How House Rx Builds Product | Denali Cahoon & Mina Iskarous

[00:00:00] Danielle: . So maybe we can start by just sharing a bit about those different departments at HouseRX and what are each one of them responsible for.

[00:00:07] Denali: Sure. You know, given that we are a technology enabled services organization, you know, the tech that that mean and team are designing and building, it's used primarily by my team by the clinical operations team. And so by default, then those departments tend to be the largest parts of the org. So are, you know, product design and engine team.

And of course, our clinical operations team. Those are significant. Our clinical operations team. It's More than 50 percent of the company and, you know, continues to grow as we, you know, very thankfully have a lot of traction in the market.

[00:00:42] Mina: internally PDE product design and engineering that's also made up of infrastructure, site reliability, um, IT security, um, and all really working together with the clinops team on a day to day basis for sure, in terms of building out our technology and

helping on processes and operations.[00:01:00]

[00:01:00] Danielle: What were some of those early on activities that you did with each other to learn about who you are, how you build and really respect each other's expertise and domain?

[00:01:11] Mina: Well, I can start because I came into this space knowing pretty much. Nothing about specialty pharmacy. My, my mom's a pharmacist in a retail setting, but I had never even heard of what specialty pharmacy is. And, um, at the time I was in Boston, Denali was in Portland. In my first week, Denali came down with our, the, the first pharmacist that we hired and we actually just spent a day on a whiteboard and Denali was like.

This is the flow of specialty pharmacy from the perspective of the pharmacy or the dispensary and how things flow through this and she So eloquently put the flow of like here's how information comes into the pharmacy. Here's what the pharmacists are doing here's what they're thinking about and so really day one was Me just like learning and absorbing from Denali.

We would go and travel to clinics, um, [00:02:00] together a bunch. Uh, and that was, you know, that first month of just kind of spending time with Denali was pretty much how I was able to get even an inch of the lay of the land, um, and start to go from there. And then that's when we really started to kind of build up that relationship is just like this mutual understanding and respect for what we were even attempting to do and seeing Denali laid out there.

She's clearly an expert in how it works and how it looks.

[00:02:24] Danielle: Denali, what's going through your head if you remember at this early stage, are, are you like, So stoked that you, you now have this team to deliver on this vision that you have on how specialty pharmacy can be better.

Like, I mean, absolutely. It's super exciting as a pharmacist. And as an operator to say,

[00:02:42] Denali: I don't have to use what has been given to me or what's available off the shelf. We can actually say this is what would enable not only my team to be more effective, but for, you know, patients to have a more enjoyable experience in, uh, interfacing with the team or for providers to have the information they need.[00:03:00]

That is, um, it's freeing. It really is freeing as a, as a, as a pharmacist to say there is something better and, you know, It is a recruiting tool that I use all the time. So when I'm talking to pharmacists or pharmacy technicians, and I'm saying, Hey, tell me about the technologies you use. Cause I need to know, you know, what their base knowledge is.

And we're talking about the technologies that they use and inevitably they're complaining and you know, this doesn't work for this or, you know, whatever's the situation. And I'm like, well, imagine a world. Where you could provide input and you could provide that input and it would actually be acted on and the tool that you'll be using day in day out to do your work is going to be shaped by by you.

That's novel. That's new. Most pharmacists don't have that experience. And so I use it all the time to recruit,

[00:03:41] Mina: you know, I won one example, one story from like the first Maybe a month or 2 that we were operating in our, in our 1st, um, medically integrated dispensary that these pharmacies that we set up with these practices.

Um, so we actually launched on technology. That wasn't ours. And I think that was a really great decision. I'm sure we'll talk [00:04:00] more about that, but it gave us the opportunity to see, we knew that stuff was missing, obviously, from Denali's experience and from the team that she recruited. But it made us like viscerally feel it and I remember a month, a month and a half in, um, we would do these daily standups every day.

Denali would talk about how things are going, what prescriptions we've received, what's happening with them. Are we dispensing them? Do we want to send it somewhere else? And I remember that we would go through this process where in a, in this tool, there was no structured way to do it. Denali and our first pharmacist Kayla came up with a list of reasons that we are not dispensing something and every time they would do that They would like put that text in they would like they figured out a way To structure that system so that we could do it and pull a report on it and that became like one of the initial Inspirations for how we're gonna start to build and structure data in our system how we're gonna be able to report and build Analytics on that [00:05:00] because they actually use that data a month later To then drive operational changes.

