Presentation on theme: "Pipeline confidential & proprietary materials1 Q2 2013 | Triple Tree Presentation May 24. 2013."— Presentation transcript:
Pipeline confidential & proprietary materials1 Q2 2013 | Triple Tree Presentation May 24. 2013
Pipeline confidential & proprietary materials2 PipelineRx | Mission Statement Combining its deep expertise, cognitive insights and robust operating processes, Pipeline provides medication management via clinical pharmacy services to ensure the highest level of patient safety and optimal clinical outcomes.
Pipeline confidential & proprietary materials3 PipelineRx | Company Overview Company Profile Founded Q4 2009, 1st Paying Customer Q1 2010. Revenue run rate of $XX million, sales pipeline of over $XX million Qualified Lead to Close – Average Sales Cycle is 6 months. 100 Active Clinical Telepharmacists – all W-2 employees Clinically verified over 2.0 million medication line orders since inception Licensed in 28 States and Operate in 11 States. Installed Customer Footprint 41 clients ranging from 25 to 722 beds each and covering > 4,800 hospital beds 2 notable 2012 accounts wins – UCSF and CHS (133 unit national chain) Typically experience a 30% order volume growth, 6 months post go-live with hospital 24x7 flexibility – ability to cover first, second and third shifts
Pipeline confidential & proprietary materials4 PipelineRx | Leadership Organization Brian Roberts – President 15 years of executive leadership in healthcare staffing and pharmacy services companies Former CEO of Canopy Healthcare Staffing, SVP of Business Development for CHG Healthcare Former healthcare venture capitalist for Acacia Venture Partners & Summit Partners David White – CIO, SVP Operations 20 years of Information Systems and Healthcare technology, development and leadership Stars Behavior Health, Posit Science, eBioCare (Curative Health) Eric Carter – CTO XX years experience developing enterprise level healthcare IT solutions Former Evolute CTO and VP of Services Chris Ciolko, RPh – SVP Business Development 34 years of pharmacy, sales, and business development RPh on the Go, Cardinal Healthcare, Baxter Healthcare Jeff Gustafson – Chief Financial Officer 20 years of financial leadership Partner with Propeller Industries, CFO for high growth companies Chuck Dunlap – National Sales Director 20 years experience selling complex clinical IT solutions into acute care hospital sector Allscripts, McKesson and Meditech Hong Lam, PharmD – Director of Pharmacy 13 years of clinical pharmacist leadership with focus on formulary & drug management 6 years of telepharmacy leadership experience
Pipeline confidential & proprietary materials5 PipelineRx | National Presence
Pipeline confidential & proprietary materials6 PipelineRx | Clinical Telepharmacy Services PipelineRx mirrors and extends the exact cognitive clinical roles and responsibilities of the client hospital’s onsite clinical pharmacists, 24/7. PipelineRx executes upon a client intimacy approach by mapping to the hospital client’s exact clinical pharmacy policies and procedures. Pipeline clinically verifies the safety of each and every medication line order. A hospital’s clinical pharmacist process on average 17-20 medication line orders per hour; Pipeline’s clinical telepharmacists process 30 medication line orders per hour.
