Raising $44 million and taking Mednow public - Karim Nassar

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I think the long -term view, and we raised 44

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million bucks, we're solving for that big of

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a problem. The long -term view is around setting

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yourself up to a sustainable arrival to profitability

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that lets you solve a significant enough problem

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that affects people's healthcare more so than

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it does their lifestyle. And if you can do that

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well, you'll get private pairs paying attention

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to you. You'll get, of course, patients paying

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attention to you because you're going to help

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them live better. And then, of course, employers.

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you know, and the path to scale for any digital

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healthcare company, which is through B2B, will

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also start paying attention. Hi, everyone. I'm

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really excited to talk to Kareem today. I've

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known Kareem for two years. I'm always impressed

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by his diligent and inquisitive nature. We have

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had countless discussions about healthcare. I'm

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happy that I get the opportunity to share some

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of them with you today. Kareem is the ex -CEO

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and co -founder of MedNow. where he took MedNow

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public at 150 million market cap after raising

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$44 million. Thanks so much for joining me, Kareem.

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Excited for this? To get started, let's dwell

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a little bit into your childhood. There are things

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we learned from our childhood which help us,

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and there are things we have to at times unlearn

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from our childhood. Just talk to me a bit about

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your childhood and if you could answer the questions

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I posed in that framework as well. Well, I had

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a fairly I guess a child that had a lot of change

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in it. I was born in Europe, and then we moved

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to the Middle East, the Emirates specifically.

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And I pretty much grew up there, at least until

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I was about 15 before coming to Canada. And then

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while I was in the Emirates, for whatever reason,

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my folks They're both academics so they were

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very attentive to the education that myself and

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my twin sister in this case were getting. So

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almost every two years we were changing schools.

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So one of the notables probably about my childhood

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is that I never really kept a very consistent

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friend throughout it. It did eventually happen

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when I went to... public schooling system for

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a couple years and the friends I made in that

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school are people that I still know today. I

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don't know anybody from my other schools that

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were, you know, just, you know, the nature of

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being an Emirates is if you wanted to learn English

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you have to go to a private school. So there's

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not the same concept of a private school as you

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would in North America. But yeah, anybody who

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I would have went to school with in these in

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that environment I I've totally lost contact

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with so I don't know what that says about me

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or what it means in terms of the context of education

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But probably the one thing that was unique and

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different between private and public was that

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public schools were All boys or all girls just

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by the nature of the country. And so there was

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definitely a lot more of a camaraderie Aspect

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to it. It was this idea that you know Boys will

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be boys and things that you'd never really experience

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as much in the co -ed environment that the private

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schools, they're provided. And the other part

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of it is I've always loved to put things together.

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I've always been, and it's probably what inspired

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me to be an engineer. So Lego and technique and

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all that stuff. Also, I did a fair bit of selling

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things. So I would find random things around

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the house. set them up somewhere and try to sell

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them. I had my little mini garage sales, which

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eventually actually played into some of my entrepreneurial

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itch, if you will. I've always fancied the idea

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of selling something for a markup. And so even

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going through university, I had a side business

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on eBay. that was of the same context, just the

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idea of making a product really appealing, buying

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it at a great price and then selling it at a

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fantastic markup, which is a lot what you get

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to do in pharmacy. So, you know, kind of a full

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circle moment for me for where I landed. Do you

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think entrepreneurship is innate or can it be

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taught? I think there's a certain aspect of it

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that's innate. And then when I say innate, it's

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more in terms of where you What experiences you

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had growing up such your question around childhood?

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I mean again my folks were academics, so they

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weren't of the entrepreneurial nature but my

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grandparents were mostly in trade and so I think

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some aspect of that carried over into them and

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Maybe that's what I picked up in terms of the

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encouraging somebody to go and again You know

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entrepreneurship a big part of is around selling

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and having the comfort to sell things. So in

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many ways, I think that I definitely picked up

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from just encouragement. Yeah, that's something

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you should do. I think if my folks were a little

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bit more inclined to be pure academics, sort

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of the traditional view of academics where just

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go to school, get good grades, and that's all

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you worry about. I probably would have landed

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somewhere different. So that's the only aspect

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of it that's innate. But the rest of it, I think,

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is taught in experiences, whether it's in your

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home or in your friends or eventually in your

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career and your work experience. We had very

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similar childhoods. I was in my 17th home by

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the time I graduated high school. Yeah, it was

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a lot of moving around. My parents were academics

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and we moved from India when I was 16. It taught

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me. how to be adaptable. It taught me to be very

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comfortable with change, but it did have me missing

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a sense of home and a sense of grounding. Do

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you find that as well? And if so, how did you

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find your sense of home and grounding? Yeah,

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it's funny that the symmetry in our life is quite

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shocking. I never knew that about you. Yeah,

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I mean, I would say the grounding has become

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was probably an issue when I was making the move

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to Canada getting to know people here and having

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friends that were in a lot of cases just also

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immigrants like myself and so when I finally

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made it to university I probably that's when

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I was starting to feel a bit more stability in

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my group of friends and so forth but then you

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know shortly after university I was off doing

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my MBA and Kingston, Ontario, and then upon returning

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from there, I was on my way back to, I was on

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my way back east heading to France in this case,

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and I worked there for a little bit. So, yeah,

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then back to Canada, but not to Toronto, to Alberta.

