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Podcast Notes

Wyndly lets you live life without allergies: https://ww.wyndly.com

Ashish Advani, CEO and Founder on InPharmD, joins Aakash to talk about how discovered a problem costing hospitals millions of dollars per year.

Ashish: https://twitter.com/aaadvani

InPharmD: https://inpharmd.com/

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Contact:

Twitter: @aakashdotio [twitter.com/aakashdotio]

Aakash's website: https://www.aakash.io

Music credits: Syn Cole - Gizmo [NCS Release] provided by NoCopyrightSounds

Autogenerated Transcript

[00:00:00] Aakash Shah: Hi there I'm Aakash, founder of Wyndly, where we fix allergies for life. This is Founders and Builders, where I talk to people who are working hard to bring something new and meaningful into this world.

Hey, everybody. I'm here with Ashish Advani: CEO and co-founder of inPharmD. I met him during my Y Combinator batch in the winter of 2021. I think he's doing something brilliant, but I'm gonna let him introduce himself.

[00:00:28] Ashish Advani: Hey guys, I'm Ashish. I'm the

CEO of inPharmD. Aakash, I'd be remiss not to start with a thank you. This is a dream come true. I've seen tons and tons of really great guests I've been incredibly impressed and really, really pleased to join today.

[00:00:44] Aakash Shah: Thank you for the kind words. I really appreciate it. Remind me to tell you the story on why we took a publishing hiatus

 That one's not for podcasting. And what's your elevator pitch for inPharmD..

[00:00:56] Ashish Advani: Before I can give you the elevator pitch, I can tell you I'm a clinical pharmacist by training and most people don't know what a clinical pharmacist does. And so I could start there doctors all across the United States and in, even in the world at every single hospital, they rely on pharmacists for their drug therapy decisions.

Doctors go to school extensively. They have tons and tons of knowledge on the diagnostic end of things. But they actually only have one semester of training on pharmaceutical care and there's about 10,000 drugs and only one semester of training. And so they'll be the first to tell you that they can't possibly know how to optimize therapy for each patient .And the best hospitals have increasing numbers of clinical pharmacists to help with this. We help to, for every patient identify the right patient, the right drug, the right time, the right dose and let the doctors do what they do best. And that's the diagnostics.

How this all got started is I was working as a clinical pharmacist for 10 years.

And one of the things that we got all the time, while we were supposed to be helping with these treatment optimizations is drug questions. We were just peppered with these drug questions and. Oftentimes, this would be like 20 to 30% of our day just answering these one off questions. And I recognize that I was answering the same question that my colleague Jim had been asked and answered maybe just a few days before, for instance, like "does levoquin cause tendonitis"

I might be looking that up today on Friday and Jim might have been looking that up last Friday and we're spending a few hours every single time going to PubMed, collecting all the literature that exists in this case, there'd be four studies that exist and then putting that together and pushing that out doing all this redundant work.

And so I created a database to keep it all straight. Be able to tag every question and answer that we got and eliminate all of this redundant work. And it worked at our hospital. We actually became the number one used database at that hospital level. Even more than up to date and up to date is a billion ARR business growing up 46%.

Yeah. Even at that size. And so that's when we first. started to think about this as a business. And from that first hospital, we scaled to our first health system. And the same thing was happening across the health system. And in 2018, that's when I quit, my job started doing this full-time and recruited our co-founder Tulsaee that year as well.

And since then we've been able to grow our business and our team and We've sold it to eight other health systems in the last three years. And the same thing is happening. Everyone is largely asking and we're largely answering the same stuff, so we can sort of serve as this single source of truth.

For really 6,000 hospitals, a hundred thousand pharmacists.

[00:03:51] Aakash Shah: thank you for taking us through that quick founder origin story. And I think what really jumps out at me is it's almost a quintessential founder story. You were doing something you saw a problem. You yourself were like, I'm gonna fix this. so I'm sure other pharmacists had noticed this problem.

why do you think the time was right for you to fix it right then and there.

[00:04:16] Ashish Advani: You know, people actually do this themselves. They'll keep a, a registry of their own questions that they've asked. So like, pharmacists are are, are smart that way. They've hacked together their own little databases. The thing is nobody's really thought to put them together.

I think this is because in pharmacy school, every time we had a group project it didn't go that well we were always like, it would always be like one person that did the work and then the three that would just kind of ride their coattails. And I look around and it's like, why are we all, not just helping each other and using each other's work, you know?

but I think that that does go back to school, we are used to kind of doing our own work as individuals and not trusting the work of someone. And and if we look around, we realize that everyone else is just as competent and we can rely on them. And especially now the workforce has just been depleted over the last couple years where people, people weren't as willing to give up parts of their plate.

If it's on my plate, I don't wanna give. But now it's the opposite where it's like, people are spread so thin and so they will readily give something up to another qualified professional. If they feel that professional's qualified.

