This week I am talking to Mark Dorner, Co-Founder and CEO PreciseMDx, a company that is rethinking the diagnostic testing journey for patients and working to create the best and most efficient diagnostic service for everyone.
The company was founded right at the beginning of the pandemic based on personal experiences with testing for cancer which had a huge impact on the positive outcome. As we discuss launching anything during a pandemic is a challenge but there were some benefits including the rapid pace of adoption and large numbers of users they garnered.
We discuss the challenges for individuals navigating the healthcare testing space and the importance that testing has on the healthcare diagnosis and the change they are empowering that puts the patient at the center of testing. Thanks in part to the changes brought about by the Pandemic there is far more understanding and expectation by the consumer from the laboratory space and we are seeing an increase in direct-to-consumer availability of tests. Mark shares his own personal experience with a screening test that was issued to him and how the journey so far demonstrates the importance and value of changing the way we think about testing and who should be in control.
Listen in to hear about the personal experiences of price transparency and the importance of data and patient confidentiality, even more so in the new era of genetic testing.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Mark Dorner. He is the co founder of precise MDX. Mark. Thanks for joining me today.
Mark Dorner
Thank you, Dr. Nick. Appreciate it.
Nick van Terheyden
So if you would tell the listeners a little bit about your background and how you arrived at this point, please.
Mark Dorner
Sure. So my personal background, I started as a software engineer about 30 something years ago in the military. 24 years ago, I was Chief Architect at relay health, which was my first foray into enterprise healthcare. Later, it was acquired by McKesson. And since then, you know, my team and I have built a lot of different platforms in the enterprise healthcare space. Fast forward to a couple years ago, my co founder and partner guy leaves net. And I have discussed starting this company to really transform and elevate the experience of laboratories, patients and providers by providing what we call a connected digital journey. The impetus for this came from two sides, I would say, guy about eight years ago was diagnosed with cancer. And as part of his journey and treatment with cancer, he came to an inflection point where he needed a lab test to help decide which path he would go down. He was being treated at Stanford, which is a an amazing facility and Frank worldwide and treating his condition. And he had some external advisors because we you know, we’ve been in healthcare long enough to always want to get second opinions. And, you know, Guy was about to do his lab tests. And his advisor said, oh, there’s a new test that’s FDA approved, and for your specific mutation is much better, and will give better information. Guy reached out to the company, it’s a company based in San Diego himself, connected them with his physician treating MIT, Stanford, somehow was able to work through the healthcare technology to get the tests ordered and completed. It was the right test for him, he had a great outcome, and it is now the standard at Stanford for his mutation of cancer. So combined with his need to saying, you know, for me, who forgot who understands healthcare, and navigating the system, how hard it was, how can we make it easier for other people to get the tests they need, when they need it in an easy manner, combined with, you know, my personal passion for solving problems. As an engineer, I like to fix things and solve problems. And as you know, healthcare provides a lot of opportunity to do that.
Nick van Terheyden
So to be clear, I want to just make sure people understand I think, if I interpret that story correctly, for guy, if he had not had the background, the connections, the resources, understanding, and indeed, even working with, you know, a leading institution, his outcome could have been really quite different, because he wouldn’t have had that opportunity for a test that had been established, but maybe not entered into general clinical practice. And, you know, for the average user or individual that sort of intersects with health care, unless you’re willing to go to bat and really sort of dive into this, which I think most people are, but they don’t necessarily have the understanding, that would be a challenge. Is that a fair summary?
Mark Dorner
Absolutely. I mean, if this was a very pivotal test, that if he had taken a different treatment path, he could have been dead. So it’s quite, quite extreme. And, you know, when you when you’re diagnosed with an acute or chronic illness, the last thing you want to do is start to project manage your own your own health. So you rely on the system, which, you know, it works, but you can always do things better. You know, in guy’s case, because he’d been in healthcare, we’d work together, we’re in the same unit, the military, so we’ve worked together on and off for 30 years. So, you know, he’s very aware of health care, and how it works and, you know, basically took the steps necessary to come up with the optimal outcome, which he did, and he’s great and cancer free and Yeah, and actually helped people at Stanford, you know, by introducing that testing into their, their standardized regimen.
