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Q2 2013 | Triple Tree Presentation May 24. 2013. Pipeline Rx | Mission Statement.

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Q2 2013 | Triple Tree Presentation May 24. 2013

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pipeline rx mission statement
PipelineRx | Mission Statement

Combining its deep expertise, cognitive insights and robust operating processes, Pipeline provides medication management via clinical pharmacy services to ensure the highest level of patient safety and optimal clinical outcomes.

pipelinerx company overview
PipelineRx | Company Overview
  • Company Profile
    • Founded Q4 2009, 1st Paying Customer Q1 2010.
    • Revenue run rate of $XX million, sales pipeline of over $XX million
      • Qualified Lead to Close – Average Sales Cycle is 6 months.
    • 100 Active Clinical Telepharmacists – all W-2 employees
    • Clinically verified over 2.0 million medication line orders since inception
    • Licensed in 28 States and Operate in 11 States.
  • Installed Customer Footprint
    • 41 clients ranging from 25 to 722 beds each and covering > 4,800 hospital beds
      • 2 notable 2012 accounts wins – UCSF and CHS (133 unit national chain)
    • Typically experience a 30% order volume growth, 6 months post go-live with hospital
    • 24x7 flexibility – ability to cover first, second and third shifts
pipelinerx leadership organization
PipelineRx | Leadership Organization
  • Brian Roberts – President
    • 15 years of executive leadership in healthcare staffing and pharmacy services companies
    • Former CEO of Canopy Healthcare Staffing, SVP of Business Development for CHG Healthcare
    • Former healthcare venture capitalist for Acacia Venture Partners & Summit Partners
  • David White – CIO, SVP Operations
    • 20 years of Information Systems and Healthcare technology, development and leadership
    • Stars Behavior Health, Posit Science, eBioCare (Curative Health)
  • Eric Carter – CTO
    • XX years experience developing enterprise level healthcare IT solutions
    • Former Evolute CTO and VP of Services
  • Chris Ciolko, RPh – SVP Business Development
    • 34 years of pharmacy, sales, and business development
    • RPh on the Go, Cardinal Healthcare, Baxter Healthcare
  • Jeff Gustafson – Chief Financial Officer
    • 20 years of financial leadership
    • Partner with Propeller Industries, CFO for high growth companies
  • Chuck Dunlap – National Sales Director
    • 20 years experience selling complex clinical IT solutions into acute care hospital sector
    • Allscripts, McKesson and Meditech
  • Hong Lam, PharmD – Director of Pharmacy
    • 13 years of clinical pharmacist leadership with focus on formulary & drug management
    • 6 years of telepharmacy leadership experience
pipeline rx clinical telepharmacy services
PipelineRx | Clinical Telepharmacy Services
  • PipelineRx mirrors and extends the exact cognitive clinical roles and responsibilities of the client hospital’s onsite clinical pharmacists, 24/7.
  • PipelineRx executes upon a client intimacy approach by mapping to the hospital client’s exact clinical pharmacy policies and procedures.
  • Pipeline clinically verifies the safety of each and every medication line order.
  • A hospital’s clinical pharmacist process on average 17-20 medication line orders per hour; Pipeline’s clinical telepharmacists process 30 medication line orders per hour.
future of clinical pharmacy enabling the ashp practice model
Future of Clinical PharmacyEnabling the ASHP Practice Model
  • ASHP - Aspirational Goals
    • Achieve 25-40% in labor savings
    • 24x7 Pharmacy Coverage reduces exposure and liability
    • Deliver an ROI for the hospital
    • Increase clinical quality and patient safety
    • Address all pharmacy complexities, specialties and locations
  • Pipeline – Business model to deliver these ASHP goals
    • Create a comprehensive + on-demand pharmacist network (CTPs)
    • Codify a hospital’s idiosyncratic policies and procedures
    • Deliver robust methodologies, processes and detailed order documentation
    • Eliminate traditional geographic barriers – recruit the highest quality CTPs
current hospital reality challenges
Current Hospital Reality | Challenges
  • EHR Require Increased Level of Clinical Activity (CPOE, BMV)
    • Meaningful Use Deadlines
  • Competing with Other Industries for Qualified Pharmacists
    • Internal Competition for limited resources
    • Skills Required (Clinical) vs. Skill Pool (Retail) Inconsistent
    • Availability of Skilled Pharmacists within local recruiting area
  • 24/7 Hospital Environment Creates Hiring Challenges
    • PTO or Shift Differential creates unpredictable staffing
    • Fulfill the complex hiring demands of the Night and Weekend Shifts
telepharmacy competitive landscape 1 0
Telepharmacy | Competitive Landscape 1.0
  • Hospital Providers
    • Larger hospitals covering smaller affiliated hospitals
      • When volumes spike, smaller hospitals are not the priority
      • Longer turnaround times, limited hours and client clinical responsiveness
  • Third Party Legacy Providers
    • Remote Order Processors
      • Limited by Hours & PIS
      • Discourage Clinical Interventions & push back orders
      • Encourage High Volume Med Order Input – key metric is Order Volume
      • Call Center, Facility Based (Centralized) – limited recruiting geographically
nascent market dynamics
Nascent Market Dynamics
  • Today – CPO is Disorganized and Fragmented
    • No clear lead company, guidelines or existence proof
  • CPO is perceived to be of limited scope & value
    • Replacing/augmenting existing pharmacy function
    • Selling into complex ecosystems with no clinical standards and/or standard behavior
