Episode 38

It’s All About the Person

with Amir Dan Rubin

December 1, 2021

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Amir Dan Rubin
Chair, CEO, President, One Medical

Amir Dan Rubin has focused his career on transforming health care. Through One Medical’s human-centered and technology-powered model, he serves on a team dedicated to delighting members with better health and better care, while reducing total costs. Previously, as an EVP and divisional CEO at UnitedHealth Group’s Optum division, he oversaw a number of areas focused on helping to make the health system work better. Amir also previously served as president and CEO of Stanford Health Care in Palo Alto, where he helped raise patient experience and quality scores to the highest levels in the nation, grow a regional network of care settings, and advance digital health and corporate partnerships. Amir also previously served as COO for UCLA Health, as COO for Stony Brook University Medical Center, and in leadership roles at Memorial Hermann Health System. He has twice been recognized as an EY Entrepreneur of the Year in Northern California. He holds MBA and MHSA degrees from the University of Michigan, and a BA from UC Berkeley.

 

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Gary Bisbee, Jr. 0:48
What if I told you there was a company that delivered health care that costs less, with improved patient outcomes and achieves a net promoter score of 90? Well, in today’s episode, we welcome Amir Rubin, the chair, CEO, and president of One Medical to share how they do it. One Medical is a membership-based healthcare organization. That is a one stop shop for the healthcare continuum. Their employees are salaried, they provide easy access to primary care, telehealth has always been part of their care platform, and everything is brought together by technology that one medical has built in house. Amir shares that these components are not new. However, what makes one medical different is how they fit these components together. We also discuss Amir’s journey from leading academic medical centers, to health insurance companies, and then to One Medical. We learned why he chose to make each of those jumps. And Amir provides advice for up and coming leaders. If you’re interested in making an impact and taking on huge challenges, healthcare is a fabulous field for you.

Gary Bisbee, Jr. 1:55
Well, good afternoon, Amir, and welcome.

Amir Dan Rubin 1:58
Thank you so much, Gary, so great to be with you.

Gary Bisbee, Jr. 2:00
We’re pleased to have you at this microphone. You’ve had really a remarkable and broad leadership career. Now of course, the chair, CEO, and president at One Medical, a very unique company, and we’ll dig into that a bit later. But what we’d like to do today is to learn a little bit about your background and what led to your leadership style. Amir, what was life like for you growing up?

Amir Dan Rubin 2:30
Well, overall, I’ve been very blessed and fortunate in my life. My parents immigrated to this country from Israel, thus my name Amir. I like to joke, my sister Orly was born there, Amir was fresh off the boat, and the third kid got “Mike”. So, grew up there and parents came to this country for the opportunities that America can bring. And so I’ve been very excited about being an American, and being in this country, and growing up seeing my father, who was a professor, but also entrepreneurial, and that had a great influence on me. Later on, when I went to college, I decided to study economics and business because I was like, American dream, right? Make an impact. And that was my youth. Also, had a kind of focus growing up on community service and I always had volunteered and worked in things, like in high school, volunteered in Van Nuys Presbyterian Hospital in Los Angeles and other places. And in my background, that kind of got me exposed to healthcare. It never really came to my foreground. And then in college, I was studying economics in business. I needed an elective that fit into my schedule my junior year and the class that fit in was this class called Healthcare Economics. And then all these themes started coming together, right? A, it fit into my schedule. But, B, the challenges that we have in healthcare, I think back then we were talking about cost, maybe not quality service access, or other things. Yeah, those are the things that kind of influenced me through the years.

Gary Bisbee, Jr. 4:00
Do you remember what your first leadership experience was such that you said, “Yeah, this is pretty cool, I want to do more of this.”

Amir Dan Rubin 4:07
I think I certainly was influenced getting involved in things with my family. You know, they would often travel to Israel. We had no relatives in this country and I was often paying the bills, doing whatever needed to be done, helping out in my dad’s company. So I think there was always this level of, kind of, you could jump in and you can do it. I think also a little bit of maybe this immigrant mentality of “go figure it out”. I think that kind of influenced me a little bit in terms of an interest and willingness to take risks and certainly to help drive change.

