What good is a new treatment if patients still struggle to get the approvals, appointments, and support needed to receive it?
In this episode of Tech Talks Daily, I speak with Amir Sharif, president and co-founder of Leap, about the operational infrastructure behind specialty care. While AI in drug discovery attracts attention, the journey from a prescription to treatment often depends on disconnected organizations, incomplete information, and manual coordination. Amir describes how Leap combines drug sourcing, distribution, care coordination, and employer benefit arrangements to address some of those gaps.
His interest in patient experience grew through work helping build healthcare businesses including Care/of and Tend. Those experiences led him to question why everyday expectations around scheduling, pricing, and customer support can be so difficult to meet in healthcare. Specialty therapies bring another level of complexity because they can require clinical administration, recurring appointments, insurance authorization, and expensive medication procurement.
We look at what happens after a physician writes a prescription. Approval may depend on the patient's health plan, supporting medical information, an administering provider, and a permitted site of care. Coordinating those pieces can fall to the patient, even while they are dealing with an illness. Amir explains why access depends on the administrative process as well as the treatment itself.
Drug pricing provides another part of the picture. Under a buy and bill arrangement, a provider purchases a drug, administers it, and bills for it. Amir says the margin added to the acquisition cost can range from 40 percent to 400 percent. These are his reported figures rather than a finding independently established in this episode. He describes Leap's model as passing its drug acquisition cost to the employer or plan sponsor and coordinating administration through home infusion or partner clinical sites, depending on patient preference and clinical requirements.
The technology discussion becomes particularly practical when Amir describes the data behind identifying eligible patients. Leap receives feeds containing diagnosis codes, claims, and prior authorization information. Its data engine normalizes those feeds so the team can act on signals that a patient is receiving, or may soon be prescribed, a therapy within the program's scope. This is a care coordination process. Amir repeatedly says Leap does not replace the prescriber or take control of clinical treatment decisions.
He also describes an average patient encounter involving over 20 coordination touchpoints. Many external parties still communicate by email or fax rather than through software interfaces. Leap uses agentic workflows to support appointment scheduling, shipment tracking, and medical order processing. According to Amir, those workflows remain supervised by care teams, and patients speak with a person when they contact the service.
For business leaders assessing AI returns, his account of model costs is especially useful. Some workflows the team considered two quarters earlier would have cost tens or hundreds of dollars per run in token consumption, he says. As models become cheaper and more capable, different operational uses become viable. The interview does not provide a measured before and after cost comparison, so the lesson is about evaluating changing economics rather than declaring a proven return for every workflow.
Leap reports a patient Net Promoter Score of 92, with surveys sent after every encounter. Amir describes this as evidence of patient satisfaction, alongside feedback gathered by care teams. Satisfaction is useful, but it should not be confused with proof of improved clinical outcomes or faster treatment across every patient. Employers can request an impact analysis comparing historical claims with the proposed cost of Leap's service.
Where would you begin when assessing specialty care, the drug price, the time patients lose, or the coordination needed to keep treatment on track? Listen to the conversation and share your thoughts with me.
[00:00:03] What happens after a physician prescribes a treatment if getting that treatment still depends on insurance approvals, drug deliveries, appointment scheduling and people connecting systems that barely speak to each other? Well today on Tech Talks Daily I'm going to be joined by the president and co-founder of a company called Leap. And together we're going to look at the technology behind speciality care.
[00:00:29] And these are often complex and expensive therapies that require a nurse or a physician to administer them. But my guest today will explain why a prescription can be the beginning of a very difficult analogue administrative journey.
[00:00:45] And I'll also learn today about how drug pricing can impact employers and patients alike and where technology can help supervised AI workflows, how AI workflows can take work off a care team's desk. And we'll also discuss the data needed to identify patients earlier, the economics of running agents and why someone should still answer the phone when a patient needs help.
[00:01:11] But if you're trying to connect it all and how technology investment with a result that people can actually feel, there's going to be a lot to consider here. So enough from me. Let me introduce you to my guest now. So thank you for joining me on the show today. Can you tell everyone listening a little about who you are and what you do? Yeah, Neil, thank you so much for having me on. My name is Amir. I'm one of the co-founders and the president of Leap. Leap is a specialty pharmacy company.
