Podcast Appearance: Power Supply Visionary Values

Intro: 00:00

Rich Palarea: And what I really saw, which was tremendous, was that this is a paper-based process. The implant rep standing in the operating room tallying everything that’s going into a patient on a piece of paper and then writing down what they want to charge and then handing that over to a nurse who signs it and then walking it down the hallway to someone in purchasing expecting a purchase order. And I thought, for just a moment, and I said “I could pass this up and go back to what I was doing and everything will be just fine, or, we can try to solve this problem”.

Opening Theme: 00:31

Voice Over: Without supplies, there’s no surgery. Without products, there’s no patient care. Welcome to Power Supply. The healthcare supply chain podcast focused on helping you navigate the intricacies of logistics, purchasing, contracting, and supplier relationships. Each episode we speak with healthcare executives, supply chain leaders, and innovative entrepreneurs across the country as they share their stories, experience, and expertise on the industry we love. From the loading dock to strategic sourcing. From buyers to the C-suite, and across the enterprise. We tackle the real-life issues impacting the healthcare supply chain. Whether you’re tuning in for a conversation or inspiration, we’re glad you’re here. You’re just in time to hear from the source and stock up on insight. So sit back and plug into Power Supply.

Commercial Break: 2:25

Justin: Joining us now is Rich Palarea, CEO at Kermit. And today we’re going to take an interesting spin on a conversation. We’re going to take everybody over to the “other side” of the table as we like to say.

We’ll be talking about the supplier side of entrepreneurship in healthcare. And so Rich you and I had a great conversation and I know you’re familiar with Hays and Garry already as well, but I wanted to welcome you to the show and introduce you to the audience.

Rich: Yeah, sure! I started a number of companies; Kermit is the latest iteration. I didn’t do this by myself, I met two former medical device reps who were working for Zimmer Biomet. And they walked in and told me a very interesting story that I didn’t know at the time, about how a medical device rep stands in the operating room with the surgeon. And I was intrigued!

I listened to the story, and they wanted to set up an operation and I gave them some assets to do that, I kind of lent some time and we have now been doing that for ten years.

Before that I actually had another company that was involved in logistics spend management. That was the company I sold to start Kermit. So, I have started four different companies, I have exited one. I have tried lots of things; I have failed at lots of things like good entrepreneurs do. But I wouldn’t have it any other way. It has been a really great journey for me.

Justin: Well, and I know that a lot of these podcasts really have to be sort of the “agnostic” to talking about the company specifically that you work for, in the hopes that we will have some CE credits for these for the CMRP Certification.

So, there’s kind of some guidelines there but I do think that telling us a little bit about why you sold your company, and started Kermit would be really applicable here because I think when it comes to entrepreneurship, there requires some calculated risk and gambles.

There’s no guarantees when you’re an entrepreneur that something is going to work and I think it's an inspiring part of your story. So, do you mind kind of talking about how you wound up starting Kermit?

Rich: Yeah of course! Yeah, I don’t mind at all. I mean I think with every entrepreneur it’s kind of the same thing. It’s either in you or it isn’t. And it’s a bit of risk-taking for sure.

I think with the Kermit journey, what I saw when I met Jason and John was this really interesting intersection of a healthcare problem, that really hadn’t been addressed up until, you know, we started Kermit. And technology, the intersection of healthcare and technology always being hot, always being under-utilized and undervalued and now we’re kind of starting to get towards the place where hospitals want to consume this data which is really great.

But what I really saw that was tremendous, was that this is a paper-based process. The implant rep standing in the operating room tallying everything that’s going into a patient on a piece of paper and then writing down what they want to charge and then handing that over to a nurse who signs it and then walking it down the hallway to someone in purchasing expecting a purchase order.

And I thought, for just a moment, and I said, “I could pass this up and go back to what I was doing, and everything will be just fine, or we can try to solve this problem”. And besides it being a big opportunity, it was really something I could sink my teeth into.

We have built a staff now of 23 people who feel just as passionately as I did, and Jason and John did, to really bring change in this area. So, I think that was really the impetus for the journey, and why the entrepreneurship piece of it was a piece that really had to stick no matter what.

Garry Skinner: Well Rich, I really appreciate you talking about that med device rep in the room. A little history with myself being in that room exactly the way you explained it. And I love the fact that you thought about a solution for a gap that you saw and identified in bringing this to market.

