Pocket Naloxone and the Business of Healthcare Innovation: Kathryn Bowsher

Meg welcomes Kathryn Bowsher, managing director of ActOne Healthcare, a consulting firm focused on commercializing healthcare innovations. Kathryn developed this expertise by launching more than 40 products and initiatives across a wide range of therapeutic areas, sites of care, and business models over the course of 25 years.

Kathryn is the co-founder, advisor to, and previous Chair of the Board of Pocket Naloxone, an over-the-counter opioid overdose treatment. 

In this episode, Meg and Kathryn discuss the challenges of getting Pocket Naloxone to market and the innovative delivery mechanism they developed. Kathryn emphasizes the importance of improving access, lowering cost, and reducing stigma associated with naloxone. She digs into the need to put patients at the center of healthcare by reducing complexity and cost for healthcare providers, and Meg asks Kathryn to share her extensive experience raising capital across her storied career.

Also discussed are many of Kathryn’s insights on healthcare challenges and opportunities such as issues with appointment scheduling and workflow, patient-centric approaches, information-sharing, telehealth, medication access, the persistence of old models of care, and educating stakeholders to further positive change. 

 

Further Reading:

• Consumer Meets Healthcare: Ted Talk
• Critical Questions for Rethinking Healthcare

Episode Credits: 

The Game-Changing Women of Healthcare is a production of The Krinsky Company. 

Hosted by Meg Escobosa. 

Produced by Meg Escobosa, Calvin Marty, Chelsea Ho, Medina Sabic, Markala Comfort, and Wendy Nielsen.

Edited, engineered, and mixed by Calvin Marty. 

All music composed and performed by Calvin Marty. 

©2024 The Krinsky Company

Creators & Guests

Host

Meg Escobosa

Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.

Producer

Calvin Marty

A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.

What is The Game-Changing Women of Healthcare?

The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.

Kathryn Bowsher: We started out with a model about the individual doctor who knows it all, lives in the small town of America…that responsibility for caring for your patient through the whole of life. They see them at church, they see them at the grocery store, and that model puts all the emphasis on the doctor. As healthcare evolved, we still built systems around enabling that individual doctor, even as we got specialists and big hospitals. And as each entity added on new services, you get more and more silos, more and more complexity, less and less individual control with this person, but in the beginning of all this, it was - that's our most expensive and valuable asset, so everything's done around their convenience.

Meg Escobosa: Welcome to the Game-Changing Women of Healthcare, featuring exceptional women making an impact in healthcare today. Together, we dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers.

I'm Meg Escobosa. Join me in conversation with some of the many brilliant and courageous women on the front lines of the future of health.

Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. A quick note before we get into today's episode, we are currently looking for sponsors for the podcast. If supporting and encouraging female leadership in healthcare is important to you or your organization, help us do that by becoming a sponsor of The Game-Changing Women of Healthcare. Reach our engaged audience with a mention by me in future episodes, or we'll produce a short audio spot for your organization. At The Krinsky Company, we believe in female and diverse leadership in healthcare. If that's important to you too, become a sponsor of the podcast and proudly share your values with the world.

Reach out to us at [e-mail], and thank you.

Today on the show, we have Kathryn Bowsher, who is Managing Director of ActOne Healthcare, a consulting firm focused on commercializing healthcare innovations. Kathryn developed this expertise by launching more than 40 products and initiatives across a wide range of therapeutic areas, sites of care, and business models over the course of 25 years.

She is the co-founder and an advisor to Pocket Naloxone, an over-the-counter opioid overdose treatment. Previously, she served as Chair of the Board for Pocket Naloxone, CEO of PurThread Technologies, VP of Marketing at Somnus Medical Technologies, and Director of Global Marketing for Baxter's largest product line. Hey Kathryn, welcome to the show!

Kathryn Bowsher: How are you today, Meg?