Well, what are the reasons we're not dispensing prescriptions? How can we improve? We're going to start taking that list. That technology, when you, when you think about a retail pharmacy, not dispensing a prescription for a specific reason, wasn't a needed use case. But for our, for our systems and for our workflows, it absolutely was.

And so that like creativity that the pharmacists have, we've, we say this often within our product organization. Anytime someone is using. Our tool in a wonky way that we wouldn't expect it's because our tool isn't servicing them the way we need to and it's actually an opportunity for us to really take a step back and say, Well, what are they looking for?

What do they need? How can we build something

that's actually going to make this way more effective for them?

[00:05:47] Danielle: DeNali, when you mentioned that you're using this software as sort of a recruiting tool and the way that you use tech at HouseRX, what, what I didn't hear, and I'm curious about is how do you actually recruit people who have that more [00:06:00] product minded ops lens?

So, you know, I've, I've. Of course, you can say like, this is great, but it's still a work in progress and your input is needed finding folks that can see almost like a product lens onto operational workflows that takes a lot of nuance and it seems to come naturally for you, Denali, or maybe through lots of practice,

But anything in your recruiting that you did or a question that you asked to help you really identify that product mindedness

[00:06:27] Denali:

that's actually a really interesting question, Danielle, because, uh, meet and I talk about this a lot are, you know, team members that have this instinct, this instinct and, and make them really great collaborators with product. Um, you know, oftentimes it's the same type of recruiting questions that you are asking to ensure that somebody is going to thrive in a startup environment, any type of startup environment.

There's so much ambiguity. There's not a lot of structure, there's not a lot of infrastructure. And so the those, the, you know, the questions that I am asking to [00:07:00] try to determine is somebody going to thrive, um, you know, is the same, you know, I guess the same, you know, type of individual that's also going to thrive working with product.

And, you know, pharmacists, most of the pharmacists and the pharmacy technicians that I'm recruiting, very few of them. I could maybe even count on one hand if that have come from startups or from technology organizations. The vast majority are coming from these, like, large, super structured, super old organizations.

So they're coming from, you know, large pharmacies, or they're coming from academic medical centers. These are organizations that, um. Everybody, you know, everything has its pros and cons. And oftentimes the cons there are people feel absolutely constrained. They feel constrained that they can't practice the way that they want.

They can't be as patient centric as they want. Um, and they, you know, they're, they're never going to influence change, whether it's on technology, as we discussed, or if it's just on an operating process, there's so much bureaucracy, there's so much, you know, layers, [00:08:00] uh, in order to get any change done. And so people are really excited.

But that doesn't mean that that individual who's excited and feels constrained is actually going to thrive in the startup environment and is actually going to be effective at working in a product org. So oftentimes, you know, it's one of those, uh, you know, I want to be free. And then they, you know, get into a very ambiguous environment and they're like, Oh no, I want to be caged again.

This is too much. Yeah. Too free. So it is striking a balance and something that, you know, probably a lot of. Particularly when, you know, it's coming to my interview round with a team member that I'm very focused on ensuring that they. That they will work and thrive and be comfortable. You don't want them to feel uncomfortable in an environment without much structure.

[00:08:40] Danielle: So then what is that question or a handful of questions that you are assessing in that moment around, Yeah, I get that you're constrained right now. There's a better world out there. Welcome. But also this world has some caveats. And it's cool that you're transparent about that as well because A lot of the selling motion [00:09:00] of startups tends to be two pie in the sky, so that that level of transparency, I'm sure, is very much appreciated from from candidates, but also, you know, speaks towards your values as an org and iteration process.

[00:09:12] Denali: Yeah, so usually I'm actually digging into, um. The work that they have done when change is happening in their organization, because, you know, though I, you know, I probably painted a pretty broad stroke on the organizations and then being old and bureaucratic

and, you know, heavy handed, et cetera.

[00:09:28] Denali: all of health care.

Yeah, yeah, but at the same point, these organizations do sort of unique pilot projects all the time. Um, so, you know, whether it's an academic health system or some of these large pharmacies, I mean, you think about even something like, you know, the, COVID. Um, so, you know, this was requiring pharmacies to be unique and innovative in the way that they deliver care and the way they deliver vaccinations and testing.

So oftentimes it's about talking about trying to get them to speak about, um, the work that they had to do that was new or had to do with changes and how they [00:10:00] participated, um, and how, you know, they felt, you know, was there a level of discussion. Comfort when there was something new that came up in an otherwise very structured organization.