If you could just maybe share a little bit with the listeners. You know, what’s it like bringing a new solution like this that you decided to take to market? What are some of the challenges and maybe share some of the opportunities?

Rich: Right, well Garry picture for a moment you’ve been sailing all your life, you know how to skipper the boat, but they drop you in a brand-new harbor and they say, “go from here”. You don’t have any chart. You don’t know where the shoals are and the rocks and the islands and basically, it’s midnight and it’s foggy. That’s what an entrepreneur’s journey is.

So, you know I definitely think you lean on some of the things that are very familiar to you. I think in my case it was technology and being able to pull teams together very quickly. Prototype tools and getting a minimally viable product up and running.

And then you know, having really good relationships with hospitals and being able to take it to them and say, “I know you trusted us in this area, would you let us kind of build this in your midst and see how it works?”.

I think we have been very fortunate to be at the intersection of a couple of those opportunities all at the same time. But yes, it was very much uncharted territory, and it still is a bit. We really don’t have a lot of competitors in what we do, so it makes it challenging to figure out everything from, “How do we price this?” to even just a general go-to-market strategy and how do you continue to bring value to a very busy area of healthcare, being supply chain.

These guys are doing lots of things, I think we ask them to do way too much in many cases and we bookended that a little bit, I am sure.

Rich: Yeah so, I think the core issue that you know you and Garry share a background there, and that’s being that rep in the OR. One of the things that the rep really struggles with is, “getting paid on time”.

I did a surgery, why is it taking weeks, sometimes months to get a purchase order? And so, I think you know the kernel of what Kermit was doing, starting ten years ago, was to accelerate that. Being able to get that P.O. on the day of surgery. And that’s where we started.

The hardest piece of all of that was collecting the data in the operating room, categorizing it the proper way, making sure the price was ok, and checking the contract for all those rules. Now that we have kind of nailed that and done that really well, we’re managing 40% of the implant spend that transacts in the state of Maryland today.

But by and large in the nation, nobody has heard of us. So, the first mission right now Hays, is to get the word out across the nation and get every hospital that wants to use this product, to make sure they have it.

What’s really exciting is bolting things onto both the left and the right of the interop process. What do I mean to the left? Earlier in the process, you have patient scheduling, you’ve got sterile processing and tray management. All that logistics stuff that really comes second nature to us. We really understand that stuff very well, especially being former med device reps.

And on the right? What happens after the payment is sent? Is there a patient billing issue? Are there product recalls? What happens with the outcome piece of it? Are we going to be able to measure that outcome and say, “Hmm the surgeon could’ve chosen a different product at a lower price and still had a great outcome.”

So, there’s a lot of stuff in this full ecosystem that we can do to bring an end-to-end solution. So, we’re looking at both sides of this, to the left and to the right, very carefully right now.

Justin: So, you kind of identified some of the challenges and definitely your story. Talked about looking at opportunities to you know address an issue in the industry. And you just did a very specific one right there.

But then there is this other challenge, which is not just the challenge of increasing awareness as a business. Like, we're here, this is what we do. But the other challenge is making it a viable business.

You got to put in a lot of money, sometimes you've got to raise capital. You've got to make sure that you turn a profit. If you're VC-funded, people go through different funding cycles. Not everybody understands that part of the process.

You could be self-funded, but then you're typically even leaner. But maybe the expectation is more self-imposed versus external pressures on the organization. So, this whole business of health care and bringing something to market, I feel like it's not easy to do in healthcare. I feel like it's much easier to do in other industries.

And I wondered if you could talk about, well address whether or not I'm correct about that. And then secondly, if I am, what does make healthcare so uniquely challenging to bring new solutions to market?

Rich: Yeah, I'd love to hear all of your opinions on this too, because each of you have touched this in some way, shape or form. For us, I think it's been not enough to just develop a really great product. And we've got lots of other companies who have started up in the past ten years since we've been doing this, who I've watched kind of rise up very quickly, got a great product, but it's more of a point solution, I would say.

It's not really an enterprise product. And so, you get these rising stars to shoot up very quickly, and then a year later, you don't hear anything from them, and they're not being acquired. I think you have to have a very broad application, a very broad platform, because healthcare supply chain in most large health systems, they want to buy enterprise systems. They don't want to buy something that just fixes one tiny little problem.