Meg Escobosa: Doing great. We're so happy to have you here. You really have quite a track record and really a lot of valuable experience for innovators to learn from, and I'm excited to talk to you about that. This experience, launching Pocket Naloxone, we'd love to hear in case people are not familiar with it - naloxone is a medication approved by the FDA to rapidly reverse opioid overdose. It's an opioid antagonist, right? That it binds against opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine and oxycodone. The epidemic of opioid use is huge. Can you tell us the experience of getting this product out into market and why you wanted to do it?

Kathryn Bowsher: It's one of those things that luck happens when you're doing other stuff. I got an email one day from someone I'd worked with on a pro bono project for Stanford Biodesign probably a dozen years earlier saying, “I'm starting a new company, I'm interested in getting your thoughts on it. Would you talk to me?”

I looked her up on LinkedIn because I couldn't actually put the face with the name. Realized that she was a Stanford GSB alum and a Princeton alum, which are my two schools. And it was a she, right? And so that's pretty much a moral obligation. You've got to say “yes” to helping another woman out and somebody who's got your school ties. That's it.

Meg Escobosa: Yeah, that's cool.

Kathryn Bowsher: And so I set up a phone call with her and I'm reading the one pager the day before, and I'm like, “Oh my God, this is so special.” She had this really elegant idea for solving real problems with relatively minor tweaks with an existing drug. It was incredible because what we did is we needed to stay outside the patent suite around the nasal sprays, which is how Narcan®, the brand best known, delivers naloxone.

That was a business challenge. You can't start a company where you're likely to get sued, and right then, the owners of Narcan® were suing all the competitor generics for the behind-the-counter product.

Meg Escobosa: The form factor.

Kathryn Bowsher: That's where the patent suite is because the drug itself was first approved in the 70s and generic in the mid-80s. So this was just 2019.

Meg Escobosa: Yeah.

Kathryn Bowsher: So the protective technology was the delivery mechanism. So she had come up with a new way of delivering the naloxone. And since the point was to solve access problems, she had designed something that would be significantly cheaper to manufacture.

Meg Escobosa: Yeah. Amazing.

Kathryn Bowsher: And then once you're into the business of getting it all to work, before you take it into the clinic, we were able to adjust the formulation for the change that's happened in the market where you've got fentanyl now in addition to all the others, which is faster acting. So we actually have a product and this has been made public in the Wall Street Journal already.

Our clinical results showed that we're 70 % more absorbed at two and a half minutes and 19% more absorbed at five minutes. I looked at that and here is a chance to improve access by going directly OTC, which was possible because of the safety profile of the drug and the fact that it was long generic at a lower cost. So reduce stigma, improve convenience, lower cost.

Meg Escobosa: Really nice.

Kathryn Bowsher: That’s like a triple win for impact.

Meg Escobosa: Absolutely.

Kathryn Bowsher: I looked at that and then I also looked at the fact that it was relatively low capital cost to get it through the FDA and onto the shelf and I was in.

Meg Escobosa: Awesome because typically if she was coming up with a new clinical solution, a new drug, that would have taken 10 to 15 years of development and huge costs, and so that alone is a huge barrier. What was the process that you had to follow to get it approved?

Kathryn Bowsher: So 505(b)(2) is an FDA pathway and it is a drug pathway at its core. And so you have to go through clinical trials, just like anybody else. But the nature of this is that it was the smallest number of patients because you're measuring PK profiles just in the first sequence, and it's not actually approved yet.

Narcan® has gotten switched to an OTC. We're just submitting at this point, because you have to go through all the manufacturing and everything else. So it is very much FDA certified. Like any new drug that hits either the pharmacy or the shelves in front of the pharmacy.

Meg Escobosa: So people can access this now or not yet?

Kathryn Bowsher: They can't access this one yet. If they're interested in getting naloxone over the counter, they can get it by buying the Narcan®. You can walk up to a pharmacy counter and private pay for it. If you want to go to a pharmacy counter and get it, anybody can get it. You can have it, I can have it, we can have it in our glove compartment, and you can get either the nasal spray or the injectable, depending upon what you're comfortable with and how cost sensitive you are. So increased availability of naloxone is something I support even without the new product that we're developing because it's a public good. So I'm happy for people to know about that.

