This is a followup interview to our original where Joe described how Culture is Everything. In this second interview Joe describes his take on Crossover values, our mission and the power of our team. He also shares a few of his passions outside of healthcare – never a dull moment!
How is the Crossover CSoH model actually different?
To be honest, the individual components, like virtual visits or referral management, have already been done. There isn’t any one thing that Crossover is doing that is unique. What is unique is the amalgamation of all of these bits and pieces. We’re bringing it all together – the true “full stack” as Scott Shreeve likes to call it. It’s unlike some of the others like Teladoc or One Medical which concentrate on one aspect like the delivery or commercial channel. We focused on the comprehensive health and total cost of the population regardless of channel and payment model.
We just launched our new clinic in Los Colinas, TX and it has new virtual medicine space, where our virtual providers come in and physically work together. Unlike other virtual services, it’s not the provider that’s remote, it’s the patient, as we feel its important for oru care teams to literally practice together. The professional connectedness pays dividends in so many ways. We are also exploring how the team can work together take care of a larger panel beyond the traditional 1,500 to 2,000 of a single primary care provider. We believe the full team can come together – including physical medicine, behavioral health, health coaches, and care navigators – to offer something exceptional beyond just a single primary care virtualist.
It’s interesting, and it’s the same with pharmacists. So much of what people do can be replaced by machines and algorithms, but the number one core role of any provider is to influence. You might be able to solve a specific problem, but you’re never going to have an overall impact on patients’ health unless you can influence change at the fundamental behavioral level, and that’s why we focus so much energy and effort on that core relationship of trust.
We’re already delivering an amazing healthcare experience and providing great outcomes. In fact, with our most engaged members, upwards of 50% of their secondary spend can be cut because they get what they need in our expanded “primary health” model and there’s no need to escalate to specialist or expanded services. Once our digital platform is fully launched, we’ll be able to tie things together and that’s what will continue to help Crossover differentiate from the market.
Do we lose the connection to the personal doctor through your “digital first approach as well as too much automation?
We can’t lose the connection. Look at Kaiser. It’s a closed system, they have all of your data, the outcomes are good but it doesn’t feel very personal. We don’t want it to feel like Crossover is a big brand. We need to build trust in order to influence, and for that you need the relationship. Now, there are going to certainly be parts where you interact with a machine, where algorithms assist with diagnosis, but we are looking for a middle ground between the physician relationship and the brand, which is where the care team – your dedicated team – comes in.
Of course, data is going to drive a lot of the insights that make the relationships meaningful and rich. It will be required for each team is going to know which patients have diabetes and where they are in the management of that condition – however, we believe all of that is actuated by the trusted relationship that develops between our care teams and each member.
So what’s your role within all of this?
My role is pretty much everything operations. We find, design, and develop health centers which aren’t going away even as we go digital. The role of our health centers will certainly change, becoming more “confirmatory” centers for members that need the physical touch. In the future, we also anticipate that we will be building several virtual-only health centers.
The team I am responsible for does everything around building the centers. We train the practitioners, design the clinical workflows, and manage cross-enterprise projects, like the actual launch (training, implementation, and optimization) of the digital platform. Jay’s team develops the technology, but my team ensures the launch closes all the operational loops from HR and benefits to marketing and finance, so on.
The biggest challenge is growing this startup into a mature organization. There’s great vision, but the practices and beliefs that got us to this point may not be what we need to get us to the next level. We’re going to need to stretch people, build new routines and standardize and operationalize routines, but still stay true to the open and collaborative culture that Scott, Rich and Nate built.
That’s hard to do, and it’s hard to let go of the hands-on management style for founders. In my pharmacy days, I had 5 states, 3 direct reports and about 50 pharmacists, and I knew them all. After a restructuring I went to 11 eleven states and I realized after a few months that I couldn’t manage the same way. So I learned to coach the leaders on my team to manage their teams. These leaders had to learn that they were the ones with the relationships, and my role was (and still is at Crossover) to go in and validate. I’ll still go in and speak to staff about how they saw their team leaders development path and take that information to guide their growth.
