Ep: 31 ‘Coded’ Differently

with Miriam Paramore

May 12, 2021


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Miriam Paramore
President and CSO OptimizeRx

Miriam Paramore is President and CSO of OptimizeRx, a digital health platform focused on medication affordability and adherence. Paramore has 30+ years of experience in healthcare with a deep expertise in health information technology. She also currently serves as Director at Medsphere Systems and an Advisor at NueCura Partners, a Nashville-based healthcare angel investment company. Previously, Paramore was Executive Vice President of Care Rx™ for PDX where she focused on consumer-centric wellness. While working as the Executive Vice President of Strategy and Product Management at Emdeon (Change Healthcare), she helped lead the company to over $1.2 billion in revenues and an IPO.

We get to define what success means for ourselves, and that can be expressing my creativity in the world. That is business; business is a creative process for me.



Sanjula Jain  0:03  

Women make up 70% of the healthcare workforce but only 20% of its leadership. On Her Story, we’ll explore the careers of bold and influential women from Silicon Valley to Capitol Hill and learn how they’ve overcome the odds. I’m your host, Sanjula Jain and this is Her Story, a program where we explore what’s beyond the glass ceiling.


I’m so excited to welcome Miriam Paramore, President and Chief Strategy Officer of Optimize Rx to Her Story this morning. Miriam, thanks for being with us.


Miriam Paramore  0:35  

Thank you so much. It’s great to be here, Sanjula.


Sanjula Jain  0:37  

Miriam was my first official Nashville welcome committee member, bringing me into the healthcare ecosystem and is a tremendous leader who has a couple of great different stories to tell us about her journey in the healthcare technology and data sphere, which we’ll jump into in a minute. For context, Miriam, why don’t you tell us a little bit about what you actually do at Optimize Rx?


Miriam Paramore  0:59  

Let me start with our company and what the business does, then I’ll talk about my role a little bit. Optimize Rx is a digital platform, so we fall into the healthcare IT and digital health sectors. We are a platform for digital communication between different stakeholders in the ecosystem. That’s kind of broad, so what does that mean? We focus on medication access, affordability, and adherence. Medication therapy and pharmaceutical therapies are a big part of peoples’ healthcare, recovery and wellness journeys, and a lot of times their affordability and access problems. There’s oftentimes a misunderstanding about the information, whether it’s the prescriber understanding a new medication or the patient understanding something that’s new to them. The folks who make the medicine are the ones who have all that information because they made it, it went through trials, it’s been approved, and now it’s getting prescribed, but we don’t have a really good way of digitally communicating that information from life sciences to providers except through what was the old pharmaceutical sales rep model. A person coming with samples, sitting down, and spending time in person began to change over the last 10+ years, and of course, was completely shut down during the COVID pandemic time. How does this information about this medication get to the prescriber so that it can get to the patient? On our platform, we make that information liquid, transport it to the provider at the point of care so they can see and know all of what’s new about the medications, or the new formulations, or their new black box warnings, or their new off label expansions so they can be the most informed at the time of treatment and get the patients what they need. That could be around what financial support, patient support programs, and new clinical research are available, but making that digital bite size available at the point of care for prescribing treatment decisions and getting it to patients via a curated conversation on their smartphone helps them adhere to their medication therapy. Sometimes they’re very complicated, people are polypharmacy, they have a lot of different conditions they’re treating, a lot of different medications they’re taking, and it can become confusing for the patient, especially over a long period of time. How do I take this? When do I take this? When do I need to go to the infusion center? Etc, and they need help and support. Those things can be digital, just like everything else is digital in our world, and that’s what we do: we take what used to be delivered in person, deliver it digitally through a device that party is using with the doctor (it’s their EHR, it’s the computer system they use when they’re treating patients). For the patient, “This is our device that we use all day, every day, to do our lives,” so we do that to support access to medications, affordability of medications, and adherence for providers and patients. That’s why I became passionate about taking on this role. The affordability of medications is a huge part of our health equity goals that we’re trying to reach for us as a country, so I see several things going on at the same time in terms of that landscape. One is the push for health equity. We focus on social determinants of health. We’ve had huge public health awareness given our pandemic situation. We also still have health equity issues with access to care in certain areas, whether they be urban or rural, and people’s ability to access the care that they need and then afford the care that they get. We have the Accountable Care Act which hoped to help get more people insured, giving them another financial option to pay for their medications and procedures, all their health care. All of that stuff is coming together when the technology we’re using right now makes possible what we would typically have to go to a studio somewhere and do in person. The internet’s real, all of digital communication is real, and then healthcare is seeking things that make access and affordability easier. We can use information technology and communication technology, like what we’re doing right now, to solve some of those problems and improve healthcare. I see those arcs continuing to come together—information technology maturity, technology maturity, digital health maturity—and the push for health equity across our nation.


