AH070 - Inside Capital Rx's Acquisition of Amino Health: Creating the Health Benefits Platform of the Future, Today

Transcript

Lightly edited for clarity.

[00:27] Justin Venneri: Hello and thank you for listening to this special episode of Astonishing Healthcare. This is Justin Venneri, your host and Senior Director of Communications at Capital Rx. And I'm thrilled to have the opportunity to interview our guests today, AJ Loiacono, Co-Founder and CEO of Capital Rx, and John Asalone, CEO of Amino Health, who along with his team at Amino has joined our mission to bring Judi Care to life.

AJ and John, thank you for coming on the show.

[00:49] AJ Loiacono: Thanks for having us.

[00:50] John Asalone: Thank you.

[00:51] Justin Venneri: So we just announced that Capital Rx acquired Amino this week and I'll link that along with some other related content in the show notes, of course. But before we get into questions about care navigation and the acquisition, anyone that's listened to the show before or follows us on LinkedIn probably knows your background, AJ -- how you started in supply chain software for pharma, realized there were and still are some very real opacity issues in PBM contracting and with drug pricing, and that you and Ryan started Capital Rx about seven years ago to solve the problems within the PBM industry. Anything you'd like to add to that?

[01:23] AJ Loiacono: No, just it's a constantly evolving mission that I've always talked about here and with customers, which is you make one observation, you solve that problem, you continue on that journey and make other observations. The additional observations that we've made is there's equal inefficiency and cost considerations and problems on the medical side, which is why we now process medical claims, moved over into benefit administration and now with the care navigation.  

And again, I think it's a continuum of solutions operating in what we call a single source of truth environment. So for the first time, everything from eligibility, plan design, processing, payments, reimbursement, navigation, information to the customer and plan, is all synchronized in real time, and this is what we'll talk about. But that's it, is just the journey never ends.

[02:12] Justin Venneri: Awesome. John, tell us about your career path and journey that led you into healthcare and ultimately to Amino.

[02:18] John Asalone: Thank you Justin. Very excited to be here. Very excited to talk about the acquisition of Amino Health and Capital Rx. My journey into healthcare is relatively recent. I am a consumer product person. I have built consumer products in several industries - energy, social gaming, ed tech, but healthcare was new to me about a decade ago.  

I started my journey joining very early on another pharmacy company called GoodRx which did consumer acquisition and prescription drug savings for consumers. And my job there was to build new consumer products. This was before Covid. We had launched a telehealth asset. So, when Covid came around, we massively scaled that business line to be in 50 states, 30 different conditions. We launched consumer subscription products there and direct to consumer mail delivery. And for me, launching consumer products in healthcare was an amazing challenge. Enormous industry, but saddled with old legacy tech. So just bringing basic consumer product instincts, making things simple, easy, intuitive to use in healthcare was a major innovation.  

And to be able to do that in healthcare and to be able to bring that into Capital Rx is really exciting.

[03:26] Justin Venneri: And one more background question: how did you two meet? How did you and AJ come together or become aware what the other was up to? I don't know if you want to go first, John or AJ?  

[03:35] AJ Loiacono: Healthcare is a fairly small pool and so you begin to know lots of people during your time in the field. And I always say people that are having an outsized effect or great operators, you know, you begin to see a recurrence in their exposure, their name.  

For myself, you know, I started to hear John's name couple times obviously during his time at GoodRx. And then later on I think we met at I think a healthcare conference for lunch or we had a quick coffee and it was great to catch up. And that was years ago. And you know, I always say is always try and maintain good connections with everybody you find as a high performer in industry and eventually you may find a point in time where you're collaborating or working together or partnering. And here we are.

[04:23] John Asalone: I actually remember the first message. I went back and through our LinkedIn history, AJ, and I saw the first time we connected. And you know the story for me, I am there at GoodRx where we are making, you know, incremental changes against the legacy PBM industry and making a lot of improvements. And then I see Capital Rx out of New York, and I could not believe what you guys were doing. I mean, making systematic change 100% transparent. And part of me thought, well, there's no way this could work. I was just astonished by the ambition of the mission.  

