Fred Ronnau, Chief Technology Officer at RubiconMD

RubiconMD was founded with the goal of increasing access to medical knowledge and ultimately improving care quality. Through the company’s eConsults platform, clinicians can seek guidance from experts across 140 specialties. In addition, the company recently launched RubiconBH and RubiconRx to tackle behavioral health care and medication management, respectively. Pulse writer Jamie Marvil sat down with RubiconMD’s Chief Technology Officer Fred Ronnau to discuss how the company aims to add value and support physicians.

The Pulse: Can you please provide an overview of your background and how you arrived at RubiconMD?

FR: Post-MBA, I spent almost eight years doing Corporate Strategy and M&A at McKesson. After that, I co-founded a startup in Denver, my first time out of the healthcare space. It lasted a little under a year, not quite like any of us had hoped on the founding side. From there, I spent quite a bit of time at CareAllies with Cigna focused on Cigna’s managed services organizations, where they partnered with physicians in the Medicare Advantage space.

In terms of how I got to RubiconMD, I ran into the two founders and was just really motivated by what they were building – at this point, they were just starting to scale. They convinced me to move from Denver to New York, to take a leap of faith and join them after the Series B. In taking on my role, I became responsible for running the engineering organization, as well as the product organization. Initially, when I started about a year and a half ago, we were really just focused on our core product, but since then, we have expanded beyond that. Now, as we hopefully start to move past COVID-19, we are looking forward to continuing to scale and grow.

The Pulse: Can you give a bit of context on what RubiconMD is and how you aim to add value?

FR: The idea behind RubiconMD is a simple one and originated because the two founders had experienced their own challenges with getting access to good specialty expertise. The core concept is taking any question that a primary care provider has and routing that question to a national network of specialists. We cover 140 specialties – pediatric, geriatric, across the board – and we get the PCP an answer from a specialist. That PCP can then use that information to really help the patient. Over 75% of the time, the information allows the provider to improve the patient’s care plan, and over 50% of the time, it eliminates the need for a specialist visit. Therefore, the platform not only reduces cost, but also allows patients to access care faster. Some of the populations we work with, whether it’s Medicare or Medicaid, are faced with wait times for specialist appointments that span weeks or months. As such, we provide a big benefit to patients and a big benefit to the providers who are driving value-based care.

The Pulse: For these eConsults, how do you think about ensuring you are providing specialists with the right volume and type of patient data to be helpful?

FR: It’s a good question and one that we’ve thought about a lot. Early on, the company went to one extreme of saying, “what if we could make it really easy to upload information from the EHR?”. However, PCPs then started attaching the whole patient chart, and the specialists couldn’t get to the specifics of the question. So, in the past few years, we’ve really focused on which critical elements of the data are needed to inform the specialist and guide the resulting answer. We spent a lot of time sourcing the right academic specialists, trying to get that deep medical expertise that a lot of times sits in teaching universities or large hospital systems. We also need to help educate these specialists on how they can best guide the PCPs, and when thinking about what makes an excellent eConsult, we use a framework of 3 E’s. The most helpful consults are evidence-based, educational, and effective.

At the end of the day, it’s extremely important to us that we educate our specialists and allow for continual improvement of the insights and information provided. For instance, we actually have a rating system for primary care providers where they can rate their experience much like you’d rate an UBER driver. Any time that we find encounters with poor ratings, we follow up to figure out why the answer proved unsatisfactory. So, as much as we offer a technology solution, we also provide a service back to primary care providers that ensures a) they get an answer and b) the answer is beneficial.

“When thinking about what makes an excellent eConsult, we use a framework of 3 E’s. The most helpful consults are evidence-based, educational, and effective.”

The Pulse: Given the data RubiconMD collects, how do you think about using this information to learn more about primary care and potentially identify new opportunities?

FR: The question we are asking ourselves is “how do we really leverage the data to help specialists provide more value to primary care providers?”. If you look at some of the areas we’ve expanded into, they are really product extensions, not new products. We are going deeper in different areas of specialty care where the medium makes sense. You have certain areas where it is difficult to get information through virtual communication. However, other specialties are such that doctors can provide a lot of guidance through looking at labs, imaging, etc.

As such, what we are really trying to do is first find the right data and second work with our larger organizations on trends. We can look at our data and say here is where our spending on specialty access is way out of line with industry standards. Those are some of the core ways we are leveraging data today.

