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Hi, everyone. Welcome to Pivotal Conversations. I'm Jeff Kelly, and this week, Dormain Draywitz

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and I welcome Dan Stevenson and Brandon Zahara from Shields Health Solutions. Shields is a

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maker of software solutions for specialty pharmacies. Dan and Brandon talk about the

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challenges of developing and running a specialty pharmacy, how Shields' software helps ensure

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patients are taking their medications as directed, and how and why Shields adopted cloud-native

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software development to build and evolve its flagship product, TelemetryRx. Enjoy.

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So welcome, guys, to the podcast. Thanks for having us. Great to be here. Absolutely. Since we've got a

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bigger crowd than normal today, so why don't we start with some introductions? Why don't you guys

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introduce yourselves to our audience, and then we'll dive right in. Yeah. Hello. My name is Dan

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Stevenson. I'm the Vice President of Business Analytics and Insights at Shields Health Solutions.

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And I'm Brandon Zahara. I'm the Director of Business Optimization at Shields Health Solutions and work

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a lot with Dan and our TelemetryRx team. So before we dive into what TelemetryRx is,

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maybe you can give us a little bit of background on Shields and, you know, what business you've been

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operating in for the last however many odd years? Yeah. So Shields Health Solutions was created roughly

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six years ago. We partner with academic medical centers to help them be able to operate and grow

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their specialty pharmacy programs within their hospital. And specialty pharma for folks who,

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you know, are kind of of the, of the lay woman variety, just saying, not speaking about myself.

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What is specialty pharma? Great question. When we think about specialty pharmacy, we really think about

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the sickest of the sickest patients in the health system. And these patients are typically patients who

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are on complex medications that have, you know, very adverse drug interactions that can be difficult to

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administer. Most of us are, unfortunately, have been witness to, you know, whether it's family members or

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friends who have been impacted by these, these types of diseases. So whether it's, again, oncology,

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multiple sclerosis, you know, rheumatology, et cetera. Now, these patients really have a difficult time

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accessing these medications and staying on these medications because they're not, they're not

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available at your typical retail pharmacy. So you can't walk down the street and pick up these

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medications. Gotcha. Okay. Yeah. So this is kind of the stuff that they don't just have on the shelf at

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your, your corner drugstore and sure, come back in an hour, we'll have it filled. And this is,

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this is the exotic stuff, if you will. Yeah. These are very complex medications that, again, require a very

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high touch type of care model. I'm really making sure that there's a big focus on their medication

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therapy management. You know, as with specialty pharmacy, most of these medications are treating

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diseases as a, as opposed to treating symptoms. So making sure that these patients are able to get on

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medication quickly and stay on medication or stay on their medication is truly vital to not only the quality

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of life, but sometimes their life. So again, being able to help a hospital take those medications and

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provide it to their patient population is, is really of the utmost importance and focus for SHIELDS.

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You know, a note that I always like to throw out there is that, you know, these patients that,

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that we're referring to, although only a really small subset of the patients that are going to be seen

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at a hospital, they actually make up roughly 35% of the total healthcare spend. So being able to

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proactively treat these patients and making sure that we're improving outcomes is not only helping

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that patient in the short term, but it's also helping the hospital and really the healthcare

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landscape as we shift from kind of fee-based reimbursement to value-based reimbursement.

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That's a great description. Um, and I would imagine that it's, it's really important to have good

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coordination between the clinicians and the physicians and, uh, the pharmacy and the patient

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even more so than in, I guess, your more traditional pharmacy, uh, situation because you're dealing with

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such, uh, serious illnesses. Yeah. You mentioned that, you know, the SHIELDS has been doing this for

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six plus years helping hospitals manage and operate these specialty pharmas. So, you know, inside the

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hospital when there's, there's a pharmacy inside, um, has it always, has software been a big part of

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delivering that, um, value back out to the, the, the hospitals and the, um, you know, the academic

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hospitals that you work with? Uh, absolutely. I think, you know, I think in our, our infancy,

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right, it was really more about building software to, to collect data. And, and that really allowed us

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to be able to provide actionable insights, you know, as, as part of our care model, uh, you know,

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when I mentioned the high touch, you know, we actually put, uh, what we call specialty pharmacy

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liaisons in each of the disease clinics. So if you are a, um, you know, oncology patient at a certain

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medical center, um, you always have the same, uh, liaison that you can go to and he or she will

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support you. And they're really an extension of the, the clinical care team. So, you know,

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they're frontward facing people who are working with these patients, uh, could be daily, could be

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weekly, could be monthly. So making sure that we're, we were able to capture, you know, the appropriate

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information, uh, distill it, and then provide them actionable insights back really is, is a key part of

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providing better patient care and freeing up the care team, uh, to be able to do just that.

