How His Grandmother’s Illness Led To A Harvard MBA Startup

RubiconMD Co-Founders Gil Addo, CEO, [left] and Carlos Reines, COO (Photo by Esther Quintana)

Harvard Business School MBA Gil Addo always knew he wanted to play a role in the healthcare space. When he was a child, his grandmother was diagnosed with a brain tumor and started commuting thousands of miles between Barbados and Boston for surgery and a long series of post-op appointments. Addo witnessed firsthand the toll this took on his grandmother who died in 2000. But it wasn’t until years later that this incident alerted Addo to a flaw in the healthcare system.

He noticed that all of the best medical expertise was located in “centralized hubs” like Boston and was therefore inaccessible to tons of individuals. In 2013, thirteen years after his grandmother’s death and two years after graduating with his MBA, Addo started RubiconMD, a company that connects primary care providers and specialists digitally, making it easier for patients to gain access to the best medical expertise.

Addo attributes the start of his company to the skills he gained at Harvard Business School as well as the firsthand experience he got while working at Putnam Associates, a strategy consulting firm focused on the pharmaceutical and biotech industries. He discovered his co-founder at an MIT hackathon and the path they took to create RubiconMD has since been made into a Harvard Business School case study. In Addo’s words, RubiconMD’s bottom line is all about “value-based care”, meaning that the intent is to deliver better care at a lower cost to benefit the people who need it the most.

AN HBS CASE STUDY EXPLORES HOW THEY LANDED THEIR FIRST CUSTOMERS

The Harvard Business School case study on RubiconMD, with Gil Addo’s nameplate in class

When Addo was in the beginning stages of starting RubiconMD, he attended an MIT hacking event where he met his soon-to-be co-founder, Carlos Reines. Reins was still a student at HBS, but the two “started dating” in the business sense, which Addo described as a turning point in the development of RubiconMD. He had taken the consulting job to help down his student debt. After a two-year stint at Putnam, he and Reines, who would graduate with his MBA in 2014, started RubiconMD in 2013. At the top of their list to help make RubiconMD a reality was to figure out if a digital system to connect primary care providers with specialists was something that doctors would use. They met with doctors and specialists to do test-runs of the software platform they developed. These low-tech trials went well, but then the pair had to answer another question: Would RubiconMD help save the healthcare industry money? Their research told them that 40% of visits to specialists are unnecessary. Addo and Reines believed they could save the system money by making it easier for primary care providers to access the right information for their patients. The last question they had to ask themselves: Will people buy it?

Turns out people would. Their first customer, who is still a customer today, was Iora Health, based in Boston, Massachusetts. They were connected to Iora by Trevor Price, the founder of Oxeon Partners, a healthcare growth services firm based in New York City. Now, RubiconMD and Oxeon share office space in Lower Manhattan.

After being introduced to their first couple of clients by Oxeon, the founders started on a somewhat unconventional path to procure more clients and grow their business. “We took this path which has been documented, it’s actually in an HBS case study that’s now taught there,” says Addo. “They [Havard Business School] basically lay out how we went from getting customers who signed, to figuring out what the market was. And so we just slowly started moving up market. We got good buyer signals.” The other thing that helped? They instituted a marketing system called 90 in 90, meaning that they would get in front of 90 potential customers in 90 days to pitch the idea of RubiconMD. “The reason we came up with this idea was we weren’t 100% sure, because health care is so complex, who was the true customer.” 

A SELF-DESCRIBED SCIENCE GEEK

Growing up, Addo was “a math, tech, science geek,” but he didn’t necessarily know that he wanted to be an entrepreneur.  He studied biomedical engineering at Yale, but after long hours in the lab, he quickly determined that “I had always been business inclined … Maybe more of a hustling mentality if you will.” So he tacked on an economics major to give him a business backbone. Addo was accepted to Harvard Business School while still a student at Yale. He was one of the youngest students in his program at twenty-three-years old. The program he was entering, called 2+2, was new for HBS at the time (2007), comprising of two years of classroom study with a minimum of two years of professional work experience. Addo fulfilled his work experience requirement by working for Xerox in investor relations. When he finally stepped on campus in 2011, he zeroed in on exactly the type of business he was interested in and wanted to make an impact on: “I wanted to build a business that kind of supported that bottom line—doing well and doing good.”

Although he determined at Yale that he wasn’t cut out for a career in life sciences, his main focus for business was still in healthcare. In his second year at HBS, Addo hosted the student-run healthcare conference, which he described as a gateway to start meeting people in the healthcare space and making connections.

Also in his second year at HBS, Addo and his classmates took a trip to India to look at different models of healthcare. “While I was there I saw this model where they essentially use technology to leverage, in rural areas, the specialists that are sitting in centralized cities,” he recalls. “And they use the community center as the hub to get the expertise for healthcare among other things.” What he discovered in India was more or less a springboard for what he would eventually base RubiconMD on, “[I] thought that there was something you could build on if you could add technology and apply it here in the U.S. you might be able to solve some of the challenges with access.”