That's really what we'd like to dive into and focus on. Even if, you know, it's, it's hard sometimes to draw a parallel between a startup and this like enormous legacy organization, but you need to find the parallel and ask about their experience.

[00:10:18] Danielle: Denali, are you finding yourself still coaching folks on how to maintain that product mindedness throughout the life cycle of building at HouseRX, and if so, what does that look like? How do you coach product mindedness?

[00:10:32] Denali: yeah, I think that Nina also participates a lot in in the coaching, and I ask him to do this actively say, you know, can you work with our pharmacists and technicians and and break them in the way that you know, I was broken in by by a product team on how to have these conversations and, you know, oftentimes it's.

You know, making sure that they feel empowered because a lot of times our team members don't feel empowered just because of, you know, maybe experiences in the past that, you know, if they give [00:11:00] a solution or if they give a recommendation or they talk about a functionality gap that they're experiencing, like, why bother?

Nothing is going to change. So, and also, you know, oftentimes they're thinking this is too small of a detail. This isn't, you know, this isn't a worthwhile, you know, feedback or comment, or they always have this mentality of, um, probably somebody else already said this. So I don't want to repeat what somebody else already said.

So a lot of times we're really coaching on and, you know, of course, we use, you know, communication tools to help facilitate this, you know, um, Um, making sure that's really easy for people to provide feedback in a structured way. But, you know, I'm always telling the team if in the moment, if something is going on with, you know, the product and you have an idea, like, don't second guess it, you know, you never want to, you know, guess whether or not this is valid feedback, or you never want to try to say, oh, I wonder if somebody else already gave this.

Like all feedback is really valid and we encourage it. We talk about it all the time. Sometimes, you know, in our messaging systems, I'll see somebody, you know, make a [00:12:00] comment. And so then I'm always prompting. I'm like, you know, why don't you put that in, in product feedback? That sounds like something that we need to let the product team know.

So a lot of times it's about, um, reminding and this like consistently telling the clinical operations. You know, organization that their feedback is valuable to prompt them to do it. And it's like exercising muscle, right? So if for however many years of your career, you know, 10, 20 years of your career, you haven't exercised that muscle because you've always just worked with the tool that you were given.

And now you have to learn that you don't just have to work with the tool that you're given. You can actually. you know, participate in the activities that shape it. You need to make sure that you know, you're, you're almost like a, you know, a trainer where you're helping them exercise that muscle and saying like, do this, do this, do this, and provide that feedback.

[00:12:44] Mina: And and with anything, right? It changes over time of how the organization grows, right? When we were, um, building our product 0 to 1, we were building everything for the 1st time. The amount of direction and feedback and teaching that the ops [00:13:00] team, the clean ops team and Denali and everybody had to provide.

We had this like blank canvas. We could go any direction with it. And so there was a lot of like of that initial feedback and initial back and forth that like really needed to be like strong perspectives from our clinical operations team. As you, we've grown the product and now we're iterating on our first version and iterating on bits and pieces of the parts of the product.

There's also like a lot of other. Inputs that go into that process. Every time I can look at data and say, well, why is this process seem like things get stuck here? It gives us an excuse to have a conversation where once we had 5 or 7 users on the platform, we would do these like weekly live video sessions where literally our entire.

Product development organization was invited to a session where somebody would literally just be doing their work and we would just sit and observe and have the opportunity to ask questions. And so the type of feedback you need on day 0 with a [00:14:00] blank canvas versus the type of feedback we might need.

Uh, you know, a year and verse three years, and we have different tools that we get to start leveraging. Um, and so it helps us also, you know, look at look at the people and know, hey, maybe, you know, over time, we don't need every single person that we hire to be this, like, super strong product minded person from the get go.

How do we give them the tools in the spaces to learn and interact with us in that way? So they can continue to be advocates for that over time and grow into that type of feedback.

[00:14:29] Danielle: So like day zero, you come in with this off the shelf solution, which, um, we've talked a little bit about, and then what's the timeline towards your MVP that I've heard you allude to where, where folks are actually using the house or X software.

[00:14:44] Mina: I would say it took a. About a year end to end, and that includes all of our back end integrations we had to do for claim processing and getting drug files and receiving E prescriptions, building out all the workflows with the analytics [00:15:00] layered on top of that and to maybe give some some context.