Sanjula Jain  5:33  

One of the things I love about your story is that you were one of the first movers in the healthcare tech and data space before we really had these formal EHRs, before we had the iPhone. As you think about your leadership roles at Optimize Rx and even well before then, do you consider your foray into the healthcare leadership arena as more of an accidental path or was it more intentional?


Miriam Paramore  5:58  

When I graduated from college in December of 1983, my first job was in January of 1984 as a programmer for HCA. My degree is in math and computer science from Belmont University here in Nashville. Then it was Belmont college, which just means it was smaller. I think there were 10 people in the school that did math and computer science because it was new. I would say it was an accident. I got into the computer science side because I figured out that I had two opportunities in math, one was to teach and one was to be an actuary. I have very little patience, so I’m not a good teacher, and I thought of actuaries as people that statistically counted death rates. It just didn’t sound interesting to me, but I loved the computer science idea. Once I got into computers, I loved solving problems with technology. I like jigsaw puzzles, so I really loved applying the logical mindset of mathematics—which can be from very abstract to very discrete problems—and then thinking about computerizing all of that. It didn’t take too long to learn how that could help in health care. I would like to say it was intentional, but I was 21 years old, so nothing was really all that intentional then. It was “get a job,” and I was fortunate enough to get a job as a computer programmer for HCA, which was my entrance into healthcare. From there, it sort of stepped through and I realized that I like the complexity of the healthcare system (in terms of it being a big system with big problems to solve) and I liked the newness of computer technology and that it wasn’t being used as a tool. It really wasn’t. It was a very, very basic mainframe with very, very basic processing. Of course, we didn’t have the internet or personal computers or any of that stuff, so early days.


Sanjula Jain  7:55  

We talked a lot about the role of women in STEM and encouraging more to pursue those career paths. You said you were a class of 10 studying that degree. How many women were in your class?


Miriam Paramore  8:07  

Maybe just me? Maybe there was another woman, but I’m not sure that there was in that major. Again, it was a small school and so an even smaller population of us that we’re in that arena. We didn’t have STEM then. It wasn’t that intentional. I was really young when I went to college and I was just studying what I found interesting. I had a mathematics scholarship and then I got into the computer side of it and it took me over. I was fascinated from thereon. Over the last 37 years now, it’s been interesting for me to watch the concept of STEM and women with these focuses on science, technology, engineering, and mathematics become an acronym and something we can talk about. One of our board members has a daughter who is maybe now a senior at a major university. He introduced me to her a couple years ago at one of our board meetings that happened to be in the area where he lived. He said, “I’d really like for you to meet my daughter because she’s studying engineering and she’s feeling a little ambivalent about whether she wants to continue because she’s the only girl in any of our classes.” I was so taken aback by that. This was like 2019 and she did not feel comfortable and was feeling a little bit unwelcome and a little bit like “what are you doing here?” This was her process of what she was experiencing and I thought, “Wow, I don’t like that at all.” I don’t like to think of us as a society at a place now in 2020, 2021 that any woman would feel uncomfortable in pursuing STEM. That’s how I know we need to focus on that conversation, so I really appreciate that question. As I spoke with her about it, she said, “I love the content and I love what I’m doing, but it’s a little bit of a boys club.” It still feels that way to me, if for no other reason than the representation of being female in that setting. We’ve made a lot of progress, but we have a lot further to go.


Sanjula Jain  10:31  

To that point,—when we had talked earlier—being a researcher, I had to go look up the stats. I think around the time when you pursued your degree in computer science, 13-14% of those degrees were given to women on average. I think now we’re closer to maybe 20%, but we’re still in the minority there, so tell us a little bit about where you grew up, your family influence, your decision to go out and take this big stride forward and pursue this degree path that was pretty uncommon for women at that time.


