, you know, our organization. Um, as we talked about before, you know, there's, there's so many additional complexities to specialty pharmacy, um, that we haven't even talked about, you know, getting accreditations, um, getting access to different payers, getting access to different limited distribution drugs. You know, these all require really, really significant, um, uh, data, um, capabilities. And so to be able to put our hospital partners in a position to be able to care for as many patients as they can, uh, it's, it's really important for us to be able to, um, uh, collect that data through our software, um, as well as, you know, some of our other capabilities to be able to meet those requirements. And then again, you know, as, as you think about the complexities of, of healthcare, and when you think about, you know, data interoperability and things of that nature, you know, to be able to, you know, really put together an analytics package that, you know, we are able to work with, you know, countless, you know, electronic medical record or medical record, uh, solutions, uh, pharmacy management systems, et cetera, and really be able to have that in a nice, clean, um, data warehouse and be able to pull insights, you know, whether it's about improving care, uh, about improving the operational performance of the program, you know, those are things, or as I mentioned, just making sure that you can stay in these payer networks, uh, you can stay in these drug networks, et cetera, is really core to what we do. I have one more question. You mentioned working with labs, pivotal labs. And so I was hoping you could sort of expand a little bit on what your experience was like, uh, working with labs. We talked a little bit about in terms of the teams being able to rapidly adopt, um, and kind of grow the, the sort of agile practices, but just otherwise kind of, what was that experience like? What were some of the, the big kind of turning points and learnings out of that?

So the, the thing we loved about working with pivotal labs is you really immerse yourself in this sort of ideal utopia of developing software. And not only are you sort of in this great physical environment, but you have a lot of creative, as well as problem solving, uh, individuals around you that are focused on solving problems across multiple different industries. And there's this great sharing of, of knowledge, uh, that you're able to benefit from as you're going through solving your own software development problems. So really leveraging a lot of those, um, you know, past experiences and other perspectives of people across the pivotal labs team was essential for us, uh, as we developed this software. Um, and then it's very easy to transplant that environment back to, to our headquarters as we've transitioned our software development efforts, uh, back, uh, into Shields Health Solutions, uh, and can continue that pace of, uh, of new software development. So that's interesting. So you're kind of describing like the outside perspective and folks who've worked on problems in different industries was really useful. You know, this is, it kind of goes against the grain of what you see a lot of folks gravitate towards, which is like, oh no, I need someone who, who knows my industry inside and out. And that's the only, um, kind of partner I'm going to trust. You're kind of saying the opposite. Absolutely. And really a lot of the, the functional round tables that we would have while at pivotal labs, whether it was around, uh, product or design or development allowed you to boil down the problems you are facing to first principles and share and understand those common, uh, sort of first principles, uh, across different projects, and then build those back up based on the, the context of the specific software you are developing. So not only were you benefiting from the specific

pivots you are working with, you actually benefit from the, the broader knowledge base that all these other companies that may be at different points along their development path, uh, are learning. So it really has that, um, not just sort of functional, but also, uh, industry specific or vertical specific, uh, learning experience. And I, you know, I just like to add to that, I think as well, transforming from a, again, a services company to a technology company presents all kinds of challenges, right? But when you, when you've been in the business for six years, um, and you've been very successful, and you've got countless, uh, hospital partners that you're supporting, you know, we have a lot of those expertise around healthcare, you know, and we really, we truly believe that we have the best model out there. Um, so, you know, when it comes to making sure that, you know, the business needs are met, um, and, you know, that we're staying true to the beliefs, uh, in, in the core, uh, principles of providing the, the level of care that, that we, um, that we do, uh, we have all of those people at our disposal that have been doing this, uh, you know, for at least six years, if not longer. So it was really nice to be able to pull from those people. Um, and then as Brandon mentioned, you know, it's, it's a lot easier to take somebody who's never worked in healthcare and use kind of some of their, um, input and, and their guidance, because at the end of the day, you know, I think that again, it wasn't just a green field for us. We, we, we truly knew, uh, what we were setting out, uh, to build, obviously, um, knowing that there was going to be lots of iterations and pivots along the way, but, you know, the overall vision and goal. Okay. Um, so I had one more question about, you know, you mentioned something that worked really well early on was, you know, having a lot of the different stakeholders really excited about what this represented, also having something that was already in place that, that had shown some

good results. Um, so some, the, the internal software that you'd built, so folks kind of knew what that was and, and you could build upon that success. What's getting those folks, what's keeping those folks excited now? Um, as you're, I don't, and I actually haven't captured like what the timeframe has been since going back to when you started the journey with labs, however many months or years that were past that, what's keeping those folks excited now? Yeah. So again, you know, going back to what I had mentioned previously about already being in the business, you know, we were able to get this software, um, into, you know, our team's hands, um, in a very quick manner. We, we didn't have to go through, you know, long sales cycles and, you know, fundraising and things like that. So we were able to really just kind of focus on the technology. Uh, and again, kind of using that, the best practices that, that we, uh, have kind of embodied from, from pivotal, you know, it's, it's really kind of constantly showing those stakeholders, the improvements that we're making every week, every few weeks, um, you know, again, having them, uh, you know, allowing them to see the actual software in our users' hands, getting the feedback, um, you know, from our users, which again, is probably the largest percentage of, um, our employee population. So really being able to give them tools, uh, to make their lives easier, that again, as I always talked about with, with the patient part, you know, being the, the crux of, of what we do, you know, again, to freeze them up to, to provide better, better patient care. So again, it's, it's, it's really, um, uh, it's, it's been a good journey with, with our stakeholders. I think they're, they're very excited about, about what we're building. Um, and you know, again, it's just, it's keeping that relationship, um, showing them what we're doing, um, you know, and always kind of brainstorming fun things to, uh, to dig into next. Absolutely. And it's really about that vision, I think that keeps everyone excited and engaged. And even what was very instrumental in galvanizing

them initially towards undertaking this, uh, big development project, uh, is this vision of building a full end-to-end specialty care solution, uh, and then really driving a meaningful effect on those patient lives across all of our health system partners. And the, what was it? 92% adherence rate to taking medications is, is a pretty good indicator of that. Absolutely. Well, thank you so much. This has been, um, really interesting and, and informative learning a lot about kind of the specialty pharma world, but also kind of just how, how Shields has been able to, to build software to really move the needle on both, um, patient goals and, and kind of deliver results back to the, to the specialty pharma departments in, inside hospitals that, that you work with. So thank you so much for all the time. Thank you very much.

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