Vantage points: MedEssist’s Joella Almeida on why being the ‘Shopify for Pharmacies’ is not enough

MedEssist CEO and co-founder Joella Almeida really wants to be a hero in Canadian healthcare. But it can be hard for any Canadian healthtech company to rise.

“This is an important time to consider how we can leverage other healthcare providers to relieve some of the stress on our healthcare system.”
Joella Almeida
MedEssist CEO

Almeida’s company, which offers clinical solutions, business tools, and support for pharmacy practices, has to navigate complex provincial health systems powered by US platforms for hesitant Canadian buyers. At the recent BetaKit Town Hall, Almeida shared how her company is fighting to change a system where healthcare workers are left outside the decision-making process.

Almeida is clear-eyed about both the scale of the problems Canada faces and hopeful about her company’s capacity to make change. But she wouldn’t mind more support (or less red tape) to help a Canadian healthcare system she says is “dangling by a thread.”

The following Q&A contains Almeida’s responses from the vantage points panel at the BetaKit Town Hall and separate interviews. Answers have been edited for length and clarity.

You have previously compared your founder journey to that of a Batman villain. Would you like to share how you’re feeling?

It’s come from a place of scrappiness and a habitual rhetoric of not complaining and just getting things done. In the movie The Dark Knight Rises, Bane overpowers Batman, explaining that Batman “merely adopted the dark,” but Bane “was born in it,” giving him perhaps an advantage during a fight in the dark. I’ve felt this way when it comes to building MedEssist because we were in much the same boat since we didn’t have resources when we started, so we couldn’t service customers unless we got scrappy.

I would really like to be Batman—a billionaire, able to afford all the gadgets to outperform villains—but there’s another side to him in his empowering of the people around him. So while we didn’t always have the fanciest tech stack in the world, we focused on our customers—every single one. We cherished every single customer, and we were absolutely relentless in building something so sticky.

You once were servicing 500,000 patients through your platform with a staff of five. Now you’re over 20 employees. What are the biggest challenges you face in scaling?

Building in a heavily regulated and fragmented industry means tackling gigantic problems that typically require lots of resources. However, being a startup with limited budgets, companies like mine are forced to hire fewer employees. It’s disappointing to hear the news about taxing innovation but it’s not the worst thing I’ve been dealing with in the last five years. What I’m building with my team is far more meaningful to us—over half of my team are pharmacists who are programmers or have a healthcare background.

6.5 million Canadians don’t have access to a family doctor or primary care provider, but pharmacists are uniquely positioned in our healthcare system to address some of these challenges. We’ve just started a national program called Access to Care, for example, that lets any pharmacy on our platform address healthcare challenges for up to 30-plus conditions for any Canadian by working collaboratively through other providers like an NP or MD.

It opens up capacity in our healthcare system, but it’s not ideal. Ideally, every Canadian would have access to a primary care provider, but since that’s a problem which is still being tackled at the national level, we’re helping the providers on our platform who’ve asked us to help them come up with a solution in the interim through this program.

Your company has been described as ‘Shopify for Pharmacies,’ but you have a different relationship with the buyers and beneficiaries of your platform because the government is involved. Talk to me about procurement.

It’s a huge compliment to be compared to one of the most innovative startups in the past twenty years. That said, being the ‘Shopify for Pharmacies’ stopped being a good comparison some time ago; it confused people, and investors would ask if “we were going to upsell [over the counter] items like toilet paper and orange juice for retail stores” or if “we were trying to be adjacent to the US startup Hims & Hers” in the retail pharmacy space. Our mandate is significantly more ambitious than that: we are trying to improve accessibility to and quality of healthcare by enabling independent pharmacies to transition into more comprehensive healthcare sites.

Unfortunately, procurement is so fragmented because, by nature of our charter, healthcare in Canada is federally procured and provincially distributed. Worse, the provinces don’t communicate with each other as much as they probably should. Procurement purchasers are missing information and input from people on the frontlines of healthcare. Unfortunately, in my experience, pharmacists, nurses, and even physicians haven’t been lucky enough to get to have a say in the systems they use.

Given the chance to just be considered, what we’ve built at MedEssist would be the winning choice for our class of providers any day. That’s been a challenge for not just me, but most healthcare technology builders. Founders like Joshua at SeamlessMD and Albert at Hypercare have all had a tough time selling to fellow Canadians, but we don’t have the luxury of relocating where we build at this stage in our journeys or just complaining. We have patient lives at stake and building world-class clinical and digital health solutions is the job we signed up for.

What would level the playing field for you?

What would help is giving healthcare workers the ability to involve them in the decision-making process, so they can choose solutions that work for them. Healthcare workers know how to pick solutions that work for themselves and their processes.

For instance, in British Columbia where pharmacists are able to prescribe for birth control, pharmacies were able to divert 300,000 visits away from walk-in clinics and emergency rooms. That’s very impactful for a healthcare system that’s facing mass staff burnout and exhaustion. Doctors are rethinking running their practices, because now they too have to consider the effects of the capital gains taxes. So this is an important time to consider how we can leverage other healthcare providers, like pharmacists and nurse practitioners, to relieve some of the stress on our healthcare system.

There have been situations where they have been mandated—nay, forced—to use a particular software or system powered by the United States that was chosen for them without any of their input. The argument perhaps may have been, “If we buy for everyone, it’ll be cheaper.” But what is the value you are trying to get: is it cheap, or does it fundamentally work to solve our healthcare problems?

When faced with these decisions, patient choice should be a priority instead of trying to adopt a one-system-fits-all approach, which almost always doesn’t work. We have such a diverse Canadian population … I believe we should let doctors, pharmacists, [and] nurses decide what works for them so they can have the impact that aligns with their professional judgement.

With files from Josh Scott. Feature image courtesy Mauricio J Calero for BetaKit.

On May 7, The BetaKit Town Hall provided a pulse check on Canadian innovation, policy, and optimism.

Please enjoy this selection of highlights and insights from the town hall: