Success Leaves Clues: Ep 296 How Healthcare Innovation Improves Patient Access with John Leombruno, CEO at OkRx

Speaker A: Welcome to the Success Leaves Clues Podcast with Robin Bailey and Al MacDonald. Have you ever wondered what makes someone successful? What are they doing that's different? How do they achieve greatness? We believe that Success Leaves Clues. In this series, we are interviewing very successful people from different walks of life to hear their stories. We'd like to remember remind our listeners that the views expressed in this podcast are those of our guests and not necessarily those shared by our hosts. Today's episode is sponsored by Life and Legacy Advisory Group. Discover our commitment to our clients at Life and Legacy. Building wealth, securing your family's future, giving back and creating a lasting legacy are not just values, but a way of life. Let us guide you toward a future aligned with what matters most to you. We're also brought to you by ARIA Benefits. If you're a business leader challenged with talent attraction, employee engagement, or supporting mental health, we can help use your benefits package as the key to unlock your workforce. Now, here's your hosts, Robin Bailey and Al MacDonald.

Speaker B: Welcome back to the Success Leaves Clues podcast. I'm your host, Robin Bailey, back at it again with my fantastic co host and business partner, Al MacDonald. Al, you must be happy these days in prime bike riding weather. I know you've been out there. How's everything been going?

Speaker C: We are finally. It's been a long, cool winter and a, uh, cool spring and not much opportunity to be out. But now things seem to have changed the corner. And yes, I'm out and looking forward to another weekend. So hopefully we've turned the corner and it'll be good cycling weather for the rest of the summer.

Speaker B: For the rest of the summer, exactly. Well, as you know, on the podcast, we get so many great intros, and today is no exception. And joining us today is John Leombruno, who is the CEO of OKRx, a Canadian healthcare software company, helping simplify how, uh, specialty medications are managed for patients, prescribers, insurers and pharmaceutical companies. A healthcare entrepreneur with a PhD and Al, help me out here.

Speaker C: I think it's pharmacoepidemiology. Did I get that right, John?

Speaker D: He says you got it. Good cheer.

Speaker C: Maybe now's the time for the cheer.

Speaker B: And Al gets the gold star for that pronunciation. And that is from the University of Toronto and an MBA from Queens University. John has built and scaled companies at the intersection of health, healthcare data and patient access. He also co founded Patient direct pharmacy and GMD distribution, both of which were acquired by McKesson Canada. John brings a rare mix of, uh, scientific expertise, business insight and entrepreneurial Experience to one of the healthcare's most complex challenges, helping patients get the right support at the right time. John, welcome to the show. Excited about this conversation.

Speaker D: Well, thanks for having me, guys. I really appreciate being here and excited to have a chat for the next little bit.

Speaker B: Yeah. Well, John, um, you've got an interesting background and just going through your bio, you know, we can see you've built companies at the intersection of health care data, uh, patient access and technology. When you look back, what experience has most shaped the way you think about solving problems in health care versus simply just building a business?

Speaker D: For sure. Uh, you know, my first experience, uh, really that kind of molded my entire, I guess, career. I was a pharmacist at sick kids and I was working in the outpatient pharmacy. And at the time, it's like basically the early 2000s, so I'm dating myself here, but I, uh, witnessed the launch of two drugs, Enbrel and Remicade. New drugs at the time. And we were administering those drugs to kids in the rheumatology clinic. And the transformation of these children was just like, astonishing. We were watching the standard of care shift from like, surgically fusing these kids joints to actually treating them. And it honestly kind of you would take a step back and it felt like we were witnessing a miracle. And I've seen, as I experienced myself, we had kids who were in wheelchairs. One week, um, they would get one or two infusions and they come back and now they're walking, which was unheard of at the time. But the way medicine works is now it's just kind of normal, and the kids don't actually get that bad that they need those wheelchairs. But it was a constant struggle. And this was at the time before these drugs were actually funded. And actually there was a supply issue at the time. They didn't make enough of these drugs. So the medication existed, the evidence was there, but the access wasn't. So I remember having to beg my contacts at the companies I sharing at Amgen to get more compassionate supply for these kids. So that experience moved me and I left direct patient care at sick kids to join one of the companies that were selling these drugs and started to work in their market access division. And my thought was that, hey, we can get the insurance companies to pay for this or the governments to pay for this, everything would work itself out. But I found that that wasn't the case. Right. So even when insurers pay for medications, there's still a lot of barriers and friction with paperwork, coordination of care Co payments and so forth. Right. And so really that became, you know, my guiding philosophy on how I would build a business. And just had two north stars. So number one, if you help patients get what they need, that's good. But also you have to reduce the burden on the hcps and the healthcare professionals caring for them. And if you can do those two things, the business will follow. And so it had a real problem to solve. And if you solve that real problem, you can build a real business.