Nick van Terheyden
You know, I I’m so glad it’s a great story, but you’re right, I think healthcare is littered with examples like this, where, you know, the failure to comprehend or even navigate, even if you understand, to actually positively influence with existing understanding is a real challenge. So, together, you formed a company precise MDX and your intention is to try and help that process. Help people understand how you go about doing that. What’s what’s involved. Uh,
Mark Dorner
well, if you think about the, the laboratory space, you know, you know, according to the CDC 70% of today’s medical decisions depend on laboratory results. So if you think about that, and you think about you go to the physician, and you have a problem. And you know, most of the time they run a test. A great example, I took my daughter to a specialist a few months ago, and she needed a blood test. So the specialists staff hand me a piece of paper, and say, take this paper to one of the labs next door down the block, and, you know, do that. So I take my paper, I walk next door to the lab, I give them my paper, they give me more paper, I fill out their paper, my daughter gives them some blood, we go home, and then silence. So I went a couple of days, because I think, Oh, this is a test that takes a couple of days, I email my physician, which is, which is new, you can email them now. And they say, Hey, any results? And they’re like, We don’t know, like, okay, but we’ll get back to you. The next day. They say, Well, we got the results, everything’s fine. And they say, Can I get a copy of the lab report, they’re like, Well, you need to reach out to the lab for that. So So you know, and that’s very typical in healthcare, by what we do, you know, by creating this connected digital journey, using technology to, from the start, connect the patient to it, giving them transparency to the process, that that makes everything more efficient, increases satisfaction, it’s kind of ridiculous that today, you can order a pizza and every step of the way, who’s making your pizza, it’s on its way it’s being reviewed, but you know, a lab test, which is slightly more important, you don’t have any visibility, you’re kind of at the whim of, you know, basically your your level of patience as a patient.
Nick van Terheyden
You know, it’s interesting, you bring up the results process even and, you know, I’m certainly, I think people that would see any of my posts will know that I’ve had issues with that, you know, the health and human services have been very, very clear about patient access for appropriate reasons. And, you know, your co founder is a good example of, you know, somebody that’s tracking. But if you think about a pivotal moment in cancer diagnosis, that test result coming back, but not being available, positive or negative is either causing, or will cause initially just stress because you’re waiting, and then ultimately, if it gets forgotten, which we’ve seen. So there’s a good reason for allowing for this, but you know, it really fails. So you’re essentially trying to connect those dots for the patients, the providers, so that now this becomes like the pizza delivery, where, you know, I can almost track my mushroom to the point on, you know, the pizza, I think, how do you go about doing that? It doesn’t, I mean, there’s a part of me that says that must be easy, but I work in healthcare. So I know that’s not true.
Mark Dorner
Well, you know, one of the biggest challenges in healthcare is interoperability, connecting systems. Sometimes it’s a technical challenge, sometimes it’s a commercial challenge. You know, I’ve been in healthcare quite some time. And, you know, I’ve seen where you’ll reach out to an EMR vendor and not hear back for a month or two. So you know, that that impedes progress, you know, we go about it a little differently, we start the journey with the patient. So the patient is the one who activates their tests are activates their kit, puts their information in and starts the journey, the provider can supplement that with clinical information where necessary, and then we connect directly to the laboratory. So everything flows electronically, you know, an outcome of this connect digital journeys, greater efficiency, but it’s also greater satisfaction, the patient who knows that their test is being processed, and it reached the lab, and you know, when to expect the results doesn’t make phone calls to the provider, or the lab, having tried pricing transparency, which is now mandated and, you know, is is also a big deal, you know, patients like to know, you know, how much is this going to cost me? Is this lab in network or not, you know, many times the physician is like, you need this test, you do the test, and then you get the bill, you probably would have done the test anyway. But it would have been nice to know ahead of time what the expectation was. So by connecting everybody and starting with a patient, you gain these benefits, not to mention the the growing direct to consumer market of home testing, where it’s very, very patient centric.