Are the original Mission and Values still valid as Crossover grows?
We’ve got some work to do to redefine them. Before we could rely on individual actions to communicate our brand, but now we’ve got to coach and mentor. And coaching itself is a specific skill. I really hate the term “constructive criticism” because it’s still criticism and instead I approach coaching with the fundamental belief that everyone wants to be successful. Maybe they aren’t, but they want to be and if they’re not meeting their goals, it’s because 1) they don’t know what is expected of them, 2) they haven’t had the training or 3) no-one has modelled it for them.
Coaching has never been a negative thing for me. I look at a coach like Phil Jackson of the Bulls. You’re telling people they need to get out there and win. You’re going to have some tough conversations but it’s never about telling people they’re going to fail. My team are the experts on facilities, people, and processes. They can run circles around me on the technical aspects. My role, really, is to remove roadblocks for them to help make them successful and quite honestly a lot of my job is just asking questions. I want to put the onus, and the reward, on them. “This is what my team did.”
What are the new opportunities you guys are pursuing?
Most of our clients continue their tactical mandates to continue to enhance and expand primary care, continue solving for access, and ensure high quality of care. We do have an exciting new upcoming partnership with a health system that going to be big. With this health system, it’s a true partnership between a primary and a secondary care provider and I think the outcome will be a product that can be sold to a new generation of employer buyers. That gets us to a place where we can say “We can deliver care to anyone.”
It’s interesting, in one of our first meetings with this health system, we told them that our approach to primary care was showing a reduction in secondary care spend. They actually said that’s exactly what they wanted to do – disrupt their own business – quite rare. They see the consumerism and employer health activism forcing change and they want to stay ahead of this, adding value through higher outcomes and lower cost, which doesn’t yet happen at scale in health systems. They see our partnership as the best way to increase qualified throughput and yet still play a part in driving costs out of the system as a whole.
It’s already happening. Walmart has developed lists of preferred providers and will pay the costs of procedures only at these locations, which have been vetted for quality and cost and as they see, the overall cost to the company is reduced because the outcomes are higher. This is where our health system partner is seeking to go, as cost and outcomes accountability increases.
From our perspective, if we can shape demand for healthcare, we can rethink our delivery channels and make our operations more efficient. The same applies to innovative health systems and even health plans who are concerned about cost, quality, and experience.
What are the measures of success?
Our Triple Aim is access, NPS and margin. There is also a fourth aim, provider satisfaction. Our providers are our internal customers, where satisfaction leads to better patient experience and where we can retain the best people in a crazy job market for healthcare professionals. With unlimited funds, you could throw so much at provider satisfaction and helping them work most effectively with patients. But, as we see in retail, margins are getting thinner yet it’s still essential to help our providers learn how to engage in the conversations that really get to the heart of someone’s health. I had personal experience with this as a pharmacist.
More broadly, in five years we have to have delivered on the promise of the CSoH. If we don’t, we’ll still be successful but our vision will not be fully realized.
And for me? I want to make a difference and have fun doing it.
So what don’t people know about you?
I get involved in lots of things, but people would be surprised to know I love astronomy. It’s more than an interest. My wife and I actually have an extremely large telescope that requires a trailer and we go out camping and stargazing with our kids who are just getting into it. It’s great being back in California because we can go out to places like Joshua Tree National Park about once a month. It’s a humbling experience.
And I’ve been watching the star Betelgeuse which is showing signs of soon turning into a nova. Now, in astronomical terms, soon could be next week or 100,000 years from now, but if it does go, that’s one thing that might pull me away from Crossover. I figure its either going to be going intergalactic with Crossover of with the star Betelgeuse!
We couldn’t be luckier to have Joe help us achieve orbit and beyond. And it’s even more awesome that he’s already an intergalactic citizen!