John Koster, M.D.: Welcome to the Gary Bisbee Show. This is John Koster. I’m welcoming Amir Rubin, who’s the CEO of One Medical now part of Amazon, and former CEO of Stanford and senior executive of Optum. Welcome, Amir.

Amir Dan Rubin: John it’s great to be with you and great to honor the incredible legacy of. Of Gary Bisbee, who is a friend, a colleague, and a mench of a human being. And wonderful to be with you. John here as well.

John Koster, M.D.: Well, Amir, I know Gary was really looking forward to this conversation. I’m glad we can have it. This is a podcast. We’re gonna talk about leadership and certainly you’ve leadership challenges. Had been successful over the last several years in healthcare, and not a lot of people can say that. So I, I think it’d be wonderful to understand, first of all your background, some experiences that is leading you to to career now in healthcare.

Amir Dan Rubin: Yeah, really, my, my background in healthcare is, I’d say largely been focused on how do we have a better consumer or human experience. And it’s certainly been a focus at one Medical where we say we deliver human-centered and technology powered healthcare, but really working from the viewpoint of the end. Customer, the patient, the member, as we call ’em. What do we want? It’s exciting to be part of Amazon now, which works in a very similar way. They work backwards as they say, we say in Amazon from the customer. It’s been a big focus in my healthcare career at Stanford. We worked on a number of things. Obviously an academic medical center, complex institution, but we were able to raise our experience scores into the 90th plus percentile in the country. And previously we were able to do a similar thing at UCOA health system. And actually there was a book written on the work we did there from the same author who had written about Starbucks and Ritz Carlton had written about how he also went from the bottom third in the nation to the 90th plus percentile. And so those have been themes throughout my career and things that I’ve been interested in, but I. To your question, I stumbled into healthcare. I was studying business and economics and as an undergraduate and needed an elective course and I stumbled into a course called Health Economics and that opened my eyes to this field. I then went to work at a startup that was doing actually in the technology network modeling space, but doing some work with healthcare and then went back. Into graduate school and did an MBA and a Master’s in health administration and a school of public health. And then started working in management consulting and then health systems and and then from there,

John Koster, M.D.: So you’ve had a lot of different leadership experiences and how do you view that, changing how you lead? I would imagine, depending on the circumstances to fit the strategy and the organizational culture that you have. How do you think about that?

Amir Dan Rubin: I’d say at some level the form factor is different in each of those organizations. But the I’ll say the leadership challenge or the leadership opportunity is really quite the same. It’s aligning People with purpose and performance. And certainly, like I said, the form factor is different when you’re in a venture back company or a public company, or now part of a bigger organization or a large complex academic health system or a health plan organization. But it’s some level you are trying to align on mission. You’re trying to model model the way yourself personally and then others in the organization? Like how do we want to be behave? You’re trying to challenge processes. Continuous improvement. I’ve often leveraged lean thinking as well as design thinking. How do you engage people in teams to look at problems and continuously Im, IM improve. And then, you want to also tie in with the heart. You wanna engage people and. And in, and encourage them in, in, in ways that ties to the heart.

John Koster, M.D.: From what I’ve gathered from people who’ve worked with you in the past, I’ve been spying on you. I told you that, you have a reputation of being out with the people without, with the employees and understanding deeply. So you clearly have a style. That is more transparent and engaging. So how, and that has worked in each one of these different settings.

