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Scott Shreeve, MD

Hey there!

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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Recap: Building Health 2.0 Into The Delivery System

Recap (rē-kăp) n.

  1. To replace a cap or caplike covering on: recapped the bottle.
  2. To restore (a used tire of a motor vehicle) to usable condition by bonding new rubber onto the worn tread and lateral surface.

We had a busy session yesterday during my panel. Besides the irritating AV problems (in/out sound, survey probs, etc), we had a pretty good conversation on stage with 4 innovative provider types who are making a real difference in health care. The slides that we used to set the stage:


  1. Integrated Delivery Systems rock. The integrated systems deliver the best results. Period. But what about the other 85% – what can they learn from them? How can we distributed thier lessons learned to others who are trying to create “systems”. Both Group Health and the Dartmouth Clinics have acheived amazing results. Of interest, audience selected by 55% integrated delivery system, and 35% chose a small group practice.
  2. Transparency Rules. We opened up our second discussion going just right to the heart of the matter – What the heck happened with ePatient Dave, BIDMC, and Google Health? While much media has been generated regarding the ptifalls and perils, I think Roni Zieger (rhymes with “Tiger” as he unfortunately had to correct me) hit the nail on the head by essentially saying “don’t throw out the baby with the bathwater”. Essentially ePatient Dave has a very complex history – 92 ICD9 codes during the course of his illness – and essentially the entire data stream was released to his PHR. This was flawlessly execute by BIDMC to Google but exploded as ePatient Dave actually looked at what was sent over. The signal to noise ratio was impercetible (so much noise!). While there was no harm done, ePatient Dave appropriately called FOUL! regarding the potential for error, problem, and pain. This created a juicy story for the media which created a potential crisis for both BIDMC and Google. In Zen-like Fashion, John Halamka immediately diffused the situation by calling a meeting with all the players, openly discussed the concerns, made both a short and long term fix, and then putting together a strategy on how to deal with this issues in the future.  While the media story was the problem with the administrative claims data being shared, the real story was how – in a health 2.0 world – being transparent allows troubles to be trumped tersely. We heard directly from Roni, from John Halmka, and also ePatient Dave who spoke out as well. It was a great session, great conversation, and great example of the brave new world of health 2.0.
  3. Death to Innovators. Rushika had alot of great comments regarding both the opportunity and the challeng faced by innovators within the system. He was shunned, excluded, cursed, vilified, and all but tarred and feathered in Boston as he chose to focus on optimizing health of individuals to the exclusion of feeding the rapacious “system” as now constituted. He has pushed the boundaries in terms of adopting and expanding on the notion of the medical home, customer service, payment mechanism, etc. But serious challenges exist to reform the regulatory, the payment, and the entire culture. Rushika mentioned that health 2.0 will allow the patients to “vote with their feet” as they move to practices who deliver in this way.
  4. No Money, No Change! The bottom line was that all the good, bad, and ugly of our health care system has some roots in the financial incentives that are created. We need to fundamentally need to get to the root of this in order to create/reform the next generation system. If the actual financing of health care does not change, there is little hope that the delivery can change. An interesting insight into this was Group Health – which financially aligns the physicians payment to quality outcomes. According to James, “listen, changing the culture toward quality outcomes is hard enough – trying to do it when its against your self interest to do it is impossible”.  Even for innovators like Myca, there rate limiting step is potentially the payment mechanism as well (although they have a very juicy $250B cash payment market to go after!).

We did not have enough time to discuss, or take questions, but I believe we were able to accomplish our stated objective:

  1. Sense of realism of the challenges, but more importantly an optimism for the potential of Health 2.0; 2
  2. A realization that not only are new entrants creating systems from scratch based on this new paradigm but large, established players are leveraging these tools/technology as well; and finally,
  3. The possibility to transform our health system will happen both inside and outside the current system to ultimately result in a high performing, value-based, next generation health system to increases individual vitality and improves community health.

4 comments on “Recap: Building Health 2.0 Into The Delivery System

  1. There is a bit of crap that keeps getting flung around in the story of my data. The grotesque errors that popped up have absolutely nothing to do with complexity.

    Example: when I went in on February 12, 2007 because I had a lump growing out of my tongue, how did it get coded as ICD-9 733.99 Bone & Cartilage Disease? That and other examples are in this post, including my being coded for 129 Intestinal Parasitism (e.g. ringworm) while I was getting an infusion of Zometa for my bone metastases. That’s insane.

    Billing data is crap. It is a totally inappropriate proxy for clinical reality. And it has nothing to do with my being a complex case.

    Sorry to get harsh but all my other efforts have been ineffective, evidently.

    It was great to meet you, Scott! You are a leader!

  2. I support your good intention on building the next generation health system to increase vitality and improves community health. Keep us posted.

  3. Keep us updated with any changes – Great blog, keep it up!

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