Pipeline confidential & proprietary materials7 Future of Clinical Pharmacy Enabling the ASHP Practice Model ASHP - Aspirational Goals Achieve 25-40% in labor savings 24x7 Pharmacy Coverage reduces exposure and liability Deliver an ROI for the hospital Increase clinical quality and patient safety Address all pharmacy complexities, specialties and locations Pipeline – Business model to deliver these ASHP goals Create a comprehensive + on-demand pharmacist network (CTPs) Codify a hospital’s idiosyncratic policies and procedures Deliver robust methodologies, processes and detailed order documentation Eliminate traditional geographic barriers – recruit the highest quality CTPs
Pipeline confidential & proprietary materials8 Current Hospital Reality | Challenges EHR Require Increased Level of Clinical Activity (CPOE, BMV) Meaningful Use Deadlines Competing with Other Industries for Qualified Pharmacists Internal Competition for limited resources Skills Required (Clinical) vs. Skill Pool (Retail) Inconsistent Availability of Skilled Pharmacists within local recruiting area 24/7 Hospital Environment Creates Hiring Challenges PTO or Shift Differential creates unpredictable staffing Fulfill the complex hiring demands of the Night and Weekend Shifts
Pipeline confidential & proprietary materials9 Telepharmacy | Competitive Landscape 1.0 Hospital Providers Larger hospitals covering smaller affiliated hospitals When volumes spike, smaller hospitals are not the priority Longer turnaround times, limited hours and client clinical responsiveness Third Party Legacy Providers Remote Order Processors Limited by Hours & PIS Discourage Clinical Interventions & push back orders Encourage High Volume Med Order Input – key metric is Order Volume Call Center, Facility Based (Centralized) – limited recruiting geographically
Pipeline confidential & proprietary materials10 Nascent Market Dynamics Today – CPO is Disorganized and Fragmented No clear lead company, guidelines or existence proof CPO is perceived to be of limited scope & value Replacing/augmenting existing pharmacy function Selling into complex ecosystems with no clinical standards and/or standard behavior Providers struggle to differentiate Poorly defined value proposition Forces many to structure offering based on lowest common denominators Prospective clients have bought into the image created by the industry Service providers don’t know how to change – price is their only lever Clients make “buying” decision based on cost & who provides least worst service Reinforces self-destructive behavior and creates a race to the bottom
Pipeline confidential & proprietary materials11 CPO Sales Process | Current Landscape Care Provider: Chief Nursing Officer Real power behind Telepharmacy buying decision – core driver is Patient Safety Pipeline - demonstrate its ability to enable greater Patient Safety Directors of Pharmacy Limited power in economic buying decision but acts as a Gatekeeper Under current budget constraints – considered a cost center Pipeline – articulate savings, create an advocate/evangelist C-Suite: Hospital Executives & Administrators Reacts to Regulatory Issues and Immediate Financial Considerations Pipeline - enables regulatory compliance Pipeline - delivers an ROI of 2-3X in reduced labor overhead
Pipeline confidential & proprietary materials12 Telepharmacy | Competitive Landscape 2.0 Emerging Providers – Clinical Telepharmacy Address Current Challenges of Hospital Pharmacy (Encourage Clinical Interventions) Built on Patient/Medication Safety and Client Responsiveness Residence Office Based (De-Centralized) – greater/better skill sets to choose HIPAA Compliant/Connectivity to Hospital’s Native PIS CTP teams built to meet Client Needs & Clinical Activities Real-time - Medication Review, Verification, Resolution STAT order Prioritization Dedicated Team of CTPs Trained on Individual Pharmacy Policies & Procedures, Nuances Remain Current on Individual Formulary and Clinical Initiatives Encourage Interaction and Real-time Access with Client’s Staff (Nursing and Medical) Extensive Check-ins/outs with documentation
Pipeline confidential & proprietary materials13 Pipeline | Clinical Activities Process All Inbound Medication Orders Discontinued or Modified Received, Reviewed, Entered, or Verified Duplicate Orders Patient Demographic Additions or Changes Clinical Recommendations Consultation & Interaction - Nursing or Physicians/Hospitalists Therapeutic/Auto Substitution (i.e. IV to PO) Clinical Initiatives - Renal Dosing, Antibiotic Stewardship, Duplicate Therapy Analysis - Labs, Allergy, Dosing, Drug/Drug Interactions Client Reporting and Coordinated Hand-offs Seamless front & back-end shift transitions
