RubiconMD democratizes access to specialist expertise by providing primary care clinicians with a broad national panel of virtual specialists. Its innovative business model empowers value-based care in communities that have been traditionally underserved through less costly, more comprehensive, and more collaborative patient care. Pulse writer Emily Wang connected with RubiconMD Co-founder Gil Addo to learn more about the company and their commitment to reducing disparities in access to care. 

Gil Addo, Co-Founder and CEO of RubiconMD

The Pulse: Can you start us off by sharing your background, and how you came to start RubiconMD?

Gil Addo: Sure. I have a father from Ghana and a mother from Barbados, and I grew up in Connecticut. I did my undergrad at Yale studying biomedical engineering, but I realized I was working too far from commercialization in a lab and wanted to understand the business side of healthcare. I ended up adding an economics major in college then going to business school after working two years at Xerox in investor relations. I then knew I wanted to get back into healthcare, so I spent some time working at a health tech startup, an internship at Cubist Pharmaceuticals, and for a drug delivery startup. When I left business school, I already had an idea for something I wanted to start, but didn’t have the financial flexibility at the time. So I did what a lot of MBAs do and took a job in life sciences consulting with Putnam Associates. There, I did a number of projects for large pharma clients, primarily pricing and market access work, then left in 2013 to start RubiconMD. 

The vision for RubiconMD came out of personal experience – earlier in my life my grandmother had a brain tumor and she traveled from Barbados to Boston for surgery, and then spent the next 5+ years flying back and forth for the management of that tumor. We wanted to address this type of challenge: how can we take the healthcare expertise that sits at centers of excellence in places like Boston and get it out to larger communities where it is so necessary and valuable? While I worked in consulting, it was very early in the ACA days and there were many discussions around empowering primary care and making that the foundation of the health care system going forward. So, we built the RubiconMD vision around bringing specialty care expertise into primary care and enabling this better access for patients.

Ultimately, RubiconMD is a digital health platform on a mission to democratize access to specialist expertise. We connect primary care clinicians to a network of specialists for virtual support. Our core business is focused on eConsults, and we aspire to be the virtual front door to specialty expertise. We’ve built collaborative management tools to allow primary care and specialists to dialogue and support patients, and eventually allow for a virtual-first experience into all aspects of specialty care. And now after eight years since our founding, we were recently acquired by Oak Street Health, an incredible organization that has been a RubiconMD partner for several years. As we started discussing partnerships and collaborations that would help us build towards our broader vision and goals for virtual specialty care, our discussions with Oak Street naturally evolved, and now they are our parent company. RubiconMD is a wholly-owned subsidiary, and we now have the support of a transformative value-based primary care organization to help us scale and continue to improve primary care.

The Pulse: Congratulations, that’s very exciting news. Looking ahead, you’ve spoken extensively about how digital health and telehealth can exacerbate existing inequities. Can you speak to how RubiconMD has prioritized health equity through its company initiatives?

GA: Thank you. And yes, there are a few tenets to the way we think about this. Some of the big issues [in healthcare inequity] are ones people don’t even think about as directly connected to healthcare. There’s lots of talk about the digital divide, since people can’t access telehealth services unless they have access to the internet. But there are even more foundational aspects of social determinants of telehealth. For example, you likely can’t access telehealth if you face housing insecurity. If you have three generations living in a one-bedroom apartment, you can’t sit and have a private conversation with a psychiatrist. To make sure we deliver telehealth well, we have to address these social determinants as well.

The other piece is around the safety net that has never been armed appropriately to provide telehealth services. When we shifted virtual during this pandemic, we saw high performing value-based organizations go from 0-10% virtual to 90% virtual. However, what you didn’t see was the same increase in the safety net, or health system that supports communities in underserved areas which are historically predominantly black and brown. When these organizations went virtual, there were a lot of places left behind where clinicians didn’t have the infrastructure to deliver telehealth. We’ve seen chronic underinvestment to support these communities, even though infrastructure on the clinician side is what you need to be able to execute telehealth well. 

The third component is just not being able to educate people on how to access the right services. There is an assumption that if you build it, they will come. And that’s not true with a lot of healthcare – it has to be culturally appropriate, culturally competent, with the right connections. And it isn’t always the case, especially when tools or products aren’t designed for some communities.

At RubiconMD, we explicitly arm the primary care clinician with resources, because what data and the COVID-19 experience has taught us is that people don’t trust information given from the high-ranking clinician on TV, but they do trust the clinician in their community. It’s cultural and local, so we try to arm the person in the community that has a direct relationship with that patient – understands the context and situation, and can speak directly to them in a way that they’ll listen and trust. Our goal at RubiconMD is to provide that person with the right access and expertise. There are services out there that are very well-intentioned, but have just decided to go outside of the system. And they might provide a fully virtual service offering, but the person on the other side doesn’t understand the context for a patient, and isn’t set up to provide ongoing, longitudinal care and support.

We’ve seen our efforts be really successful. Some notable examples: we support state prisons, so in 10 states we have on-site clinics since in this situation you really need to understand context; there are things you can’t prescribe to somebody who is an inmate. There are treatments or care that are dangerous, and you need to understand what people mean even when they’re not clear about their needs. We also work with Medicaid populations, dual-eligible patients, underserved communities, and there are always important local dynamics and circumstances to consider; situations where you need to really understand the community. So many people of color have been left behind, and this is why we need to be very cognizant that the way we design our products and services is culturally competent and enables access for every major disease, especially those that disproportionately impact black and brown people and drive significant costs. 