We should all carry it. That is the goal that was reflected in the name of pocket naloxone. People die unnecessarily. We have a drug that works reliably, is safe. It wouldn't affect you if I gave it to you right now, and everybody can save a life.

Meg Escobosa: What are the key takeaways that you got from that experience?

Kathryn Bowsher: That was the ultimate “think about what problems you're solving very holistically”. It wasn't a new molecular entity, which I've done a lot of. I've done a certain number of new devices, totally new ways to treat things, but thinking about what impact you can make with smaller changes. And in this case, it was really more of a business model change, a cost structure change and then the delivery mechanism wasn't for a scientific end other than we needed something that would get the drug in because of the FDA pathway in a bioequivalent manner to what was already on the market. So we just designed around that problem.

Meg Escobosa: Were there any products that existed that kind of you modeled after? Did you look for inspiration?

Kathryn Bowsher: I was not overly involved in that design process. Credit fully goes to Ashanthi Mathai for that one. She was the CEO for 5 years and the original inventor of the device. There were pieces she took from different things, but it was just a lot of research of what achieves the bioequivalence, where can I pull something that will work that's not too expensive to do. And then we were lucky because the applicator is somewhat swab-like and everyone's a lot more comfortable with that. We started in 2019 and now everybody sticks swabs up their noses.
Meg Escobosa: Amazing. Honestly, I thought it couldn't have been better timed.

Kathryn Bowsher: Exactly. And then the other beauty of it is that she's designed something that we can use for other drugs that are nasally absorbed down the pike.

Meg Escobosa: Very cool. Yeah. Yeah.

Kathryn Bowsher: Once again, lowering cost of delivering well-established drugs to other people.

Meg Escobosa: Very cool.

Kathryn Bowsher: Yeah. It's an incredible lesson about how really looking at what the barriers are to the goal can help you solve it. So much more business model innovation and cost focused design, rather than you don't need a whole new drug.

Meg Escobosa: How big was the team? I mean, did you guys all brainstorm together? Was this just a little sort of inventor go off into their workspace and what was the creative process like?

Kathryn Bowsher: She had done a lot of work by the time she sought out my input on the basics of the design, what she thought in theory should work and checking out with the FDA what they thought about it and talking to scientific experts. So she brought in a ton of people already.

And then we had the next round of people, which is how do you build the business around it? How do you raise funding for it? How do you get it through the clinic? She wasn't operating in an isolated way.

Most small companies, particularly drug ones, you start out with a small core team and a bunch of experts that you're bringing in as advisors or consultants at different points in time because you don't need most of those.

You want the very best of the best. You don't need those best of the best on a full -time basis for multiple years. So the actual core team was pretty small at that point. At this point, as we're approaching go-to-market, which is a whole nother ramp up and development process, if you will, they're expanding the team significantly.

That's the last round that I just raised in the spring along, of course, with the help of others, you don't do these things, but we raised an up around series A and now that money is funding the growth of the team.

Meg Escobosa: Very cool. We know that fewer dollars go to women founders in healthcare specifically. How did you find that fundraising experience? What did you notice, and how did you get your resources?

Kathryn Bowsher: Yeah, I think in this particular case, you never know for sure, right? Well, actually, I take that back. I was going to say the women thing didn't make as much of a difference as some of the other challenges, but near the end, I was having a I-should-have-tried-this learning moment. So the biggest challenge for this was that we didn't fit the standard theses. So a biotech fund is in the business of technical and scientific risk, and I got into this because it had the lowest scientific risk, cost of, capital cost, etc., between this and FDA approval.

It just wasn't a fit for the average biotech fund. But then when I started looking at impact funds, consumer funds, medical device funds since the primary IP was medical device, none of those would take FDA drug risk.