[00:01:41] We provide a benefit to employers and we're really designing a new set of rails, a new set of infrastructure for thinking about how specialty pharmacy makes it from a manufacturer all the way through to a patient. Before this, I was a venture investor for a very long time. I spent a lot of time building in early stage tech as well. And yeah, happy to walk through that history. Yeah, one of the things I love about recording this podcast every day is finding out more about my guest's origin story.
[00:02:10] So tell me a little bit more about the experiences that might have led to you building Leap. There's got to be a story there, right? Definitely, yeah. Maybe it's helpful to actually kind of give a bit of context. I started out my career as a venture investor in growth equity, so very late stage investing. And I was always really passionate about finding an opportunity to work with earlier stage entrepreneurs, kind of folks that were actually shaping their businesses. And in that capacity, I ended up meeting a couple of folks.
[00:02:37] We started a fund called Juxtapose Together that's an incubator based in New York. And in that capacity, our mission really was different from a traditional investor. It was to focus on ideas that we were passionate about having as portfolio companies and then helping to build them from scratch. In that capacity, we started a company together called Careof, which was a vitamin supplements prescription or non-prescription business. It was a subscription business that we launched in 2016.
[00:03:02] And that was kind of my first exposure to thinking about how consumers think about their health, think about wellness. And it was outside of a clinical capacity, but it kind of opened our eyes to how different touch points within a wellness journey could actually inform how people think about their exposure also to healthcare. We ended up selling that business to Bayer, the pharma conglomerate based in Germany.
[00:03:29] And that was, for me, my first exposure to also thinking about how pharma thinks about patient access, how they reach their patients, how they're able to sort of get drugs to market as well. But beyond that, we started a couple of other businesses. One of them was a dentistry business called Tend.
[00:03:45] And really at the heart of that business, all we were doing was reshaping the consumer experience, the sort of patient experience, thinking about it from first principles, rather than defining it around status quo dentistry and what patients typically experience in dentistry. How could we tweak it so that it feels easier to schedule, easier to actually understand what your out-of-pocket obligations are going to be before you show up for an appointment?
[00:04:08] Really simple touches that you would expect to be part of a typical sort of modern consumer experience that are missing often in healthcare. And that business ended up really opening my eyes to the opportunity to define new healthcare businesses just around reshaping the patient experience itself. And that was a really fun journey. We got to build that company with Doug Hudson, who was the former co-founder and CEO of Smile Direct Club, and a really fun experience for all of our team.
[00:04:38] And subsequent to that, I've spent a lot of time looking at different opportunities where patient experience is really lacking. And that's part of what brought me to Leap. But let me pause here. Happy to kind of pause here for quick questions. I was just going to say, it's an incredible story there. And on this podcast over the years, I've heard a lot around AI accelerating drug discovery. But I mean, although discovery still involves considerable scientific and clinical challenges, though.
[00:05:05] So a question I'd love to ask you here is, why hasn't the infrastructure for delivering complex treatment, why has it not kept pace? And where does that gap become most visible to patients as well? Yeah, it's really a big puzzle of a lot of different stakeholders. What's challenging is once you have a candidate therapy, you actually then have to take it through clinical trials. And that means you have to recruit patients.
[00:05:29] That can be really challenging because patients are, for these specialty drugs, small populations that are distributed across the country. And in order to get them through clinical trials, you have to find sites that are close to them that are able to handle their trial experience. Once the drug, let's say, makes it through the clinical trials process and is approved, you then have to think about market access. Kind of this framework of how do you make sure that the drug is actually covered under the medical plans of these patients?
[00:05:57] How do you make sure that patients are aware that the drug exists, that prescribers are aware that the drug exists? And how do you make sure that it's easy for them to actually get started on these new therapies? And there you kind of have to connect a lot of dots. You have to educate prescribers. You have to go out to market and make sure that patients who have diagnoses that are relevant to the drug are aware that the drug exists as well. You have to find ways to actually communicate the value of the drug to plans that are going to be sponsoring the cost of the therapies.
