Joella Almeida, Co-Founder & CEO, MedEssist

Joella Almeida, Co-Founder & CEO of MedEssist, met me at House 831 for a quick chat about what she has going on, curiosity throughout her career, and operating under different regulations in new markets. 

Who is Joella?

I'm the co-founder of a company called MedEssist. I’ve had a history in the payments industry, then by virtue of just playing around with code, I ended up being a Shopify partner in 2010 - helping people set up their stores, helping with merchandising, and I ended up managing a dozen stores by mistake. But it was a good, happy mistake as it forced me to learn coding and web programming, and it got me thinking about how everything connected to the payment framework. I'm very grateful for it.

What do you think has been the common narrative around your career up till this point?

I think it would be small businesses. When I was in the payments industry, we were facilitating payments for small businesses, and it gave me insight into what it takes to essentially get a company set up. You can have everything you want, but if you can't take payments, you're pretty limited to selling within your local community. Going online gives you this ability to have a facade of being a very big store and to sell whatever it is you want all over the world. You can have a very international footprint without having to take on much.

That opened my eyes, coupled with being part of a payments startup in Toronto; I always think of how when you're growing up, you're only really exposed to the job opportunities that your friends, parents, relatives have. If you don't hear of someone doing a certain job, you don't know what other roles are out there. So, you go into school or you pursue a career knowing only what you know about the limited roles you know of. When I was in the payments startup, I got exposed to the marketing team, deployment team, logistics and operations; I had never heard of operations or logistics, programming terminals for payments, and it was all very new to me - I really loved learning on the job. 

I think from there, the common theme really became payments. And then when I left to start my own merchandising store, leaning into Shopify, being part of it in Canada is inevitable if you’re doing anything online (meaning ecommerce), and you can't help but run into them. So I had a store at Shopify and when I left that business, all the merchandising vendors I supported didn't want to run their stores. They were very much fueled by their creativity - their photography, their blog writing, their social media management, the marketing side of things and less the web development, less the update, less the online store management it took to manage online procurement and the actual online storefront or the website itself. And I really liked that side of things.

There's something in there about curiosity and discovery too. In what jobs exist, the reach you can have. 

At the payments company, probably 50% of the business was coming from small businesses. But eventually, the accounts that I grew into managing were the likes of Costco and AmEx., which are not tiny accounts. Looking on the back end, they look similar on paper. But the massiveness of what they were doing in payments volume is totally different. There was something powerful about being able to understand infrastructure and how to hold up businesses of this scale. They could be tiny and run by two people and look very massive, or they could be multi-million-dollar, multi-location businesses, but they would feel the same and look the same in the way that they took payments. 

I think the concept of being able to bring that sort of scalability and ease of bringing the entire business online to pharmacies when I eventually met Michael, my Co-Founder, was very intriguing. It felt both challenging and yet attainable if that makes sense.

How did you and your Co-Founder bring about MedEssist

I was introduced to him, and he had built a tool that would let you pass the data from a picture, especially medical data without taking any patient's information. He had invented something and had a patent on it, but we didn't really figure out how to monetize it efficiently. The first year, he was lucky enough to get some provincial funding from the Ontario government, which was minuscule in terms of what we're doing now, but it helped us to start having conversations, it helped us get doors open.  We would start at 7 in the morning and come home at 11 at night, and we would just talk to pharmacies north, east and west of Toronto, we'd go everywhere. We'd just assume that we don't know what was really going on with these users, but came from a place of wanting to help solve a problem of patient ease, and pharmacist-roadblocks, and showed them the invention -  we have this tiny thing that could maybe do that.

Back then, we were very much trying to solve this problem of medication adherence that’s been around for decades. Your grandma doesn't take her medication properly, she knows she’s supposed to take it, well why didn't she take it? She forgot. She’s been taking this for the past seven years. What was different today? Everyone wants to solve it, but it's a very complicated problem to solve. 

Those first couple of years, we just spent having conversations with people. We didn't say it was the best or that it was the most awesome time and we didn’t truly have a real end-goal - it was just about pure curiosity. We just said ‘I think this can help. Try it out. There's no cost to it. See what happens.’ And it gave us a lot of learnings. There was no real product that we sold out of that; it was just about learning.

I hear a lot of the conversation about the importance of doing what’s not scalable, and you're bringing that up with talking and visiting pharmacies one by one. 

