Glenn Gow, The Scaling Executive Coach and host of The Scaling Executive Podcast, brought Karthik Ganesh on to answer a question most high-growth CEOs avoid asking out loud: how do you sustain the mental clarity to build something that lasts when you’re compounding revenue at 111% annually?
This episode is for CEOs who are driving aggressive growth targets and beginning to wonder whether the intensity required is sustainable — and whether it has to be.
Key Takeaways
- Process obsession and daily dispassion — not outcome fixation — is what sustains strategic clarity at 111% compound annual growth. Ganesh drove EmpiRx Health from $48 million to nearly $500 million in revenue using this discipline across five years.
- A three-to-five year strategy that cannot bend to disruption is, in Ganesh’s words, worth less than toilet paper — the CEO’s job is to be planful about direction and relentless about adapting to present conditions.
- Purpose and mission are not synonyms. Mission is stakeholder-focused and KPI-measured. Purpose is societal — it answers why a company has a right to exist at all, and it determines who will fight to build it.
- Culture is not perks, flexibility, or work-life balance. Culture is whether the people you hire embody the purpose. Ganesh tells candidates directly: if work-life balance is the question, OnMed is not the answer.
- AI belongs everywhere in operations, but patient care at OnMed ends with a human. The rule is non-negotiable: tech enabled, AI powered, human delivered.
How a CEO Delivers 111% Growth Without Getting Destroyed by It
Ganesh’s record at EmpiRx Health is the context. In five years as CEO, he grew the company from $48 million to nearly $500 million in revenue — entirely organically. EBITDA moved from $1 million to $52 million. By the time he left, investors had seen a 60x increase in enterprise value. He is now CEO of OnMed, a healthcare access company recognized by Time and CES for rethinking how Americans receive care.
What drives that performance is not a productivity system or an execution methodology. It is a philosophy Ganesh has spent 13 years building, rooted in a discipline he calls dispassion — the practice of caring completely about the work and not at all about the outcome.
“The faster you can get from what to so what, is a huge enabler and it is jet fuel as a leader,” Ganesh told Gow.
The practical expression of dispassion is a daily reset. Every morning, before anything else, Ganesh asks himself one question: of every decision I made through yesterday, are there any I would completely rethink if I could? Most leaders treat strategic commitment as a virtue. Ganesh treats the willingness to question it daily as the actual discipline.
His test case is COVID. A CEO who had a three-to-five year plan and could not respond to that disruption, Ganesh argues, had no real strategy at all. “Those strategies were not even worth anything more than toilet paper,” he said. “The idea is how are you incredibly planful for where you want to go, but incredibly adapting to where you are?”
The distinction matters operationally. Planning gives direction. Dispassion gives permission to adjust the route when conditions change. A CEO who conflates the two — treating the plan as the goal rather than the direction — loses the ability to adapt at exactly the moment adaptation is most valuable.
This is also where the 60x enterprise value originates. Not from a plan that held for five years. From a leader who questioned the plan every morning and adjusted to what the market was actually doing.
How Purpose (Not Mission) Builds a Company That Operates as One
Ganesh draws a hard line between mission and purpose — and the distinction shapes everything about how he hires, leads, and communicates.
A mission is stakeholder-focused. It defines what the organization will deliver and to whom, measured in KPIs and wins for specific constituencies. A purpose is societal. It answers a different question: what does this company owe the world, and why does it have a right to exist?
At OnMed, the framing is deliberate. Ganesh uses “purpose, vision, and values” — not “mission, vision, and values.” The purpose: 120 million Americans have no viable access to healthcare. 167 million are delaying care. OnMed exists to solve that, starting with underserved America.
“Brand and culture are more important than the strategy,” Ganesh said. “The strategy can be whatever you want it to be and the strategy needs to be resilient and malleable based on market dynamics.”
Brand, in Ganesh’s model, is the North Star made visible — how the company talks about its why, and how it lives it. Culture is the mechanism that makes brand real: who you hire, and whether those people embody the purpose rather than just agreeing with it.
He applies a filter Ganesh borrowed from Jeff Bezos — an empty chair in every meeting, representing the person the organization ultimately serves. Every decision runs through one question: how would the chair feel about this?
The hiring expression of that filter is equally direct. Ganesh tells every candidate at OnMed: if you want work-life balance, ask that question of your next employer. “If you want to singularly be able to impact the lives of millions and give them the quality of life and the sense of wellbeing that they deserve and that they’re entitled to… show up. For any other reason, don’t be here.”
The result, Ganesh says, is an organization that moves as a single entity rather than a collection of competing motivations. “Being able to get an entire organization operating as one, not as multiple entities with multiple different motivations — that has been, with all humility, my superpower.”
How CEOs Should Think About AI When the Last Mile Must Stay Human
Ganesh’s AI strategy at OnMed runs on two tracks, and the boundary between them is fixed.
Track one is operations. AI is being introduced across the company with a mandate Ganesh gave his senior team directly: think AI-first in how we operate. Every function, every process, every workflow is subject to that question.
Track two is patient care. Here, AI powers the care station and shapes how clinicians prescribe and diagnose. But the delivery of care itself does not change hands. “Healthcare needs to be human delivered,” Ganesh said. “The last mile will always be human.” That is not a preference or a current technical limitation. It is a non-negotiable edict.