Meg Escobosa: It's true. There's like, you're in a chasm. You're in your own category.

Kathryn Bowsher: And so we ended up mainly having to do high net worth, angel groups, etc., even for the series A.

The key was getting a couple of high net worth individuals who knew other high net worth individuals and gradually building it out from there. And I, one point I was looking at bringing in somebody who isn't traditionally in this space, runs an investment advisory group and someone I'd known since childhood, and he's like, “If you'd mentioned this to me before reunions, the two of us could have run around the tent at reunions for college,” because we went to college together. And he's like, “We could just run around and hit up all the people who come from family money in our college class. And we probably could have done this round over the weekend.”

But you know, that's, I think a little bit more of the cultural guy-to-guy, with no embarrassment about just knowing who has family money and going after it and that never occurred to me.

Meg Escobosa: It's interesting, actually.

Kathryn Bowsher: But in terms of not taking women seriously in the investment cycle, I didn't experience that directly, and I think because it was such a nonstandard thing, I've experienced it in other scenarios. The problem with pitching something more classic to more classic investors is that if the male VC doesn't get that problem, they have a tendency to think it's not a big problem.

I can remember one time calling out one of - a VC I had a good relationship with. I was pitching them a vaccine company, but it wasn't a new vaccine. It was a vaccine tracking app. And he's like, “What's the point?” And I'm like…

Meg Escobosa: That would be so useful.

Kathryn Bowsher: …”The wife would be the one.”

Meg Escobosa: It's so true. Manage the family vaccines. Yes.

Kathryn Bowsher: Yeah, there's a whole thread going on LinkedIn, like two weeks ago about the incredible things VC investors have said to founders of women's healthcare companies.

Meg Escobosa: Oh, I'm going to have to look at that. Yikes.

Kathryn Bowsher: Ask my secretary.

Meg Escobosa: Yeah. Yeah, exactly. Exactly. Oh my gosh. Wow. Yeah. So I'm happy to hear though, that you managed to find the resources. You didn't encounter too much, too many challenges. That's great.

Kathryn Bowsher: Oh, I wouldn't say not find, encounter challenges, but the challenges were not necessarily gender-based. It took us over a year. Yeah. And the final part of the round is being raised by a male investor who's taken on the chair of the role. But, you know, whatever works to get it to market.

Meg Escobosa: No, that's true. And actually, I mean, if you, do you, would you care to share any takeaways from that experience? You said, “Yes, had you known, you might have talked to some people earlier,” but were there other takeaways about raising the funds?

Kathryn Bowsher: I think the biggest thing is I would have figured out the family wealth earlier. The ability to convince the people with access to the right money is the key. And I tried a lot of other things because I didn't necessarily know who was that wealthy.

I was just more trained in standard pathways. Everything else I've ever worked with has been raised in a more traditional manner. So once again, everything's a learning journey. Every new experience is a learning journey. And this one, I'm not sure how much of it was gender influence. Lots of things in my life have been, but I'm not sure this one was one of them.

I do think guys are a little less shy about asking for it, but I think I've been doing it enough. This was not the first round I've been involved in raising. I'm comfortable asking for it. I'm less comfortable going to somebody I went to high school with who I know has family money and asking for it.

But I'm comfortable asking for money. Because, I mean, this was an interesting one. You had to be able to defend. There are so few people specialized in this space that I was asking for the money. So I'm asking people who want a double bottom line and don't know the space.

And so the stigma around the space, there were a lot of things I had to answer. And then the other interesting thing I had to answer, because we were a for-profit company, And we intend to be, and I think that's important. I think people should understand that things have to be financially viable to be sustainable.

Part of the issue is that right now, most naloxone gets purchased with grant money. We can't. endlessly increase grant money to get that supply up, right? So it has to be something other people can buy more easily, which argues for a for-profit company. But we are planning to price for access. That's where we see the growth opportunity. So that's just putting on your MBA hat and saying the growth opportunity is significantly widening the market at a reasonable margin.