Miriam Paramore  11:04  

It was very uncommon. My personal background is I grew up as a child in Nashville and a little bit in North Carolina. My family’s from eastern North Carolina. My grandparents on both sides were farmers, so a very basic agricultural beginning that many of us here can appreciate and understand. My parents went to college at a religious school, a very small religious school. My dad finished and my mom didn’t. I was born in 1963, so my generation was the “Enjoli generation,” I call it. There was a perfume commercial for Enjoli that was a jingle. I’m going to sing it for you. “I can bring home the bacon. Fry it up in a pan. And never let you forget you’re a man.” Jazz hands. Those three things were the mantra I was raised with. You can and should, in this order, (1) get a degree, (2) get married, and (3) get a job and have a career and have kids. You should do all of those things and in that order. Especially being in the south back then, it wasn’t acceptable to be a single woman with a career. I’m happy we’re beyond the “why aren’t you married if you’re 25 or 30 years old,” that sort of thing. I’m glad that we’re past that. We seem to be passed that in our society, which is good, but that commercial showed that what was appealing and what was being pushed was “it’s okay for you to have jobs and work as long as you’re married and you keep the man happy AND you cook dinner and kind of do a striptease from the door to the kitchen and have the kids taken care of too.” It was really “and, and, and,” so I felt a ton of internal pressure and I felt external pressure from my family to be married and do the traditional thing. I also felt pressure to be good at everything at the same time. I’ve always been very ambitious. I loved solving problems and using technology. It takes a lot of time and focus to do those things, so there was always a little bit of “it’s okay to be good in that, but don’t forget about all this other stuff you also have to be good at.” (1) Pleasing the man, (2) stay married, (3) have children. Just “have.” There was no “like.” Would you like to have children? No, no, no, everyone has children in this part of the country at that time. Given the fact that we had the privilege of going to college—and we were encouraged to go to college by our parents and get educations—it’s a “yes, and.” There are these other expectations. That’s the framework I grew up in and brought in to the college setting. At that time, most women who were going to college were choosing female-friendly or more female-oriented roles. Belmont has a pretty big nursing school, as an example which trends female and doesn’t trend towards engineering or mathematics. In the business world where—if you follow the money and go up the entrepreneurial chain from friends and family to venture capital, private equity, and then the public markets—there are fewer and fewer women, that 20% to 13%. Very, very small. We have that same pattern with women in STEM, with women in finance or women in banking or women in private equity or women in board seats, and that’s a real opportunity for us.


Sanjula Jain  15:18  

Absolutely. That was one of the origin stories for why we created this show. Of the few women who are occupying those seats, let’s learn from each other and try to grow that percentage over time. That “yes, and” philosophy though, is incredible. I have a whole new appreciation. That’s really important to sink in, because to your point, it may have gotten easier over the years, but I think a lot of women even today still feel that pressure. Yes, it may be more acceptable to delay getting married—instead of your 20s, it’s 30s or 40s—but the expectation to do it all is probably still there, so it’s refreshing to hear you share that pressure that so many of us actually feel. Let’s go into your trajectory from there. You got your degree in computer science, your first job was at HCA, so you kind of lucked out by jumping straight into healthcare. You’ve built a career around what I would call smaller growth-stage tech companies, and you’ve seen a lot of that activity over the course of the evolution of the industry in parallel to where you started leading up to Optimize Rx and some of the other stints you’ve had along the way. How have you viewed the landscape within that?


Miriam Paramore  16:36  

I view my career as having three sections. The first section was “just get a job,” and then figure out if you like your job and if you want to keep doing it and I really did. What I learned in the first 10 years of my career is that I love technology and I like programming. We used languages. You said to set the stage for what it was like. I’ll tell you what it was like: this is an index card. There were these things called punch cards and they had holes punched in them. You coded in a language called Fortran. It was like dinosaur days. This machine punched out these cards and that was the code you wrote. There were a whole bunch of them in a stack and that was the instructions. Like, instruction one, instruction two, and then comes this instruction. If you dropped them on the floor, you were completely screwed unless you had taken time to number your cards because that was your code. That’s literally how we coded. Then you would put them in a machine. There’s your card stack. That was your homework, and then the teacher would put the card stack in the computer and see if the thing would run or if it would blow up. Computers were so big that it took a whole building. Like, my whole house would be full of computers, but folks like us never saw the computers because we were on green screen terminals. They were called terminals that had a big wire coming out that was into some routing mechanism that connected to these mainframe computers (which were in some other building somewhere) through some sort of telecommunication and supercenters that took forever. Now we call it the cloud, and it’s sexy, and all that stuff. It’s personal computers and they have memory and nobody does punch cards. The philosophy of accessing computer power that’s “out there,” we did that then, we just had really ugly green screens and big bulky terminals. Coming out of school and going into that first 10 years, technology was very, very young. It was mainframe computing. I remember the first day personal computers came into our office. It was 1984 or ‘85 and it was the IBM 5150. It was this enormous thing that sat on a table and it was called “dual floppy disk.” Think of it: it had no CPU, it had nothing in it. It was like a big box that would run things, and you put these five and a half inch floppy disks in there to make it run. That was the first personal computer that came out of IBM. Shortly thereafter, the Macintosh computer came out. It was a little bitty thing with this little face on it. That became the next evolution of tech, but it was way before what we have now in terms of personal computing and being able to do things powerfully with microcomputers, which is what they were called at the time. There’s also a whole bunch of technology that’s dead now: the mini computer, the IBM AS400 series, the deck series, and healthcare still has a bunch of stuff that runs on these old mainframes.