[00:06:26] And all of that requires a lot of stakeholder management that today leaves the kind of infrastructure very broken and very piecemeal. And that's really the blocker that keeps often a lot of new therapies from being prioritized, being commercially viable to bring to market. You raise such a great point there around insurance approvals of any new medication and something I've not thought about.
[00:06:49] And for people listening outside of the industry too, can you maybe walk me through what happens after a physician prescribes a speciality therapy using an anonymized patient example? Just to explain where these insurance approvals, procurement and scheduling can all actually delay great treatment. Absolutely. It starts with just also understanding what we're really describing here.
[00:07:14] Specialty drugs are drugs that are clinically complex, often requiring clinical administration, meaning that a physician or a nurse has to be present to administer the therapy and supervise the encounter. And they tend to be high cost. So you're dealing with encounters that can be per dose tens of thousands, if not hundreds of thousands of dollars. There's some therapies that get into the seven figures.
[00:07:36] And so what that means is that before the patient can actually start therapy, their insurance is often required to be involved in the process of approvals. That typically looks like the physician writing the script and then kicking off a process referred to as prior authorization or preauthorization, where depending on the patient's plan and their sort of plan documents, their plan procedures,
[00:07:58] a bunch of procedures, a bunch of different medical details need to be gathered to specify the necessity of the drug, specify how the patient's site of care mandates are going to determine whether they get access to the drug. And then ultimately, the approval is granted for the patient to get started on the therapy. That approval is tied to the administering site. So whoever's the physician or nurse that's actually going to be providing the therapy to the patient.
[00:08:23] And it can actually get very complicated because all of those decisions require coordination between the prescriber, the administering physician, whoever's in network for that patient and their plan documents requirements. And also the patient themselves often is the one that's left pulling all these threats together, which can obviously for from a patient experience perspective lead to a really negative experience, delays, friction that ultimately are impact care outcomes.
[00:08:50] And I suspect many people listening won't be familiar with the buy and bill where a provider purchases a drug, administers it and then seeks reimbursements. How does that model affect treatment costs and access? And what makes that so difficult to change too? This is one of the parts about specialty pharmacy that was most surprising to me when I was first learning about how the system works.
[00:09:17] Basically, because these drugs are administered by a clinician, the patient is not the one that actually is procuring the drug. So you can kind of think about this in contrast to retail pharmacy. A patient goes to a CVS or Walgreens, you know, retail pharmacy down the street. They present their insurance card and they pay for their copay and they get a drug that they can take home and take on their own. In the case of specialty pharmacy, they're going to a provider's office and the person who's actually purchasing the drug is the provider.
[00:09:46] Ultimately, what happens is the provider has to bill for the drug every time they administer it to a patient. And they end up billing for that drug a margin, typically, which is referred to as the buy and bill margin. So they're buying the drug and billing a margin on top of it. And that buy and bill margin can be anywhere from 40 to 400 percent on top of the cost of the drug.
[00:10:06] And when you're talking about these therapies that cost tens of thousands, hundreds of thousands of dollars, that's actually significant markup that really starts to weigh on both the plan sponsor, the employer, whoever sort of taking risk on the health benefits pool of that plan. But it also means that patients, as a result, have higher out-of-pocket costs. It impacts their coinsurance costs. It impacts the amount that they have to pay toward their deductible in order to be able to continue to get access to these therapies.
[00:10:33] So it ends up having a really big downstream effect on patients and the way that access can be granted. And, of course, employers and health plans, they all want to control spending, while patients on the other side of the coin there, they need timely treatment in an appropriate setting. So how do you distinguish savings that remove unnecessary costs from restrictions that could make care even harder to receive? It feels like somewhat of a balancing act now.
[00:11:01] Definitely. This is, for us, the most important part of building the product. We actually have been very lucky in finding an opportunity where not only are we able to drive savings, but we actually increase access and increase choice for patients. So when patients get access to drugs through LEAP, we eliminate the buy-and-build margin. So we're sourcing drugs and passing the raw costs that we pay for that drug to the employer, to the plan sponsor. And it means for them, not only are they getting rid of the buy-and-build margin that they otherwise would be paying for that encounter,
[00:11:31] but for a lot of these plan sponsors, it's the first time they actually get visibility into what the cost of these drugs actually is. So it's a really core part of our product is that pricing transparency. But the way we deliver care is also defined around improving access, improving patient experience. So for our patients, we enable them to receive care in the home.