  • Providers struggle to differentiate
    • Poorly defined value proposition
    • Forces many to structure offering based on lowest common denominators
  • Prospective clients have bought into the image created by the industry
    • Service providers don’t know how to change – price is their only lever
    • Clients make “buying” decision based on cost & who provides least worst service
    • Reinforces self-destructive behavior and creates a race to the bottom
cpo sales process current landscape
CPO Sales Process | Current Landscape
  • Care Provider: Chief Nursing Officer
    • Real power behind Telepharmacy buying decision – core driver is Patient Safety
    • Pipeline - demonstrate its ability to enable greater Patient Safety
  • Directors of Pharmacy
    • Limited power in economic buying decision but acts as a Gatekeeper
    • Under current budget constraints – considered a cost center
    • Pipeline – articulate savings, create an advocate/evangelist
  • C-Suite: Hospital Executives & Administrators
    • Reacts to Regulatory Issues and Immediate Financial Considerations
    • Pipeline - enables regulatory compliance
    • Pipeline - delivers an ROI of 2-3X in reduced labor overhead
telepharmacy competitive landscape 2 0
Telepharmacy | Competitive Landscape 2.0
  • Emerging Providers – Clinical Telepharmacy
    • Address Current Challenges of Hospital Pharmacy (Encourage Clinical Interventions)
    • Built on Patient/Medication Safety and Client Responsiveness
    • Residence Office Based (De-Centralized) – greater/better skill sets to choose
  • HIPAA Compliant/Connectivity to Hospital’s Native PIS
  • CTP teams built to meet Client Needs & Clinical Activities
    • Real-time - Medication Review, Verification, Resolution
    • STAT order Prioritization
  • Dedicated Team of CTPs
    • Trained on Individual Pharmacy Policies & Procedures, Nuances
    • Remain Current on Individual Formulary and Clinical Initiatives
    • Encourage Interaction and Real-time Access with Client’s Staff (Nursing and Medical)
    • Extensive Check-ins/outs with documentation
pipeline clinical activities
Pipeline | Clinical Activities
  • Process All Inbound Medication Orders
    • Discontinued or Modified
    • Received, Reviewed, Entered, or Verified
      • Duplicate Orders
      • Patient Demographic Additions or Changes
  • Clinical Recommendations
    • Consultation & Interaction - Nursing or Physicians/Hospitalists
    • Therapeutic/Auto Substitution (i.e. IV to PO)
    • Clinical Initiatives - Renal Dosing, Antibiotic Stewardship, Duplicate Therapy
    • Analysis - Labs, Allergy, Dosing, Drug/Drug Interactions
  • Client Reporting and Coordinated Hand-offs
    • Seamless front & back-end shift transitions
Technology Report | CPOE Inbound Integration Requirements for Inbound Medication Order Integration into PipelineRx
  • Gaining proper clinical data access: Requires third-party (PipelineRx) to have 24/7, 100% real-time, reliable access to the hospital client’s internal UNVERIFIED medication order data. The required CPOE medication data fields exist today and resides within the PIS (Pharmacy Information System). Currently, Pipeline gets this medication information via fax, scan.
  • How does one get reliable access to this UNVERIFIED clinical data? Optimally, with advanced IT connectivity tools embodied in a flexible, configurable and scalable integration engine that can simultaneously accommodate various hospital EMR and PIS systems. Upon confirming due diligence in Q2/Q3 with 3 PIS vendors, (HMS, Allscripts and EPIC), without scale, working directly with PIS vendors to build point-to-point integration to individual hospitals is sub-optimal.
  • Do these hospital integration engines exist for this application? Yes, see the next slide for overview of the vetted IT HL7 integration vendor/partners.
  • Why is this CPOE integrated approach considered transformative? Remote clinical telepharmacy services is a new industry, no one has imagined the need to have real-time access this UNVERIFIED medication data OUTSIDE the processing environment of the client’s PIS system. This distributed workflow approach is transformative, enabling Pipeline to effectively create a scalable industry workflow standard – similar to the standards created by GE & Siemens in tele-radiology.
  • Why is this novel? With the advent of CPOE (stimulated via Meaningful Use incentives) – for the first time, the inbound medication order information to the pharmacy is now in an electronic format. With the UNVERIFIED data in an electronic format it can be inbound integrated (automatically accepted) into PipelineRx and thereby eliminate the manually intensive medication order entry requirements by Pipeline’s clinical telepharmacists. No one has monetized this fundamental sea change of clinical pharmacy distributed clinical workflow. CPOE for care providers is analogous to retail banking consumers inputting their own specific banking transaction requests at any remote ATM machine versus the labor intensive, facility centric legacy teller process.
  • How does CPOE increase demand for telepharmacy? The care provider is now under a real time electronic audit, creates objective clinical workflow visibility. In addition, post CPOE, Pipeline as seen a 20-30% order increase per shift.
  • For Pipeline, how significant an impact does this inbound integration have on the number of medication orders processed per hour? This inbound integration will allow a Pipeline clinical telepharmacist to increase by 50% their productivity without sacrificing any clinical quality or turnaround times from 30 to 45 medication orders per hour.
pipelinerx it platform strategy
PipelineRx IT Platform Strategy

