Episode 12: Cheaper, better, faster, smarter. How automation is revolutionizing your pharmacy with Scott Seidelmann of Omnicell

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.

Justin Steinman:
Hello and welcome to the latest episode of Definitively Speaking, the podcast where we have data driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. I'm joined today by my friend and colleague, Todd Bellemare, and Scott Seidelmann, the Chief Commercial Officer at Omnicell. Omnicell is a leading provider of automated medication management adherence tools to pharmacies and healthcare systems. If you've ever been to a hospital, the chances are high that your drugs were dispensed by one of their big cabinets.

Justin Steinman:
What's cool about Omnicell is that they're taking drug delivery and dispensing into the next generation by adding new cloud based analytics and new solutions for 340B program administration and population health. If you don't know what some of that stuff is, well, neither do I, but Scott will explain it all to us shortly.

Justin Steinman:
Scott's also a pretty interesting guy who's bounced around the healthcare ecosystem for more than 20 years. Before joining Omnicell, he started and sold, not one, but two different radiology related businesses. So you might say that Scott is pretty plugged into what's going on in hospitals, healthcare systems and how they can all use technology to improve patient care and bend the cost curve.

Justin Steinman:
Scott, welcome to Definitively Speaking. We're happy to have you.

Scott Seidelmann:
Thanks guys. Really excited to be here.

Justin Steinman:
Great, great. So let's just jump right in. I'll be honest, before you joined Omnicell four years ago ... And, folks, I've known Scott because I was working in radiology when I was back at GE Healthcare, so I knew him through the industry, but when you went to Omnicell, Scott, I'd never heard of the company. Yet, this is a company that's been around since 1992. Can you give us a little bit of background on who Omnicell is and what was interesting about it?

Scott Seidelmann:
Yeah, totally. And, in full transparency, I didn't really know much about the company either. And, as you said, I've been in healthcare, bouncing around healthcare, which seems totally appropriate for quite a while.

Scott Seidelmann:
So we are a really unique company in the sense that our founder is still our chairman and CEO today and still as passionate as ever about solving problems in pharmacy. So he started the business in 1992, very personal story, had a child in the hospital, was watching nurses struggle with meds, thought it would lead to errors. And, literally, in a garage in Silicon Valley invented this device which, it's not too often that you invent a medical device and it becomes standard of care.

Scott Seidelmann:
And, as you pointed out, automated dispensing cabinets are in ... I'd like to think of them as the last mile of drug dispensing in the United States and they are in every setting of care, every hospital, they're all over the hospitals, outside of the hospitals, they're in SNFs and LTACs or Urgent Care centers and EDs. They're, literally, everywhere and it is the standard of care.

Scott Seidelmann:
And so, Omnicell, there was really ... Primarily today, it's a duopoly. There's two companies. We're, essentially, neck and neck. It's us and a division of Becton Dickinson called Pyxis. Omnicell was always the little guy competing against Pyxis and was, and continues today, to be very entrepreneurial and to continue. And now we're roughly approximately 50:50 share today.

Justin Steinman:
That's great. That's great. So why did you go ... I mean, automated pharmacy management's a pretty big leap from a previous gig at Candescent where you sold and built ... Or built and sold ... Excuse me, cloud based radiology workflow and analytics. Radiology to pharmacy. What's going on there?

Scott Seidelmann:
Yeah, totally. I mean, Omnicell's not a huge company, but it's certainly a big-ish company. I've been an entrepreneur for quite a while in healthcare and that was my plan just to continue doing that. I had known Randy Lipps because he had been on the board of my previous companies and got to know him and he was always a mentor. And when he first approached me about coming to Omnicell, I had the same reaction. I was, "I don't really want to go join a big company and what would the role be? And, honestly, isn't this just standard of care med device and how interesting could it be?" et cetera.

Scott Seidelmann:
But as I really dug in, I think the things that I got excited about was ... First and foremost, for me, it's always been about care delivery model redesign. That's what radiology was always about, which is a huge portion of healthcare. How can you really enable radiologists to deliver better, more efficient care? That was what that decade for me was about and I think we achieved a lot of that and like many entrepreneurial stories in healthcare didn't achieve some of it.

