In Part 1 of our interview with Stephen Ezeji-Okoye, MD (Chief Medical Officer of Crossover) he shares his experience practicing at the Veteran’s Administration, and how the introduction of data and systems for the population changed care for the individual. In this post, he relates how this is influencing his thinking while leading Crossover’s clinical transition to virtual primary care.
How did you come to Crossover?
It wasn’t a plan. My secretary came to say someone who she thought was from the New Jersey VA wanted to speak about integrative medicine. I had become the internal expert on this, and in fact, my focus in my last years at the VA was on health and wellness. Aligning our care with the life goals of our veterans, was an obvious extension of the work we had already been doing, so the request was not unexpected.
It turned out that this person was a recruiter! I spoke with them anyway and was intrigued by this company, Crossover Health, that was changing how people thought about healthcare. Crossover seemed to be building a social and holistic model of care, with a focus on health and well-being. Like I said, I’ve always wanted to have an impact and Crossover felt like the right direction. At the VA, the average age of the veterans is over 65 and many already had chronic diseases, so Crossover provided an opportunity to have an impact on a younger generation. I saw in Crossover a place where I could apply my VA lessons within an organization that was more nimble and with clients that were more nimble too. It was very compelling.
What are some of your goals as Chief Medical Officer?
My focus is to work on overall clinical quality, and lead the transition efforts on both population health as well as the introduction of asynchronous care. Crossover has always done an amazing job on access as well as the experience for members, but for the next stage of growth we are going to need to leverage our EHR and member technology to further the quality of care for our populations. We’re already improving outcomes while reducing costs even before we have fully leveraged our technology and data, so I think the future is really bright.
The Crossover mission is clear and one I’ve completely embraced. We’re going to disrupt what people can expect and get from healthcare; we’ll use technology to transform it, and as a result, we’ll transform the health of the nation. Our new platform is going to allow us to shift to digital first, with access to care anywhere, and with the right data, we will be able to allow members to engage our system in the right channel for their needs.
A big part of this is moving from transactions to relationships, so I found it a bit ironic that a lot of the metrics at Crossover were about visits. When you look at our mission, you realize that we shouldn’t be taking care of visits, we should be taking care of people, and measuring those outcomes. So a big focus of my role has been re-framing how we think about our business, what metrics we use to measure success, and how our care model aligns with these strategic objectives.
The great thing about our platform is the learning that will come from the data warehouse we’ll be building. It will allow us to know if our interactions are filled with the right people at the right time. It will allow us to build personalized prompts and fill gaps in care. It will help us reach out to patients with the right information right when they need us most.
Most importantly, we can have data-driven, quality conversations with the providers, developing metrics beyond the subjective, and addressing system, rather than personal, issues. Without the data, conversations about goals and outcomes remain personal, and as I saw at the VA, even the best caregivers can’t personally recognize all the opportunities to improve that may be right in front of them. They need the evidence.
I like the Crossover approach, with the “episode of care,” but what I really want to do is turn all the episodes of care into an ongoing conversation. The new platform will collect and provide the data to the provider and member and help both enter a new world of shared decision-making. And making the record accessible for the member will make it easy for them to see, and ask, “how am I doing?” It provides numerous opportunities to engage, during and between episodes, and reduces the barriers to contacting the provider—we need to make these type of micro-interactions with the care team much more normalized and routine.
It’s one of the things I took from the VA. The patients, by and large, were very happy with their care, as well as the experience with their care teams, which created an unusual sense of camaraderie. It gave us permission to really push the model in new and novel ways. We’re building the same thing here at Crossover, but with much more sophisticated digital tools, enabling technology, and more comprehensive care teams.
Finally, I am also responsible for the hiring of our providers. We want people who self-select to Crossover, embrace the shared decision-making, and know how to leverage their own interests to align with ours. We live by a principles-based culture, not a rules-based one, allowing flexibility, but always in one direction.
How do you see population health playing out at Crossover Health?
The best way to improve the health and wellbeing of a population is to focus on those interventions that will have the greatest impact. We are deeply committed to identifying the care standards that will improve the health of the members we serve. By investing in an electronic data warehouse, we can now mine our electronic health record and claims data to measure our performance against those standards and identify care gaps and make them visible to our care teams. This allows us to engage patients in a proactive way and to develop processes that will maximize the effectiveness of our care teams and result in greater partnerships with our members.
It will allow us to extend care beyond the visit and to make sure that our members know they are the center of their health journey and that they are surrounded by a proactive, technology enabled care team that cares about their wellbeing. Crossover already has incredible patient satisfaction scores and data that shows it delivers care at a lower cost. Our focus on population health will allow us to show that we also deliver better outcomes. Better quality at a lower cost defines value. With our population health approach Crossover will be able to show that it is possible to achieve the triple aim in healthcare, and that the Crossover experience shouldn’t only be desired, it should be demanded.
What’s your secret passion?
Trivia. I’ve always loved trivia and how very small things influence how people behave. What are the systems around behavior? I’ve always been an observer. Maybe it comes from being in so many environments in my life, from Nigeria to the UK to Canada and may different parts of the US. I love understanding cultures and behavior.
Part 3 of our interview with Stephen will discuss his leadership role in helping Crossover respond to the COVID19 Pandemic. We discuss how the company began to prepare, developed response levels, effectively overnight transitioned to virtual care, is guiding employers through testing, tracing, and tracking decision points, and where he sees the pandemic leading in the next 6-18 months.