Gary Bisbee, Jr. 4:40
Moving on to health systems, you have a distinguished career there. I think Memorial Hermann was the first, then Stony Brook, then UCLA, then Stanford. Is that the right order?

Amir Dan Rubin 4:51
Yeah, that’s right.

Gary Bisbee, Jr. 4:52
What got you to Memorial Hermann to start off with?

Amir Dan Rubin 4:55
I went to graduate school, and I did an MBA, and I also did a master’s in Health Services Administration in the School of Public Health. And so, by this point in my career, had gotten steered towards healthcare and healthcare leadership, and administration. And after grad school, went into healthcare consulting in San Francisco, but I was fortuitous not only to get two master’s degrees, but also to meet my wife in graduate school. After graduate school, we both went to the San Francisco Bay Area and worked in different management consulting firms. And then actually an opportunity she had led us to Houston, where I started working with Memorial Hermann. And that really got me involved in health care systems, and medical group management, and financial management, and operations in academic medical centers. And then that kind of got me on a path towards other opportunities in health systems: COO at Stony Brook, COO at UCLA, and CEO at Stanford University’s health system.

Gary Bisbee, Jr. 5:51
What were some of the decision points that led you to move to the various health systems?

Amir Dan Rubin 5:57
Well, the first one, I was young and loved and geographically unaware, so…

Gary Bisbee, Jr. 6:02
That was easy.

Amir Dan Rubin 6:03
That one was easy. I probably didn’t think about it as much. But, you know, certainly looking back, I think I was very, very fortunate, more by good fortune than maybe my good planning, to work in outstanding health systems with really outstanding leaders and people, and providers, physicians, and teams. These are really excellent organizations. And every organization in its own time has its own challenges. And certainly the ones I worked with had their challenges during their times, but these were really great organizations. They were all very mission driven, very values driven. And that really resonated with me. I believed in our missions and still do believe in their missions. And I believed in the values of the organization and how the organizations were led. And those were tremendously great role models as organizations and the people in those organizations. You know, I would also say, I was fortunate to have opportunities in my career to take on risks and challenges, maybe because some other people didn’t want those opportunities. And I was naive enough to say, hey, these might be good opportunities. I also think, between my wife and me, I think we were both open towards changes, moves, different geographies, taking on new challenges. You know, as one friend told me once, you know, “you’re leaving a perfectly good job, you know”. Whether it was leaving UCLA or Stanford, these were more than maybe perfectly good jobs. And maybe that harkens back a little bit to the immigrant mentality, to youth, to the risk-taking mindset of, hey, why don’t you go out and see if you can make an impact? And if you’re not so wedded into the current state, you’re maybe a little bit open to the future state and to pushing change for the future state.

Gary Bisbee, Jr. 7:44
Well, I can remember when you left Stanford and went to Optum, there were a number of CEOs in the field, you know, “this is one of the best CEO jobs around, why would Amir be leaving?” So that one was one that the field looked at. Looking back on it, it was a terrific move, I think, because it really led to One Medical, but what was your thinking about going to Optum, Amir, at the time?

