(A previous series available on SoundCloud) Welcome to Health Pilots, where we interview people pursuing new solutions for health care in low-income communities. You’ll hear about new technologies and workflows, human-centered design, and how to collaboratively innovate. Gil Addo is co-founder and CEO of RubiconMD where he drives RubiconMD s vision and strategy. He has seen firsthand the pain in getting a loved one to the right specialist and believes there is a better way. Formerly a Consultant at Putnam Associates, a pharma strategy consultancy, Gil designed payer and market access strategies for fortune 500 clients. He holds a BS in Economics and Bioengineering from Yale and an MBA from Harvard. In 2016, Forbes named Gil one of its 30 Under 30 in Healthcare.
“I had a grandmother in Barbados who developed a brain tumor and had to travel to Boston for treatment and then travel back and forth for all the post operative treatment because there was no local specialist expertise and the community provider didn t have the level of comfort to manage or assist in management of the patient.”
Hello everyone, this is Chris Conley and today I have a cohost Ray Peden from the Center of Care Innovations where he is the strategy and innovation consultant. And today we are thrilled to be joined by Gil Addo who is the CEO and cofounder of Rubicon MD. Rubicon MD is a population health management solution that connects primary care providers to networks of top specialists for quick e-consults. Gil was just name to Forbes 30 under 30 in healthcare which highlights the brightest young entrepreneurs, breakout talents, and change agents.
Gil welcome to the show and thank you for joining us on Health Pilots.
Thank you guys for having me here today.
So to get started it would be great to hear a little about yourself on your journey to founding Rubicon MD.
I m originally from Connecticut. I trained as a biomedical engineer. I went to Yale and became very engrossed in the research aspect of things. Then I decided I wanted to move to the business side of healthcare. I had a couple of jobs in the life sciences. Then I did an MBA at Harvard. Then I used that to transition into consulting.
While I was there, I was focused on the problem of solving better patient access in a community setting. Is there a better way to enable resources and enable technology to provide better access locally to this specialist expertise? And that was the emphasis for Rubicon MD. I had some personal experience with this that made me want to solve this. So I took a look at the healthcare system and saw an opportunity to build something that would enable greater access to provider satisfaction and help patients.
Can you say a little more about your personal experience?
I had a grandmother in Barbados who developed a brain tumor and had to come to Boston for treatment and then travel back and forth to Boston for post op treatment because there was no local specialist expertise and the community provider didn t have the level of comfort to assist or assist in the management of the patient.
I love it when a personal experience is a driver for a new innovation. It happens to so many entrepreneurs. But you couldn t have been the only family dealing with this kind of issue?
I think for what we were doing, it was a very clear need and almost everyone had a story about access, going to the wrong specialist, having to go to multiple specialists. It began to coalesce as a very clear need that wasn t just me.
You used the term access a little bit which can mean insurance or getting an appointment with a doctor. Can you talk a little bit more about that?
That s a great question because the way I use it isn t explicitly what it always means in healthcare. I m not just talking about providing someone with insurance. Access can mean geographical limitations, cultural limitations, it can mean any hurdle that prevents someone from accessing the right care. What we provide is a tool that helps people get access to specialist expertise in a convenient and fast way.
Tell us about Rubicon MD and how the solution works.
We founded the company three years ago on the premise of providing better access on a community setting. The way the solution works now the patient will see their primary care provider and if there is something outside of their expertise they can go to the web based tool, access the portal and ask a question. We will figure who the best matched specialist is, route the case to them, and we ll have an answer within a few hours. We like to call it on demand access to specialist expertise in primary care.
Very interesting. It s a little bit different than I anticipated. It s using email or text to do the communication rather than real time video chat or phone calls to get somebody on the line right then and there?
Yes. It s a text based exchange. Its between two doctors or clinicians to enable the one treating the patient to be able to ask a question and upload any labs and relevant studies for an opinion from the specialist.
I love the simplicity of the solution. Can you show an an example of an example use case?
Yeah. Some of the classic examples a patient presents with a rash or set of rashes and a dermatologist or infectious disease can simply snap a picture and upload the question with relevant information and we get a specialist to take a look at it. A patient comes back with slightly elevated labs and the primary care provider suspects hypothyroidism but the labs don t reflect that. You can send the case to Rubicon MD and an endocrinologist can weight in and add additional information within a few hours.
I m trying to wrap my ahead around the full interaction. And how that initial question leads to a back and forth between the doctor and the specialist. Can you tell us a little more about that?
That s a great question. On the actual interaction its typically one and done. There are a small handful of cases where there is clarifying question on one side. We do lots of coaching with specialists to provide them an appropriate clinical roadmap in the absence of potential pieces of information. The exchange can go on for longer bust most are resolved with one back and forth.
