WEBVTT 00:00:00.000 --> 00:00:02.740 I think the long -term view, and we raised 44 00:00:02.740 --> 00:00:04.519 million bucks, we're solving for that big of 00:00:04.519 --> 00:00:08.539 a problem. The long -term view is around setting 00:00:08.539 --> 00:00:11.500 yourself up to a sustainable arrival to profitability 00:00:11.500 --> 00:00:15.279 that lets you solve a significant enough problem 00:00:15.279 --> 00:00:18.140 that affects people's healthcare more so than 00:00:18.140 --> 00:00:20.399 it does their lifestyle. And if you can do that 00:00:20.399 --> 00:00:23.219 well, you'll get private pairs paying attention 00:00:23.219 --> 00:00:25.079 to you. You'll get, of course, patients paying 00:00:25.079 --> 00:00:26.179 attention to you because you're going to help 00:00:26.179 --> 00:00:28.320 them live better. And then, of course, employers. 00:00:28.730 --> 00:00:31.350 you know, and the path to scale for any digital 00:00:31.350 --> 00:00:33.530 healthcare company, which is through B2B, will 00:00:33.530 --> 00:00:35.929 also start paying attention. Hi, everyone. I'm 00:00:35.929 --> 00:00:38.109 really excited to talk to Kareem today. I've 00:00:38.109 --> 00:00:41.570 known Kareem for two years. I'm always impressed 00:00:41.570 --> 00:00:45.210 by his diligent and inquisitive nature. We have 00:00:45.210 --> 00:00:47.350 had countless discussions about healthcare. I'm 00:00:47.350 --> 00:00:50.409 happy that I get the opportunity to share some 00:00:50.409 --> 00:00:54.409 of them with you today. Kareem is the ex -CEO 00:00:54.409 --> 00:00:58.600 and co -founder of MedNow. where he took MedNow 00:00:58.600 --> 00:01:01.659 public at 150 million market cap after raising 00:01:01.659 --> 00:01:05.239 $44 million. Thanks so much for joining me, Kareem. 00:01:05.239 --> 00:01:09.200 Excited for this? To get started, let's dwell 00:01:09.200 --> 00:01:11.780 a little bit into your childhood. There are things 00:01:11.780 --> 00:01:13.859 we learned from our childhood which help us, 00:01:13.859 --> 00:01:15.920 and there are things we have to at times unlearn 00:01:15.920 --> 00:01:18.640 from our childhood. Just talk to me a bit about 00:01:18.640 --> 00:01:21.260 your childhood and if you could answer the questions 00:01:21.260 --> 00:01:25.219 I posed in that framework as well. Well, I had 00:01:25.219 --> 00:01:31.870 a fairly I guess a child that had a lot of change 00:01:31.870 --> 00:01:36.150 in it. I was born in Europe, and then we moved 00:01:36.150 --> 00:01:39.469 to the Middle East, the Emirates specifically. 00:01:40.650 --> 00:01:44.409 And I pretty much grew up there, at least until 00:01:44.409 --> 00:01:50.310 I was about 15 before coming to Canada. And then 00:01:50.310 --> 00:01:52.790 while I was in the Emirates, for whatever reason, 00:01:52.930 --> 00:01:56.319 my folks They're both academics so they were 00:01:56.319 --> 00:02:00.519 very attentive to the education that myself and 00:02:00.519 --> 00:02:04.299 my twin sister in this case were getting. So 00:02:04.299 --> 00:02:06.299 almost every two years we were changing schools. 00:02:07.400 --> 00:02:09.360 So one of the notables probably about my childhood 00:02:09.360 --> 00:02:11.900 is that I never really kept a very consistent 00:02:11.900 --> 00:02:16.879 friend throughout it. It did eventually happen 00:02:16.879 --> 00:02:19.990 when I went to... public schooling system for 00:02:19.990 --> 00:02:22.750 a couple years and the friends I made in that 00:02:22.750 --> 00:02:26.090 school are people that I still know today. I 00:02:26.090 --> 00:02:29.009 don't know anybody from my other schools that 00:02:29.009 --> 00:02:32.310 were, you know, just, you know, the nature of 00:02:32.310 --> 00:02:33.990 being an Emirates is if you wanted to learn English 00:02:33.990 --> 00:02:35.590 you have to go to a private school. So there's 00:02:35.590 --> 00:02:37.889 not the same concept of a private school as you 00:02:37.889 --> 00:02:40.900 would in North America. But yeah, anybody who 00:02:40.900 --> 00:02:43.580 I would have went to school with in these in 00:02:43.580 --> 00:02:45.979 that environment I I've totally lost contact 00:02:45.979 --> 00:02:48.699 with so I don't know what that says about me 00:02:48.699 --> 00:02:51.719 or what it means in terms of the context of education 00:02:51.719 --> 00:02:55.479 But probably the one thing that was unique and 00:02:55.479 --> 00:02:57.639 different between private and public was that 00:02:57.639 --> 00:03:01.020 public schools were All boys or all girls just 00:03:01.020 --> 00:03:03.919 by the nature of the country. And so there was 00:03:03.919 --> 00:03:06.840 definitely a lot more of a camaraderie Aspect 00:03:06.840 --> 00:03:09.280 to it. It was this idea that you know Boys will 00:03:09.280 --> 00:03:12.280 be boys and things that you'd never really experience 00:03:12.280 --> 00:03:14.819 as much in the co -ed environment that the private 00:03:14.819 --> 00:03:18.300 schools, they're provided. And the other part 00:03:18.300 --> 00:03:20.120 of it is I've always loved to put things together. 00:03:20.419 --> 00:03:23.020 I've always been, and it's probably what inspired 00:03:23.020 --> 00:03:26.780 me to be an engineer. So Lego and technique and 00:03:26.780 --> 00:03:32.240 all that stuff. Also, I did a fair bit of selling 00:03:32.240 --> 00:03:35.159 things. So I would find random things around 00:03:35.159 --> 00:03:38.419 the house. set them up somewhere and try to sell 00:03:38.419 --> 00:03:42.719 them. I had my little mini garage sales, which 00:03:42.719 --> 00:03:46.919 eventually actually played into some of my entrepreneurial 00:03:46.919 --> 00:03:50.759 itch, if you will. I've always fancied the idea 00:03:50.759 --> 00:03:55.199 of selling something for a markup. And so even 00:03:55.199 --> 00:03:57.659 going through university, I had a side business 00:03:57.659 --> 00:04:01.780 on eBay. that was of the same context, just the 00:04:01.780 --> 00:04:04.659 idea of making a product really appealing, buying 00:04:04.659 --> 00:04:07.659 it at a great price and then selling it at a 00:04:07.659 --> 00:04:10.560 fantastic markup, which is a lot what you get 00:04:10.560 --> 00:04:12.639 to do in pharmacy. So, you know, kind of a full 00:04:12.639 --> 00:04:16.160 circle moment for me for where I landed. Do you 00:04:16.160 --> 00:04:18.839 think entrepreneurship is innate or can it be 00:04:18.839 --> 00:04:22.620 taught? I think there's a certain aspect of it 00:04:22.620 --> 00:04:25.759 that's innate. And then when I say innate, it's 00:04:25.759 --> 00:04:29.600 more in terms of where you What experiences you 00:04:29.600 --> 00:04:32.160 had growing up such your question around childhood? 00:04:32.220 --> 00:04:35.439 I mean again my folks were academics, so they 00:04:35.439 --> 00:04:39.839 weren't of the entrepreneurial nature but my 00:04:39.839 --> 00:04:44.420 grandparents were mostly in trade and so I think 00:04:44.420 --> 00:04:48.560 some aspect of that carried over into them and 00:04:48.560 --> 00:04:51.860 Maybe that's what I picked up in terms of the 00:04:51.860 --> 00:04:54.639 encouraging somebody to go and again You know 00:04:54.639 --> 00:04:56.600 entrepreneurship a big part of is around selling 00:04:57.300 --> 00:05:01.600 and having the comfort to sell things. So in 00:05:01.600 --> 00:05:04.379 many ways, I think that I definitely picked up 00:05:04.379 --> 00:05:06.579 from just encouragement. Yeah, that's something 00:05:06.579 --> 00:05:09.180 you should do. I think if my folks were a little 00:05:09.180 --> 00:05:13.879 bit more inclined to be pure academics, sort 00:05:13.879 --> 00:05:17.379 of the traditional view of academics where just 00:05:17.379 --> 00:05:19.620 go to school, get good grades, and that's all 00:05:19.620 --> 00:05:21.819 you worry about. I probably would have landed 00:05:21.819 --> 00:05:23.839 somewhere different. So that's the only aspect 00:05:23.839 --> 00:05:25.500 of it that's innate. But the rest of it, I think, 00:05:25.600 --> 00:05:28.160 is taught in experiences, whether it's in your 00:05:28.160 --> 00:05:30.959 home or in your friends or eventually in your 00:05:30.959 --> 00:05:34.939 career and your work experience. We had very 00:05:34.939 --> 00:05:37.939 similar childhoods. I was in my 17th home by 00:05:37.939 --> 00:05:42.339 the time I graduated high school. Yeah, it was 00:05:42.339 --> 00:05:44.360 a lot of moving around. My parents were academics 00:05:44.360 --> 00:05:47.360 and we moved from India when I was 16. It taught 00:05:47.360 --> 00:05:50.949 me. how to be adaptable. It taught me to be very 00:05:50.949 --> 00:05:55.730 comfortable with change, but it did have me missing 00:05:55.730 --> 00:05:59.069 a sense of home and a sense of grounding. Do 00:05:59.069 --> 00:06:00.970 you find that as well? And if so, how did you 00:06:00.970 --> 00:06:04.290 find your sense of home and grounding? Yeah, 00:06:04.709 --> 00:06:09.029 it's funny that the symmetry in our life is quite 00:06:09.029 --> 00:06:12.029 shocking. I never knew that about you. Yeah, 00:06:12.069 --> 00:06:15.750 I mean, I would say the grounding has become 00:06:16.620 --> 00:06:20.779 was probably an issue when I was making the move 00:06:20.779 --> 00:06:24.339 to Canada getting to know people here and having 00:06:24.339 --> 00:06:26.899 friends that were in a lot of cases just also 00:06:26.899 --> 00:06:30.439 immigrants like myself and so when I finally 00:06:30.439 --> 00:06:34.800 made it to university I probably that's when 00:06:34.800 --> 00:06:36.560 I was starting to feel a bit more stability in 00:06:36.560 --> 00:06:39.000 my group of friends and so forth but then you 00:06:39.000 --> 00:06:41.560 know shortly after university I was off doing 00:06:41.560 --> 00:06:45.050 my MBA and Kingston, Ontario, and then upon returning 00:06:45.050 --> 00:06:47.689 from there, I was on my way back to, I was on 00:06:47.689 --> 00:06:49.629 my way back east heading to France in this case, 00:06:49.629 --> 00:06:52.089 and I worked there for a little bit. So, yeah, 00:06:52.089 --> 00:06:54.449 then back to Canada, but not to Toronto, to Alberta. 