Scott Seidelmann:
Pharmacy was exactly the same thing. I mean, when I was thinking about what I wanted to do next, there's no shortage of areas of healthcare where you can apply technology and do something faster, better and cheaper, but for a whole bunch of good reasons and a whole bunch of really bad reasons innovating in healthcare is just really, really hard. It's why we haven't seen an Airbnb, an Uber-like disruption and probably never will. But, for me, pharmacy is the largest portion of healthcare by dollars, touches every patient in every setting of care, arguably one of the only ologies that has a true ROI, whether that's clinical or financial in healthcare. So that was really exciting for me. Clearly, the pharmacy supply chain is under massive disruption and so that just seemed like there was a ton of opportunities.

Scott Seidelmann:
As an entrepreneur for a decade across two different companies in healthcare, I had personally come to the conclusion that the hardest thing to do in healthcare is to build a channel and that getting into these places is so hard. You want to sell ... You're an entrepreneur, you've got some great technology you want to sell into healthcare. Well, you've got three constituents: Hospitals, providers and health systems, payers or drug manufacturers. All three of those industry segments are dominated by huge players. The Top 300 health systems control 80% of the beds in the United States, and simply getting into those places and developing a relationship with them, it's so hard.

Scott Seidelmann:
So there is no ... If the three of us went and started a startup tomorrow, cloud based accounting software, we'd go to market by attacking that small and medium sized business market. We'd go after the 300,000 businesses out there where our product has the feature set that would be relevant to that market and, more importantly, where we could experiment and fail. You can't do that in healthcare. There's no SMB market. So the notion of a startup, it'll take you two years just to get an NDA signed with a health system for them to even consider experimenting with your product. It's hard to do.

Justin Steinman:
So do you feel that ... As we've talked about the disambiguation of healthcare a lot in the last couple years or so where we see more and more small Urgent Care centers popping up here and there or the Walgreens and the CVSs with their MinuteClinic type situations, where the focus of care is starting to happen outside of the hospital. And so is that the market that you guys are seeing as the next horizon for expansion?

Scott Seidelmann:
Yeah. I mean, look, I think we've all been talking about care moving outside of the acute care setting for the last 20 years. I think it's clearly happening. It's starting to go that direction. But what's really going to end up happening? I mean, when you look at the health system in the US, just take hospitals, it was designed a hundred years ago when transportation was incredibly difficult, which is why you drive down the highway, you see an H sign in every town. And I think that the reality now is that we probably have too many hospitals and so I think what you're going to see happen is that I think that a lot of these smaller community, rural hospitals are probably going to become imaging centers with helipads on top of them. And really what they're going to be doing is triaging those patients off to the Quaternary care facilities, the MGBs now, the big health systems in the big cities.

Scott Seidelmann:
But I think that what's going to happen is I don't think you're going to see a reduction in their number of beds. I think all you're going to see is the acuity of the patients in those beds is going to increase and health systems and other players are going to get really good at treating lower acuity patients outside of the hospital, whether or not that's in a care setting, such as an LTACH, a SNF, an Urgent Care center or the home. And so I think that's where you're going to see the shift. I think that largely the big health system in that big Quaternary care facility is probably going to be a winner in the next generation of where this all goes, but I think that they're going to participate in managing and treating these patients outside of that hospital.

Justin Steinman:
Yeah. So there's some interesting data that followed behind that, Scott. So according to some of the data that we've tracked, ambulatory surgery center volume increased by 20%, actually more than 20% between 2019 and 2021, while hospital surgical procedure volume decreased by 7% during that same time period.

Scott Seidelmann:
For sure.

Justin Steinman:
So what are the impacts of that on your business?

Scott Seidelmann:
Look, pretty limited. I think that going back to why did I join Omnicell? Which is really around, we have this incredible channel. We do business with half the hospitals in the United States, half the post acute care environment, half the retail pharmacy. So we've got the entire continuum of the healthcare system. And so if you're talking about transforming this thing called medication management ... And when we look at our business and our strategy to say, "Look, how can we really ..."