Nice. I continue to be impressed by the simplicity of the solution the ability of the primary care physician to reach out and ask a specialist a question. I imagine since there is a lot of back and forth but its not real time the patient will be gone but when the results are back they can communicate the results to the patient outside the clinic. So can you talk a little bit about what the benefits are for a primary care physician?
For a primary care provider particularly those operating in a safety net setting, there is always a challenge getting your patients in to a specialist and get them access and coordinated in such a way that they make it the specialist for an appointment. For the primary care provider this allows for those things that can be handled through an e-consult, it allows you to go the extra mile on behalf of your patient without having to generate a referral. The key thing is the access to specialist expertise in the community setting. There are a number of secondary benefits there a number of things that don t translate to a referral but could enhance the practice in the community setting. Allowing primary care providers to just ask a question. We call this advanced primary care and it allows physician or nurse practitioner to simply ask a question if there is something that could be helpful in patient care.
It seems like such an obvious connection to make between primary care providers and specialists.
Exactly. We are putting the best specialist expertise in the country at their finger tips.
I can imagine that in many communities in the safety net without a lot of access to experts this is an amazing lever to them to access the best?
We made a conscious decision to get some of the best specialists who were practicing and who were out there doing these cases and seeing these types of patients daily rather than people who sit in front of a computer. We work with a handful of academic medical centers and we essentially build our panel based on referrals. Our specialists are providers who have a day job, who are practicing and seeing patience, and do this when they have free time. This fits into their work flow and day. They are able to answer these questions on behalf of the primary care provider.
Can you talk about the payment and how easy or difficult it is? We all know that payment models in healthcare need to be reformed. In how your system works are you providing a lot of pain for the provider?
We ve tried to simplify quiet a bit. We have a subscription based model where we allow the groups to access the platform and use it as an all you can eat model. We want to make this a tool that supports better care and we want to offer it in a simple way without having to create complex billing relationships. It s meant to be a simple way in which the entire group can access it and use as much as they deem clinically appropriate.
I like the all you can eat model through subscription. Seems like a great way to provide enough service and people are concerned about how much they have left on their plan. Can you talk a little about the billing and the ROI the organizations see from the solution?
That question has different answers by state and type of organization so its difficult to give a broad answer as to how all the groups work. The simplest way is that most groups that use this and pay for the service, and then there are benefits in terms of the ability to see more patients, ability to follow up with and hold on to your patients, and do more for them. As well as secondary benefits tied to the reduction in cost for specialist services. So they experience the ROI the things around billing differ some from state to state.
This highlights an issue that so many healthcare innovators deal with: you not only have to have a solution that is simple and fits in the work flow, but you have to figure out the business model in an innovative way so people can try it and adopt it and have it make since in their financial operation. Its an innovation of itself.
That s one of the things we are doing here we are building an innovative business model. We are helping organizations that can message the benefits of this from a financial standpoint and a clinical benefit. That s one of the things thinking about e-consults that you have to think about and justify.
So many good points Gil. We appreciate you being here. I am going to hand it over to my cohost to see if Ray has any questions for Gil and any thoughts your having about the Rubicon MD perspective.
Ray: For my perspective thinking about my life in healthcare so many times in an academic institution we could get a hallway consult simply because we were in the hallway with the orthopedic specialist or the endocrinologist. The noble laureate happened to be next door so we could knock on the door and ask the question and get on with our day. I think to an extent Rubicon MD represents the ability to do that in a safety net in a primary care setting. It allows the primary care physician, or nurse practitioner, or physician assistant to really practice at the top of their license and to be that go to person for the population of patients they are caring for. So when I ran into Gil I said how does this work and we went through everything we d gone through so far in this interview, it sounded so much like wrapping an academic institution into the hallways of a community center that I got excited about it. It is a casual question to get what you need to know to provide the best possible care for the patient. That s what got me excited.
Gil I would like to hear your thoughts about those observations.
One of the things we talk to people about if you are training in an academic institution you have this type of interaction regularly with your peers. You are able to get that expertise and shared learning. We deployed this in a rural community in Connecticut and the provider said in addition to helping my patients this is the most doctor to doctor interaction I ve had in months. I m in an isolated setting and it s a way I can interact and get the support I would from a collaborative teaching hospital or institution. So there is definitely that element that we are building a virtual hospital or a virtual center of excellence for these groups. I absolutely agree with you Ray and I think that is a big part of why this fits in communities where there is a challenge in accessing specialist expertise. This is a tool that allows the provider to do the things while they were in an academic setting.