[00:05:32] Aakash Shah: Gotcha. So it's actually a combination of two factors. One. It was that there really wasn't a collaborative culture and inPharmD is enabling that collaborative culture. Because you yourself are a trusted partner. You are an expert clinical pharmacist that was literally working beside your users, and two the incredible demand for health services

people need the help and inPharmD is providing that help. They're helping scale the pharmacist so that they can get more work, done, increase the productivity, so to speak. Am I correct there?

[00:06:10] Ashish Advani: That's right. They should be doing with a hundred percent of their day what I started telling you that they do: help identify for each patient, the right drug at the right time at the right dose. But . 20% of their days are just spent on PubMed, looking up these answers to these questions.

And so you're right. If you give them that time back, it's not like they go and play fantasy football or browser on, on Facebook, they go and optimize patient care with the remainder of that time.

[00:06:37] Aakash Shah: And I think that's really interesting because I've always found something that is personally draining for me is tedious work. That takes up a lot of time that I don't feel energized to do. right. I don't wanna file my taxes. I don't want to deal with administrative stuff. I want to actually do my job : the part that excites me.

And I'm sure for a clinical pharmacist, you knew better than anyone else. What is exciting versus what is tedious? And it sounds like you're automating away the tedium..

[00:07:06] Ashish Advani: When we talk to our users they're just drowning in all of this administrative burden that takes them away from patient care. So it's like a teams meeting or a text message or. You know, believe it or not a page sometimes. And , these are things that are taking away their joy in their jobs.

And if you can give them back some time it's like giving them that life raft when they're drowning, and that's been really rewarding as we talk to more users is being able to.

[00:07:35] Aakash Shah: That's incredible. So one challenge I've always had, right? You're selling to health systems. You're not selling to the individual pharmacists. That's hard that there's no other way of putting it. That is a hard enterprise sale that you've done multiple times successfully. how is that process going from being a clinical pharmacist, to someone who understands the needs of an executive at a health system and is able to convince an executive at a health system that they should invest in their clinical pharmacy operat.

[00:08:08] Ashish Advani: I'm glad you asked me that because earlier when I had said that, when the pharmacist gets 20% of their time back, that they're going to not spend it, you know, surfing the internet, but they're gonna spend it optimizing more patients care. But the CFO of every health system, they don't think like that.

They, they don't like time as a metric that we save their people, even though they know that they're people are drowning and they have. Staff shortages at the moment. The executives that we pitch to which by the way, is the chief pharmacy officer at every health system. They can't go to their CFO and say, Hey, this tool saves us time and that's why we need to buy it.

The reason why they have been buying from us and the reason why we've had such traction. Is really not because we're saving them time. You're exactly right. Users love that. And, and when they, when they write, like they write with such passion about how much they appreciate it.

 But when I talk to the chief pharmacy officer, we talk more about drug therapy optimization. And how that saves them money at the larger macro level for the health system.

For every one of our systems their drug budget is 300 to 500 million every year.

And oftentimes they are taking the Cadillac option when the Ford option will do just fine. If they need to get from point a to point B. Every doctor wants, like the best way to do that. No shame against doctors, but they just don't know the data between the Cadillac option and the Ford option.

And so of course, they're gonna kind of pick the one that has the best marketing or, or perceived in their minds as, as that Cadillac. and so pharmacists can help do this and we specifically help do this is help them understand where safety effectiveness and costs all marry to where they are always promoting the most cost effective options. They're always promoting that forward instead of the Cadillac to get from point a to point B. And, and so This is done by a pharmacy and therapeutics committee. And about half of the work that we do informs the decisions of this one committee.

And so we spend 99% of our time talking about that with these folks. And for every system I'm proud to tell you we've saved between six and 30 million in the last year.

[00:10:27] Aakash Shah: That's really, really interesting. And that's such a great insight that it's not about saving the end pharmacist time, but it's about saving the entire health system and each individual hospital you're optimizing their spend. You're letting each dollar that they spend on drugs.

Go farther and do more and improve more patient outcomes. You're literally improving the care that a health system provides and, and, you know, drug costs can get outrageous in the us. And so having an expert in your pocket quite literally, who is helping with that, which is what in farm biz that's that's that's revolutionary. And those numbers right there at the end, you said 60 to a hundred million that's that's like 20% of their total budget that you've been able to save them.

[00:11:15] Ashish Advani: It was 6 million to 30 per year, and it's a lot of money every year compared to, our ROI is like 20 X or, or even greater in some cases. Because. They don't pay us much to be able to get all of this in return.

[00:11:32] Aakash Shah: So, what would you say was the biggest challenge in getting from when you launched in 2018 to here today, where you've got a significant stable of customers and you're comfortable with your product market fit and you're trying to scale the business.

