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Scouting Report-RubiconMD: An Integrated e-Consult Platform, Reducing Barriers and Costs

The Driver:

The explosion of growth in telemedicine during the COVID pandemic gave rise to a corresponding increase in demand for additional services like second opinions and e-consults. As increasing amounts of care shifted to virtual delivery, payers soon realized they had to look at managing the costs of specialty care and turned to providers of second opinions and online or e-consults like RubiconMD. Rubicon, which raised an additional $18M in a Series C funding in March 2020 just before the pandemic, has raised $40M to date backed by Deerfield Management Co. and existing investors, Optum Ventures, HLM Venture Partners, Waterline Ventures, and Heritage Provider Network.

The Entrepreneurial Insights:

  • When dealing with the underserved, it's incredibly important to understand the cultural and social context of products designed for them.

  • Early on during COVID as virtual healthcare took hold it actually exacerbated health inequities, however, gradually disparities became more broadly recognized and inequalities are slowly being addressed although there is still much more work to be done.

  • The U.S. had a mental health crisis before the pandemic hit and still has a mental health crisis that requires more holistic/integrated care for patients

  • Many healthcare organizations falsely assume that they can’t make money by creating products or services specific to underserved populations.

The Story:

Founded in 2013 by CEO Gil Addo and President Carlos Reines, RubiconMD enables primary care doctors to electronically consult with specialists in order to determine appropriate treatment protocols, care plans and if needed an in-person appointments with a specialist. One of the company’s primary missions is to eliminate barriers to specialty care given that underresourced patients must often confront the obstacles of transportation costs, time off from work and an inability to determine medical need when evaluating the need for specialty care. We spoke with RubiconMD CEO Gil Addo who stressed their recognition of the urgency of bringing their vision to reality with the onset of the pandemic and the civil unrest shining a light on the existing health care disparities. RubiconMD is currently in operation in 37 States and covers 130 specialties and subspecialties. RubiconMD hires verified specialists who are academic clinicians and well-versed in current practices and methodologies for its second opinions. RubiconMD’s specialists fill in the “second opinion” gap and provide clinicians with the best possible solutions for each case, allowing the PCPs to make the final decision. There are significant costs associated with referring patients to a medical specialist and it has proven to be a barrier for the best standard of care for patients. RubiconMD’s e-consult visit improves patient’s health outcomes, increases satisfaction, and reduces healthcare spending. Moreover, RubiconMD is adding to and reinforcing general practitioners’ knowledge of current practices which boosts confidence when treating patients. RubiconMD has found that patients often do not need an in-person visit with a specialist and can be more effectively treated with continued monitoring and additional follow up care. When necessary they are referred to a specialist.

The Differentiator(s):

According to Addo, most Rubicon e-consults have a response time of 3 hours since RubiconMD retains over 300 specialists and connects them directly with clinicians. Rubicon’s e-consult platform significantly cuts healthcare costs by avoiding the unnecessary referrals, additional testing and lab services often associated with referrals to specialists as well as proactively reducing ER utilization through early detection and improved care protocols. RubiconMD provides clinicians with the best possible solutions for their complicated cases. It improves patient care by 80% and reduces healthcare spending. Addo was proud to report that a recent claims-based analysis of Rubicon’s e-consults from a national payer-partner over a two year period, found a 50% lower per member per month cost for patients where an e-consult was conducted, which persisted over the entire two year period. Addo has noted that “we are in a major mental health crisis in this country, there is a dramatic lack of supply [of mental health professionals] in this country” and mental health conditions are a major driver of costs in the healthcare system.

The Big Picture:

The U.S. has one of the highest rates of healthcare expenditure at almost 20% of GDP of which a large portion is often attributed to the practice of defensive/invasive medicine. In addition, the COVID pandemic has highlighted the presence of significant inequities of access to healthcare and disparities in levels of health literacy. RubiconMD is working to shift the narrative by facilitating how medicine can be practiced less defensively and more equitably in the U.S. as the use of telemedicine and virtual care becomes cemented into our healthcare delivery system. Rubicon will also help address the U.S. physician shortage and particularly the scarcity of specialists predicted by the American Association of Medical College predicts to be between 34,000 and 87,000 positions. Rubicon has had great success in expanding access to practitioners in fields such as orthopedics, cardiology, general pediatrics, and more, in underserved and rural areas thereby improving access to convenient high-quality care. RubiconMD has also seen the need to broaden its footprint to include holistic care of a patient’s physical and mental health. Patient’s direct mental health expenditures account for only 5% of healthcare expenditures while those same patients' health related expenditures can account for up to 60% of all healthcare expenses. Finally, given their success in reaching patients impacted by disparities, Rubicon has demonstrated that as noted in the words of CEO Addo, “when dealing with the underserved, it is incredibly important to understand the cultural and social context of products designed for them” not just redesign or repurpose products designed for other populations.


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