Amir Dan Rubin 8:10
I was very privileged to have the opportunity to work at Stanford, and UCLA, and Stony Brook, and Memorial Hermann, these were all outstanding organizations. And it this point in my career, that was my fourth health system, and fourth academic medical center. I always was personally driven by, how do we make a significant impact in healthcare. That’s what’s interested me. And then I kind of got on a path of these health systems and these academic health systems, which was great and amazing, but I never actually saw myself as necessarily a health system person or an academic health system person or a health plan person or medical group person. I just saw myself with, how do we make impact in healthcare? So you know, after the fourth academic medical center opportunity, you know, to a COO, one as CEO, I started thinking, hey, how can we kind of transform healthcare in some different ways? Maybe we should come at it from some different direction or look at it in some different kinds of organizations. And with United Health Group and Optum, it was a little serendipitous. I happened to connect up with the, at the time, the CEO of United Health Group and he said, hey, just come work for me. There was no job, there was no search. And I think I’d watched one too many Seinfeld episodes, which was a show about nothing. I basically took a job about nothing. Now, I wasn’t completely naive. I was pretty intrigued with the opportunity to not only combine insurance, but with care delivery and technology. And that’s really what ultimately then got me excited about One Medical, which was a company I met when I was at Stanford. We actually had a little venture arm, we actually invested in One Medical. And really, where my head was at the time was, how do we think about alternative ways to transform healthcare, and might that be from different avenues? And that’s what I was exploring really in these opportunities, at least from a personal perspective.

Gary Bisbee, Jr. 9:57
Can you describe One Medical for us?

Amir Dan Rubin 9:59
Absolutely, so One Medical is a member-based, or human-centered-based, and technology powered primary care organization that’s looking to transform healthcare. And we want to deliver better health, and better care, and lower costs. And we do this through this member-based and technology powered model. So member-based, we think about members, rather than patients. And people sign up as a member. That allows us to do a number of things, including allowing us to do longitudinal population health, even in a PPO open-ended world. It allows us to do outbound digital health, outbound risk stratification, and not just in a kind of closed network capitated way, but in whatever the plan the persons is. And then, technology powered. We built our own technology from the ground up. And you know, some might say, well, that’s crazy in this day and age. But actually, really, that gave us tremendous amount of freedom to redesign the member-consumer-patient experience, to redesign the experience with employers and payers, to redesign the provider experience and workflows, and to clinically and digitally integrate with health systems, and redesign that coordinated care experience across primary specialty diagnostics and other services. So, modernized primary care model, member-based, technology powered. And in time, we’ve extended ourselves really across every stage of life from not just adults, if you will, either direct consumer sign up for us or employers that increasingly are offering One Medical, but also kids and now seniors, including seniors in Medicare risk programs.

Gary Bisbee, Jr. 11:37
I know that you don’t actually own the insurance piece of it. But, how would you respond to somebody that scratching her head and saying, gosh, that sounds maybe like Kaiser?

Amir Dan Rubin 11:47
Well, I think a few things, and there’s a lot of great organizations out there, Kaiser included. Where there may be some commonalities is in the sense that we have a longitudinal member-based salaried model approach. But maybe unlike some other models, this year, we’ll be in 28 markets being able to reach 40% of the population, built on our own model, our own chassis, our own technology. And so at some level, we can deliver almost that, like, tight network HMO, narrow network performance, but yet in a very high service, open network environment. So I think we’re blending a lot of insights from a lot of different models out there. But just as an example, we’re delivering 90 net promoter scores. So off the charts service, 90th percentile in quality, heated scores. And we just had a great paper published in JAMA Network Open Journal of American Medical Association last year, where we took out 45% of the cost for an employer. And we just had a paper published showing that we had two x the results of kind of other digital solution in diabetes management. And New York just released data on, once again, that we were ranked number one in managing complex HIV patients, managing their viral load so no patients going from HIV to AIDS. So being able to delight the member, while serving the employer and payer, while not only just addressing the demand side, but also addressing the supply side, reducing the burnout and burdens of desktop medicine on providers through our own technology, through a salaried model, through a digital system that allows work to be routed off of the in-office provider, and then fitting in with health networks, health systems, and health plans to coordinate care. So yes, some similarities, but also, we kind of have some differences.

Gary Bisbee, Jr. 13:34
I mean, the 90% net promoter score really caught my eye when I first heard about that. How do you reach 90% and then stay at 90%? That’s very impressive.

