The ShiftShapers Podcast

Ep #484 Medication Intelligence via AI with Yoona Kim of Arine

• David Saltzman • Episode 484

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This episode of the ShiftShapers podcast features an interview with Yoona Kim, the CEO and co-founder of Arine, a company focusing on medication intelligence via AI to improve clinical and financial outcomes in healthcare. In this episode, Kim shares insights from a healthcare background into the challenges surrounding drug prescriptions including accessibility, cost, and the impact of incorrect or suboptimal medication on patient outcomes. Arine leverages large-scale data analysis to provide actionable recommendations, aiming to correct discrepancies in medication use, particularly in polypharmacy (multiple medication) cases. The technology not only promises to significantly reduce hospitalizations and overall healthcare costs within a short period, but also enhances patient adherence to prescribed medication regimes. Kim elaborates on the collaborative process with healthcare providers and insurers to implement these changes effectively, highlighting the potential for widespread improvement in healthcare management and outcomes.


Speaker 1:

How can AI help ensure that patients have the right drug, the right dosage, to move the needle, both on the clinical and the financial outcomes? We'll find out on this episode of Shift Shapers.

Speaker 2:

Change either energizes or paralyzes. The choice is yours. This is the Shift Shapers podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry shifts. And now here's your host, david Saltzman.

Speaker 1:

And to help us answer that question, we've invited Yuna Kim, who is the co-founder and CEO at Areen. Yuna, welcome to the program.

Speaker 3:

Thank you for having me.

Speaker 1:

It's my pleasure, so talk a little bit about your background. We're always fascinated to hear about how people got to be doing what they're doing.

Speaker 3:

So I grew up in and around healthcare. My mom was a public health nurse, so I would follow her to the LA County Public Health Clinics where she worked at, and I would always wonder as a kid why is care so difficult to access? As I saw the lines of people going out the door Fast forward. My first job out of college was as a benefits consultant, and there I was crunching the numbers and the rates and then I asked myself not only is it difficult to access, but why is it so expensive and seemingly unsustainable, especially when it came to the prescription cost trends? And in fact as a nation we spend $530 billion on prescription drugs annually and at least that much on the problems they cause.

Speaker 1:

That's amazing that you know. We've talked to some folks who are starting to do widespread pharmacogenetic testing to try to get around that, et cetera. Beyond that, I mean, there's not only the problem in the spend and the overspend and the unnecessary spend, but we have problems with outcomes because of prescriptions, don't we? Can you talk a little bit about what causes those?

Speaker 3:

Yeah, great question. So their prescription drugs are very powerful. Medications can cure or they can lead to fatalities as well, and patients being on the wrong drugs is, in fact, the third leading cause of death, next to cardiovascular disease and cancer. And there are many different problems that can happen with prescription drugs, such as it's the wrong drug, it's the wrong dose. There could be interactions, perhaps someone isn't properly treated on medications when they should be. A perfect example of something that we commonly see and we shouldn't see, it is the combination of someone taking Entresto and an ACE inhibitor. This is, in fact, a dangerous combination, but oftentimes physicians don't realize that Entresto also has an ACE inhibitor component and when you combine the two of them together, that can cause dangerous consequences such as hyperkalemia, which can cause arrhythmias, consequences such as hyperkalemia which can cause arrhythmias, acute kidney disease and many detrimental things can happen as a result of that. It could also be a problem causing from One doctor doesn't see what another doctor is prescribing.

Speaker 1:

Yeah, we keep talking about electronic medical records and I suspect we're going to be talking about it for a long time, whether we actually ever get there or not. Different conversation. So that's kind of some of the low-hanging fruit. What are the other things? When you take AI, let's dial back. Let's talk about how you apply AI to these data sets and what it is that the AI is both looking for and learning.

Speaker 3:

Sure. So we built a medication intelligence platform that can take in available data and typically we bring in the payer claims data, both on the medical side and the pharmacy side, as well as the eligibility data, and we turn it into actionable recommendations around in which patients would a small medication change lead to a big difference in outcomes and what should that right drug and dose be? So we are taking into account multidimensional data elements in each of our recommendations. Which medications have been tried and failed in the past? What are the demographics of that member? What are their other clinical, social, behavioral risk factors to pinpoint the right medications this member should be on.