And over years I just saw more and more clients, added more and more features. You see more and more headlines around employers and plans. Being frustrated with the lack of transparency. And to see the founding team at Capital Rx and just the first principles - let's just give control back to employers, to plans to give them control and transparency. I was very impressed and I wanted to learn a lot more.

[05:17] Justin Venneri: Cool. And so at a high level, let's dig in a little more - care navigation, digital care navigation. John, a couple of questions for you. Can you please explain what healthcare navigation is and what care navigators do? What problem or problems does this solve?

[05:31] John Asalone: Great question. When you say care navigation in this space everybody has their own definition of it. On one end of the spectrum there is a simple directory product, self-service directory product. On the other end it's a people powered process, one where you're doing the most high acuity cases, where there's a individual that is paying attention to your specific needs.  

So how I think about it, sort of in the bell curve of care navigation. You know, right now, today, if you are a member of a health plan and you're looking to find a provider -- the most simplest use case, I want to find a primary care provider -- you have effectively two options. You can go to the directory product at your health plan, or you can do a Google search. That is how the vast majority of people find care today.  

So if you go to the health plan site you will see that there is no personalization for your actual experience, for your actual benefits that your employer is giving you. There's no quality indicator or experience indicator of the provider or facility you're going to. You are on your own when it comes to finding care.  

If you go to a Google search, there's some things that are better about that. You'll see reviews, you'll know if the parking is good near the facility. You will see if the provider has good bedside manner and is quick with follow ups and can schedule quickly. But you don't actually fundamentally know if the provider is very experienced in treating people like you.  

So what we've done at Amino is try to bring transparency, quality, and experience into the directory product. So, for us when you are searching for care, we are going to show you these providers are in network, they are very experienced at treating the condition that you are looking for and they're very high quality. So that just very simple level of insight is not being done today.  

And with Amino Health, now to be rebranded as Judi Care, what we want to do is to put quality, cost insights, and all of the benefits that your health insurance provides into one simple search box.  

So for us care navigation is the ability to help a member find really high-quality care with objective information.

[07:28] AJ Loiacono: One thing I just want to build on that, that gets us so excited and we'll dive deeper into in a moment, is all the additional insights and information that comes from the data that we sit on as claim administrators. Simple workflows of eligibility, more complex ones of plan design, pharmacy history, medical history, payments, deductibles. All of this now can also help in what John just described, which is improving care navigation.

Related Content

• Judi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards Program
• Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform
• Capital Rx Adds More than 80 New Partnerships in 2024 and Eyes Another Year of Record Growth in 2025
• AH065 - The Bridge to Value-Based Care: Unified Claims Processing™, with Dr. Sunil Budhrani
• Beyond cost, what barriers to health care do consumers face?

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[08:00] Justin Venneri: And forgive me for asking this, but, and maybe John, this is best for you. How is it that this problem hasn't been solved or why is this still an issue? Is it just a challenging issue because it's a data issue and there's so many providers out there and there's change, or is there some other reason? I know a lot of people try to tackle care navigation from different angles, right?

[08:17] John Asalone: You're absolutely right. Healthcare is getting more complicated. It's getting more complicated on how benefits are designed. It's getting more complicated in terms of how much you pay when you go and see a provider. It's getting more complicated for employers administering this complexity, and that complexity has frankly made it harder for the individual member to know what is covered, what is not covered, how much am I going to pay, and who is the best provider? So part of the complexity of the industry is being reflected on the care navigation side.  

Now one of the opportunities, the flip side of that, is we have built Amino Health to be a platform that is highly configurable. Meaning as the industry gets more complicated, as plan design gets more complicated, we can take all that complexity and simplify it for a member and just focus on the core use cases -- help me find a high quality provider that is in network. And we can abstract all of the complicated data parts of that.  