Amir Dan Rubin 13:45
Yeah, I think a few things. First of all, you design an entire business around it. And so there’s a lot of parts of our model that are quite different. So first of all, people don’t love being nickeled and dimed for stuff in any arena. So what if you say, anytime you want, you can get on the app and talk to anybody, and we won’t charge you at the margin for that, whether that’s a video chat, whether it’s an asynchronous message, whether it’s five times in the night with your kid, whether it’s we go outbound and contact the member. So we reduce that friction. And that’s through the technology that makes it that way, it’s through a model where everybody is on straight salary, they’re not motivated to just churn the next visit. Whether it’s the virtual team that’s covering overnight, or the in-office team, or doing a remote visit with your providers, they’re all on that aligned incentive. So the membership model allows for that kind of frictionless access. The provider and team model allows for that. The technology stitches it together to make it really seamless. We then developed physical locations, as well as our virtual offering, that really we’re thinking about human centered design, right, like essentially you come in, there’s no wait. It’s same or next day. You’re calling your provider by their first name, you have a first person relationship, you could get your lab and bloodwork there done at the same time. You can coordinate your specialty care, it’s really what people want. But you have to build a business model, kind of a technology model, an operating model, a staffing model, a physical plant model, all around that, which is what we’ve done. And so that’s a key part of delivering those results for our members.

Gary Bisbee, Jr. 15:29
So what percentage of your touches or visits with any given patient, any given member, a year would be virtual versus in person?

Amir Dan Rubin 15:38
Yeah, so we have about 10 touches per member per year. So you think about in a typical primary care environment, it may be one to two plus, depending on the age of the person, a little more with seniors. So on our under 65, we have about 10 touches per member per year. Our over 65, we have about 19 touches per member per year. And it’s about a four to one ratio of digital to in person. And that’s really quite different. And again, because the team is not on fee for service compensation, because we allow people to engage with us, sure people can have inbound video chats, but they don’t have to do a video because I don’t have to rely on that just to bill people that way. So we can do asynchronous. Oh, you have this issue? You can message me. And then we can use smart machine learning and natural language processing that could read that message. And based on what the issue is, we can route it to the right personnel. Oh, I see you have an issue with your referral, your authorization, your scheduling, your prescription at the pharmacy. That may not need my personal PCP and we can route that work off the in-office provider, reducing their burdens, increasing their resilience, but responding in a quick timeframe to the consumer.

Gary Bisbee, Jr. 16:43
Did COVID help familiarize people with virtual services? Have you noticed people are more comfortable now with virtual services?

Amir Dan Rubin 16:52
Well, it’s interesting. So I like to joke, we’re another overnight success in our 14th year. So we’ve had this membership model for a while. So actually, for our members, no, actually, this wasn’t novel. We were hybrid all along. We had virtual and in person. We have this membership model. Even before COVID, we had about eight touches per member per year, six digital, two in person. So digital has increased, I would say, a little bit in COVID. But there is also a reason to engage even more, you know? What is this? What’s going on? I have these questions. But I would say, in our model, not really. Now, if you look at society more broadly, sure, right, you know, people have certainly been exposed to digital, everything and more virtual life. But we were built really well for this kind of hybrid environment.

Gary Bisbee, Jr. 17:36
Yeah, for sure. But can we talk about the members for a moment? Last number I saw was 715,000 members growing steadily over time. How would you break the members down, Medicare versus adults, for example?

Amir Dan Rubin 17:53
I think, yes, growing steadily over time. We just reported earnings, that 715,000 numbr was a 40% increase year over year. So, pretty good steadily. Of that, 683,000 of those members were what we call consumer and enterprise. And 32,000 of them were at risk, largely the senior at risk population, largely represented with the acquisition of Iora Health, which was a member-centered technology powered organization serving seniors in at risk financial relationships. So that relationship closed September 1 and we have brought them in. So that’s kind of the mix. From a revenue perspective, the at risk members includes really the global capitation, if you will, type of dollars, whereas the enterprise and consumer is more equivalent to the primary care components plus, in a revenue perspective,

Gary Bisbee, Jr. 18:48
So is the at-risk group mostly Medicare Advantage at this point or all Medicare?