00:06:54.589 --> 00:06:56.490 So there's, you know, there's always this movement 00:06:56.490 --> 00:06:59.050 in my life throughout. And so it's not only until 00:06:59.050 --> 00:07:02.769 very recently, when I got married, and now I 00:07:02.769 --> 00:07:04.910 have two beautiful girls, you know, five and 00:07:04.910 --> 00:07:07.610 three, that that sense of being grounded, I actually 00:07:07.610 --> 00:07:11.709 find it in them. And then sort of the idea of 00:07:12.290 --> 00:07:15.709 the purpose of being a father, if you will, to 00:07:15.709 --> 00:07:19.990 really get that sense of security, that that's 00:07:19.990 --> 00:07:23.389 a constant. That's very difficult to change, 00:07:23.449 --> 00:07:25.149 you know, God forbid anything would happen, but, 00:07:25.149 --> 00:07:27.329 you know, they're always gonna be there as long 00:07:27.329 --> 00:07:29.930 as you're there. And I think that's probably 00:07:29.930 --> 00:07:33.209 one of the ways that I really maintain that sort 00:07:33.209 --> 00:07:34.829 of sense of groundedness. And then, you know, 00:07:34.910 --> 00:07:38.689 others, I think I'm generally spiritual, so taking 00:07:38.689 --> 00:07:42.790 the time to be grateful for what you have and 00:07:42.790 --> 00:07:44.750 just being content with what you got. That also 00:07:44.750 --> 00:07:47.709 creates a sense of stability and grounding that 00:07:47.709 --> 00:07:52.250 I find quite helpful. Let's move forward in time 00:07:52.250 --> 00:07:54.870 to starting MedNow. Talk to me about how that 00:07:54.870 --> 00:07:57.870 idea came to you and how did you get the team 00:07:57.870 --> 00:08:00.430 together and how did you launch the company? 00:08:01.750 --> 00:08:03.470 So that's a very big question. I'll start with 00:08:03.470 --> 00:08:07.420 the idea and how it came to me. So after spending 00:08:07.420 --> 00:08:11.240 some time doing home healthcare, which was specifically 00:08:11.240 --> 00:08:13.920 around the sale of medical devices to support 00:08:13.920 --> 00:08:16.480 patients that have a sleep disorder called sleep 00:08:16.480 --> 00:08:20.879 apnea, and more importantly, home oxygen, which 00:08:20.879 --> 00:08:26.120 is the therapy of oxygen supplement to patients 00:08:26.120 --> 00:08:30.040 that normally have a condition called chronic 00:08:30.040 --> 00:08:34.580 obstructive pulmonary disorder, COPD, and what 00:08:34.580 --> 00:08:37.450 really The challenge there was about bringing 00:08:37.450 --> 00:08:42.129 these medical devices or these essentially flammable 00:08:42.129 --> 00:08:44.730 gases that are compressed in cylinders to people's 00:08:44.730 --> 00:08:48.470 homes, in this case all over Canada, where I 00:08:48.470 --> 00:08:50.669 work in that business so that they can continue 00:08:50.669 --> 00:08:52.909 to live as long as they can and maintain their 00:08:52.909 --> 00:08:55.330 activities of daily living as well as they can. 00:08:56.210 --> 00:08:59.830 What I was able to do after that was to join 00:08:59.830 --> 00:09:02.779 McKesson in a strategy role. So McKesson is one 00:09:02.779 --> 00:09:04.779 of the largest wholesalers and distributors of 00:09:04.779 --> 00:09:08.379 pharmaceuticals in the world. I came in to primarily 00:09:08.379 --> 00:09:12.480 support all that is retail banner programs, so 00:09:12.480 --> 00:09:15.960 what McKesson puts out to retail pharmacies in 00:09:15.960 --> 00:09:18.340 terms of a support program that has to do with 00:09:18.340 --> 00:09:21.820 marketing, more principally buying the generics 00:09:21.820 --> 00:09:25.299 that they use, marketing, and all the things 00:09:25.299 --> 00:09:28.419 that relate to operating a pharmacy profitably. 00:09:28.639 --> 00:09:31.080 So that was one focus of mine. The other focus 00:09:31.080 --> 00:09:35.139 was specialty pharmacy, which is expensive drugs 00:09:35.139 --> 00:09:38.500 that require a high -touch model of care, usually 00:09:38.500 --> 00:09:40.580 requiring an intervention of a nurse or a case 00:09:40.580 --> 00:09:43.879 manager and delivery to home. So there was a 00:09:43.879 --> 00:09:46.159 certain parallel from being in the home oxygen 00:09:46.159 --> 00:09:49.379 business to being in specialty. And then finally, 00:09:49.480 --> 00:09:51.639 I was also quite involved in M &A activities. 00:09:52.399 --> 00:09:55.159 Around the time McKesson bought Remedies RX, 00:09:55.980 --> 00:09:58.980 there was the shoppers divestment of their assets 00:09:58.980 --> 00:10:01.840 when Loblaws bought them. So I was involved in 00:10:01.840 --> 00:10:04.460 leading some of these deals into the way they 00:10:04.460 --> 00:10:06.840 were sold, either to members, in the case of 00:10:06.840 --> 00:10:10.519 shoppers, members of McKesson's banner, or into 00:10:10.519 --> 00:10:13.559 the acquisition of Remedies RX, in which case 00:10:13.559 --> 00:10:16.899 that was the moment McKesson... officially entered 00:10:16.899 --> 00:10:20.379 being a retail pharmacy operator and competing 00:10:20.379 --> 00:10:23.220 with their own customers of wholesale, who at 00:10:23.220 --> 00:10:26.960 that point were always uniquely the only consumer 00:10:26.960 --> 00:10:31.559 of their wholesale services. So that was the 00:10:31.559 --> 00:10:34.480 exposure I had to the community pharmacy model. 00:10:35.059 --> 00:10:37.460 And throughout I just realized, even through 00:10:37.460 --> 00:10:40.159 the Banner programs, there was never really much 00:10:40.159 --> 00:10:43.120 technology. Everything was still very much in 00:10:43.120 --> 00:10:47.090 analog mode. the pharmacist and the patient would 00:10:47.090 --> 00:10:49.210 only be able to communicate when they're together 00:10:49.210 --> 00:10:52.029 in the pharmacy, the pharmacist on one side of 00:10:52.029 --> 00:10:54.570 the counter and the patient on the other. And 00:10:54.570 --> 00:10:56.350 it's when I was really inspired to think, well, 00:10:56.470 --> 00:10:58.830 there should be a way to to kind of advance this 00:10:58.830 --> 00:11:03.149 to the mode of Amazon e -commerce, Uber dinners 00:11:03.149 --> 00:11:05.929 and taxis and all the things that we started 00:11:05.929 --> 00:11:07.690 taking for granted in terms of how everything 00:11:07.690 --> 00:11:11.029 is available through our phone. And even at the 00:11:11.029 --> 00:11:13.970 time, I pitched McKesson on a an app so they 00:11:13.970 --> 00:11:16.629 can have a long -term relationship with their 00:11:16.629 --> 00:11:18.830 patients, or specifically that their band members 00:11:18.830 --> 00:11:20.570 can have a relationship with their patients once 00:11:20.570 --> 00:11:24.269 they've left the pharmacy. And in the typical 00:11:24.269 --> 00:11:28.370 large -corp notion, they liked the idea, but 00:11:28.370 --> 00:11:31.230 they weren't willing to risk being the ones to 00:11:31.230 --> 00:11:33.769 create it. So I decided I wanted to create it. 00:11:34.129 --> 00:11:36.389 And that's the inspiration for MedNow. MedNow 00:11:36.389 --> 00:11:38.509 itself didn't happen until a few years later, 00:11:38.509 --> 00:11:40.590 two or three years later. But it was definitely 00:11:40.590 --> 00:11:43.500 the bug and the seed that was put in my mind 00:11:43.500 --> 00:11:46.100 at the time to recognize the opportunity there. 00:11:47.639 --> 00:11:50.200 And what was the business model you had in mind 00:11:50.200 --> 00:11:52.600 when developing this connection between pharmacists 00:11:52.600 --> 00:11:57.080 and patients? So for me, it was around transforming 00:11:57.080 --> 00:12:00.460 the pharmacy experience from being an in -person 00:12:00.460 --> 00:12:04.720 only available on -premise and primarily in a 00:12:04.720 --> 00:12:10.139 synchronous mode to being entirely virtual, permitting 00:12:10.139 --> 00:12:15.129 asynchronous communication. and a real concept 00:12:15.129 --> 00:12:19.269 of customer management in the sense of I want 00:12:19.269 --> 00:12:21.450 to be able to see this customer throughout their 00:12:21.450 --> 00:12:23.929 life cycle. Not just at the moment where they 00:12:23.929 --> 00:12:26.230 pick up their drug and I'm as a pharmacist, I'm 00:12:26.230 --> 00:12:29.129 dispensing, but from the moment they have a concern. 00:12:29.490 --> 00:12:32.350 So MedNow had a telemedicine. function where 00:12:32.350 --> 00:12:36.649 they would intake patients and process them to 00:12:36.649 --> 00:12:38.090 whatever, you know, whatever the issue they might 00:12:38.090 --> 00:12:41.429 have. A pharmacy prescription would be issued. 00:12:41.769 --> 00:12:43.950 If the patient chooses, they can fill that right 00:12:43.950 --> 00:12:47.429 at MedNow and then there'll be sort of a full 00:12:47.429 --> 00:12:50.549 cycle where patient gets a prescription, goes 00:12:50.549 --> 00:12:53.919 to our pharmacies. and then gets delivered to 00:12:53.919 --> 00:12:56.759 them the same day for free. And then beyond that, 00:12:56.799 --> 00:12:59.320 there was the follow up that was done via text 00:12:59.320 --> 00:13:01.360 or video calls, which is something that most 00:13:01.360 --> 00:13:04.299 pharmacies at the time did not have the facility 00:13:04.299 --> 00:13:07.480 to do. And even beyond in terms of refilling 00:13:07.480 --> 00:13:09.919 or having to see your doctor again. So there's 00:13:09.919 --> 00:13:12.399 really just sort of a life cycle extension to 00:13:12.399 --> 00:13:14.980 any of the customers that was totally different 00:13:14.980 --> 00:13:17.539 than the transactional mode that patients had 00:13:17.539 --> 00:13:21.769 experienced in retail pharmacy. That was really 00:13:21.769 --> 00:13:26.590 the collective of the MedNow supply chain extension, 00:13:26.590 --> 00:13:28.570 if you will, I think about it as a supply chain, 00:13:29.549 --> 00:13:33.610 where it didn't terminate in the pharmacy interaction 00:13:33.610 --> 00:13:36.509 where here's your white bag, read the instructions, 00:13:37.090 --> 00:13:39.769 and call me if you need anything. So we really 00:13:39.769 --> 00:13:42.470 wanted to create pharmacy as a healthcare hub. 00:13:43.129 --> 00:13:44.769 And I think we succeeded in that, and MedNow 00:13:44.769 --> 00:13:47.509 continues today with very much the same vision, 00:13:47.649 --> 00:13:51.320 this idea of it being more of a hub for That's 00:13:51.320 --> 00:13:53.279 a very accessible hub compared to, say, your 00:13:53.279 --> 00:13:55.779 family doctor or your walk -in clinic to help 00:13:55.779 --> 00:13:58.659 people navigate through what is a very complicated 00:13:58.659 --> 00:14:01.320 journey, which is getting you health care and 00:14:01.320 --> 00:14:03.440 a publicly funded health care system like Canada. 