Sanjula Jain  19:47  

That might explain our pace of change in the industry.


Miriam Paramore  19:50  

That’s true. Those first 10 years were about being a programmer and learning healthcare. I went pretty early into a consulting company where I learned from a management consulting perspective what the healthcare industry is and what the different sectors do. They’re healthcare service providers, they’re insurers and healthcare payers. There are pharmacies and PBMs, there are manufacturers, there are patients, and I learned how all of these things weave together. Those are big complicated business problems, so I got to apply technology in solving those problems. That’s where I got interested in the type of thing I do now. That timeframe was full of what I would call decent normal jobs, but I was recruited to be general manager of a revenue cycle company that happened to be owned by Anthem, a big insurance company at the time. From there, I was given my first CEO job. I was about 30 or 31, running an Anthem-owned technology company that was giving out these personal computers to doctors so they would use a computer to file claims electronically with the Anthem insurance companies, so there was a standardization of information that was happening at the time. Standards groups like HL7 didn’t really exist, but there was ANC, so data and data standardization were maturing because people had computers for the first time and began information exchange. Instead of HCA having big computers that just ran HCA stuff, HCA had computers, Anthem had computers, and doctors had computers because we gave them to them. We had a field staff that went out and gave computers to doctors. We said, “Please file your claims electronically instead of filing them on paper.” That was in the early 90s, so that part of my career was learning how to run a business unit at the company where I had that CEO role, so I would call that the first part.


Sanjula Jain  21:59  

To interject on that phase. You glossed over it, but you were given this opportunity, a door opened where you were taking on this senior leadership role. Just briefly, tell us a little bit about that inflection point for you personally. Did you feel like you were prepared to take on that additional responsibility? Was that what you were trending toward? How did you make that jump from the first page to the second stage?


Miriam Paramore  22:24  

When I was in consulting, it was doing well and it was a great environment for me to apply my strategic mind to certain problems and help companies solve them, so I was introduced to this revenue cycle management world of healthcare, which I found very interesting because I love math and it was all about numbers and making numbers true-up between what providers were claiming one insurance would pay and then what patients had to pay. I liked all that and that opportunity came and I took it. Then I learned I really liked managing a unit of people to do a bunch of problems at the same time and get an overall result. When the CEO role came up for the technology company, I thought, “Oh my goodness! I never would have imagined that I would have an opportunity like this.” The reason that I did was because I had a bunch of technical knowledge about EDI and revenue cycle and how hospital systems work and how insurance companies work because of all the steps I’d done up until that point. I was also a decent communicator and manager of things, so my name somehow got into the mix and I was interviewed for it and I thought, “Oh, I can definitely do this. It’s great.” I lived in Indianapolis at the time and I was so happy and impressed and everything else that I could get to go do this, but “you have to move to Louisville,” so I moved to Louisville. I had a seven-year-old son and six-month-old baby and it was maybe six months to a year after I got there that I got divorced, so I don’t think I was holistically ready. I was career-ready, but I probably wasn’t personal life plus career ready, but I was there. It was a big job. There was a lot of pressure. It was a big company and I did really well in the role. We were really kicking butt—this was the mid-90s now—and really transforming the way healthcare operated through technology by implementing electronic claiming, electronic remittance, and the electronic interaction between providers and insurers for purposes of revenue cycle. We were really, really going hard. We had huge goals to transform the insurance business away from paper to fully electronic using every digital means possible. There was lots of money being spent. This was the heyday of ICR and OCR technology, inbound paper converted. There was a lot of heavy work and then the combination of the divorce and the move happened at the same time that Anthem took go-public strategy where they were going to become WellPoint, so we acquired Connecticut. They were going to become WellPoint and the opportunities for those of us who were running separate business units were changing because we were going to divest those business units. That was the first time I learned about how to package up a business and potentially sell it to somebody else. We franchised our business to multiple blues so I had to negotiate out of contracts that we would no longer do. There was a lot of change like that and I had never done anything like that, so that got me into the transaction side of buying and selling businesses. After that, we had a choice of staying with the insurance company because the unit I ran was gone. It didn’t exist anymore. It was in the process of being gone.