Scott Seidelmann:
Ultimately, what we want to do is that we want to transform this big portion of pharmacy by enabling the pharmacist, the nurse, the caregiver, the doctor, to focus on the things that are really, really hard and really, really important, which are the clinical elements of medication management. And can we strip away or automate away all of the administrative garbage that is overwhelming this provider in the US?

Scott Seidelmann:
And that's really what we're trying to do ultimately. And when we started with point of care in this cabinet, and now we've added central pharmacy automation and technologies that help hospitals manage drugs across their continuum, helping pharmacists to engage patients outside of the hospital and participate in this ambulatory environment. So, for us, in terms of this shift, how it impacts our business? Look, like I said, I actually think the larger health systems where we're focused today are getting bigger and actually expanding and taking on more of our solutions and services as they and other constituents start to focus on lower acuity patients outside of the hospital.

Scott Seidelmann:
Well, the reality is that their medication management or their pharmacy problems go with them. So the reality is just because you're not treating Mrs. Smith who has multiple comorbidities and is taking seven different medications ... You used to treat her on a bed on the fourth floor of the hospital. Now you're treating her at home. Well, I'd actually argue that you have more complexity from managing those five or seven medications you're on. And so now it puts more pressure on the health system and they need more services from us to say, "Okay, now you need a central pharmacy capability that can supply those medications, not just on the fourth floor, but in the Urgent Care center, in your a hundred physician offices to Mrs. Smith at the home and you need tools that enable you to know where are these meds? How do I make sure those meds are getting to the right place at the right time, whether it's in the hospital or outside of the hospital? And you need tools that enable your pharmacist to do more than simply fill amber vials."

Scott Seidelmann:
Those pharmacists now have to be triggered to engage Mrs. Smith to say, "Hey, Mrs. Smith, you're not taking the right med. Did you take it today? Are you adherent?" Population health speak. But, "Are you taking these meds in the right way?" et cetera.

Scott Seidelmann:
And so it's that full portfolio of solutions that we've added in the last few years that supports med management in and around the hospital, not just inside it.

Justin Steinman:
I think that's an interesting thought. I would hazard a guess that a lot of people when they hear about the dispensing cabinets type of software ... Not software solution, but the actual ... What's the word?

Scott Seidelmann:
Hardware.

Justin Steinman:
Hardware. Thank you. So I work at a software company. Never remember that word. So I think a lot of people think of that hardware as being it, and then a human has to be making a lot of the decisions and the quality control, but getting that the right drug out into the hands of the patient.

Justin Steinman:
So can you just talk a little bit about those add-on pieces to the hardware, a clinician decision making software or things like that to look at, "Here's the type of patient, here's their history or here's their comorbidities. Be cautious when you're dispensing drug A, B or C." Or something pops up on the screen to say, "Remind the patient of A, B or C when you're giving them this medication."

Scott Seidelmann:
Yeah. So let's just follow the evolution of this really quickly over the last 30 years. So 30 years ago, the ADC didn't exist. Drugs were just stored in a basement somewhere and so the patient may be wherever that patient is, but largely at that time in the hospital. And so the workflow had to be getting that drug from the basement to the floor, to the patient's bedside, et cetera and that drug was up there. Well, that was inherently, as you can imagine ... And today it's the same thing. You're throwing lots of bodies at a problem with lots of manual processes that's going to result in slow, expensive and really error prone.

Scott Seidelmann:
So, ergo, the invention of the automated dispensing cabinet, which is, basically, just a par location closer to the patient. So now I don't need to keep the drugs in the basement. I can stick them on all the floors. So now I have this problem, which is that, "Okay, but I still have a hundred or 200 people in my basement that are just pulling drugs off of shelves and trying to get them to these locations. Well, and not only do I have floors in the hospital, but I've got a hundred physician practices that I've acquired, I've got Urgent Care centers. Those now all have par locations." Okay. Well, so what did we really just describe? We described Logan Airport, whose job it is, is to land planes and take them off on time without killing people. But all I've really done is I've created planes and maybe a tower with windows. So how am I possibly managing that? I'm looking out and I hope the weather's nice and it's during the day and I'm trying to radio the plane, "Land on seven and you take off on five." It's too complicated.