Meg Escobosa: Absolutely. I mean, you just, what we were saying, the number of people who need it is enormous. It's a huge market.

Kathryn Bowsher: But answering everybody's questions about moral jeopardy, if you make it easier to revive while people take more risks, then is that bad? How do these people, can they actually afford, can the average junkie afford to buy it at Walgreens? Right. Or even theft risk. But the thing is, most people with opioid misuse disorder are not junkies. They're people with chronic pain who have ended up addicted.

Meg Escobosa: All you have to do is look at the number of prescriptions written in a year for opioids. I mean, that's a huge number. It's like, it's a crazy statistic. It's like five scripts per person.

Kathryn Bowsher: And opioids, you develop tolerance. Trivia I picked up when my husband was with a pain company looking for a non-opioid alternative for neuropathic pain.

Meg Escobosa: Wow. So your worlds overlapped.

Kathryn Bowsher: Oh yeah. We have some interesting dinner table conversations.

Meg Escobosa: Yeah, I'm sure.

Meg Escobosa: Pulling the camera back a little bit. Can you tell us like, why do you think it is so hard to bring new products and solutions to market? And what would your advice be to future entrepreneurs who want to do medical or clinical products?

Kathryn Bowsher: Okay, I talk about healthcare sometimes as an ossified hairball.

Meg Escobosa: That's a new one, yeah.

Kathryn Bowsher: We started out with a model about the individual doctor who knows it all, lives in the small town of America and sees his, and back then it was his, because we're talking about, about 1914 was when they formally, I believe that's the right date, formally coined the model, which was used in the professionalization of med schools.

And it's about that responsibility for caring for your patient through the whole of life. They see them at church, they see them at the grocery store, etc., and that model puts all the emphasis on the doctor. Doctors caring all the way for everything. As healthcare evolved, we still built systems around enabling that individual doctor, even as we got specialists and big hospitals.

And now we have hospice, and outpatient and the surgery centers. And as each person or entity added on new services, you get more and more silos. More and more complexity, less and less individual control resolving with this person. But in the beginning of all this, it was, “that's our most expensive and valuable asset, so everything's done around their convenience,” right? But then you want to fix something. And then you layer in the complexity of reimbursement in this country. And then you layer on all these other things, and so you've got all this tangled complexity. And then we want to go for control and safety. And we have all these checklist protocols and quality controls and stuff like that, and that's what I think of as the ossifying factors.

Meg Escobosa: Yeah.

Kathryn Bowsher: So you've got this brittle, tangled mess. of pieces of unintended consequences, adding on good intentions gone awry because you solved this problem without any thought about the ripple effects. And so when I watch people coming in to solve their problem that they experienced with the healthcare system, you really got to think holistically.

First of all, about what's going to solve it. Is it a new drug? Is it a better communication system? How does that fit into the business model? What is the root cause of whatever unpleasantness you experience? This is particularly for people from outside the industry, which we have a lot of nowadays with the growing consumerization.

And for people inside the industry, you gotta understand beyond your experience of it. Right? Because what you do for this specific oncology patient has impacts on all the rest of their life. And there are a lot of things that don't require a new drug or a whole new surgical procedure. And how do you marry up the different pieces of technology?

And you better have experts who are expert in more than one type of technology, more than one piece of the science, or more than one piece of the therapeutic area because, and this is partially my bias, I've done a wider range than most people. I didn't come up with a very linear siloed track. I see models that have worked in different settings that are similar that I can pull from. And I see people who have a hard time getting outside of their traditional box because it's never been done that way. They're not allowed to do this piece of it. And what we have is a very Ptolemaic system, and I had to look that word up the first time somebody put it in a survey that I had written.

Meg Escobosa: Define it for us, yeah.

Kathryn Bowsher: Ptolemy is the philosopher who believed that the sun revolved around the earth, okay? And as the science was coming up that suggested that the earth revolved around the sun, the people who followed Ptolemy, did all sorts of weird things trying to prop up the rightness of their answer.