Speaker B: John, I want to go back because we in our family, we had some experience. I had a cousin who was born with spina bifida. So early, very early part of her life was spent down at sick Kids hospital. And I remember for a long time just thinking the incredible work that was going on there. And then from your experience seeing these life changing drugs help these people, that must have been very moving. And I see it on my side of the business as well. And in the employee benefits, you know, we get to see what are the top drugs being used. And there's that two sides of the coin. Like, yes, very expensive in a lot of cases for some of these drugs, but just life changing for those families and those members that are on these drugs. How do you think those early experiences have kind of led to that North Star of where you're going?

Speaker D: Well, I mean, it's hard not to when you see the change in these people. And at the time, because I'm going back to the early 2000s, there was no treatments for these kids to seeing how treatment affects them, it was mind blowing. So anyone who witnessed that has gone through that and that kind of moment happens at different times in a lot of different therapeutic areas, but that just hits home so much. Right. And then as you said, you know, even for me, when you're a healthcare professional, like, so these patients come and then you get so focused on helping them and moving from task to task to task.

Speaker C: Right.

Speaker D: And so sometimes as a healthcare professional, it's easy to kind of lose track of, uh, the profound effect that these medications or treatments have on people. But then when you bring it back to your personal life and just like you ram, um, you know, I have friends and family that they get diagnosed with scary things or prescribed expensive medications. Right. And I'll go through the exact same process I would to help a patient through our business. But when it hits you in real life, you kind of always remember how important that these things are for people. Right. So pretty powerful, pretty awesome to witness that.

Speaker C: John, you, uh, mentioned a couple of specialty Drugs. You mentioned Remicade in there. And I'm sure there's a number of specialty medications that we know can really enhance people's lives. But I think there's probably some issues around people, number one, knowing that they exist, number two, how do we access them, uh, how do we pay for, for them? So can you talk a little bit from your perspective, just where does that patient experience break down the most in terms of trying to know about and access some of these drugs? And what do you think, let's say, a truly patient centered system would look like?

Speaker D: Well, the process breaks down in so many different spots. We could probably spend the whole afternoon talking about it and, you know, just scratch the surface. And I think each therapeutic area brings its own unique set of challenges and barriers. Right. So I think it would be challenging to sort of pinpoint where the actual minutiae of the problems are. But at the end of the day, there's a lot of them and they're all kind of the same. It's all basically, I feel, comes down to one fundamental thing. It's like the lack of information. So to me, if you were to think about a patient centric system, it would be a system where all the people involved in a patient's care, so that includes the patient themselves. And for some patients they're very engaged and for others they're not. But for sure, the patient, their prescribers, their pharmacists, and of course in complex care, there's a bunch of nurses and drug access navigators that envelope the care for the patient. So a truly patient centered system would be at any point in the journey, any one of those, either healthcare professionals or the patient would be able to go to one spot and kind of like one spot all the time, not 100 different spots, one for each insurer to get the answer that they need. So, and the answer when it comes to drug therapy would be, hey, does my plan cover this? Yes or no. And the reality is that because you mentioned the economics, there's, you know, can't cover everything for everyone. That's just not the world we live in today. Right. But if it is covered, what are the conditions? It's covered. And then what's ultimately does the patient need to pay? And you can think about it, there's an entire ecosystem out there, like patient support programs, and there's over like, I think four or five thousand employees in Canada trying to help all these patients out, just trying to navigate all of the different systems. And this whole approach like, was never really designed with the patient in mind. Because if you think about how all the systems in healthcare kind of always start with either the physician, either physician centric or pharmacist centric. Right. So there's really no one who's come together to sort of build that one stop place where we can figure all of this out for a patient. And again, it can't just include the patient because as a healthcare professional, we've all met patients who can't navigate it themselves. Just sometimes it's not going to happen. And so that point's got to be available for all of the patients, healthcare, uh, providers.

Speaker C: So in your mind, and I guess this is a little, little bit just of your own opinion, do you think things are improving or do you think. Because I could see things almost going backwards with the amount of information that is available and it could be just overwhelming, you know, trying to do everything yourself. So like, where do you think the direction is moving right now in terms of this patient centric idea?

Speaker D: Well, I feel like the actual process hasn't changed much over the last, I'm going to say 20 years. But what has changed dramatically is the number of drugs that are kind of going through this process. Just the number of specialty medications and, you know, the specialty medication envelopes getting closer and closer to like mainstream medicine. You know, I used to say like 10, 15 years ago that, you know, one day it's all going to be specialty medications. Right. Just because that's where things are heading. So I feel like the problem itself hasn't really changed, but the scope of the problem has probably, you know, over the last 20 years, increased 10 to 20 fold.