Scott Seidelmann:
It's the exact same problem for a chief pharmacy officer of a health system like MGB. My job is what they call the five rights is to get the right drug to the right location at the right time at the right dose. I've got to make sure these planes are landing and taking off across this massively geographic complex environment. What do I have? Tens of thousands of drugs in my formulary and so how do I do that? Okay, well, what I actually need now, which is a service we've launched called Omnicell One, which is a predictive analytics subscription that sits across all those devices, looks at all those par levels and predicts what drugs need to be in what locations when.

Scott Seidelmann:
So now we can actually help that health system optimize the five rights because previously it was tribal. It was just this chief pharmacy officer knew that on Wednesdays the nurse on floor seven tended to take more doses of X, Y, and Z. And then the nurse would go to get the next dose because the patient needs it and the cabinet's empty. And so now ... Or I've got hundreds of people taking scripts out of my central pharmacy. Why don't I just do that with robotics? Why don't I just put robots in the basement that are automated and picking drugs 24 hours a day, seven days a week and the software's just telling the planes where to land and where to take off. And triggering these humans, these techs, like a Uber, instead of the pharmacist saying to Bob, the tech, "Hey, can you run this up to floor seven? Oh, and by the way, when you're up there, could you grab five doses of that? And we're going to need to get that probably to floor six."

Scott Seidelmann:
Well, not anymore. Omnicell One just predicts that and sends a notice to the tech to say, "Bob, go to floor seven. Okay, Bob now grab doses and go to floor five and now go there and go there." That's the level of prediction.

Justin Steinman:
You've, basically, just described a logistics problem.

Scott Seidelmann:
Exactly.

Justin Steinman:
Right?

Scott Seidelmann:
Yep.

Justin Steinman:
I never would've thought as drug dispensing in Logan Airport in the same sentence, but I totally am buying what you're selling here. If we could just sneak some pneumatic tubes in there, just-

Scott Seidelmann:
Oh, I know.

Justin Steinman:
[inaudible 00:17:16] movement around [inaudible 00:17:17].

Scott Seidelmann:
It's amazing. You go meet with chief pharmacy officers and it's all logistics is what you just said. They like to call it the industrial component of pharmacy. And what chief pharmacy officers will say is, "We were never trained to do this. We were trained to do the clinical problems. It's how we self-actualize. It's where we want to be at the top of that Maslowian hierarchy, not dealing with all of this logistics and administrative and logistics crap."

Scott Seidelmann:
And that's where Omnicell comes in to say, "Hey, look, why don't we help organize all of that for you? We're not the star of this play. You are. We're a minor character actor, but how can we take a lot of that stuff away from you so you can just actually go treat the patient?"

Justin Steinman:
And the logistics are becoming more complicated as we're introducing more sites of care and different sites of care and-

Scott Seidelmann:
Correct.

Justin Steinman:
... people then getting home. And so you've got to really manage that entire medication workflow for your location dispersal.

Scott Seidelmann:
Totally. And COVID just made this ... I don't know whether you want to say it's better or worse, but just created so much more pressure on this because now the pharmacist, appropriately, a couple of hundred thousand of them ... CVS and Walgreens have made sure that there's one from five miles from 95% of the population in the United States, they're being asked to do so much more than just fill a script. Administer COVID vaccinations, immunizations, testing, et cetera, et cetera. And so now all of a sudden you've taken a burdened part, an overwhelmed portion of healthcare, and you're just simply asking them to do more. And, to your point, they need tools to help them do that too, right?

Justin Steinman:
Yeah. You actually just hit on something that Todd and I have talked about with a bunch of our other guests, which is maximizing the efficacy of the healthcare workforce. We talk all the time about the "practicing" at the top of your license, whether you're a nurse, a nurse practitioner or primary care or clinical specialist. And, at the same point in time, you've got people leaving the workforce in droves. I mean, we hear about this. We're going to have a shortage of millions and millions of providers at all levels. And the theory here is if every person or patient sees the lowest cost provider with the skills to treat them and the capability to treat them, we should, I emphasize, should, be able to eliminate cost or reduce cost and also free up capacity in the healthcare system.

Justin Steinman:
But, I mean, are you starting to see that when you're out there talking to your clients and your pharmacists?

