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Neil Patel

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Rami Karjian’s healthcare startup has not only raised tens of millions of dollars, but has redefined what hospitals are. The timing couldn’t have been better. His company Medically Home has successfully raised $80M from top-tier investors like Cardinal Health.

In this episode you will learn:

  • Timing your market as a startup
  • How COVID has changed healthcare
  • Managing through highly complex markets as a startup
  • Rami’s top advice for other entrepreneurs

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    About Rami Karjian:

    Rami Karjian is the CEO of Medically Home. Rami Karjian began his journey in healthcare with McKinsey & Co, working together with health systems to improve patient flow across different areas of their hospitals.

    After a few years in the US, Rami Karjian moved to Asia to lead the firm’s Operations practice in the region. After over a decade with McKinsey working with hundreds of clients across the globe, Rami Karjian wanted the challenge of taking on an operating role allowing him to personally put into practice what he had been advising his clients for many years.

    Rami Karjian joined Flextronics as President of Flextronics’ Global Services & Software business (the leading technology repair and reverse logistics company globally) where he was responsible for a business of 15,000 employees with operations in 25 sites across the Americas, Europe, and Asia focusing on forward logistics/distribution and reverse logistics/repairs and spare parts, enabled by leading-edge software solutions.

    Since 2015, Rami Karjian efforts have been focused, with his co-founders (Raphael Rakowski and Andy Lipman), on scaling Medically Home Group as its CEO. Medically Home Group is the first commercially viable Virtual Hospital healthcare technology services company, providing all tools allowing its health system customers to safely bring hospital-level care where patients live.

    As part of that, Medically Home’s team of nurses and physicians in its Mission Control Medical Command Center in Boston provide Virtual Hospital care to patients across Massachusetts, as well as additional customer operated command centers, providing Virtual Hospital care to patients across Florida, Wisconsin, Oregon, California, and Ohio.

    Connect with Rami Karjian:

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    FULL TRANSCRIPTION OF THE INTERVIEW:

    Alejandro: Alrighty. Hello everyone, and welcome to the DealMakers show. I think today’s guest, we’re really going to be learning a lot. What a journey, bouncing from one place to another growing up and now building a company that is a rocket ship. We’re going to be learning quite a bit, and I don’t want to make you all wait any longer. So, without further ado, let’s welcome our guest. Rami Karjian, welcome to the show.

    Rami Karjian: Thank you, Alejandro. What an energetic introduction.

    Alejandro: So, born in Beirut. Obviously, Beirut has gone through a few bumpy decades with all the changes in politicians and also a civil war. So, how was life growing up there?

    Rami Karjian: Bumpy would be such a great expression, but also, lots of contrast. A great example is my family grew up skiing in Lebanon before Dubai had the only skiing in the Middle East. On weekends, we would go skiing, but in order to get to the ski resorts, we had to pass through a sniper zone. So, you have to duck at exactly the right time to avoid getting shot. That says so much about Lebanon in terms of the contrasts of Lebanon and the love that the Lebanese have for life.

    Alejandro: Wow! That’s amazing. I guess, obviously, those were times of uncertainty, times of fear. How would you say that has shaped you and your personality, and perhaps your entrepreneurial spirit, too?

    Rami Karjian: I think there’s something among so many Lebanese, which I share, which is a very optimistic outlook on life. In a way, it’s the only way to survive a lot of the challenges that Lebanon went through with the civil wars and the other disasters. I think that optimism, as an entrepreneur, building a company with my partners has served all of us very, very well.

    Alejandro: Let’s talk about coming to the U.S. Why did you decide it was time to come to the U.S.? And even before this, I guess you also bumped a little bit, or you jumped from one place to another after the civil war started, so I’m sure that helped you be a little bit more at ease, perhaps with uncertainty and with having to start all over again with new friendships and new beginnings in new places.

    Rami Karjian: Yeah, that’s exactly right – dealing with a lot of ambiguity and a lot of change. Until 2010, my wife and I joke that I had never lived in the same country for longer than three years since I was born because of all of the moving around. I think, to your point, it does make me very resilient and very adaptable to change, and also, always learning – the chance to learn new cultures. After we left Lebanon, I spent some time in Saudi Arabia. I spent some time in Kuwait, and I spent some time in London, which were very different cultures and a wonderful learning experience.