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So there's, you know, there's always this movement

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in my life throughout. And so it's not only until

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very recently, when I got married, and now I

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have two beautiful girls, you know, five and

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three, that that sense of being grounded, I actually

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find it in them. And then sort of the idea of

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the purpose of being a father, if you will, to

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really get that sense of security, that that's

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a constant. That's very difficult to change,

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you know, God forbid anything would happen, but,

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you know, they're always gonna be there as long

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as you're there. And I think that's probably

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one of the ways that I really maintain that sort

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of sense of groundedness. And then, you know,

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others, I think I'm generally spiritual, so taking

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the time to be grateful for what you have and

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just being content with what you got. That also

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creates a sense of stability and grounding that

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I find quite helpful. Let's move forward in time

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to starting MedNow. Talk to me about how that

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idea came to you and how did you get the team

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together and how did you launch the company?

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So that's a very big question. I'll start with

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the idea and how it came to me. So after spending

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some time doing home healthcare, which was specifically

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around the sale of medical devices to support

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patients that have a sleep disorder called sleep

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apnea, and more importantly, home oxygen, which

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is the therapy of oxygen supplement to patients

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that normally have a condition called chronic

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obstructive pulmonary disorder, COPD, and what

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really The challenge there was about bringing

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these medical devices or these essentially flammable

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gases that are compressed in cylinders to people's

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homes, in this case all over Canada, where I

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work in that business so that they can continue

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to live as long as they can and maintain their

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activities of daily living as well as they can.

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What I was able to do after that was to join

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McKesson in a strategy role. So McKesson is one

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of the largest wholesalers and distributors of

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pharmaceuticals in the world. I came in to primarily

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support all that is retail banner programs, so

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what McKesson puts out to retail pharmacies in

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terms of a support program that has to do with

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marketing, more principally buying the generics

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that they use, marketing, and all the things

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that relate to operating a pharmacy profitably.

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So that was one focus of mine. The other focus

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was specialty pharmacy, which is expensive drugs

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that require a high -touch model of care, usually

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requiring an intervention of a nurse or a case

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manager and delivery to home. So there was a

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certain parallel from being in the home oxygen

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business to being in specialty. And then finally,

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I was also quite involved in M &A activities.

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Around the time McKesson bought Remedies RX,

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there was the shoppers divestment of their assets

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when Loblaws bought them. So I was involved in

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leading some of these deals into the way they

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were sold, either to members, in the case of

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shoppers, members of McKesson's banner, or into

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the acquisition of Remedies RX, in which case

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that was the moment McKesson... officially entered

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being a retail pharmacy operator and competing

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with their own customers of wholesale, who at

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that point were always uniquely the only consumer

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of their wholesale services. So that was the

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exposure I had to the community pharmacy model.

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And throughout I just realized, even through

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the Banner programs, there was never really much

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technology. Everything was still very much in

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analog mode. the pharmacist and the patient would

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only be able to communicate when they're together

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in the pharmacy, the pharmacist on one side of

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the counter and the patient on the other. And

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it's when I was really inspired to think, well,

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there should be a way to to kind of advance this

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to the mode of Amazon e -commerce, Uber dinners

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and taxis and all the things that we started

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taking for granted in terms of how everything

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is available through our phone. And even at the

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time, I pitched McKesson on a an app so they

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can have a long -term relationship with their

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patients, or specifically that their band members

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can have a relationship with their patients once

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they've left the pharmacy. And in the typical

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large -corp notion, they liked the idea, but

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they weren't willing to risk being the ones to

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create it. So I decided I wanted to create it.

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And that's the inspiration for MedNow. MedNow

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itself didn't happen until a few years later,

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two or three years later. But it was definitely

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the bug and the seed that was put in my mind

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at the time to recognize the opportunity there.

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And what was the business model you had in mind

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when developing this connection between pharmacists

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and patients? So for me, it was around transforming

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the pharmacy experience from being an in -person

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only available on -premise and primarily in a

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synchronous mode to being entirely virtual, permitting

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asynchronous communication. and a real concept

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of customer management in the sense of I want

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to be able to see this customer throughout their

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life cycle. Not just at the moment where they

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pick up their drug and I'm as a pharmacist, I'm

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dispensing, but from the moment they have a concern.

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So MedNow had a telemedicine. function where

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they would intake patients and process them to

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whatever, you know, whatever the issue they might

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have. A pharmacy prescription would be issued.

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If the patient chooses, they can fill that right

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at MedNow and then there'll be sort of a full

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cycle where patient gets a prescription, goes

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to our pharmacies. and then gets delivered to

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them the same day for free. And then beyond that,

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there was the follow up that was done via text

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or video calls, which is something that most

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pharmacies at the time did not have the facility

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to do. And even beyond in terms of refilling

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or having to see your doctor again. So there's

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really just sort of a life cycle extension to

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any of the customers that was totally different

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than the transactional mode that patients had

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experienced in retail pharmacy. That was really

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the collective of the MedNow supply chain extension,

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if you will, I think about it as a supply chain,

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where it didn't terminate in the pharmacy interaction

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where here's your white bag, read the instructions,

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and call me if you need anything. So we really

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wanted to create pharmacy as a healthcare hub.

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And I think we succeeded in that, and MedNow

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continues today with very much the same vision,

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this idea of it being more of a hub for That's

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a very accessible hub compared to, say, your

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family doctor or your walk -in clinic to help

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people navigate through what is a very complicated

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journey, which is getting you health care and

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a publicly funded health care system like Canada.

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And how did you find your founding team? So it

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was through my consulting practice that I was

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essentially looking for clients. So after leaving

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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.