00:14:04.879 --> 00:14:09.240 And how did you find your founding team? So it 00:14:09.240 --> 00:14:13.399 was through my consulting practice that I was 00:14:13.399 --> 00:14:15.919 essentially looking for clients. So after leaving 00:14:15.919 --> 00:14:19.240 McKesson, I decided to go on my own and consult 00:14:19.240 --> 00:14:22.360 in digital health. primarily around helping startups 00:14:22.360 --> 00:14:25.379 that were targeting specialty -like medicine 00:14:25.379 --> 00:14:28.279 or specialty -like technologies. So as an example, 00:14:28.399 --> 00:14:30.299 I supported a company called Winterlight Labs 00:14:30.299 --> 00:14:34.320 that had developed a way to determine your cognitive 00:14:34.320 --> 00:14:37.139 impairment from no more than 30 seconds of speech 00:14:37.139 --> 00:14:41.799 using a neural network that was trained based 00:14:41.799 --> 00:14:44.559 on other patients that were scored on their cognitive 00:14:44.559 --> 00:14:49.460 impairment. It was a very natural use of AI in 00:14:49.460 --> 00:14:52.679 this case to just train it to determine the cognitive 00:14:52.679 --> 00:14:55.419 impairment. Because alternative was a 30 minute 00:14:55.419 --> 00:14:58.179 sit down with a nurse where he or she would have 00:14:58.179 --> 00:15:00.259 to test you on things like would you know what 00:15:00.259 --> 00:15:02.519 day it is, can you read the clock, and so forth. 00:15:04.039 --> 00:15:07.240 So my consulting practice was heavily focused 00:15:07.240 --> 00:15:10.500 on digital health. And in my journey to find 00:15:10.500 --> 00:15:13.669 clients, I reached out to the president of retail 00:15:13.669 --> 00:15:17.450 pharmacy manor at McKesson and he said well you 00:15:17.450 --> 00:15:21.070 should talk to this guy and so that was the first 00:15:21.070 --> 00:15:25.309 time I met with Ali Rehani and his partner Philip 00:15:25.309 --> 00:15:29.269 Campisano and you know the three of us created 00:15:29.269 --> 00:15:35.309 at the time MedNow as an extension first to Ali 00:15:35.309 --> 00:15:38.470 and Philip's aggregator of pharmacies and then 00:15:38.470 --> 00:15:42.620 eventually as a standalone body where I took 00:15:42.620 --> 00:15:45.659 over as CEO. So it was a very interesting and 00:15:45.659 --> 00:15:48.639 organic growth because they also haven't been 00:15:48.639 --> 00:15:51.379 owners in pharmacy and entrepreneurs of pharmacy 00:15:51.379 --> 00:15:54.039 could see the same opportunity that I saw while 00:15:54.039 --> 00:15:56.320 I was at McKesson, which is there needs to be 00:15:56.320 --> 00:15:59.759 a digital aspect to pharmacy. It's kind of a 00:15:59.759 --> 00:16:01.659 dark age just to continue to do the same thing 00:16:01.659 --> 00:16:06.460 as we were. Your undergrad was in applied sciences. 00:16:07.080 --> 00:16:09.159 Why did you pick applied sciences and if you 00:16:09.159 --> 00:16:11.519 had to do it all over again, would you pick something 00:16:11.519 --> 00:16:15.940 else? That's a great question. I picked engineering 00:16:15.940 --> 00:16:19.100 because I was very good at all things to do with 00:16:19.100 --> 00:16:21.279 computer programming and I like to build things. 00:16:21.379 --> 00:16:23.159 So I kind of put those two things together and 00:16:23.159 --> 00:16:26.159 I thought engineering was the way to go. I have 00:16:26.159 --> 00:16:28.519 no regrets around taking engineering as a degree 00:16:28.519 --> 00:16:31.899 because it definitely taught me how to be very 00:16:31.899 --> 00:16:34.159 analytical, how to take a very large problem 00:16:34.159 --> 00:16:37.080 and split it down to small pieces and help solve 00:16:37.080 --> 00:16:39.000 each of them separately and bring them back into 00:16:39.000 --> 00:16:41.799 a sort of a mega solution that helps move forward. 00:16:42.529 --> 00:16:45.570 What I probably really missed through my engineering 00:16:45.570 --> 00:16:47.710 degree was all the time that I was trying to 00:16:47.710 --> 00:16:50.269 figure out how EMI waves were traveling over 00:16:50.269 --> 00:16:53.029 long power lines or you know, because computer 00:16:53.029 --> 00:16:55.070 engineering is essentially electrical engineering 00:16:55.070 --> 00:16:58.450 with an element of do you know how to program 00:16:58.450 --> 00:17:00.990 microchips and you know how to program code. 00:17:01.129 --> 00:17:03.470 That was essentially what was added on. So things 00:17:03.470 --> 00:17:05.309 like software architecture and software engineering. 00:17:06.410 --> 00:17:08.109 There's certainly the software engineering aspect 00:17:08.109 --> 00:17:11.660 I really enjoyed. and some aspects of programming 00:17:11.660 --> 00:17:14.019 chips and so forth but the electrical engineering 00:17:14.019 --> 00:17:16.579 aspect which was a sort of a primer and a principal 00:17:16.579 --> 00:17:18.940 part of becoming an engineer was interesting 00:17:18.940 --> 00:17:20.960 but I've never had to use that information ever 00:17:20.960 --> 00:17:23.819 again so for those reasons I would have wanted 00:17:23.819 --> 00:17:25.900 to use that time instead to be focusing on learning 00:17:25.900 --> 00:17:28.880 business and entrepreneurship and startups and 00:17:28.880 --> 00:17:31.740 getting really exposed to the world of getting 00:17:31.740 --> 00:17:34.519 a company going and seeing it succeed or fail 00:17:34.519 --> 00:17:38.000 and being able to do that early on So maybe if 00:17:38.000 --> 00:17:40.599 there was a degree that was an engineer, B .Com, 00:17:40.819 --> 00:17:42.940 blended together, I would probably want to take 00:17:42.940 --> 00:17:45.420 that. The alternative would have been to take 00:17:45.420 --> 00:17:48.980 a law degree, because I think I appreciate what 00:17:48.980 --> 00:17:53.259 law can do when it's used innovatively. In the 00:17:53.259 --> 00:17:56.440 sense of, you know, IP law is an example of law 00:17:56.440 --> 00:17:59.420 that kind of focuses on how to sort of channel 00:17:59.420 --> 00:18:02.599 creativity in a way where the creators get their 00:18:02.599 --> 00:18:05.420 rights protected and, you know, can profit off 00:18:05.420 --> 00:18:07.859 of these. you know, the genius that their ideas 00:18:07.859 --> 00:18:10.640 are. So something like that would have also been 00:18:10.640 --> 00:18:13.160 probably quite interesting, because it also would 00:18:13.160 --> 00:18:15.279 have quite likely exposed me to entrepreneurship 00:18:15.279 --> 00:18:18.779 a little bit earlier. And did you build the product 00:18:18.779 --> 00:18:22.500 yourself or did you hire a team? We hired a team. 00:18:22.539 --> 00:18:26.819 So by the time I was running the development 00:18:26.819 --> 00:18:30.579 at MedNow, I had been out of programming for 00:18:30.579 --> 00:18:34.980 10 years or so. And not that I didn't know how 00:18:34.980 --> 00:18:37.779 to code still. But I wanted to focus my energy 00:18:37.779 --> 00:18:43.200 more on creating what was the MVP, including 00:18:43.200 --> 00:18:45.619 being able to expose it to market in a certain 00:18:45.619 --> 00:18:49.380 fashion, being able to set up the infrastructure 00:18:49.380 --> 00:18:52.240 and the transformation of what is an on -premise 00:18:52.240 --> 00:18:55.500 pharmacy to being a virtual pharmacy, which meant 00:18:55.500 --> 00:18:57.799 it becomes a dark pharmacy, as in no customers 00:18:57.799 --> 00:19:00.400 really should be walking in to get their services 00:19:00.400 --> 00:19:04.039 on one side. And on the other side, being able 00:19:04.039 --> 00:19:09.730 to do what I call the connectivity of a pharmacy 00:19:09.730 --> 00:19:12.769 network, right? So our pharmacies in Toronto, 00:19:13.190 --> 00:19:18.109 in Vancouver, in Calgary, in Halifax, Winnipeg, 00:19:18.170 --> 00:19:21.690 Montreal, will always see Rashad as the same 00:19:21.690 --> 00:19:24.430 person, Rashad Osmani as the same person, which 00:19:24.430 --> 00:19:28.109 is very unlike the traditional pharmacy. When 00:19:28.109 --> 00:19:31.470 you go to a shopper's, even if you go to the 00:19:31.470 --> 00:19:34.799 one across the street, they won't know you. to 00:19:34.799 --> 00:19:37.119 be the same person. So they'll have to ask you 00:19:37.119 --> 00:19:38.980 to re -register your insurance, your address, 00:19:39.059 --> 00:19:40.940 and all of the pertinent information for them 00:19:40.940 --> 00:19:43.380 to be able to service you. And so if they can't 00:19:43.380 --> 00:19:45.420 even figure out who you are or the fact that 00:19:45.420 --> 00:19:47.440 you've already visited other shoppers, how could 00:19:47.440 --> 00:19:49.420 they possibly be able to maintain that sort of 00:19:49.420 --> 00:19:53.539 life cycle view of your malady, whatever it is 00:19:53.539 --> 00:19:57.579 you're going through, so that they can... really 00:19:57.579 --> 00:19:59.420 manage you properly, regardless of where you 00:19:59.420 --> 00:20:01.200 are in the country. So if you're somebody who's 00:20:01.200 --> 00:20:03.599 traveling on business, you happen to reside in 00:20:03.599 --> 00:20:05.059 Toronto, but you have a lot of businesses in 00:20:05.059 --> 00:20:07.779 Vancouver as an example, that person would have 00:20:07.779 --> 00:20:10.339 found in MedNow an ultimate solution because 00:20:10.339 --> 00:20:13.039 there was no reason why they would have to re 00:20:13.039 --> 00:20:15.240 -educate the Vancouver pharmacy on what happened 00:20:15.240 --> 00:20:18.799 in Toronto or vice versa. So that sort of infrastructure 00:20:18.799 --> 00:20:20.839 play in and focusing on how to get these things 00:20:20.839 --> 00:20:23.839 to talk. And then also the accessibility of the 00:20:23.839 --> 00:20:26.529 pharmacy being that it had to be easy enough 00:20:26.529 --> 00:20:28.869 to call because most people call pharmacies. 