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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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Full Stack Healthcare? Now, that’s an interesting term.

Jay Parkinson, MD – our new Chief Designer and one man digital accelerator – recently drew my attention to this phrase. The more I have thought through it, the more I like this concept to describe what we are trying to accomplish with our Connected System of Health. Maybe more important, it crystalizes a perspective I have had on technology and healthcare as well as technology in healthcare.

Full Stack” was originally coined by tech developers to describe applications that integrated both back end and front end functionality, and “Full Stack” engineers were those rare coders and developers who could effectively work in both ends of the software environment. It has gained more importance as we start to move away from the separation of back-end platform environments and user-facing software to a more integrated approach, especially for new style enterprise businesses. Some may think this is simply returning to software’s roots, but there’s a key difference, which is essential to understanding the analog of how the merging of digital and physical can really change how care is delivered and health is experienced.

Before we get into Full Stack Healthcare, let’s consider how this term has been appropriately appropriated from its software development roots. A Full Stack business is one that has more than just good integration of all of the necessary components to meet customer needs. Instead, it uses a technological backbone and construct as the foundation for all aspects of its business, from meeting and engaging customers to predictive analytics and supply chain management, even if its output is physical or in the “real world”. Uber is a good example, effectively eliminating a previously fragmented, data-poor, and service dismal process (trying to hail and pay for transportation) around a deceptively simple app. Given the Full Stack approach Uber took, they removed incredible levels of complexity behind what became effectively one button simplicity. A simple digital action online initiates a complex set of physical process that ends up with a car right where you requested.

But it all starts digital first. Now, lets take this concept for a spin as applied to healthcare.

It’s not news that I am less than ecstatic over the way technology has been (often awkwardly) inserted into healthcare. Mostly, people look at digital health technologies as ways of automating or accelerating existing processes—everything from wellness apps, online appointment bookings, managing prescriptions, and billing reconciliation. To be fair, some applications serve their specific purpose well, helping remove points of friction within a practice or between patients and care teams. Others, like stand-alone telemedicine services, seem built on the premise that a discrete virtual experience designed to simulate a physical encounter, can be bolted on as an effective part of a care relationship. Like I’ve posted before, the evidence says otherwise.

What really creates the rub, for me personally, is how digital “solutions” seem to be further fragmenting an already complex experience for patients, providers and payers. Instead of making our lives simpler, these digital solutions are too busy,  too buzzy, or just too bossy. Instead of being served up with the context of a care plan, they just increase friction and digital noise. This doesn’t open communication, close care gaps, or otherwise move the needle. And the costs and headaches of procuring, let alone managing, the many programs and digital initiatives are not winning friends among busy employers managing multiple competing priorities.

Enter “Full Stack Healthcare.”

As we are building it at Crossover, our Full Stack approach is not only tying together all functions into one common digitally-enabled platform, but actively building from a “digital first” mindset. It includes everything from how we think about member engagement, why we develop our own software platform, how we integrate care management into routine care, to how we are redesigning our physical facilities (yeah, this is changing, too!), pooling insights from our growing enterprise wide data warehouse, and how we identify, evaluate, integrate, and then prescribe digital health solutions.

With digital as the backbone, not simply as bolt-on or swap, the future of (our) care delivery will primarily be online and strategically in-person. Even compared to our current in-person model, where visits are 2 or 3 times longer than in normal primary care, digital first allows far more regular and meaningful contact with a member (what you might call asynchronous micro encounters) ensuring a stronger relationship, more compliance, and better outcomes. And it all can be delivered nearly anywhere, at a scale significantly larger and more widely distributed than anything that’s been done to date. Effectively, we are scaling our “magic” – which is being the most trusted entity in the health ecosystem because we actually touch the patients (in every sense of the word!).

The commitment to a Full Stack backbone also gives us much more flexibility to adjust our care model to accommodate new service lines, new engagement strategies, and more effectively aggregate the point solution apps, devices and programs and present them as one seamless experience to the member. Our individual and population health data are always present and can be used to make evidence-based decisions both with our members and with our employer customers. We control the most effective channel of communication – and its both powered and protected by trust:

For members, Full Stack enables interactions like: How are you actually doing? What’s the best care plan for you? Can we connect you with the right specialist to assist you in your health journey? Can we reconnect by chat in a day or two? Meanwhile, are you OK sharing your remote monitoring device with our care team?

For clients, Full Stack enables interactions like: What is your employee population profile look like? What has been the result of the programs we’ve implemented to address high value opportunities? Where should we be making the next program investments? From our benchmarks with your population, how should we evolve our services and team?

Full Stack Healthcare means that communications are connected, seamless, and frictionless.  Communication and relationships with our members are not thought of as different things – the documentation / treatment often IS the communication. The efficiencies gained with asynchronous delivery are immediately reinvested in other value added services like referral coordination, care navigation, and health management activities. Full Stack Healthcare consumes fewer finite resources while opening up an infinite array of followups, new engagement models, and increases in accountability so vital to true behavior change. The virtuous cycle is a real thing, and we see Full Stack Healthcare being a major force multiplier in the near term.

Building a Full Stack model is not a straightforward task. Everything has to work seamlessly together, security is paramount, the experiences have to be carefully designed (not just a nice UI and UX but also a seamless flow of data, language and relationships between media) and our care teams also need retraining on these new forms of engagement to fully embrace the possibilities (this is actually a big switch, no pun intended, for providers as well).

No doubt it will be a full-tilt effort to achieve Full Stack Healthcare.

7 comments on “Full Stack Healthcare

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