RESTRUCTURING THE PATIENT, DOCTOR, SPECIALIST RELATIONSHIP 

All the while, his grandmother’s experience was at the forefront of his motivation. “We were very close,” says Addo. “From the time I was nine months old until I started high school, we went to Barbados each year to visit my grandparents and family. And my grandmother took vacation to visit us in Connecticut almost every year.

“There’s some things that you can’t do remotely. A lot of it is tied to the fact that the expertise to manage patients like that doesn’t reside in places like Barbados. But it does reside in these communities in Boston and in these hubs around the country.”

In response to this fundamental issue of lack of access, RubiconMD seeks to restructure the relationship between doctor, patient, and specialist, whereby technology steps in and acts as a vehicle for communication, putting less pressure on the patient. “Through RubiconMD, primary care providers go to our platform and they put in any relevant patient information, and through our platform, we’ve assigned cases to specialists who provide same-day, digital consult back to the primary care provider,” explains Addo. “And then the final thing is that this allows these primary care providers to determine whether or not further specialist intervention is necessary.”

The customers of RubiconMD are health plans themselves who purchase their eConsult platform and “roll out the solution with primary care providers or people tied to that health plan or that health system.” RubiconMD charges the healthcare systems a fee to use the platform and the specialists that RubiconMD hires receive payment from the company each time they respond to an eConsult.

By restructuring how patients get access to medical expertise, RubiconMD hopes to make it easier for people who don’t live in medical hubs like New York or Boston to receive advice more quickly and maybe even save them a trip to see a specialist if their symptoms don’t warrant one.

GAINING VALUABLE EXPERIENCE AND CONTACTS AT PUTNAM

In between HBS and the start of RubiconMD, Addo worked at Putnam which provided valuable experience for his role as an entrepreneur. For one thing, it allowed him to save money to start his business. For another, the consulting gig offered him access to more people in the healthcare industry. He worked on orphan drugs—pharmaceuticals developed for a small group of people who suffer from very rare conditions—and finding ways for these drugs to be more accessible to the people who need them. His exposure to medical specialists gave him an edge when it came to understanding the structure between patient, primary care provider, and specialist. “You find out that a lot of the specialists don’t see the patient until they’re further along,” he says. This serves as a problem in cases where early intervention is crucial to treat certain illnesses.

A lot of the exposure that Addo got at Putnam solidified his understanding of the healthcare system and what needed to be fixed. From the experience with his grandmother to the healthcare models he’d found in India, it was all starting to come together when he learned from working closely with specialists that lack of access was a critical issue of many patients. His Putnam job also have him a head start on raising seed capital. RubiconMD also has a team of investors such as Waterline ventures based in Boston, the California Health Care Foundation, Blueprint Health, More Distribution Please (through Athena Health), and more. All told, RubiconMD has raised slightly more than $6 million in funding. “What they’re [investors] betting on isn’t the fact that we know and understand everything, it’s the fact that we’re pretty quick at getting access to the information that we need. Getting in front of the people that we need to and learning fast enough to grow with the business.”

THE FUTURE OF HEALTHCARE IS BASED ON VALUE

Addo put a lot of emphasis on value-based healthcare, which he says is part of the company’s mission. It’s the idea that a company should add positive value to the industry and at its cores does work to help others. With the understanding that 20% of GDP is now consumed by healthcare, Addo believes that RubiconMD’s effort to reduce costs makes the company essential no matter what the politics are around healthcare. “There was an early feature on us called ‘A Healthcare Startup That’s Big on Obama Care.’ We understood that that’s where the world was going.” Addo believes that RubiconMD is about solving the problem of access, not peddling a political agenda. “At this point, we understand that it’s not a bi-partisan issue, irrespective of all the things happening in health care right now, and all the things happening in DC.”

While Addo says real world experience is critical when it comes to starting a business, he acknowledges that his time at Harvard Business School was extremely helpful. “People ask, what’s it like running a company? It’s like using every single class of your MBA every week.” More than that, however, he has found the alumni network to be a source of great support. “If I ever need to learn or understand things in a different space, I have such a broad base of people doing interesting things that I can tap into.”

As Addo puts it, “My job changes every four to six months.” Owners of start-ups have to be able to adjust to the various roles of running a company; being the face of that company; pitching it and yourself several times throughout the week. Addo reverts back to the idea of an “MBA toolkit,” a set of skills and insights that come from classes and resources offered through MBA programs. He thinks that his MBA helped him do market research and communicate with key stakeholders from potential clients to investors. The professors and advisors that he had at HBS, even alumni, continue to offer a network for him to tap into.

At the end of the day, however, his memory of his grandmother’s experience is a constant reminder of why he is committed to making RubiconMD more than just a company. For him and his co-founder, this five-year-old startup has become a mission.

About the Author...

John A. Byrne

John A. Byrne is the founder and editor-in-chief of C-Change Media, publishers of Poets&Quants and four other higher education websites. He has authored or co-authored more than ten books, including two New York Times bestsellers. John is the former executive editor of Businessweek, editor-in-chief of Businessweek. com, editor-in-chief of Fast Company, and the creator of the first regularly published rankings of business schools. As the co-founder of CentreCourt MBA Festivals, he hopes to meet you at the next MBA event in-person or online.