We're actually really. Proud of both the speed and the focus that we had that went into that, um, multiple companies in the pharmacy space that have built their own pharmacies and have inevitably maybe built their own pharmacy technology. Um, a few of them are advisors to our team. We chat with them. We follow up with them.

I had not heard of a team that was able to deliver something. of that magnitude of a product in less than two, two and a half years. And I had no idea what I was signing up for. I showed up and Alda said, we're going to do this in a year. And I said, that sounds awesome. Let's do it.

[00:15:39] Denali: it, you know, it does help that we have a, a generally, a fairly narrow use case, right? A lot of the people in the pharmacy space are di designing software that they're going to go out and market and sell.

They're trying to sell to every pharmacy, every pharmacy in the country, so long-term care pharmacies and, and retail pharmacies and, you know, specialty pharmacies and, and they're, they have [00:16:00] very different needs. Um, so given the fact that we had. Such a, a narrow use case where we were servicing specialists, we're servicing medically integrated dispensaries.

And it, it, it really informed, you know, how, what that MVP looked like and, and allowed us to bring it to market in a year. Yeah. So

[00:16:19] Mina: like put it bluntly, I had, I had one customer for the first year. It was Denali's Pharmacy. That is the customer that we have to get off the ground and make sure that it works, and works effectively.

Um, and, you know, of course our, our

practices and everyone we're working with, um, um, um, exaggerating. But that's, that's how we were able to focus.

[00:16:37] Danielle: When you look back at that year of building and launching at the same time, do you think that there was an advantage to actually starting to see patients on day one? Thank you. Versus if you were to do it all over again, would you have, like, would you have done that any differently?

[00:16:53] Denali: I don't think that we would have done it differently. There is always, you know, of course, you talk about commercial tension. We wanted to get, [00:17:00] you know, clients live. Um, and I think that the benefit to it is, is learning. So, you know, every iteration, every patient, every provider we work with, even if it's not necessarily in our technology, it informs what we want to build.

And we learn more and more from them and from the experience.

[00:17:17] Mina: Yeah, I think it was also incredibly, um, validating of the direction that we wanted to take things. We had our team, you know, Denali already knew this, but for the rest of the organization that maybe hadn't worked in specialty pharmacy or hadn't used these other systems outside of our operations team, it was incredibly validating to see all the struggles that we were maybe facing with some of these other pieces of technology when they weren't multi tenant, when they didn't have it.

More direct EHR integrations when they didn't provide analytics. We were feeling that pain. Um, and so it was validating on the direction that we were going. And so when we were able to pull people onto our technology, it wasn't just this like shot in the dark, like we're pretty smart people. We think this is going to [00:18:00] be effective.

We were already feeling the pain and we were saying we couldn't wait to get onto our technology that really enabled this for us.

[00:18:07] Danielle: Yeah. You created motivators within your org just by way of using the old tech. Yeah.

[00:18:13] Denali: Yeah, reflecting back as Mena was talking, the first clinic that we launched on an off the shelf product, because of the structure of the off the shelf product, we had to essentially our users, they had to have a individual laptop that was dedicated to that clinic.

By a VPN tunnel into a desktop at the practice, so that desktop could not be utilized by any of the practice because it was connected. I have a tunnel to the laptop and you think about scaling something like that. I'm trying to envision a user with like 10 laptops across their desk for all of the things that they're utilizing.

So yeah, very quickly. We said, yeah, this isn't going to work.

[00:18:53] Danielle: Wow, that's that's crazy. Were there any other. Like investments that you made early on that you're like, wow, thank God [00:19:00] we invested in that on the tech. And then on the flip side, was there an investment that you were sure about maybe were wrong about?

[00:19:08] Denali: Um, I'll, I'll talk maybe about an investment that we were, we were wrong about. Um, you know, you can. Maybe chime in on the on the positive side. One investment really, really early on. This is very early on. Um, I think that we, you know, wanted to, um, show some, you know, real initial value with some, you know, product build, um, to support the practice.

And so we looked sort of beyond the actual scope of, you know, pharmacy services and said, you know, what other pieces of technology can be built that would just help the practice and practices have all kinds of challenges. Many, many challenges in operating their business and one is, and I'm sure that this resonates with everybody, you know, if you've ever gone to a doctor's office and you had to fill out paper forms and you're like writing out your, you know, it's 10 pages long.

Uh, so we initially made some investments on [00:20:00] helping to automate that system, uh, which is very, very painful, but, you know, it really wasn't core. Uh, so that was something where I think that we all look back and say, you know. Maybe, maybe that wasn't where we should have been spending a lot of time.