    Alejandro: Let’s fast-forward and talk about coming to the U.S. Why did you want to come here to the U.S., and how was that experience?
    Rami Karjian: A wonderful experience, and set me up for life. I met my wife when I came to the U.S. for college. Look, the reputation that the U.S. has in terms of its universities and colleges and the training is really world-class, and I was so attracted by that. So, that drew me to the U.S., to come for college. Then I met my wife, who is American and loves to travel and loves to learn. Then, we continued the journey together from there.

    Alejandro: After college, you did work a little bit for Procter & Gamble, and then you got your MBA. Then, instead of really doing the entrepreneurial journey right away, which is typically what people do after doing an MBA, you decide to go into corporate, and you do consulting. You were there for quite a bit, so how was that for you?

    Rami Karjian: In a way, I saw it as a continuation of the MBA. I went to UVA, which is 100% case-method-based, and I loved learning all these stories of companies and how they fought the good fight or didn’t. I saw consulting as a wonderful way to continue that and to continue learning. I thought that after a year or two at McKinsey, McKinsey would decide that it no longer needed me. But, I blinked, and 13 years and about seven countries later, I had had a wonderful, wonderful experience and learned a ton.

    Alejandro: They say that consultants make really good entrepreneurs. Why would you say that’s the case?

    Rami Karjian: I think one of the characteristics is being very curious. Any consultant who has been in that environment for a while, you learn to get curious. That’s how you see opportunities for your clients, and I think that’s a big part of it – being curious, seeing opportunities, always wondering if there’s a better way to do things, always wondering if there’s a different angle you can take on the problem that hasn’t been done before. I think those are characteristics that also really help entrepreneurs.

    Alejandro: After 13 years, why did you decide it was time to move to more of an operational role?

    Rami Karjian: I wanted to move from advisory and setting strategy, as a consultant, to doing and a chance to focus and dig in and implement what I had been advising my customers. So, the opportunity that I had after that was leading a team of 15,000 people, which was a wonderful way to put into practice a lot of what I had been advising my clients and a chance to do it for an extended period of time.

    Alejandro: Let’s talk about meeting your two partners and traveling around the world.

    Rami Karjian: Look, I’m blessed with two incredible partners. I didn’t know what we would do together, Raphael, Andy, and I. I just knew that we would accomplish something that would change the world and that we just had to be open to the universe guiding us what that would be. We did many different things together. We did solar; we did energy; we went to El Salvador and Costa Rica. We helped buy a cargo airline, and all of those things set the pattern of how the three of us would work together, have fun together, make big things happen together before we started Medically Home together.

    Alejandro: And starting and building and scaling a company, there’s a lot of intensity, and a lot of uncertainty, and a lot of action. But you’re exposed to action way before that when you were with your partners traveling in El Salvador with a hotel bombing.

    Rami Karjian: Yes, that’s exactly right. We were doing trips to El Salvador a couple of times a month, and the hotel where we liked to stay, after our last trip, the day after we left, the restaurant of the hotel where we liked to hang out at night and strategize our next moves was hit by a grenade. El Salvador deals and dealt with its own struggles, in many ways, like Lebanon. That marked our last trip to El Salvador.

    Alejandro: Because Intersection Partners, what was the company about?

    Rami Karjian: The company was started by my partners, Raphael and Andy, with the idea to heal the planet, and work on clean energy, and also heal each other, and work on healthcare. I joined them under that mission, and it took us a broad range of places.

    Alejandro: Why did you guys decide it was time to transition into Medically Home? What was that transition like?

    Rami Karjian: It was an incredible transition, and part of it was driven by the very strong conviction that Medically Home was such a big idea and such a great opportunity to affect change that we didn’t want to just incubate it and hand it over to a management team. We wanted to be part of that management team and do it full time. It’s, in fact, an idea born out of a personal disaster that my co-founder, Raphael, had with his father and hospitalizations that his father had experienced, and it was a continuation of that idea. We just weren’t ready to let go of that, and we wanted to go all into it and build a team with us to do that. That’s how we ended up going full-time on Medically Home.

    Alejandro: Let’s talk about the early days of Medically Home. How did you guys bring it from incubation to life, and what was that like?