Amir Dan Rubin: Yeah, that’s thanks for pointing that out. I think it’s key to Performance. And really to all of those things to aligning on purpose to modeling the way to continuous improvement. It’s certainly a key tenant that we’ve learned from other kind of performance improvement methodologies like lean. You go to where the work is done by the by with the people who are doing it. And as a ex c o of Toyota said, you go see, you ask why, and you show respect. It’s still pretty good council these decades later and you learn a ton. And also it it creates a culture of the people delivering the care are. Central to what we’re doing right? And we have to not only of course support the end user, the patient, the customer, the member, but also the clinicians and team members who are doing this work. And we have to continuously look for ways to improve processes, to make the work more streamlined to take the heroism every day. It shouldn’t be heroic to make a referral. The heroism should come from the empathy and compassion, but, Sometimes in healthcare it’s heroic work just to get a referral or an appointment scheduled. I’ve often found it’s not just makes for a better performing organization, but it also engages a team, Hey, you made my work more meaningful. People are great and people wanna be great and they wanna do great things. And and then it also helps having personal relationships with people. And so it shrinks the gap, when we’re doing hard things, sometimes things that haven’t been done before and all these kinds of organizations, but certainly when you’re, a startup or taking a company public or other things, and trust matters, relationships matter and and people know they could reach back out to me.

John Koster, M.D.: As you’ve gone across all these different types of systems with different stakeholders and things, as you put it, what is your, how has that changed your perception of the healthcare ecosystem?

Amir Dan Rubin: So I think I’ve gained a lot of perspective from that, from, being in regional health systems, academic health systems, and a big public health services and health plan oriented company, then to a very technology oriented and startup, if you will. And now in. Part of Amazon in a big diverse technology and logistics oriented company I think it’s helped me and our teams see how to help improve the healthcare ecosystem if you understand how different parts of it work. I think it helps us think through where to improve for, to take an example at One Medical, we like to say we’re trying to simultaneously address the needs of multiple stakeholders. For the listeners who don’t know what we do, we’re a modernized primary care organization, a doctor’s office that combines digital health and in-person care. And we have a membership for on-demand digital health. And then we have in-person care that’s in network. And increasingly people can. Sign up for membership online. They go to Amazon. There’s a special promotion right now. Or also b2b. We sell to employers who offer this as a benefit. One of the things that I think we’ve seen that’s powerful is we try to think about that entire ecosystem and how we fit in. And I think that’s, What I’ve gathered through my career and have tried to apply it certainly at One Medical. So for example here, yes, we start with the consumer, the member of the patient, and we want great access. We have same and next Day Access. We have 90 Net Promoter scores, really off the chart. Experience lovely offices. Lovely people. But we also then think about the employer and the payer experience. The employers want people their employees to get and stay healthy, to be productive, to show up to work whether it’s in person or remotely these days. And they wanna not spend too much money on healthcare. We actually look at that as well. But we don’t just look at the demand side, the. Employer and payer and the consumer. We also look at the supply side, so we’re looking at the physician experience, the team member experience. And not just employee engagement, which of course we look at, but how many clicks does it take for a physician to do an action? How many messages come into a physician can we route to somebody else to handle? And we have a machine learning layer that routes messages, and increasingly we’re using automated technology, machine learning, and now these large language models to help respond to these things. So I would say by having these experiences, it’s some of these different stakeholders and working at different organizations, Now more at the primary care side, at some level, more on the specialty side. And in between, on the plan and services side, you start saying, Hey, these things need to get connected. How can we connect? And so it’s definitely influenced our thinking at one medical from that perspective.

John Koster, M.D.: As you look at the evolution, It’s going on now with all the providers and pharmas getting into primary care how do you view, how are you viewing some of those competitors, both of health systems and of view and others as multiple different types of organizations that haven’t been in the direct provision of care are now making pretty rapid acquisitions in order to be in that space?