[00:20:14] Mina: Yeah, I, I, I'll, I'll, maybe one other.

Place where I think we look back and say, maybe we would, we would have done something slightly different on the technology as well is, you know, early in this conversation, we talked about the benefit of how focused our product build out was for building for the, uh, imaginative Denali's pharmacy and making sure it could, it could.

You know, fix and be used in that situation, and I think we alluded to it. Our commercial team was going out. They were building up a strong customer base. People were really excited and, um, you know, some of them had slightly different, like, slightly different operating models or slightly different paths that they wanted to work on.

We were learning about how we wanted to continue to improve and change on our operating model. And so [00:21:00] really quickly, we got this first customer on. Yeah. Yeah. We got everybody on our technology for the first time. And by the time we got to the second, third, fourth, we already started. We were like, okay, we're going to be iterating.

We're going to be doing these things and iterating is great. There's no downside to iterating, but I think we were sometimes a little narrow and saying, we're going to solve for this exact use case. And the product wasn't as flexible early on. To manage different situations, um, or have more self serve capabilities.

And I think just taking a look back at that and saying, you know, we could have still had a strong opinion on how we wanted things to flow. But how do you still build a little bit more flexibility into the product early on? I think would have saved us some future troubles that we had that we've gotten through.

But, um. That that was another place where I think if we, if I went back, think, think a little bit more about, um, just that flexibility in the product early on, knowing that you're going to scale to more customers that are not going to be the exact same as that [00:22:00] first customer.

[00:22:01] Danielle: What does that mean?

Tactically flexibility.

[00:22:04] Mina: We thought about workflow products of, you have this prescription that's flowing through your system, and at this point, you take this action on it. At this point, you take this action on it. It's this linear stage gate process that a prescription runs through. Yeah. And that is fine and dandy in the best use cases, and it goes great.

And then you need to redo something. You feel like you want to see something that you that you set earlier. You want to just like, have an admin page to be able to better manage these things. And we were so focused on the workflows. Um, that we didn't invest as much into some of the self serve admin tooling that I would have liked early on as well.

We knew we did some of it, but it wasn't to the extent that made it our system as flexible as we wanted. Um, and now we have this framework, um, one of our design leads. I love this framework that he has. He calls it nouns and [00:23:00] verbs. Isn't it? Other people might call it like entities and actions. And we've actually spent a lot of time in these products and operations conversations saying.

Pharmacy. There's this entity called a prescription, and a prescription has a fill, and what do you actually do to a prescription, and where can you do it, and when can you do it, when should you do it, and so we've built this, like, dictionary of, like, the different, like I said, nouns and verbs that we have in our system, and it's just this diagram that actually, like, helps influence us a lot, which is if I know that I'm gonna do, take this action on a prescription, and I'm doing it in a workflow, because that's the logical part of the workflow, I might need to change that later on.

I might need to do something different outside of the workflow. And so how do you make sure that you have that flexibility to take those actions on those entities? Not just in the core workflow, but at any time when you need it, because inevitably something's going to happen that's slightly different than exactly what you want to have [00:24:00] happen.

[00:24:01] Danielle: So that is like, um, to, to play that back. The prior authorization is that entity which fits within the workflow of. Send, you know, send me the Rx, I get the prior authorization, but then the, the verbs part is basically decoupling the prior authorization entity from that workflow and then layering in, well, you could cancel a prior authorization or you could then do all those little Excel dropdowns or so on like that Denali, you had talked about a little earlier, which is like, what do we do to a prior authorization?

And that represents the verbs.

[00:24:36] Denali: Yeah, that is a. Thank you. A good example, Danielle, and a good example of, you know, where some of the flexibility came in. Because if you think about a prior authorization, a prior authorization, um, you know, typically that happens, we receive a prescription. We realized that that prescription requires a prior authorization, and then we submit that prior authorization.

And so if you have that rigidity in the workflow that Mina's talking about rather than [00:25:00] flexibility, well, it doesn't come up with a use case where, you know, two months later you change your job and you get new insurance. And so you need a new prior authorization. True. But that is not associated with the workflow of receiving a prescription.

So, really, that's where we needed to start, about building in flexibility to, to that workflow. And saying, you know, when, when will you need to take, you know, when will you need to do these verbs? When will you need to take these actions? And they're always associated with that, that

[00:25:24] Danielle: entity. That's fascinating.

And this, uh, nouns and verbs diagram. Where does that live? What does that look like?