Amir Dan Rubin 18:54
Yeah, so the at risk group is a combination, heavily Medicare Advantage. And then we also participate in what Medicare, the Center for Medicare and Medicaid Innovation, CMMI, has, which is called the direct contracting program. So some of those members are Medicare Advantage, but also, particularly some of those incremental members from the last time we announced the at risk members kind of pre closing of 21,000. Now we have 32,000. You know, some of that incremental growth has been from direct contracting members, which just rolled out this past April, so it’s a new program, as well as Medicare Advantage growth.

Gary Bisbee, Jr. 19:30
And I’m assuming that long standing adult patients that become Medicare eligible will just continue on with One Medical and become Medicare patients. Right?

Amir Dan Rubin 19:40
That’s right. So this is the other interesting opportunity we have, you know, when you have 90 plus percent retention and you’re heading into your 14th, 15th year, some of those people are 14 years older. People age. So we actually have thousands of Medicare members in One Medical, historically. We serve Medicare. We actually have thousands aging in. So this is a really neat opportunity to age into Medicare.

Gary Bisbee, Jr. 20:03
How is it going with corporations? Are they beginning to see this is a way for them to really make important savings, at the same time it would appear to increase the quality of care to their employees?

Amir Dan Rubin 20:16
Yeah, absolutely. I mean, when the company was started, we were really a direct to consumer approach, started in the Bay Area. Boy, getting on an app was a crazy novel thing. Only techies would do that, right. And then over the last number of years, we really started going to companies, to employers. And now we have 8,000 companies, greater than 8,000 companies, who offer One Medical. And what’s nice is we accept their insurance, we’re in network, and then we have this little membership fee. And actually, for employers, it’s even discounted off the direct to consumer fee. So it doesn’t cost a lot. We’re easy to fit into their networks. And we see a few things. First of all, we have 90 plus percent retention on the enterprise and on the consumer. Why would we have these 10 touches per member per year, we have 45%, monthly active use on our app, right? Very high engagement here. And what employers often say is, you know, some of my employees say you’re my most loved benefit, and they’re paying $21,000 a year, plus or minus, for family health benefits. And we don’t cost a lot. But we’re used by a lot of people. When we roll out, we’re often kind of taken up by half of the entire company. So this isn’t a 1-2% sliver using us. This is high engagement, and we’re helping people live healthier lives. Some of the results I talked before, whether it’s diabetes, or managing chronic conditions, or HIV or other conditions, we’re helping them be more productive. They can reach out to us synchronously, asynchronously. In this hybrid world we live in, in-person, in-person in multiple markets virtually. And we’ve shown we can help people return to work, whether it’s dealing with COVID issues, vaccination issues, tracking all of these things, and then lowering costs. So this is a really pretty compelling approach. And I think what employers are understanding is, and I think where we’re so powerful, is they’re understanding what’s broken in the healthcare system. And I think the fact that we’re simultaneously addressing the needs of multiple stakeholders is kind of how we fix it. I mentioned this before, but we are delighting that employee, that member, that patient. We’re making the access frictionless. We have very high service and that’s really important. And we’re making it easy to access primary care. You know, it’s 29 days wait in the US to see a family physician. And that’s with good insurance. So it’s same and next day access, so it can help on that productivity. As I mentioned, the JAMA study and others, we can reduce cost. And then also on the supply side, by having salaried model providers with 24/7 coverage in lovely convenient locations, it not only helps the employee be productive and get access, it helps the provider. They have more time. They don’t have to have a short visit and refer it all out to a specialist to optimize their take home pay because that’s not how they get paid, which then serves the employer. And then we’ve connected with the health systems, so that employee and that employer, if they need further care, we can coordinate that care, versus, good luck. In one of my jobs in the health system in the past, a patient once said, you know, it’s a full time job trying to be a patient here, right? It’s not easy to navigate the healthcare system. We work with our health system partners, we know it’s complicated, and help that employee navigate that. So all of that is of tremendous value, I’d say, to all those stakeholders. But certainly the employer understands and increasingly the leadership there is understanding how we’re making these impacts and why that’s so foundational to I think better results.