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    Rami Karjian: The first thing I’ll say is like any entrepreneur in a startup, we had an enormous amount of conviction, and we bootstrapped the company, and we didn’t want to take any outside capital until we had treated our first patient. So, we were laser-focused on working with our first customer to get to the first patient. And the three of us and the small team that we had at that time – we did everything. Whatever needed to be done got done by the three of us, and we all played lots of different roles working with the team. That sense of satisfaction when our small band treated our first patient, a 96-year-old, legally blind, hard of hearing, a wonderful gentleman by the name of Chuck, we brought the hospital to his home after probably 18 months of effort to build all of the infrastructure required to do that. It was such a feeling of accomplishment to be able to help him and his family.

    Alejandro: That’s something that I wanted to talk about, which is taking the company from launch to the first patient. I know the story with the first patient was really amazing. So, can we expand on this?

    Rami Karjian: Sure. The core idea of the company is it treats patients in their homes with all of the care and the services that they would have received in the hospital. It’s a mix of telemedical care with an iPad, and a phone, and devices and in-person care with nurses and others going into the home. But the key point is, these are patients who otherwise would be in the hospital. Our very first patient, Chuck, that we had all worked so hard to set everything up to care for – when we admitted Chuck into the program, Pippa, our Chief Medical Officer, who is still with us from back then, was explaining to us what the patient was like, and she was saying, “Look, he’s legally blind. He can’t hear. He’s very old, and he’s been in and out of hospitals six times in the last 18 months.” We thought that’s quite a patient to start in – very, very sick, high acuity. I remember a phone call that my partner Raphael made to our customer CEO, Steve, and the reaction was from Steve was like, “Wow. That patient sounds like he’s really sick. Are you sure he doesn’t need to be in a hospital?” Raphael, without missing a beat, said, “Well, he is in a hospital. He’s in our virtual hospital.” That adrenaline of the first patient and such a hard first patient was really something, and it set the course for our company because now, we’re known as the high-acuity, very, very sick patients’ hospital-in-the-home people.

    Alejandro: In terms of explaining a little bit more on the business model, how do you guys make money there?

    Rami Karjian: Our business model actually shifted, and it was one of the big learnings for us to be open to where the market could go. When we started, our business model was, we would provide all the care to patients and their families, like Chuck. What we learned was, the need in the market was to have somebody who could enable really high-acuity, high-quality safe care on behalf of other health systems which would deliver it themselves. So, we switched from a care delivery company to a platform that enabled other health systems to deliver the care. So, the core business model is, we enable our customers, large health systems, who want to provide safer, better care to their patients, and we essentially charge them for virtual beds. So, say that a hospital may build a new tower that might have 50 new beds in it, we help our customers build new virtual towers on top of their existing hospitals, and then we charge them per bed.

    Alejandro: That’s amazing. I assume for something like this, money is required, so how much capital have you guys raised?

    Rami Karjian: We’ve raised, to date, almost 80 million dollars. What’s really important about that is, we worked really hard for it to be almost entirely strategic capital – either capital that came in with partners of our who we work with to build the virtual hospital, or partners who are part of supplying the care to our customers as part of the virtual hospital, or our customers themselves who are investors in the company. That has shaped the culture and the outlook of the company having all of that strategic capital that puts the patient, their safety, their clinical outcome, at the heart of everything we do.

    Alejandro: How would you define strategic capital because I’m sure there are a lot of people that are listening, thinking, “Hey, what’s the difference between just getting some money in or getting strategic money in?” What is strategic capital to you guys?

    Rami Karjian: My simple definition of strategic capital versus financial capital would really be around capital that wants to support us in building the business and also wants to be part of that either as a customer, as a partner, as an enabler, and somehow involved in the operations of the business as opposed to more financial capital that is looking to add value to the business through advisory services and the capital itself.
    Alejandro: Got it. Is there a process that you guys follow to qualify that, maybe like the network or previous experience or things like that?
    Rami Karjian: A little bit of all of the above, and we’re blessed with a great network and a focus on people and people who we can be great partners to. So, ultimately, that’s been our big focus, whether it’s customers, partners that we work with, or capital is just people who think the same way we do, hold the same values that we do, want to change the world in the same way that we want to change the world, and like attracts like from that standpoint.

    Alejandro: 2020 was a difficult year for absolutely everyone. Obviously, going through this COVID thing has been pretty crazy, to say the least, but for a company like Medically Home, definitely, it has accelerated. Maybe the vision or where you thought that you were going to see yourselves, I’m sure it has advanced by a mile of things. Is that right?