[00:25:32] Mina: It's like an existing Figma doc that we come back to. Honestly, constantly. It's how we think about like in our product world, how we think about the information architecture in the application, how we think about creating different pages and navigations.

And if a patient has a prescription, then logically in my patient page, prescription should somehow be associated to that patient and not on a completely separate page. And [00:26:00] so, um, it exists. And this is kind of what I was saying is that part of Our role in product in this world, especially early on, is taking this mental model of the pharmacy world that Denali and their team has in their head and starting to translate that.

Into software, because more often than not, I think, particularly in operationally focused or workflow focused products, that's kind of what you're trying to do is you're trying to say, how do we take this workflow that happens in the real world? Right? How do we help emulate it in software to then guide that process to then automate that process to build analytics on top of that process?

And if your mental model to start, um, isn't being. Captured and kind of shaped the right way, then you're probably in a world of pain later on that you're gonna have to fix

[00:26:48] Danielle: you. Well, in the original mental model that I heard was this, this flow chart where you all are collaborating on the life of a specialty pharmacist or pharmacist.

[00:27:00] And then now I'm hearing. Uh, almost like a advanced version of that where it's like, yeah, that flow chart was like V1, but now V8 is like, I can handle every workflow that you ever, you ever got to

[00:27:14] Mina: V1 is like

The happy path and maybe some of the, some of the initial branches and it's, um, you don't, you don't, and then you start to layer it in and you're like, oh, this V1, like, this one thing has like 10 things I need to think about with it that I want to be really thoughtful about that I'm going to have all these different branches once you like, click in a layer deeper.

Um, and that V1 was like, how does a prescription move through a pharmacy? And what we're getting to now is how does our software. Manage prescriptions and patients and therapies and how does it move through software? Um, not just the real world

[00:27:53] Danielle: I'd love to hear a little bit about, like, your KPIs early on, on the product side of things, or even on the op side of things, [00:28:00] are you sharing these KPIs, and do you think that anything in there really informed your ability to then grow into those crazy sophisticated workflows?

[00:28:10] Denali: Yeah, I'll, I'll, I'll share one in particular, uh, cause I, you know, thinking about the unhappy path, I use a specific example, uh, when we were thinking about the happy path, it was, you know, we get this prescription, we do our work, ultimately we determine exactly how much, uh, the patient's out of pocket is, hopefully it's very low because we've gotten the financial assistance, we call the patient, we're talking to them about their medication and we're collecting payment.

You know, we're collecting their credit card to pay their, you know, 5 out of pocket. And then we arrange for them to, you know, come on into the practice and pick it up. It's a great happy path. Well, unhappy path is what if a patient actually doesn't want to pay over the phone and they want to come in and they want to, you know, bring in cash or they want to bring in a check or they just, you know, they, Rightfully so they're a little bit concerned about giving their credit card number over the phone.

So they want to bring that in. [00:29:00] Okay. Well, the system, you know, maybe doesn't support that for that use case in our air v1. So therefore what happens? a blow up of support tickets. So talking about our KPI, we have KPIs around support tickets. And so if a ton of people are saying, Hey, I need you to bypass this payment processing because, you know, the patient wants to come in, there's this proliferation of support tickets.

And so we're obviously not meeting our KPIs there. And so that helps to inform how we get to, you know, V5, where we have this flexibility and therefore, we don't have to sort of work around, um, Work around the system. I always, I think it's always interesting. You think about product influences and oftentimes it's a support that is a product influence because if they get really sick of fixing something, then they're like, okay, we need to fix this because sick of doing the support tickets.

Yeah, yeah.

[00:29:54] Danielle: So support tickets would go to you Mina.

[00:29:57] Mina: Yeah. So in, in, in our world, and we're [00:30:00] lucky to be, most of our users are, are internal members. We've got a support flow. They say, Hey. I'm having trouble with X part of the product. Um, it's not letting me do the thing. I was hoping it would or allowing me to do it.

And so it would go to our support team. And, you know, there are times where we have workflows or protocols or, you know, processes that we said, okay, this is how it's going to fix this or whatever we need to do to fix the situation, unblock the situation at hand. Um, and getting to the point where. Yeah. The things that were coming to support were not feature gaps, but are actually maybe start to resemble more of like usability questions.

I'm trying to find this page. I can't find, I don't know how to do this thing. It's there, but the user may be not know. How did get there? Then you started moving from we have feature gaps and functional gaps to we can improve the product experience. Um, and we're getting that type of feedback. And so that was a big thing for us was how do we move the needle [00:31:00] on support?