Gary Bisbee, Jr. 23:30
Amir, I can see there’s a number of answers to this. But let me ask the question, how does One Medical decrease costs?

Amir Dan Rubin 23:37
First and foremost, we start with the member, as opposed to calling it the patient, right? We have the concept of a member model. And so if you know who the member is, you can start doing a lot of population health type things on them. But typically, in commercial insurance, it’s hard to know who the member is because they’re in an HSA, high deductible free for service wide network. Well, we’ll participate in those networks or in a capitated HMO network, either one, but in the open network, we know who the person is. And then because we make access frictionless, they really like engaging with us. 45% monthly active use on the tech. So already, we’re off to a great start. I know who the person is, and they want to engage with me, and they trust me. And then you could start nudging them and reminding them and helping them, whether it’s time for a mammogram, or a pap smear, or colon cancer screening, or managing your blood sugar, or blood pressure, or anxiety and stress. And by the way, we can manage all of that in our model. And people can get on 24/7 in our tech and engage on that or can come into one of our locations. So having the membership model, being able to engage in population health proactively, sets you up on a good footing. Then we’ve done a number of things beyond that. Well, having a primary care model that not only is easy to access, and we show we have in that JAMA study. We not only showed that we save costs, but we showed we had 33% reduction in emergency room costs, 43% in surgery, and 54% in specialty costs. Well, why is that? What happened? Well, if you have a salaried model primary care that you can get into anytime easily and you can get online that won’t charge you, and you trust it, and will even reach back out to you, and the providers are paid on salary, and have more time, so they don’t have to refer everything out unnecessarily, it takes down costs. So I think the components that we have aren’t novel, per se, I think what’s novel is stitching those components together into a technology operating and business model that can perform at scale. But I think a lot of people know like, if you make primary care really easy, don’t charge people at the margin for things, don’t pay the physician to do a lot of things, that those things can help reduce downstream spending, which is what we’ve demonstrated.

Gary Bisbee, Jr. 25:44
Yah, you can’t overweight, the value of the membership model, if you ask me. I was pleased to see that you’re expanding the continuum, added pediatrics, behavioral health, chronic disease care. What does that actually mean for One Medical and the service you provide the members?

Amir Dan Rubin 26:03
Yeah, this is really exciting. We believe we can be a ubiquitous model to transform health care for all across the country. I mean, in the next year or so, we’ll be in 28 markets, which can reach at least, population wise, 40% of the US population. And we believe we can do this across every stage of life, from pediatrics to geriatrics, if you will. We can leverage a common brand, a common technology platform, these relationships with these great health network partners for coordinated care. And certainly, we can do that for kids, adults, and seniors. Now, there may be different reimbursement models in the at risk senior place versus the commercial, or they may converge. We could take at risk and commercial. It just depends what’s out there, but we basically have the capabilities to serve all these populations and can leverage kind of this common clinical background, technology background, and operating background or operating system to serve a wide population range.

Gary Bisbee, Jr. 26:59
Will you be adding additional specialty areas?

Amir Dan Rubin 27:03
Well, we have kind of, I’ll say, built out on top of primary care. You know, I think one of the things that makes us so great is we’re built for purpose. We work with amazing health systems that do incredible specialty care. Let’s leverage the best in specialty care and then make that coordinated for our members, rather than us, so to speak, making that on our own. So we see ourselves as helping coordinate across things and help that member own the complexity of getting health care. But we really see ourselves as delivering care around the primary care arena. Now that could include, we’ve included behavioral health. That can include, obviously, chronic disease management and other areas. But, we want to partner with the best partners, whether it’s health systems or health plans, to offer those other services. And that’s partly how we deliver 90 NPS and how we take down cost of care. We’re focused on those things, right? And we let other great organizations focus on what they do well.