[00:11:54] What that means is that a nurse that is trained in infusion therapy is able to attempt at the patient's home to administer care on site. For a lot of our patients, it's the first time they're learning that they can get access to infusion therapy in the home. It also means that they don't have to drive 45 minutes, an hour to a clinical site where they might be exposed to high-risk sites. Often we're talking about hospital settings that have high risk of exposure to infections.
[00:12:20] And it means that they can kind of get access to this care and the comfort of their homes. These can be multi-hour long infusion appointments that rather than having to drive out, sitting in a chair and in a hospital setting, they can get access to at home. So it's a really big benefit to our patients. It's a huge convenience driver and a comfort driver for them. We also have a network of partners that provide clinical sites, brick-and-mortar clinical sites that are closer to patients' homes,
[00:12:49] where we're able to administer care for patients who either prefer to receive care outside of the home or for whom clinical necessity requires a brick-and-mortar set, a clinical setting outside of their home. And what that means is we're able to find sites that are closer to their homes that are typically also significantly better patient experiences than the typical status quo of going to a hospital setting and being in an open floor plan space where you might be exposed to more infections or more clinical risk.
[00:13:16] So it's a very rare opportunity for us to deliver not just a savings opportunity, but also better patient experience. And that's really defined by, you can kind of measure that in our NPS. Our patient NPS is 92, which in the context of healthcare is, you know, I haven't seen that across the companies that I've worked with. And we're really proud of that NPS as a marker of our patient experience where we're able to deliver in terms of patient satisfaction.
[00:13:41] And LEAP was founded to solve this problem that's been hiding in plain sight for a long time now. Patients who depend on life-sustaining infusion therapies and find themselves forced into navigating a system that just makes it harder and more expensive than it actually needs to be. And you do this by sourcing, distribution, care coordination and payment all into one operation. But again, for people outside the industry, what does this allow you to do differently?
[00:14:09] And what checks ensure patients retain appropriate choices and physicians also retain control over treatment decisions too? Tell me a little bit more about that. Absolutely. Neil, I feel like you did such a good job summarizing the pieces of our business. At our core, we are not replacing a prescriber. We're not taking over clinical decisions.
[00:14:30] We really are a point of access for these specialty therapies that patients are receiving prescriptions for in their course of care. What we are able to do is really connect all the dots from manufacture, identifying new therapies, identifying opportunities for new candidate drugs, all the way through to patients receiving the care.
[00:14:52] Those intermediary steps include us being embedded with the patient's plan design, which allows us to simplify patient access to these drugs. It also includes us coordinating care, which means us taking over the responsibility of finding a provider that's going to be approved, that's going to be in network, considered a network for the patient's plan.
[00:15:12] And it also means taking over all the steps of procurement, making sure that the drug actually makes it to the relevant site, whether it's the patient's home or whether it's a clinical site for administration. Today, all of these pieces of the puzzle sit with different intermediaries who are disconnected from each other. And often that's kind of where you find patients falling into care gaps, falling into adherence issues that are causing them to basically lopsom their therapies.
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[00:16:06] Essentially, you're building a predictive platform that helps identify people who might also need speciality care earlier. And as this is a tech podcast, I'd love to hear more about the tech that makes that possible. And also, what signals make those predictions useful? And how do you handle things like patient privacy, incorrect predictions if AI is involved, and the need for a clinical review there? Tell me more about that and the technology behind it all too. Absolutely.
[00:16:34] So, to the earlier point, we don't take over clinical decision-making. What we are responding to are signals that a patient has been prescribed or is likely to be prescribed. One of the therapies that is on our drug list. And basically, what we are doing is when we implement LEAP with one of our clients, we're able to get access to a more embedded model of care.
[00:16:59] What that includes is access to data feeds that help us identify patients who are receiving diagnoses or receiving care in other settings that indicate either they've been prescribed a specialty drug or they're on track to be prescribed a specialty drug. We typically will do that through looking for diagnosis codes in prior encounters, looking for prior authorization submissions across their history of clinical encounters to indicate that a patient is within our eligibility scope.
