Expanding Health Access Through Virtual Care

Next Gen Thought Leader Series #3: Gil Addo

For the third entry into the “Next Gen Thought Leaders” series, we dive into an area I am particularly excited about: Digital Health. Specifically, we’ll explore how virtual access to specialist physicians can enable more convenient and lower cost care for patients in the United States. I am thrilled to have had the opportunity to interview a total rockstar, Gil Addo, the CEO and co-founder of RubiconMD. His company is on the leading edge in the space, offering a digital platform that removes barriers to specialty physician expertise by rapidly connecting primary care clinicians to board-certified experts (his full bio is at the end of the interview).

What’s your story? What experiences shaped you the most in your journey prior to becoming a digital health entrepreneur?

Growing up, my grandmother was diagnosed with a brain tumor.  She started commuting thousands of miles between Barbados and Boston for surgery and post-op appointments.  Not having access to specialty care took a devastating toll on her.  Years later, I recognized that the best medical expertise, the top specialists, were all located in “centralized hubs” like Boston and other major cities that are inaccessible to many people for a variety of reasons. A person’s geography, income level or other factors shouldn’t dictate their ability to access high-quality healthcare, but that is exactly what is happening in our country.  I knew technology could help address the access challenge, so in 2013, I started RubiconMD with my co-founder Carlos Reines. We had the vision of expanding access to the best medical expertise for all people, regardless of who you are or where are you are from.

What a prescient vision you and Carlos had! How did you gain the conviction to start the company? What doubts did you have to overcome?

I think we always believed in the need and the mission of RubiconMD. What we didn’t know early on was whether our solution was going to work in practice. Neither Carlos or I are doctors so we didn’t know how eConsults would work and whether physicians would adopt it. After we ran our first pilot, we surveyed the clinicians and found out that they absolutely loved the interactions. That’s when we knew we were truly on to something.

We had to overcome self doubt along the way. And there were no shortage of challenging moments to test our belief and conviction in RubiconMD. But I believe it’s about the journey as much as the destination and those defining moments allowed for more personal and professional growth than I could have ever dreamed of. 

The success of RubiconMD is a testament to your courage and ability to overcome that self-doubt. A good lesson for budding entrepreneurs in the digital health space.

Can you share a bit of broader context re: access to specialty physicians in the U.S. and how Rubicon MD tackles those challenges?

Let’s start with some data. On average, about 50% of patients who are referred to a specialist doctor from primary care DO NOT end up going to see the doctor they are referred to.

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  And the average wait time for patients to see a specialist is 24 days.

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It’s difficult for patients to navigate the healthcare system, and many patients have access issues: distance to a specialist, financial constraints, time of work, childcare, etc. When they don’t follow through and visit the specialist, it often results in their condition (or conditions) worsening.  They can become much more ill or end up in an ER, which is costly financially, physically and emotionally for both the patient and everyone in the health system.

As the virtual front door to specialty care, RubiconMD tackles this access challenge head on.  We connect primary care clinicians to top specialists via our digital platform.  We are the creators of the specialty eConsult for primary care.  Our solutions empower clinicians to develop higher quality care plans for their patients, informed by board-certified top specialists from across the US, in a timely manner (i.e., just a few hours vs. 24 day average to see a specialist). 

Ah, so the platform allows primary care doctors to get access to top specialists who can virtually advise them in nearly real-time on how to help treat a patient. Is that the right way to think about it?

Yes. Our platform empowers primary care doctors with expert-level guidance from a specialist. This often helps the primary care physician to treat the patient, avoiding unnecessary referrals and services. In other cases, it ensures the patient gets the best interim care plan possible before they visit the specialist.  As a result, we are making care more accessible and convenient for patients.  We are expanding the knowledge base of primary care doctors.  And, we are lowering cost of care.

Enabling more convenient and lower cost care, while also empowering the primary care doctor sounds like a combination that the U.S. healthcare system could really benefit from.

I’d imagine the COVID-19 pandemic created significant opportunity as well as enormous challenge for RubiconMD. How did you and the team respond to COVID-19 to best position the company for growth and impact?

Our office is based in NYC, so we were immensely impacted by the pandemic along with everyone else. We shifted to being fully remote and made the decision to begin hiring beyond NYC, which opened up our talent pool and allowed us to build out our team with top talent from across the US in the healthcare technology space. 

Within healthcare, specialist wait times became even longer and access issues, particularly for chronically ill patients, were exacerbated by the pandemic, so the need for a service like ours became even more essential and the demand really grew.

Glad you and the team already had a few years under your belt so that you could respond so quickly to those needs.

How does virtual care particularly for specialty physicians help to increase equity in healthcare?

There are several ways in which specialty eConsults help to increase equity, trust, access, and cost. 

Given the fact that structural racism and discrimination remain pervasive in healthcare, it’s understandable why a lack of trust of specialists may exist in some underserved communities.  What is crucial is to create a “whole-person” patient experience centered around their needs and limitations, while also validating their concerns.  Primary care physicians (PCPs) are embedded in a patient’s community, so when they are at the center of patient care and have the input of a top virtual specialist, you increase the odds of building a foundation of trust and of delivering culturally competent care that is high quality. 

With every eConsult completed, PCPs are delivering greatly needed specialty care in a primary care setting, which  otherwise would be out-of-reach for patients.  For patients in underserved or under-resourced areas, this approach improves how quickly they receive care and increases convenience. It also certainly will have an impact on outcomes when compared to a patient getting no care at all because it’s not accessible for them.

Last, the cost of care is a reason that many patients delay or forgo care altogether.  eConsults ease financial concerns for patients by taking costs out of the equation. For example, about 50% of the time, unnecessary referrals, diagnostics, and procedures are avoided.  Moreover, by submitting an eConsult instead of immediately referring patients out to a specialist, expensive co-pays, deductibles, transportation costs, or other burdensome costs associated with making time to see a specialist may also be eliminated.

