Tony Willoughby Of Stellus Rx On 5 Things We Must Do To Improve the US Healthcare System
An Interview With Jake Frankel
I’d say that any material work we can do to align, simplify and ease the patient experience, the better outcomes would be. There are a lot of people and companies out there trying to do this … through apps, through navigation services, through concierge care models, you name it. The challenge is that each solution tends to own only one part of the journey. If patients had a clear source of truth for their health journeys, a singular reference point around which they could orient all their disparate care interactions, this intrinsically fractured system we’ve all inherited could at least begin to come into clearer view.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Tony Willoughby, Stellus Rx.
Tony Willoughby, Pharm.D., is CEO and Co-founder of Stellus Rx. Previously, he served as President of Catalyst Health Group, creator of Texas’ largest clinically integrated network of independent primary care physicians, and as co-founder of Thrive Pharmacy Solutions, which would eventually become Stellus Rx. Tony has more than 20 years of pharmacy and operational leadership experience, which has bolstered his passion for building solutions that help people make the best and most sustainable decisions for their health.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
The exact moment I decided to become a pharmacist still stands out to me, because that was the moment I saw the impact that pharmacists could truly make in the lives of patients. I was a college freshman, working at a local retail pharmacy as a pharmacy technician. A middle-aged husband and wife came into the pharmacy often to get medication for their daughter, who I knew was around my age.
My interest was piqued about why they came in so regularly. I wasn’t familiar with the medications they picked up, so I did some research in the pharmacy reference books we had behind the counter. (These were pre-Google times!) Based on the medications, it looked like the couple’s daughter had cystic fibrosis.
One night, the couple came in with a prescription for another medication I had never seen before, so I looked it up and found out it was an IV antibiotic — an odd medication to have filled at a retail pharmacy, but this was also early in the days of home health infusion. My supervising pharmacist told me we didn’t have it and that it’d be hard to find … but he also gave me permission to help the couple find an answer to this problem. So for the next couple hours, I called pharmacies and hospitals in the surrounding area, with no luck. I finally found the medication stocked at a drug wholesaler in the next state.
It was a Friday afternoon and the wholesaler wouldn’t be able to deliver it to us till Monday, but I asked if they would let me pick it up if I drove there myself. I had a relative in that state who always believed in me and supported me, so she picked it up and met me halfway.
Around 11:00 that night, I was finally able to deliver it the patient’s house. I’ll never forget seeing the young lady in a hospital bed in her home … or the grateful handshake from her father and the hug from her mom. I’m sure it sounds a bit trite, but that’s the moment I knew that I could make a real difference and that I’d do whatever it took to make that difference through my work.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Funny or embarrassing … I think these memorable events always come from assuming. As a young pharmacist, I once had significant concerns when a pregnant woman came to pick up medications that were contraindicated for pregnancy. I even called her doctor to inform him about the situation and ensure that he knew all the risks this patient was incurring for her pregnancy. The doctor explained to me with absolute certainty that the patient was not pregnant. As it turns out, I just made a very poor assumption, which my wife (rightfully) gave me a lot of grief over when I got home that evening!
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
This one seems to have grown a lot in visibility and popularity in recent years, but I love the “Citizenship in a Republic” speech by Teddy Roosevelt (a.k.a., “the man in the arena” speech). You know the phrases from it, I’m sure … “It is not the critic who counts … credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood … who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly.”
Such powerful words that hit on key themes for my own life — being vulnerable enough to take value attempts at new things with the goal of driving significant change … whether that’s accepting a number of moves earlier in my career to take on new responsibilities and serve as something of a turnaround specialist for my company … or leading Stellus Rx today, with a vision of changing the health of people nationwide by bringing pharmacist-led expertise and empathy to each moment that matters in medication journeys. In my moments of self-doubt or failure, I go back to that quote — that speech — and draw consolation and strength that our superpower is our willingness to try, again and again.
How would you define an “excellent healthcare provider”?