Nick van Terheyden
Yeah, I’ve got to say you hit a nerve. I have a very personal one. I had testing that was authorized by my provider, the healthcare insurer if rejected that test, the 1000 over $1,000 A bill for a test that was, in our view clinically, valid, showed up, I submitted an appeal to the insurance company who Wow shock horror said no, no, we were correct. I actually went through the process as an external review process. And they came back and said, No, this was an appropriate use of clinical resources. And my bill dropped all the way down. I want to say it was like 10, or $13, if some extraordinary number, and that’s only because like your co founder, I have some of that. So it sounds like you’re essentially presenting a pathway for individuals, to help them through that process, so that they don’t have the surprise and be to present and allow that control. It feels like that putting the patient at the center may seem simple, but I feel like that’s a critical element of this.
Mark Dorner
Yes. And, you know, we were just said, there’s a there’s a national lab show called The Executive work college. And if you looked at the theme of all the sessions and keynotes, it was all about the patient is the customer. Right? So laboratories typically worked with providers were the labs, but the patient is the customer. And they’re the one paying, and they’re the one who’s getting the result, it’s going through the provider who orders it and reviews it. And but they reemphasize what we understand is that, you know, patients or customers, consumerism and health care is growing. And there’s a demand for control and modern technology to enable that. So So in your case of like having on your own to advocate not to pay a bill, and you know, with your knowledge, you’re able to succeed, I feel like very few people would have succeeded. And it would have gone down the path of them either, you know, negotiating a reduced bill with the lab, or, you know, not paying or who knows which way it would go, you know, medical billing is very complex. Our experience in the field allows us to simplify that and present things where I would say it’s kind of like just in time of data, right? When you’re about to get the test done, it’s nice to capture the information you need, and get the information you want. You know, as the test is being processed, you’d like to know what’s going on, you know, from a, you know, a test or resulting standpoint, also from a billing standpoint, if this is a test that needs pre authorization, you know, don’t run it till you get it, right, why run it and then run the risk of balanced billing the patient, you know, and then they then come back, maybe there’s an alternative test, maybe there’s another path. I’m sure you enjoyed spending, I don’t know how many hours on the phone with health plans and utilization review. And they probably, you know, at some point, you’ve went past the point that where it’s not cost effective for them to fight you, and they just gave it.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Mark Dorner. He is the co founder of precise MDX we were just talking about the process of approvals pre authorization, you were just into intimating that, you know, I struggled with this whole process. And you know, that’s absolutely true. It was time consuming. I will say for those listening, if you wanted a hint, my now preferred means of communication, I won’t use the telephone, I only use faxes, I have a record of delivery, it’s required. It’s all written, I will not take any phone calls or actually commit to phone calls, although my big struggle is actually finding fax numbers. But here we are, we’re solving the problem with precise MDX I think, you know, tremendous progress. And you bring up a couple of things that I think are worth exploring. So, you know, the consumerism of this, I think has been accelerated. And before we get into that opportunity, and where that’s going and you know, putting that patient at the center, it would be remiss not to talk a little bit about the pandemic and what that’s had in terms of an impact in this whole space. Tell us what that’s been like. You’ve obviously gone and grown, I imagine through that experience.
Mark Dorner
Yes, absolutely. I mean, we launched at the start of the pandemic, we feel like it was a catalyst for growth and change. And there was a big shift in health care, both in traditional health care, moving to remote care, telemedicine, and other opportunities, but also with patients undergoing so much testing, the realization that they can get a test, get the result, know more about their medical condition, whether it’s testing for COVID, or looking at their, you know, thyroid panels or lipids or cholesterol. And it’s created an appetite that they want the convenience of on demand testing. So they want the convenience that they can get a test. They don’t have to go to the provider necessarily to order it and that they want to take it at home or take it at a location near them very easily. And that’s that’s really been a catalyst for change. Ange, I think that if you look back a few years ago, if you talk to people about QR codes, they would have been like, What are you talking about? Now, every restaurant menu has a QR code, every place you see it. So the small incremental changes that that have a big impact.
