Interview with Joe Ennesser, Part 1 – Culture is Everything

We spoke with Joe Ennesser, who joined Crossover Health last summer to lead up our Operations. Scaling what we do, managing our transformation to a digital first company and formalizing procedures is all part of his role at Crossover, but it’s his views on experience and managing growing teams that are really compelling. 

What’s your background?

I’m trained as a pharmacist and after some time took a role with Target in their pharmacy operations. One of the things that became apparent immediately to me, was that Target was really a human resources company that happened to sell fashion, electronics and groceries. I could tell that their secret was really in the culture that they cultivated – and I loved being a part of that. That was really their secret. At the time, HR ran that organization and they had a different thought process on the development of people. They saw the value in people and people’s leadership skills more than their inherent knowledge. It was not uncommon for people to be working in areas that they were not expert in but were good leaders. A good example – although the VP of pharmacy ran pharmacy for the total organization, his previous role was as a regional HR lead. No pharmacy background whatsoever but the programs he put in place really elevated Target’s pharmacy programs and engagement. It was a testament to the fact that if you’re a great leader and you have people with you who are subject matter experts, you can really make some amazing things happen. 

Target chose to exit the pharmacy business and sold their operations to CVS which is how I ended up at that company. In the US, pharmacies are really starting to consolidate and it’s really come down to CVS and Walgreen’s, which each have about 10,000 locations between them (and that comes with some challenges!)

What drove you to make the shift into healthcare and out of pharma?

I wasn’t specifically looking to come into primary care, to be honest. Having a healthy family and a happy life is what drives me. I want to have fun, I want to be engaged and be challenged, and I want to accomplish something and be a part of something great. I had been looking at a director of pharmacy role for a large hospital organization in Phoenix when the same person who had offered me that job also suggested that I look into this primary care company in California he had heard about through LinkedIn. When Crossover first called, I was completely confused, as I thought the recruiter I was speaking with was from the hospital in Arizona. We cleared that up and she began to describe this exciting new model of primary care. It was at that time, that I realized my friend who wanted to hire me – was simultaneously introducing me to Crossover with the subtle hint that this would be a better fit for me.

We set up a meeting really quickly and as I started to speak with Scott, Celeste, and the team and I was sold as soon as I understood the value proposition. There were so many things that would made this a compelling opportunity – we are at the cusp of some amazing growth, we will be nationally scaling the organization, and I felt like me skills could really contribute at this unique point in the companies history. I have never been career or title driven, and when I talked through with Scott both COO and VP Operations roles, I just told him, “You can call it whatever you want but here’s what I can bring to the organization, here’s what I can do, and here is why I want to be here.”

How would you summarize the challenges in primary care today?

Healthcare’s broken in the US and there are a lot of aspects that need to be fixed. Right now we’re in a position where the consumer is the actual purchaser of healthcare although they don’t really recognize that yet. I really think this might be one of the biggest challenges, just like I saw in pharmacy, that behavior can really change when you’re actually spending your own dollars. 

Of course we’ve made healthcare way more complex than it needs to be and simplifying it is one of Crossover’s greatest value propositions. But I don’t think consumers have gotten into the mindset that they’re actually buying healthcare, maybe not always directly, but you’re also making a healthcare purchase choice when you’re looking at employers and deciding on benefits. We need to shift the perspective so the consumer is more engaged in what their healthcare purchases actually are for, and the value they are receiving for the price they are paying. When that shift happens, it’s going to drive a lot of downstream changes because we’ll be looking at healthcare in a different way, at outcomes, at what I’m getting for my healthcare dollar. Employers are just now getting into this mode, but most consumers aren’t there yet.

The lack of clarity and the absence of consumerism has led to one of the downfalls of the US healthcare system. The intermediary third parties, just like the PBMs in pharmacy, don’t add healthcare value to the chain. You look at the amount of money that’s extracted, that doesn’t add value to the patient or the primary care provider, and I think the lack of clarity that allows this to happen has got to change now – in a big way.

What does the new Crossover model look like?

The exciting part of what Crossover is doing is simplification. At its core is that we don’t do medical billing, and in a sense we’re beginning to reduce complexity even more by taking on more of the spend. We really haven’t taken on a lot of risk yet, but our goal is to take on more risk in the future because that’s the only way to simplify healthcare and drive better outcomes while creating more value.

The Connected System of Health (CSoH) is like primary care on steroids. I look at regular primary care like a hose. Visits and patients flow in one end and out the other, but there’s no real closed loop. There’s no follow up. The system is incentivized for more flow, more repeat visits, and more transactions. You get paid more for more visits, so more visits happens – thats just “good business” but unfortunately really bad for good value.

What’s great about our vision for the CSoH is that it closes the many open loops. Our digital platform connects us deeply to the member, and our referral management service directly addresses high quality but low cost secondary care without any biased incentives (we act as an independent, non-conflicted fiduciary for our employers). The focus of the CSoH is on positive outcomes and the interesting thing is, when you look at the clients who have shared their full data with us, we’re already making really positive impacts in the total healthcare spend and outcomes by closing these loops. And we really haven’t started to push on the accelerator on the CSoH yet. We really haven’t put structured focus to bring all the pieces together yet, and we’re still seeing these outcomes, so when we put all the pieces in place, it’s going to be amazing.

So what has to be done?

The number one thing is to get our digital platform done. We won’t get the throughput we need unless we can triage before you come into a physical center, and we have to reduce the number of in-person visits for convenience, speed to care, and overall care team efficiency. There’s a lot you don’t even need to come in for, even physical therapy, so the more we can appropriately eliminate the in-person visit, the more we can make it convenient from anywhere, the better the patient will respond and get care when they need it versus delaying care because it’s not convenient. One of the benefits is that this will free up access in our physical centers for the high priority visits that really do need to happen in person.  

Traditional EHR software was built for the old practice of healthcare with billing being the primary “problem to solve”. Our new member engagement platform which disintermediates us from the complexity of that old world allows us to focus on a streamlined UI and workflows for our care teams. We are purpose built for creating meaningful relationships and communication with each member – a totally different perspective. You will see and hear much more of this as we launch some significant enhancements to our digital platform this spring. We are stoked for that.

Joe is focused on building not only the systems but also the culture that enables a new kind of healthcare experience. Read more of Joe’s thoughts in Part 2 of the interview.