So I would say the reason why it's been a hard problem to solve, if you do not have access to the core data, as AJ mentioned, it becomes really difficult to show high quality recommendations to a member. So by joining Capital Rx, we are now going to start having access to claims data, to eligibility files, to the raw data. That'll enable us to make it simpler on the consumer side.

[09:37] Justin Venneri: And AJ, what did we start looking for in a care navigation partner or why was Amino the right partner? What did you see that gave you the confidence that this would be a great potential partnership?

[09:47] AJ Loiacono: Yeah, I think you start with your why. You know, for us we always continue in our innovation journey. You know, you start with pharmacy. We started to observe similar behaviors and inefficiency on the medical side. And I often joke whenever you have to do something twice, it's at least twice as expensive. You know, why do we have one process where you go down this long meandering path for pharmacy and one for medical? And what people don't understand is on the medical side, even in particular, there's dozens of third-party dependencies and vendors and subroutines. And this just adds to the cost and the encumbrance of price and oftentimes creates friction of experience with the member.  

And so, as we're making this massive of investment in our tech stack on what we call Unified Claim Processing™ - one system, medical, pharmacy, it doesn't matter. You know, you move from this concept of you're a PBM, to really you're an HBM; you're a health benefit manager. And our job is to provide the tool sets to give payers - and that can be anything from an employer group to a health plan - the tool set and the freedom to do whatever they want.  

And I think this is such an amazing moment, but you spend all this time, what I often say in plumbing, as you've heard me talk about hundreds of times in an infrastructure, what's below the surface or what's inside the building? But people obviously interact with the architecture itself, the very building itself. Is it aesthetically pleasing? Is it well laid out? Well, this is care navigation in many ways and we're powering that experience on the back end.  

So the fusion of back end meets unified front end. This was a moment that we had to do. And I always want to point out, we are independent. We obviously push and pull data and provide integrated solutions with any vendor or solution. But more and more of our consultants, either A, don't have a unified care navigation solution, or are looking for one, or perhaps it wasn't priced competitively. And I think this is the other thing that we offer is very reasonably priced products because of our efficiency and our integration in scale. And I think this enables us to have an outsized effect or impact on the industry.  

So yeah, the fusion or that combination of we have unified claim, unified experience on the back end, let's give it to the front end. And so, you know, you can always, as I say, many instances you might want to build this out, but for us we're so focused on the infrastructure side, we just felt we would go with best in class and find the perfect partner on the front end. And that was John and his team at Amino.

[12:21] Justin Venneri: All right, John, maybe let's just go right to some of the top ways Judi Care can bring value to employer plan sponsors. You already described the ease of search for a member and how you can configure it. Can you go into a little bit more detail about maybe specific use cases or ways that can help reduce costs or bring value to the member and empower the relationship between the member and the plan sponsor?

[12:45] John Asalone: Absolutely. And one thing I should mention off the top is one of the first major product bets that Amino Health made in the last two years was to integrate medical navigation and pharmacy navigation inside the same platform. And for us what that meant is instead of just searching for medical conditions, providers, procedures, facilities, you would also be able to search for drugs and find a prescriber, to find a drug savings, or to route directly to a care coordinator, especially for very expensive drugs or drugs that may not be covered by your plan.  

So over the last few years we made our search agnostic across pharmacy and medical. And there's a reason for that, because the consumer is just looking for care, okay? They don't understand that one company runs one part of your benefit, another company runs another part. They're just looking for care. So, several years ago we changed how our front end and what could be searched for, which just enabled us to route to more solutions.  

So some of the core use cases we can solve now, we can show you a primary care provider that is in network. We can show you the most experienced oncologist that accepts your insurance nearby or anywhere in the country. We can also book appointments directly, confirmed appointment, real time, back to school shots, vaccines. There are hundreds of conditions that we can book against. And we can also help employers execute whatever their benefits strategy is by doing, we call this real-time routing. So when you search for care, we can route a search for asthma directly to the preferred vendor or program that an employer has set up.  