Amir Dan Rubin: Yeah, I’d say first of all, execution matters. How different are the strategies of different organizations in healthcare? If we go back to our health system days, they were all pretty much had the same strategy. The question is, could you do it? And I think that plays here. Yeah. We all wanna have great service, great quality, lower cost, great value, engaged team members. Okay. And then you could, oh where in the care delivery or or plan provision. Part of the value chain. D. D does your organization play fine? But that’s not that hard to map out. What’s really hard to do is execute on this stuff. With a lot of these other efforts, one needs to look at. What is the organization trying to accomplish with this? What is their commitment level to this? A lot of these things take long-term commitment, investment, execution and so it’s not obvious that everybody’s gonna be successful. I think it’s probably obvious not everybody’s gonna be successful in these things. Which is okay. But I think the exciting thing in general is, There’s room to improve in healthcare and it’s, I think it’s great to have other viewpoints, thinking people coming from different backgrounds. That’s the other fun thing about Amazon. It’s not a healthcare organization, right? It’s got great consumer experience, great logistics, and great tech. Gosh, that could be useful in, in, in healthcare. And one medical’s kind of in a blend of that. We call it human-centered and technology powered. We’ve built our own tech, but we clearly have providers in clinical team members. So I think in general it’s exciting. I think the other thing too I would certainly say this about one Medical and Amazon We’re just part of the health ecosystem, right? Like we partner with health systems and health plans and diagnostic centers and laboratories and pharmacies, right? Like part of that is how do you stitch all that together? And how can we make that experience better and more seamless for all the stakeholders? A, a again, which I’m not sure everybody has that strategy, but that’s certainly been our strategy, which is if you can make it better for all those stakeholders, there’s huge demand. There’s total unmet need, there’s lack of access to primary care. There’s, a lot of opportunity in managing chronic disease and so many other things.

John Koster, M.D.: I wanna go b go back and talk about the physician side of this. I know I have an interest having run medical groups in the past and looking at the different strategies that some of these new competitors. Including one medical, new ways of looking at physician practice. And you have a very non-hierarchical view of clinical work, which I think is a bit unique in, in each one of the. Types of new entrants I’ll call ’em, that have, are acquiring medical groups or have different philosophies. Tell me a little bit about that philosophy that you have about, engaging physicians and teamwork.

Amir Dan Rubin: Yeah We say our mission is to transform healthcare through a human-centered and technology powered model. And we wanna do that to deliver better health and better care and better value in a better team en environment. And so I’d say, John, it goes back to thinking about the multiple stakeholders and we’re deliberate in that. And so going back to what I was saying before, we think about what the consumer and the employer and payer want, but then we also have to think about the other side of that. So the consumer wants frictionless access 24 7. Which at some level we’ve tried to offer. Okay, what does that then mean for the team and providers? That may mean a lot of asynchronous messages that may, we have video chats and messages that we don’t bill for. A consumer loves it. No copay, no deductible, no claim. I can get access 24 7. The provider’s whoa, I can be overwhelmed. So then we had to build different models. We built team-based models of care. We have a natural language processing layer that reads, for example, a lot of the messages and says, oh, this is a routine question. I could route it off of the in-office provider to another team member. We call it our virtual medical team member. To take that burdens of desktop medicine, if you will, off the in-office provider and share that work around. And increasingly we’re using technology to automate those responses. But we’re thinking about how that in-office provider can work at the top of their license, how they can focus their energy and time on the patient in front of ’em, not all the pings and emails. While the commercial insurance world is largely paid on a fee for service basis, all our providers are on straight salary. So they’re not disincentivized to say, Hey, why don’t you email me? Or we can have a message or a video chat. Cuz today, in many organizations, that’s a hit against somebody’s compensation, not in our model. And we also have, for example, our in-office appointments. So 30 minutes, they’re longer. So our primary care providers have more time to think about anxiety and stress and managing diabetes as opposed to sometimes in a fee for service compensation model. Let me hustle up and refer the rest out to specialists. So I could see the next patient and get my next, R V u relative value unit payment. Which then doesn’t help the other stakeholders, the consumers out of work, going to another specialist, the employers or payers paying more. So we’ve tried to align these stakeholders. How do we have a great consumer experience, but how do we then build a work environment with the, if you will, compensation incentives team-based care. And then building modernized technology around this was important. It people thought we were nuts to build our own electronic records, our own population health management tools, our own, virtual care. But it allows us now to route these tasks, if you will, or clinical items a across team members. We do think we’re a great place if you’re interested in value-based care and population health and technology and team-based care. We got a great model but may not be the right fit for everybody.