The other thing that impresses me is that its current. The argument is if you completed residency twenty years ago that is how you are practicing. I think the currency of the interaction is important to bring to the care delivery model. I see this as a lot more relevant than continuing medical education for care providers to stay in tune with the latest and greatest thoughts from every subspecialty in medicine.
Part of the reason we are so deliberate about the specialists we bring on is that we think there is a teaching mission to what we are doing as well. These are providers who are closest to the latest research and can bring that expertise to their peers in whatever subspecialty they exist in. There is an element where you have an academic clinician who is close to the research who can provide a little bit of teaching or coaching through the tool.
I hadn t considered that. You are also providing access to the specialists to reach a far broader category of primary care physicians not through the specialists writing white papers or through research or their practice but by responding to real questions in the field and allowing them to use the latest knowledge they have and share that all the way down to the most remote rural community where that impact can have an impact on people s lives.
Gil I think you were also going to mention something of the model earlier and I cut you off. What was that about?
I was going to say that the piece about the model that we have been very deliberative is that this fits into the clinical workflow. The important thing about healthcare is first to think about the clinical work flow. We made a decision to make this an e-consul and an asynchronous interaction not just for specialists but because the primary care provider wants to maintain control and be able to make decisions on behalf of their patients. A real time interaction with the primary care and patient doesn t provide the same advanced primary care that we support.
It s a case of really thinking through the model. A less technologically advanced solution is actually of more value to the type of care you want to provide. So say one of our listeners wants to implement this at their institution, what is the model for adopting Rubicon MD and getting something going?
There are a few elements of an e-consultant program if you want to build one for your health center there s the technology, the operations, the specialist expertise, and a cultural change element. Along the technology standpoint there s a question of whether you d like this to be a tool to integrate to the EMR. We ve integrated into a handful of EMR s that s an organizational question. If not we have a phenomenal web-based portal that groups go to and can deploy there. The second piece is operations which is what our team is doing actively. We will engage with the organization to help them understand how that works. The third piece is the specialist expertise if they have certain certain specialists they d like included we identify those and bring them in. Then we augment their network with our own specialists. The final piece is the cultural element. E-consult requires a degree of engagement both from the primary care and specialist side. If groups are interested in using e-consult they have to think about each of the four buckets. An organization like us is here to help you cross that spectrum but there are things that the organization has to do and be aware of. For each provider there is a one hour onboarding. We like to be at the provider meeting to engage the organization. Its about a half hour and then we allow for questions with the individual provider as well. If there is interest in going down the path of doing additional integrations, there have to be resources available. Those are typically less than a half day of a technical leads time. From there its supporting and evangelizing. A large part of the cultural element is helping providers feel more comfortable using this tool. It s a simple intuitive solution but it takes a little of an adoption curve. The organization itself being able to support and provide and have feedback and be excited with us is a driving key to success. The benefits are things you see immediately. If you are an organization that is looking to do a number of innovative things in tele-medicine or tele-health or these other innovative tools this is a way to get people up this adoption curve in a relatively low tech way. As people get comfortable with this there are other things that could be added. So we think about this as a piece of a broader tele-health strategy.
Now you opened up another question. I have been thinking about Rubicon MD as the solution for institutions without any access to specialists. But in fact everybody probably has one or two specialists. Are the providers interacting with their own local specialists in one way and then through Rubicon MD in another? Or do you integrate the institution specialists into the platform?
We have two models. For organizations where there is specialist expertise in place we onboard them. This is a more efficient way for them to communicate with the providers that they work with. For those that don t have it we have that s okay we have over 100 specialties and subspecialties. For those that do we onboard and we engage them as part of the e-consult program.
Now I see why you were named to the Forbes 30 under 30. You seem to really get in there and try to make this new solution work. I feel this is a viable model for healthcare in general given what has happened in the industry.
Broadly speaking, there is a very clear challenge and mandate for us as a country around healthcare. Costs have come up and we are increasing the number of insured. There has to be a way to scale our offerings to provide care for large populations and new populations joining and to reduce the overall cost in health care. We know we will have to do that over the next several years. There is a clear role for technology to play. Most people in the technology community acknowledge that technology isn t the solution for healthcare, technology is an enabler to get to services and solutions that are more scalable. That s broadly why there is such a role for technology. There is a need to figure out better scalable ways. Within the safety net setting, you have an even greater strain where access is an even greater challenge and demand is high. Those are the settings in which you want to engage technology to figure out ways to scale the people and processes you already have in place. There is an incredibly role technology can play but its not the solution, it helps to enable the solution.
So you are actually not too long into the journey for a startup under five years. How has the journey been? What are some of the challenges or experiences you ve had and key things you ve learned?