I think what's special to me is the learning. I think it’s really important to be curious and understand that you don’t have all the answers when you’re starting out. 

When it comes to our new product release - deliveries, for example. When we start a feature launch, what we do is not scalable in the long run, maybe, but I think if we build it in a way where it delights the user, it has returns that can be threefold. We've had pharmacies who've gone from signing up with MedEssist, going through the terms and conditions, ordering a driver, getting the driver to come to the pharmacy, pick up the package, deliver the package, all within 29 minutes. Which is unreal, we were like, ‘wait, how? What?’-- it shows a certain fluidity and ease of a new product that’s truly seamless, frictionless. It shows the build was thoughtful and well-executed. I think there are rewards that come from it. 

Yes, visiting a pharmacy to learn where they were having problems was not scalable back when we started. But if you are approaching problem-solving from a place of curiosity, I think there's a lot to learn. And there's humility in learning, we don't need to assume we know everything.

Why the move out here to Calgary?

I've been coming to Calgary for the past 10 years; my partner is from Calgary. I never thought I would move here, I have very much been in love with Toronto for many reasons. But coming out here has opened my eyes;  I've loved the people. I would only come over to ski, to be honest, but I've always loved the people. And there's so much about the city that I really think is growing and I believe in. 

And from a business perspective, it makes a lot of sense. Alberta pharmacists have the widest prescribing scope in all of Canada. And they've had that for the past 10 years. But most Albertans just don't know that and that's very intriguing to me. It’s an opportunity for learning again - to get to the real “Why”. A lot of the story I tell is about how when we're children and we're growing up and if we get sick, the first thing your parents tell you to do is go to a doctor. It's not ‘try going to your pharmacist’, it's ‘go to your doctor’. The fact that Alberta has had this wide prescription scope for the past 10 years and nobody has made that mental change or paradigm shift tells me that there's an opportunity to be found here. 

So, if we can crack the nut on growing our presence here, growing our products that are working with our pharmacies, then we can scale our model across the U.S. very easily too.

How have you found going into the U.S. and operating under different regulations in medicine than here?

Different rules to play by. If there's two industries that I think are most heavily regulated, it's probably healthcare and banking. 

I think if you can have the guts and the fearlessness to build infrastructure, to figure it out in one area, you can probably scale it in others, which maybe sounds easier than it is or naively aspirational. It's actually very complicated, a hard problem that can take months, maybe even years. I look at companies like Uber, and I'm like, “Wow, they scaled across the world”, and it feels really unique - it’s a verb. You Uber places now - it’s a verb in our language that didn’t even exist a few years ago. And I look at Airbnb, they scaled across the world in the same way. As the user you have this seamless experience that really stems from a few clicks on your phone, it's wild. 

When I look at pharmacies, I feel there’s potential to do the same because you can enter a pharmacy in Spain and not speak Spanish, in Germany and not speak German, but you know you can get healthcare there - medicine, bandages, help for an inquiry. You don't need to speak the language to do that. I’ve always said pharmacies can transcend geography and language. And that's how I look at growth and expansion in the US, too. Bureaucratic, complicated, heavily regulated, but I think if we can figure out easy yes’s and solve problems for people, we don’t need to be scared.

Do you think that having a community around an industry can help businesses grow stronger than without?

I think everyone can benefit from a community and mentoring support (official or unofficial). But I think – this may hit a nail with some people -  there's a larger discussion about having too many accelerators and incubators in Canada and not enough capacity to run experiments, grow, make large bets and take risks. Going through an accelerator program and an incubator program, it's almost like you get punished for being curious and running experiments, because they want you to follow their structure.

With our team, we've often talked about the concept of finite and infinite games. We've tried to cultivate an area in the company where we can always be experimenting with new things, new features, and new products. I think there’s a real strength in the anti-process, not having rigorous structuring in an early-stage startup, and maybe even beyond that - I’m not sure yet. 

I think what’s missing in Calgary is experiences of people in the community that have built and scaled tech startups in particular before, past the early stage. A no-ego approach to telling those stories, a willingness to share those stories. I think there's a lot to learn from the way different people approach problem solving. I have this feeling that Calgary is going to grow in this respect. Tech is complicated, hard, and sometimes the path forward can feel vague but it's getting easier to solve problems because more playbooks are being shared now. If we approach building through community and from a place of solving problems, I think there's a lot of growth to be had here.

What are you proud of?