The formula Ganesh uses to describe OnMed’s model: “We are tech enabled, AI powered, but human delivered care.”
The distinction has strategic implications beyond healthcare. For any CEO leading a company where the product ultimately touches a person — in healthcare, education, financial services, professional services — the question is not whether to deploy AI. It is where the hand-off back to a human must occur, and whether that line is explicit or assumed. Ganesh’s approach makes it explicit, which means it can be defended, communicated, and built around.
The AI-first mandate for operations and the human-last-mile rule for care are not in tension. They are the same philosophy applied to different layers of the business: be limitless where you can be, and be intentional about where you cannot.
How Ganesh Connects Dispassion, Purpose, and AI Strategy
| Principle | What it means in practice | Named evidence from this interview |
| Daily dispassion resets strategic flexibility | Every morning, question every decision made the day before — not as doubt, but as discipline. Commitment to a direction is not the same as commitment to a plan | At EmpiRx Health, this practice produced 111% compound annual growth over five years, $48M to nearly $500M in organic revenue, and a 60x increase in enterprise value for investors. |
| Planful about direction, adaptive to conditions | A strategy that cannot bend to disruption is not a strategy. CEOs control the response to present conditions, not the destination. | Ganesh’s COVID test: any leader who could not adjust a three-to-five year plan to that disruption watched their strategy lose all practical value at the exact moment it was needed most. |
| Purpose over mission aligns the entire organization | Purpose is societal — it answers what the company owes the world. Mission is stakeholder-focused — it answers what the company delivers to specific constituencies. The difference determines whether people fight for the company or just work for it. | Ganesh replaced “mission, vision, values” with “purpose, vision, values” at OnMed, building the company around solving healthcare access for 120 million underserved Americans — and uses purpose as a direct hiring filter that self-selects out candidates unwilling to commit at that level. |
| Culture is embodiment, not environment | Culture is not perks, flexibility, or fun. Culture is whether the people you hire live the purpose. Hiring for culture fit means hiring people who would put the purpose in their eulogy. | Ganesh describes the ability to get an organization operating as one entity rather than competing motivations as his single superpower — and credits direct, unambiguous purpose communication at the hiring stage as the mechanism that produces it. |
| Human delivery is non-negotiable at the last mile | AI belongs in every layer of operations. In any business where the product ultimately touches a person, the question is not whether to deploy AI but where the hand-off back to a human must occur — and that line must be explicit, not assumed. | At OnMed, the explicit edict — tech enabled, AI powered, human delivered care — governs both how the company builds its care stations and how it communicates its model to the market. |
Quotes from This Episode
- “The faster you can get from what to so what, is a huge enabler and it is jet fuel as a leader.”
— Karthik Ganesh, CEO, OnMed - “If you want to singularly be able to impact the lives of millions and give them the quality of life and the sense of wellbeing that they deserve and that they’re entitled to… show up. For any other reason, don’t be here.”
— Karthik Ganesh, CEO, OnMed - “Being able to get an entire organization operating as one, not as multiple entities with multiple different motivations — that has been, with all humility, my superpower.”
— Karthik Ganesh, CEO, OnMed - “Brand and culture are more important than the strategy.”
— Karthik Ganesh, CEO, OnMed
Frequently Asked Questions
How do CEOs sustain high performance without burning out under extreme growth pressure?
Karthik Ganesh argues that burnout in high-growth environments traces back to outcome fixation — measuring yourself against results you cannot control. The alternative is process obsession paired with daily dispassion: reset every morning by questioning yesterday’s decisions, stay absolutely committed to the process, and accept outcomes with gratitude rather than anxiety. Ganesh drove 111% compound annual growth at EmpiRx Health using this discipline and credits it with preserving strategic clarity across a five-year tenure that delivered a 60x increase in enterprise value.
What is the difference between a company purpose and a company mission, and why does it matter for hiring?
A mission is stakeholder-focused — it defines what the company will deliver and measures success in KPIs for specific constituencies. A purpose is societal — it answers what the company owes the world and why it has a right to exist. The distinction matters for hiring because purpose attracts people who will fight for the company, not just work for it. Ganesh tells every OnMed candidate directly: if work-life balance is a priority, they should ask that question of another employer. OnMed’s purpose — solving healthcare access for 120 million underserved Americans — is the filter.
How should a CEO set the boundary between AI-driven operations and human-delivered service?
Ganesh’s rule at OnMed is explicit and non-negotiable: AI belongs everywhere in operations, and AI powers the clinical tools clinicians use to diagnose and prescribe, but care itself is always human delivered. The last mile stays human. For CEOs leading any business where the product ultimately touches a person, Ganesh’s framework is that the question is not whether to deploy AI — it is where the hand-off back to a human must occur, and that line must be made explicit rather than assumed.
CEOs Work with Glenn Gow to Scale Their Companies and Careers
Glenn Gow is The Scaling Executive Coach — he coaches ambitious executives into the CEO seat and CEOs into successful exits. With 25 years as a CEO and 5 years in venture capital, Glenn helps leaders scale their companies by scaling themselves first. If this conversation was useful, you can apply for executive coaching with Glenn Gow or apply to be a guest on The Scaling Executive Podcast.
