Richard Lungen (HC9)

You mention your third company, TAVHealth. Can you tell us a bit about that, and how it may have inspired you to found RightSite.

Jamo Rubin (RightSite Health)

We first tackled this back when Don Berwick took the helm at CMS. He saw that fee-for-service medicine rewarded activity, not outcomes, and moved quickly to flip those incentives. Nobody was calling it “value-based care” yet, but his Triple Aim—lower cost, better outcomes, and a great patient experience—set the goalposts.

That shift inspired TAVHealth. Clinicians knew how to treat patients inside the hospital and their clinics, but they had no visibility once those patients went home. Too often, people returned to the same conditions that made them sick—housing, food, transportation, you name it. Under fee-for-service, readmissions pay. Under value-based care, readmissions hurt. So we linked hospitals and health plans to the community groups already solving social-determinant issues. When we were able to connect the clinical care plan a social care plan, you got the Triple Aim: outcomes improved, cost went down, and satisfaction rose – for everyone.

By the time we sold TAVHealth to Signify, we’d helped about six million people close those SDOH gaps. It was never an easy business, but it proved how critical SDOH is to real-world results, and we learned a lot about how to do this work.

RightSite grew out of a pattern we kept seeing at TAV: when people don’t know where to turn, they dial 911. Every doctor’s voicemail even tells them to. America’s 911 system now fields over 130 million medical calls a year, and roughly half aren’t true emergencies. Yet the EMS dispatcher has only one tool – an ambulance. Once an ambulance shows up, the default destination is the ER, which costs eight to ten times more than necessary and clogs critical EMS capacity.

RightSite adds another option: real-time telehealth that keeps non-emergent callers out of ambulances and the ER, connects them to the right care, and addresses the social issues that likely triggered the call in the first place. It’s the next step in making value-based care work where it starts—at the moment of need.

Richard Lungen (HC9)

Thank you for that explanation. Can you talk a little bit about how RightSite solves this problem?

Jamo Rubin (RightSite Health)

When a 911 call involves an urgent medical concern that is not life-threatening, 911 dispatchers or in the field EMS will offer to a patient an on-demand telehealth visit with a board certified RightSite ER physician and a navigator.

They’ll say, “look, ma’am, you have an urgent problem but not an emergency. We can send an ambulance and take you to the ER, but because you don’t have an emergency, you’re going to sit in the back of the waiting room. You could be there for many hours. I have no idea how you’re going to get home, and there will be no follow-up. I’m ready to take you, but if you’d like to talk to an ER doctor immediately on my iPad with me sitting next to you, I can tap the Zoom link and we’ll be on with a doctor and a navigator. What would you like to do?”

When EMS offers RightSiteto non-emergent patients, over 95% of these patients choose not to go to the emergency room.

So what does that mean? It means patients called 911 to see a doctor, not to see an emergency room. They just didn’t know they could see an ER doctor in their own home. Now, when RightSite’s board-certified ER doctor shows up on this tele-health call, their first job is to confirm that the patient doesn’t have an emergency and then to quickly create a clinical care plan in real time.

Then the RightSite Navigator, who is always on the call with the Physician, helps and follows up with the patient to execute the clinical care plan laid out by the Physician. For example, when working with a patient with a urinary tract infection, the Navigator would find a close-by urgent care clinic, schedule an appointment, arrange for transportation (50% of RightSite patients don’t have access to transport) and then arrange for prescription pick-up or delivery. The Navigators solve social determinant barriers like access, transportation, and medication with a closed-loop referral process. About 75% of these patients will take our Navigator’s call the next day which is many times higher than any health plan’s follow up reach. Why do these patients pick up the phone? Because their navigator was kind, empathetic, solved their problems and helped them avoid going to the emergency room.

For the patients, the result of this on-demand tele-health and social determinant navigation is that appropriate care is delivered on the spot. Additionally, social determinants, which are often the root cause, are solved, and unnecessary current and future ambulance transports and ER visits are avoided.

The patients aren’t the only ones who benefit, all stakeholders benefit when RightSite is deployed in a community.

For EMS, it decompresses their overwhelmed response system. If 50% of these calls are non-emergent, that means 50% of the ambulance rides don’t need to happen. If you call 911 with a true emergency, it will take longer to get an ambulance because half the available ambulances are tied up with runs they don’t need to be on. It also saves the EMS system $1000 for each avoidable ambulance run.

For health plans, the measured value is for cost avoidance that they can see almost in real-time. This generates immediate savings for health plans that are clearly attributed to RightSite. And the numbers speak for themselves, with 85% of non-emergent patients redirected to alternative (non-emergency room) sites of care.