Scott Seidelmann:
Absolutely. I think in a couple different settings. And first and foremost, our vision is to enable that pharmacist, caregiver, nurse to practice at their top of their license by eliminating all that administrative work inside and outside of the hospital, right?

Justin Steinman:
Right.

Scott Seidelmann:
Everything we do and every new product or service that we've launched has a labor efficiency component to it. It is all about, "How can I enable that nurse to spend less time on medication management? How do I utilize and make the pharmacy tech much more efficient?" Who, by the way, the attrition rate of the pharmacy tech right now inside of hospitals, is 30 to 40%. I mean, they're leaving at a massive rate. You've got pharmacists now playing the role of, literally, a $17 an hour employee and carrying drugs around because they can't hire enough pharmacy techs. And I think as you hit on outside of the hospital, that pharmacist plays such a critical, but I would say, underutilized, role. Clearly.

Scott Seidelmann:
And I think what you're going to start to see is that ... Our hope is that as we add new services that are as focused on optimizing that labor and that efficiency, now the conversations with hospitals and health systems are saying, "Hey, look, we can help you have the nurse spend less time on medication management so they can focus on other things. We can make the pharmacist labor more efficient." "Hey, retail pharmacist, we can enable you to engage Mrs. Smith to have conversations with her around, 'Are you on the right drug? Are there any other medication conflicts? Are you on the right health plan?' Because the reality is that you're going to get hit with a $300 copay with the current plan that you're on, which is not good for you and it's certainly not good for me." But now this pharmacist, who's ill-equipped to have those conversations is engaging that, because Mrs. Smith saying, "But I can't pay for this and I can't do that." And they're just trying to fill the script.

Scott Seidelmann:
And so we have outside of the hospital, we actually, a couple of years ago, created a business unit called EnlivenHealth. And what Enliven is doing is it's a Saas platform for retail pharmacies that does things like personalized communications, mundane, that automated, "Press one, press zero," but now more sophisticated when I call, "Hey, Bob, I have five medications for you. Which one do you want to refill?" et cetera. But also does things like scheduling appointments for patients to go to retail pharmacies, gives analytics and predictive tools around what plan they should be on, those types of things.

Scott Seidelmann:
And so that Enliven platform sits on top of the pharmacy management system, which PMSs have been out there for a long time, 30 years. And what that really is just, it's about filling a script and billing for it. And Enliven works very seamlessly with all of those systems, but sits above, but just enables the pharmacist more efficiently to do these other value add tasks.

Justin Steinman:
So our data actually says that 92% of hospitals have a pharmacy management system. So my question is what are those other 8% of hospitals doing?

Scott Seidelmann:
Yeah, I don't know. What's more amazing to me is the stats that are always around. We do run into hospitals here and there that don't have ADCs, right?

Justin Steinman:
Right.

Scott Seidelmann:
Don't have Automated Dispensing Cabinets too. What are they doing? So-

Justin Steinman:
Yeah. So I actually have data on that too. We track more than 7,300 hospitals in the US, according to our data, but 96.2% of them, not to put too fine a point on it, 96.2% have an automated dispensing machine. So you still got 3.8% of Greenfield for you out there.

Scott Seidelmann:
Yeah. And our growth really comes from ... Look, every five to seven to 10 years, you've got to ... We have a new ADC and it's got better features, better capabilities, more modular, more intelligent, et cetera. But the real growth from us is coming from the fact that, as I pointed out before, which is, ultimately, why I joined, is that we have this superlative channel and these health systems have done business with us for 10/15/20 years, and as the importance of pharmacy has grown over the last decade, like a boat on a tide, we've risen that. And so now we're really perceived as a strategic pharmacy partner for, not just the health systems, but outside the health systems and so the strategy has been great.

Scott Seidelmann:
As I pointed out, all the other problems you're having, whether it's in central pharmacy or IV compounding or making sure you're getting the right drugs or the right location or optimizing the efficiency of your pharmacist, we've added or acquired over the last four years, four ... Oh, I think we've organically delivered five new services and we've acquired three or four other ones. And so now we're walking into that health system or that provider and saying, "Hey, look, med management, you're simply not getting enough value out of this care delivery model. We can help you reduce drug spend, improve quality, improve provider efficiency and we can do that through a whole portfolio of products or services." And so it's really that expansion, the new products, that is driving the growth.