    Rami Karjian: Alejandro, that’s absolutely right. It has accelerated by years what we saw as our true trajectory. The biggest part of that is Americans and the world no longer look at traditional hospitals the way they did before COVID. And that’s really changed the importance and how people view hospital in the home, and the ability to have the hospital come to your home where you feel safe, where you feel secure. That change in outlook and mindset has been huge in terms of catalyzing the business both from customers who want to extend their traditional hospitals by having a hospital-in-the-home capability. But also, patients and their families that now know they have an alternative to going to an institutional setting, and rather have the hospital come to them, which particularly given COVID, what we’ve seen, as you can imagine, is people are very, very reluctant to go to the hospital now.

    Alejandro: One of the things that comes to mind here is that as an entrepreneur, myself, and also you, here, Rami, we know that timing is everything. I find that being able to do your right analysis and be able, as well, to capitalize on the momentum is critical. In this case, you guys started the company in 2016. All of a sudden, COVID started to happen. How did you guys approach this, maybe at a strategic level, in order to ride the wave, and then also in order to put your company to go at the same speed in parallel with a momentum?

    Rami Karjian: The first thing I’d say is, my partners, Raphael and Andy, started working on this back in 2010. We joke when people say, “Your timing was right.” Our timing was right after 11 years. I really think it’s about being open to what the market, to what your customers, to what the world is telling you. It’s very easy with hindsight to talk about strategic decisions that we made. I think so much of our success and our success during COVID and using that as a catalyst was about being open and willing to change and about having great people around us who created those opportunities and helped us execute on those opportunities. I don’t think it’s the result of a well-laid strategy, and in fact, if I told you what our strategy was five years ago as compared to what’s happening now, it looks completely different. And that’s okay.

    Alejandro: Yeah. In this case, for you guys, where do you think we’re heading from the medical care and things of this nature, especially now that we’re going to hopefully get to that new reality or new normal soon?

    Rami Karjian: Well, look. Let’s hope things start to change soon. It’s desperately needed, and it feels like such a long road, I think, for everybody. I don’t have a crystal ball. I don’t know what that is going to look like. I do think that people’s viewpoints of healthcare and of work, of course – but to focus on healthcare – will never be the same. There is no going back. We view telehealth now and the ability to get a doctor on demand when I need it as things that we don’t want taken away as consumers and as patients. And I think the same thing holds true for our businesses is, people won’t view hospital-at-home the same way ever again. The other thing that I think it’s done, which has been very, very positive, frankly, has elevated the role that clinicians, doctors, nurses, those who work with doctors and nurses, play in our society and how important that is not only during the good times but especially during the bad times. I think that’s been very important to recognize the clinicians who have helped the world heal.

    Alejandro: Absolutely. Now, they’re on the covers of newspapers and magazines, which is amazing. One of the things that I wanted to ask you here is, when you’re building and scaling, distribution is everything. I’m sure that for you guys, landing Mayo Clinic was quite an accomplishment.

    Rami Karjian: We’re so proud of having Mayo Clinic as a customer and a partner. They’re great people; we’re blessed. Again, I wish I could tell you that was the result of a well-thought-out strategy. Almost all of our business development quite unusually has been – in fact, all of it is a result of inbound calls from people who were attracted to us to our mission, to our capabilities to what we wanted to do, and we found kindred spirits in the team at the Mayo Clinic. The funny story with that is that we got a call from the team at the Mayo Clinic. Basically, they had one conversation with my partner, Rafael, and then they called back and said, “We urgently need to come to Boston,” which is where our command center is and our company. “We urgently need to come to Boston next week and meet with you.” We thought, “Wow. This is pretty incredible. We don’t usually get calls from people saying they urgently need to meet with us and come to Boston. And to have that come from Mayo Clinic is such an incredible honor. But it wasn’t the result of strategy. It was the result of being who we are and attracting people who resonated with that. Now, we’re making history together.
    Alejandro: That’s fantastic because typically, being able to land a partner of this caliber, it takes a lot of red tape when we’re talking about this industry.

    Rami Karjian: Yeah, and in some ways, that’s true.

    Alejandro: Definitely, one of the stories that you’re going to share with your grandchildren one day is working with the White House, so what is it like to work with the White House when you’re a startup?