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What have you seen change in, in the last six years, possibly from a technology landscape or just

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from a requirement standpoint that has caused you to take a different approach and, and kind of begin

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the, the, the work that we're going to sort of dig into today. So one of the, the main trends we've

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seen is hospitals and more generally, generally health system providers across the, the healthcare

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landscape, look at what are the different technology and software solutions that can help solve some of

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the very complex problems that they face. So one that enable one trend that enables, uh, a lot more

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flexibility in the technology space is the, the move to, uh, cloud delivery of, uh, software services. And that's really

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one that allows us as a, uh, a software provider to scale, uh, a lot of the great solutions that we've built

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across a vast number of, of hospitals, uh, in a very efficient, um, manner.

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So is telemetry RX a new solution that you've built, or is this something that, um, you've kind of been

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offering for a long time and has kind of iterated in a new way?

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So the first version of telemetry RX has been around for about three and a half years. Um, you know,

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it's really been kind of a cornerstone of what we do as an organization. And it's really around again,

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being able to take it, take data and be able to provide insights into those folks that we have in the

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clinics to be able to help them, um, identify, you know, which patients are the patients in the most

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need of care, uh, and being able to go and proactively have conversations with those patients.

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And if, you know, if those patients do decide to end up filling with the hospital specialty pharmacy,

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this tool also allows, um, for that patient to have a better opportunity and a better chance

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to stay on their therapy, uh, due to our retention, uh, workflows that we have built in. So it's really

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around trying to, at the end of the day, create an end to end specialty pharmacy solution that's going

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to allow hospitals to operate a specialty pharmacy program based on the best practices that we've

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learned in a very easy, simplified user interface software solution.

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Okay. So if I, you know, I just, I was just at the doctor, you know, at the hospital,

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just got diagnosed with some kind of chronic condition, my head spinning, right. Cause I'm like,

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oh gosh, what, what's the rest of my life going to be like? And they're like, oh yeah, by the way,

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you're going to have to go get a bunch of, uh, medication for this. And here it's like, okay,

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I can just go to the hospital. You know, I can't go to the corner drugstore, but right here in the

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hospital, I can go to the specialty pharmacy department. And what happens as a result of

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that pharmacy department, um, using telemetry Rx. Yeah. So it really, again, it really,

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it does a few things, right? So, um, I think of it as, as kind of being able to identify and attract

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patients to the specialty pharmacy, um, process patients, again, you know, these, as you mentioned,

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with these medications, not being available at your, at your local, uh, you know, um, corner pharmacy,

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you know, there's a lot of, you know, administrative work that's, that's required before a patient can

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even go on these medications. So, you know, things like prior authorizations, uh, we're also very

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proactive with helping patients with financial assistance. As you can imagine, these are high cost

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medications. Um, so really being able to, um, you know, make sure that patient can, can get on therapy.

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And then again, the last piece is, is really helping them to, to stay on therapy and improve

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their quality of life. And really the goal of that is again, you know, right now there's so much

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administrative work that's being done by these hospitals to be able to get these patients on service,

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that our solution allows for not only automation, but scale so that, you know, physicians, nurse

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practitioners, you know, nurses, et cetera, don't have to worry about the administrative work.

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And they can really focus on doing what they do best. And that's caring for patients.

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I'm, I'm hearing parallels, Dormain, between, uh, what, uh, what Shields does and what Pivotal does

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in terms of our platform, which is about taking care of a lot of the operational, uh, operational

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concerns of building and running software and letting the developers really focus on what they do best,

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which is build software that was, that was certainly not lost on us. Uh, when we were in our evaluation

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process of who to partner with, I actually use that, that's that same analogy quite often.