Justin Steinman:
So let's talk a little bit about specialty pharmacy. So you do a lot of work with specialty pharmacies, right?

Scott Seidelmann:
Yes.

Justin Steinman:
So according to our data, there are nearly 3,200 specialty pharmacies across the US from about 440 or so different pharmacy and health system networks. And yet the large, large majority of these specialty pharmacies tend to be located in and around urban areas, which makes sense, given the specialized handling required for orphan drugs and complex conditions of patients. But nearly 20% of the US population lives in a rural area and many of them lack the financial resources or time to travel to the urban areas to get these drugs.

Justin Steinman:
So how do we help 20% of the US population get access to these drugs that they desperately need?

Scott Seidelmann:
Yeah. I think that ... So, first off, this is an area, specialty is an area for us where, for four years, we didn't really do much of anything, but it was an area of, as you pointed out, such rapid growth with the 340B program, which we could talk a little bit about. But the 340B program, which is a federal program, the bottom line is that it is, essentially, a federally mandated discount for hospitals, health systems, FQHCs that treat a percentage of their population that are really underserved populations, poor, et cetera, Medicaid, that they are ... The federal government requires that manufacturers give those providers a discount, a pretty significant discount on purchasing those drugs. And the reason being is it was a straight up negotiation to say, "Look, this is a way that we can help subsidize these providers to deliver care to these underserved populations."

Scott Seidelmann:
And so now for specialty medications that grew at the same time where the reimbursement is very, very high, when you add that to the discount for the three 340B program, now, basically, specialty pharmacy is driving a significant financial benefit to those providers, which is being used to fund programs to support the underserved populations.

Scott Seidelmann:
To your point, I think approaching the more rural environments, yes, I think health systems and community hospitals that are three 340B eligible that serve those populations, ensuring that the 340B program stays intact and that they can deliver specialty pharmacy to those FQHCs, is the same thing. The challenge is, is that operating a specialty pharmacy is a whole different animal than operating a typical retail pharmacy or an inpatient pharmacy.

Scott Seidelmann:
And so for most health systems, it's just a very different skillset. And there's two complexities to it: Which is, one, how do I contract with payers? How do I engage manufacturers? How do I operate the specialty pharmacy in, I'll say, the fabric of my clinical settings; and, two, the 340B program is incredibly complex and it's very difficult to do correctly.

Scott Seidelmann:
So we acquired two businesses over the last few years: One is a 340B TPA, essentially, so software and expertise around how to operate the 340B program; and, two, we acquired a business called ReCept, which is a specialty pharmacy managed service organization. And what that means, you put those two assets together and now you can go to health systems and say, "Look, you either have, and it's underperforming, or you should have, a specialty pharmacy program and you really need to have a perpetual inventory management system. We, now, as Omnicell, we've been partnered with you for 15 years on point of care, we're expanding our relationship with central pharmacy automation, we're helping you optimize meds across your various facilities. Now, we can help you optimize outside of the hospital as well to operate your specialty pharmacy. With our Enliven platform we can help you engage these patients who are at home in a rural setting and aren't coming to the hospital," et cetera, et cetera. So that's how the whole thing comes together.

Justin Steinman:
Do you think there's opportunity there with the expansion of services that keeps on coming as things get more complex and you have different solutions for those complexities, maybe even a direct connection from maybe a more urban centered, especially pharmacy and the rural centers out there, where it's even like services that, literally, drives the specialty pharmacy drug from point A to point B. I think some of those things, too, to help those services. And, like you said, it's a logistics problem, as well. There's obviously the details behind getting the 340B set up correctly and the relationships between maybe a one health system and another that's in a rural area, but I think, too, that logistic problem is something that might be open for opportunity.

Scott Seidelmann:
Totally. And I think with the ... I mean, look, mail order has become so prevalent and even now health systems, they don't have to stand up their own mail order operations. There are companies now that will stand up and operate those for them and handle the logistics piece of the mail order.