John Koster, M.D.: Oh, you’re shepherding a beautiful culture, Amir. How do you take care of you? These are high stress jobs and I look at what you’ve done and there’s gotta be moments. It’s whoa, baby, this is really hard. How do you take care of you? What is your recharge strategy for Amir?

Amir Dan Rubin: There there’s no stress. There’s just really important things that must be done correctly. The timeline’s very short, and if you don’t do it right, there’s huge consequences. But there’s no stress, John.

John Koster, M.D.: You bet.

Amir Dan Rubin: I say that a little bit in jest, but actually I try to approach things that way. Like it is a privilege to be in this field, to work with incredible team members, to have the opportunity to be invited into patients, members, customers lives, to help them with their health issues. And so I try to be grateful, show gratitude. I do think spending time with people and in the field energizes. Me, I try to approach things with positivity and humor and a continuous improvement mindset. Wherever we are, we can be better tomorrow as individuals, as an organization. And yeah, try to see the positivity and the humor in life. And of course I get great energy from people in my family. But I’ve tried to integrate things into my life. I tend to work a lot, but I like what I do and and I feel the responsibility and accountability of it as well. It’s hard not to, I know you’ve felt the same way in your career when you have team members, counting on you and certainly patience. So that’s why ultimately you have to really love this thing. You gotta love what you do, and. And I do. And then I get energized by it

John Koster, M.D.: and then you never have to work a day in your life.

Amir Dan Rubin: Exactly.

John Koster, M.D.: Let me close with the Gary question as we call it. What advice would you give up and coming leaders about leadership and healthcare, particularly looking forward into the future and what you think healthcare is going to look like as if any of us know, but best guess what? What do you, what would advice would you give to up and coming leaders?

Amir Dan Rubin: I think a few things. I think one try to understand how things work today. Often what I’ve found throughout my career is nobody understands how the full process works. I’m like, none of us. And you could come in with fresh eyes and you go and go say that’s interesting. Why does it work that way? Or is there a different way to do it? And so I think that’s out there. I think one can read a lot. There’s public companies, private companies, all kinds of sources. There’s podcasts like this. There’s a lot of places where you can learn and get up to speed on things. And I think that’s available. So I try to read all kinds of things whether it’s industry items or areas or topics outside of the direct industry where there’re analogs and other industries. I spend a lot of time in technology what’s happening outside our field. After you get some of that perspective, it’s also then helpful as you ideate on whether it’s new companies or ideas or. Or team goals. So those are some of the things I’ve thought about throughout my career.

John Koster, M.D.: Yeah, I think that’s great advice. Had just, did you have a mentor or role model or somebody you wanted to grow up to be like, or did you have somebody who helped you time?

Amir Dan Rubin: I would certainly say there was many people I talked to from time to time. Certainly I was inspired by my parents and my dad who immigrated to this country and they were great role models and had an entrepreneurial mindset and. And certainly throughout my career I’ve met wonderful people along the way. I don’t think there was a single kind of person I’ve gone to, but I do tend to, try to take in what I’m seeing from people, including ones that I don’t wanna be like, I’m like, oh, I don’t wanna do it that way. That can also be useful too This isn’t the way I wanna do things, or this isn’t the environment that would best suit me. I think those are interesting learnings as well. And that learning mindset, that growth mindset is a great way to be. And it’s also fun because you can meet new people and learn new things.

John Koster, M.D.: Boy, thank you. Thank you for joining us today. This has been, So helpful. You’ve made so many salient points. I hope that the young folks all leaders that are listening to this really pay attention to what you’re saying because I, you’ve your fingers right on the,

Amir Dan Rubin: Well, John, thank you. Thanks for the opportunity and it was a pleasure being with you.

John Koster, M.D.: you take care.

Amir Dan Rubin: Take care.