In Part 1, we spoke to Karoline Hilu, MD, Chief Strategy Officer at Crossover Health, about her personal background and fresh perspective on primary care. In this post, she speaks about the impact of COVID19 on Crossover’s model of care, and what she sees as the fundamentals of the new normal for both healthcare and society.
What’s the impact of COVID-19?
In an uncanny way, COVID-19 reminds me of Chernobyl. An unexpected event which drives a total lack of information, isolation, and a sense of helplessness. Because of its digital first model and its close connection to the CDC, DOD, and VA at the leadership level, I think Crossover will be able to touch all three of these areas for our members I wrote about our pandemic primary care model a few weeks ago. We’ve been able to keep real-time tabs on the emerging information and tie it to our own protocols. We host weekly client meetings to provide our latest updates and to answer questions, both during these group sessions as well as in private followups. We’ve set up open air testing and we are working on home-based testing, pending the right FDA approvals. Finally, while we’ve been able to flp to a virtual model overnight, I’m also especially proud that we are providing urgent COVID-19 care while simultaneously continuing to take care of all of our chronic populations including critical behavioral health support. Our clinical teams have had such a positive experience in proactively reaching out to all of our patients across the country. We see COVID-19 as something our teams are working to respond to in the moment, as well as preparing for, as we face future clusters and outbreaks in the months ahead.
Where does Crossover go next?
With some recent contracts and plans for massive expansion in 2020-21, we are no longer the little-known startup from SoCal. When I started, we had a clear mission to work with self-funded employers to create a next generation population health vehicle. Five years in, our mission is to use what we’ve built to impact the lives of those who would never have been able to gain access to this kind of model in the first wave. As you can imagine, this means a lot to me on a personal level. Our model is ideally suited to the care needs of our population during the pandemic, but it has tremendous potential even as we come out on the other side. Access to care is such a fundamental boost to people working hard every day to make ends meet to fuel the recovery of our economy, particularly post COVID-19.
The other theme is that we are not interested in primary care only, rather we see it as a key entry point, or lever, to more long-term outcomes. Crossover’s magic is when a provider and care navigator team can steer, stay with you, and follow up with you at every point of the journey. When I first sat down with one of our co-founders Rich Patragnoni, MD in early 2015–and this is part of what made me want to join Crossover—he and I talked about the vision of a “healthcare bubble.” What if you not only create a great experience in primary care, but the patient also stays within expanded care eco-system for the entire journey? After all the time I spent looking at big provider organizations and seeing them struggle with population health, I believed you could pull it off if you were directly contracting with large, self-funded employers.
When I left my previous role, CMS was putting up shared savings experiments and then shutting them down decisively as hospitals backed out of them—the hospitals found they were investing far more than could be recouped by the shared savings. Despite the best intent, they didn’t have the right physician enterprises, or underlying technology, or even business models that could properly control the complex psycho-social external factors within the populations they were attempting to manage.
We do. And, this is what makes XO’ mission so powerful. As we have evolved, the vision has not deviated at all. The Connected System of Health is the big phrase we use, but it’s really that bubble of health I spoke about. Someone who is with you at any time, and any place in the journey, and completely understands you, where your baseline might be, and where you want to be in the future. The bubble is effective, and I hope, will prove to be more equitable. “Equitable” is the critical link and endgame for our model.
Tell us about the Digital First model.
I was recently on a conference call speaking about telehealth companies, and one participant noted that 60% of its virtual care was with people who had never used it before, but started to because of COVID-19–and they’re coming back because they liked the experience. I think we’re getting over the hump of “let’s try this new thing one time.” There’s no going back. The question about the staying power of virtual care has been rendered almost obsolete—it will be impossible to revert to the old, inefficient way of doing things, especially now that patients and providers both realize you don’t need to physically go to the doctor’s office.
I think, however, that we need to be clearer on what this new model (the “new normal”) has to be. It is NOT a virtualized video visit, a proxy for how things used to be (i.e. taking the old and virtualizing it then calling it new). Rather, the new model is a digital front door that could be asynchronous, synchronous, could include a telephone call as needed, communication and info transfer to other members of the care team—all virtual. Or it could include a visit to a clinic in a city that’s not your own. I love exposing that flexibility and combination of the parts, because that’s where the care and behavior change gets so interesting, and where we start to map to the reality of people!
How do you make the new normal stick?
We have to make it real and not theoretical for as many people as we can. We need to experience this model first hand and actually see how good this is both for the patients and for ourselves, the providers. It will have to look like driving access for patients who may be stuck at home and acutely ill, routing them in real time to the right setting of care with capacity, and then catching them on the other side. We also need to help essential workers who may not have been able to get any access at all and so they can continue working, as well as enabling our providers to provide care as long as possible, to as many patients as possible, around the clock during this crazy time. All of the above is critical to driving the belief that this new normal will stick. When we embrace it, we also push it forward into being. The pandemic has focused our attention, to be sure, but there’s a silver lining to be found in the challenge as we radically accelerate use and further pivot away from an old, inefficient model.
What happens to Crossover over the next 2-3 years? What is the end game?
As Crossover continues to demonstrate an impact on total trend and clinical outcomes, I believe it will scale to new risk-bearing segments beyond the employer space. For me, the most meaningful end game will be creating a product that is scaled to create accessibility for all types of “essential workers” who would not have gotten access to this type of great care during the first phase. This is what the second wave of growth will be all about for us.
Philosophically, I would also like the product to continue to evolve down a transparency arc, particularly on the PBM front, which is a space where hidden markups, rather than value, determine economics. We have seen many great PBM players, and the combination of a care delivery asset like Crossover and a transparent PBM would be an awesome combination.
If you weren’t at Crossover Health, what would you be working on?
Team is everything. I’ve chosen every step not based on the industry space and economic opportunity but rather on the team. The people are critical—I want to respect the people I work with, to learn daily from them, and to work through hard things with them. Partnering with people to solve problems in all kinds of stressful situations , and then being able to say you would do it all again is the hallmark of teams I want to be part of. I have a lot of respect for the work and culture that Matt Hobart and Martin Coulter and many others have built at TPG. They tell great jokes and make transformational bets, like Evolent Health, that try to tip inefficient systems forward.
Anything else we should know about you?
The ultimate revenge is making your father watch a girl coach boy’s soccer.
Many thanks to Peter Heywood (one of our long-standing brand advisors and business consultants) who helped conduct these interviews.
Scott Shreeve, MD 