Matt Johnson's various interests (pharmacy, coding, entrepreneurship) have collided in the form of Amplicare, a successful venture that helps pharmacists better serve their patients. But while getting the company off the ground, Johnson suffered a rare brain condition that threatened his life.
The blood vessels were tangled together, like ear buds found in the back of a drawer. They weren’t supposed to be there, and they were causing problems.
The way Matt Johnson ’13 (Pharm.D) talks about the removal of the golf-ball-size mass of unwanted arteries and veins from his brain reveals a lot about why he’s become a successful entrepreneur. In the library bar of the historic Nomad hotel in Midtown Manhattan, a short walk from the offices of Johnson’s company, Amplicare, he talks about the ordeal clinically, thoroughly and with fascination.
“I’ve got it on video,” he says. “You only get so many chances to watch your brain on video, so I had to see it.”
Johnson, 30-year-old CEO and co-founder of Amplicare, is still recovering from the potentially life-threatening procedure, which took place four years ago and resulted in a couple of strokes. Even now, Johnson has to check his left leg every so often to make sure he isn’t invading anyone’s personal space.
Otherwise, he comes across as any other young professional trying to make it in the Big Apple. Since founding their company as iMedicare in 2012, Johnson and Flaviu Simihaian, a fellow software-coding enthusiast from the Charlotte area, have been methodically filling a gap in the market, brick by painstaking brick. With close to 50 employees, Amplicare is on track this year to serve 15,000 pharmacies, which pay a couple of thousand dollars each a year for an array of services.
The company is a nontraditional venture for a pharmacy grad, but it’s completely up Johnson’s alley. It combines his love of computer technology, his pharmacy background and his longtime desire to run his own business in a unique way: Via automated software, Amplicare makes life easier for pharmacists, especially those who regularly dispense medical advice to loyal patients.
While helping get the company off the ground, Johnson essentially worked two jobs: fourth-year student in the Wingate University School of Pharmacy, and committed entrepreneur. Johnson would do his day-long clinical rotations, come home with sore feet and a head buzzing with new pharmacy experiences and knowledge, and work on the iMedicare business until 2 a.m. Four hours later, he’d wake up and repeat the process.
Even after he graduated with his doctor of pharmacy degree, Johnson regularly worked 14-hour days.
“I guess that’s why you don’t see that many entrepreneurs,” the Hendersonville native says. ”It can be financially terrifying and very uncomfortable in the beginning.”
Making a success of an entrepreneurial venture takes a single-minded focus and a keen ability to handle stress, and even then there’s no guarantee of a return on your investment: It’s said that nine out of 10 entrepreneurial ventures fail, for a variety of reasons.
But three years after its founding, iMedicare was gaining significant traction, with more than 3,000 customers. Then Johnson began feeling numbness on the left side of his body, and an MRI revealed the mass on his brain.
“At this point,” Johnson says, “I’m thinking, Man, we’re still trying to grow our business. The last thing you want hear is that you might not be alive in the next few years.”
Johnson has always enjoyed solving puzzles. When he was introduced to computer programming, as a 12-year-old, he found that it stimulated that puzzle-craving part of his brain. He spent hours writing fun coding scripts, building games and pranking his sister – “things that a kid that age would want to do.”
Johnson continued fiddling around with computer code in his spare time through his college days, a hobby that fine-tuned the problem-solving skills that would come in handy after he launched iMedicare.
Johnson also enjoyed another, more unusual hobby: breaking down the active ingredients in drugs. “When I was younger, I would go through drug manuals to see how drugs would work,” he says. “I found that very stimulating.” He interned at a pharmacy during high school, and although he knew that one day he wanted to start his own business, he enrolled at Wingate as an undergraduate with hopes of getting into the “2+4” pharmacy program, in which undergrads are ushered into the School of Pharmacy after two years. Johnson considered pharmacy to be his “safety net.”
“At the time, there was super-high demand for pharmacists,” he says. “And my parents thoughtfully encouraged me to pursue that direction.”