This whole conversation could be about just that. For the sake of brevity and clarity, I’ll say that — all things being equal in the matters of patient outcomes delivered — excellent healthcare providers are the ones who listen and who seek to understand first, before taking action. When providers apply that learning mindset to patient care and team dynamics, and then focus on improving outcomes for all through their actions, they become more than deliverers of care — those excellent healthcare providers become part of the healthcare transformation that I know we’d all like to experience in our lifetimes.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I read a lot and listen to audiobooks even more, probably an average of 1–2 per week, with the goal of trying to integrate a lot of what I read into the way I show up for the people in my life — whether that’s my family, my team at Stellus Rx, my friends and colleagues. The books and resources that have shaped me most aren’t necessarily the ones focused on inspiring better leadership; they’re more focused on how I can serve others in more caring and giving ways. The Kingdom Within is a current favorite of mine that I find myself coming back to for further reflection.
Are you working on any exciting new projects now? How do you think that will help people?
Recognizing how biased this sounds, I think the entire purpose of our Stellus Rx business is exciting and new. Think about how many questions people have when they’re prescribed medications: How will this affect my life, will this really help me, how much will this cost, what if I can’t afford it, what if this makes me feel worse? The list goes on and on. Now think about how much that list of questions and concerns gets magnified for people with a chronic condition, or multiple chronic conditions. In those moments when people have the most questions about their medications and have to make the difficult choices of whether or not to fill and take their medications, they’re often left with very few answers or resources they can turn to for trusted support.
We’re working to change all of that by connecting patients to personal pharmacists who can guide them through the obstacles in the medication journey; pharmacists who will listen to patients and understand their fears, biases and goals before offering direction and support. Right now, we’re working to scale that model — both in terms of the number of people we can reach and the ways people can interact and engage with us for the benefit of their health. I view this work as the most important thing I’ve ever done, and if we’re successful, I believe we have the chance to bring meaningful improvement in the value that medications can have on people’s lives.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us a few reasons why you think the US is ranked so poorly?
Wow, that’s a weighty question that we could take a lot of different ways. One underlying theme is certainly the fractured nature of our healthcare system and the misaligned incentives and financial structures that sprout and spread from that. The study talks about the need to strengthen primary care, better coordination throughout the care continuum, improving affordability and access … I agree with all of those. At the same time, I think our biggest opportunity for improvement lies in the transformational shift of what we incentivize, and thus, what we prioritize.
As the saying goes: Leaders get the teams they deserve. Teams’ dynamics are a reflection of their leaders, right? I think we see a similar principle with our broader healthcare system. We have this fractured, siloed, complex, costly system because as a country, we’ve enabled (and in some cases, actively worked for) that to happen. We’ve regularly prioritized choice — in providers, in sites of care, in consumer-directed medication channels — and volume over evidence-based outcomes and value.
It sounds grim, but I’m an optimist and a problem-solver by nature and so I’d also say that the good news is that it’s improvable. I’m encouraged by the momentum we’re seeing with value-based care and the recognition of the good we can create when we incentivize patient health above all. I continue to be amazed by healthcare innovation and the impact created by novel treatments, new technologies and increased precision in how medications can be used to change lives. I have hope for our healthcare system so long as people continue to have the energy and the passion to push for healthier communities.
As a “healthcare insider,” if you had the power to make a change, can you share 5 changes that need to be made to improve the overall U.S. healthcare system?
Clearly we’ve reached the “no more softball questions” point of the conversation! You know as well as I do that there are a million different changes we could make to improve the U.S. healthcare system — and that maybe the biggest issue is that, as siloed as our healthcare system is, it’s challenging to make any sweeping change without creating unintended consequences that affect massive swaths of our population.
So rather than wading into wishful thinking territory, maybe I’ll limit my response here to some changes that I have some ability to influence (however small that influence might be).
- First, I’d say that any material work we can do to align, simplify and ease the patient experience, the better outcomes would be. There are a lot of people and companies out there trying to do this … through apps, through navigation services, through concierge care models, you name it. The challenge is that each solution tends to own only one part of the journey. If patients had a clear source of truth for their health journeys, a singular reference point around which they could orient all their disparate care interactions, this intrinsically fractured system we’ve all inherited could at least begin to come into clearer view.