Almost not having to do any feature gaps. And we're at that point right now. And that's what we've been working on for a while as we've scaled up these customers. And some of it is you go to a customer that then has a specific challenge that We didn't anticipate, um, early on.

[00:31:17] Danielle: Are there lessons there in having that support to get infrastructure on day one to help guide and push product in certain directions and slight nudges without having to use your words and or knocking on doors?

Well, it

[00:31:30] Mina: definitely was not, uh, a report I could pull in the first month. It was somebody posted on the Slack channel and between myself and Alda and our support team, uh, we'd jump on it and we'd fix it and we'd. Put a checkbox in slack, and then we were like, okay, we got to track this. We got to know how much this is happening.

You got to know where this is happening on what things. Um, so definitely would have been nice to have that type of tracking, uh, early on. So, I think that's 1 metric that we spent a lot of time on. I think another metric that we [00:32:00] were, um, focused on even earlier than that in, in the specialty pharmacy world to patients getting their therapy and they're getting their medication quickly.

Uh, is not the norm. You can probably read a bunch of people. You can go on Twitter and search about specialty pharmacy. It's not the fastest process, uh, despite the fact that these are patients who maybe they're a cancer patient and this is their life saving treatment and it's a longer delay than you would like to get that, that treatment, which is awful.

Um, and so. Early on, this operating model of medically integrated dispensing has all of these benefits to make that process much faster. This metric called time, time to fill or time to dispense of how quickly can you get this medication for this patient is like an anchor that you can show this specialty pharmacy is operating really effective.

That was the North Star. Yeah, that was our, that was a North Star from an operational standpoint. And so one of the things we wanted to ensure is [00:33:00] when they moved from other pieces of technology to our piece of technology. Not only could we match that, but can we improve it? Um, and I think early on we were able to roughly match it and have been making progress to improving that over time.

And that is another type of KPI that was like a huge alignment between products and ops. I think both of these are right. Is like every user should be able to do everything they need to do to do their job. Every user should be enabled to be the best version of their specialty pharmacist. Um, and so both of those are KPIs and metrics that.

Uh, really align both of our organizations really well.

[00:33:35] Danielle: Any tips for folks as, as we wrap up here and you step into your giving advice to others mode, any tips for how to really get that joint alignment on day one or things you would advise folks to do, right? It seems like you two are. I mean, you're literally in the same room right now, so clearly, clearly you're getting along.

Any advice for, for folks that are trying to really build

[00:33:59] Denali: that bridge? [00:34:00] I do, you know, we've talked about this, but I do think it's about taking the time because oftentimes, you know, it's a sprint. It's a sprint from the day, you know, it's basically like, what is your training in an early stage startup?

Here's your laptop and go. And so oftentimes it feels like a luxury to take the time. To learn and to spend those like initial, whether it's a whiteboarding session or, you know, traveling together, whatever that looks like, you're never going to regret investing in that investing in, you know, the days, the weeks, the months.

I think it's critical. And oftentimes, you know, we have to, I have to remind myself when a new team member starts that that's the space that they need to learn and to be effective. But I think that's what we could remind. I

[00:34:41] Mina: certainly agree with that. I don't think we would have been able to move, you know, part, part of the, you know, backing to that is not just taking the space and time to learn about the thing.

We had experts in the thing we were about to do. Denali had built in medically integrated [00:35:00] dispensing, had built in specialty pharmacy operations, organizations. Um, some of our founders, Ogie and Tesh, had worked with oncology practices for a while who we were selling to. And so we had the luxury of we could start to go really fast.

Because we had context and information, and then we took this additional step to say, okay, there's a bunch of people who are about to build a lot of things, and if they don't have that context and understanding, we're probably gonna make a lot more poor decisions than if they spend the time, two weeks, just to spin up that information.

And so, uh. Call it luck. Call it strategy to have a team that had a lot of expertise early on and then to actually take the time to say, well, we're going to disseminate that expertise so that we're effective at what we're doing. Um, I think. Both of those things were so helpful for us.

[00:35:48] Danielle: There seems to be a winning formula here to a certain degree of you bring together people who know a lot about the space, start super focused, bring together builders and designers [00:36:00] and engineers that can actually make that thing.

Yeah. Those three seem like a really core core formula towards your early success. Looking back, is there anything else that you wish you kind of had on day one that you think other folks that are building and choosing to build or not buy or have this one year timeline and crazy, crazy expectations for what's going to be built?