Speaker 1:

Do you find more let's call them discrepancies rather than errors. Do you find more discrepancies with certain diseases than with others?

Speaker 3:

I would say, rather than by disease area. It's really. We do see an increase in discrepancies. When there's a large number of medications and 50% of Americans are on multiple medications and when you look across, oftentimes different doctors are prescribing each of these medications. They don't have visibility into what another doctor is prescribing each of these medications. They don't have visibility into what another doctor is prescribing. Or, again, these medications must be prescribed in the context of that full picture of that member, of that individual, and oftentimes that full picture is missing.

Speaker 1:

Are the problems more acute in certain populations than others?

Speaker 3:

in certain populations than others. I would say that they are more acute in the polychronic members where there's multiple medical conditions to consider alongside the medications. I often say that the human brain cannot get this right every single time because it takes multiple data elements to consider from the medication history, the medical history, the age, the personal circumstances of that individual to actually put all these data elements together and get it right each and every time.

Speaker 1:

So there's the clinical part of this and the patient satisfaction part, but there's also the financial part of it. What kind of delta can this technology make for an employer or a plan?

Speaker 3:

There is a huge difference that we can make in terms of cost savings. This, in fact, is a larger source of waste in our healthcare system. One in every six healthcare dollars is spent on, again, the patients being on the wrong medications and the complications that this causes. So if we think about that, what we've shown by getting the medications right and I often say that it's also much easier to change a medication than it is to wait for a patient to change their behavior and these lifestyle and diet changes to kick in, oftentimes switching out a medication A to a medication B which is a better option you can see that immediate speed to outcome. So what we've shown in our own data is that we're able to reduce hospitalizations by 40%, cost of care by 10 to 15%, and we can show this statistically significant savings within six months. So again, there's that immediate speed to outcomes.

Speaker 1:

How do you interface with the provider community?

Speaker 3:

Great question. So we have a. Usually the users of our platform are like the nurses and the pharmacists. There can be the clinical care team of the carriers or the PBMs even. We also can supplement with our own clinical teams when a customer needs our clinical help as well. Clinical help as well, and essentially these are the users of our platform. These nurses and pharmacists, or medical assistants and health coaches, and our platform will guide exactly who needs outreach. What should that medication change and intervention be? These clinicians, because our platform is doing the work, is freed up to spend time on the actual member, counseling of how exactly they should be taking their medications. And if and when there is a prescribing change that is necessary, our platform will generate a prescriber-facing recommendation that could be sent directly from our platform to the prescribers.

Speaker 1:

If there are, as you alluded to earlier, if there are multiple prescribing physicians, how do you, or do you, coordinate all of those folks?

Speaker 3:

We do so. We can see from that claims data set, which is an extremely powerful data set, who is prescribing which medications. Where is that member going for their PCP appointments, for their cardiovascular appointments, going for their PCP appointments, for their cardiovascular appointments? And from there we can assign these recommendations to be sent to these specific prescribers, the correct prescribers, and we do coordinate between the different specialists that member is seeing.

Speaker 1:

So if I'm Dr A and you're Dr B, we both get a notice saying, hey, we're recommending a change.

Speaker 3:

We are sending it. We are sending mostly all of the recommendations over to the member's primary care provider and when there are specific recommendations pertaining to a specific condition, like their cardiovascular condition, we are sending that over to their cardiologist. But we are also including a list of all the medications that individual has taken and indicating who the prescribers are, so that provider is also aware.

Speaker 1:

Well, with all of us baby boomers floating around who are both multi-chronic and multi-pharmac, that's probably a very smart thing to do. One of the things that I found intriguing that you mentioned to me in the pre-interview was that you can also cut emergency department visits. How does that work and what's the kind of deltas that you're seeing there?