Meg Escobosa: Oh yeah, gosh, that sounds so familiar.

Kathryn Bowsher: So think about the weird things that happen in healthcare today because it's all supposed to center around the hospital. How many people are trying to go backwards on the, you can do that at home. You can do that by video.

Meg Escobosa: Yeah. We think of it as antibodies to innovation.

Kathryn Bowsher: Exactly or unity to change. So, a lot of that is very Ptolemaic. Why wouldn't you come and get your lab work at UCSF because the results will be available in an hour to your doctor vs. go to the LabCorp where you can be in and out in half an hour parking on the block the day before. Because all you need is for your doctor to call you that night and say, yeah, you're good to go. Start the next round of the drugs tomorrow.

Meg Escobosa: So you have described this ossified hairball as an incredible analogy. So with the increasing complexity of healthcare, how do we put the patients in the center? I know that's something that you really care about. You talk about this. How do we do that?

Kathryn Bowsher: Unfortunately, a step at a time, people who go into the practice of medicine went into it to help patients. When I look at a commercial assessment of some sort, how are we going to take this to market? How, who's really going to buy this, pay for this, prescribe it, etc, so that we can make a business out of this if I'm evaluating an investment or something like that.

What you quickly realize is that you got multiple stakeholders. with pieces of the problem. New solutions get designed around the macro problem, or they get designed around someone's personal experience of the problem, one of the two. And then everybody who needs to adapt and adopt has their own personal, more micro experience of the problem.

Think blind people and the elephant. If you're trying to make change happen, You have to understand what the change lift is across the landscape. And what I have found over the years is that what you have to do is break down the change and the effort of change and the tasks. And hopefully substitute rather than add, which all too often is part of the experience, and you have to get it as small as you can. So there's the least changelift possible for each of the people. And then you have to be able to tell that stakeholder profile how they're doing that better serves the patients they see, because if they know that they will do it. So there's a lot of stuff where people assume you have to pay the doctor or pay the clinic to do something like there has to be higher reimbursement or there has to be an additional kind of get paid for. And in a lot of cases, there's enough work that yeah, you got to have that because otherwise you're asking them to go economically backwards, but if you can just be economically neutral and it's good for the patient, I've never seen anybody not make the effort. We're not motivated by being paid extra. What they can't afford to do because of all the cost pressures they're under, no matter where they are in the system right now, or workload pressures, they can't afford to do extra stuff easily. And so you have to make sure that it's not going to have a hidden cost, even if it looks like it's cost-neutral on the surface.

Meg Escobosa: That's a great point. Yeah.

Kathryn Bowsher: That's the way to think about it. I've never met someone who went into medicine as some place in the clinical chain, or even most office managers, if they're dedicating their time and energy, they're there to do right by the patient, they want to help.

And so if you just can reduce the stress and complication and cost, and explain to them why this piece contributes to the whole. Then they usually do it.

Kathryn Bowsher: So in healthcare, I see culture and process in both strategy and good intentions. I've had to schedule some complicated stuff recently, personally, and I've been astounded at how little the person scheduling this stuff understands about scheduling outside of this academic medical center.

And, I mean, really basic stuff to the extent where one time they'd moved the appointment once and I didn't know about it and then they tried to move it again, luckily. Because they're like, we want to move your nine o'clock to one o'clock. I'm like, I don't have a nine o'clock. I've got an 11. Are you calling the right patient? And they're like, “Yeah, it is. Let's verify your birth date yet again.”

Meg Escobosa: Amazing. Amazing.

Kathryn Bowsher: And I'm like, yeah, can you just send me a calendar item? They're like, “Well, you have access to Epic.” I'm like, “Yes, I can go in and I can download the static item that you've obviously already changed without forgetting to notify me.”

Epic - it's only your workflow. It is nobody else's workflow. And trapped time is a problem. We've got all your appointments on one day, so you only have to drive over here once. I'm like, “Yeah, but you've got an hour and a half between this one and two hours between that one.”