And then the next question is, how do I bolt that onto my Epic implementation or my Cerner implementation? They're going to want something that's more broad-based. So, I think for us, we didn't take a lot of money to start the company.

We actually started negotiating implant contracts on behalf of the hospital, saving them money and taking a portion of what we saved them as our fee before Kermit was even conceived. We then launched Kermit. We raised about a half million dollars. We were sitting around the boardroom with our newly minted investor. We were all celebrating and said, hey, let's be a software company. And everyone thought it was a great idea, big, multiples and the like.

And then we looked at the amount we raised, and we said, there's no possible way we can do this. We don't have enough money. So, for us, just in the journey was one of a bootstrapped type of situation, and we just went forward like that. And over ten years, we've been very fortunate to turn a profit every quarter except the first one that we were in business.

But I think about that, and I think about how many great ideas have actually never really seen the light of day in the hospital because of two main reasons.

One, it's not enough to just have a great product. You got to have a business sense about how you're going to bring that to market and launch it and stay.

And number two, boy, is it hard to sell the supply chain. It's just hard to sell the hospitals, period. Right? And so, if you have a really embattled supply chain who is just being whipped every day to save money. And we're asking them to do really complicated things like buy capital equipment and evaluate IT systems. And then the experts on implants too. I just don't think it's fair that we do that to them.

They really need a good, I don't know what you would call it, like a sourcing board almost. Somebody who can bring technologies and bring them in a vetted way to hospitals and say, here's the best of the best in every category. We've looked at these and I think there have been some startups that have come and gone in that space, but nobody, in particular, has really stuck.

And I think there's a big need in technology, in particular, to help supply chain and other health care professionals understand what's available to them and what really works.

Hays: I talked to a company the other day who actually has a share of Market International and they're coming over here and they've just hired a new team.

But to echo your point exactly, I think they have a pretty good product. But in my conversation with the guy, they've hired to run healthcare, a couple of things he asked me, or I said the word GPO to him. He had no idea what that meant.

And then I later said IDN he didn't know what that meant, and I knew then they're up against it, right? It's going to be challenging, but there are a lot of great products out there that just they don't have the resources, they don't have the connections, they don't have something.

And it is a challenge because getting into hospitals, healthcare, it's unique and it's different and sometimes extremely challenging. But yeah, just again, just to your point earlier.

Rich: Yeah, it's all of them, Garry and Value Analysis and other people you've talked to on this podcast, it's going to differ based on the environment we're selling to.

If I walk into a small community hospital where they're not getting great pricing, they just don't have the volume. Maybe they have a GPO or two helping them, but they're just not in the tiers where they need to be, where they can really get the attention, they need. Those folks are very pragmatic.

I will usually talk first to a CFO and my sales team talk to a CFO. It's all about saving money. And if we can do that for them and our approach is one where we don't charge them anything. If they allow us to negotiate knee and Hip contracts for them, fine, we'll give them the software for free, and we'll let them just pay us out of the savings. There's no risk. They like that when you start to go into larger environments, small health systems.

Hays, you mentioned IDNs some places where the GPOs are very, very entrenched and kind of even sometimes they've outsourced the entire supply chain. We have one health system where Vizient is running the supply chain for them. So, you can imagine I don't negotiate anything in their midst. They do all of that. I tend to stick with the VP of Supply Chain or the Chief Supply Chain officer in some cases.

I love, and you guys will probably support me on this, I love the fact we've brought this whole industry from fluorescent lights and the basement and a blue-collar type of approach to managing a warehouse to the white-collar place that it needs to be, managing large budgets and really honoring these folks for the hard work that they do.

And so, I tend to want to talk to a supply chain person, but at the same time, I'll say this. There are some environments we will go into where I will get arms crossed and folded across the table from me with a scowl, looking at me like, there's no way you're going to find $10 million of savings here. And if you do, I will not let anybody know. So, I've got to be quite careful about that message.

A lot of what the software does, too, is a lot of things around efficiency. So, we're checking these paper bill sheets and digitizing, and nobody should be doing (manually) that in today's world. We should redeploy those people to very important tasks, around Periop and patient care, etc.