00:20:29.569 --> 00:20:31.750 The idea of texting pharmacies, as much as it 00:20:31.750 --> 00:20:35.569 is very convenient, was not in a standard buying 00:20:35.569 --> 00:20:38.750 habit for a pharmacy customer. They normally 00:20:38.750 --> 00:20:41.789 would just call the pharmacy. So again, in the 00:20:41.789 --> 00:20:43.569 same way, I had to kind of familiarize myself 00:20:43.569 --> 00:20:47.349 with what is a way to set up a call center that's 00:20:47.349 --> 00:20:51.470 entirely virtual, that can have fall overs. So 00:20:51.470 --> 00:20:55.019 when Toronto closes, Vancouver picks up and You 00:20:55.019 --> 00:20:57.019 know that sort of thing or Halifax is the first 00:20:57.019 --> 00:20:58.980 one up because they can catch customers at six 00:20:58.980 --> 00:21:01.240 in the morning in Toronto time so these are the 00:21:01.240 --> 00:21:06.539 facilities that virtual pharmacy can give That 00:21:06.539 --> 00:21:10.440 a retail pharmacy can't and and finally central 00:21:10.440 --> 00:21:13.779 filling which is a principal aspect of Being 00:21:13.779 --> 00:21:15.740 able to do a virtual only pharmacy, which is 00:21:15.740 --> 00:21:18.339 everything is delivered So logistics was always 00:21:18.339 --> 00:21:20.339 going to be something that had to be figured 00:21:20.339 --> 00:21:23.559 out. How do I get that? drug which if I were 00:21:23.559 --> 00:21:25.460 to go to the pharmacy will take 15 minutes or 00:21:25.460 --> 00:21:28.519 20 minutes to fill and be handed to me in some 00:21:28.519 --> 00:21:31.920 acute cases like say you want an antibiotic or 00:21:31.920 --> 00:21:35.539 something of the kind that required same day 00:21:35.539 --> 00:21:40.099 administration basically that couldn't be that 00:21:40.099 --> 00:21:42.359 okay you got me the prescription for an antibiotic 00:21:42.359 --> 00:21:45.220 I'll get it to you tomorrow so the same day delivery 00:21:45.220 --> 00:21:47.640 was a was another real logistical challenge that 00:21:47.640 --> 00:21:50.140 I have to solve for that's why when you think 00:21:50.140 --> 00:21:53.200 about the logistics the infrastructure, joining 00:21:53.200 --> 00:21:56.059 pharmacies together, and all things to do with 00:21:56.059 --> 00:21:58.160 what is a user journey that will be attractive 00:21:58.160 --> 00:22:00.759 to a customer and marketing that user journey. 00:22:01.319 --> 00:22:05.079 That took over most of my capacity, which necessitated 00:22:05.079 --> 00:22:07.160 that I would have hired the development team 00:22:07.160 --> 00:22:09.200 and even a lead to the development team so that 00:22:09.200 --> 00:22:13.000 they can focus on making the technology work 00:22:13.000 --> 00:22:15.720 while I kind of do all the other things that 00:22:15.720 --> 00:22:18.900 I just listed. It sounds like you could have 00:22:18.900 --> 00:22:21.059 done this a couple of different ways. It sounds 00:22:21.059 --> 00:22:23.819 like what you did was a direct to consumer play, 00:22:23.940 --> 00:22:27.359 but also a B2B play. What you could have also 00:22:27.359 --> 00:22:29.940 done potentially, and I'm just thinking of this, 00:22:30.660 --> 00:22:33.599 is have warehouses in a distributed fashion across 00:22:33.599 --> 00:22:36.059 the country, but have a centralized pharmacist 00:22:36.059 --> 00:22:39.660 or maybe three or four pharmacists to provide 00:22:39.660 --> 00:22:44.289 the B2C. service of order creation and then fulfillment 00:22:44.289 --> 00:22:47.230 and distribution and shipping can happen in these 00:22:47.230 --> 00:22:50.150 decentralized warehouses. Did you think about 00:22:50.150 --> 00:22:53.269 the two models? And then if you decided to go 00:22:53.269 --> 00:22:57.369 on the D2C plus the B2B play, did you launch 00:22:57.369 --> 00:23:01.490 with one pharmacy or how did you grow MedNow? 00:23:01.490 --> 00:23:04.930 Essentially, how did you scale? Great question. 00:23:05.079 --> 00:23:09.019 And I tell you, if I was able to do the latter, 00:23:09.140 --> 00:23:11.319 the idea of having a small pharmacy team that 00:23:11.319 --> 00:23:13.880 was centralized and did all the service while 00:23:13.880 --> 00:23:16.099 the logistics were being handled in a distributed 00:23:16.099 --> 00:23:19.460 fashion, that would have saved us a lot of grief. 00:23:20.160 --> 00:23:22.519 The reality is in Canada, health care, as you 00:23:22.519 --> 00:23:25.700 of course know, is provincially mandated and 00:23:25.700 --> 00:23:31.039 funded. So that forces every health care body 00:23:31.210 --> 00:23:33.710 which of course, as you know, to comply with 00:23:33.710 --> 00:23:38.769 this provincial regulations. And so we wouldn't 00:23:38.769 --> 00:23:41.950 really be able to or couldn't have a situation 00:23:41.950 --> 00:23:43.890 where we didn't keep replicating the pharmacy 00:23:43.890 --> 00:23:48.109 teams across every province, despite it being 00:23:48.109 --> 00:23:49.910 true that Toronto, Vancouver were probably the 00:23:49.910 --> 00:23:52.930 busiest pharmacies when we got started, but we 00:23:52.930 --> 00:23:54.849 would have still needed to get a crew going in 00:23:54.849 --> 00:23:57.109 Halifax, another in Calgary, another in Montreal, 00:23:57.250 --> 00:24:00.380 because that was the nature of... you know, the 00:24:00.380 --> 00:24:02.200 provincial management of our healthcare system. 00:24:03.619 --> 00:24:05.480 You know, one of the things that we were able 00:24:05.480 --> 00:24:09.599 to, however, do is in cases where there was a, 00:24:09.599 --> 00:24:12.900 call it an intra -province treaty where, say, 00:24:12.940 --> 00:24:17.000 Ontario can handle some Nova Scotia aspect of 00:24:17.000 --> 00:24:19.460 practice of pharmacy. I'm not a pharmacist myself, 00:24:19.460 --> 00:24:22.000 so of course, I don't want to speak to that in 00:24:22.000 --> 00:24:24.599 any kind of detail, but the idea really is being 00:24:24.599 --> 00:24:28.940 able to support Ontario to Nova Scotia or until 00:24:28.940 --> 00:24:34.740 we got going, BC to Manitoba and to Alberta and 00:24:34.740 --> 00:24:38.180 so there was just sort of the prairies and maritimes 00:24:38.180 --> 00:24:41.279 sort of ways to get around the need to replicate 00:24:41.279 --> 00:24:43.000 that but it was never going to be something that 00:24:43.000 --> 00:24:46.279 you could do at scale because then there was 00:24:46.279 --> 00:24:49.380 a need to demonstrate why you're servicing in 00:24:49.380 --> 00:24:51.900 this case a Halifax patient out of Ontario on 00:24:51.900 --> 00:24:55.859 a regular basis. So the replication was unavoidable. 00:24:56.420 --> 00:25:00.460 However you know things like standard of care 00:25:00.460 --> 00:25:03.380 that was discussed across all pharmacies, what 00:25:03.380 --> 00:25:06.740 can we do to really improve on a diabetic's care 00:25:06.740 --> 00:25:10.380 or improve on a hypertension patient's care and 00:25:10.380 --> 00:25:13.500 so forth. Those were definitely opportunities 00:25:13.500 --> 00:25:16.220 that we capitalized on because we were having 00:25:16.220 --> 00:25:19.500 so many different great minds in pharmacy. We 00:25:19.500 --> 00:25:24.779 have probably the best pharmacy crews in Canada 00:25:24.779 --> 00:25:27.769 because they had to make as we did the adjustment 00:25:27.769 --> 00:25:29.950 to the pharmacy and the way pharmacy was conducted 00:25:29.950 --> 00:25:32.269 from in -person on -premise to being virtual 00:25:32.269 --> 00:25:35.990 and cloud. You know that transformation was also 00:25:35.990 --> 00:25:38.130 necessary for the pharmacist and the pharmacy 00:25:38.130 --> 00:25:41.289 staff for them now to take orders virtually and 00:25:41.289 --> 00:25:43.490 be able to speak to sometimes some of their patients 00:25:43.490 --> 00:25:45.970 never see them and only talk to them on the phone 00:25:45.970 --> 00:25:50.269 or by texting them. And so you know when you 00:25:50.269 --> 00:25:53.369 kind of put it all together that was the reason 00:25:53.369 --> 00:25:58.859 why the advantage of central filling per province 00:25:58.859 --> 00:26:03.920 was still giving a lot of advantages around practice 00:26:03.920 --> 00:26:06.440 improvement, if you will. And like, let's see 00:26:06.440 --> 00:26:09.440 how we can make this a virtual experience that's 00:26:09.440 --> 00:26:13.240 even better than the in -person experience. From 00:26:13.240 --> 00:26:16.259 what I've seen, there's pharmacies doing this 00:26:16.259 --> 00:26:21.789 for specific indications like hair loss. or Botox 00:26:21.789 --> 00:26:25.390 or ED or things like that. And it seems like 00:26:25.390 --> 00:26:29.569 they're targeting high margin medications and 00:26:29.569 --> 00:26:32.849 not, you know, the moxibustion antibiotics because 00:26:32.849 --> 00:26:34.950 there's not much money to be made there. Yeah. 00:26:35.009 --> 00:26:38.670 But you took a different route. You were trying 00:26:38.670 --> 00:26:43.670 to service every patient, it sounds like. Was 00:26:43.670 --> 00:26:47.170 that a decision? How did that decision come to 00:26:47.170 --> 00:26:52.380 be? And where Because you're almost opening pharmacies, 00:26:52.619 --> 00:26:54.720 but you're also then bringing them customers. 00:26:55.640 --> 00:26:57.839 What was your relationship like with the pharmacies? 00:26:58.000 --> 00:27:00.940 Were they contractors or was it a profit share 00:27:00.940 --> 00:27:04.259 agreement? Tell me a bit more about how you decided 00:27:04.259 --> 00:27:07.500 how to grow this from the financial capacity. 