Speaker 3:

Great question. So we can cut emergency department visits We've shown in our data by 25%, sometimes even more than that, and the way that we do that is we look at some of these conditions Like we've seen. A perfect example is individuals with COPD and asthma oftentimes are going in and out of the emergency department visit due to shortness of breath symptoms, and the core reason why is because they're simply not on the right inhaler therapy. This is extremely complex. There's lots of different choices and then there's lots of different combination inhalers. So by getting members on the right inhaler therapy, we can prevent these emergency department visits.

Speaker 1:

And now a word from our sponsor. This episode is sponsored by MZQ Consulting, a concierge compliance firm that excels at making the complex simple. Have you seen the news lately? Johnson Johnson is being sued because J&J's health plans failed to negotiate lower prices for prescription drugs. In the case of one drug, the plan paid $10,000 for a drug that regularly is available for under $80. Not only were the members of the benefits committee named personally, but their benefits advisor was also named in the suit.

Speaker 1:

And that, dear listeners, is why you need a top-flight compliance firm. Yes, MZQ handles all the usual compliance stuff, from ACA reporting and tracking to RAP documents, 5500s, mental health, NQTL and QTL analysis and a whole lot more, but the heat is being turned up on fiduciaries who don't act like it. In this environment, using an ERISA attorney-led compliance consulting firm is your best strategy, your clients too, and MZQ Consulting is where you should go For more information. Go to wwwmzqconsultingcom or email them today at engage at mzqconsultingcom. Now back to our conversation. For a long time, what we focused on in large measure with pharmaceuticals was compliance. Does this impact compliance and, if so, how? Or can you give us like a practical example?

Speaker 3:

Interesting question. Everybody focuses on compliance. In fact, I used to work at a medication adherence company and that is all that we focused on. I started ARENE because I believe that adherence is only part of the equation and we have to look further back. Is that the right drug to take on a regular basis in the first place? So that is the core that ARENE is solving for, and once we identify the right medications, then we do track the prescription claims history to make sure that that individual is taking those important chronic medications on a regular basis and as appropriate. So we do catch adherence gaps and we do resolve them, but first and foremost we ensure that they're the right medications to take in the first place.

Speaker 1:

Do you find, even anecdotally, that there's an increase in adherence once folks know that there's an entity that's intervened and helped them get on the right drug?

Speaker 3:

Absolutely. So. We find that once members get that assurance that this is indeed the best option for them, because oftentimes they don't understand their medications, they don't know why they're important and they have questions about is it this particular medication I should take or this other, option B so once they have that assurance, they do indeed stay adherent to their medications.

Speaker 1:

That's fascinating. Do you also work with some of the clinical management firms that are now being broadly used by advisors who are selling self-funded plans where they're able to find best in breed of all of their compliance things?

Speaker 3:

We do often work with other programs, other clinical management programs. For instance, in one of our planned customers we are finding that oftentimes we identify members and are identified for the medication optimization program that they would also be good candidates for their care management program and we have a flow in which we can navigate members from one program to another and vice versa. The care management program might find that this member's on 10 plus medications they also need medication management and send them to our program. So are you patient?

Speaker 1:

facing as well, or just physician or provider facing? So are you patient-facing as well or just physician or provider-facing?

Speaker 3:

We are both. We are both because, when it comes to medications, there's two components. Our platform will generate patient-facing care plan and education materials, as well as provider-facing materials so that the provider can make the needed prescription changes so that the provider can make the needed prescription changes.

Speaker 1:

So when you have a first encounter with a patient, do you use things like Prochaska and other protocols to assess how ready they are to actually make this change, or do you leave that for the primary care physicians.

Speaker 3:

When our platform identifies that this is a member that needs outreach, we are actually identifying specific medication-related issues that we see in the data. So we are recommending these changes and counseling the members. But, again, these are medication changes that should be made. So we're also notifying the prescribers that indeed, you know, making this change could be keep the patients healthier can be life-saving at times and if it is something that requires the member to do something, such as maybe the intervention is keeping members adherent to their medications, we do provide and we address barriers to care, to address and we have smart questions within our platform to ask for important patient-reported outcomes, such as what are those reasons for non-adherence? So we prompt the clinician to ask important questions to the member, get those member inputs, important behavioral inputs, and then we generate very personalized recommendations addressing their concerns.

