Carlos is the President and Co-founder of RubiconMD. Originally from Spain, he’s passionate about leveraging technology to drive change in healthcare and improve patient lives. Prior to RubiconMD, Carlos led a division at Telefonica, one of the largest telecom companies in the world. He began his career in digital health at Siemens Medical in Pennsylvania. He obtained his Engineering degree at the Polytechnic University in Madrid, Spain; with specialization in Biomedical Engineering at the Technical University of Delft in the Netherlands. He also holds an MBA from Harvard. Carlos was named a Young Global Leader by the World Economic Forum.
USEC had a unique opportunity to hold this exclusive interview with Carlos to discuss his career, his international experience, his business, COVID-19, entrepreneurship and other topics..
1) You came to the US with an engineering degree from the Polytechnic University of Madrid and executive experience at Telefonica in Spain. After getting an MBA at Harvard, you co-founded RubiconMD in New York City in 2013. Creating a successful start-up with no prior professional experience in the US is an outstanding achievement. What do you think were the keys of this success and what lessons did you learn in the process?
To be fair I had a little bit of prior work experience in the US since I had started my career at Siemens Medical in Pennsylvania in 2007/2008, but for all practical purposes, I was indeed starting from scratch when we founded the business in 2013. I think almost every entrepreneur has a little bit of 3 factors: irrational optimism, true passion for something and the willingness to work hard irrespective of how difficult things get. In my case improving access to healthcare was personal to me, and that was key to give me the energy and motivation to overcome the many barriers on the way.
One thing that has been constantly both a key to success and also a lesson upon which to keep improving is the importance of having the right talent and partners onboard. Starting with a co-founder but also across employees, investors and clients, I believe it’s critical to always surround ourselves with people who are better than we are and then empower them to own their function and be accountable to their results. We would not be here today if it wasn’t for the amazing employees, investors and partners we’ve been able to bring onboard.
2) How would you summarize the value proposition of RubiconMD?
In the US healthcare system, there’s a double challenge with the fact that roughly 50% of the country really struggles with access to specialty care, while at the same time about 40% of the visits to specialists are unnecessary.
RubiconMD tackles both problems by connecting primary care clinicians (PCPs) with specialists for remote consults. Whenever a PCP or general practitioner has a question about their patients, they can ask a top specialist on RubiconMD across more than 100 specialties and subspecialties. Based on the response from the specialist, the PCP can make a more informed decision on diagnosis, treatment plan or next steps in patient care. This results in improved care plans and avoidance of unnecessary referrals, both providing better care in primary care and reducing total cost of care.
3) COVID-19 has disrupted multiple services but it has also created enormous opportunities for many companies. How has it impacted your company during 2020 and what are your expectations moving forward regarding changes in society that may become permanent?
COVID has pushed forward telemedicine to the point where many clinics were conducting over 90% of their patient visits virtually. This has introduced both patients and providers to try telemedicine for the first time, and many will likely continue even after we are past the pandemic. We believe that virtual first primary care is the future, and that RubiconMD can serve both the virtual and traditional in-person settings. The pandemic has also highlighted other areas of need for primary care, especially behavioral health, and we have rapidly developed and released a BH product to best serve our primary care partners and their patients. We will continue to expand upon our capabilities to best meet the needs of our clinicians.
Traditionally, we talked about improved care and reduced costs for the system, but during the pandemic the impact has magnified tremendously as we’ve contributed to save lives. Eliminating the need to go see a specialist unnecessarily when Covid infection rates are still high, has become a lifesaving intervention for senior patients or those with chronic conditions.
4) Are there any plans to take the RubiconMD business to Spain or other countries?
RubiconMD has a Spain based wholly owned subsidiary from which we hire strong technical talent. We have developers in several cities in Spain and plan to continue growing the team given the exquisite quality of the engineers in Spain.
In terms of commercial presence, we’ve been focused on the US doe to the size of the problem and the complexities of the system. We have also done small projects internationally supporting clinicians across school systems, refugee settlements or malnutrition clinics, as part of our efforts to give back to society.