00:27:09.500 --> 00:27:12.799 So I'll address the last question first. And 00:27:12.799 --> 00:27:14.480 just because it's a very short answer, we owned 00:27:14.480 --> 00:27:18.019 and operated all of our pharmacies. So we didn't 00:27:18.019 --> 00:27:20.339 want to get into a situation where we were creating 00:27:20.339 --> 00:27:23.220 these partner pharmacies Some companies at the 00:27:23.220 --> 00:27:25.480 time were trying to do the same thing but when 00:27:25.480 --> 00:27:27.759 it's up happening is again because of the nature 00:27:27.759 --> 00:27:31.019 of the regulation that that is around pharmacy, 00:27:31.619 --> 00:27:33.920 there'll be things like, okay, well, who is liable 00:27:33.920 --> 00:27:36.599 and responsible for that patient's care? Is it 00:27:36.599 --> 00:27:39.900 you who has got the sort of interaction and relationship, 00:27:40.019 --> 00:27:42.539 or is it the pharmacy that actually holds the 00:27:42.539 --> 00:27:44.299 patient profile on their pharmacy management 00:27:44.299 --> 00:27:46.920 system? And it always is gonna be the pharmacy 00:27:46.920 --> 00:27:50.099 that has delivered the care and the owner of 00:27:50.099 --> 00:27:52.240 the profile. And so that pharmacy now has to 00:27:52.240 --> 00:27:55.299 be sure that it has... everything it needs like 00:27:55.299 --> 00:27:57.539 it knows everything it needs to know around that 00:27:57.539 --> 00:28:00.539 patient or off that patient to avoid things like 00:28:00.539 --> 00:28:03.079 a contraindication, dispensement or anything 00:28:03.079 --> 00:28:06.420 that would would potentially harm that patient 00:28:06.420 --> 00:28:08.519 because they just didn't have a direct connection 00:28:08.519 --> 00:28:11.299 to them. So we very quickly rejected that model 00:28:11.299 --> 00:28:14.079 and said we're gonna raise the money. I raised 00:28:14.079 --> 00:28:16.259 44 million bucks for MedNow through private and 00:28:16.259 --> 00:28:21.269 public rounds to be able to own build and operate 00:28:21.269 --> 00:28:24.630 all pharmacies on our own and really do everything 00:28:24.630 --> 00:28:27.190 in terms of a supply chain from the moment of 00:28:27.190 --> 00:28:30.789 intake via our app or website or what have you 00:28:30.789 --> 00:28:35.130 in terms of the prescription or the medical order 00:28:35.130 --> 00:28:38.809 all the way to its fulfillment delivery and follow 00:28:38.809 --> 00:28:41.730 -up. So that was key for us to really be able 00:28:41.730 --> 00:28:44.509 to be the controllers of a full customer experience. 00:28:45.250 --> 00:28:50.160 It was a very expensive way to do things. I think 00:28:50.160 --> 00:28:51.480 there were definitely, there's always going to 00:28:51.480 --> 00:28:53.619 be an argument for advantages and disadvantages 00:28:53.619 --> 00:28:57.099 to approaching it that way. Probably the only 00:28:57.099 --> 00:29:00.460 thing I would say MedNow could have done differently 00:29:00.460 --> 00:29:05.339 is become more regional power centers ahead of 00:29:05.339 --> 00:29:09.059 going after the national deployment, which would 00:29:09.059 --> 00:29:13.660 have been really, at the time, necessary because 00:29:13.660 --> 00:29:16.480 we started really thinking about the B2B market. 00:29:17.660 --> 00:29:19.579 So the B2B market, we started thinking about 00:29:19.579 --> 00:29:22.500 national employers who are looking to add us 00:29:22.500 --> 00:29:25.380 on as a preferred pharmacy. They'd much rather 00:29:25.380 --> 00:29:28.000 have a pharmacy that can service all of their 00:29:28.000 --> 00:29:29.759 employees, regardless of where they are in Canada, 00:29:30.380 --> 00:29:33.440 than one that can only say, I can only do Ontario, 00:29:33.559 --> 00:29:36.900 I can only do BC for now. And so, you know, you 00:29:36.900 --> 00:29:39.920 kind of create an obligation, or at least a self 00:29:39.920 --> 00:29:41.920 -selecting mechanism where only employers that 00:29:41.920 --> 00:29:45.640 were just in Ontario or just in BC would sign 00:29:45.640 --> 00:29:48.140 up to your preferred pharmacy network service. 00:29:49.019 --> 00:29:52.440 So, you know, in retrospect, you know, sort of 00:29:52.440 --> 00:29:57.599 hindsight 2020, as they say, our B2B market didn't 00:29:57.599 --> 00:30:01.259 grow as quickly as we were expecting. There was, 00:30:01.259 --> 00:30:04.599 you know, I'm kind of digressing here a little 00:30:04.599 --> 00:30:05.940 bit, but I'll just take a minute because I think 00:30:05.940 --> 00:30:08.849 you did talk about DTC versus B2B, but. When 00:30:08.849 --> 00:30:10.910 you think about who makes the decisions inside 00:30:10.910 --> 00:30:15.049 of an employer around workplace health or workplace 00:30:15.049 --> 00:30:18.869 wellness for the employees, a lot of the time 00:30:18.869 --> 00:30:24.289 it just lands into either HR or CFO office or 00:30:24.289 --> 00:30:27.190 the financial office because or finance office 00:30:27.190 --> 00:30:29.289 because they're the ones paying for the service 00:30:29.289 --> 00:30:30.769 and they're the ones actually paying for all 00:30:30.769 --> 00:30:33.609 of the drugs through the provision of these private 00:30:33.609 --> 00:30:37.769 payer benefits. And so they are after mostly 00:30:38.079 --> 00:30:41.000 Getting a better rate than dough rate, which 00:30:41.000 --> 00:30:43.099 is give me something that's better on the markup 00:30:43.099 --> 00:30:45.619 Which is usually a percentage basis that each 00:30:45.619 --> 00:30:49.220 pharmacy charges based on who they have a relationship 00:30:49.220 --> 00:30:52.779 with it with a payer and the dispensing fee which 00:30:52.779 --> 00:30:56.380 is a fixed dollar amount that will change from 00:30:56.380 --> 00:30:59.779 pharmacy to pharmacy and it's meant to to pay 00:30:59.779 --> 00:31:03.079 for the effort of dispensements, you know above 00:31:03.079 --> 00:31:06.349 and beyond the markup, which is where the Profit 00:31:06.349 --> 00:31:09.990 is for a for a pharmacy and so kind of putting 00:31:09.990 --> 00:31:16.309 it all together we We we had to convince HR and 00:31:16.309 --> 00:31:19.650 finance that this is a great deal before convincing 00:31:19.650 --> 00:31:21.109 them that this is actually really really good 00:31:21.109 --> 00:31:23.809 for your employees because If we can manage your 00:31:23.809 --> 00:31:27.049 chronic disease is better if we can get to them 00:31:27.049 --> 00:31:30.150 to be more proactive with their health care All 00:31:30.150 --> 00:31:32.470 of that is going to lead to things like lower 00:31:32.470 --> 00:31:34.859 disability whether it's long -term disability 00:31:34.859 --> 00:31:38.420 or short -term disability, it'll lead to better 00:31:38.420 --> 00:31:40.619 productivity because people are showing up to 00:31:40.619 --> 00:31:44.079 work well and healthy. And so they're going to 00:31:44.079 --> 00:31:46.900 probably be more productive. And then just in 00:31:46.900 --> 00:31:51.740 general, absenteeism is one of the other measures 00:31:51.740 --> 00:31:54.339 of productivity in the workplace. if somebody 00:31:54.339 --> 00:31:57.720 doesn't have to leave their office to go see 00:31:57.720 --> 00:31:59.619 a doctor and then after seeing the doctor go 00:31:59.619 --> 00:32:02.400 to the pharmacy and if that matter is requiring 00:32:02.400 --> 00:32:04.619 them to if they have a specific drug that's not 00:32:04.619 --> 00:32:06.799 generally available at every pharmacy they might 00:32:06.799 --> 00:32:09.119 have to try drive a little bit longer to get 00:32:09.119 --> 00:32:11.299 to it all of that was sorted because we were 00:32:11.299 --> 00:32:14.019 able to do everything virtually and so you know 00:32:14.019 --> 00:32:16.859 and we kind of were able to attack productivity 00:32:16.859 --> 00:32:21.200 absenteeism and managing disability or at least 00:32:21.200 --> 00:32:24.250 working on setting up a framework that would 00:32:24.250 --> 00:32:26.109 normally affect all these things positively, 00:32:27.170 --> 00:32:29.769 you know, that is a very different thought process 00:32:29.769 --> 00:32:32.049 than how much money am I going to save on my 00:32:32.049 --> 00:32:37.609 benefits budget. And so eventually, and another 00:32:37.609 --> 00:32:40.789 why that's significant is private payers already 00:32:40.789 --> 00:32:44.509 know that drug expenditure is the most significant 00:32:44.509 --> 00:32:47.809 line on their expense list. Drugs are the most 00:32:47.809 --> 00:32:51.410 expensive thing that our insurer pays for. And 00:32:51.410 --> 00:32:53.789 a lot of times it's not insured by the insurer. 00:32:54.009 --> 00:32:56.869 it's normally paid for by the employers. So in 00:32:56.869 --> 00:32:58.609 a lot of ways, it's not really their problem. 00:32:59.069 --> 00:33:02.170 But what they also try to do is restrict these 00:33:02.170 --> 00:33:05.089 markups right at the point of adjudication of 00:33:05.089 --> 00:33:07.069 the claims. They'll say, well, if you're a Sun 00:33:07.069 --> 00:33:09.730 Life member and you come to a pharmacy, regardless 00:33:09.730 --> 00:33:11.910 of that pharmacy, we will never pay more than 00:33:11.910 --> 00:33:13.650 this markup. We will never pay more than the 00:33:13.650 --> 00:33:16.049 dispensing fee. And so normally what happens 00:33:16.049 --> 00:33:18.130 at the pharmacy level at that point is that the 00:33:18.130 --> 00:33:20.470 pharmacist or the dispensing pharmacy would ask 00:33:20.470 --> 00:33:22.670 for the difference from the patient. to pay out 00:33:22.670 --> 00:33:27.170 of pocket and so you know in a lot of ways the 00:33:27.170 --> 00:33:30.930 problem of cost was already isolated to a payer 00:33:30.930 --> 00:33:34.630 to employer relationship and there wasn't much 00:33:34.630 --> 00:33:37.589 more that we needed to do on it we were really 00:33:37.589 --> 00:33:39.369 pushing for the fact that a virtual pharmacy 00:33:39.369 --> 00:33:41.410 is better for a patient especially when you add 00:33:41.410 --> 00:33:43.349 things like telemedicine nutrition and supplements 00:33:43.349 --> 00:33:45.529 and all other things that met now did at the 00:33:45.529 --> 00:33:48.289 time it does some of it today but you know at 00:33:48.289 --> 00:33:52.660 the time in the 2020, 2021, and 2022 period, 00:33:52.859 --> 00:33:55.799 it was a very broad service offering that had 00:33:55.799 --> 00:33:59.759 to get scaled back a bit, just for multiple business 00:33:59.759 --> 00:34:03.960 reasons. What would you change about Canadian 00:34:03.960 --> 00:34:08.380 healthcare or pharmacy regulation? Well, this 00:34:08.380 --> 00:34:09.880 is the kind of questions you get in trouble for. 00:34:10.380 --> 00:34:13.480 What would I change? I say insist on patient 00:34:13.480 --> 00:34:17.400 choice. We're so big on patient choice. We insist 