Speaker 1:

So if I'm a benefits advisor as the vast majority of our audience is, and I want to have this conversation with a plan or an employer, how does that conversation go? Do you start with the clinical outcomes? Do you start with the financial outcomes, or what's that conversation like?

Speaker 3:

So if a client is interested in a ring, we can actually take in the claims data and show them what we see within that data. Where are the medication-related problems in their population? What does that mean in terms of the clinical and financial outcomes we see and what is the potential ROI if they were to implement a program like ARENES?

Speaker 1:

So if an advisor suggests ARENE to an employer or to a plan mom, they would work directly with you to help gain access to the claims data for a particular period of time and you would do an assessment and then you and the broker or the broker would bring that back to the client.

Speaker 3:

That's right.

Speaker 1:

That's right, that's interesting.

Speaker 3:

Yeah, yeah, and then we would work with the client on implementing a program that works within their member population, based on the specific data that we see and the opportunities we see in their population.

Speaker 1:

So is your business model a per employee per month type program.

Speaker 3:

It is a per member per month type of pricing model, month type of pricing model, and we are willing to also put these at risk based on those clinical and financial outcomes, because essentially we view ourselves as really an outcomes-focused company that is making substantial and significant improvements on both the clinical and the financial outcomes.

Speaker 1:

Can you give us an example of a company that you went into and started this program and where you ended up after, let's say, 12 months and where the plan ended up?

Speaker 3:

We can give an example. We have several, actually, examples of this. So a lot of our clients today are indeed the health plans and we are working across all different lines of business, from commercial to Medicaid and Medicare. And again, the way that we start with a client is oftentimes this opportunity assessment is what we call it where we pull in the data, we show the opportunities we can project out the ROI and then we design a program around the opportunities that we see.

Speaker 3:

We call this our high-risk, high-cost or Luminate solution and essentially then we deploy, we work within the workflows that are existing within that client. We can leverage their existing clinical programs and existing clinical staff, or we can also supplement with our clinicians and we get an ongoing claims data feed so that we can work on their member population dynamically as we see increasing risk. We can outreach if and when needed and have these interventions throughout the year to sustain the clinical and economic impact. So as a result of these programs, we've seen consistently across all of our clients, more than a $1,500 in annual per member savings for every member who's even received an AREN intervention May not have been implemented yet but again, that's the average savings we see. So if you multiply this across thousands of members, you can see how this can result in millions of dollars of savings.

Speaker 1:

Where do you see yourself and Irene in, let's say, three years and then maybe five years?

Speaker 3:

That's a great question. Actually, what we are focused on and the reason why I'm hesitating on the answer is because we want to see that these medication optimization programs are offered to every member on multiple medications. In fact, I think it's essential because they're again, medications are powerful. They can cure or they can kill and, as a result of that, we want to make sure that this program is accessible. And everyone's talking about the prescription drug cost trends, but it's not just focusing on prescription drug costs alone and playing like whack-a-mole game of prescription costs and coverage. What matters is the total cost and the outcomes, and that is what ARENE is focused on. We're using the medications as a lever, but again, the focus is on total cost and outcomes. So in three to five years, we want to continue to expand these programs and make them accessible to all members on multiple medications.

Speaker 1:

So you're back to the lessons that you learned from watching your mom.

Speaker 3:

That's right.

Speaker 1:

And it's a great place to end our conversation for today. Una Kim, CEO and co-founder at Arena. Thank you so much for sharing your expertise and we hope you'll come back and let us know how the program is progressing.

Speaker 3:

Thank you so much.

Speaker 2:

Shout out to the crew at Grand River Agency for their awesome post-production. This Shift Shapers podcast is copyrighted content and may not be reproduced in whole or in part without the express written permission of Shift Shapers Solutions LLC. Copyright 2024.