Nick van Terheyden
So I get a good point around that sort of accessibility for individuals, we’ve seen people accessing it, obviously, it, I guess, opened the eyes for many that, you know, had not noticed or not seen it. You know, first off congratulations of launching a company during a pandemic, I think most people would say, based on business school, that you’re going to be an outstanding success. If you’ve managed to do that. I think, you know, we see a lot of organizations that do, which is, you know, tremendous. As you think about those areas of consumer demand and capabilities, I mean, there’s regulatory pieces, so you can’t just issue tests, or people can’t just get them without orders. In some cases, there’s some component of that, do you think that’s going to change? And, you know, How hard are the consumers now pushing? I mean, since you’ve put them at the center, and they’re, you know, they realize this, do you think we’re going to see even more of this taking place?
Mark Dorner
So can you address what you started with me, definitely, starting and growing a company during the pandemic was interesting. One of the benefits is, you know, we, you know, we’ve seen almost 8 million patients for our platform. So the speed at which your platform matures, because of the pandemic was amazing, you know, so, you know, something that would have taken, you know, many years was condensed into to a smaller period. You know, there are legislations passing related to consumer directed testing. So different states have different rules about what can consumers ordered directly, versus what requires a provider sign off, obviously, don’t get oncology testing, you’re not going to go on the internet and order yourself to go to a provider, it’s a serious condition. But if I want to check my cholesterol, I want to get an STI panel, and I wanted to be anonymous, I, you know, you can order those by yourself. And, you know, companies also utilize something called a provider of service, where they have providers licensed in many states that can sign off on orders. So you can fill out a medical questionnaire, depending on the test, maybe have a telemedicine visit, and then they’ll will sign your order, because it requires it for that type of tests and that state of physician signature. But definitely, there’s a lot of growth and companies starting in the direct to consumer market, everything from wellness testing, to I saw one company at the last hims that was doing your annual wellness visit in a box, which is a pretty comprehensive test. So
Nick van Terheyden
So I think great opportunities, you know, I’ll push back a little bit on the cancer, and maybe it’s not entirely a disagreement. But, you know, as an example, I think colorectal screening, and you know, we’ve seen, you know, the launch of Color Guard, which is a genetic sort of biomarker, the idea that I need to go to my physician for that just I don’t know, I think there’s, I think we’ll see more of that, because why would you not want to screen, if it’s widely available, it’s easy to to actually carry out, I recognize that there’s some downstream consequences. But we know that earlier, diagnosis is always better, even if it’s bad news, bad news earlier is better than bad news later. So
Mark Dorner
I absolutely agree with that, I think definitely for screening purposes. You know, that kind of brings you into the subject of testing compliance. You know, I went to my primary care physician, and said, Oh, I’m at the age where I should probably get this test. And he was like, and it was actually the fifth colorectal home screening test. And he was like, I agree, take this home with you, you know, get your set of specimen, drop it off, and we’ll run it now, I purposely didn’t take the test. I took it home. And I waited to see if anybody would remind me to take the test. Because, you know, I like health care. I’m an engineer, and it’s been sitting my desk for four months. I’m assuming there’s some liability in the fact that no one reminded me to take the test that I should get. But, you know, this brings up that whole testing compliance thing where, you know, payers and providers and everybody recognize that they’re better clinical and financial outcomes. If people take certain tests. You know, on the payer side, it directly impacts there, he just scores a lot of times which which have large financial implications, you know, driven by clinical outcomes. So I definitely agree that this on the screening side, absolutely.
Nick van Terheyden
I just think that’s a fascinating experiment. I applaud you for that. Because, you know, it’s really poignant, because others might do that, not because they intentionally but it got forgotten you No, we got put somewhere didn’t happen. And we do we need reminders. So well, that’s obviously
Mark Dorner
it’s unintentionally, but now I’m actually just waiting to see if someone’s gonna say something, I probably should really take that test though.