Some employers believe in and invest heavily in telehealth. We can instantaneously route thousands of searches directly to their telehealth vendor, which is a perfect way for employers to triage care, to manage expenses, and to ensure that members are seeing a provider quickly. And then a provider is able to say okay, go here or go there or we can handle you with a virtual assessment.  

So the ability to bring pharmacy medical into the same search and then to configure it to wherever the eventual sponsor wants the care to go, it's very powerful to do that unification. So in some ways it was sort of meant to be that Amino Health and Capital Rx converged given the alignment of mission.

[15:02] Justin Venneri: Yeah, and that certainly seems like given the complexity you described earlier, simplifying that care journey by just making it a very smooth process from search to booking the appointment makes a ton of sense. It's awesome.

[15:13] John Asalone: Consumers are smart. They know what they're looking for. They have identified a problem, they want to find it. If we can just take the back end and merge it with the front end and make those things seamless, we can help people find care.

[15:25] Justin Venneri: Yeah, surface that information in an actually helpful way instead of a more complicated way. Last thing you need is on a list to confuse you while you're trying to figure out what oncologist to go to.  

AJ - anything you'd add from a synergies perspective?

[15:37] AJ Loiacono: I mean, I think back to the vision, you know, back to the mission and purpose, we're very much aligned and so makes for a very seamless partnership. I think the technology on the front end, which is now Judi Care with Judi Health™, our backend, is going to be really powerful.  

And I often talk about the now and the later, and immediately it's incredibly helpful. You know, we've already turned it on for our benefit program, our membership here at the company, and working with select partners as well who are equally excited and you know, you already see the benefit. But you talk about the later, which is the combination of this data, the combination of oversight and you start to enter into a really cool phase of technology where you're no longer necessarily limited, as we were talking about, as lists and text based interactions, where this is going to become conversational with Judi and Judi Care.  

It's going to be almost like having a conversation with someone that understands everything about your benefits and benefit plan, and your out of pocket, and your deductible, and your network, and your access and your patient and record history. And this has never happened. And again, I go back to the power of unified claim, with the power of unified front end, and then delivering an experience that is far superior to anything we've even imagined over the last decade.

[17:03] Justin Venneri: AJ, can you continue with your description or your vision for the future here? What innovation can you see as a result of this partnership?

[17:10] AJ Loiacono: Well, you know me, I'm a little bit secretive. So we always want to build something stealth because you don't want to reveal the plot, you know, in the first episode.  

So you know, what we're going to try and do is tease everybody a little bit about what's happening. But I think we're seeing a massive acceleration, and these gains that we're seeing are enabling us to deliver on things that were dreams, or whispers, or promises.  

I often say, like hey, where's my flying car? What happened to that promise? And I think this is one of those areas where the promise is becoming reality, that the technology is enabling us to do things, but it can't be done without the unified tech stack.  

And the other thing that makes I think the Judi Health, Judi Care component, back end, front end, so powerful is that people always forget, like people talk about AI and the ability to read data and insights and help decision, but when you have a true administrative platform, it's read and write operable. And what I mean by this is something can make an insight and then begin to actually present actions and options in real time to make the patient and family's life better. You know, that member is now experiencing something they've never had before.  

And I think that without going into detail, this is what the next generation of care is really going to be. It's going to be this sequencing of events that is built back on that single source of truth. So there's no gaps in knowledge or numbers or care or pricing. And it's, you know, again, fully transparent, a high level of integrity where your services are built on membership. What I mean by that is flat cost, what does it cost to administrate a plan or a patient? Not what I would say, cost models that are based upon revenue driven on premium or drug price or encumbrance of premium dollars or encumbrance of drug or prescription dollars.  

I just think we're entering into a different era, and I think it's completely aligned with what the US consumer wants out of their health care, which is truthful, actionable information at the lowest price, at the highest quality. And this is what you're driving towards. John, feel free to add.