He never left his love of coding and information gathering behind. As a side project one year, Dr. Michael Manolakis, director of interprofessional education and an associate professor in the Wingate University School of Pharmacy, asked students to look up how senators and congressmen voted on particular bills related to pharmacy. It was an ungraded, spare-time project for which students volunteered.
“Matt went out over a relatively short period of time on his own and found all the federal databases that had all the information on the senators and how they voted on different bills, and he created a database, so we could sit at our desks and reach out and query all this information,” Manolakis says. “He just did it. That’s kind of his brain. He’s a problem solver in those ways.”
Johnson also kept his coding skills sharp by attending software-development workshops in Charlotte. That’s where he met Simihaian, a recent computer-science grad at UNC-Charlotte. They did some gratis projects for local nonprofits before deciding to dive into business together, in 2012.
Pharmacy was a natural field to enter. In fact, Johnson had been playing around with a business idea ever since he was a P1, or first-year, pharmacy student. P1 students are introduced to the Medicare Part D Plan Finder, a website run by the Centers for Medicaid and Medicare Services. It’s an old-school website that provides information for Medicare customers.
“It offers phenomenal information, and it’s incredibly helpful to consumers,” Manolakis says. “It’s quite a powerful tool.”
But maybe not the most efficient one. Johnson “looked at it through a different lens,” Manolakis says. He toyed with making it more user-friendly, and he kept at it for the rest of his time at Wingate. He and Simihaian’s due diligence when forming the startup sealed the deal.
“We probably went to about 30 pharmacies, just in driving distance, and asked them what their pain points were,” Johnson says. “Nine times out of 10 they mentioned something about Medicare Part D as being a big struggle.”
Helping pharmacists help their customers
Pharmacists, especially those in smaller towns, do much more than simply dispense medication from an elevated platform. In many cases, they give primary-care advice to people too busy or too poor to see a doctor.
“If you are especially low-income, and you have a bruise or something and you don’t want to schedule an appointment with your doctor, you can visit your local pharmacy,” Johnson says. “It’s much more accessible.”
In their first year of pharmacy school, Wingate students spend time working with the Medicare Plan Comparisons website. Back during Johnson’s P1 days, Dr. Greg Alston, now associate dean at the South University School of Pharmacy in Savannah, Georgia, discussed with students just how difficult the site was for pharmacists, and many customers, to use. He said the problem was in need of a solution in the next few years.
A couple of years later, when they were in the initial stages of setting up their business, Johnson and Simihaian found that Alston was correct: Pharmacists were spending an inordinate amount of time poring over potential Medicare plans with their customers, especially during the open-enrollment period. That’s time they weren’t spending filling prescriptions.
Although Medicare is government-administered, it isn’t a single-payer program. Private insurance plans compete to grab a share of the market and are reimbursed by the Medicare system. That means there are plenty of options, and the buffet can overwhelm participants.
“We’re used to clicking through multiple screens to get to an end point,” Manolakis says. “That would be overwhelming, potentially, to a 67-year-old end-user who’s never spent a lot of time with computers.”
"I wanted to get this over with, instead of just waiting for this time bomb to go off in my head."
Pharmacists help customers wade through their options for a variety of reasons: to engender customer loyalty, for workplace variety, as a courtesy to people who have nowhere else to turn.
But it can take valuable time.
“It took an average of 30 minutes to effectively help a patient',” Johnson says. “If you’ve got to do that 10 times in a day, you can’t run a pharmacy.”
That’s where Amplicare comes in. In seconds the company’s flagship product, still called iMedicare, boils down the Medicare Part D options for a particular patient, enabling the pharmacist to give her customers the help they need without interfering with the zillion other tasks she has on her plate.
Thousands of pharmacists have signed up. “We’ve targeted independent pharmacies initially, the mom-and-pop stores,” Johnson says. “They’re much more customer-service-oriented, because usually the owner’s the one running the pharmacy day-to-day, and they see the impact on their bottom line when a patient goes out the door.”