    Rami Karjian: I will say it’s pretty incredible when COVID hit, and the nation’s capacity of hospital beds just got into a severe crunch, and we know the story of how that played out with ICUs. We had an opportunity to work with the White House and to work with CMS on coming up with some creative solutions that involve some of the solutions that we offered in terms of creating capacity for hospital beds in the home. I remember we were working one particular intense week period with a couple of our partners to send a letter into the White House and have conversations with the White House about how we could play a small part in solving this crisis. And it was 24/7 work, and very, very intense, and lots of people involved, and lots of creativity. Our company was at the center of that. And just to be able to witness how a startup, with the right partners, could play on a national stage and could be working with the White House to come up with national solutions. We, together, sent this letter into the White House that said, “This is what we need to be able to create new virtual beds for the country.” Then, a couple of weeks later, “Here you go. Have at it.” That’s just amazing to see the pace, how quickly the impact that can have as a startup on a national level feels like you never see that. That felt like a once in a lifetime.

    Alejandro: That’s amazing. In this case, imagine you go to sleep tonight, Rami, and you wake up in a world where the vision of Medically Home is fully realized. What does that world look like?

    Rami Karjian: I have a big smile on my face because I think the first thing about that is, I’m probably not waking up in the United States. I really believe that this model of care that our company has bought, that so many people have worked on, needs to go out into the world. So if I think about five years from now, I’m hoping that I’m waking up in Europe; I’m waking up in Australia; I’m waking up in Asia; I’m waking up in China; I’m waking up in Africa; I’m waking up in South America, and our model is starting to get ahold there. People all over the world deserve this. There’s no reason why this needs to be a U.S.-only effort. Our shareholders, our partners, the people on our team are all very energized about taking this to people all over the world. That’s what I would hope in five years if I woke up. It’s not what I’m doing; it’s where we’re waking up and where we’re touching lives.

    Alejandro: Absolutely. I love that. Let’s say that I’m taking you now in a time machine, and we’re going back in time, and you have the opportunity to have a chat with your younger self, with that younger Rami that is thinking about launching something. What would be that one piece of advice that you would give to your younger self and why before launching a business knowing what you know now?

    Rami Karjian: Oh, how fun. I think the biggest thing I would tell my younger self, very simply is, it’s all about the people. It’s all about the people. Finding people that share your values, your dreams, your hopes, your aspirations, your fears – it’s all about the people. I would tell my younger self, don’t focus on what you’re going to do, don’t focus on where, don’t focus on how, focus on who you’re going to do it with, and if you find the right who, then everything will take care of itself. I’ve been blessed with incredible partners and incredible who’s around me to do this together with. So that’s what I hope my younger self would really take in.

    Alejandro: I really love that because, obviously, those people that you bring in are really going to make it or break it. I’m sure that there are some people now that are listening, and maybe they’re thinking about either partnering up with someone or perhaps hiring someone that could be a big hire for the business. Is there anything, like a tip, that you could give them based on your experience on what you’ve learned around people?

    Rami Karjian: I’d love to make sure that there’s an emotional connection. If I’m going to do something with somebody either as a partner, either as a big hire, there has to be an emotional connection. The work of a startup is too hard for there not to be an emotional connection with the people that you do it with.

    Alejandro: I really love that. What does an emotional connection at its best look like?

    Rami Karjian: How to describe it? Imagine the rhythm of your heart beating to the same time and what it feels like when you’re really in sync when the hopes, dreams, and aspirations you have are aligned, when you really connect with somebody, not at an intellectual level, but as two souls coming together and feeling connected, and you really care about them, and they really care about you, and you worry more about their success than you worry about your own. That’s what an emotional connection looks like.

    Alejandro: Very powerful, Rami. So, for the people that are listening, what is the best way for them to reach out and say hi?

    Rami Karjian: Oh, my gosh. We love to connect with people. If you go to our website, MedicallyHome.com, there’s information there about how to reach us. We love to give post-COVID. We love to give people tours of Boston and for them to meet our team. Anybody who is interested, we’d love to get in touch with you.

    Alejandro: Amazing. Rami, thank you so much for being on the DealMakers show.

    Rami Karjian: Alejandro, this is such an opportunity. I’m so privileged. Thank you.

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