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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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Cognitive Capacity, Part 1 explored the concept of Cognitive Capacity and how COVID-19 could serve as the catalyst and global call to higher and better use of our collective cognitive power. Part 2 explores how Care Team Cognitive Capacity is maximized through Virtual Load Balancing when delivering Pandemic Primary Care. 

Pandemic Primary Care is a new term coined by Crossover Health to describe our transition from an in-person, integrated, coordinated, multi-discipline primary care medical group into a digital first, member-centric, connected primary care service focused on delivering essential pandemic services. This move was necessitated by a variety of circumstances including the highly infectious nature of the Coronavirus, policies of physical distancing and isolation, client campus/health center closings, and a general desire to preserve care team capacity by going to a “remote only” stance. The move to an exclusively virtual care model is something we have talked about extensively (here, here, and here) but we never could have imagined the circumstances in which COVID-19 would accelerate this process from 3-5 years to almost overnight. 

But here we are . . .  and here is what it looks like:

RolesComprehensive Primary CarePandemic Primary Care
Physician LeaderX
Practice Leader (RN)X
Primary CareXX
Physical TherapyXX
Behavioral HealthXX
Health CoachingX
Fitness ServicesX
Specialty Care (Derm, Allergy, Psych)X
Care NavigationXX
The Transition from Comprehensive to Essential Services 

Pandemic Primary Care as a care model is all about stripping the entire care model down to the core services necessary during an extreme crisis, and responding to severe constraints on staff, resources, and capacity. I want to be CLEAR that this is NOT a relative judgement on whether the services removed are valuable or not, or whether they are considered essential (of course they are!). Rather, it is an indication of what is required during a pandemic. Quite simply, there are certain things we are no longer able to do or provide. The two actions of paring back service lines and paring back services within the remaining lines, actually becomes our key capacity preservation strategy. It enables us to extend the ability of our entire team to provide care as long as possible, even as the pandemic progresses. 

The actual Pandemic Primary Care services offered by the pared back, now virtualized team are centered on staying in close communication with members through an already established trusted relationship and our digital engagement platform. This platform allows our care team to asynchronously message members as a first line care delivery approach, schedule synchronous  appointments (phone calls or video visits) strategically as needed, and ensure the member feels supported and surrounded by our care. We are able to follow up on medication refills, source labs as necessary, and help navigate our members to appropriate secondary care, diagnostic facilities, or hospitals with capacity. We are also acutely aware of significant stress and anxiety caused by the crisis, which is why we continue to offer mental health services as well as movement medicine (via physical therapy) to ensure resiliency. New services include ensuring key medical supplies are available to members (medications, durable medical equipment, etc), the offering of open air testing, and soon, various forms of digital contact tracing with members’ permission to ensure they stay safe and healthy. Overall, our framework for care during a pandemic is to help our members prevent, detect, treat, and cope with COVID-19. 

Which brings me to some of the questions that often come up from clients as we make this transition to fully virtual: Why am I paying the same amount as I did when you guys were in person care only? Why am I paying for a full care team when you guys are offering fewer services? What are the other care team members who are not part of the pandemic team doing?  Effectively, how am I getting value from the cognitive capacity of the entire care team as you switch to Pandemic Primary Care?

Paring back to Pandemic Primary Care means that our providers who no longer provide care as they did under our previous model are now transitioned into Care Navigators, Health Counselors, Gaps in Care closers, and partners to physicians working to manage the new workload in the form of messaging and related follow ups. In a previous post, I spoke about the “negative robustness” we’ve built into our model and our culture.  Our care model flexibility allows us to continue to offer the expertise of these excellent clinicians while they flex to manage patients in new ways, leveraging their familiarity with our technology while ensuring we continue to create value for our clients through proactive care. Effectively, the agility and robustness of the care model is such that we can pivot the total cognitive capacity of the care team to activities that address new pandemic care needs. 

This whole care team approach becomes increasingly important not only for load balancing cognitive capacity but also load balancing care capacity; i.e., as one team goes down with viral infection, another team can step up to take on member care. This load balancing is an important feature of Pandemic Primary Care, and takes advantage of Crossover’s national network of clinics and clinicians (a previously unappreciated, but inherent feature of our model). Small onsite clinics can benefit from this as well. For example, we had  an entire five-person care team go down—one with infection and four with exposure, but a nearby nearsite had redundant capacity so that team immediately stepped in to fill the gap. As primary care services near an overwhelmed state, the non-pandemic clinicians can step in to offload the significantly increased messaging, member care follow ups, referrals, and sourcing that have proven to be so vital amidst the chaos. 

Virtual load balancing—between basic care and new tasks as well as between comprehensive and pandemic clinicians—is an effective approach to ensuring members receive the care they need, as they need it, especially during the crisis. And while we’ve stripped down the services to address the pandemic, load balancing allows the cognitive capacity of our entire care team to be put to work in perfect balance. 

One comment on “Cognitive Capacity, Part 2 – Virtual Load Balancing

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