Sanjula Jain  25:55  

In that process, would you say it was kind of learning as you were doing, just figuring out what needed to be done at that point in time?


Miriam Paramore  26:01  

I didn’t know anything. I didn’t know how to do any of it. What are all of our contracts with these outside insurance companies? What are our expectations for all the providers we serve? Who’s gonna run this stuff? What’s it worth? How do you put a value on a business unit? Who might buy it? How would you transition it over? What gets internalized on the Medicare side versus sold on the commercial side? There was a lot of complexity. There was just a lot of OJT there. My choice then became staying with the insurance company and doing something very different, or doing something else. I chose them, and I did gloss over it a little bit because I was only 30 or 31 years old. That was a big job at that age. It’s a big job for anybody doing it now at that age, but I didn’t want to go back. I felt like if I went back into the big insurance machine, I would be going back versus going forward. Even though it was a business unit, it was still running a business. I wanted to run a business. I have built a lot of confidence through these various complexities and I started a consulting firm. HIPAA had passed and all of the HIPAA wave of implementing the technology standards, the information exchange, the privacy and security standards, was going into force, so the whole industry had to learn to adopt it. I had built a very strong personal/professional network through my work with the various volunteer groups in the technology side of the business, which is something I would say everyone needs to lean into: groups, doing actual work on committees, and becoming an expert in things helped me start my own firm. That was the middle of my career. I had my own consulting business for seven years. I kept it at a lifestyle pace because now I was a single mom and didn’t really want to overdo things. I was trying to not be the Enjoli commercial.


Sanjula Jain  27:58  

I think that’s really important. You were balancing this high, intense job and this change based off where the business was headed, but then you had all these dynamics happening in your personal life. To to your point, is it because you had to bear more of those single mom responsibilities that you said, “I really need to find something and do something that’s going to give me that flexibility?” Or was it more of a “No, this is actually what I want to spend my time doing from a healthcare point of view?” I know that’s not an either-or, but what’s the relative balance of the two things you were weighing in your head to make that decision?


Miriam Paramore  28:31  

The honest answer is that it was primarily driven for personal reasons. I knew I could make a good living as a consultant. I had learned how to be a consultant and I had a lot of very specific subject matter expertise that not many people had at the time and still not very many people have in general even now. I was experiencing the devolution or the unraveling of those basic things I believeed I had to do all at the same time. I said, “Well, this isn’t actually going all that well.” One part of the things I have to do is not working now. What am I going to do and how am I going to handle it? I took an enormous risk and stepped away from an extremely well-paying and secure job to go into a complete unknown, but I had the professional confidence that I could do it based on the work I had done coming into that point. I knew I could count on that part of myself, but I also knew I had to attend to myself. I knew I was really struggling with the losses and the disappointments emotionally. I knew I had a lot of emotional work that I needed to do and I needed to be there for my sons. In order to be a mother, which is my priority above the other things, I needed to get myself together, and I wasn’t going to be able to do that on somebody else’s eight to five or seven to 10, or whatever timeframe. I had to invest in myself and setting up a different way of working and being, so it was primarily was personal but driven by a professional confidence because of what I had earned. My encouragement to women is to believe in yourself and follow your intuition about what is right for you at that stage in your life when you have to make a big decision, despite what the risks are, because your intuition will guide you to do what is right for you, if you can listen to that. Also believe in your ability to win and your ability to do it with the professional skills and experiences that you bring with you. Your life circumstances will change, but what and how you do what you do doesn’t go away. People can’t take that from you and life can’t take that from you.


