This interview will introduce Crossover’s Chief People Officer Celeste Ortiz. Celeste talks about her past experiences, her earlier career, and how she joined XO towards the end of 2017. She was hired to help position the company for scale, including ensuring that the culture could continue to be a differentiator for the organization. She shares the lessons she’s learned as a globe-trotting executive for large companies, and what lessons are applicable to a startup transitioning to a “real” company. Interview 1 of 2.
What’s your backstory?
I was born in South Carolina, but raised in Detroit. Where I grew up influenced what I thought I’d want to do and the industry I’d be in. I’m a big car fan. I look at cars as freedom, and I learned at an early age how to work on them, so I thought I’d end up in the auto industry.
Not surprisingly, my high school counselors tried to steer me towards engineering school, which I thought I might like because of my interest in mechanics and cars. While I was a student, I interned with a group of engineers through the GM’s internship program, and I met a woman from Columbia’s organizational development program who told me, “I think you’re enrolled in the wrong school.” She gave me a development program form showing me how my key strengths could play into the field of human resources and management science.
My undergrad ended up being in HR management and organizational development, and after graduation, I spent about ten years in the automotive industry in the human resource department. Then I had a recruiter call me and say, “Why don’t you think about getting into healthcare?”…and that was all it took. I went to work for Pfizer when it was doing about $30 billion in US sales, and I had responsibility for growing the US sales force. We had 12,000 people in sales at the peak, with 15 different drugs doing about $1 billion each at the time. I was then recruited by Johnson & Johnson for an international position, helping to commercialize a research and development acquisition they had made in Israel. I was there for two years building out their management team, and when we had them recruited, trained, and growing—which was an incredible experience—I was ready to come back home.
After J&J, I worked for Medtronic for 12 years, running human resources for their diabetes franchise. The headquarters for their diabetes group was a 500,000 square foot facility in Northridge, and at the time, the group was doing $600 million/year in sales. Through the organizational development we did, and the recruiting that followed, I helped build talent capabilities that transformed them from a hardware-only organization into a software and services company. It was an explosive period of growth for the company—we almost quadrupled revenue to about $2.3 billion when I left.
I love HR because you have an opportunity to look at organizations systemically and create the conditions necessary to help people be successful. I’ve worked in big companies with a variety of environments. At this stage in my career, I’ve formulated a view of how to grow positive cultures—I know that the right culture not only makes a significant difference in the performance of the people, it affects the business overall, which is an impact I love having.
Pfizer was a highly-centralized culture and I saw the benefits of it, as well as what could hold it back. J&J was very different and decentralized environment, and a fantastic experience for me. While I was there, I saw general managers in their mid-thirties, running a $3 billion franchise. Pfizer, you had to really earn your stripes—you had to have so much more experience before you’d ever be considered for a senior role. Seeing the contrast between those two companies helped me realize that it’s not only possible, but important, to accelerate experiences and give opportunities to people much faster and much earlier in their careers. People are very capable, and you don’t always need to have a centralized planning process, or the most senior people making decisions for the organization to be successful.
How did you make your way to Crossover?
If you work for Medtronic, at some point along your career trajectory, you need to consider doing a stint in Minneapolis. But once I moved to Southern California, I didn’t want to live anywhere else. I bought a beach property in Laguna beach about twenty years ago with the idea that this would be my retirement home but also had another house in Northridge, CA that was closer to Medtronic. I was settled in for the long haul. However, about two and a half years ago, a recruiter called me and said I had to meet these guys in San Clemente. I hesitated. Medtronic was going great—I was just doing my thing there. But he insisted, “You have got to meet them. You want this job.” I met Nate, Rich, and Scott, and literally stood up in the middle of the interview and told Scott, “ I can do this job. Give it to me!” I had never done something like that before in my life.
The older I get, the more I have to trust my gut, and it just felt right. It was in SoCal, it was on the beach, and it was healthcare delivery. I started getting very interested in healthcare delivery when the then-CEO of Medtronic, Omar Ishrak (now Chairman), talked a lot about value-based healthcare and how fee-for-service was going to go away. Medtronic started buying clinics, and I started learning a lot more about primary care. As I saw it, to make a fundamental change—one that I had grown convinced was necessary—you would need to go directly to the physician and patient level and re-architect actual healthcare delivery (which was exactly what Crossover was doing!).
I have spent a lot of time helping businesses focus outside the US market, so I’ve been out of the country a lot. I earned over two million frequent flyer miles and saw very different systems of healthcare globally. I knew an organization like Crossover would be needed to do the difficult work of disrupting the US healthcare system, and I wanted to be part of that effort. It didn’t hurt that it was also an opportunity to actually be in Southern California and enjoy living in paradise.