[19:27] John Asalone: You said it: personalized care. That's what I'm excited about. We have seen at Amino Health, when we have access to claims, we get more engagement, we get better recommendations, better outcomes. And the problem is it's not easy to always get access to that data. By Amino Health and Capital Rx coming together, we're going to be able to unify the stack, which means the consumer experience, the member experience is going to get better. And that is the vision that I'm really excited to execute against. And it can only happen when you've got great data and great infrastructure that comes together with a great consumer experience.

[20:01] AJ Loiacono: And I always want to make, you know, this is a great, I think, moment for us to kind of pause and have people understand not just the application and practicality of what we're describing, of this service and solution is, you know, our organization going forward.  

So I mean we are Capital Rx, a full-service pharmacy benefit manager, and we service hundreds and hundreds of largest payers in the country - everything from mid-market employer, Fortune 500, Fortune 100, universities, health systems, municipalities. And that's on our pharmacy benefit side.  

We have another suite of solutions and that is on what we call the medical side, and that's our Judi Health side of it. And now we have the Judi Care side. And Judi Care can integrate and interface with not just our solutions but also third party solutions in market. And then the other part of it is dependent upon if our customers are coming from the pharmacy side, the medical side, pharmacy and medical side, you now have this additional layer of care and support, again, and Judi Care was the name and what we thought was really a great way to encapsulate what our mission was. And also it's a great way for people to understand that these are modular services. You could use our PBM and not use our medical services on Judi Health and not use our patient navigation on Judi Care. Or you could use all three.  

But this is what we're about is we're about empowering our customers to have the freedom to define the benefit they want. And we believe we have the tool sets to do just that now.

[21:37] Justin Venneri: And it seems like there's a real opportunity here to just improve overall like equity of care through this process. John, would you agree with that? How do you think about that in the future?

[21:46] John Asalone: I think there's an opportunity here to leverage technology to actually make the rare common. And for me this is very personal. I am the parent of a child with a rare disease. And, you know, today he is healthy and stable, but still receives monthly infusions where we go to the hospital for the better part of a day as part of his ongoing care. But we got lucky because we live in a metropolitan area, and we happened to go to the right children's hospital and we got a diagnosis fast. That does not happen for everybody.  

And one of the things I think that we can do is we can use our data to identify, hey, this provider actually has experience in this rare condition. And we can automate that at scale. Which means if someone is doing a search for something that may not be common, we can actually connect them to the human being who has specific experience with that. Even if there are five, ten doctors that have ever seen the specific condition. That is actually the power of our technology and tools today, and integrating front end and back end, we will be able to, at scale, allow someone, a parent like me, to search for care and say, oh, this provider has experience with this very rare condition and takes my insurance. That is a very powerful thing to do. Absolutely would not have been possible five years ago, but is something that we can do at scale, which means we can take the power of insights that are locked up under complicated systems and processes and make it simple for a individual person to find care. So that is part of the ambition, I think, joining companies.

[23:16] AJ Loiacono: Yeah. And let's add on that, because that's really exciting is the added power is let's continue down that path. So if someone is looking at their care options, when you're also the adjudication layer, you could say, let's start with the basic questions: are my benefits eligible and active? What is my deductible year to date? What would be my deductible for the use of this service? Would it satisfy 100%, 50%, a portion? What's the remainder?  

In addition, if you're receiving a medication on the medical side, it can even start to contemplate is it better to source the medication through the pharmacy benefit, have the medical procedure fulfillment happen at that site of care at that location, and these are things that you could start to layer in for the first time.  

And I'd like to say if everyone has very robust benefits and you have zero exposure to cost, then you may not necessarily care. But most people in the United States have some form of coinsurance, deductible, or even a high flat copayment, and you are going to consider these things more and more. The quality of the care, the quality of the outcome, the ability to understand price upfront accurately and obviously feel as if the system or solution that's presenting this information is unbiased.