Scott Seidelmann:
The most important part of the process with a specialty medication is around the longitudinal connectivity between the pharmacist and the clinician and the patient, meaning that these are complex drugs treating complex conditions. And so the reality is that, "Hey, as a pharmacist, can I seamlessly, and maybe over the phone, engage with this patient on behalf of the clinician that prescribed the drugs to make sure that you're on the right one that has no adverse interactions, that you're taking it properly and you're following up? The drugs will show up at your house tomorrow, mail order, but, you as a patient, trust me because I'm part of health system X, Y, and Z, which is where you're getting your cancer treatment or you're getting your dermatologic care." As opposed to, "I saw my doctor at health system X and then I get a phone call from CVS and that pharmacist doesn't have access to my clinical record."

Scott Seidelmann:
But that's what happens today and that's why you have mis-adherence and you have all these problems. And so I think most health systems or hospital pharmacists would argue that they're going to yield a better clinical outcome, given that they have the right tools, hopefully, that someone like Omnicell can provide them where they actually can engage these patients seamlessly and directly and the meds will show up at their door.

Justin Steinman:
Interesting. So, Scott, this has been great today. I appreciate all that you've shared us. I personally learned a lot.

Justin Steinman:
But before we let you go, I got one last question for you: So we talked about a lot of different things today. I live one mile from a Walgreens in one direction and one mile from CVS in the other. So your comment earlier today about 95% of the American population is within five miles, I'm right there with you. I get my prescriptions filled at both of them. I get my cholesterol medicine delivered to me by PillPack, so the automatic, mail order pharmacy stuff that you just mentioned, all there. I feel like I'm living your world here.

Justin Steinman:
So my question to you, given everything we talked about today, is how long is it before my prescription is filled by a robot? Or if not actually a robot, maybe an automated, self-service vending machine at my CVS or my Walgreens? Or a drone?

Justin Steinman:
But I mean, all kidding aside, do you see a day when I go to CVS and I swipe my driver's license and I swipe my AMX and my pills just roll right out to me? Is that where this is going?

Scott Seidelmann:
Yeah. I think it is. I think you and I aren't the patient where we have to solve these problems for. It's the 5% of patients driving 50% of the cost. Multiple comorbidities, social determinant problems, et cetera that, frankly, also are known as the polymeds. They're taking seven/10 different medications. This is really complex stuff. And the reason that they like going to CVS and Walgreens or Fred's Pharmacy is they remember that on the third Wednesday of every month they get their hair done and they happen to go in there.

Scott Seidelmann:
I don't actually think that that's where the med needs to be. I think what has to happen there is you got to free that pharmacist up to have a very real conversation with that patient around, "Hey, look, these are complex meds. Are you taking them correctly? Are you on the right ones? How do you follow up? Hey, can I call your daughter tomorrow to make sure that when she checks in on you, you can do X, Y, Z?" That's where we've got to free that up.

Scott Seidelmann:
How the med is actually distributed, I mean, frankly, it should just be mailed to their home or the courier comes that evening or a nurse drops it off. It's a narcotic or something. But that I think should just be seamless. I think what we need to do, whether we're talking about pharmacy or another portion of healthcare, is just free up that clinician to look that patient in the eye and have a real conversation about what's going on with their life and are they on the right things? So I think that's how this all changes.

Justin Steinman:
It does sound like that human element, it needs to be a remainder within there. So it's good to hear that they're still looking for opportunities to keep that as being the primary focus of those clinicians. Because, like you said, the logistics and the filling of machines and things like that need to be taken off their plate. And it ties in a lot with all the conversations we've had about trying to keep people within the marketplace and to stem that tide of attrition, keeping people at the reason why they became a clinician in the first place.

Scott Seidelmann:
For sure. Completely agree.

Justin Steinman:
Awesome. Scott, thanks for taking the time to talk with us today. This was great. I really enjoyed it. Todd, always a pleasure to have you bring the knowledge. Drop some on us. And for all our listeners out there, thank you as always for listening to Definitively Speaking, a Definitive Healthcare podcast.

Justin Steinman:
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Justin Steinman:
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Justin Steinman:
Until next time, take care and, please, stay healthy.