[00:17:26] And those signals are really important for us to identify as early in the care journey as possible because the optimal thing for us to do is to be able to support patients early in that process, help simplify all the steps that might otherwise result in a care gap or an adherence lapse issue for them. So, we look for a lot of those signals that indicate likelihood of a prescription through diagnosis codes, through prior claims, and then similarly through prior authorization submissions,
[00:17:55] claims that indicate a patient's already on therapy, on receiving recurring treatment for that therapy. Those will sort of identify the opportunity for us. From an engineering perspective, what that really means is we're ingesting a lot of different data feeds. These data feeds come in a lot of different schemas that we don't have control over. And what we've built is a data engine that allows us to receive those data feeds, normalize them, house them within our ETL process, our data warehouse,
[00:18:22] and be able to respond to them based on the signals that they're identifying. So, I'm looking for the signals as early in the care journey as possible, as I mentioned, and trying to find ways to reach out to patients at the best point in their care journeys as possible. And no data, bad data or siloed data means no AI. That's a phrase I hear a lot at tech conferences right now. And of course, automating coordination sounds pretty straightforward
[00:18:51] until I would imagine that you're inevitably going to encounter different health systems, incomplete records and exceptions, etc. So, what parts of the patient journey do you think technology reliably can handle today? And where do your care guides still need to step in and ensure that human is in the loop? Absolutely. So, our product, I think, would not be possible to have built or scaled two years ago.
[00:19:17] Really, what we're dealing with is in connecting all of the different pieces of a care journey for our specialty patients, we're interfacing with a lot of external counterparts, a lot of third parties that are offline. So, we are interfacing with the prescribing physician for that patient. We're coordinating care across a number of different providers that might be relevant to the care journey of the patient. We're coordinating procurement for the drug. All of that is happening with external parties that often do not have APIs,
[00:19:46] that are not programmatic in their way of engagement with outside parties, and are often relying on human manual processes. So, they might be sending emails, they might be sending fax, that's kind of the status quo of the communication flow. And for us, in order to be able to serve our patients, you can imagine there's a lot of friction associated with these offline touchpoints. I think we measured this at some point. Our average patient encounter, in order for us to be able to coordinate care for an encounter, takes over 20 touchpoints.
[00:20:16] You can kind of add it up. If each of those touchpoints takes 10 minutes of time, you know, for our team to coordinate, that's over three hours of work for each encounter. That doesn't scale if you have humans running that process. So, what we've built is a lot of agentic workflows that help support our care teams to enable a lot of the work that otherwise would be happening in a manual approach with programmatic means. It's all supervised by our care teams.
[00:20:42] There's no part of our agentic workflows that runs in a fully automated way without a human in the loop. But what this means is that we're able to schedule appointments, we're able to track shipments, we are able to coordinate across our care network, receive medical orders, process those medical orders in a programmatic fashion that eliminates human time that would otherwise be spent clicking through or getting on the phone or coordinating kind of these pieces manually.
[00:21:09] There's a lot more that we are excited about building in terms of agentic workflows. And the last piece here is for us, it's really important to always maintain a human in the loop. Our clinical operations team is always the one that is effectively acting on these signals or acting on these workflows. So, there's always a human in the process before something is either externally communicated or processed internally.
[00:21:34] And the last piece that I'll just emphasize is, again, we don't replace a clinician. But whenever our team is also interfacing with patients, we have a human picking up the phone and having that conversation. And so, we want to ensure that our patients always have access to someone that is a real human. They're not interfacing with AI in that capacity. There's so much I love about what you're doing here.
[00:22:00] When I was doing a little research on you, one of the things that stood out to me wasn't just the technology or how you're using technology to make a real difference here. We often talk about ROI of AI on this podcast as well. One of the things that really stood out, though, was Leap reported a patient net promoter score of 92, which is an incredible achievement on its own.
[00:22:21] So, how is that measured and what other evidence do you track to show whether patients are starting treatment sooner, continue receiving it, and facing lower costs, ultimately proving that ROI question on the technology involved? No, I appreciate it. Yeah, our NPS of 92 is something we're very proud of.