Speaker B: John, can we talk about your company for a second? You know, like you said, I think we could talk all afternoon, you know, based on one topic here. And I think this is really important, but I do want to find out, and I want the listeners to find out a little more about okrx. Tell us a little bit about your company, why you're there, what you're doing, how you're assisting, and as we said in the beginning, making sure patients get access to the right drugs at the right time.

Speaker D: Yeah, so I mean, I had been in healthcare for a while and I had a company that was basically a patient support program. And so typically the way patient support programs works is that the pharmaceutical company will fund the program, then the physicians will refer patients to the program, and the program then helps out the patients get on therapy. So doing all the paperwork and kind of quarterbacking the whole situation. So I had sold that company to McKesson back in 2018. And I always tell people the story that that year before we sold my company and I was like, you know, maybe the fourth largest player in this industry, we sent out a quarter of a million faxes, right? And this was in, uh, 2018, which just seemed odd. So after I left McKesson, I, you know, I came up with the approach that a lot of these things should be digitized or as much of the process as possible. And so I reset out to digitize that process. And the process that we focused on first was prior authorization, when prior authorization. For people who don't know, it's basically to make sure that the insurers are funding patients who are appropriate because, you know, some of these drugs are 50, 60 thousand dollars a year. So, I mean, it's appropriate that the insurers want to make sure that these patients are appropriate for therapy because it's a big ticket item. But part of that process is to fill out basically a piece of paper, asking a bunch of questions. And in general, the way the process starts today, that the insurers will have these forms on their website. Someone has to go to the website, download the correct form. That sounds easy, but sometimes that's a challenging process in itself. Fill out this form. So the patient has to sign it, the physician has to sign it. And the reality is that one stakeholder, so the patient or the physician or the pharmacist, whoever's looking at that piece of paper probably doesn't have all of the information. So you're forced to go to the other stakeholders to get information. So now someone has to quarterback this process on a piece of paper that's getting faxed around. And we've all dealt with faxes before, maybe you guys not so much lately, but I still deal with a lot of them. But by the time that fax hits the third or fourth person in the chain, it's m looking pretty beat up. Right? And that was 2018, 2019. And I just thought that that seems crazy that we're still doing that, but fast forward 2025, and I can tell you that my company today probably sends out more faxes, but in terms of percentage wise, we've reduced that to about 50% of the volume there's doing. Right? So right now we're about half digital and half fax. And our company today focuses on that prior authorization process, making that easier and simpler for everyone and really trying to push the agenda of digitizing this process.

Speaker B: You know, you have such an interesting background. We're Getting to know you, you know, on our last call, and obviously, you know, going through your bio today, like you have that rare combination of scientific research, business leadership, entrepreneurial experience, you know, you've already exited companies. John, how has that combination influenced the way you approach decision making today and going forward?

Speaker D: Well, thanks for. That's a pretty good combo. So thank you for that. Um, you know, I think like anyone else, you know, my experience has shaped the way I see the world and ultimately how I make decisions. But I think I would be oversimplifying or maybe, uh, embellishing a bit if I thought that there was one clean framework that I always use to make a decision. So I think it just kind of depends. So in some scenarios, I feel like I'm pretty conservative. So, you know, we deal with patients, so when we're talking about patient safety or trust, trust with physicians, trust with insurers, trust with the pharma companies, probably pretty conservative. We want to be like 99, 100% sure before we move. But in other situations, like a new market opportunity, some new backroom process, you know, I can be pretty aggressive and willing to take risk. So at the end of the day, it's kind of like I don't think there's one specific thing that guides me, but I will say, and I think this is true for many healthcare professionals. When you're a healthcare professional, it's ingrained from your early training to always consider the impact on the patient. So I feel like a lot of my decisions are rooted in, hey, how is this going to affect the patient? I don't think it's something I consciously turn on. I think it's just always there and ultimately probably grounds a lot of my decision making. So it doesn't matter how fast we're moving or the pressure we're under. A lot of times I think if it's going to affect patient safety or affect the patient in any way, probably affects my decisions quite a bit.

Speaker C: John, you just used the word trust there three or four times in your last response. And I'm just curious, if you look back in your career now, do you think that you can point to anything that maybe some entrepreneurs underestimate in terms of building their business? In industries like yours, where it's not simply all about growth, it's about relationships and trust and reputation, and those things probably matter as much as just the numbers?