Gary Bisbee, Jr. 27:59
So I’m assuming with your background, really, and with this model, that health systems would be interested in a relationship with One Medical. What is that trend? You have access to 40% of the population in a country. Does that mean that there’s going to be a large number of health systems that you have a relationship with?

Amir Dan Rubin 28:20
Well currently, before adding Iora, you know, we have partnerships in 100% of all of our markets, which before I era will be 22 markets with Ira will be in 28 combined markets. So, yes, and these are working with, you know, premier health systems in the US to coordinate care. And they’re large and complex and doing a lot. We kind of fit in them as another strategy for growing their attributable lives for coordinating care. Consumers, and employers, and some interested in at risk and seniors, we’re another avenue for them to kind of build out their network strategies. From our perspective and from our members’ perspective, this is facilitating access to the best health care in the United States and doing it in a seamless coordinated way. I mean, that is what I believe we need to do nationally. You mentioned Kaiser before, which is a great organization. It’s pretty tough to vertically integrate in every market.

Gary Bisbee, Jr. 28:32
Yeah.

Amir Dan Rubin 29:10
So why not, if you will, do that digitally and clinically, with best partners in each of the markets, and create that kind of vertically integrated experience that’s delivering HMO-like cost results with concierge-like customer service results with the best health systems and health networks and health plans out there. That’s kind of how we’re seeing the future and how we’re partnering with these great organizations.

Gary Bisbee, Jr. 29:35
Well, we mentioned Iora several times. Can you just quickly share with the audience, what is Iora’s business and why One Medical chose to acquire Iora?

Amir Dan Rubin 29:47
Yeah, absolutely. So it’s very similar to our legacy One Medical, if you will. This was a member-centered, patient-centered, largely thinking about members in an at risk perspective, and technology powered organization, primary care organization, with salaried providers and built for purpose technology. They were just built largely around the senior space. So that really lined up nicely with us. They also had a model that was very digital forward. They have 19 touches per member per year, four to five to one ratio digital to in person, very similar to our ratio at One Medical. And they had really built out capabilities on managing at risk populations, engaging these members, managing their health, managing the capitated dollar, if you will. And that fit very nicely with our member model, technology model, that also managed the total cost of care very well, had very high service. So this allowed us to accelerate kind of our development in the senior space. And, frankly, we were already having thousands and thousands of seniors, and thousands and thousands aging in in legacy One Medical. And as you go to 22 markets plus and have reach to 40% of the United States, you start serving more and more populations and the at risk model if you can perform in it. And we are and we believe we can continue to. It makes a lot of sense in the senior space. And now you have about 40% of seniors in the US ain Medicare Advantage. And now with this direct contracting model, which is basically an ACO like model, but allows the ACO, the provider, the group, to take 100% up and downside risk. So it’s not for the faint of heart. But this now expands basically a wide swath of Medicare that you can take full risk on, not just those choosing an HMO or a Medicare Advantage plan, but also original Medicare patients. So that really creates a wide opportunity for us to expand our total addressable market as well.

Gary Bisbee, Jr. 31:41
I’m going to ask a question that I’m sure all the Wall Street analysts ask. And that is, are there additional acquisitions in your future?

Amir Dan Rubin 31:49
We certainly don’t close ourselves off to opportunities. But even I’d say with the Iora acquisition, really, our model is an operating system model. It’s not an acquisition model. The reason we brought in Iora is because it fits with our current model. We will be one model, we will have one brand, we will have one technology, we will have one group approach. That approach might be titrated, if you will, based on complexity of the patient, how they risk stratify, and what needs to be done on that patient, vis a vis their reimbursement model. I think the key thing about us is, we’re a model that we believe and we’ve shown can scale and deliver that kind of consistent service and experience and cost results at scale, because we built a tech and operating platform to do it. You know, this isn’t about just buying groups or something. And that can be a fine strategy for people. But our approach is to have a consistent experience nationally. Think more like Starbucks than a roll up of coffee shops and diners. Right, a consistent experience.