00:34:17.400 --> 00:34:21.219 on it in every way. if it's a choice of, a lot 00:34:21.219 --> 00:34:24.039 of times it's a choice of pharmacy. That's something 00:34:24.039 --> 00:34:26.360 I didn't know well because I was very close to 00:34:26.360 --> 00:34:30.000 it. And it's one of the things that we consistently 00:34:30.000 --> 00:34:33.840 were striving and ensuring is present on our 00:34:33.840 --> 00:34:37.440 platform. Even though we had our own telemedicine 00:34:37.440 --> 00:34:40.780 provision on the app, we wanted to make sure 00:34:40.780 --> 00:34:42.239 everybody understands that they don't need to 00:34:42.239 --> 00:34:45.320 go to MedNow for the prescription because that 00:34:45.320 --> 00:34:47.840 would create a conflict of interest between the 00:34:47.840 --> 00:34:52.300 two parties. So in the same way, patient choice 00:34:52.300 --> 00:34:56.719 should be to allow somebody to have a different 00:34:56.719 --> 00:34:59.320 say in which doctor they see and how they interact 00:34:59.320 --> 00:35:01.460 with that doctor and whether they should pay 00:35:01.460 --> 00:35:04.260 them or not. All these are choices that the patient 00:35:04.260 --> 00:35:09.760 should have. And this idea that, well, let's 00:35:09.760 --> 00:35:11.739 just address the pink elephant in the room. If 00:35:11.739 --> 00:35:16.440 we say, well, private pay is going to cause a 00:35:16.440 --> 00:35:18.909 brain drain. from the public side of the healthcare 00:35:18.909 --> 00:35:20.429 system to the private side of the healthcare 00:35:20.429 --> 00:35:24.230 system, I think that's not necessarily the consumer's 00:35:24.230 --> 00:35:27.309 problem as much as it is the regulator's problem. 00:35:27.550 --> 00:35:31.250 They need to put in place the measures that allow 00:35:31.250 --> 00:35:36.690 free individuals, doctors such as yourself, to 00:35:36.690 --> 00:35:41.369 decide where and how they want to operate and 00:35:41.369 --> 00:35:44.869 how they integrate into the healthcare system, 00:35:44.949 --> 00:35:47.199 the Canadian healthcare system. again, regardless 00:35:47.199 --> 00:35:50.820 of the mechanism of how that gets managed, the 00:35:50.820 --> 00:35:54.880 patient should have that choice. And, you know, 00:35:54.980 --> 00:35:57.739 it's like there's one, two sides to every business 00:35:57.739 --> 00:35:59.380 problem. There's a demand side and there's a 00:35:59.380 --> 00:36:02.920 supply side. So the demand side could be to be 00:36:02.920 --> 00:36:05.840 a bit more free. You create a supply problem 00:36:05.840 --> 00:36:07.900 for sure. But then that's a problem that can 00:36:07.900 --> 00:36:10.360 also be solved, you know, whether it's in allowing 00:36:10.360 --> 00:36:12.860 foreign doctors to be more easily entered into 00:36:12.860 --> 00:36:15.829 the system. being more efficient with budget 00:36:15.829 --> 00:36:19.190 on health care provincially and federally that 00:36:19.190 --> 00:36:22.449 you can allow the supply to, in fact, increase. 00:36:22.510 --> 00:36:24.269 Because it's not always a question of whether 00:36:24.269 --> 00:36:29.050 or not you're allowing a doctor to come in maybe 00:36:29.050 --> 00:36:32.190 quicker than you would have prior. It's also 00:36:32.190 --> 00:36:35.110 whether you should be able to pay that doctor. 00:36:35.829 --> 00:36:38.869 And if you can't solve for that, which I find 00:36:38.869 --> 00:36:42.679 hard to fathom, I'm not an expert in how that 00:36:42.679 --> 00:36:46.340 budget would normally get split, then maybe the 00:36:46.340 --> 00:36:48.739 private element and allowing somebody to, well, 00:36:48.739 --> 00:36:52.019 if you can't cover that from tax revenue that's 00:36:52.019 --> 00:36:55.000 been collected, maybe allow me as a customer 00:36:55.000 --> 00:36:57.780 to pay for it because then I can all substitute 00:36:57.780 --> 00:37:03.199 the loss of salary that this doctor today is 00:37:03.199 --> 00:37:04.960 not going to be able to have because you can't 00:37:04.960 --> 00:37:06.760 afford them because your budget doesn't permit 00:37:06.760 --> 00:37:11.329 it. And so I think patient choice give patients 00:37:11.329 --> 00:37:16.230 the choice, both in the provider and in the fashion 00:37:16.230 --> 00:37:18.989 that you pay that provider, whether it's with 00:37:18.989 --> 00:37:22.409 your health card that's issued by Canada or your 00:37:22.409 --> 00:37:26.530 province or using your wallet. I think that that 00:37:26.530 --> 00:37:29.510 choice will eventually be difficult at the very 00:37:29.510 --> 00:37:32.710 beginning, but as it settles and the chips settle, 00:37:33.230 --> 00:37:36.050 you'll get a different environment where, you 00:37:36.050 --> 00:37:38.849 know, like anything, markets are inefficient 00:37:38.849 --> 00:37:42.320 at first. they tend towards efficiency. So we 00:37:42.320 --> 00:37:44.739 will get to an efficiency, but it has to become 00:37:44.739 --> 00:37:46.739 inefficient first before it becomes efficient. 00:37:48.440 --> 00:37:53.079 You think health care should be federal? I think 00:37:53.079 --> 00:37:56.760 from a point of right access to health care, 00:37:57.059 --> 00:37:59.360 yes, I think it should be, especially given how 00:37:59.360 --> 00:38:02.840 small our population is relative to others around 00:38:02.840 --> 00:38:06.340 the world. I mean, we have another complexity 00:38:06.340 --> 00:38:10.860 in our healthcare system, which is just the broadness 00:38:10.860 --> 00:38:13.920 of our geographic area. I mean, if you were to 00:38:13.920 --> 00:38:17.699 keep it provincial or even worse municipal, you 00:38:17.699 --> 00:38:20.300 might be in a position where in the same way 00:38:20.300 --> 00:38:23.079 that actually is already the case. Certain municipalities 00:38:23.079 --> 00:38:25.460 today, I'll give you an example that I'm very 00:38:25.460 --> 00:38:29.019 close to. There's a little town called Georgina 00:38:29.019 --> 00:38:32.179 that's just north of Newmarket that has approximately 00:38:32.179 --> 00:38:35.380 45 ,000 people living in it. On the other side 00:38:35.380 --> 00:38:39.550 of Lake Simcoe is Orillia. which has almost about 00:38:39.550 --> 00:38:43.630 the same level of population. Orillia has a hospital, 00:38:44.010 --> 00:38:47.630 Georgina does not. So somebody in Georgina who 00:38:47.630 --> 00:38:50.510 is requiring urgent care needs to travel to at 00:38:50.510 --> 00:38:54.210 least 45 minutes down to Newmarket to get to 00:38:54.210 --> 00:38:57.300 South Lake Regional. or over to Uxbridge to Oak 00:38:57.300 --> 00:39:00.760 Valley Health, which is another 45 minutes. And, 00:39:00.760 --> 00:39:02.679 you know, and what it's happening is Georgina 00:39:02.679 --> 00:39:05.039 splits the West, the people that live in Keswick 00:39:05.039 --> 00:39:07.960 and around it go down to Newmarket and the people 00:39:07.960 --> 00:39:11.219 that live on the East side go down to Uxbridge 00:39:11.219 --> 00:39:13.900 and Oak Valley Health. So, you know, and that's 00:39:13.900 --> 00:39:15.980 already in a federally managed health care system. 00:39:16.000 --> 00:39:20.840 So I imagine if if the division of budget was 00:39:20.840 --> 00:39:24.280 to become at, in terms of the collection of the 00:39:24.280 --> 00:39:27.119 tax and the and the dispensing of it completely, 00:39:27.739 --> 00:39:30.440 even at the level of municipal, it would completely 00:39:30.440 --> 00:39:33.980 fail, because it's already failing in being democratic 00:39:33.980 --> 00:39:38.039 and equivalent in the possibility of care for 00:39:38.039 --> 00:39:41.920 every Canadian. It's not equivalent today. If 00:39:41.920 --> 00:39:44.719 you were given $10 million to launch a startup 00:39:44.719 --> 00:39:48.199 with the potential to be a unicorn today, what 00:39:48.199 --> 00:39:54.409 would you do? It would be a supply chain. optimization 00:39:54.409 --> 00:40:00.869 play that uses AI to shorten waiting times, connect 00:40:00.869 --> 00:40:04.610 providers better in the healthcare space, and 00:40:04.610 --> 00:40:09.829 make the patient experience one that's much more 00:40:09.829 --> 00:40:13.769 coherent and cohesive with very prominent navigation 00:40:13.769 --> 00:40:17.150 and advocacy elements that are supported using 00:40:17.150 --> 00:40:21.130 that AI engine, where Decision support, which 00:40:21.130 --> 00:40:23.969 is something that today AI is not allowed to 00:40:23.969 --> 00:40:27.849 really do in terms of medical opinions, but any 00:40:27.849 --> 00:40:30.510 decision support is better than no decision support. 00:40:31.190 --> 00:40:33.909 I have some doctor friends that would always 00:40:33.909 --> 00:40:36.389 tell me, like, it's not that I don't want to 00:40:36.389 --> 00:40:39.030 see every patient. I want to see the patient 00:40:39.030 --> 00:40:41.110 once I know what I need to know that could have 00:40:41.110 --> 00:40:44.170 been collected by a nurse or by some other mechanism. 00:40:44.740 --> 00:40:47.940 aka maybe a very very intelligent chatbot that 00:40:47.940 --> 00:40:51.579 is AI powered and then I'm focusing on the aspects 00:40:51.579 --> 00:40:54.820 that relate to what I know in my training and 00:40:54.820 --> 00:40:57.539 my obligation to ensure this patient is getting 00:40:57.539 --> 00:41:00.340 the best care possible also taking a lot less 00:41:00.340 --> 00:41:02.420 time to arrive to the same conclusion therefore 00:41:02.420 --> 00:41:05.099 allowing me to see more patients you know again 00:41:05.099 --> 00:41:06.960 so by increasing that efficiency in the market 00:41:06.960 --> 00:41:10.119 I'd want to be able to these doctors said I did 00:41:10.119 --> 00:41:14.199 want to have that as as an outcome versus what 00:41:14.199 --> 00:41:18.679 it is today, which is triage is not significantly 00:41:18.679 --> 00:41:22.599 advanced compared to 20 years ago or 30 years 00:41:22.599 --> 00:41:25.880 ago. And so everybody is being, everybody's a 00:41:25.880 --> 00:41:29.320 nail and all you got is a hammer that needs to 00:41:29.320 --> 00:41:31.659 change. So that would be, I don't even think 00:41:31.659 --> 00:41:33.880 10 million would take you very far these days, 00:41:34.239 --> 00:41:35.900 especially if you bring in the element of AI 00:41:35.900 --> 00:41:38.039 and finding talent that can help you put it together. 