Eren Bali, Co-founder and CEO, Carbon Health
Dr. Marlow Hernandez, Chief Executive Officer, Cano Health
Dr. Alex Oshmyansky, Founder and CEO, Mark Cuban Cost Plus Drug Company
Moderator: Beth Kowitt, FORTUNE


Brainstorm Health 2022 - Accelerating Health Equity By Challenging The Status Quo 

Conferences

Eren Bali, Carbon Health
Dr. Marlow Hernandez, Cano Health
Dr. Alex Oshmyansky, Mark Cuban Cost Plus Drug Company



Accelerating Health Equity By Challenging The Status Quo 


Eren Bali, Co-founder and CEO, Carbon Health
Dr. Marlow Hernandez, Chief Executive Officer, Cano Health
Dr. Alex Oshmyansky, Founder and CEO, Mark Cuban Cost Plus Drug Company



Brainstorm Health 2022 - Accelerating Health Equity By Challenging The Status Quo 


Okay. So you know, I think Alex we have to start with you with the obvious question here, which is the name of your company, the Mark Cuban cost plus drug company. That is extremely literal. So tell us a little bit about the background of that. Oh that is that literally comes direct from Mark. Uh It's like what should we call it? And he was like, let's call it the Mark Cuban cost plus drug company. Uh I think I think the way he puts it is he likes inch long names that really like just get to the point immediately. So you you called pitched him. What was the pitch? Oh essentially I would like to decrease the cost of medications for everyone in the company or everyone in the country by uh getting around the pathologic intermediaries and the pharmaceutical supply chain. Uh We have drugs that Oh of course I apologize. Yeah, he's like you got the name wrong. No, but there are drugs we have in our formula. We gotta thank you know from a patient yesterday who's being asked to pay uh $2000 in co payment for chemotherapy drug. Uh And through us this exact same drug is $50. Yeah. Yeah. And uh believe it or not the pharmaceutical manufacturer we believe makes more going through our supply channels than they do through the conventional ones. So someone's getting that $1950 and it's not the manufacturer. So it's really breaking down those pathologies in the supply chain. So how do you do that essentially. There are these entities called pharmacy benefit managers. Um, they're meant getting chuckles from the crowd that's a good sign uh, they're meant to negotiate drug prices on behalf of americans, but just sort of the way they do, it winds up creating de facto bribes in the form of rebates. Basically, if you give us money we will place you on an insurance company formulary and what winds up happening when we talk to the big pharma companies, they're like, yeah, we pay more in these rebate dollars, de facto bribes to get an insurance company formularies than we do actually on research and development. So the extent of the problem is enormous and hopefully we'll be able to break through it as we bring on more and more pharma partners over the course of the coming years. So it Aaron before starting carbon health, you founded in education startup. Okay, so how did you get from there to here? Yeah, there was a commonality. So I started coming to me with the intent to make online learning more accessible because of the means for people to change their lives. Um, and while I was doing that, I um, I eventually just moved out to another ceo like five years ago and now the company's public, but I just started event from how do you make education more accessible to Hollywood to make health care more accessible. And one of the things that really bothered me was that there were all these startups trying to make health care better but it felt like all ultimately trying to sell to google and please and there wasn't really any company kind of trying to drastically improve health care for just the average teacher, average retail employee at home depot. So that kind of mass market population felt fairly understood from the technology angle. And I as an engineer, I believe that mess markets healthcare is the part where you need to technology the mosque like we don't have a second to waste for them to provide this time because you're not able to charge a premium rate decisions are not very wealthy nor very sick. So nobody's paying a premium for their health care. So you just have to be, it actually felt a lot more like a technology company than the others areas and it felt fairly underserved. So how have you been, have you been able to do that? So we started, the main thing we do different is like extreme vertical integration. So we started started 16, opened a small clinic and we build all the software from the ground up or the HR patient application. Everything actually made this forbidden. So for our teams to even look at other HR I just like nobody's gonna just see how that they work. Start from first principles removed everything that that Bass Pro at this time. So by the time you're talking to a provider, All the information is already in the system. A lot of the intake is already done prioritized 60% of the time. You have entire care plan pre created with our algorithms and really the provider is able to kind of spend most of your time with just your patient education. So it's really just obsessive focus on every single thing that goes secure delivery costs and just trimming them out marlo what access and equity barrier is your company really trying to fix here? Yeah. And that is the big question because health care is broken and that word is perhaps overused. There are structural problems within the system per se. There are our problems with the payment mechanisms, there are problems that arise from it. There's lack of accountability and I started kind of health back in 2009 because I believe there was a huge unmet need because I made a promise to my grandmother to heal her and that health care should be a right and not a privilege and that physicians providers should be aligned with the clinical outcomes of our patients as simple as that. And when you look at it in terms of treating patients like family, you make healthcare more connected, more relational, more proactive and so how do we fix the access and the inequities of the system which in my view as an immigrant are a major impediment to the american dream. Well you you do it by making it easier for patients to to reach you by making it more cost effective by giving tools to connect at home by designing programs that treat disease for the individuals because there's no such thing as a diabetic, there's just a patient with diabetes and when you understand that, but then you use big data to formulate improved protocols for that individual, then that's where the magic happens. And then you also address the social determinants of health through wellness offerings. Um You need the classes, you you need the sense of community, you need to get people moving and teach them about nutrition and about their health care options. So, when you have all of them, within a model of care that is aligned with the patient's health and what kind of health over 90% of our revenues are global accounting. So we don't make up any more by doing that extra procedure, seeing that extra patients were incentivized to keep them healthy. And through that we've been able to achieve lower mortality rates, lower hospitalization rates, lower er rates. So, uh Aaron and I are doing a lot of the same things, you know, different populations tackling it from different vantage points, but