The healthcare system in Spain is not perfect but it provides very good access to care when compared to many other systems and the overlay of the public and private systems makes it also very competitive. I believe we’ll have an opportunity to contribute in the future and support clinicians in the national health system (most of primary care is in the public system) and potentially help reduce wait times across specialties. It would mean a lot to me.
5) Health is a highly regulated industry, even more in the US. What kind of regulatory issues (FDA, etc) has your company had to deal with and what lessons did you learn from the process?
One of the biggest hurdles we’ve had to overcome in the early days of the company was understanding the regulatory framework and ensuring that our specialists could respond to consults from across the country as we designed our solution to be an informational service amongst clinicians.
Given we’re an online service that handles protected health information, we had to build our infrastructure to maximize security, comply with the corresponding regulations (mainly HIPAA) and even achieved third party accreditation through HITRUST. These are requirements that most tech startups don’t face in other industries but in healthcare (and similarly in finance) these are absolutely necessary pieces of the innovation process.
6) Why did you decide to create your company in New York City rather than in Silicon Valley or biotech hubs like Boston?
My co-founder and I actually met in Boston at a Hacking Medicine event at MIT. We however did an incubator program early on in NYC and hired our first team members there, making the decision to settle in the City. NYC was a great place to start the business at the time, given the prevalence of talent, investors and also a solid healthcare ecosystem with large systems, healthcare payors and pharma companies based in NYC or close to it.
Given how remote the world has turned during the pandemic, we’ve broadened the scope and now we hire team members not only in Spain but also across the entire US and not necessarily just in NYC anymore.
7) COVID-19 has impacted significantly New York City and other big cities leading to massive amounts of people moving to lower cost areas while telecommuting. Some companies have decided to maintain telecommuting even after the pandemic ends. How has your company adapted to the lockdowns and what kind of changes do you expect to be preserved in the future?
Even before COVID, we as a company had a pretty flexible work-from-home policy and employees working fully remote from California and Spain. So, when the pandemic hit, we already had some semblance of how to work together in a remote setting. Of course, it was and still is a big challenge to have everyone remote all the time, and we have put a lot of effort into making sure our employees have what they need from a tools and set-up standpoint to work from home. We have also had to find the balance between ensuring we remain connected while not causing extreme Zoom fatigue on the team. Moving forward, I would expect remote work to become a bigger part of how we work but am very much looking forward to having the team back in office!
8) After 8 years since the company was founded as a start-up, what kind of advice would you give to international entrepreneurs regarding how to interact with venture capital firms in the US?
There are wide differences across VC firms in the US alone and it’s important for every entrepreneur to understand what they want first and then to find the fund and the partner inside the fund that will be a good fit for them.
Some funds have an investment thesis around backing companies who can become a Unicorn, even if they have a 98% chance of failure and will want to be in and all or nothing mindset. Other funds will want to see business fundamentals across every step and push entrepreneurs to be a lot more conservative with expanses and extend runway. There’s now right or wrong answer, what’s important is that both the entrepreneur and the fund are aligned.
Outside of that, it does require time and effort to build those relationships with funds. Trying to open up a new door when the need to raise the funds is already here is likely not going to end up in a successful outcome. I’d recommend doing the homework upfront and building the relationships over time so they can get comfortable with the team, the idea and monitor the progress over time before talking about investment opportunities.
9) Having led teams on both sides of the Atlantic Ocean, which have been the most relevant cultural differences that you have found and what advice would you give to executives from Spain working in the US?
I think as Spaniards we tend to be a lot more measured when we communicate our ideas, and we don’t let our passion show too much. I’ve noticed that founders and executives in the US are, generally, very strong presenters. It’s important to understand that we’re competing with very eloquent native speakers who have mastered the art of delivering an idea with full energy and conviction. It’s also not easy to push yourself out of the comfort zone if you’re not a natural-born public speaker but, whether you’re fundraising, selling, recruiting or else, I believe this is a critical skill, and would encourage everyone to practice over an over since there’s not such thing as being good enough at it!