00:41:38.519 --> 00:41:41.909 But that would be my first inclination. My second 00:41:41.909 --> 00:41:44.170 inclination would be much more simpler than that, 00:41:44.329 --> 00:41:46.269 which is think about the source issue, which 00:41:46.269 --> 00:41:49.309 is we're not able to bring doctors into the system 00:41:49.309 --> 00:41:51.829 because of budget constraints. How can you solve 00:41:51.829 --> 00:41:55.070 for that? What is Canada really known for? And 00:41:55.070 --> 00:41:58.510 the plain, simple reality is around energy. And 00:41:58.510 --> 00:42:00.929 that being a commodity that's quite valuable 00:42:00.929 --> 00:42:04.090 and it's in a resource -rich country like Canada, 00:42:04.530 --> 00:42:06.110 it's something that we have that others don't. 00:42:06.130 --> 00:42:08.530 So it would be... 10 million bucks going towards 00:42:08.530 --> 00:42:11.269 building a business that would optimize the supply 00:42:11.269 --> 00:42:13.630 chain to allow Canada to be a better exporter 00:42:13.630 --> 00:42:15.869 of energy. So something completely out of left 00:42:15.869 --> 00:42:18.030 field, nothing to do with health care, but it's 00:42:18.030 --> 00:42:21.170 about creating the revenue that this country 00:42:21.170 --> 00:42:24.010 needs to bring up its infrastructure, to bring 00:42:24.010 --> 00:42:26.369 up its health care, to do all of the things that 00:42:26.369 --> 00:42:29.289 we wish our government could do today, but can't 00:42:29.289 --> 00:42:32.250 because the only way they can do it is to increase 00:42:32.250 --> 00:42:34.610 taxes, which they've already done, as you saw, 00:42:34.630 --> 00:42:37.170 of course, with the capital gains tax. I think 00:42:37.170 --> 00:42:40.650 it's really around thinking, again, it's a demand 00:42:40.650 --> 00:42:42.969 and supply. Your demand is exceeding what you 00:42:42.969 --> 00:42:45.750 have in terms of budget, which is the supply. 00:42:46.230 --> 00:42:48.510 Find a way to increase the supply without alienating 00:42:48.510 --> 00:42:50.429 your entrepreneurs and business people by raising 00:42:50.429 --> 00:42:53.730 taxes, especially on business. So that would 00:42:53.730 --> 00:42:56.510 be probably where I'd go, actually. I think healthcare 00:42:56.510 --> 00:42:59.050 is much more political than it needs to be in 00:42:59.050 --> 00:43:01.389 Canada. I think there's way too many hands in 00:43:01.389 --> 00:43:06.170 the pot. I don't think... there is a clear leader 00:43:06.170 --> 00:43:09.610 who really can move the needle on anything so 00:43:09.610 --> 00:43:12.849 it ends up being this never -ending negotiation 00:43:12.849 --> 00:43:15.650 that's very time -consuming and more importantly 00:43:15.650 --> 00:43:20.050 very money -consuming and so we we just not likely 00:43:20.050 --> 00:43:21.769 I don't think we'll see a conclusion on that 00:43:21.769 --> 00:43:25.010 but energy and revenue to more revenue to government 00:43:25.010 --> 00:43:28.860 I'd say that's probably got more legs The one 00:43:28.860 --> 00:43:32.059 problem I see is healthcare delivery and healthcare 00:43:32.059 --> 00:43:35.219 payment is decoupled in Canada. So you have Ministry 00:43:35.219 --> 00:43:37.480 of Health, which essentially pays for all healthcare. 00:43:38.000 --> 00:43:40.179 But then you have the hospitals fighting the 00:43:40.179 --> 00:43:42.199 physicians, fighting the nursing homes, fighting 00:43:42.199 --> 00:43:44.519 the retirement homes, fighting the community 00:43:44.519 --> 00:43:47.420 centers. And when I say fighting, they are fighting 00:43:47.420 --> 00:43:50.539 for the same pot of money. Exactly. You get these 00:43:50.539 --> 00:43:52.739 different organizations as incentives are just 00:43:52.739 --> 00:43:55.590 to maximize the money they get from the Ministry 00:43:55.590 --> 00:43:58.050 of Health. And the Ministry of Health often just 00:43:58.050 --> 00:44:00.090 gives the money to whoever has the loudest voice. 00:44:00.730 --> 00:44:04.269 So there is providing good, efficient care is 00:44:04.269 --> 00:44:07.989 nowhere in that equation. Optics are everything. 00:44:09.110 --> 00:44:12.590 So one thought would be is the ministry should 00:44:12.590 --> 00:44:15.530 be the pay rider. They should pay, but they should 00:44:15.530 --> 00:44:19.369 also operate the facilities directly, not through 00:44:19.369 --> 00:44:22.949 these middle men, for lack of a better word. 00:44:23.340 --> 00:44:27.400 And what happens in this model is you get infinite 00:44:27.400 --> 00:44:29.380 organizations fighting for that part of money. 00:44:30.000 --> 00:44:33.539 So you have a lot of primary care advocacy groups, 00:44:33.820 --> 00:44:36.320 patient advocacy groups, because it's just one 00:44:36.320 --> 00:44:39.780 centralized part of money. I think a much more 00:44:39.780 --> 00:44:42.340 efficient model is the pay by the model, which 00:44:42.340 --> 00:44:46.780 is what quesa permanente is, to an extent, in 00:44:46.780 --> 00:44:49.000 which the person paying for health care provides 00:44:49.000 --> 00:44:52.210 it. And then they can also skirt accountability, 00:44:52.469 --> 00:44:54.929 because the Ministry of Health skirts accountability 00:44:54.929 --> 00:44:58.250 constantly, because they're not the ones delivering 00:44:58.250 --> 00:45:00.210 healthcare, and they can say, per capita, we 00:45:00.210 --> 00:45:02.889 spend enough. And it's not my problem, healthcare 00:45:02.889 --> 00:45:05.750 isn't delivered, but it's the problem of all 00:45:05.750 --> 00:45:09.610 these local decentralized organizations, which 00:45:09.610 --> 00:45:12.289 makes accountability much harder because it's 00:45:12.289 --> 00:45:15.900 distributed. There's no one vectoring. It's multiple 00:45:15.900 --> 00:45:18.880 necks and multiple heads. Yeah. So do you think 00:45:18.880 --> 00:45:21.380 that's by design or do you think that's just 00:45:21.380 --> 00:45:23.360 kind of, it just happened because that's how 00:45:23.360 --> 00:45:26.699 the dominoes fell? And does that need to be, 00:45:26.719 --> 00:45:28.639 because no one seems to be talking about that, 00:45:28.639 --> 00:45:32.880 the structure of healthcare delivery and payment. 00:45:34.820 --> 00:45:38.400 I think it's, you know, the basis of value -based 00:45:38.400 --> 00:45:42.440 healthcare, right? The pay -vider, Whoever is 00:45:42.440 --> 00:45:46.300 paying for the care should also be the one who 00:45:46.300 --> 00:45:49.320 cares the most, excuse the pun, about the outcomes 00:45:49.320 --> 00:45:52.519 of that care, right? So I think that's kind of 00:45:52.519 --> 00:45:55.780 the essential note around pay viders. It's I'm 00:45:55.780 --> 00:45:58.199 creating value -based healthcare. I will only 00:45:58.199 --> 00:46:01.019 put dollars into a healthcare system, or in this 00:46:01.019 --> 00:46:03.360 case, let's bring it right down to the patient 00:46:03.360 --> 00:46:05.880 level. I will only invest in this particular 00:46:05.880 --> 00:46:09.739 patient. What I believe would produce the outcomes 00:46:09.739 --> 00:46:14.380 that are positive and improve their life and 00:46:14.380 --> 00:46:19.420 all of the very specific calories and other health 00:46:19.420 --> 00:46:21.860 economics metrics that are out there and very 00:46:21.860 --> 00:46:25.679 well studied and I myself actually took went 00:46:25.679 --> 00:46:27.400 out of my way to understand health economics 00:46:27.400 --> 00:46:30.449 and and outcomes research just to really figure 00:46:30.449 --> 00:46:33.289 out a little quick certificate at the University 00:46:33.289 --> 00:46:36.469 of Washington. And what that gave me is it allowed 00:46:36.469 --> 00:46:39.570 me actually over the span of two years to understand 00:46:39.570 --> 00:46:43.269 how the U .S. solves for that. And so there's, 00:46:43.269 --> 00:46:45.150 you know, what you're saying makes a lot of sense. 00:46:46.289 --> 00:46:48.710 The one thing that you need to have in Canada 00:46:48.710 --> 00:46:52.030 to permit that model to work is to create, again, 00:46:52.090 --> 00:46:55.329 a free market when it comes to healthcare. So 00:46:55.329 --> 00:46:57.780 when you... Let's see how that's working out 00:46:57.780 --> 00:47:01.300 in the US. Of course, because it's entirely a 00:47:01.300 --> 00:47:03.539 free market there, the rich get great healthcare, 00:47:03.699 --> 00:47:07.340 the poor don't. There's not enough of a, call 00:47:07.340 --> 00:47:10.219 it a bottom. There's not really that safety net 00:47:10.219 --> 00:47:13.340 that should be there to hold up all of those 00:47:13.340 --> 00:47:16.519 people that have votes, but they're not strong 00:47:16.519 --> 00:47:19.820 votes. They're not votes that can cause something 00:47:19.820 --> 00:47:23.159 like the Affordable Care Act to really stand 00:47:23.159 --> 00:47:26.059 up and create insurance that can allow every 00:47:26.059 --> 00:47:29.679 citizen of the USA to have almost equal access 00:47:29.679 --> 00:47:33.780 to at least urgent care, palliative care, any 00:47:33.780 --> 00:47:36.880 of the things that we know how to solve for today. 00:47:37.070 --> 00:47:40.530 We're not talking about people that are getting 00:47:40.530 --> 00:47:46.030 premature organ replacements or knees and hips 00:47:46.030 --> 00:47:49.869 and all of the fixings and really over treating 00:47:49.869 --> 00:47:51.909 themselves because they have the money to do 00:47:51.909 --> 00:47:55.389 so, which does exist in the US. Or we're not 00:47:55.389 --> 00:47:56.829 talking about the other side of the spectrum 00:47:56.829 --> 00:48:00.650 where people, when COVID came, most people that 00:48:00.650 --> 00:48:04.650 died of COVID were black and poor. That thing 00:48:04.650 --> 00:48:07.409 has to, that had to change, but it didn't because 00:48:07.409 --> 00:48:10.730 there, the federal concept of healthcare doesn't 00:48:10.730 --> 00:48:12.829 exist anywhere near the strength that federal 00:48:12.829 --> 00:48:14.750 care exists here in Canada. So if you switch 00:48:14.750 --> 00:48:18.949 back to the Canadian side, and you think about 00:48:18.949 --> 00:48:22.710 what is a pay via model that would be instated 00:48:22.710 --> 00:48:25.250 by federal government, you know, you can't help 00:48:25.250 --> 00:48:26.570 but think about, of course, something that's 00:48:26.570 --> 00:48:28.489 already happening like national pharma care. 00:48:29.510 --> 00:48:32.309 And, you know, the most recent discussion around, 00:48:32.309 --> 00:48:35.639 say, diabetics, which is which is again a sizable, 00:48:35.760 --> 00:48:40.420 it's actually the one, it is the most spent on 00:48:40.420 --> 00:48:42.739 or the most expensive element of medication. 