This episode of The Dish on Health IT features guest Kyle Kiser, CEO of Arrive Health, joined Point-of-Care Partners (POCP), hosts and health IT leaders Pooja Babbrah and Jocelyn Keegan to discuss price transparency and real-time pharmacy benefit (RTPB) check. They also discussed user centric design, optimizing adoption, and related policy and standards. 

To kick off the episode, Pooja Babbrah introduced herself as the host and Pharmacy PBM Lead with Point-of-Care Partners. Jocelyn Keegan then introduced herself as the POCP Payer Practice Lead. Pooja then asked Kyle Kiser to introduce himself where he explained he is the CEO of Arrive Health and has been with the company for almost 9 years. 

They then talked about the benefits of tools that allow for more visibility for providers and patients into coverage and price, as well as the key considerations when designing and rolling out new tools to optimize adoption and consistent use. They also discussed the role of policy and standards related to price transparency and RTPB.

Kyle explained that Arrive Health is a company inspired by Dr. Kevin O'Brien's experience with his mother Lucy. When she came to Dr. O’Brien with an issue of out-of-pocket spending, using his expertise, he sought out ways to reduce her spend. This led to the creation of Arrive Health and the mantra “Lucy Up” which is a reminder of their mission to make sure patients can afford their medication. They focus on the patient-provider relationship, and their customers and partners are those looking to save money on their medications.

The conversation shifted to focus on the vision and mission of a company that has been around since 2013. The focus from the beginning was to improve healthcare value by connecting patients and providers with the right information at the right time to drive the right decision. This conversation then shifted to price transparency and the policies that have been put in place to make it easier for patients to understand what they are paying for and how the industry can help to smooth out some of the pain points they face when it comes to affordability. The company is committed to its mission and is continuing to focus on the patient-provider relationship as the most leveraged opportunity in the value chain.

The conversation then focused on the current state of making price more transparent in the healthcare industry. The group agreed that real-time benefit check has been a successful addition, offering a strong value proposition for providers, payers, and patients. They also acknowledged that there is still much work to be done on the medical benefit side. 

The group discussed the ever-increasing complexity of benefit carve outs and the ongoing challenge of validating patient identity and connecting with their benefit details at the granular level needed to really understand coverage and out of pocket costs. They then discussed the role of policy in raising the floor for the industry without boxing out innovation by making requirements too narrow or prescriptive.

The conversation shifted to prior authorization and the work of Da Vinci Project on price cost transparency. The participants recognize the need to get pricing information to the payer and patient at the right time so that they can make decisions about their care that they can afford. Da Vinci's four guides allow for similar workflows to that of RTBC today due to the separation of activities on the medical side compared to a dispense event.