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Smart people think alike. I like it. Um, so let's talk, let's talk a little bit about the architecture.

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So, and, and, and the approach to building software at Shields, you know, was there a moment

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when either because of, you know, technology trends that are happening, feedback from your customers,

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where Shields kind of had a moment where they said, look, we need to think about modernizing the way we,

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we approach building this software. Was there an aha moment and maybe help us understand the

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old way and compare it to the new way. And we can, can dig into that a little more.

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Yeah, absolutely. You know, I think there was an aha moment and I think that it was,

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there was really two major factors to that. Um, you know, one of it, one of them is, is really just the,

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the success and the growth that Shields has had, uh, in this space. So again, as we've talked

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about, uh, you know, originally kind of being founded as a healthcare services company,

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as we've started to scale or grow and expand our national footprint, um, you know, being able to

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have, uh, standardization is, is obviously of the utmost importance because that's the, the core

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of the care model. Uh, I would say the other part is that, you know, it's becoming more and more

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difficult, uh, as you know, insurers and pharmacy benefit managers are getting more and more pressure

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around costs, um, to be able to effectively and efficiently get these patients on therapy.

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Uh, so that was another big, uh, driving force behind us realizing that, you know,

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just the barrier to get into the market, the barrier to, to entry, uh, was, was growing every single year.

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Um, so we needed to be able to provide, um, that type of solution, uh, as well as, as the reporting

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requirements, um, that, that are required to be able to, to be in the specialty pharmacy space.

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Okay. Yeah. I mean, and that's, you know, as you say, like, there's a lot of awareness about the cost of

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healthcare in general and the cost of medications, but you know, it sort of seems like, yeah, the solution

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isn't to just not treat all these people. The solution is to become more efficient in all the other

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places, um, and, and help people manage their chronic diseases more effectively because what gets so

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expensive about chronic diseases is when they're not being managed effectively. Um, so that makes

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a ton of sense. So that's kind of like the catalyst moment is we've, we're growing and we need to be

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able to grow more efficiently. And at the same time, we have an opportunity to kind of make the whole

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industry more efficient. So, um, how did you get started? What was kind of the, what was the first

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steps that you were taking? Yeah, I think, you know, the first step was obviously getting consensus

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across the stakeholders of the organization. Um, as I mentioned, being a healthcare

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services company and trying to pitch the idea of, uh, becoming a software company or at least having,

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uh, you know, a much larger software presence, um, and portfolio, um, that can always be a challenging

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task. And, uh, it was, it was certainly, I think kind of the, the first step in the process. You know,

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I think that again, as we, as we talked about with our previous version of telemetry OX, I think the

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results were there enough that we were able to, to convince the stakeholders, um, to, to allow us

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to proceed with this, um, which really kind of kicked off our search, you know, knowing that we've kind

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of been a small internal team that has supported a services company, you know, to really go out and

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find a partner who was going to teach us really the best practices about building an enterprise level

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software solution, not just something internal. So, uh, you know, when we found, uh, pivotal,

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we really focused on, you know, how do we build up, uh, and adopt some of the agile software development

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practices that some of the best startups, whether it be in, in healthcare or across the, the broader

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software ecosystem we're, uh, adopting and really through our, our partnership and building up our

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internal software development team, making sure our, our folks were understanding a lot of these best

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practices and then building, uh, a great software platform in telemetry RX that is able to, uh, you

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know, continually grow and help our organization progress as hospitals continue to focus on, uh,

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you know, the answering the question, what is the technology that can help me be more efficient,

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that can help me be more effective in, uh, treating patients, uh, with chronic or, or specialty diseases.

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And when you talk about best practices, uh, I, I think you're referring to things like,

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um, some of the agile development, best practices, some of the things we preach here at pivotal pair

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programming, um, uh, test-driven development. Absolutely. Yeah. And, and for, for, I know for some

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of our customers, that can be a real culture shock, uh, when we, when that's introduced, what was it

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like at your organization? You mentioned you had a relatively small team, I think before, you know,

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engaging with pivotal and making this transformation. Um, so I imagine you had two, two challenges, one

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to introduce some of these new best practices and new ways of working at the same time, grow the team.