Meg Escobosa: Yeah. No, not helpful.

Kathryn Bowsher: And so that kind of stuff, it's something that I hope everybody picks up on over time. And all of us who are trying to make change happen need to have a kind and patient attitude in the education, but we also need to remember that the training is Ptolemaic. We all need to remember that they're doing their best. They need to remember that the rest of the world's workflow and life does not revolve around the hospital.

Right? And that's a big one. I'm a breast cancer survivor. I can remember one time. Being in a waiting room at my oncologist, where I was always the healthiest person there. Because I was lucky, it was caught early.

Public service announcement, if you're behind on your mammograms or your colonoscopies, go get them. Checking them early is the key. And I was furious because somebody had scheduled me for a 30 second blood test, a finger prick, 45 minutes before my doctor appointment because that was the only 15 minute time slot that they had available in the lab outside the doctor's office. And that's the way their scheduling system worked. And while I'm sitting there fuming, I watched this poor guy pulling his IV pole with him and begging the receptionist to get his next doctor's appointment so that he doesn't have four hours between his next chemo session and the doctor's appointment. And they keep saying they can't. And so there's a whole education on the clinician side that needs to happen, that the world doesn't really revolve around them.

Meg Escobosa: Yes.

Kathryn Bowsher: But you need a kindness because their intentions are good.

Meg Escobosa: And they themselves are overwhelmed, too. So it's true.

Kathryn Bowsher: Physician burnout, etc. And that's why I'm so excited about a lot of these new models. of care that move care closer to the patient is because once you get them rolling, they open up new possibilities. And that's another one of the things I do in addition to thinking about how you break down the micro and reduce the change load.

Meg Escobosa: Yeah.

Kathryn Bowsher: Across all stakeholders and position in the middle, all those classic marketing things they teach you in school. The other thing is I always try and position whenever I can. That it also opens up new possibilities to you, more time with the patient, the benefit of accounting for what's going on in their home life.

Meg Escobosa: Yeah.

Kathryn Bowsher: Things like that because like I said, it all comes back to, they really want to just spend their time with the patients. Number of times I've heard, and I bet you've heard it too. I got an MD, not an MBA. They're overwhelmed by the complexities introduced by the payment models and the other stuff.

Meg Escobosa: Absolutely. Yeah. So I like your framing. It opens up new possibilities. It's a great way to think about it.

Kathryn Bowsher: I had a conversation about video health with a friend of mine who's a pediatrician and he specializes in trans and other gender, non binary care these days. And he's like, “If I could do more things by video, I wouldn't need an office full time. I could have my own independent practice vs. being in the office all the time and things like that.” So it opens up new possibilities for them too. But framing it so it's not just more. And that's on the business people and the cycle.

Meg Escobosa: Yeah.

Kathryn Bowsher: And the other thing that I've seen in the, on that business people cycle thing, I've been in conferences where we're like, “We should have patients represented here,” and I'm like, “Patients are us. Bring your patient to the boardroom with you.” I can still remember one time hearing someone say, and I won't name her, “Consumer health doesn't matter until the patients are writing the check.” And then the next minute I know she's stepping out of the meeting to take a call because she's got an aging parent with a healthcare question, and I'm like, “Bring those experiences in here and think about how you solve the problem.”

Meg Escobosa: Yeah. Good. Great. Now you, this week is JPM in San Francisco, JPMorgan Health Conference. You were out and about, I'm sure connecting with folks. What was your experience and what did you hear most, what were the questions that you heard most?

Kathryn Bowsher: The question I heard most is, “What do you think, because I was talking so much about moving care closer to the patients, what do you think about Lilly's move going direct to the patient with her own telehealth for the Ozempic?“

Meg Escobosa: Oh, wow. That makes sense. Yeah. What do you think? What is your take on that?