Amplicare has begun signing up a few chains, and now about one-third of its business is with multistore outfits.
That Johnson is around to see the company grow is something close to a miracle.
‘Go back in’
In January of 2015, Johnson was living in Winter Park, Florida, with his wife, Beth Mella, near where she grew up. Even in winter, temperatures in central Florida often rise into the 70s, so Johnson wasn’t alarmed when he felt a cool sensation on the left side of his body while sitting at his computer, working remotely to run iMedicare alongside the New York-based Simihaian. “I’m like, what’s going on? Am I having a stroke?” Johnson says. “I thought, No, it’s just the air conditioning blowing on me. My leg would go numb – ‘That’s probably just the way I was sitting.’”
The sensation continued off and on until one day in February of that year, when Johnson and Mella were heading out to see a movie. “I felt this numbness on the left side of my body,” Johnson says. “I thought, This is odd. It’s happening when I’m not at my seat and the air conditioning is not blowing in my face.
“I felt strange – a little dizzy and somewhat out of it. My wife said, ‘We really need to go to the ER. This doesn’t sound right.’”
An MRI revealed that Johnson had a huge mass on his brain. It turned out to be an arteriovenous malformation (AVM), which occurs in less than 0.018 percent of the population. The mass’s location over the motor and sensory strip in Johnson’s brain was causing the numbness.
The outlook was not good. Almost all brain AVMs are formed at the time of birth. More than two-thirds of them rupture before the age of 40, often resulting in permanent disability or death. The size and complexity of Johnson’s AVM made it a risky case for treatment. He traveled to five specialized brain surgeons in search of an optimistic opinion. The last one he visited, the head of neurosurgery at Johns Hopkins, compassionately told him: “Look. Just enjoy your life while you can. If we operate, I cannot guarantee that you won’t be in a wheelchair for the rest of your life. If it ruptures, you could still survive. And perhaps, better treatment options will be available before that happens.”
Johnson took that information with him on a work trip to Romania, where about 40 percent of Amplicare’s employees are located (also Simihaian’s home country). When he returned, he took one last shot at finding some good news. He got it at New York Presbyterian Hospital.
There, Dr. Robert Solomon told him that they could make it safer to remove by performing two surgical embolizations a week prior to removing it. They would use a catheter that enters an artery from the thigh and travels up into the blood vessels of the brain. At this point, they would inject the mass with a glue-like substance, making it bleed less during the subsequent surgery. A recent advancement in the embolization technique at NYP made it less likely to cause a stroke. And they could schedule him in within just a few weeks.
Johnson didn’t hesitate. “I wanted to get this over with, instead of just waiting for this time bomb to go off in my head,” he says.
In May of 2015, the surgeon performed the two embolizations, the second of which caused a stroke, something Johnson shrugs off as “one of the risks.” The next day they performed the 12-hour surgery.
It was only a partial success. After performing an angiogram, the surgeon realized that there was a smaller AVM that had been hidden beneath the larger one. He gave Mella, a registered ICU nurse, two options: They could go back in to finish the job or try radiation later – a treatment that takes several years.
“Go back in,” she said, “because if he wakes up and he’s told there’s something still left, it’s going to ruin his year.”
That decision most likely saved Johnson’s life. “They opened up the folds of the brain to go really deep down to remove the additional AVM, and it just started bleeding without even touching it,” Johnson says. “My surgeon stated that the outcome would have been catastrophic, likely resulting in death that very night. For this, I give so much credit to my wife.”
With a surgery such as Johnson’s, if there are no complications the patient can usually go home a day or two later. Because he had a stroke in the process of having the mass removed, Johnson stayed in the hospital for a month after the surgery. He had to relearn the basics: how to walk, how to pick up a fork, how to type. “Just trying to touch my fingers together, I would break a sweat,” he says.
Four years later, he still has a dull numbness on the left side of his body – “like if you stuck your hand in ice water.” He can’t always tell where his leg is in space. “When riding the subway I’m always checking to make sure I’m not hitting somebody,” he says. “Proprioception is something you don’t appreciate until you lose it.”
