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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Change Agent: "The Prevention Experience"

Prevention (prĭ-věn’shən) n.

1. The act of preventing or impeding
2. A hindrance; an obstacle
3. A “preventive

My tour of the Health 2.0 companies begins by focusing on the “Prevention Experience.” Earlier this month, a new company with lots of big name healthcare people announced to world (via the Wall Street Journal) that they would like to engage the American public on a new model of healthcare – based on healthcare and NOT diseasecare (see previous post).

That is an interesting concept, and something that I have seen repeatedly within the healthcare reform literature that is growing steadily larger. More impressive, it is part of the outcomes and results reporting movement where we are seeing showing that with appropriate “care models” (managing medical conditions over the complete cycle of care) we can dramatically improve the healthcare people receive, reduce the costs of services, align incentives, and thereby directly influence their quality of life. Like the old adage, “An apple per day keeps the doctor away“, their is mounting evidence that a focus on prevention in the care cycle can give you dramatically better results at a fraction of the cost. Better care, higher quality, and lower costs – this is the new equation for healthcare value (outcomes/price).

But how is that possible?

Enter US Preventive Medicine – whose mission statement is: to organize and advance a “culture of prevention” throughout America by partnering with Hospitals, physicians, and employers”. The basic concept is the USPM will function as a health services company (“healthcare when sick, health services when well“) that will provide the very best and very latest in preventive medicine services to individual customers. This will include a focus on a comprehensive assessment, targeted intervention, and educational resources at the critical point within the care cycle to have maximum impact (which is long before the symptoms of disease become progressive, and thus more expensive) all based on evidence-based medicine and preventive best practices. Based on a consult from a USPM clinic, a Prevention Plan will be developed that addresses lifestyle, behavior modifications, medication therapy, and consumer specific objectives to create a comprehensive preventive plan. This plan is then communicated and shared with the primary care provider in a collaborative fashion.

The service offerings, protocols, and practices will be bundled as part of a complete solution in partnership with prestigious healthcare centers in every major market in the country. These franchised Center’s of Prevention Medicine will be part of an overall US Prevention Network to provide a compelling “prevention experience“. The Network will ensure that the services are offered as part of a “completely packaged solution from a trusted brand, that can be purchased conveniently, and delivered consistently anywhere.” This “prevention” approach that USPM is advocating has been codified within the catchy marketing phrase, “more good years“.

This sounds good, and I am cheering them on, but I was left with several questions from the information available on their website:

  • First, for all the big blast Wall Street Journal ad, I was surprised to find that there is only ONE Center for Preventive Medicine in the entire US. There are projections to enter into several other markets, but no details about who else might be interested in this concept. Seems like if you are going to have the big, splashy coming out party that you should have somewhere for the interested people to show up.
  • Second, the success of this service appears to be related to its connectedness at the physician-patient level and in managing health issues over time. I am unclear how USPM services will be part of a coordinate cycle of care. For example, perhaps USPM does a bang up job developing a Prevention Plan for a patient, how does that transfer back to the individual physician who is totally disconnected from this process, losing revenue because he is not providing these services, and now has another person telling him what to do?
  • Third, who is going to want to pay for this? Will my insurance reimburse for this? I read the half-hearted pitch to physicians about increasing revenue with a voucher system but wondered who is paying for the voucher? I can also promise you that it will be a hard sell to get physicians to “devote (donate?) their time to the practice of preventive medicine at the Center, supplementing their income…” I don’t see the totally slammed internists, under the current reimbursement schemes, flocking to “enter the Center”.

It still seems quite formative, but promising, and definitely moving in the right direction. A focus on prevention requires an engaged, informed, and collaborative patient, physician, and payer relationship. This relationship in turn depends on sharing of information, the alignment of incentive, and catalyzed by a focus on values based competition of medical conditions over the complete cycle of care. In this setting, I believe that the “Prevention Experience” can has the potential to be an important participant in redefining the US Healthcare Experience.

* Based on my personal experience with the various “preventives” I have effectively used in the emergency room,
the informed patient will find the USPM concept of prevention highly palatable.

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