and facing not a staff of overworked doctors and nurses, but an inviting conversation. A talk with a healthcare professional who has plenty of time, isn’t in a hurry and is ready to listen to a recital of the different aches and pains of your life. Someone with expertise in medications dedicated to making your life easier and healthier. A professional who makes and then hands you a cup of coffee before you even start talking.
That initial conversation, Hoban says, helps build more trust with patients, helping them feel heard in a healthcare system that can often feel “patriarchal”—ignoring patients’ own desires. “We use that conversation to build the initial trust,” he says. Then nurses handle nondrug interventions while the prescribing pharmacist works with the doctor to determine ideal courses of therapeutics.
The key to the company’s success, and what differentiates UpStream from other value-based care companies, according to CEO Sanjay Doddamani, 49, is that it puts pharmacists at the center of caring for patients. The current American system, he says, is “underutilizing the expertise of a pharmacist who’s spent four years in pharmacy school and two years in fellowship. They have tremendous expertise, they know disease states, yet we have not used them.
As he worked with that first company, he became fascinated by the workings of the healthcare system itself. So in the late 1990s, he got his M.B.A. at Trinity College Dublin, where his studies focused on the American healthcare system. What attracted him to learning more about how things got done in America, he says, was his “fascination with the last country in the world that believes that the competitive economic framework can solve this greatest of human problems.
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