The Pulse: This is incredibly interesting. How does this work on a broader level? There are many different communities that are so different – how do you find a way to scale your operations to try to locate the best clinicians in these communities? 

GA: We have built our specialist panels to understand value-based care for specific groups for certain regions, and specific panels of specialists that support different primary care organizations or health systems. But we do rely most heavily on primary care clinicians to understand patient context and translate it. On the question of scalability, that’s also part of our answer – our network of specialists is extremely scalable since they’re located across the country, and they’re the best at providing clinical guidance for their specific area. So we make this a collaborative interaction and discussion, where they can work with the primary care clinician who should know the patient’s circumstance really well. And if that primary care clinician does their job well, they’ve built a longitudinal relationship and understand the social considerations to help increase patient adherence to a care plan. And they get input from whoever is the specialty care expert in the area. So it creates this kind of multidisciplinary collaborative approach. And we’ve found that, because the network is virtual, we can get the right expertise really quickly. And because it is a clinician-to-clinician interaction, we can do it in a scalable way where we’re essentially delivering a virtual specialty network or hospital to every single primary care organization across the country.

The Pulse: When you’re looking at different innovations focused on health inequities, where do you see some of the most exciting innovations? Which do you feel will be here to stay and improve health access?

GA: People may think about RubiconMD as a technology innovation, but we’re actually just a business model innovation. We’ve figured out how to enable access to specialist expertise without necessarily going through traditional fee-for-service payment mechanisms. And we’ve stripped out the layers of reimbursement code, facility fees, etc. and dramatically reduced costs to get the expertise of the person you need. So what is most innovative is not our technology, and while our network is incredible, we’re not the first group to build a high-performing network… it’s the fact that we can connect clinicians this way and dramatically reduce the price of access. This means we’re democratizing healthcare and getting it into the hands of more people across the country.

I think of exciting innovations in healthcare as those that are powerful enough to bring down costs, and where you can create a connection to care or expertise that didn’t exist before. The problems I’m seeing people solve right now I think are the problems for the next century – maternal mortality, chronic conditions, and their disparities – I think there are some companies that are doing it really well. But I think the fundamental thing here is that companies that are really innovating are not necessarily building really novel technology – and I know there is a lot of interesting movement around machine learning and AI – but most companies that are innovating are finding ways to create connections, strip out layers of the system, and bring down total costs. 

The Pulse: Let’s talk about your vision for RubiconMD long-term; what is RubiconMD’s ideal position in the healthcare ecosystem?

GA: If we’ve done our job really well, we’ve enabled value-based care. I think the existing fee-for-service infrastructure will only hold up for so long. And like most healthcare challenges, it can be traced back to the fact that we’ve created a code for everything, and you have to pay for it in that way. Fortunately, we’re moving from a world of fee-for-service – where we can’t move forward fast because innovation has to keep pace with reimbursement codes – to a world of value-based care that is far more scalable and allows us to take advantage of technology that already exists in every other sector. We’re hoping RubiconMD can enable value-based care proliferation, and we’ll do so by providing the front door to specialty care that enables primary care organizations across the country. Making this virtual-first makes it scalable. If we build a brand and space synonymous with specialist consults, my hope is that it will become part of a default way medicine is delivered.

The Pulse: What’s an exciting initiative or opportunity that you and your team have been working on recently?

GA: We recently launched a behavioral health offering that leverages collaborative care management. This essentially means that you can virtually bring a psychiatrist onto the care team, and they can dialogue with the PCP and rest of the team through a care manager and create a collaborative plan for the patient. It’s very scalable because the specialist can work alongside a care manager and support a very large panel of patients. 

This isn’t something completely novel, but we were well situated to do something like this in a multidisciplinary way across every specialty. Imagine a world where you have a patient with several comorbidities – because most patients aren’t just siloed into one disease – and you can address all the challenges of the patient in a truly patient-centered way. You can bring in the cardiologist, psychiatrist, endocrinologist, and hear all their expertise in a collaborative discussion to be able to provide the right care for a patient. And you can do this all virtually, near real-time. That’s the power of what we’re building now and what we’re trying to unlock in our future stage. Our goal is to take some of the things that have proven valuable in behavioral health and scale it across any and every specialty in a multidisciplinary, patient-centered way.

The Pulse: I look forward to hearing more about RubiconMD’s work in the future. One final question – what is your advice for students searching for healthcare opportunities like your own, whether starting a company or finding a role within an organization that contributes to healthcare improvement?

GA: If you want to start a company, one piece of valuable advice I’ve received is to find places that have built something well, or that are scaling, and learn there because that gives you the best view into how you really build a business that can succeed and last as a brand. Finding those places to gain experience is really valuable because that’s what you’ll need to build something yourself as a leader of your own company.  

Ultimately, though, the first thing you should focus on should be solving real and meaningful problems you’re passionate about. As MBA students, time is scarce, and you can work on things that generate the most money for you, or you can work on things that have the most impact. I would always over index impact because I think the financial part can follow if you solve a real problem. But again, as long as you are working on something you believe in that addresses a challenge in healthcare, any other piece of advice I give you is just tactical under that.

Interviewed by Emily Wang, December 2021. 

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Join us at this year’s WHCBC! On Feb 10-11, 2022, Wharton is excited to feature more expert perspectives at our annual Wharton Health Care Business Conference. This year’s conference is virtual and themed ‘A Fair Shot at Health’. Tickets available here