My team. That's not a cop-out answer in any shape or form. There's been a lot of healthcare worker burnout since the pandemic and every form of healthcare worker, from nurses, pharmacists, doctors, psychiatrists, surgeons, are all exhausted. They got into this field, completed their studies because they thought they would be helping people and then the pandemic came and the pandemic went and they didn't get to help the people they really wanted. They saw a lot of horrifying things that they probably never expected to see - apathy, bureaucracy, loneliness, misaligned vision on how a health system is supposed to be run, versus how it’s actually run. It's hard to maintain your motivation in an environment like that.

70% of my team are healthcare workers. I have pharmacists, physicians, nurse practitioners, and registered nurses, and we're building a startup together. That feels very strange in some ways. But every week, every month, we’re seeing wins. And we keep feeling like we have this inside secret, about something happening from within that’s changing how healthcare works in the ecosystem. I think this year, we've helped 20 or 25 pharmacists start new practices. Meaning, they come to us before they open their doors to the public, before they even put in their lease.  They've heard that we're a team of pharmacists on the back end, that we've built something special, and that they should come to us first to get our help and references on what they need to do to start. And that feels very special. 

How do you not go crazy?

I think most of my team would say this; when you're building what we're building, we’re handling real-world, tangible interactions. Last July, I spent a whole month in BC visiting customers. And one day, I walked into one of our customers' shops, and she called me behind the counter to help because she was alone and we were talking as customers were walking in. She had just asked me to be her assistant and to help her go through my own software to help her with a patient. After the patient leaves, the pharmacist says, “Thank you, thank you, thank you. I'm so sorry. I didn't have any other help today.” I remember texting the whole team and saying, ‘Guys, I'm behind the counter, I don't know what I'm doing here, but I just used this thing that we just built as a customer, and it's so fast and seamless. Good job, everyone.’ We have experiences like that almost every day, we have a live chat with all of our customers and they share incredible stories of how we’ve helped them when they need us. It all just feels very special and very personal. We have pharmacists asking, “I have my laptop at home on the weekend. Any chance you guys can take a call on Saturday morning?” and we say sure, because most of my team are pharmacists, they know exactly why that person is asking. 

It feels very real, it feels very powerful when these healthcare workers on the ground are asking us as a software company for clinical advice or thoughts on how to solve a situation they are encountering. It shows that they trust us and they know us enough to know we build valuable tools for them. I always like to say that we're here to keep pharmacies in business. If we can help them open a second and third store or launch a new service, or hire one more person, then we've done our job. And that keeps me from being crazy. 

What comes next?

We have this idea that we can scale accessibility. Someone told me about an experience the other day, about how there's no walk-in clinics in Calgary anymore. That you try to walk into a walk-in, and they ask if you’re a patient here with an appointment, or if you can return at 7 AM the next day and wait in line because there’s no availability when you walk-in. Imagine that - a walk-in clinic with no availability and no next appointment for the whole day. Your only other option is the Emergency Room at a hospital then, which is just an awful strain on the healthcare system but that’s what 1 in 6 Canadians are facing.

Yet, there's a pharmacy on every block that could be part of the solution. A lot of Canadians don't know that there are 12,000 pharmacies in Canada, only maybe 3,000 of which are corporate owned. That’s a big number. In the US, there's 88,000. If they all had this magical prescribing ability like Alberta does, you could basically stand up mini clinics at all of these pharmacies to help with the capacity issues, and that’s exactly what we're doing right now.

We call them pharmacy health clinics, and we've started about 25 of them so far, probably 30 by the time this article goes live. Basically, they merge the concept of a pharmacy and a walk-in clinic in one location. If you can't get access to your doctor immediately, no problem, this pharmacist can help you, instead of you having to go to the ER. It's not foolproof by any means and in an ideal world, every single one of us would have a family doctor. We're not trying to replace primary care in any malicious way. I myself moved to Calgary two years ago and it took me two years to find a family physician that would accept new patients. There are a lot of people who haven't seen their doctor in two or three years because the barriers to getting an appointment with them are just so high. If we can enable the local pharmacy to do more, and do so efficiently and cost-effectively, if we can free up their time, reduce the admin burden, suddenly we're getting Canadians access to basic healthcare that they couldn’t otherwise access easily.

It does feel heavy, big and monumental, and I hope we can figure it out. I feel like we're on the path to figuring it out. If we can find a way to scale that, I think it can make a really big difference in health care accessibility.

Thank you, Joella.