[00:11:49] Ashish Advani: I think YC taught us both. This is that it just takes some time. The very first health system that believed in us, you know, I told you our founding story that that's easy to kind of see how that got started, but then the second one was quite tough to be able to get, like, how do you convince a second one?

They probably think that, that this was designed really as a one health system thing, you know? And, and why would it apply? Why would it scale beyond that? Why would this even matter to anyone else? And so the second system was the hardest one. I. And the third was a little easier. The fourth was a little easier.

And now that there's nine it's still hard, but it's less hard. And and so we benefit from that. At the user level too, like when more and more users come on board, they ask more and more questions. And then the likelihood that we've already answered their questions before is higher.

And so then they get a higher, a, a better first experience as well. And so from both the buyer level and the user level just having more people on our platform makes it even better as an experience for them.

[00:12:56] Aakash Shah: so really your biggest takeaway was that the first adopter was doable because , it was in your network. It was the hospital that you'd worked with before. Maybe you knew the buyer. That makes sense. It's the second and third one that was almost an insurmountable sale , I mean, I understand the difficulty.

Sometimes it feels like once you have the wind at your back, you can keep sail. but, you know, getting your boat in the right direction to make that possible can feel really, really difficult .

[00:13:26] Ashish Advani: we're all like herd creatures, you know? And so if, if everyone's doing something that you gotta look at, They're all doing. And then if no, one's doing something you benefit from you don't benefit from that at all. In fact, it's, it hurts you when they ask, like, who else uses this and so just that one thing, I think saying the course, and then just benefiting from that one thing is is probably the biggest lesson.

[00:13:49] Aakash Shah: If you were to go back in time to 2018 Ashish, what would you tell?

[00:13:53] Ashish Advani: that same thing, probably like just trust in the process and stay the course. YC has studied startups and so they can give us this advice. But at that time I hadn't studied startups. I didn't know what we were getting into. And so I didn't know if we would ever get that second sale of that third sale.

[00:14:09] Aakash Shah: Do you think not knowing what was ahead of you was a benefit. For me sometimes I think if I knew how hard it was, maybe I wouldn't have done it.

[00:14:18] Ashish Advani: Yeah. Yeah, totally like I don't know how multiple founders have that same kind of, because. You know, getting started, you don't know what you're getting into and the amount of work is not quantifiable. And so then it's just sort of like, yeah, let's do it now three years in, you know, there's no turning back.

It's only another seven ahead and that's the only way we're going. But, but yeah, knowing what 10 would look like in the beginning. And so then afterwards to think like, oh, another repeat founder would just do another 10 like that. Like with that same energy, I just,

[00:14:48] Aakash Shah: So I, I think the repeat founder, I think what ends up happening is we're not gonna make the same mistakes. So we think we know it's gonna, we think we, we think we know it, right? Like, oh guys, it's gonna be easy. It's just harder in a different way,

[00:15:02] Ashish Advani: For like the few people that can do both like Jack Dorsey or Elon Musk. Like there's only a few of them in the world cuz I just feel like there's so much that goes into it. I'm sure you'd agree to it's like people, people that have never done it before, it's hard to even explain.

[00:15:17] Aakash Shah: I agree Well, is there anything else you would like to say Ashish before we wrap.

[00:15:23] Ashish Advani: The same way I started. Thank you for having me. This has been a dream. I, I didn't start with as much detail, but when you and I were in the same batch, I was, I was looked up to you and Manan and, and especially this podcast was really impressive because it's like, we just were talking about how hard it was to.

go from zero to one, and then you guys are going from zero to one and doing this . And so I was like, oh, maybe someday I'll get to be on there after I think, I, I think the deal was after we raised our seed round, then, then I can, I can then we've made, we've made it to that level where I can, I can be on this five.

I was just waiting. I was just waiting for my invite. And when I got that email my eyes lit up. So I'm just pleased to, to be here. And and thanks for everyone for listening.

[00:16:09] Aakash Shah: What was wonderful having you on Ashish and we'll definitely get you back because it sounds like you're gonna take over take over health systems and IPO

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[00:16:18] Aakash Shah: This episode of Founders and Builders is brought to you by Wyndly. At Wyndly, we fix allergies for life with personalized treatment plans that train your body to ignore your allergies.

Our doctors use an FDA-approved treatment, allergy immunotherapy, to train your immune system to ignore its allergy triggers. By exposing you to naturally occurring allergens in gradually increasing doses, we fix the root cause of your allergies. Plus the entire Wyndly experience is convenient and easy with telehealth visits and medicine sent right to your door. You never have to go to a doctor's office.

 If you want to live without allergies, then visit https://www.Wyndly.com that's wyndly.com. Remember, life's better without allergies.

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[00:17:04] Aakash Shah: Thanks for listening to Founders and Builders. Make sure to subscribe and share this episode with a friend. You can find more episodes at https://www.aakash.io. That's aakash.io, or just find Aakash on Twitter @aakashdotio.