Sanjula Jain  31:13  

That’s phenomenal perspective. Thank you for candidly sharing that because I think that’s something we don’t talk enough about. We’re all human beings, it’s not just a gender thing. Male or female, we all have personal dynamics and different points in our life that pull us in different directions. I think it takes incredible strength and courage and self reflection to consciously think through what you need to do for yourself to optimize performance, both at home and work.


Miriam Paramore  31:38  

Thank you. I hope so. At the time, I’m not sure I was so conscious of everything, I just knew I was motivated to do and had to act. Then, when you’re out there on your own, you need to make a living, you have to raise your family, so you have a different level of motivation. That worked really well. I tie that together with my opportunity to come into Emdeon, the third phase of my career. At this point, I knew a lot more, I felt even more confident in getting things done because I’ve advised a lot of different companies at different levels. I had taken on an advisory board seat at CareSource, helping them with their technology evolution as a health plan. I just knew a lot more. I was blessed to be the first person George Lazenby—who became CEO of Emdeon (this was pre IPO)—recruited into his executive team and I came in as the executive vice president in charge of strategy for that enterprise. It was probably 600 million in revenue. In 2008 we took it to about 1.2 billion. We took it public and it was the largest health IT IPO at the time. It was an extraordinary process and I had corporate strategy as well as product and some P&L responsibilities throughout there. During that time frame, we did nine acquisitions underneath our strategy that I helped create, so we had quite a successful ride there, which was a big opportunity for learning as well.


Sanjula Jain  33:07  

That’s quite an accomplishment for that period of time. Contrast that to what’s happening right now. There’s so much activity in the health technology/data space, like just a couple of weeks ago with the Microsoft/Nuance deal and the record levels of lending and digital health companies. From your perspective, it’d be interesting to talk a little bit about, as a leader navigating that IPO process and watching this company go through that big transformation, how did that shift what you had to do not only from a healthcare strategy but you personally as a leader? How did you have to operate differently or work with your teams differently?


Miriam Paramore  33:43  

There’s a huge difference between being a private company and being a public company. The primary difference is governance and reporting, and everybody gets that because of the SEC, but it changes the way a company behaves. The way you make decisions also changes as you become public. It’s not that you’re less entrepreneurial, it’s just that there is more structure and everything needs to be a little bit more buttoned up. When you do a lot of acquisitions, it’s easier to buy a company than it is to integrate a company that you just bought and to do that well. Buying a company is not easy, so finding and buying a company is not an easy thing, but integrating businesses is even harder to do successfully without losing momentum. The behavior of the business shifted and my role shifted to helping our board of directors understand how our strategy was playing out in the things that we had acquired and what assets we were going to continue to invest in. As a public company, it becomes about balancing the market expectations for growth across the portfolio of businesses that you had because that’s a pretty big business. It’s a billion to four verticals, payer, hospital, office-based providers, and then pharmacy. Four different verticals with multiple products growing at different rates becomes more about managing the financial market performance expectations than about doing what you might do in an earlier stage, which is taking more risk in certain areas. You have to show up on the scorecard. Then the conversations and the decisions that get made trickle down from “if this is what winning looks like on the market scorecard, then how does that trickle down into my three-year plan, my annual budget, my operating plan, the deployment of capital?” How we used capital to do product development became very different than those things you have to set up, so part of my job was to set up an investment committee and capital allocation plan. Then you have to kind of compete to get your idea funded versus just saying “I have an idea, let’s build this new thing.”


Sanjula Jain  36:07  

For those in our audience who may not be as familiar, Emdeon actually rebranded to Change Healthcare. Many people are familiar with Change right now. There are a lot of discussions around how that company is going to become potentially even larger and working with Optim and others. It seems like your career has been in that growth stage of these companies. Whether it’s with the Anthem deal or the Emdeon now Change deal, it seems like they hit this point, become really large, and then you have the option to continue on in that larger organization, but it seems like you prefer to jump back into the deep end and go tackle another company. Is that a fair assessment?