Justin: And it's interesting what you just said, too, with all the different stakeholders. You said you get everybody involved. But that's part of what makes it complicated to sell into healthcare and specifically to sell to supply chain, because they have to manage all of those internal stakeholders as well.

And I think that's one of the unique differences with some of the other industries. The stakes are high in healthcare. You're talking about patients’ lives, and you're talking about a certain level of criticality that you have to have a high level of trust.

And so, when you're a new solution, there's low trust because you don't have the testimonials behind you as an organization yet. You have to establish that you don't have the network in many cases unless the people that are on your board are already well connected.

So, there's a lot of pieces that I think that have to really be in place for things to move forward for that organization, but it's still doable. And I like what you said about supply chain and selling to supply chain, but one thing.

Yes, you're in the boardroom, you've got the whiteboard, you have the strategy. One thing that we still have to do a much better job of is developing that talent. So, we're elevating their status, but we're not necessarily as an industry doing a great job of nurturing and creating the next generation of supply chain professionals and giving those types of opportunities.

And so, the thing that I heard as you were describing the arms crossed and not really being open necessarily or end up in a situation where the ego could get hurt or it could be a bad look for them, it reminds me that they're very political environments and that is another big part of the navigating and selling into healthcare. Do you want to talk about that a little bit more?

Rich: Yeah, I think your average startup who, especially if you're in the device side of things and you've got to go through value analysis, and you got to get an approved list and then all you've been given is a hunting license. That doesn't guarantee you anything, you've got to go out and sell it to every surgeon in every hospital. That's just a really tough road to go down.

I don't know that the average CEO or startup who comes up with a great product is thinking about all of that. And I forget what they call it in the startup journey. But it's the Valley of Sorrows or what is the term they use when you think like you've got the product nailed. You've got all this stuff and then you wonder it's just taking so long to get traction.

And you wonder, “Maybe I should just stop and maybe my dad was right. I should just go do something else. This was a pipe dream.” And for people that give up at that stage, I wonder how many have given up and really could have hit a home run.

Perseverance is, and that kind of “sticktoitiveness” is so important, not just in healthcare, but just in this journey in particular. I wonder. The road behind me is littered with all kinds of great companies who didn't really persevere to see it through. And I'm not one who plays the politics of selling. I don't like that. I don't like calling in favors from board members and that kind of thing. It's just not my style and I just don't do it very well.

When I need to ask for a favor, I come off as a sheepish kid who's got his hand out for an allowance or something. And other people do it very well. But I think for the average person, you really do need to understand how things are connected.

This healthcare ecosystem in the United States is quite, I don't know what the word is, it's very well connected. If you meet two or three or four well-connected people, they will get you to 5, 15, or 25 hospitals and at least get you a meeting.

And so, I think there has to be a balance Justin, between that. How do you play the politics of how this all goes down? And at the same time, I really don't think supply chain people like to get phone calls from their board members.

Probably the last thing they want is, hey, I'm referring somebody to you. Take a look, right? And that's just a bad look. So, you've got to be in really valuable ecosystems. I think some of the stuff that the three of you are doing in healthcare, supply chain is a very good example of how that should work, and it's a good balance.

Rich: I did not understand that Justin I married somebody from here. I'm from California. So, we were here visiting her folks for Christmas one year. She picked me up at the airport.

We jump in the car, we're driving back to her folk’s house, and I'm seeing stickers on the backs of cars all the way. There are lots of stickers for schools. And I'm like, wow, you guys have a lot of colleges here. She goes. Those aren't colleges. Those are all private schools.

And that's how it works. That's how the ecosystem works. If you go an hour south of here to Washington, DC. It's very transient. A lot of people come to DC to make their fortunes. A lot of people leave. That's what I'm used to in California. That's how it was there.

Baltimore is not like that. And I've heard of other kinds of situations in other cities where it works kind of the same way, but that's why they call it Smalltimore. You're exactly right.

Justin: That's good. That's really good stuff. And then you also talked about the long sales cycles, essentially.

You didn't say it right out loud, but you said lots of people didn't have the “sticktoitiveness”. They didn't make it because eventually they just gave up and you might even get a few wins.

But when you finally do after that long sale cycle, the payment cycle can be equally as brutal. So, you might finally get there and then not get paid time to stay cash relevant, and then you still wind up going under. So that payment cycle is equally as brutal as the long sales cycle in healthcare.