ultimately, solving for that same thing, which is making healthcare work for all communities. Um I'm gonna go to questions in a second, but first I just want to follow up on that. I mean, you focus on the senior community. Right, so your I believe your patient outcomes were better during covid than the broader population. How how did you manage to do that? Well, yeah, our covid specific mortality rate, peer reviewed study, 60% lower among older, sicker poor patients, mostly african americans and Latinos. Thank you for that. Uh The way that we were able to do that is because we used our pop health platform that takes in data much of it in real time to formulate specific plans for those are the highest risk, which then we refer to what we established covid protocols and task force. Then we did home, we got to them earlier were hospitalized them earlier. And appropriately we make sure that they had their their park sells their oxygen. There were so many things to talk about as to how we accomplished that, but we didn't have any magic drug available. All we did is to make sure that we have their hypertension control and their diabetes and if they had a a complication and and a material infection that we were able to get it in time to chf there's COPD it's the less sexy stuff but you know, talking about drugs and we were talking backstage, you know, Alex and I and actually last week we spoke, I'm a big fan of what he's doing. Um a big fan of Aaron as well. Um and this is so necessary for for our country because patients. Uh it's it's not only the met adherence and the healthy literacy and the lack of access points to primary care, they literally can't afford and they have to pick between food uh and their drugs or their families, you know, livelihood. And that's not OK, so I'm so glad that we get this opportunity to share and how healthcare is accelerating in the positive direction, but we still have much work to do. Do we have any questions from our audience here? We have a question right up here in the front. I love the Mark Cuban cost to us. The whole concept, the way it came about, fascinating, um, what's the competitive edge and what what does it stop few other entrepreneurs to compete with you? So that there is a positive momentum in dramatically lowering the price to common drugs, the common top 100 drugs that that you guys are focusing on and what's the secret sauce? If you are happy to share some of it, Mark Cuban, it's all Mark Cuban, I'm just a pretty face, but uh, but yeah, in terms of competitors, I would love to have competition. That's our goal to transform the system. So the more people can get into providing low cost drugs the better. From our perspective, that that's a win, Not a negative, but that being said, some of the major entrenched actors in the system already heard that they've reached out to our suppliers and, you know, they're not supposed to do this and it's not on paper, but have effectively threatened them said stop doing business with Mark Cuban. Uh, God bless our suppliers. They've stuck by us. But yeah, it's gonna be hard. Uh, and the way, you know, we've gone about it, uh, you know, the pork of point of Mark's name on the company. Um, you know, he has an incredible per personal brand and it was incredible that he would, would risk it on this project. So I'm grateful to him, not just for his financial support, but for all the equity he's put into his brand to leverage that to allow us to have discussions with pharmaceutical companies and say, hey, this is for real. Like we're putting a lot of, we're staking a lot on this and I think that gets us in the front door to say, hey, let's let's work something out that benefits you that benefits patients and gets around these structural problems. Any other questions from the audience here? Hey erin, we're in L. A. So I need to ask you about this. You played a really critical role in the vaccine rollout here. How did you get involved with that? How did that happen? Walk us through that. So that's probably the craziest time of my life. So that the background stories, vaccines are being distributed and like everybody assumes CVS and Walgreens will do almost all the vaccinations. But I made the match from the first principles, like it takes Two minutes to vaccinate somebody about 15, 30 minutes to monitor them. I said like the Bottleneck is going to be physical space, there's no way small pharmacists primary offices can actually take a lot of low because monitoring is just going to space is gonna break the system. So I made a sketch about how I would do it if it was up to me just make a couple of wire frames. I said this has to be mass vaccination sites cannot be small offices. So and then at that time LS vaccine program was really kind of behind and not going very well. The state system was crashing so the mayor's office kind of called us just getting like suggestions. I said here's what I think what we should do. And they said how fast can you do this? I said 36 hours. So we launched the scheduling size 36 hours after that where I think we have 25,000 people booga employment in like the first couple of minutes so far. And then nine days later we launched the dodger stadium with the L. A. Firefighters corps like this like a public private partnership wasn't just carbon, but we were the technology back and and I'm supposed to get all all in efforts. I mean everything from like apple executives just like drove around apple stores collect all diapers they could collect, there is the nightingale was kind of like Access to this is like a huge effort to do it together. But when we were like here for 20 days it's all of our team, how are you able to do it that fast? It's actually the main thing is like we own 100% of technology platform, like we own all the operations, we all know the workflows, we own all the like little network infrastructure configurations so essentially we don't need to wait for anybody else that we want to do this and that's what, what changed things. Great, okay, so Marlowe, I'm gonna give you the last word here. We have only a couple of seconds left. What in your view is the greatest barrier that you see in terms of equity in healthcare? Well before I answer that question, let me just put it back on iron which is, it was kind of a crazy vaccine rollout, you know, wasn't it? And it seemed logical. Okay hospitals and the pharmacies, but where do you get your vaccine? It isn't until you actually partner with the primary care providers. Right. I mean that's where you vaccinate your kids and you get your flu shot etcetera. And you know, if when it comes to vaccine delivery, um if there were pizza we're pizza hut and it seemed like they were giving it to KFC and it just made absolutely no sense whatsoever until we actually got a call the same thing happened in florida for us and we vaccinated, you know tens and tens of thousands of patients but single barrier um five seconds. Yeah. The payment system. It's got to move from from volume and what we do to patients of what we do for the patients. It's about outcomes, it's not about the the the volume and the actual services themselves. And then doing so would ensure that it's equitable across the population, not just over indexing to those who can pay for it. Great. Thank you all. Thank you for what you do towards fighting for equity in health care. And thanks for the conversation.