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Yeah. You know, I would say that again, we, you know, as Brandon mentioned, we were very diligent

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about selecting a partner that, that we thought was going to, um, put us in a position to, to succeed

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and, and looking at the different styles in which people promote development. Um, you know, I think

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when it came to make the choice of partnering with pivotal and really that kind of first step, uh,

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quite honestly, um, you know, I think one of the beauties of being a, um, at the time, you know,

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somewhat of a startup company is you've got a lot of really entrepreneurial minded, uh, hungry people.

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Uh, so we just dove in head first, you know, the, the team was completely on board. Um, you know,

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we've got a, we've got a great product team, uh, that's willing to, to, to, you know, work as,

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as hard as possible to make this product, um, come to, come to fruition in a reality. Um,

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Yeah. And I think one of the things that was great as we were basically taking a, an idea and a proof

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of concept and building up a team and ultimately a business line around it was we were able to adopt a lot

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of those agile software development practices into our development culture from day one and then

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continue to build a team along those lines. So we really have that, that kernel of the culture

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that we were able to build a team around rather than a lot of bigger companies sort of face the

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challenge of having an existing culture that they have to then, you know, layer over some of the agile

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software development practices that may be foreign to many of their team members.

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Yeah. Yeah. That can definitely be a benefit. Um, and, and, and related to that on the business side,

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uh, a challenge can be, uh, when you think about budgeting for new products and things,

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the old way is very much, Oh, give me a, give me this, you know, this large document with all

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the requirements and we'll figure out exactly how much it's going to cost. And we'll budget that

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over a two year period. And, you know, in two years, maybe we will, maybe we won't have the solution,

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but it's, it's kind of the known model, whereas with developing in an iterative way,

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it's a little bit more challenging because you don't necessarily know what to tell your business

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stakeholders, what you're going to have at the end. We know we're, we're iterating based on what our

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customers want and that's going to take the shape that it takes. And so that can introduce some

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challenges in both getting business buy-in, but also in terms of how you budget and things like

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that. Were there any challenges on, I guess, the business side of adopting this new way?

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Uh, yeah, certainly. You know, I, I think you really kind of hit the nail on the head there,

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right? I think that, you know, it's always a challenge and it, you know, any, any software

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development, you know, is a challenge. And certainly with kind of the iterative, um, you know,

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constant deployment, uh, approach that, that we've learned, um, you know, the best practice from,

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uh, with, with Pivotal, uh, to your point, it does make, uh, setting deadlines and, um, you know,

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forecasting budgets and things like that, uh, a little bit trickier. Uh, you know, I think that

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that's, you know, it's really important at that point, you know, and I think we did a good job in,

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in the initial phases of really fostering that, that excitement with, with our stakeholders so that

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they understood, you know, really kind of the journey that we were going on. Um, and so, you know,

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it's been really, really important to make sure that, um, you know, we, we keep the team, um, you know,

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the, the, the rest of the stakeholders really kind of involved in, in how we're developing,

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what we're developing, uh, you know, when we have to pivot for a certain reason, no pun intended.

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Um, so, you know, I, I think that was really something that allowed us, um, or it has allowed

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us to kind of continue and use these best practices, um, of, of agile development that, that we've learned

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at, uh, at Pivotal. Absolutely. And I, I think the other, uh, element I'd like to emphasize is that

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the user centered design approach, which very much resonates with our executive team here,

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as well as our specialty care teams at hospitals across the country, you know, we're really putting

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that, uh, specialty care team user front and center and thinking about, you know, how is our software

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making their life easier? How are we making the interaction between that care team and the patient

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easier? And then working backwards such that we're able to build sort of simple purpose-built

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software that solves those, uh, key sort of patient engagement problems.