It’s not noticeable to anyone else, though, and it’s been getting progressively better. Johnson wakes up at 5 a.m. every other day to work out in the gym, a habit he especially appreciates because the soreness he feels later gives him a better idea of where his limbs are. He’s also been undergoing hyperbaric oxygen therapy. For about two hours at a time, he lies in a chamber of 100 percent oxygen with 2 atmospheres of pressure. The high pressure enables the oxygen to penetrate deeper into tissues to promote recovery, “It has helped amazingly well,” he says. “I regained some feeling back in my pinky and arm. It was the biggest jump in progress since the first year of my recovery.”
There's just one problem. “For brain injuries, hyperbaric oxygen therapy is not yet covered by insurance," Johnson says.
That’s one problem Amplicare can’t help with, but the company is making strides in expanding its portfolio of service offerings.
Amplicare is branching out beyond its initial area of focus (hence the name change). The company offers automated refill reminders for customers. Another product analyzes patients’ medication profiles to make sure drug-induced nutrient depletion is not a factor in their health care.
Yet another helps pharmacists recommend alternative drugs that are covered under a patient’s plan. For instance, if a doctor prescribes the statin Lipitor, but it’s not covered by a patient’s Medicare plan, Amplicare can figure out quickly an alternative that is covered, and the pharmacist can contact the doctor directly – and swiftly – on the patient’s behalf.
“It empowers the pharmacy in a lot of ways to be better informed,” Johnson says. “It doesn’t have anything to do with their clinical knowledge. It has to do with traversing all of these complexities in the insurance industry.”
Johnson’s overarching goal is to enable pharmacists to make full use of the four years of knowledge and experience they gain during pharmacy school.
“It’s been hard for pharmacists to get the recognition they deserve, considering the amount of studying and training they go through,” Johnson says. “They remain the most accessible health-care provider in the United States, and they know so much more than is being put into practice.”
Expansion was all part of the plan – even as far back as 2012, when, as a P3 student, Johnson took a pharmacy-business-management course under Alston. In that class, students worked on a business plan, something Alston said they should “squirrel away” for later years, in case they’re running their own business.
Johnson appreciated the hands-on nature of Wingate’s program, especially the practical courses that had real-world applications.
“Wingate’s program made a lot of sense,” Johnson says. “It wasn’t hyper-focused on the scientific portions of pharmacy, yet rather the clinical and applied aspects of practicing it. This was much more pragmatic.”
Johnson says that Alston and Manolakis encouraged him to forge his own pharmacy path, and he readily heeded their advice. “It’s amazing how someone’s added encouragement can inspire us to pursue a direction otherwise thought too difficult to achieve,” Johnson says. “Their mentorship at Wingate had a profound impact on me, and for that I will always be grateful.”
“We’re trying to teach students to be entrepreneurs,” Manolakis says. “We’re trying to teach them to be problem solvers. So coming up with a business plan, or thinking through how you do these things – that’s incredibly important.”
But Manolakis adds that Johnson didn’t need that much encouragement, or guidance. “Matt really stood out as somebody who is different, who is ‘more,’” he says. “They come along rarely.”
Johnson, he says, is the living embodiment of a creed he tries to instill in all of his students.
“One of the things I always told the students is you’ll find the greatest joy in your work when you find the point where your professional training intersects with your personal interests – those things that really drive you passionately,” Manolakis says. “That’s where you’ll really find your joy. Matt is in that place.”
Johnson is also in a position to effect real change in the industry. The next expansion for the company is likely to be overseas, where the variety of health-care systems provides clear opportunities.
And, Johnson says, Amplicare is thinking big: “It sounds like a big, hairy, audacious goal, but over the next 10 years we want to affect 1 billion patients’ lives in a measurable, positive way.”
Think of it as a little bit of payback from a guy who knows a thing or two about positive medical interventions.