We’ve been speaking to a number of people on the Crossover rocketship in the past few months, getting their take on the company’s mission and vision, and how their contribution is going to impact our success. In doing so, they tell us an awful lot about themselves.
In this post we’re talking to Stephen Ezeji-Okoye MD, (A-zay-g Ocoy-yeah!) or as we tend to call him around here, SEO. Stephen has been the Chief Medical Officer at Crossover since July 2019 and was previously the Medical Director of our Facebook Health Center. In this, the first of two posts, he speaks about his experience with the Veteran’s Administration, where he spent his entire professional career before joining Crossover in January 2019.
What’s your background?
It’s different. I was born in the UK, moved to Nigeria when I was less than a year old, lived in the far north in Canada, and then went to boarding school back in the UK. I earned my medical degree in Texas and did an internal medicine residency at Stanford. Right out of my residency, I went to the Veteran’s Administration system in California, where I stayed for almost 27 years before making the move to Crossover at the beginning of 2019.
What took you to the VA?
Where I was in residence, the providers were told that we couldn’t refill the scripts of patients not in the system, even when they had been admitted, because the in-patient pharmacy was losing money. The outcome was pretty obvious—because they weren’t getting or taking their meds, many patients had to be readmitted. So, the pharmacy wasn’t losing money any longer, but it ended up costing the system far more money. That didn’t make sense and was wrong on just about every level to me.
I was attracted to the VA because it approached healthcare differently. There were no payer issues. Patients could simply get the care they needed, with no hassles. It was integrated, with care easily available across many specialties. It wasn’t transactional medicine.
I started in a VA emergency room. I have always wanted to feel like I’m making a difference in the environment I’m in, and I noticed that doctors were selecting the patients they wanted to see from the charts on the wall, basically choosing what interested them. The result was that some patients were seen right away while others had to wait so long they often gave up and went home. To fix that, I set up an ER triage system which organized the workload and prioritized the patient roster for everyone. In the end, everyone was happier and productivity went way up. I guess that experience is what exposed me to management and became my entrée into medical administration.
From there I ended up being in charge of primary care, then Deputy Chief of Staff, and finally, acting CMO for the region that took in northern California, Nevada, and Hawaii. I became the in-house subject matter expert, looking at the implications of integrative medicine, and what would be justifiable investments or actions to take from a systems perspective.
What did you take from the experience?
I know that great care all comes down to the individual, but the quality and outcomes are so dependent on the systems that enable a practitioner to do the right thing (which is also what attracted me to Crossover). Working in administration (and with some great mentors!) helped change my perspective – shifting it from the the individual provider, to the hospital, and then to the whole system. It gave me not only an understanding of the rules that governed the VA, but I also learned how to work the rules in order to change the way care was delivered and build better systems.
How did you see the systems evolve at the VA over the years you were there?
When I started at the VA, most of our work was from paper charts. And anyone who has worked with these charts knows you usually don’t get complete information. Ken Kizer, MD (who was then the Under-Secretary for Health) was focused on improving quality and outcomes at the VA, and as a result championed population health analysis while supporting the broader adoption of VistA (one of the first system wide EHR’s). VistA was an early medical IT system, and back when we first started using it, it worked well, even if a bit clunky. But it achieved its core purpose as a tool to help the VA track quality scores and improve outcomes.
Unlike most EHRs, VistA is a care engine, not a billing engine. It enabled individual charts to be complete, and by being able to aggregate data and look at our entire population, that data allowed a change in the perceptions of the role of care. It showed me and everyone else that when you don’t have a system you’re not practicing at full capacity.
For our providers, it allowed them and others to stand back and look at the overall picture. On our own, we only have so much capacity, and VA providers couldn’t see the opportunities they were missing because they were working in the moment. The data forced change and helped establish both a population perspective as well as a team approach.
Part of the outcome was the change in systems and growth of smart clinical reminders, both in diagnosis and ongoing care. For instance, we instituted reminders to check for Vitamin B12 deficiencies with diabetics, and redesigned the eye tests after data showed that people with supposedly 20/20 vision had more brain injuries. And it was easier to implement because the VA is a closed and complete system. There were also incentives to provide the best care; in essence it was a tech-enabled, data-complete capitated system like Crossover’s!
How would you say the VA is different than traditional healthcare?
In the VA, you take for granted that everything is connected, whereas everywhere else it’s fragmented. The VA has a standard formulary, care is delivered by organized teams, consultants are integrated into primary care, and it functions as a closed system. Frankly, until you look outside, you forget how well the connectivity and the data actually work within the VA.
Part 2 of our interview with Stephen will share his experience joining Crossover, and the journey he has been on to introduce systems thinking into the company and care delivery model.