[24:34] Justin Venneri: All right. And here we are, last question. John, I'm going to start with you.  

You just shared a powerful story. Thank you for that. What is the most astonishing other, or surprising thing, you've seen or experienced that relates to our discussion today? And that's safe and compliant to share?

[24:47] John Asalone: [Laughs] Safe and compliant to share. Okay. Now, you know we work in healthcare. Okay.

[24:52] Justin Venneri: Yep. Facts.

[24:53] John Asalone: Well, I want to just reflect on, you know, this acquisition is brand new. Our team at Amino Health has been welcomed into Capital Rx. And you know, one of the, I'll say astonishing observations is the culture of Capital Rx.  

At Amino Health, we're a small, lean team that ships constantly, okay? Multiple times a week. And we're very proud of that. And anytime you join other company, you sort of wonder what's it going to be like? What's the culture of this place? And I have to say, we have been floored at the level of client service, the ambition, and the culture of Capital Rx. I've already been in meetings where a client has asked for something, and the tech team has shipped it. And I just want to say this does not happen at a lot of healthcare technology companies. This is something that is actually unique to Capital Rx.  

As the organization is getting larger and larger and more complex, the rate at which it is developing, shipping, solving client problems is actually accelerating. That is a wonderful thing to be part of.  

For me personally, I feel the ability to learn and expand is going to be great. And I would also just say to other developers, engineers, salespeople in the market, this is an organization you want to be part of. This is a career accelerator and a place to have an enormous impact in healthcare.

[26:08] Justin Venneri: AJ, same question to you. Anything related to care navigation or our discussion today that you want to build on?

[26:14] AJ Loiacono: The excitement of the partnership, which I think the potential trepidation is bidirectional, where you're just like, well, I think they're going to be great to join with us and be good partners and we're all going to collaborate and work well together. But it was apparent to us the moment that we started to broaden the discussion and introduce each executive leadership team and what I would say, key stakeholders in each organization, that it was readily apparent that we shared many similar values, similar direction, going back to the mission and core principles and it was going to be an easier integration between the teams.  

But I think the accelerant that we saw in this, again, is what John's referring to is we meshed really well, we got along really well, and I think we still try best we can as we get larger and larger to remember we are an agile organization, that we must continue to stay at the forefront of innovation. And you can dream big and have great ambition, but unless you continue to deliver on that and are willing to make what I would say sometimes sacrifices - I wish it was always an easy process of triage, of just yes, why wouldn't we do that? Why wouldn't we add more?  

And I think for us we don't want to sacrifice first and foremost on the innovation and the vision, and I think we're onto something that's really special. I think we have an ability to have an extraordinary, outsized impact on the future of all of healthcare. That sounds like a bold statement, but when you manage tens of millions of lives and you work with the most critical workflows of adjudication, eligibility, payments, reimbursements, and it continues to expand at an extraordinary pace, you now add in this very powerful dimension of personalized care, and taking all of that information on the infrastructure side and putting it in a very clear format that now people can access and interact with. It's really exciting. There's never been a more exciting time to be here and working with the teams. And I think, I'm not even going to say both teams; it's one team now. We feel this.  

And that's the note I want to end on here, which is we're one organization now. We have one mission, and that is to give our country the infrastructure we need for the healthcare we deserve. And I joke about this all the time, we can think of hundreds of brilliant ideas to improve healthcare and I'm like, good luck implementing any of it on our aging infrastructure. But with Judi Health and Judi Care and our Capital Rx PBM Solutions, you can do just that. And the future is bright.

[29:01] Justin Venneri: All right, AJ and John, thank you for taking the time and sharing your thoughts. We're excited to have everyone on the Amino team on board and we're going to see what Judi Care is capable of.  

So I can't wait to have you both back on to talk about how things are going. Have a great rest of your day.

[29:14] AJ Loiacono: Thanks, Justin. Thanks, John.

[29:15] John Asalone: Thank you, Justin.

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