Pipeline confidential & proprietary materials14 PipelineRx | Competitive Differentiation & Complementary Business Models Legacy Telepharmacy ProvidersPipelineRx’s Clinical Solution Night coverage only Adult internal medicine only 24/7 Coverage Adult, Pediatrics, Oncology services Essential CPOE & PIS conversions Compete on Price Offer a clinical compromise Offer a service compromise Unsustainable in ACO environment Compete on demonstrated clinical value No comprises Zero lost clients on clinical quality 1099 Contractors Blend of Retail and Clinical Skills All W-2 Pipeline employees 65% hold PGY1 and PGY2 degrees Average 7 years hospital experience Medication Order Approval Only Regional Call Centers - bullpens Rejected Orders on every shift Slow Turnaround Times Medication Order Clinical Verification Dedicated Pharmacy Work Teams No Rejected Orders Average Turnaround time of 8 minutes STATS turnaround times are faster and are flagged Loose on State RegulationsMeet all State regulations Exceed ASHP guidelines
Pipeline confidential & proprietary materials15 Technology Report | CPOE Inbound Integration Requirements for Inbound Medication Order Integration into PipelineRx Gaining proper clinical data access: Requires third-party (PipelineRx) to have 24/7, 100% real-time, reliable access to the hospital client’s internal UNVERIFIED medication order data. The required CPOE medication data fields exist today and resides within the PIS (Pharmacy Information System). Currently, Pipeline gets this medication information via fax, scan. How does one get reliable access to this UNVERIFIED clinical data? Optimally, with advanced IT connectivity tools embodied in a flexible, configurable and scalable integration engine that can simultaneously accommodate various hospital EMR and PIS systems. Upon confirming due diligence in Q2/Q3 with 3 PIS vendors, (HMS, Allscripts and EPIC), without scale, working directly with PIS vendors to build point-to-point integration to individual hospitals is sub-optimal. Do these hospital integration engines exist for this application? Yes, see the next slide for overview of the vetted IT HL7 integration vendor/partners. Why is this CPOE integrated approach considered transformative? Remote clinical telepharmacy services is a new industry, no one has imagined the need to have real-time access this UNVERIFIED medication data OUTSIDE the processing environment of the client’s PIS system. This distributed workflow approach is transformative, enabling Pipeline to effectively create a scalable industry workflow standard – similar to the standards created by GE & Siemens in tele-radiology. Why is this novel? With the advent of CPOE (stimulated via Meaningful Use incentives) – for the first time, the inbound medication order information to the pharmacy is now in an electronic format. With the UNVERIFIED data in an electronic format it can be inbound integrated (automatically accepted) into PipelineRx and thereby eliminate the manually intensive medication order entry requirements by Pipeline’s clinical telepharmacists. No one has monetized this fundamental sea change of clinical pharmacy distributed clinical workflow. CPOE for care providers is analogous to retail banking consumers inputting their own specific banking transaction requests at any remote ATM machine versus the labor intensive, facility centric legacy teller process. How does CPOE increase demand for telepharmacy? The care provider is now under a real time electronic audit, creates objective clinical workflow visibility. In addition, post CPOE, Pipeline as seen a 20-30% order increase per shift. For Pipeline, how significant an impact does this inbound integration have on the number of medication orders processed per hour? This inbound integration will allow a Pipeline clinical telepharmacist to increase by 50% their productivity without sacrificing any clinical quality or turnaround times from 30 to 45 medication orders per hour.
Pipeline confidential & proprietary materials18 CPOE Integration | Phase I and Phase II Pipeline Enters orders into client PIS Pipeline Enters orders into PipelineRx Pipeline Reviews order data Pipeline approves orders in client PIS Current Fax/scan Orders are already entered into client PIS Pipeline Enters orders into PipelineRx Pipeline Reviews order data Pipeline approves orders in client PIS CPOE No integration Orders are already entered into client PIS Orders already entered into PipelineRx Pipeline Reviews order data Pipeline approves orders in client PIS CPOE Integration Orders are already entered into client PIS Orders already entered into PipelineRx Pipeline Reviews order data Pipeline approves orders in PipelineRx Bidirectional Integration
Pipeline confidential & proprietary materials20 PipelineRx | CPOE Integration Progress Focus on Cerner, Meditech and McKesson Paragon – PIS vendors. Largest impact with CPOE and Gross Margin for current account installed base. First Client – Canton-Potsdam (New York) – April 1 – Meditech account. Detailed CPOE rollout roadmap schedule – see attachment.