Nick van Terheyden
Well, I’m not gonna get in step into that particular quagmire. But I love the experiment, because I think this is the way that we fix healthcare to understand those breaks and failures. But, you know, you brought up some other points there, you know, other tests, and, you know, privacy and, and control, if I’m initiating a test, do I control it is, is what, where do you think that’s going to go? Because, historically, I think we saw this as part of the patient record, and it just became almost part of the public record at some point. So we have HIPAA, there’s, you know, coverage for private or, you know, personal health information. Where do you see this testing going, given that that 70%, you cited at the beginning, that’s very significant.
Mark Dorner
It’s very important that the, the clinicians and care providers are able to access you know, with certain permissions, your health information to treat you, right. So if you had a test done, you know, at a provider’s office at a laboratory, you show up in the hospital, it’s important that they they know you have the test done, and what the outcomes, we’re talking about privacy, a great examples, we worked with a lot of university campuses, a few of them have started to, they had vending machines that had COVID kits in them, now they’re going to put a CI kits in them to get STI testing. And I asked them, you know, why is that? And they said, well, a lot of the students are on their parents health plans, and they don’t want the tests appear on the health plan. And their parents see that they’re doing certain tests, so they’d rather just pay for them directly and get the test and it’s allowed. And that’s, that’s reality, and, you know, that kind of comes into the privacy realm where you know, who can access your information? And should they be able to and, you know, should you be able to take tests anonymously, and, and just, you know, have the information to yourself, it’s a, it’s a very slippery slope. You know, HIPAA is in place to make sure that in order to treat you, there’s accessibility to information, but it’s protected and secure. One other area, I would say is that in the diagnostic space, you know, you’re giving samples that have DNA. And a lot of times people like to, you know, use this for clinical research. So it’s not necessarily associated with your personal information. But, you know, could be useful for clinical trial to develop future therapies and drugs. But they recently ruled that, you know, your DNA is something that could personally identify you. So again, that’s another just kind of slippery area where, you know, you want to further and help science, but you want to respect people’s privacy.
Nick van Terheyden
Yeah, that particular area is exceptionally challenging. And, you know, even with basic data, I mean, what I think we’re down to about eight data points, and we can uniquely identify somebody based on browser history, and, you know, a number of other factors DNA, I, I’m, I’m gonna say one DNA. And to be clear, it’s got to be more than just general. So I think, very complex area. But you’re right, the importance of protection, and maintaining that is central to this. As you think about the future. Where do you think this is all going? What are the opportunities?
Mark Dorner
I mean, you know, it specifically in the lab space, I think there’s a lot of opportunity, like you said, to get people, screening tests at the right time testing compliance, improve outcomes, improve healthcare in general, and really kind of work side by side with this shift in telemedicine and remote care to include the laboratories in that space as well. So I think there’s a lot of opportunity there, we’re continuing to explore it, and, you know, make things easier and more efficient for people.
Nick van Terheyden
So I think overall, exciting area laboratory investigations, you know, critical path. I’m not sure how that’s changed over time, I’d be interested in sort of thinking about this, you know, how much more does it contribute, as we’ve added a more tests more understanding, certainly, you know, an essential part of medicine and the way that we sort of look at patients, but I think, importantly, this push over to greater control, and I’m, I’m particularly taken by that patient at the center of testing, which I think a lot of people that will resonate with, I know, for some of the old school, maybe not so much, you know, patients, you know, don’t have the responsibility, but as I often say, there is nobody in the room in a consultation that has a bigger vested interest in the positive outcome than the patient. You know, second to that maybe the physician but it’s definitely a second to be clear. So I think put Seeing them in control, giving them the tools and helping them navigate. Exciting, tremendous opportunity. Just unfortunately, we’ve run out of time as we do every week. So it just remains for me to thank you for joining me on the show, Mark. Thanks for coming
Mark Dorner
out. Thanks, Dan. I really appreciate the invitation