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Yeah. I'm sure that could be pretty refreshing for, you know, folks, uh, you know, we've gotten used

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to in our consumer apps that the folks building consumer apps are really tuned in to trying to make this

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something that you're going to want to click. You're going to want to buy, but in so much enterprise

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software, it's like the user can be such an afterthought and it's like, no, the user will

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adapt to the software we have built and not the other way around. Um, so I, I, that makes a lot of

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sense that, you know, being able to bring in those specialty pharma care folks so that they get to be

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part of the process, you know, can just have tremendous, both, you know, impact on building

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better software that that's actually solving their challenges, but also, you know, their psychological

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buy-in to using the software since you're, you're, you're, what you've described as transitioning from

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healthcare services company to something that's very technology powered and enabled with the software

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that's now going to be out there in front of, um, probably your team as well as your customers'

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teams. So you're, you're helping kind of foster that, that transition and making that transition

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easier just by bringing them into the process. Am I, am I totally in left field here or?

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Yeah, no, that, that's exactly right. And it's really about, uh, you know, taking what their goals

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are, you know, and aligning them with some of the, the business priorities and health systems priorities

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around giving patients a higher level of care and a higher quality of care and doing that in an

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efficient manner such that, you know, it's not costing the, the health systems a prohibitive amount

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to care for the, the thousands or tens of thousands of patients that, that they have to. And really

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taking that user-centered design approach, uh, enables those frictionless health experiences

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for the patient because you have a, a specialty care team that is, you know, not worried about

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administrative burdens of really complex EMRs or other software. You have something that's sort of

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simple and pleasant to use. So you're, you're reducing the burnout of the care team and they're

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able to focus on those patient interactions. When you talk about this frictionless, um, care

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experience, you know, what can you tell us about what it's meant? Um, uh, what kind of results and,

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and the outcome, like, can you quantify that? How can you demonstrate that it's actually a more

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frictionless experience? Yeah, absolutely. So when we think about the metrics, you know,

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our objectives are fundamentally, you know, improving the care that patients receive and

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improving the enrollment and expanding access of patients to our higher degree of a specialty pharmacy

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care. So when we look at the, the care component, you know, we really focus on our medication adherence

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metrics or PDC proportion of days covered. So that is our patients actually taking their medications

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and following the regimens that doctors are prescribing to them. Um, and when we look across our network,

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we do see about a 92% average, uh, medication adherence rate, which is phenomenal compared to the industry

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averages around 65% or, or even as low as 50% in many estimates. Uh, on the enrollment piece,

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we really look at how many patients are the, the doctors seeing and writing specialty prescriptions

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to, and what percentage of, of those patients are actually choosing to fill with the, the hospital

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specialty pharmacy and receive that higher level of care, really get access to those, uh, best in

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class care services. And across a lot of our health system network, you see, you know, over 60% of

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patients are actually choosing to fill with the hospital specialty pharmacy. Whereas, you know, when we, uh,

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we start with a new client, often that number is, you know, sort of below 3% even.

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Okay. So that's a big jump. Okay. So yeah. And that's, thank you for walking through those two

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sort of high level metrics to look at, um, you know, for, for those of us kind of outside the,

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the industry. Um, I want to also ask, I don't know if it's the S word or the H word. Um,

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so security, but then your case, since it's, you're talking about healthcare software,

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HIPAA and HIPAA compliance is kind of, um, you know, uh, another, another important

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piece of the overall architecture. So can you talk a little bit about how you're able to achieve,

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um, meeting those kinds of security and compliance challenges with building and I write to describe

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it as almost like a SAS based software that's getting delivered to, um, the specialty pharma

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departments? Absolutely. So, uh, you know, when you're delivering a software as a service, you know,

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sort of via cloud environments at massive scale, you know, making sure you're adhering to the,

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the highest standards in security and HIPAA compliance is really essential. And when we think

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of HIPAA compliance, there's really two elements of it. You know, there's the security piece,

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which I think a lot of people are focused on, particularly in light of the well-publicized data

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breaches. So really making sure the data is secure and malicious actors don't have access to that data.