I ve been on the road for three years. It feels longer. We are in 25 states now. We ve been able to figure out enough of a mouse trap to figure out half of the country now. There is no shortage of learning. There s so much evolution a change in healthcare. We went in with a solution that we knew had clinical values and we went to organizations that should have seen that clinical as well as the ROI for it and we found that as many of them bought as did not. So we were able to stand back and learn that organizations are at different stages in their evolution. There are a number of organizations that are very forward thinking, that are on leading edge of innovation, and then there are organizations that are just getting up the curve. There are organizations taking on a ton of risk and have evolved to be fully value based. There are organizations that are on the other side of the curve. So I think solving for where a group is today and then helping them to evolve is important. Don t try to solve for where the group should be. But if your solution fits and you can help them today that s great. If it doesn t fit and its not for the organization today. Maybe they ll evolve and you can come back six months later and they ll be ready. A large part of what we do from our standpoint is we are able to provide data and report it and help organizations add more visibility into their specialty services costs and into the types of things that go through different specialties and questions that are asked. There is a lot of rich data there. So we can use that data to help organizations evolve in their level of sophistication. There is a partnership there. Its not an out of the box solution you can take and solve it and helps you and your organization tomorrow. I think that s one of the most important things we ve learned as we ve traversed the country to get this into so many different hands.
So you mentioned organizations can be in different situations and different states of readiness for a solution like this. If somebody is interested how do they asses their own organization? What should they do, what next steps should they take to see if this solution is for them?
If groups are just starting to think about this, one of the things you can do is to look at how your specialists costs look? Where are the gaps, what are the needs? It creates a richer interaction. We can say okay well that s what we ve seen in other organizations. Its getting a little more insight. Groups that have challenging access, that is a group that we believe is right for e-consult. Its somewhat innovative but somewhat simple and standard interaction that can help.
If people want to learn more I have to imagine you could share or have published some content that helps show what the solution is about and the type of impact it can have?
We do have content. Its already posted on our sight. We ve put out a paper that shows the results and how we have been able to help across six different organizations in six different states. Its about how we ve been able to help better access and the cost savings that its driven for their organization. This is thinking beyond Rubicon MD and how e-consults can help. We ve published that and put the data out there. One in every three visits to a specialist could be avoided by using an e-consult interaction or could be satisfied. It shows nearly $400 in savings per each case through the platform. We ve put those out and interacted with a number of group in academic settings. There is a phenomenal group we work with in the Bay Area as well that put out a New England Journal Medicine article on the value of e-consultant. We are working and collaborating because we believe that this an interaction that is beyond Rubicon MD. It is a way for clinicians to interact with each other and provide a virtual hospital across different organizations and communities.
Ray do you have anything else for Gil?
Ray: One question is you embarked on this journey three years ago based on a personal experience that drove you to consider building something new and different and providing a different kind of model that is traditional in healthcare. I know there are lots and lots of people out there that are saying I m going to solve the healthcare problem. So what advice would you give other people who are thinking about trying to solve some of the other healthcare issues we are facing today?
Great question. The way I think about this is when you are building something in healthcare the immediate impetus and feeling is to try and build a fancier widget or a cooler interface. So many groups and people I talk to lose sight of what s at the core the patient. You can t do anything in healthcare that doesn t have a benefit for the patient at the core of it. That s why a lot of people get into healthcare but a lot of people forget that element. We ve tried to really keep that in mind. The doctor patient relationship interaction Is never going to go away. Groups that are trying to build innovations around it the only solutions that will end up winning are those that enrich that relationship. Solutions that are meant to try and get in the way and add more paperwork to an extent they can be there and do certain things but a solution really needs to enhance that physician patient relationship. We ve been very conscious and made deliberate decisions. We wanted to make sure we fit into the clinical workflow. Any solution whether you ve been in healthcare for thirty years or are new to healthcare anything that you are building to solve a bigger problem you have to fit into that clinical workflow and put the patient at the core. I know it sounds obvious, but you can get so many years into building these complex technologies that you do forget that.
Gil you show wisdom beyond your years. This has been fantastic. We are coming up on the 40-minute time limit on the interview and I just want to thank you for you time and insights. Thank you for building a platform that seems to be having a real impact on people s lives, giving them access to specialist care in convenient and cost effective way.
If people want to reach and learn more about Rubicon MD what should they do?
We are at RubiconMD.com. You can also find us at Twitter Rubicon_MD. You can find me as will at Gil Addo on Twitter.
Fantastic. Gil thanks again for spending time. All the best for success with Rubicon MD and a big impact in healthcare.
Thanks for having me.
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