The Pulse: Have you found that there are any specialties where RubiconMD has been particularly successful?

FR: It’s really funny because we initially thought there would be one specialty where this was the case. However, we’ve found our platform to be beneficial across the board when the right types of questions are asked. I think the easiest one for us though is something like dermatology, where a PCP can easily upload an image that’s then sent to a dermatologist.

Similar to that, specialists can easily provide guidance and commentary on abnormal lab results, something you would see in oncology as an example. A lot of time we are compared to an interactive UpToDate, where not only can a provider do research on published studies, but they can also do that same research real-time with a specialist on the other end. Getting back at your original question, where we really help the most is when there is some grey area that requires an additional perspective or areas where primary care providers could extend themselves with just a bit more training and education. It provides PCPs with a sense of confidence in their ability to assess.

The Pulse: The US is seeing a growing provider shortage and increased prevalence of physician burnout. How does RubiconMD work to address this issue and alleviate some of the challenges faced by physicians?

FR: Our physicians really think of us as an indispensable tool to help them extend their knowledge base and find better solutions for their patients. Ultimately, where our platform is particularly relevant is in the value-based care realm. There, we help alleviate burnout by giving physicians who are responsible for outcomes the tools to manage their patients more effectively – they can have a specialist in their back-pocket who can help them in their journey.

“Where our platform is particularly relevant is in the value-based care realm. There, we help alleviate burnout by giving physicians who are responsible for outcomes the tools to manage their patients more effectively”

Where we still struggle is with physicians who are in a pure fee-for-service model. These doctors have a hard time working with us and finding the time to engage with our service. As such, we really help in parts of the industry that have evolved to more value-based care.

The Pulse: Many trends in healthcare have been accelerated by COVID-19. Of these trends and transformations, which do you see as being here to stay for the long haul?

FR: I think the most interesting trend is the trend towards more consumerism. I think there is going to be a battle between consumerism and the effective model for a healthcare organization. From a patient’s perspective, it’s ideal to be able to talk to a doctor virtually, so there’s an aspect of consumerism that’s been accelerated by everyone going virtual. You see that in the sheer number of virtual-care first delivery models that are launching right now. I think you are going to continue to see that accelerate.
The interesting thing to me is the flip side of that. While virtual care is great, it’s not always the most efficient or the best vehicle for the physician. The economics from the healthcare provider perspective are in some ways in conflict with that of the consumer. It’s going to be interesting to see how that evolves as the world goes back to normal. How much of that drive towards a better patient experience will continue?

The Pulse: In 2020, RubiconMD launched a new behavioral health offering amidst a time when COVID-19 was shining a light on mental health. Can you talk a bit about this launch and how the product has better addressed patient mental health needs both during COVID-19 and broadly?

FR: I can point to a couple things. First, if you think about the core of what we do, it’s really trying to help primary care providers deal with challenging patients, often patients with not only physical ailments but mental illnesses. There’s a lot of companies doing great things in this space, but we are trying to figure out how you integrate psychiatrists and behavioral care managers to better support primary care doctors.

One way we have done this is through simply connecting doctors directly to a specialist, rather than having them write a consult. The nuances of dealing with a patient’s behavioral needs are often much more easily discussed over a phone call. Another way we have tackled this issue is getting into the collaborative care model, where organizations build out care teams that allow a psychiatrist to guide and provide recommendations to a large set of patients. The primary care doctor is still able to treat those patients but is doing that in a way that places a care manager in the middle. The question is really, “how do you leverage that specialist time?”. We have a severe lack of psychiatrist resources for many populations. So how do you accelerate a model that is more effective at delivering that care? For a lot of our providers, it’s helping them treat issues that will go untreated if not addressed by the PCP. At the end of the day for us, it’s a matter of enabling the primary care doctor to do more.

The Pulse: How has RubiconMD innovated or been forced to adapt during COVID-19?

FR: The most direct one is the fact that we now have a COVID-19 specialty. It’s our eighth or ninth most used specialty at this point. We have a panelist of infectious disease doctors that answer questions related to COVID-19. It’s a resource that PCPs have found to be tremendously effective. We’ve spent a lot of time with content as well – our infectious disease doctors have done webinars that have been watched by thousands of doctors. At this point, it’s really about helping PCPs understand the nuances of the virus, especially as guidance and data is changing so rapidly. How do we help our providers stay on the forefront?