November 1, 2019 – Earlier this week, I presented our future vision at the HLTH conference in Las Vegas. I was fortunate to share the stage with Tanya Benenson, MD who serves as the Chief Medical Officer of ComcastNBCUniversal based in Philadelphia, PA. It was awesome to be able to speak passionately about our vision for a different healthcare delivery system in tandem with a client who is just as driven by the dream of reinventing healthcare as we are. The HLTH conference was, in many ways, both a coming-out party for Crossover Health on our tenth anniversary as well as a “call to arms” for health activist employers who are just realizing their power to fundamentally re-architect care delivery.
As I considered the past decade, our first – and really our foundational – innovation was to remove ourselves from the fee for service system. By engaging directly with employers as payers, we found a safe harbor to innovate care delivery. We began with primary care, and extended into physical therapy, chiropractic, and acupuncture. Later we expanded to include behavioral health, health coaching, fitness, and then more recently have added specialty services like optometry, dental, dermatology, allergy, and psychiatry to ensure a comprehensive breadth of services available in our primary health platform (it’s so much bigger than primary care!). This evolution, in partnership with health activist employers like Comcast, has been both rewarding and impactful.
I have been pleased to see our health product and care model resonate in the market with the members and clients we serve. We can now prove that better primary care costs less, creates more value, and drives a virtuous cycle of innovation if done well, done right, and done for the right reasons. Our cumulative metrics, after more than 1.5M member visits, remain off the chart. This leads me to conclude that the “reports of Primary Care being dead have been greatly exaggerated” (to riff off an old Mark Twain quote). People and purchasers have just been waiting for something worthwhile to pay for.
However, to meet the challenges and opportunities of the next decade, we must continually evolve, iterate, and improve even more rapidly as I have been posting over the last several months. All the success we have had to date has been “necessary, but it is not sufficient.” No matter how impactful Crossover is in the areas we serve, no matter how strong and consistent the results, we will never be successful in achieving our objective to fundamentally transform healthcare unless and until we can do more than we do today, unless we expand our reach, and until we have even more capabilities.
What is this heresy, you daresay?
A deeper dive into the underlying architecture of healthcare spending will quickly reveal the problem. Even if I make Primary Care maximally efficient, I am only impacting 15% of our partner employers’ spending. Think about it . . . if I reduce primary care costs by ~25% (which we’re doing, and a huge success in most people’s books) I am still only reducing employers’ total spend by less than 4% (which barely covers CPI increases)! There is a full 85% of healthcare spending that occurs outside the purview of my four walls, beyond the reach of traditional primary care teams, and outside the field of view of most employers. This is where healthcare costs are out of control — in every sense of the phrase. Failure to organize, coordinate, and direct this spending will result in a lack of movement of any efforts to achieve the Triple Aim, no matter how good or effective our primary health platform is.
The Secondary Care market is complex, confusing, and costly. The visual I used at HLTH was a pinball machine bouncing the patient from specialist to facilities to diagnostic center and back to specialist, meanwhile racking an impressive and rapidly accumulating “high score” to the benefit of current healthcare incumbents. It’s closer to the sad truth and daily experience than many would choose to acknowledge. We realized to help our clients impact this core area of spending, we would have to go deeper, to be more capable, to have more information, and well . . . we would have to arm our medical group with new superpowers to position ourselves for the next decade of impact.
This was also the genesis of introducing our Connected System of Health as the way forward, the means in which to move from “Local to Connected,” and to deliver on this vision at scale across the country. So, what’s the formula?
- Start with a Comprehensive Primary Health Platform complete with care teams, evidence-based care models, and an integrated philosophy that is paid for creating value.
- Extend their reach by adding a “Digital-First, Strategically In Person” capability to serve the entire population. We believe this approach allows members to make the value / impact tradeoffs of in person or remote access. By creating a new channel, a new financial model can also emerge to expand the geographic reach and delivery options.
- Add a repository of permissioned health data that can help shift the care model to proactive / predictive care; where we can leverage the best of care science, data analytics, artificial intelligence while also ensuring an amazing consumer experience!
- Partner with our clients to ensure that each member has an annual health strategy, that those with health conditions are proactively engaged by embedded Care Managers, and that we evaluate, validate, and integrate deeply with digital health tools and technologies already paid for by our clients; and,
- Finally, ensure our members are surrounded by a trusted, known care team as they engage with the costly, complex secondary care system for closed loop Care Navigation and coordination. This requires that we staff Care Navigators as core members of the integrated, multi-disciplinary care teams (and we believe they pay for themselves rapidly).
- Finally, you can step back and see how the Connected System of Health all comes together to drive value. We plan to leverage this model for our next 10 years. What is fascinating to me is that the component pieces of this concept have all existed for years. However, what is new and exceptional and differentiated is that a single entity—the trusted medical group for the first time—has these capabilities embedded and available to deliver to its members at scale everywhere across the country.
What I have always found so ironic as the leader of a medical group, has been the energy, effort, and work arounds expended by others to ensure that the “last mile” of care can happen. As one of the few entities that actually “touches” patients, we are—in my view — best positioned to transform care by building on the trust that already exists and we have already earned.
Which leads me to my final rallying cry. This work is important; but it is also important to understand how this will work. Our objective in transforming our successful “local” care model into a Connected System of Health will be achieved person by person, practice by practice, city by city, state by state, region by region, until we are “One nation, under health, inevitable, and connected for all.” We can see this important work led by activist employers, and soon to follow health system innovators, and ultimately the payers who are most comfortable paying for the value being created.
This work is not truly complicated, it’s just hard. And, it starts now with us, and I hope with you, and with all the other activist employers, health plans, and health systems who are joining in our efforts to create a super-powered network of Connected System(s) of Health stoked by a super-powered Medical Group.
Now, all we need to bring is the red capes!