Pipeline confidential & proprietary materials21 Integration GM Impact | Phase I and II Post-CPOE Fundamentally Reduce COGS/Order Improve GM Established IT Product Development Roadmap | 3 Phases Phase 1: Incremental operational efficiency gain via UI (underway) Phase 2: Inbound CPOE Integration Achieve 45 orders/hour Phase 3: Full Integration through Uberqueue One User Screen and 100% Clinical Work Flow Achieve 60 orders/hour COGS/Script | Targeted Cost Reductions Today: PipelineRx | $2.07/order | at maximum of 30 orders/hour Q4/Q1: Inbound CPOE Integration | $1.38/order | 45 orders/hour | a 33% cost decrease 2014: Uberqueue | $1.03/order | 60 orders/hour | a 50% cost decrease Remove actual costs – too sensitive and bankers and prospective clients (who are potential competitors) do not need to know until discussions get more serious and there is NDA)
Pipeline confidential & proprietary materials22 Pipeline’s Role in a Health System’s Viability Client Challenges Pipeline’s Audience Client’s Upside Client’s Downside Pipeline’s Value Proposition Meaningful Use: New technologies Process changes Behavioral changes C-suite CNO DOP Financial Incentives ↓ Reimbursement Assist: PIS eMAR/BMV/CPOE Cost-Effective: Hard 3:1 ROI Variable Costs Compliance: 24/7 Coverage Clinical Expertise: Exceed ASHP Guidelines Budget Reality: Real Constraints C-suite CFO IDN Consolidator ACO Environment ↑ Clinical Demands ↓ Financial Resources Regulatory & Accreditation: Joint Commission State Dept of Health MERP CNO DOP Brand RecognitionFinancial Penalties 24/7 requirements Best Practices: Patient safety Patient satisfaction C-suite CNO DOP Brand RecognitionBrand Risk
Pipeline confidential & proprietary materials23 CPO – Pharmacy – following the patient
Pipeline confidential & proprietary materials24 The Future of Telepharmacy Acute Care – multi-billion $ market Services Expansion - Day Work, ER Work, Discharge Planning Tactical – med reconciliation, rounding, remote monitoring, 24/7 Large System Opportunities (C-Suite) – CHS, Vanguard, CHI, Ascension, HMA New Distribution Channels CareFusion GPOs, Healthcare and Operational Consulting Firms Other telehealth providers and also national staffing firms Full Pharmacy Outsourcers – PharmaCare, CompleteRx Specialty Hospitals and Outpatient Opportunities Heart, Psych, and other focused hospitals Rehab, LTACs – HealthSouth, Select Medical All have meaningful use requirements and labor constraints Outpatient Long Term Care, Assisted Living, Home Care, Dialysis Outpatient pharmacies for hospitals Other important pharmacy settings for remote model Retail pharmacy Prison Systems State and Federal Organizations – large Mail Order/PBMs - ExpressScripts Acquisitions/Tuck-ins Both Pure Play mom/pop competitors and also Divisions of Larger Companies (CPS) Internal Telepharmacy Efforts within Health Systems – Adventist, Via Christi
Pipeline confidential & proprietary materials25 PipelineRx Core Assets: Technology PipelineRx IP and trade secrets Pipeline IT (Evolute) Uberqueue Proprietary Distributed Workforce Model Triage Home office based Highly experienced team of employee clinical tele-pharmacists State Legislative/Regulatory Experts Highest Quality Expert Pharmacists
Pipeline confidential & proprietary materials26 Benefits of PipelineRx’s Integration Into Larger Organization Resources for Uberqueue Bidirectional Integration True Marketing Dollars Access to Established Distribution Strategy and Salesforce Activates and Accelerates our Values in a Profitable Manner Bundling Complementary of existing services Complementary of future services SCALE Ensure Highest Level of Patient Safety to all Patients at Lowest Cost
Pipeline confidential & proprietary materials27 PipelineRx Partner Universe Spectrum Hospital Patient Care Outsourcing Players Patient Discharge/Homecare Drug Distribution Clinical Services A.B.C. Mckesson CFN Omnicell Cardinal CPS Walgreens CVS PipelineRx