OnMed’s CEO says growth follows an unchanging playbook

the unchanging – A longtime healthcare executive argues there is no shortcut to building a high-growth company—only a repeatable playbook built around relentless clarity of mission, process over outcome-chasing, decisive execution, and integrity. The approach is illustrated th

When people ask how to build a high-growth company—one with a rapidly expanding footprint and rising enterprise value—the answer can sound unsatisfying. There isn’t a secret formula, no hidden shortcut.

But there is a playbook.

Karthik Ganesh, CEO of OnMed, says the playbook doesn’t change, even when the industry does. After more than 13 years leading organizations across the healthcare spectrum, she argues that teams and products can shift, and sectors can evolve, yet the underlying way to run the business stays the same.

She points to two companies that reached outsized growth on different paths: EmpiRx Health. a pharmacy benefit management (PBM) company. where she took the business from early stage to a scaled. nationally recognized tech-enabled PBM; and OnMed. where revenue grew 3. 500% in a little over two years. The common thread, in her telling, is not a tactic—it is discipline.

For Ganesh, the first job of leadership is making the mission impossible to misunderstand. The “North Star” can’t be something a team nods at during a meeting and then forgets. The most dangerous assumption, she says, is believing the team automatically understands the mission.

At OnMed. she describes the North Star as simple and constant: “quality. affordable. equitable care for every person. in every community. regardless of ZIP code.” In her view. it has to be communicated so often and so clearly that it stops feeling like communication and starts feeling like the air the organization breathes. If a team member hits a hard call and still needs to ask the CEO for direction. she argues the job isn’t done.

That clarity links to how decisions get made. Ganesh warns against obsession with outcomes—saying outcomes matter, but they should be the result of executing the right things the right way, relentlessly, not the result of chasing a scoreboard. Organize around outcomes, she says, and corners get cut.

She describes the test every company faces: chapters where “nothing worked as expected. ” when headwinds feel too strong. timelines too long. and obstacles too many. Those moments—she says—reveal whether culture is real or aspirational. She doesn’t change the destination during these stretches; she returns to process: execute in the present. stay close to the customer. lead with integrity. and do the right thing not when it’s easy. but especially when it’s hard.

The playbook also has a way of handling uncertainty that Ganesh doesn’t mince words about. “No what-ifs—ever,” she says. The teams that break down. in her view. aren’t facing the hardest circumstances; they’re spending energy second-guessing decisions already made. What-ifs. she argues. pull people out of the present and into a past they cannot change—creating hesitation precisely when execution demands certainty.

So she describes a deliberate culture: gather the best information, make the decision, commit fully, and execute without looking back. If the decision is wrong, correct forward. Own the decision, learn, and move. Accountability sits at the highest level.

Ganesh then turns to a sports story to explain how cohesion is built. Daniel James Brown’s The Boys in the Boat chronicles the 1936 University of Washington crew that went to the Berlin Olympics and beat global competition. Brown’s core detail. as she frames it. is that the eight men weren’t necessarily the most gifted rowers individually. They won because of something rare: “the moment of swing. ” when the shell moves on its own as eight men become one—each stroke indistinguishable from the next. with each rower surrendering individual glory for collective force.

That “moment of swing,” she says, is the culture she builds toward: teams that internalize the North Star so deeply they pull together instinctively when conditions are hard, the race is close, and no one is watching.

Her view of leadership roles is equally direct. “The CEO is not the strategist,” she says, arguing most CEOs misunderstand the job. In her framing. the CEO must be hands-on and close to the action—visible to the team—not hovering above the organization with a strategic view. The CEO, she says, is “communicator in chief,” and the mission cannot be delegated. The CEO is also a “chief simplification officer.” Growth creates complexity, and complexity becomes the silent killer of execution.

Her job is to strip noise, cut distractions, and refocus the management team on what matters right now. The rule is simple: do fewer things, do them brilliantly. Each time the organization drifts toward doing more, she says, the CEO pulls it back.

Finally, Ganesh returns to integrity as a practical constraint on how fast a business can grow. There will always be a faster path. a convenient shortcut. a deal that works if you “look the other way.” Her playbook answers with a hard no—not because it’s about reputation risk. but because companies that endure are built on foundations that can hold the weight of growth. Shortcuts. she argues. leave hairline fractures that don’t show up until the company is scaling fast and the structure cracks.

In her view, skill is teachable, but conviction is not. The playbook is simple, she says, but it is not easy. It is repeatable, and she intends to run it again.

Karthik Ganesh is the CEO of OnMed.

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