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And that's one key element that we really focus on, uh, through encrypting our data, both in rest,

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as well as in transit, um, and, uh, a number of other sort of third party systems that we use

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in order to make sure our data is secure. But the important aspect of HIPAA requirements also mandate

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that you control the, the access to the data and then that it's being used only by the people who

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really need to use it. So making sure we have, uh, user-based or role-based user access controls,

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uh, multi-factor authentication to make sure that if someone is logging into our, uh, software, we know who

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that is and we're actually controlling what information they can see. It's not just carte

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blanche to look at all the healthcare data within our software. And does HIPAA require you to also report

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against that, uh, information? Absolutely. So, uh, logging and auditing are essential when you're,

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when you're talking about HIPAA compliance. So we've built in on the back end through one of our partners,

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Sumo Logic, uh, a lot of automated logging, uh, and error reporting to our platform team.

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So they can look at, uh, what are the, the security concerns that we may need to look into. And again,

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that, uh, culture of continuous improvement of our security, such that, uh, you know, we're keeping

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up with all the potential, um, intrusions, uh, that are out there, uh, across the globe.

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So stepping back, are you able to comment on how PCF, uh, as sort of the platform on which you're

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running TelemetryRx has been able to help, um, meet the security piece and the data access piece

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and the logging piece? Absolutely. So one of the reasons we chose Pivotal Cloud Foundry, um, as our

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platform is that it has a lot of these really easy to use and easy to develop on top of hooks into some

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of the, the best in class third-party services like a Sumo Logic, as I mentioned, or like Okta for

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multi-factor authentication. So it's really easy for our software development team to build in a lot of

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these security and privacy best practices. I think the, the other element that's really important is the,

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the automated, uh, views of the cloud infrastructure so that we can understand what is, uh, what users

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are looking at across our system in a very efficient level. We can make sure we have reliability built

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in, uh, and we make sure that we have the auditing set up and audit logs are, are being stored at,

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in the appropriate places, uh, within our, our broader database platform.

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So, and I'll just add to it, uh, in a very less technical, uh, manner than, than Brandon did. You

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know, I almost kind of think as of security, kind of the same way that I think about our business,

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right? Which is the patient is always first. So, you know, really when you think about security,

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the biggest issue with security is making sure that your patient's information isn't exposed to the public. Uh,

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so again, just a, a small little parallel that, that I always think in my mind. And again, when we talk to

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the platform team and we, the app team, and we talk about security, you know, it's, I think giving that

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little extra, uh, context really kind of helps them understand, you know, why it is so important, uh,

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to be compliant, um, to be secure, uh, and to make sure that people aren't accessing this data that

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that shouldn't be. I was going to try and get more technical right there, but you know, you just,

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you just took it in a different direction. Um, but yeah, no, yeah, no, I think it's important to also be

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able to, you know, from a, uh, communication standpoint, when you're trying to explain to the

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teams, you getting them to care, like that's absolutely the best practice that, you know,

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I'm, um, I, I've heard, for example, like Molly Crowther and our team, as she's working through,

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um, raising everyone's security awareness is actually just sitting down and spending the time

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getting people to, on a human level, wrap their head around why it's important and why they should care.

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And then from there, they're far more likely to take the steps that they need. Um, especially if

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you make, you know, doing the secure thing, the easy thing, um, then, then you get a lot more sort

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of developer compliance with, uh, just security best practices. I think the last thing I was going to

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ask about was going to be around data and analytics and the role that plays in both the actual product

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itself, uh, in terms of delivering insights to the users of the product, as well as how you think about

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using data when you're continuing to develop the product. And we touched on this before,

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but you know, you want to focus on the user. And so you must be getting a lot of user data. Here's

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how they're using the platform. Here's our, they're using our solution, which informs how you then

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develop future features or capabilities. So I wonder if you could just talk a little bit about the role

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of data, uh, as you see it, uh, in your product and your, your whole approach to the software.

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Yeah. You know, I think data at the end of the day is really the lifeblood of, of, you know, the software

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as well as, you know, our organization. Um, as we talked about before, you know, there's, there's so many

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additional complexities to specialty pharmacy, um, that we haven't even talked about, you know, getting

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accreditations, um, getting access to different payers, getting access to different limited distribution

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drugs. You know, these all require really, really significant, um, uh, data, um, capabilities.