Miriam Paramore  36:54  

It is, and I hadn’t actually thought about it exactly like that. I do like solving problems, building things, and the innovation and the fun of making something better versus just doing the same old thing. Most people do that. When I left Emdeon, which is now Change, it was at the end of 2013 and most of our management team then left because, after we took it public, we took it back private. We had new private equity owners, so that’s a good time for different management changes. I’d been there for about six years then, so I was ready to move on. That’s when I started doing angel investing because I had never risked my own money. I have three active health IT, help tech investments that I’m involved in. I helped get our new cura angel investing group off the ground here in Nashville. I’m still actively involved there. Then I had the full suite of investing experience from my own money, angel investing, I had already worked a lot with venture, with private equity, and the public markets so I had the whole swath. Over the last five years, I added that intentionally. I helped a couple of companies that were trying to birth some babies because I had a couple different friends that were in two different spaces. I didn’t think I’d go back into a daytime operating role, but I met a board member from Optimize Rx. Her name is Lynn Vos. I met her at the WBL (Women Business Leaders in healthcare) annual conference at a reception. She said, “Hey! What do you do? Maybe you should meet our CEO. I’m on this board. It sounds like you know everything there is to know about health IT. We’re coming at it from a life sciences perspective. We need to blend the two,” and I did and I became so passionate about the ability for this information that life sciences makes available about affordability programs. It’s about $7 billion a year in patient financial assistance via copay cards. On top of that, 90% of the money from all of these patient support programs is unused. All of that money that patients could be using is just left on the floor. The primary reason it’s not used is people don’t know it’s there. Why don’t they know that it’s there? The information isn’t distributed in a digital way to the right people, to the prescribers, and to the patients so they can use when they need it. That’s now a part of this whole health equity conversation. We know how to distribute information. For goodness sake, we have the internet now. We have cloud computing, it’s not 1984 or 1985. There are no punch cards, so we can do this. We just need to connect the sectors and let this data be liquid and let the data flow. We need to do that, in the right way,—structured, secured, all that stuff—that it makes the real difference. I’ve really enjoyed it and, at Optimize, to your point: tiny company. Tiny, tiny company. It was on the pink sheet, the penny stock. We up-listed to NASDAQ. We’ve had extraordinary, extraordinary growth. We’re doing really well and doing good while we’re doing well, so that makes me happy.


Sanjula Jain  40:13  

I know relationships are important to you, whether it’s having access to network groups or whatever it may be, you’re always thinking about connecting people and opening doors. I know one thing you’re passionate about within the change context is how we can broaden the talent pipeline, make it more diverse, make sure we have more women in STEM careers. You’re holding the company accountable for some of these metrics. You’re not just talking about it, you’re demonstrating the impact of metrics. Talk a little bit about what you’re doing there.


Miriam Paramore  40:44  

Thank you for that. This is the best part of my job. I love my job, but this is the very best part of my job. Last year, our CEO acknowledged Juneteenth and made it a company holiday. I never even knew what Juneteenth was raised in the south. I’m ashamed to say, but that’s true. There are these things we don’t know about our history, or they’re not promoted, that we should that are all equity and human rights-related. That was a bold step. We have a largely white Caucasian workforce, but pretty balanced. We have good female representation, but not a lot of racial diversity in our company. One of our African American colleagues said, “This is super meaningful. Thank you.” From there, we started a diversity and inclusion committee that he runs and I’m the executive sponsor of that committee. I get the huge pleasure of working with this small committee of five, six people that have a passion for diversity and inclusion, and we try to promote that in our culture. We want to have something that’s sustainable, so the first thing we did was take the parity pledge. There’s a group called parity.org. What it says is, if you’re going to try to be diverse, then be diverse. That goes to your hiring practices, so make a pledge that for every job that’s a VP level or above, for every position, you will interview one female. That’s where it started, but then we added one diverse candidate. When you’re small, growing fast, and trying to hire fast, you don’t want to do anything that slows down hiring, but if we’re going to make a change, we have to be intentional and we have to have things that are systemic. I’m pleased to say that we do that as part of our normal course now in our hiring practices. We use virtual meetings for everything like everybody does, but we have a big tech presence in Malaysia. We only have about 80 people in our company, so when we do these virtual coffee/happy hour type things, we have some intention to share something that’s culturally specific to people and where they live and how they work so other people can appreciate that. We’ve also set some of our own metric things in place, which right now is just “what’s our baseline and how do we want our baseline to grow based on these new hiring practices?” Everybody that works on that group wants there to be something that actually moves the ball forward and keeps the ball moving forward. We didn’t want to just put a statement on our website or say anything political about something that is topical. We want it to be the change that we were talking about, and we’re actually doing that. It’s an example that, even in a small company, we can do that. It’s just a choice.