On-Demand Telepharmacy Solution

pipeline rx cpoe integration progress
PipelineRx | CPOE Integration Progress
  • Focus on Cerner, Meditech and McKesson Paragon – PIS vendors.
  • Largest impact with CPOE and Gross Margin for current account installed base.
  • First Client – Canton-Potsdam (New York) – April 1 – Meditech account.
  • Detailed CPOE rollout roadmap schedule – see attachment.
integration gm impact phase i and ii
Integration GM Impact | Phase I and II
  • Post-CPOE
    • Fundamentally Reduce COGS/Order
    • Improve GM
  • Established IT Product Development Roadmap | 3 Phases
    • Phase 1: Incremental operational efficiency gain via UI (underway)
    • Phase 2: Inbound CPOE Integration
      • Achieve 45 orders/hour
    • Phase 3: Full Integration through Uberqueue
      • One User Screen and 100% Clinical Work Flow
      • Achieve 60 orders/hour
  • COGS/Script | Targeted Cost Reductions
    • Today: PipelineRx | $2.07/order | at maximum of 30 orders/hour
    • Q4/Q1: Inbound CPOE Integration | $1.38/order | 45 orders/hour | a 33% cost decrease
    • 2014: Uberqueue | $1.03/order | 60 orders/hour | a 50% cost decrease
    • Remove actual costs – too sensitive and bankers and prospective clients (who are potential competitors) do not need to know until discussions get more serious and there is NDA)
the future of telepharmacy
The Future of Telepharmacy
  • Acute Care – multi-billion $ market
    • Services Expansion - Day Work, ER Work, Discharge Planning
    • Tactical – med reconciliation, rounding, remote monitoring, 24/7
    • Large System Opportunities (C-Suite) – CHS, Vanguard, CHI, Ascension, HMA
  • New Distribution Channels
    • CareFusion
    • GPOs, Healthcare and Operational Consulting Firms
    • Other telehealth providers and also national staffing firms
    • Full Pharmacy Outsourcers – PharmaCare, CompleteRx
  • Specialty Hospitals and Outpatient Opportunities
    • Heart, Psych, and other focused hospitals
    • Rehab, LTACs – HealthSouth, Select Medical
    • All have meaningful use requirements and labor constraints
  • Outpatient
    • Long Term Care, Assisted Living, Home Care, Dialysis
    • Outpatient pharmacies for hospitals
  • Other important pharmacy settings for remote model
    • Retail pharmacy
    • Prison Systems
    • State and Federal Organizations – large
    • Mail Order/PBMs - ExpressScripts
  • Acquisitions/Tuck-ins
    • Both Pure Play mom/pop competitors and also Divisions of Larger Companies (CPS)
    • Internal Telepharmacy Efforts within Health Systems – Adventist, Via Christi
pipelinerx core assets
PipelineRx Core Assets:
  • Technology
    • PipelineRx IP and trade secrets
    • Pipeline IT (Evolute)
    • Uberqueue
  • Proprietary Distributed Workforce Model
    • Triage
    • Home office based
    • Highly experienced team of employee clinical tele-pharmacists
  • State Legislative/Regulatory Experts
  • Highest Quality Expert Pharmacists
benefits of pipelinerx s integration into larger organization
Benefits of PipelineRx’s Integration Into Larger Organization
  • Resources for Uberqueue
    • Bidirectional Integration
  • True Marketing Dollars
  • Access to Established Distribution Strategy and Salesforce
  • Activates and Accelerates our Values in a Profitable Manner
  • Bundling
    • Complementary of existing services
    • Complementary of future services
  • Ensure Highest Level of Patient Safety to all Patients at Lowest Cost
pipelinerx partner universe spectrum
PipelineRxPartner Universe Spectrum

Outsourcing Players

Hospital Patient Care

Patient Discharge/Homecare

Drug Distribution Clinical Services










pipeline rx partner universe spectrum
PipelineRxPartner Universe Spectrum

Patient Discharge/Homecare

Partner Universe Spectrum

  • Walgreens
  • CVS