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And so to be able to put our hospital partners in a position to be able to care for as many patients

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as they can, uh, it's, it's really important for us to be able to, um, uh, collect that data through

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our software, um, as well as, you know, some of our other capabilities to be able to meet those

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requirements. And then again, you know, as, as you think about the complexities of, of healthcare,

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and when you think about, you know, data interoperability and things of that nature,

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you know, to be able to, you know, really put together an analytics package that, you know,

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we are able to work with, you know, countless, you know, electronic medical record or medical record,

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uh, solutions, uh, pharmacy management systems, et cetera, and really be able to have that in a nice,

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clean, um, data warehouse and be able to pull insights, you know, whether it's about improving

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care, uh, about improving the operational performance of the program, you know, those are

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things, or as I mentioned, just making sure that you can stay in these payer networks, uh,

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you can stay in these drug networks, et cetera, is really core to what we do.

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I have one more question. You mentioned working with labs, pivotal labs. And so I was hoping you could

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sort of expand a little bit on what your experience was like, uh, working with labs.

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We talked a little bit about in terms of the teams being able to rapidly adopt, um, and kind

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of grow the, the sort of agile practices, but just otherwise kind of, what was that experience like?

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What were some of the, the big kind of turning points and learnings out of that?

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So the, the thing we loved about working with pivotal labs is you really immerse yourself in this

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sort of ideal utopia of developing software. And not only are you sort of in this great physical

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environment, but you have a lot of creative, as well as problem solving, uh, individuals around you

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that are focused on solving problems across multiple different industries. And there's this great

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sharing of, of knowledge, uh, that you're able to benefit from as you're going through solving your

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own software development problems. So really leveraging a lot of those, um, you know, past experiences and

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other perspectives of people across the pivotal labs team was essential for us, uh, as we developed this

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software. Um, and then it's very easy to transplant that environment back to, to our headquarters as we've

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transitioned our software development efforts, uh, back, uh, into Shields Health Solutions, uh, and can

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continue that pace of, uh, of new software development.

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So that's interesting. So you're kind of describing like the outside perspective and folks who've worked on

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problems in different industries was really useful. You know, this is, it kind of goes against the grain of

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what you see a lot of folks gravitate towards, which is like, oh no, I need someone who, who knows my

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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.

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Absolutely. And really a lot of the, the functional round tables that we would have

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while at pivotal labs, whether it was around, uh, product or design or development allowed you to boil

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down the problems you are facing to first principles and share and understand those common, uh, sort of

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first principles, uh, across different projects, and then build those back up based on the, the context

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of the specific software you are developing. So not only were you benefiting from the specific

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pivots you are working with, you actually benefit from the, the broader knowledge base that all these

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other companies that may be at different points along their development path, uh, are learning.

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So it really has that, um, not just sort of functional, but also, uh, industry specific

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or vertical specific, uh, learning experience.

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And I, you know, I just like to add to that, I think as well, transforming from a, again,

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a services company to a technology company presents all kinds of challenges, right?

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But when you, when you've been in the business for six years, um, and you've been very successful,

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and you've got countless, uh, hospital partners that you're supporting, you know, we have a lot of

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those expertise around healthcare, you know, and we really, we truly believe that we have the best

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model out there. Um, so, you know, when it comes to making sure that, you know, the business needs

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are met, um, and, you know, that we're staying true to the beliefs, uh, in, in the core, uh,

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principles of providing the, the level of care that, that we, um, that we do, uh,

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we have all of those people at our disposal that have been doing this, uh, you know, for

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at least six years, if not longer. So it was really nice to be able to pull from those people.

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Um, and then as Brandon mentioned, you know, it's, it's a lot easier to take somebody who's

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never worked in healthcare and use kind of some of their, um, input and, and their guidance,

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because at the end of the day, you know, I think that again, it wasn't just a green field for us.

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We, we, we truly knew, uh, what we were setting out, uh, to build, obviously, um,

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knowing that there was going to be lots of iterations and pivots along the way, but,

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you know, the overall vision and goal.

371
00:36:33,340 --> 00:36:41,020
Okay. Um, so I had one more question about, you know, you mentioned something that worked

372
00:36:41,020 --> 00:36:47,260
really well early on was, you know, having a lot of the different stakeholders really excited about

373
00:36:47,260 --> 00:36:52,620
what this represented, also having something that was already in place that, that had shown some

374
00:36:52,620 --> 00:36:57,180
good results. Um, so some, the, the internal software that you'd built, so folks kind of

375
00:36:57,820 --> 00:37:01,420
knew what that was and, and you could build upon that success.

