Josh Rabuck joined Indiana University Health in 2011 as the system’s first CIO, charged with establishing an insourced investment management program.

Since then, he has helped finance and develop a downtown hospital that is expected to open in 2027 and also held the title of treasurer for a while. He also leads the team of seven managing the system’s $13.5 billion portfolio, made up of $4.7 billion in defined contribution plan assets, $400 million of foundation assets, a $300 million captive insurance pool, a $500 million liquidity pool and an $8 billion long-term investment pool of unrestricted balance sheet assets that “are there to help fund the business and bridge different operating challenges,” Rabuck says.

Returns over the last one-, five- and 10-year periods, annualized, net of fees, have been 11.3%, 7.6% and 6.32%, respectively.

The winner of CIO’s 2025 Industry Innovation Award for Health Care/Hospital Plans says he gave up the title of treasurer after finding that the role actually consumed more time than the investment side and was “operationally more demanding.”

That said, Rabuck says he values the insights he gathered when he oversaw both sides of the institution’s balance sheet and that the experience “makes me a better leader, not just for my team, but for [working with] the board.”

He says the dual role helped him get better at “translating what we [investors] do and showing how different asset growth applies directly to the business” of running a health care system.

Over nearly the past two years, the Indiana University Health investment office has helped the organization navigate “one of the most complex financial environments in recent history, supporting strategic priorities while preserving liquidity, transparency and long-term resilience,” Rabuck says.

He points to work on the $4.29 billion Indiana University Health Academic Medical Center in Indianapolis, the largest health care construction project in Indiana history and one of the largest active projects in the U.S.

“We’ve also supported a system-wide [electronic medical records] modernization, major care expansion across the state, including a significant initiative in Fort Wayne,” Rabuck says. “We have done so in a system that has held prices flat for patients five years in a row, [supporting] an extraordinary commitment to affordability.”

In 2025 alone, due to volatile markets, eroding diversification benefits and shifting policy signals, Rabuck and his team executed more than $800 million in portfolio rebalancing, which involved “activating our institutional ‘playbook’ for just the fourth time since 2016.”

The playbook is a structured, repeatable framework designed to “script courage” in moments of market fear, enabling the Indiana University Health investment team “to lean into dislocation with intention,” Rabuck says.

Within the team, he also conducted a full transformation of the office “from a generalist model to a specialist team of senior allocators, each with a primary asset class and a secondary leadership responsibility for one of our major pools (retirement, foundation or insurance).”

Rabuck says the team eliminated analyst roles by leveraging artificial intelligence tools, such as Microsoft Copilot and Canoe; focused the portfolio on a concentrated manager roster; and remained 100% passive in public equities to make more time for areas like hedge funds and private markets, which have more variability, risk and the possibility of return.

“Our philosophy is ‘Risk First,’ starting with the risk of drawdown,” Rabuck says. “It is different from focusing on return. The market doesn’t have to give you the return you want or the return you model. We do things to be aligned with our objectives. … We are here to help fund the business.”

—Amy Resnick