- Second, I’ll repeat my call for the expansion of value-based care with clear definitions of the value posts we’re striving for. Above all, people want to be healthy and healthier people cost less to care for. So the more we can reform and rehabilitate our healthcare system to incentivize the most possible healthy days for patients and match our delivery models to that (think: more emphasis on primary and preventive care, more support for medication adherence and chronic condition management, more access to behavioral health resources, more connected care experiences), the more effective and efficient our healthcare system will be.
- Third, the drug economics in our country need massive reconsideration. Thousands of pharmacies throughout the country serve as the principal conduits of medication-focused care — they are literally the last checkpoint that patients have between the time their physicians prescribe medications and the next time patients are in front of their physicians. Work that pharmacies do to ensure safe and effective dispensing of medications has inherent value that’s tied to the expertise of the licensed pharmacists and their certified pharmacy technicians. So why are the economics of their work tied to the costs of the specific medications they dispense … or even worse, tied to the contracted rates negotiated by parties that individual pharmacies have zero ability to influence? The grave consequences of the current model are the potential loss of pharmacies as access points and health hubs for communities that count on them for vital care.
- Number four is tied to number three: We need to create mechanisms that leverage pharmacists’ deep medication expertise in more holistic, more longitudinal, more personal ways. These are professionals who have dedicated their professional careers and their vast intellect toward deep understanding of medications and the role that medications play in the health of patients. These are people who entered the field to help patients and collaborate with other healthcare providers. We need to position them to be able to consult more with physicians on appropriate therapies for patients (which medications have greater efficacy for specific patient attributes, which medications present fewer cost obstacles, which medications have lower risk of side effects when combined with a patient’s other medications). And we need to free up more time for pharmacists to counsel patients throughout their medication journeys, because the most urgent medication challenges hardly ever occur right at the pharmacy counter.
- The fifth and final thing I’ll mention is the reframing of how we evaluate healthcare costs. Too often, even the healthcare experts in our country consider healthcare costs in two distinct categories: medical costs and prescription drug costs. I understand why that happens; it’s logical to feel the need to create segmentation to identify where costs are coming from. But in this case, the segmentation causes us to lose context for the relationship between the two cost categories. Put another way: Prescription drug costs and medical costs are inexorably tied. We only take medications to be healthier, to feel better. So if drug costs keep going up, we should see medical costs flatten and decline. Instead, year after year, we see both numbers continue to climb. Rather than focusing on cutting prescription drug costs, I’d push us to consider why both numbers are increasing in tandem and address that issue. It seems far more likely that if we helped people take their prescribed medications more effectively and adherently, we could make huge strides toward improving health outcomes — which ultimately, would help us lower both medical costs and drug costs.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
The biggest step we can take is to continue our push for value in healthcare … and continue to push for clarity and alignment on what value truly means. It’s not just about bending the cost curve. It’s not solely focused on curating services or steering people to specific providers and specific medications. Those are tools to evaluate, but the push for value should center on outcomes and what can be done — proactively, preventively, consistently, broadly — to build health early and sustain it enduringly. That’s the only way our healthcare system can support the health we all desire.
How do you think we can address the problem of physician shortages and provider burnout?
At the risk of being redundant, we have to unlock the expertise of our pharmacists and propagate care models that empower them to support patients more individually and longitudinally. That doesn’t mean replacing physicians or other clinicians. It means supporting physician-directed care plans by serving as medication experts for physicians and for patients, acting as extensions of the care delivered by physicians in their practices.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
This isn’t a new idea, but I wish it were a more widely ingrained one: I’d love it if we could all seek to understand one another, rather than seeking to debate one another. If we could let go of the need to be right — or at least loosen our grip on that need — we’d learn a whole lot more about one another, and I think we’d find more ways to do good in the world together.
How can our readers further follow your work online?
- https://www.stellusrx.com/
- https://www.linkedin.com/in/tonywilloughby/
- https://www.linkedin.com/company/stellus-rx
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.