Any other missing components there?

[00:36:25] Mina: I will say very early on, um, Who's our CEO? We would be having product conversations or he'd be looking at designs or he would ask me questions. And sometimes, sometimes my answer would be, well, well that's what Denali told me. And he said Denali is probably going to be right 99 percent of the time.

But even when she's right, you should constantly ask her why, because either you'll go down this rabbit hole of being like, well, now I just learned the time, which is most of what happens. And in the like, very, very, very rare cases, we might take a step back and say, Actually, we [00:37:00] could maybe do this differently.

Maybe it would work. Um, and that only works because we also have people who are like humble enough to spend the time talking about these things and not, you know, as much expertise as Denali has. Like, she never gets offended when I ask a question. And so, uh, you know, part of that awesome team is not just the expertise, but it's the personalities and knowing that if we're going to try it, To do something that this industry isn't seeing we're probably going to ask why a bunch of times and maybe push each other and say Hey, maybe we think the others wrong and we should have a conversation about that.

That's not an insult It's just like we're trying to do something different. We're trying to do something new

[00:37:41] Denali: If I had to say what I, what I wish that I had had earlier on, um, but I think this is what everybody wants in a startup. It's, it's a little bit more time and space. You know, I wish I had, you know, as much as we talk about how much time I got to spend with Nina and the product team and the engineering team and everything else.

You're pulled in a million directions. Right. So at [00:38:00] this time, you know, we didn't have an implementation team. So I was, you know, physically going to clients and, and, you know, putting together furniture and, and, and everything else and training them, which is also invaluable experience. Um, but I, I think that, um, oftentimes what I want is just more time.

I, I wish I'd spent more time with, with the product team and the engineering team. Um, so you, you know, you take your time and you build your team eventually, and I have a wonderful team now and. Um, I still get to go in and put together furniture, but, uh, Yeah, wait, why do you have to put together... I, I,

[00:38:32] Danielle: why are you putting together furniture?

What, what is furniture?

[00:38:35] Denali: You gotta, you gotta, you gotta, actually, you have to set up the dispensary. So, like, the physical space where you're... Oh, I see, I see. Um, but I... I would say, you know, advice to people is, is make sure you carve out the time every, every moment that you spend talking to, to product is going to be worth it.

[00:38:55] Danielle: Yeah. And I definitely didn't add that in my formula, which is. [00:39:00] Taking that time and to your point, you know, good things happen when you do it and invest. And also the other really core theme of our whole conversation was how much you were actually present and physically in places, right? Like, I mean, you flew and met up together in person and then you would actually go on site.

And so it sounds like there was a very clear investment around gaining that real world visibility, not just from, you know, Denali's pharmacy, which was this fictional one, but real, real ones and bringing many team members together for everyone to see it, because a lot of times I think that that's sort of just becomes like a product thing or an ops thing.

Right. How do we all see the same thing? And you all seem to have invested in that early on.

[00:39:45] Mina: You know, the nice thing is we. We still do it for most of our go lives. We try to have somebody from product design or engineering there. Sometimes they're just there to sit and learn and observe and they've never sat [00:40:00] in a clinic that has an infusion suite and that now has this dispensary and they get to talk to the staff and learn about what they're doing and spending their time on every day.

It's just this level of empathy and set of ideas that come out of it that Make every conversation so much better.

[00:40:18] Danielle: Fascinating. And now I'm already, you know, thinking of, um, furniture as a service to set up. It sounds like a new business you all can invest in.

[00:40:30] Mina: If you can get better printers for us to use, we'll be eternally grateful.

We've probably spent hours. Debugging printers all together in many places.

[00:40:38] Denali: So, yeah, why can't I get it to line up? Unsolved things.

[00:40:44] Danielle: Okay. Well, folks, listeners, if you have a state of the art printers and or, uh, protocols for debugging printers that can save, save a lot of time for I'm sure many people in healthcare, let us know.

Otherwise, Mina and Denali,

I [00:41:00] am so inspired by the way that you each give a platform for each other to both speak your, your expertise, but also be humble enough to hear about how you can be doing better. And the way you both have rolled up your sleeves from day one to be on the same team and build together. Uh, it certainly left an impression on me and I think folks, folks will learn a lot here.

So thank you both so much for your time today.

[00:41:25] Denali: Thank you, Daniel, of

[00:41:27] Mina: course.

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