00:48:43.900 --> 00:48:45.760 And if you look at any kind of record of what 00:48:45.760 --> 00:48:48.960 gets the most money, diabetes and diabetes drugs 00:48:48.960 --> 00:48:52.179 are the ones that do. And so the idea of saying, 00:48:52.539 --> 00:48:54.599 okay, National Pharmacare is now gonna make that 00:48:54.599 --> 00:48:58.260 completely available with your health card, regardless 00:48:58.260 --> 00:49:01.900 of where you are, but it only focused on the 00:49:01.900 --> 00:49:04.590 drugs. It didn't think about, okay, what will 00:49:04.590 --> 00:49:08.210 happen now as it relates to this person's life 00:49:08.210 --> 00:49:11.429 cell modifications, their food, their exercise, 00:49:11.929 --> 00:49:13.989 how are we going to manage to catch diabetic 00:49:13.989 --> 00:49:17.929 feet in time, the socks, the eyes, all of the 00:49:17.929 --> 00:49:21.969 things that a diabetic has to deal with. It's 00:49:21.969 --> 00:49:25.570 impossible to manage that from a budget point 00:49:25.570 --> 00:49:28.599 of view, which is... One of the things that happened 00:49:28.599 --> 00:49:32.559 at McKesson quite often, and I had one of the 00:49:32.559 --> 00:49:36.280 greatest bosses there, he used to be the senior 00:49:36.280 --> 00:49:38.059 vice president of strategy there, his name is 00:49:38.059 --> 00:49:41.519 Ravi Deshpande, and he used to say this, which 00:49:41.519 --> 00:49:44.559 I think still holds true today, it's really easy 00:49:44.559 --> 00:49:48.579 to cut back on the prices of generics and the 00:49:48.579 --> 00:49:51.139 general cost of drugs, because it's a clear line 00:49:51.139 --> 00:49:54.980 item. You can't really measure time spent by 00:49:54.980 --> 00:49:57.880 a doctor to outcomes, like from a value -based 00:49:57.880 --> 00:50:00.480 point of view, it's much harder to do that. For 00:50:00.480 --> 00:50:02.599 drugs, yep, too much money, we're gonna cut it 00:50:02.599 --> 00:50:04.219 back, we're gonna cut it back, and national pharma 00:50:04.219 --> 00:50:07.460 care is gonna cause even more cutting back. However, 00:50:07.719 --> 00:50:09.980 it still doesn't replace the fact that when a 00:50:09.980 --> 00:50:12.440 pharmacy decides to say, then there are digital 00:50:12.440 --> 00:50:14.320 pharmacies out there that now just do diabetes, 00:50:14.780 --> 00:50:16.039 when they need to go out of their way to say, 00:50:16.079 --> 00:50:19.739 I'm going to hire diabetes education certified 00:50:19.739 --> 00:50:22.880 diabetes educators, which is a designation that 00:50:22.880 --> 00:50:26.179 a pharmacist can pursue. I'll have all of the 00:50:26.179 --> 00:50:29.019 devices. I'll have a way for it to navigate through 00:50:29.019 --> 00:50:31.500 all that. All that can really exist in private 00:50:31.500 --> 00:50:35.800 enterprise. For it to exist at a public pay vital 00:50:35.800 --> 00:50:39.139 mode, which it should ideally, that's sort of 00:50:39.139 --> 00:50:41.840 idealistically where we should land. would require 00:50:41.840 --> 00:50:45.880 very extensive controls put in place by the government 00:50:45.880 --> 00:50:49.519 to permit the view of healthcare to be much more 00:50:49.519 --> 00:50:53.139 than the cost of a drug, the cost of a doctor's 00:50:53.139 --> 00:50:56.599 fee for an interaction with a patient. But again, 00:50:57.059 --> 00:51:00.360 measuring the outcomes and having a view to what 00:51:00.360 --> 00:51:03.300 is the value of that interaction or that medication, 00:51:04.099 --> 00:51:07.210 that is very difficult to do without a much more 00:51:07.210 --> 00:51:10.750 significant take on data, being able to really 00:51:10.750 --> 00:51:12.630 track outcomes in a much more efficient way than 00:51:12.630 --> 00:51:15.409 we do today, which I would suggest is almost 00:51:15.409 --> 00:51:18.489 nonexistent. There isn't very good outcomes tracking 00:51:18.489 --> 00:51:22.949 today in Canada. I realize we're out of time. 00:51:23.030 --> 00:51:26.090 Do you have time for one question? Yeah, absolutely. 00:51:26.349 --> 00:51:29.409 Please. So you've raised 44 million dollars. 00:51:29.829 --> 00:51:32.389 I think a lot of founders listening will have 00:51:32.389 --> 00:51:36.019 lots of questions there. What is a piece of advice 00:51:36.019 --> 00:51:38.400 you have for founders who are trying to raise 00:51:38.400 --> 00:51:42.699 for a healthcare startup? Do things that matter. 00:51:43.199 --> 00:51:47.460 Don't spend too much time on the fireworks. There's 00:51:47.460 --> 00:51:50.099 a lot of things you could do with pyrotechnics 00:51:50.099 --> 00:51:52.679 and, oh, we're going to go change the world and 00:51:52.679 --> 00:51:55.480 do this and do that. But it's a lot of the discussion 00:51:55.480 --> 00:51:57.940 we just had today. The problem with healthcare 00:51:57.940 --> 00:52:00.840 is fairly simple. It's just very disconnected. 00:52:01.860 --> 00:52:04.239 There's the total lack of navigation. people 00:52:04.239 --> 00:52:07.360 are lost, they don't know where to go next. These 00:52:07.360 --> 00:52:10.539 are real problems that are well documented and 00:52:10.539 --> 00:52:12.880 you should start solving those problems before 00:52:12.880 --> 00:52:16.300 you start thinking about all of the other lifestyle 00:52:16.300 --> 00:52:18.099 stuff that we discussed earlier in the call, 00:52:18.559 --> 00:52:23.260 which are great because they make money. No one 00:52:23.260 --> 00:52:26.400 is gonna live a lot, you know, well sure you 00:52:26.400 --> 00:52:28.320 might live a better life if you get to your vagar 00:52:28.320 --> 00:52:31.659 sooner But at the same time it's not gonna necessarily 00:52:31.659 --> 00:52:34.320 be a healthier life because you've forgotten 00:52:34.320 --> 00:52:36.219 about all the other reasons why you might be 00:52:36.219 --> 00:52:39.280 suffering from ED in this moment, right? So I 00:52:39.280 --> 00:52:41.559 think it's really having that holistic view of 00:52:41.559 --> 00:52:43.139 a patient and that's what med now set out to 00:52:43.139 --> 00:52:45.719 do It's from the get -go holistic care was in 00:52:45.719 --> 00:52:49.079 our investor pitch deck, right? So we wanted 00:52:49.079 --> 00:52:51.900 to make sure people understood we dig, take a 00:52:51.900 --> 00:52:54.760 generalist view of the world, which is one of 00:52:54.760 --> 00:52:57.039 the more expensive ways to solve a problem, because 00:52:57.039 --> 00:52:59.460 then you're trying to make room for all of the 00:52:59.460 --> 00:53:03.380 permutations of that problem, right? Specialists, 00:53:03.679 --> 00:53:05.079 you know, the likes of Felix, you know, when 00:53:05.079 --> 00:53:07.260 they started in lifestyle and then they're progressing 00:53:07.260 --> 00:53:09.960 themselves to other therapeutic areas, that's 00:53:09.960 --> 00:53:11.619 another really good approach. And I'm really 00:53:11.619 --> 00:53:14.579 glad to see them get into things like pressure, 00:53:14.780 --> 00:53:17.420 blood pressure and cholesterol and all these 00:53:17.420 --> 00:53:20.619 other important diseases. But The reality is 00:53:20.619 --> 00:53:22.500 business likes money, investors like money, so 00:53:22.500 --> 00:53:23.820 they're going to focus on things that are high 00:53:23.820 --> 00:53:28.239 margin first. Do you bring, do you nationalize 00:53:28.239 --> 00:53:30.820 even the innovation in healthcare? I think there's 00:53:30.820 --> 00:53:32.440 some attempts to do that with things like Mars 00:53:32.440 --> 00:53:35.539 and the Discovery District, to try and encourage 00:53:35.539 --> 00:53:38.219 a specific kind of innovation. But at the end 00:53:38.219 --> 00:53:41.380 of the day, I think the long -term view, and 00:53:41.380 --> 00:53:42.900 you know, we raised 44 million bucks because 00:53:42.900 --> 00:53:44.940 we're solving for that big of a problem, but 00:53:44.940 --> 00:53:48.309 the long -term view is around setting yourself 00:53:48.309 --> 00:53:50.909 up to a sustainable arrival to profitability 00:53:50.909 --> 00:53:54.730 that lets you solve a significant enough problem 00:53:54.730 --> 00:53:57.570 that affects people's health care more so than 00:53:57.570 --> 00:53:59.829 it does their lifestyle and if you can do that 00:53:59.829 --> 00:54:02.650 well you'll get private pairs paying attention 00:54:02.650 --> 00:54:04.750 to you you'll get of course patients paying attention 00:54:04.750 --> 00:54:05.969 to you because you're going to help them live 00:54:05.969 --> 00:54:08.650 better and then of course employers and you know, 00:54:08.809 --> 00:54:11.010 and the path to scale for any digital healthcare 00:54:11.010 --> 00:54:13.429 company, which is through B2B, will also start 00:54:13.429 --> 00:54:16.750 paying attention. But it's a long road and you 00:54:16.750 --> 00:54:19.289 need to be ready for it. Stay focused and just 00:54:19.289 --> 00:54:22.269 stay on task because it's very easy to burn up 00:54:22.269 --> 00:54:25.389 our runway if you get distracted by too many 00:54:25.389 --> 00:54:28.610 shiny balls. And, you know, we've all been there, 00:54:28.650 --> 00:54:31.230 if you will. So that would be it. And, you know, 00:54:31.309 --> 00:54:32.769 I wish them all the best of luck. We could use 00:54:32.769 --> 00:54:34.690 all the help we can for Canadian healthcare. 00:54:34.889 --> 00:54:37.929 There's so much to repair and fix. Well, thanks 00:54:37.929 --> 00:54:40.570 so much, Kareem. This has been amazing. Thanks, 00:54:40.630 --> 00:54:42.750 Rishad. Thank you so much for having me.