Kathryn Bowsher: I think it's really fascinating because it gets back to the how do you think about and frame the problems. It is making it more accessible for patients who can't get into a doctor to prescribe it for whatever reason, be it the time, be it they don't have a primary care, they're on a wait list, it's two months even if they do have a primary care, whatever the issue is, it's solving that access problem.

It's trying to address cost by making it available for those without insurance at a lower price point than it currently would be. And it's cutting costs out of the chain. If you think about all the middle people in the normal chain, so that Lily can make potentially the same amount of money while charging the consumer less.

The risk issue is how much side effect management and monitoring are you able to achieve in that setting?

Meg Escobosa: Are people self diagnosing? I mean, is that what's also going on? I mean, the assumption is the reason that people want Ozempic is that there's a group that need it for obesity and there's a group that believe they need it for weight loss pre-diabetic or not at risk, but just more weight management. Would you agree with that?

Kathryn Bowsher: Yes. There are definitely segments that want it. I think the biggest risk factor is the managing of the side effects because I've known one or two people personally who've taken it. The side effects are meaningful, and so do you have a good setup for accessing and do people call their video provider of this script or a video provider about their side effects?

So that'll be the thing that's a risk. Now then there are other companies already doing this by video, right? This is an area where I think we're going to learn somewhat the hard way and regulation will follow. So patients, even if they're not paying directly for their care, have more of an impact on outcomes and cost than people initially think because they don't see the cash transaction.

Is a patient more likely to call a doctor they've had an in person relationship with or a video service if they're experiencing side effects, right? That's an adherence, safety management, risk liability issue that the patient controls ultimately.

And a certain amount of the controls that make healthcare brittle are our efforts to limit the patient's ability to do something that we might end up holding the bag for financial liability or guilt, right? And not a lot of trust in the patients to do the right thing. I've fascinatingly learned at a health tech for Medicaid had a great seminar at JP Morgan, and they talked about the fact that the people who are lower income, often on Medicaid, who have to take three buses to get to their doctor's appointment get coded oftentimes in Epic as likely to no show and then get automatically double booked. So then these people are the ones waiting longer in the waiting room for whom it's more of a problem because they've had to take off work they can't afford to take off from anyway.

So it's understanding how you create incentives, not necessarily cash-based, for everybody in the cycle. Patients too. We are affected as a business, as a hospital, as a practice of whatever, when patients and on outcomes and outcomes are factoring more and more into payment metrics. Patients need to learn to communicate with clinicians in ways that are useful and show up for appointments and stuff like that, but also, clinicians need to understand that the system has created a lot of disincentives for the behavior they want and that these have outcome costs and economic costs for both sides if you don't get that connection. And so everybody accepting that moving forward with better intentions, and that's very Pollyanna, but those of us who are in the change making business, I feel like a responsibility to help educate everybody on how we put that together.

Meg Escobosa: Really nice, Katherine. I so appreciate you taking the time to be on our show today. This has been a great, a really great conversation. I really appreciate your work and I'm excited to see what you do. And where can people find you if they want to find out more about ActOne Healthcare?

Kathryn Bowsher: It's www.ActOneHealthcare.com.

Meg Escobosa: Fantastic. It's pretty simple.

Kathryn Bowsher: Yeah. Do spell “one” O-N-E and don't put a digit in.

Meg Escobosa: Okay. Awesome. And we can find you on LinkedIn, of course, as well.

Kathryn Bowsher: Yes. LinkedIn is always great because that goes with me no matter what.

Meg Escobosa: Yes. You have been really passionate about making change in healthcare. It's clearly a theme of your work and your career, and it's just really delightful to hear your practical experience, your insights, and your takeaways. So thank you for sharing that with us on the show today. It really is great.

Kathryn Bowsher: My pleasure. Thanks so much for having me.

Meg Escobosa: Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho Medina Sabich, Wendy Nielsen, and me, Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts. It really does make a difference and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions, please email us at [e-mail] and visit us on the web at www.thekrinskyco.com.

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