[00:22:40] We survey our patients after every encounter, and it's what allows us to have our finger on the pulse of our overall patient quality of care and outcomes and satisfaction. Our team is also in touch with our patients before, during, after encounters. We have a lot of qualitative touch points that span outside of that NPS score as well that help us get a really concrete sense of how our patients are responding to Leap.
[00:23:06] And it's really always the most gratifying thing to be able to see our patient testimonials, the feedback that we get from our care teams about how patients are responding to Leap. You know, we're saving folks hours of time. We're saving them from the headaches of the status quo process.
[00:23:22] So the 92 NPS is something that we're very proud of, and it's frankly unfortunate that it's easy to beat kind of the status quo system because of how rough, roughly defined the patient experience journey is when patients don't have access to a team like Leaps. I think it's important to emphasize when we think about technology ROI, one of the things that's actually really interesting to think about is the cost of these agentic workflows as well.
[00:23:49] When we were initially building Leap just even two quarters ago, a lot of the workflows that we're most excited about today would have cost tens if not hundreds of dollars per run. And that's just in token consumption. And as you're seeing models evolve, become more capable, and also become more cost efficient, a lot of these workflows are becoming much more viable to actually operationalize.
[00:24:13] And so we're just continuing to be excited about developments in AI, how we're able to kind of build our stack around frontier models that enable us to have the most efficient and most effective tooling for our patient journeys. And I always like to give people listening a valuable takeaway.
[00:24:31] So if we do have an employer or even healthcare leader reviewing speciality care today, what should they ask their current partners to understand where patients are getting stuck and where listeners also wanted to dig a little bit deeper on anything we discussed today, where they can learn more about your work at Leap too? I appreciate it.
[00:24:51] I would wonder if there's visibility around how much the buy and build margin is in the employer's total specialty drug spend. I anticipate that it'll be a surprise. And something that our team helps conduct is for all of our clients as we kind of think about sizing the opportunity of whether Leap is a valuable offering for their plan. And we help drive an impact analysis and we look at historical claims.
[00:25:19] We measure what our cost of care delivery would look like compared to their status quo. And it gives our clients a very concrete understanding of where Leap savings and the overall ROI of our program could be. And so for anyone interested, we would encourage you to go to our website.
[00:25:39] You can request an impact analysis directly by reaching out to there's a form on our website for employers to fill out or for brokers, sponsors, folks that are interested in supporting a more efficient healthcare system in general. And for any employers that are listening, some pretty big stats on your website as well about eliminating drug markups that can often exceed 400% and delivering up to 60% savings on specialty spend.
[00:26:07] So again, a big ROI answer there to a question that I'm hearing more and more, especially where AI and tech projects are concerned. So I'll include links to everything that we've talked about today, the Leap website and indeed your social channels. And we'll try and keep this conversation going. But just a big thank you for taking the time to sit down with me today, bring it all to life and talk about it in a language that everyone can understand. Appreciate your time. Appreciate it, Neil. Thank you so much.
[00:26:35] I think Amir's account of Speciality Care offers a useful reminder that technology can earn its place by improving what happens between organisation. Organisations, departments and most importantly, people. Because a treatment can be available, but access can still depend on someone coordinating an approval, a delivery and an appointment. And anyone that has been caught up in that healthcare admin will know that all too well.
[00:27:03] And for employers reviewing healthcare benefits, I think his practical starting point is to understand the existing drug costs and compare the proposed service against historical claims. And for tech leaders, I think I'm going to take away a fairly difficult question here. Are you measuring the total cost of the workflow, including model usage, human review and exceptions, or only the time an agent appears to save?
[00:27:30] And the reason I'm thinking this is because patient satisfaction adds useful evidence, but it also deserves to sit besides measures of access, continuity and cost. So a big thank you to my guests for joining me today and raising these issues. And remember, you can learn more about Leap and request an impact analysis at leaphealth.com. But over to you, where could better coordination improve a service that you depend on? I'd love to branch this out to all industries.
[00:28:00] I'd love for you to share your thoughts. So please pop over to techtalksnetwork.com. You can find 4,000 interviews there and many ways of getting in touch with me, including leaving an audio message. But I'm afraid once again, we're out of time. So thanks for listening as always. Bye for now.