At the same time, I imagine that virtual care could also create some barriers, particularly for those communities of color and low-income households. What are some of these barriers?

Telehealth equity is a major concern. Our virtual care platform is utilized by primary care teams, and it’s at no cost to the patient.  The doctor submits an eConsult on behalf of the patient and delivers better care because of it.  So, if the patient doesn’t have a computer or Wi-Fi, that’s okay, as the care team are the users of our solution.

You’ve led the charge in some of the efforts to address barriers to telehealth. What programs or services do you think will have the greatest impact?

Speaking specifically to specialty eConsults, the barriers we face are around educating primary care clinicians on the value of taking a few minutes of their day to submit an eConsult on behalf of their patient.  PCPs are asked to do so much with very little time, so it’s a challenge to implement a process where they submit an eConsult, before referring out. Our data shows that it improves the care plan, reduces unnecessary services and lowers costs for everyone involved. Through education efforts and increasing the number of PCPs who use this service, eConsult can have an immense impact in improving outcomes for underserved patient populations.

What about tech-enabled programs more broadly?

Tech-enabled programs that make it easier for multiple clinicians to virtually collaborate on patient care will have a transformative impact on healthcare. People don’t trust politicians or experts on TV. They trust people in their community who speak their language, share their values and have earned their trust over years. Being able to arm those community-based clinicians with the right expertise is how we achieve more culturally sensitive and equitable healthcare.

Many patients suffer from multiple chronic conditions and need to see several specialists.  And if you look at all the major chronic conditions, from diabetes to chronic kidney disease, they all disproportionately impact people of color in this country. When we are able to arm the primary care doctor with the tools to virtually and collaboratively care for that patient, along with multiple specialists, we limit the burden on the patient and increase the likelihood that people, regardless of their zip code, can properly manage conditions and can remain healthy.

The acquisition of RubiconMD by Oak Street Health represents an exciting milestone for you and the team. What do you expect this combination will unlock?

What this means for our current and future customers is that RubiconMD now has an improved readiness to help our clients achieve the triple aim (improved health outcomes, quality patient experience and lower cost). We are working diligently with Oak Street Health to create improvements in our offerings that we will quickly scale to all of our customers.  We are now primed to develop the future state of virtual, collaborative specialty care.

What are some other promising companies or initiatives in Digital Health that you think can have the triple impact of improving care, reducing costs, and expanding access?

One of the areas of greatest need and emergent innovation is behavioral health. While mental health has been a longstanding challenge in the U.S., the pandemic further spiked the need for accessible mental health services. This past year we launched a product called BHcare, which embeds a virtual psychiatrist into the primary care team, using the Collaborative Care Model to improve patient care and outcomes.  Primary care is an ideal setting to support patients with behavioral health needs, but most primary care docs receive minimal training in this realm. Our platform equips the primary care team to support patients with anxiety, depression, sleep disorders, substance abuse, and more.

Given that behavioral health is intrinsically linked to a patient’s ability to manage their care, initiatives like BHcare are badly needed. There are several other digital health companies also working on behavioral health efforts, as it will have a huge impact on making care as comprehensive as possible, reducing costs and making mental healthcare more accessible.  

That’s a really important product. Primary care physicians need to address health comprehensively including behavioral health and this feels like an important tool that empowers them to do so more effectively.  

Any final advice for other up-and-coming thought leaders at the intersection of health and technology?

Healthcare moves slowly. Acquiring a truly value-based healthcare system will take time. As a healthcare leader, it requires a certain grit and tenacity to make meaningful change to the system. But if you’re working to improve people’s health and lives, it can be an endlessly rewarding career.

And last, my favorite question, what 2-3 specific works of art (songs, movies, theater work, visual art, or something else) do you turn to for inspiration?

Take Care by Drake [Album]

The Beautiful Struggle by Talib Kweli [Album]

Kobe Bryant’s Muse

I love documentaries and biographies so if you want the real answer - there’s laundry list of stories I’ll go back to for inspiration.

That’s a great list and of course, the Kobe connection is strong with me.

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Thanks for sharing your story, Gil, as a Next Gen Thought Leader! I’ll be closely following the next chapter of RubiconMD and can’t wait to hear more about the transformative impact you and your team will have on the U.S. healthcare system.

Gil Addo is CEO and Co-founder of RubiconMD, a digital health platform that allows primary care clinicians to access same-day opinions, or eConsults, from top medical specialists to improve patient care.

Founded in 2013, RubiconMD serves primary care clinicians across 37 states. The company has raised over $40 million in funding from top tier venture capital firms. In 2015, The Huffington Post named RubiconMD one of the “Five Companies Defining the Future of Healthcare.” Prior to founding RubiconMD, Gil was a Consultant at Putnam Associates, a pharma strategy consultancy, where he designed payer and market access strategies for fortune 500 clients. He previously held strategy and business development roles at Xerox, Cubist (acquired by Merck), and two early stage healthcare ventures.

Gil has appeared in Inc, Forbes, CNBC, Fortune and Entrepreneur Magazine. He’s been named one of Forbes’ “30 Under 30” in healthcare, Crains New York Business 40 Under 40 and Business Insider’s 30 under 40 in healthcare. In 2020, Crains New York named Gil to its list of the Most Notable in Health Care and in 2017 he received their Heritage Healthcare Innovator of the Year award. He holds a BS in Economics and Biomedical Engineering from Yale and an MBA from Harvard.

1. Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era | IHI - Institute for Healthcare Improvement. Institute for Healthcare Improvement. (2017). http://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx

2. https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/

3. Frequent readers will think I somehow slipped this one in, but I promise this came from Gil.