RubiconMD CEO shares insights on behavioral health and outlines rural health initiative

This interview is part of a series powered by HLTH and CHIME to highlight key insights and perspectives from leading executives speaking at ViVE

Improving access to specialty care is one of the pain points in healthcare that RubiconMD seeks to address. Gil Addo, co-founder and CEO of the company, will speak at the ViVE conference March 6-9 in Miami Beach.

First, he’ll be part of the  discussion, The Next Frontiers in Value-Based Care Technology: How New Population Health, Digital Health, and Next Generation RPM and Diagnostics Technologies Can Accelerate the Value (Presented by Deerfield Management).

He’ll also join a panel discussion, Addressing Inequitable Access #RuralHealthDilemma. In addition to Addo, other panelists include:

To view the full agenda, click here.

To register for ViVE, click here.

Note: This interview has been lightly edited for length and clarity

In the run-up to ViVE, Addo discussed recent behavioral health and rural health initiatives undertaken by RubiconMD as well as its response to Covid-19 and the recent acquisition by Oak Street Health.

How has RubiconMD evolved since 2014? What were some of the milestones you achieved in the years leading to the acquisition?

The first was to really validate the need we supported around value-based care. We’ve worked hard to develop the payer relationships and partnerships necessary to execute this. What we do is more scalable access to specialty expertise and that takes a lot of unnecessary costs out of the system…From there, it’s been almost entirely laser-focused on the product and how we innovate around primary care.

We’ve developed a whole bunch of different tools and pieces to fit into the primary care workflow in a more seamless way. We’ve developed deep integrations with EHRs to be able to make it very easy to submit e-consults. We’ve developed functionality on mobile [devices]. We’ve [also] developed functionality to be able to engage other members of a clinic or a care team to participate in the process.

We’ve done a whole bunch from the user interface/ user experience perspective to make it as easy and as seamless as possible for primary care.

The other big thing that’s happened is when we started we had [around] 30 or so specialties and subspecialties. We determined that one of the most important things about making this as easy as possible for primary care is to have as many specialties as possible on the platform and really to be able to answer every question. Today, we have 140 specialties and subspecialties on the platform. That’s important because we want primary care [practices] to feel like this is the tool that they go to for all of their support and needs around specialty care. That includes everything from traditional specialties such as cardiology and dermatology to a deep bench of pediatric subspecialties, clinical pharmacy, genetics, etc.

You launched a behavioral health module. Could you provide an overview?

We’re in the process of commercializing it broadly. It’s about being able to provide greater wraparound support for primary care.

The thing we heard consistently through the history of RubiconMD is, ‘Can you provide greater support around behavioral mental health?’ and our value proposition was that we could reduce cost and empower primary care. But if you’re only doing that on the physical health side, but not on the mental health side, you’re not really providing integrated care and support.

We had to invest to really build this. The data suggests that it may not be the mental health condition itself [that’s] the high driver of cost, but patients with mental health conditions are a 6x higher cost for this system. Primary care is the place in which you can capture, support, and manage a lot of those patients who may not ever make it to a specialist. We needed to create this tool to provide holistic support to be able to build that bridge. It’s been incredibly well received.

How does this work in practice?

Patients go to see their primary care physician, and the physician can use RubiconMD to get an opinion from a specialist. We curate a network across the country, and those opinions come back in a couple hours to the primary care clinician. That clinician can then use it to follow up with the patient.

With the behavioral health offering, there are a set of patients who are identified as being appropriate for collaborative care. They are put into our program where there is a care manager…who is managing that set of patients alongside the primary care clinician. Then we bring a virtual psychiatrist to the care team and they can support the management of those patients longitudinally over time. They can participate in any number of interactions, we have a collaborative workspace that they can use. They get on the phone weekly to talk through the cases with the care manager. They can interact directly with the primary care physician as they have questions, and in limited ways they can also interact with the patient as needed. This is bringing a psychiatrist directly to the care team and to [provide] support for that set of patients, the primary care clinician and their team to be able to better manage the care.

Also, we custom built a registry, to include the evidence-based collaborative care tools for care managers to use to manage patients.

So the biggest differences are that it’s collaborative and longitudinal at the same time, versus the e-consults that are across pretty much every specialty, but it’s around specific questions and patients.

What specialty areas do the primary care physicians using your platform call on the most for e-consults?

The top ones include dermatology, cardiology, endocrinology, and then hematology-oncology as a joint specialty…OB-GYN, infectious disease, orthopedic surgery. Neurology is another big one.

How did your platform adapt to the Covid-19 pandemic?

Virtual was the word of the day when the pandemic hit. We adapted really well. People didn’t want to be seen unnecessarily in person — we provide a much more efficient way to access the right expertise at the right time.

You had a lot of the folks who were on the frontlines who were really struggling….so we had to step up in certain areas and just be able to provide the support….It was just crisis mode for a lot of these clinics and organizations.

We created a specific Covid-19 panel to help people learn how to treat and manage patients with [the condition], how to manage their workforce and staff. There were a lot of questions [at the start of the pandemic] that now seem well-accepted behavior and practices but nobody knew early on.

We also do CME so we offer CME through every console. We also have webinars on it — that’s actually another thing that’s changed over the years. We did CME to help train and give clinicians a greater understanding on how to meet and manage the needs of their patients with Covid-19.

That also ties into your work in health equity?

The thing that we saw through the pandemic …we saw a lot of people lean in on health equity and how to support the most vulnerable. I think people really went above and beyond at that time to support vulnerable populations and we are, first and foremost, a tool to be able to provide more equitable access. We saw a lot of organizations that were trying to figure out how to address disparities and how to better treat communities that have less resources. We’ve been able to forge partnerships with a lot of community health centers, a lot of organizations that support underserved communities. We’ve launched a Rural Health Initiative, which we’ll be talking about at ViVE, to be able to support those in rural areas that just lack the same access.

The chronic conditions that drive the cost of healthcare are the same conditions that disproportionately impact black and brown people. So solving for systemic racism also [addresses] costs in healthcare.

Could you talk a bit about the Rural Health Initiative and what that involves?

We already had large populations that we supported in rural areas — we wanted to figure out ways to better tailor the offering and partner with organizations to be able to scale faster in these rural areas. Rather than just developing relationships with every single clinic in every single geography, we wanted to figure out ways that we could partner broadly to be able to provide support across large geographies —areas where there is not as much population density, but the same needs for access to specialty care. It was really important for us to figure out scalable ways to be able to meet this need and meet our mission of democratizing medical expertise.

So we launched the Rural Health Initiative to find partners. We’ve got a couple of large partners that we’ll be talking about at ViVE in case studies that have allowed us to do some incredible work, in Kansas, in Missouri, work that we’ve done in Texas.

And that brings us back full circle to Oak Street Health’s acquisition of RubiconMD. How did that deal come together?

Oak Street Health has been a longtime client and partner. It started as a discussion around how do we evolve from what we’re building around behavioral health to be able to provide full collaborative care and management and really evolved towards this vision around virtual specialty care. Can we be the front door for every primary care organization to specialty care where the specialty is all virtual first? So being able to do the things that we’ve done in behavioral health, and do that across essentially every specialty and create these multidisciplinary care teams that aren’t just siloed in academic medical centers, but can be given to every primary care organization across the country. Over time, we think we can become the operating system for specialty care for any organization that’s trying to do value-based care. That’s really the vision of what we wanted to build. Oak Street Health has obviously been a leader in primary care and so we came together with them. We get a lot closer to primary care centers to be able to innovate to support our clients.

Illustration: elenabs, Getty Images