Sanjula Jain  43:50  

In our last few minutes together, I want to jump a little bit to your at the center of all this action. You’re bringing along the next generation of leaders, you’re at the forefront of healthcare transformation, as you take a step back and think about lessons learned for a second, you talked a lot about expectations that you felt as a female and in the healthcare space early on. Is there something you believed early on in your career—whether it was something told to you or something that you were made to believe—that you now take a step back and say, no, that’s not actually true?


Miriam Paramore  44:23  

I think I accepted as true the construct of that commercial that I sang. I accepted that “this is how it has to be.” We all deal with the imposter syndrome. You’ll hear people talk about that if they haven’t talked about that already. We all deal with the imposter syndrome, but if you put the female expectation and then, in my case, the southeastern Bible Belt cultural expectation on top of that, it becomes ingrained in your psyche. It feels like the truth, so you measure yourself against your ability to meet those standards of ultimate truth. What I’ve learned is there’s probably no such thing as the ultimate truth. We’re all sort of determining our own paths. We’re heavily influenced by our culture, by our families, by our DNA, by our heritage, but we really do get to define what success means for ourselves, and that can be really holistic. For me, it needs to be about my personal life and my professional life. It needs to be mind, body, spirit, so I need to take care of myself physically and mentally and emotionally, take care of the ones I love, and then also allow myself to express myself creatively in the world. A lot of that is business as a creative process for me. I’ve come to believe that we do get to design that for ourselves. I didn’t believe that early on. I tried to force myself into doing all of these things. I was ashamed and embarrassed. I still have a little bit of discomfort being a single woman. I feel like I’m looked at like, “Oh, well, yeah, she’s just another divorced business executive.” I think we have a lot of those judgments and I just have to let go. I have to accept that those things are out there but let go of my own belief system.


Sanjula Jain  46:32  

It’s really good advice. You’ve said this to me and I didn’t quite appreciate it until putting your pieces together, but it’s so powerful to show that you can really create your own destiny. You broke out of that mold of what was expected of you, you went into a career path that was pretty uncommon not only for women but in your cultural norms of growing up in the south and in your family. I think you have been in the odds, so to speak, in a lot of those regards, so congratulations for charting the way forward on that. As you think about the legacy from a healthcare leadership perspective that you want to leave behind, what would be the title of your book?


Miriam Paramore  47:13  

The Only Girl in the Room would be the title of my book. That’s been my experience as I have been in so many rooms and gone from being an individual contributor to running businesses to being on boards. I’m really passionate about changing that. I would encourage everyone to think about networking very seriously, but also volunteering and getting involved in technology groups or healthcare industry groups that you’re interested in. Do the work so, when you find the room, you’re qualified to be there, you can show up and bring your presence there, you can feel comfortable in your own skin, and you walk in there and just do your part and you’ll shine. I hope we can connect more folks that are close to your age and folks that are closer to my age and realize that some of us know where the room is, some of us found the room, and we want everybody to come along. You don’t have to go to a fancy school, you don’t have to be in one of the cars you can get there. You’ll have ups and downs, but we all do, so I really appreciate the chance to be on this show with you. I wanted to thank you for what you’re doing because what you’re doing is everything we’ve talked about: you have a full-time gig, you’re doing this on top of it because we’re passionate about it, you’ve invested in it, you’re putting tons of effort into it. You’re raising everybody up by just giving us a place to even talk about it with a lot of intention, even the title of the podcast, Her Story. Let’s tell it. It can be lonely, so let’s let it not be lonely.


Sanjula Jain  49:09  

Indeed. Thank you so much for that, Miriam. I really appreciate it. It’s a testament to all the incredible stories and hard work that folks like you have done, so thank you for being so willing to openly share and we look forward to having you back on.


Miriam Paramore  49:23  

Thank you so much. It’s been a real pleasure. Good luck to you. I know this is going to be a great success. Thanks for doing it.


Sanjula Jain  49:29  

Her Story is a podcast produced by Think Medium. For more leadership stories from inspiring women across healthcare, tune in every Wednesday. Please subscribe to Her Story on Apple Podcasts, YouTube, or wherever you’re listening right now. You can also view Her Story episodes and video and access exclusive content on our website at ThinkMedium.com. Be sure to rate and review Her Story so we can continue bringing you insights from influential women across the country. If you enjoyed this episode, we appreciate you spreading the word to your friends, family, colleagues, and mentors who might be interested. For questions and suggestions, please contact us at herstory@thinkmedium.com. Thanks for listening!

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