Gary Bisbee, Jr. 32:47
A couple of questions for you as the CEO. First of all, you followed Tom Lee, who was the founder of One Medical, and there’s all kinds of horror stories, of course, about following founders. How did that go when you made that transition?

Amir Dan Rubin 33:00
Oh, that all went great. You know, I had met Tom, the founder, when I was CEO at Stanford well over a decade ago, and we at Stanford, through our little venture arm invested in it. And you know, I didn’t really have a otherwise close connection to him all these years. But, you know, it was a point in the lifecycle, of his lifecycle with the company, and of the company that they were looking to bring in new leadership. And that’s when I engaged, so it was it was great. It was very smooth.

Gary Bisbee, Jr. 33:27
Yeah, as long as it works, it’s terrific. And obviously it has in this case, so credit to you and to Tom. Another question of interest to people will be, One Medical went public almost a year ago now. Being a CEO of a publicly traded company is somewhat different than being a CEO of a private company. How have you found that transition, Amir?

Amir Dan Rubin 33:48
Overall, it’s been great. I’m focused on the same things that I’ve always been focused on, which is, my true north is the member, the patient, the customer. How do we deliver for them? And how do we do it through this human centered, member centered, and technology powered approach? You know, at some level, that’s not that different. I don’t really focused on the stock price, right? I’m not naive to these things. We obviously have, you know, quarterly earnings and investors. And those are, you know, really important, but we had private investors before this. They were really important. On nonprofits, we have boards and community stakeholders who are also really important. So I’m not sure from an overall leadership perspective, that’s that different. I mean, at some level, it’s a different financing mechanism, right? Going to the public equity versus the private equity markets versus the private debt markets if you’re a nonprofit or if you’re in a for profit health system, you know, equity and debt. What is different, what I really do like, I do like engaging with the investors and analysts because they’re smart. They have great questions, they’re studying the market, they keep you on your toes, which is great. And so I think that part is super fun. But I’d say on a day to day basis, and in the company, people are doing the same things. I’m not sure that changes that much kind of from an operations perspective.

Gary Bisbee, Jr. 35:02
Amir, this has been a terrific interview, very engaging, very informational. I have one question to wrap up if I could, and that is that our audience consists of a number of early stage leaders, kind of up and coming leaders. What advice would you have for an upcoming healthcare leader today?

Amir Dan Rubin 35:22
Yeah, well, you know, it was like when I took that health economics class in college. You know, part of what got me excited was I was like, wow, this, this is a giant system here. And it’s not working, s well. I wonder if a new young person coming into this can make a difference, right? So you could still say that same thing today. Gee, this is a giant system that isn’t working quite that well. I wonder if there’s some new thoughts and energies and ideas. So I think that is absolutely true and continues to be true. So I think it’s just a wonderful field to be in and it’s vast, right, you know, approaching $4 trillion in the healthcare ecosystem. So there’s a lot of areas to get involved with. So I think it’s a fabulous field. I also think for me, at the core, it’s about helping people. And that’s really rewarding. And you get to work with mission driven, caring people, which I think is great. When I step back a little bit, and at One Medical, we want to help our members. We also want to transform the entire system. So you know, that’s a big goal. But I think that’s fun. And I also think, you know, if you love what you do, then you can really work hard at it, and you can be energized in it, and you can study it, and you can engage with people. And I think that leads to further positive things. Success, however, one defines success in one’s own mind. But if you enjoy what you do, and you feel like you’re making an impact, so I think healthcare leadership is a fabulous field to do it in. There’s so many great organizations over there out in the industry, and it’s changing, it’s ever changing. I feel very blessed, very fortunate to be in this field.

Gary Bisbee, Jr. 36:54
Well Amir, we appreciate your time today. You’re doing a terrific job at One Medical and we look for big things out of One Medical going forward. So thanks again.

Amir Dan Rubin 37:04
Gary, thank you, a real pleasure being with you. Thanks so much.

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