376
00:37:02,460 --> 00:37:08,220
What's getting those folks, what's keeping those folks excited now? Um, as you're, I don't,

377
00:37:08,220 --> 00:37:13,260
and I actually haven't captured like what the timeframe has been since going back to when you

378
00:37:13,260 --> 00:37:21,020
started the journey with labs, however many months or years that were past that, what's keeping those

379
00:37:21,020 --> 00:37:21,980
folks excited now?

380
00:37:22,780 --> 00:37:27,180
Yeah. So again, you know, going back to what I had mentioned previously about already being

381
00:37:27,180 --> 00:37:33,900
in the business, you know, we were able to get this software, um, into, you know, our team's hands,

382
00:37:35,020 --> 00:37:40,060
um, in a very quick manner. We, we didn't have to go through, you know, long sales cycles and,

383
00:37:40,060 --> 00:37:44,940
you know, fundraising and things like that. So we were able to really just kind of focus on

384
00:37:44,940 --> 00:37:50,940
the technology. Uh, and again, kind of using that, the best practices that, that we, uh, have kind

385
00:37:50,940 --> 00:37:55,900
of embodied from, from pivotal, you know, it's, it's really kind of constantly showing those

386
00:37:55,900 --> 00:38:00,780
stakeholders, the improvements that we're making every week, every few weeks, um, you know, again,

387
00:38:00,780 --> 00:38:06,140
having them, uh, you know, allowing them to see the actual software in our users' hands,

388
00:38:06,140 --> 00:38:11,660
getting the feedback, um, you know, from our users, which again, is probably the largest percentage of,

389
00:38:12,380 --> 00:38:18,620
um, our employee population. So really being able to give them tools, uh, to make their lives easier,

390
00:38:18,620 --> 00:38:24,620
that again, as I always talked about with, with the patient part, you know, being the, the crux of,

391
00:38:24,620 --> 00:38:30,540
of what we do, you know, again, to freeze them up to, to provide better, better patient care. So again,

392
00:38:30,540 --> 00:38:35,820
it's, it's, it's really, um, uh, it's, it's been a good journey with, with our stakeholders. I think

393
00:38:35,820 --> 00:38:40,940
they're, they're very excited about, about what we're building. Um, and you know, again, it's just,

394
00:38:40,940 --> 00:38:46,540
it's keeping that relationship, um, showing them what we're doing, um, you know, and always kind of

395
00:38:46,540 --> 00:38:51,820
brainstorming fun things to, uh, to dig into next. Absolutely. And it's really about that vision,

396
00:38:51,820 --> 00:38:59,020
I think that keeps everyone excited and engaged. And even what was very instrumental in galvanizing

397
00:38:59,020 --> 00:39:04,940
them initially towards undertaking this, uh, big development project, uh, is this vision of building

398
00:39:04,940 --> 00:39:11,180
a full end-to-end specialty care solution, uh, and then really driving a meaningful effect

399
00:39:11,180 --> 00:39:15,020
on those patient lives across all of our health system partners.

400
00:39:15,660 --> 00:39:21,740
And the, what was it? 92% adherence rate to taking medications is, is a pretty good indicator of

401
00:39:21,740 --> 00:39:22,860
that. Absolutely.

402
00:39:22,860 --> 00:39:28,300
Well, thank you so much. This has been, um, really interesting and, and informative learning

403
00:39:28,300 --> 00:39:35,100
a lot about kind of the specialty pharma world, but also kind of just how, how Shields has been

404
00:39:35,100 --> 00:39:43,260
able to, to build software to really move the needle on both, um, patient goals and, and kind of deliver

405
00:39:43,260 --> 00:39:48,620
results back to the, to the specialty pharma departments in, inside hospitals that, that you work

406
00:39:48,620 --> 00:39:51,260
with. So thank you so much for all the time.

407
00:39:51,260 --> 00:39:54,940
Thank you very much.