For emergency departments, it solves the problem of an already overcrowded waiting room, full of patients who don’t need to be there.

Richard Lungen (HC9)

We always have to ask this in healthcare, who’s paying for it?

Jamo Rubin (RightSite Health)

RightSite is paid only after the health plan measures value – no one pays us up front. We get paid after plans save. Health plans don’t have many opportunities like RightSite, where, on the same day of service, quality improves, costs go down, and attribution is clean. With no upfront cost.

Richard Lungen (HC9)

So this model is beneficial to all stakeholders.

Jamo Rubin (RightSite Health)

Yeah, it’s really interesting. In health care innovation, there’s almost always a winner and a loser. In this case of improving non-emergent care for 911 callers, there really aren’t any losers.

So we’ve identified a big problem and created a very elegant solution where essentially there are no losers.

Richard Lungen (HC9)

Are there other people doing this in the country? This is clearly a big problem countrywide. How is your model differentiated from anyone that you would consider a competitor?

Jamo Rubin (RightSite Health)

This is a big problem with a long history. Over the past few decades, payment rules have nudged almost every patient toward the emergency department. EMTALA guarantees care, but the dollars only flow when an ambulance drops someone at a hospital, so EMS is paid to transport—even when care could be delivered elsewhere. Over time, 911 and EMS have become the default front door for non-emergent clinical and social-determinant gaps, stretching EMS agencies really built for true emergencies. Now, the 911/EMS/ER model is out of sync with patient needs, cost pressure, and the technology that’s available.

I think one of the reasons that it is just now becoming solvable is due to a couple of things. COVID introduced telehealth to the world. It also introduced the idea that emergency room waiting rooms are full of sick people, and you don’t want to be there. What was new is the idea that you could take technology like telehealth, you could create an elegant operating platform that made it available on demand and activated by EMS, and that solves both a clinical and social determinant or logistical problem in real-time.

A few competitors are trying to solve this problem, and that’s healthy because the need is huge. RightSite, however, offers what the others don’t. We connect patients with board-certified ER physicians on demand AND pair each telehealth visit with a Navigator who solves the SDOH and logistical hurdles that otherwise push people to the ER. Take away the RightSite Navigator, and even with a telehealth doctor, most 911 callers still end up in the ambulance on the way to the ER. Our deep experience with SDOH and our commitment to using only board-certified ER doctors are hard to match.  After 12 years of running TAV, we know just how hard this work is and we know how to do it. Success is relationship-based, and we have figured out how to build those relationships with patients, their families and our EMS partners. That is one of the competitive advantages that we have. Our proven ability to de-escalate, connect, and make our patients feel that we see them is critical. And it’s not just plug and play. It’s not standalone AI. It’s not an app. It’s a relationship.

Richard Lungen (HC9)

So, Jamo, what’s next for RightSite. Where will you be focusing for the next year.

Jamo Rubin (RightSite Health)

Well, you know, everybody’s got their dreams of what’s in the distance. Let me just talk about 2025. Building tech-enabled service companies, it’s very easy to get ahead of yourself. This year is about the discipline of building out the operating platform. It works today. No doubt it works. We’re re-directing the care of 85% of the non-emergent 911 callers. But the next layer of operational execution is to get the platform ready for scale.

Richard Lungen (HC9)

And finally, why did you choose to work with HC9?

Jamo Rubin (RightSite Health)

Our management team has worked in the startup/VC world for many years, and we’ve had the opportunity to meet a lot of groups that could be great partners as investors and as board members. And so we were picky, and we were lucky enough that we could be picky, and that doesn’t always happen.

We chose HC9 because of the track record that you all have brought in your careers to help companies like ours, tech-enabled service companies, refine strategies and business models, and help position value with health plans so that they understand that what a particular company does is different, purposeful, measurable, and matters.

Additionally, and important to me, was that you guys are operator-led. Most of you have been operators, and bringing that operating experience across payers and providers, and frankly, you’re entrepreneurs. You started a fund. Almost 20 years ago, you and Charlie built a business consulting with companies for growth services. And I know you and Charlie also were involved in pulling out a company from United Health Group and grew it extensively.

That experience at a board level is a very important balance to other investors and board members that are financial-based which is an important perspective. But the trick of a really valuable board is to have a balanced view when things are tough, and the solutions are ambiguous, and the news is bad – that’s critical. To have both an operator-led perspective and a financially led perspective available to help management figure out how to solve problems that sometimes seem intractable, was very important to me. And you guys brought that in a very important way.

About RightSite:

RightSite partners with EMS in-dispatch and on-scene to connect non-emergent patients with a Telehealth ER Doctor and navigate them to the right site of care.

For more information visit rightsitehealth.com