Rich: Although I will say this, Justin, I think we've been very fortunate Kermit to work with some really great hospitals both in Maryland and outside of Maryland. And even during the pandemic, we never had to chase anybody down for payment.

Everybody honored their contracts. That has never been an issue for us. But boy, are you right about the sales cycles. I think if you don't really prepare your investors, your board, your salespeople, your chief growth officer. All these people have to understand this journey that this isn't just selling widgets.

You don't just walk in, and somebody looks at the product, puts it in their hands, and says, I'll take 20. It's a very long, drawn-out process and you've got to have patience. And what's been really interesting about the COVID era is it's much easier to get meetings.

Like, Hays, you were talking at the top of we were just chatting about how many Zoom meetings you had today. Zoom meetings are prolific. It's pretty easy to get a supply chain person to take 15 minutes to meet with you.

What is very difficult are meetings number two through ten. Once they leave that meeting, they go back to their desk and all the things that weren't done when they met with you are still not done. Million fires to put out.

And so, getting them back on track and trying to get back in front of them has been really hard. And so, Justin, I'd say the average time that it takes us to just get the system deployed, get a decision on, is probably twelve months.

Rich: Although I'll say this, Garry, one of the things that we did on purpose was we kept it very simple. When we built this, it was all going to be cloud-based and that's how we launched.

So, we don't have to go behind the firewall, we don't have to really interact with it, other than we do have to go through the HIPAA compliance and the security and all of that. Just the amount of hospitals that are targets or have been hacked is on everybody's radar.

So, we take that all very seriously. We can stand up in the cloud and somebody will say to me, well, how long does it take you to implement? Literally a day. If you can give me your price files and the doctor's names and the people that need to be trained, we can stand this up today and we'll be training you tomorrow.

But it doesn't typically work like that for most IT. And when I say that nobody believes me. So, we got to be more realistic. We say it will take us a week.

Hays: Rich, you talked about just the challenges of selling and IT and everything else in a year. One of the things you also mentioned was that supply chain guy, or Gal, who is Radisson, who thinks they already have a great price on their implants and stuff and therefore they don't want you in there because you might show them a quote, right?

Do you have a story? Do you have something you could share about when you do come in and say, guess what, we can bring another million dollars in savings, did their C Suite get upset at them for bringing those savings? In other words, should they be doing a better job? How is that viewed?

Rich: It’s kind of what I was saying before when I said, I was mentioning kind of the blue-collar transition to the white-collar job. I really think it's a leadership thing in the hospital or the health system to not hold these folks accountable to understand this technology. They just can't do it. It's just not even realistic. You've got 3D printed material, you've got titanium, this and that. I mean, there's just no way.

So, I think if you have really great leadership, who says, we'll look at any startup, we'll look at any technology, we're going to vet the heck out of you and we may not do anything with you, we'll run you through the wringer, but we're willing to look at anything that's great.

And I really appreciate just a fair shake when we're summarily dismissed out of hand because we say, hey, we think we can save you 30% of your annual spend on your hip and knee or spine or cardiovascular, any of these big spend categories and people just shake their head and go, no, I'm not doing this whole thing with savings.

It's everything that has come before us, especially the guys who come before us, who have taken a portion of savings as their fee, who have kind of set up a bad taste in everybody's mouth.

So, I always appreciate somebody that will just let us level set, give us just 15 minutes to talk about that if at the end of that they don't want to do it. The way I look at that Hays is, that's not a no, it's just not a yes for today. Because behind that person saying no, there are probably five people I need to talk to who really need the help and will appreciate this. I will just politely dismiss myself from that conversation and say, let's see if we can talk to somebody else.

We have only scratched the surface of all the hospitals out there in the nation and I know there are lots of them that really need help in saving money. So, it's just a matter of just kind of failing quickly. Get past that call. If they don't want us to mess with them and we'll go to the next one, I think eventually people will come around.

I think for a lot of people you have to de-risk the thing. They can't be your first customer. Nobody ever was shot for buying IBM or whatever the saying is, that's what they want. And so, everybody is going to take them a little bit of time to get that kind of traction and notoriety.

But if you stick to it and you got a great product and you got a good process, I think anybody can make it because healthcare, especially in technology, really need this kind of help.