What was your focus early on?
Scott said at the outset that he needed my help scaling the business. We needed to think about the next generation of leaders, and look how we could maintain what was good about the company’s culture. I had a point of view on this, based on my past experiences with all sorts of organizational cultures. A lot of the things that we were able to do quickly—like asking employees what is most important to them, or initiating leadership training and providing targeted development opportunities—has already helped us shave 10 points off of staff turnover during my tenure. I have been pretty pleased with that! This is really the power of a great culture and what is possible when it’s a prime focus. It’s all about creating a place where really talented people want to stay and grow.
When people leave a position, they’re leaving their leaders, not the company. Scott said to me at the beginning not to assume that Crossover’s healthcare providers have had any leadership training. They’re rarely taught, as it turns out, how to do some of the basics like lead developmental meetings, have difficult conversations, or manage their direct reports in a way that helps them set and achieve inspiring goals. So we began offering training courses—we called them Crossover Academy, or XOA for short—and did this training cohort by cohort, to anyone who has leadership responsibilities, whether at a site or in one of our medical guilds. I love the engagement we get from people who say, “I’ve been doing this for so long and everyone just assumes you know how to do this, but no one has ever taken the time to teach me these fundamental skills.” As we have continued to expand the program, we are now systematically taking every manager through the course, which allows each one of them to be a culture evangelist—they can absorb the XO Magic and help spread it wherever they lead, manage, and work. It’s about behaviors and how we do things, which can be driven by a set of core principles and values. Those values are then modeled for others to see in real life work situations.
How has the company changed since you arrived?
We are standardizing and developing consistent metrics across each function in the business, which we certainly didn’t have when I arrived. We’re moving from a visit-based healthcare organization to a population health-based organization. We’re partnering with our clients to demonstrate real, tangible, and repeatable outcomes. Some of our results are surprising even to us—we always quote to clients that we can achieve 10% to 20% reduction in costs, and then when we drill into the data we are consistently seeing cost savings on risk-adjusted cohorts north of 30%. It’s seriously mindblowing the impact that primary care can have. I mean, we all believed it and that is why we are here, but to see cost, quality, and experience metrics really moving that much—that blows us away. We’re able to demonstrate over time how self insured employers can provide such a great experience to their employees, which then drives high engagement, which then allows the care model to have the cost, quality, and experience impacts we promise. This chain of events is predictable, repeatable, and we are seeing it consistently across clients, geographies, and even with different mixes of care delivery approaches. We’ve learned that a little focused attention at key points in the healthcare cycle can have tremendous impacts. Now with the proof points in hand, my job is to continue to find the key talent that helps us continue to accelerate our impact while simultaneously accelerating our market share growth.
How does this experience with outcomes play into the transition to a Digital First practice?
Of course the COVID-19 pandemic has been a massive accelerant on the whole thing. What we need to do is help people understand the “why” behind this massive—and sudden—transition. We emphasize that it’s not about the one thing you’re doing, it’s about all of us rising up and transforming healthcare every day. A full schedule in our clinics is not success anymore. It’s really about thinking about how you are managing your assigned panels, and how you’re driving the clinical operating standards and outcomes we expect for each care team.
In the trainings that I mentioned previously, we share our strategy and where we’re headed. It’s like that old story where someone’s passing by and sees three men working on a building. The first guy says, “I’m laying bricks.” The second guy says, “I’m making a wall.” And the third guy says, “I’m building a cathedral.” We need cathedral builders who totally get, understand, and perhaps most importantly can “see” what we are doing. These are the type of people that not only can see it but they also work in a much more motivated, positive, and energetic way to accomplish the end objective. Sometimes you have to believe it to see it—and then those that see it can help open the eyes and minds of others as well. You have to help people see how each change we make—each brick we lay—will ultimately help us build this beautiful, primary care cathedral.
I’m really not doing the story or the analogy justice, but I really like it because I really feel it when speaking to others in our organization or people we are recruiting into the organization. In fact, that is what I love about Crossover and it highlights our first core value—Inspire People! But inspiration isn’t enough either, you have to show the how laying the bricks this way and then that way is what builds these beautiful arches, flying buttresses, and whatever else I was supposed to remember from humanities class. Some people can naturally see the entire cathedral even before you clear the land, and others come to visualize it over the course of different phases and stages. But, everyone has their light bulb moment where they say, “Wow—what we are doing and what we are building is really cool.” And that is what I have loved most about joining Crossover at this early stage.
In Part 2, Celeste tells us more about how her former experiences are being leveraged to build a talent machine that will help Crossover meet its aggressive and ambitious growth targets.