What does it really take to build a primary care model that works, for patients, clinicians, employers, and health systems, at scale?
At the recent Future of Health (FOH) Summit in Los Angeles, Amir Dan Rubin, CEO and Founding Managing Partner of Healthier Capital and former CEO of One Medical, took the stage to explore exactly that question. Drawing on his experience across startups, big tech, venture capital, and leading academic health systems, he unpacked how technology, capital, and human ingenuity can combine to deliver meaningful, measurable impact in primary care.
Starting From the Problem, Not the Product
Rubin began with a simple but often neglected starting point: define the problem before building the solution.
On the demand side, he described a reality that feels familiar across many countries. Patients wait weeks or months for appointments, struggle to access behavioral health, and often feel that navigating the system is a job in itself. In the U.S., he noted, a majority of people report that coordinating their care feels overwhelming.
Payers and employers are under their own kind of pressure. Healthcare spending in the U.S. is nearing one-fifth of GDP, with hundreds of billions of dollars tied up in administrative processes that still rely heavily on manual work rather than modern technology. At the same time, clinicians, especially in primary care, are burning out, facing increasing demand with limited support, rigid training pathways, and productivity pressures that can undermine their sense of purpose.
Rubin’s message was clear: you can’t design a sustainable solution if you only optimize for one stakeholder. Any credible model has to work for patients, payers, providers, and the wider health network at the same time, a true “win–win–win–win.”
One Medical as a Living Experiment
To make these ideas concrete, Rubin walked the audience through One Medical as a kind of living laboratory for primary care innovation. The core insight was deceptively simple: treat people not as episodic “patients,” but as members in a long-term relationship.
That membership model created the foundation for a very different kind of primary care experience. Members had always-on access through a digital app, both synchronous and asynchronous, combined with convenient, well-designed clinics located in high-traffic urban areas. The goal was to remove friction at the point of need: no waiting weeks, no complex claims at the margin, and no confusing pathways to get basic questions answered.
This approach resonated. Satisfaction scores were exceptionally high, and members stayed for many years on average. But it wasn’t just about experience. Rubin highlighted published data showing that this model could also reduce overall costs of care, including a JAMA paper that documented a significant reduction in costs for one large employer population. Better access and better experience did not have to mean higher spend.
Clinician experience was another deliberate design choice. Rather than forcing primary care providers to adapt to hospital-grade electronic health record systems, One Medical built its own EHR tailored specifically to its model, resulting in far fewer administrative tasks. Clinicians were paid straight salaries instead of volume-based incentives, an intentional move to reduce the sense of running on a productivity treadmill and to support more team-based, relationship-centered care. Physicians were also directly involved in product and software development, helping shape the tools they used every day.
Behind the scenes, One Medical invested heavily in integration with major electronic record and lab systems, working to “own the complexity” of coordination on behalf of the patient. For members, the experience felt simple, even when their care involved multiple institutions and platforms.
Scaling Impact: Distribution, Business Models, and Execution
Rubin then shifted from design to scale. A great primary care model on paper, or even in a few clinics, doesn’t automatically translate into system-level impact.
One Medical initially grew as a direct-to-consumer offering, but the economics of marketing and acquisition eventually pushed the company to focus more on employers and B2B distribution. The pitch to employers was multifaceted: better access and experience for employees, support for attraction and retention, improved engagement, and evidence of lower total costs. Over time, large organizations such as major technology, financial and professional services firms came on board.
That, in turn, set the stage for the company’s next chapter. Rubin recounted how discussions with Amazon evolved from potential cross-promotion to a full acquisition, ultimately making One Medical one of Amazon’s largest acquisitions in its history and embedding its membership model within Amazon Prime in the U.S.
Yet, for Rubin, this wasn’t a story about strategy alone. He stressed that even the best product–market fit, distribution strategy, and economic model will fail without disciplined execution. Drawing from his experiences at health systems and in the startup world, he emphasized the importance of Lean and agile approaches, continuous improvement every day (not just in annual planning cycles), and tightly aligned teams that can iterate quickly. At One Medical, for example, the technology teams pushed code multiple times a day, with clinicians working alongside engineers to refine workflows and tools.
Why AI and Automation Must Be Part of the Future
In his closing remarks, Rubin connected these lessons to the broader FOH conversation on AI and the future of work in healthcare.
He contrasted an image of an Amazon fulfillment center, largely automated, with very few workers visible, with the default mindset in healthcare, where each new demand or access problem typically leads to calls for more staff. With aging populations, workforce shortages, and burnout already widespread, he argued that simply adding more people is not a viable long-term strategy.
The next stage of scalable primary care, in Rubin’s view, will depend on using technology and AI to automate routine tasks, streamline workflows, reduce administrative burdens, and extend the reach of human clinicians. The challenge, and opportunity, is to harness automation to make care more human where it matters most: in the relationship between people and their care teams.