Justin: Amen. One of the things I say to other aspiring entrepreneurs is you can do anything you want if you're willing to do it for free. The key is how do you turn a profit in a timeframe? But I think love, passion and sincere interest is what helps you leap a lot of those hurdles.

And Rich, your story is, I saw this and thought, this is something I want to do. And that's so important, trying to launch something that even if you see the opportunity, if it doesn't get you excited, you're probably not going to stick it out through the duration and you're going to find yourself being unhappy, demotivated.

And I really like what you just said about de-risking it for the customer. Everything is about transparency. It's about risk share, profits share, revenue share. These are the topics of today's supply chain to survive what's been going on.

So, final question I want to throw at you, and then we'll wrap up. It's really about developing principles. This is something that you and I touched on when we got introduced, and it has a lot to do with not only did you as a CEO and a founder and you're getting something off the ground that you really believe in, but then you have to extend that out to all the employees that follow. And so, some of that has to be about how the solution is developed as well because you don't want to send a sales force or an Ops team in to do an implementation or sales presentation and be entirely misaligned with the customer.

Every single customer contact in the early going is critical. It's so important, you want them all to at least do something with you. And so how do you develop those principles and culture as an organization so that you stay relevant throughout the early going and ultimately as you scale up?

Rich: Yeah. So, on the inside, looking out, if you're going to ask me as a founder and co-founder CEO, how are we doing that with our staff? We're at 25 right now and looking at making a very critical hire right now who will join the executive team, but we probably won't be bigger than 30 or 40 people max.

It doesn't take a large platoon of people to power this. It's more about using our own technology to do things faster and smarter. And that's what we're showing the hospital how to do as well.

I'll tell you the real challenge right now, Justin. At ten years in and sitting on the back porch of our little shop here in Maryland. Ready to go out on a national stage is, how do we take the fingerprints of the founders off of the product? Off of the company and let departments that were just forming these departments. Let them own the product. Let them understand if they're in Texas and they understand how to sell to large IDN in Houston.

It doesn't have to look the way we did it here with the University of Maryland, for example. We had success here, we've had successes in other states, but let's empower them to take what we've built now, make it their own, and go out and translate that into the marketplace.

And that's been probably the most difficult part of where we are at this stage. I think it's a very temporary thing. I'm very encouraged because as much passion as you hear my voice to solve this problem, we're seeing it from our staff to everybody who comes here, whether they come from an industry like Hays and Garry, or they come from healthcare Supply chain, we've got some folks from the GPO that are here. We've got great analysts. I've got a data scientist from a very large IDN in Baltimore who has joined us.

It doesn't matter what walk they come from, they share the passion of trying to reduce the cost and help these folks in supply chain do this better and smarter and cheaper, really, and let them go solve and tackle the bigger problems that they need to not managing this stuff.

And I think when we can kind of finish that loop, so to speak, which is probably we're very close to doing that, then I think we're going to have tremendous success because we just want to talk to anybody who needs this product in the service, and I think these folks will be able to do that.

Justin: Rich, I really like the point you brought up about stuff. We always talked about managing the staff, reducing spend so we can take care of staff and patients. So, I really appreciate you bringing that up because that's really what it is about cost savings and making sure we have the staff to take care of our patients. So, thanks for bringing that up too.

Rich, you did a really nice job on this. The interview went by quick, and I know we could talk about entrepreneurship and the hurdles of trying to bring a product to market and healthcare for quite a long time, but we're getting back to in-person events so people can seek you out and ask you about your experience as an entrepreneur.

And I will also say there's lots of people out there that are working on the front lines and supply chain who know these issues. And so, if deep down they have that entrepreneurial spirit, they just need to network with other people that have done it and see how they might try it themselves.

And if not, don't hesitate to reach out to an entrepreneur and share a good idea because that's how these problems get solved. You may not be the one to execute it, but if you've got a good idea, somebody does need to execute it.

Rich: For sure. And I think the more that we can engage in small groups and sharing experiences and doing that kind of thing, the more that we all benefit.

One thing is so great about being in the hospital business is we really don't compete against each other. If you're running a hospital, what better place to get together in a small group of people who do your job to share experiences and learn from everybody?

And that's really what community is about. You just can't do that if you're selling widgets, and somebody is going to beat you on two cents on a price or something like that. But in healthcare, we have the ability to do that.

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