Speaker D: Yeah, for sure. Trust matters huge. And specifically in healthcare, I think, because you mentioned numbers. So numbers comes, you know, after when you're evaluating the business. But the Business only comes with trust, right? To build a business. And in our world, there's a little bit of attention in healthcare because you want to move fast and you want to do things quickly. And especially as a health tech CEO, and just in general, the world's moving so quickly these days. Right. That you can't expect everyone to move at your pace. Right. So a physician who's been practicing for 20 years has built their entire workflow around systems and processes that are very familiar to them. Right. You can't just come in and start changing things. It's just not going to work. It's not going to fly. Right. So you have to build trust. And the way that I would say we try to build trust is when you're. Susie, we're speaking with healthcare professionals, at some point, they're willing to start working with you, and you can't push them to do things your way. So they'll give you a little bit of insight or a little bit of a room, say, hey, we're willing to do this and you have to deliver right away to them. Right. So we have to move quickly internally for them to build trust with them, and then, you know, they give us a little more. You kind of move slowly. So from an entrepreneur's perspective, if you're thinking you can come into healthcare and move really quickly, I mean, I think we all have aspirations to do that, but I've been at this for like six years now, and we haven't unlocked the way to do that. So it's kind of like slowly building trust. And with each sort of person who trusts you, you kind of like build your reputation and sort of move from there.

Speaker C: I think you kind of mentioned this already, but from your perspective, if you're seeing these new drugs, if you're seeing new technology, if you, in your mind, you're able to deliver a better outcome for the patient, and yet the system's slowing you down. Have you found a way to address that, overcome that? Uh, you know, help people nudge them along a little bit more quickly, or what's your approach to that?

Speaker D: You nudge them along more quickly by building on, like, little successes. Right. So you, like I said, when you start interacting either with a pharmacist or a physician or insurer, no one's going to change everything at once, right? So they give you a little piece and you have to perform there. You have to execute and make them happy. And then that's basically just go step by step with them. And that's kind of the way it's worked with us, like I said, with physicians and prescribers and insurance companies today, for sure. Whenever you're talking about the relationship with a, uh, healthcare professional or even an insurer and their patients, it's kind of sacred. Right? So they don't just let anyone into that. So that's cornerstone. And really the only way that we've kind of determined how to build trust is just to start with one or two projects or, you know, one or two aspects of the process and then build from there.

Speaker B: So, John, it wasn't that long ago that a good friend from the industry reached out to me and said, you got to talk to John. You're gonna have a really good conversation. And that was Rami El Coulee. Just m a wonderful guy I've kept in touch with over the years, of course, adjacent to my space. But we've always followed each other and had really good conversations. And I'm really glad, I'm really glad he did this introduction because we've had offline a couple of good conversations and now today, and I'm sure this is just the start of our relationship. But as you know, John, we do have a sign question. I'm already hearing things that could be your answer, but there might be something else. So if you're up for it, I'd love for Al to take it away.

Speaker C: Yeah. So the question, of course is a, uh, society grows great when old persons plant trees in whose shade they will never sit. So I think based on what you're doing in the healthcare industry, there's some obvious answers there. But I'm curious too, like maybe there's some things that you are doing in the community or things that you're doing with your family or whatever the case may be. So I'm just curious as to how you might answer this question.

Speaker D: Well, you know, speaking to what we're doing at OKRx, that pro really resonates with me because I've been working on this project for a long time. So, uh, the analogy of plant a seed and grow a tree over many years kind of hits home. But for us, the moment that really crystallized was a couple of years ago. So one of our partners, Greenshield, who uses our technology, they received a, um, two year grant from the Canadian Medical Association, MD Financial Management and Scotiabank as part of the Healthcare and Burden program. And that initiative was specifically designed to reduce the administrative burden on, uh, physicians and give them more time to actually care for their patients. That funding and guidance allowed us to plant two very specific seeds One was electronic prior authorization and electronic benefits verifications. Kind of the processes we spoke about before where there's one spot that the healthcare providers and patients can go to really figure things out. Uh, so we've watched those seeds sprout and, you know, the first leaves are just visible now. And I really couldn't be more proud of that work because I feel it's profoundly going to change the way healthcare providers provide specialty medications. So we're just at the beginning, and I have a lot of hope that this is going to grow into, like, two, you know, mighty trees, and then we'll be able to sit in the shade of those trees one day.

Speaker C: Thanks for that, John. I really appreciate it. And your answer kind of takes me back to something that you said at the very, very beginning of this was you talked about relationship building and the care of the pat and what that meant to you, and then the business would follow. Right. So I think that's really reflected in your answer now, and I really enjoyed you, uh, sharing that with us today.

Speaker B: Yeah, thanks, John. This has been a great conversation again, I'm looking forward to our future conversations offline. This is just the beginning for us. Hopefully. For listeners who are interested in learning more about what you're doing, what's the best way to reach out?

Speaker D: I'm on LinkedIn, so that would be perfect.

Speaker B: Okay, you heard it there. If anyone wants to reach out to Al or myself, you know where to find us. Can always join the conversation that we're having on LinkedIn. We saw it here today very clearly, my friends. Success leaves clues. We'll see you next time.