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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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Primary Health is an emerging care model that is designed to address the needs of any type of healthcare payer seeking to control cost, quality, and experience. Created as an extension of the  good work done to promote the patient-centered medical home, Primary Health is more comprehensive, integrated across more disciplines, and includes more coordination than is possible under existing reimbursement models. As we shared in the first post in the series, Primary Health also uses a different unit of account for care (the Episode of Care vs. the Visit), practices in Care Teams, and has advanced capabilities that allow the care to be more connected, more proactive, and more accountable in producing desirable outcomes. Led by self-insured employers who are willing to pay directly for this Primary Health model, Crossover is addressing care needs across the care continuum, across different care channels, and via different care modalities.

Let’s look at each of these delivery perspectives  in more detail:

Cross continuum. First, for care to be effective it must address a wide enough range of services in a manner competent enough to have a material impact. This is the problem with concierge medicine—it is too narrow in scope and too exclusive in access to have a meaningful population-level impact. While the value to individuals who can afford this type of care may be large, the impact to the overall system at a population level is very small. Primary Health addresses this head on by democratizing the experience of concierge medicine, not only making it accessible to a much larger population, but by also expanding the service lines to catch more of the population at different entry points. The expanded service line approach also helps avoid the “generalist problem” where you have a wide range of services but no depth. In the case of Primary Health you achieve the breadth through these expanded service lines, while also simultaneously plumbing the depths by having functional domain experts as part of the expanded care team. And, to ensure the relationships are maintained and strengthened over time, Primary Health also addresses the full acuity spectrum from preventive (a core focus given the financial model), to acute (the urgent issues and conditions that arise), and most importantly the chronic (where about 40% of employer spending is currently occurring). It also means we address the full continuum of health as well—from true medical concerns, to active care issues, to preventive health, to wellness promotion, and ultimately, to performance services. This ability to go wide, to go deep, and to go “long” is both critical in achieving Primary Health outcomes, and possible only when done at a specific scale, which is why it is rarely seen (and even more rarely attempted) under existing financing models.

Multichannel. Primary Health must be dramatically more accessible to have its promised impact. This requires it to be available through multiple channels, in real time, and nearly all the time. We often use the phrase “digital first, and then strategically in person” to describe how we view access to the service. Historically, care has only been available in person—in clinical “meetings” which require your schedule to coincide with your busy physician’s in order to conduct the meeting. Because there is no alternative means to connect, there is incredible pressure on this narrow time window—you have approximately 7-12 minutes to get out everything you have saved up, to rush through all your questions, and then to try to remember (knowing you’ll forget 85% of what was spoken) what was discussed in a stressful, hurried setting filled with medical jargon and power differentials. 

The whole thing should actually be reversed—take the time you need to do most of the preliminaries online, using asynchronous digital tools that allow for thoughtful responses, and then have your in-person meeting be focused, to the point, and confirmatory rather than exploratory. Perhaps more important than whether the visit occurs in person or online, is the fact that the conversation can even happen at all. The ability to be connected, and to then connect at convenient times for the member is critical. We have found—over and over—that when the member has a relationship, meaning when they trust the provider to respond in a reasonable manner, and they know they can call if they really need to, their willingness to wait for an answer to a question is dramatically increased. It is the certainty of a response through expanded care channels, combined with the possibility of connecting immediately if needed, that significantly narrows the need for after hours conversation. It seems that multichannel connectivity plus Care Team trust equals confidence in the Primary Health care model. 

Multimodal. Primary Health also has the ability to be delivered via the same Care Team approach with the same advanced capabilities, but through multiple modes including onsite, nearsite, and virtual. Each of these modes serves a slightly different purpose and each is typically offered with a different financial model based on who is paying for the physical assets inherent in that delivery model. With onsites, the employer is paying for the capex, labor, and supplies directly. In the nearsite mode, each of these costs are shared by the employers based on their relative contribution of employees to the overall population served. In the virtual mode, all the physical components are removed but the labor costs remain. It is important to note that the same exact clinical care and operational standards are consistently applied. Crossover doesn’t view the place of delivery to be relevant to the Primary Health services that we provide. We are comfortable delivering equally across all three care modes with the caveat that 30% of the time we will need to see someone in person to complete our care. In fact, we believe the mantra that “Care is Care” no matter which channel it is delivered through or which financial mode is used to pay for the services. 

Conclusion

Having first defined Primary Health in Part 1, we have now highlighted its expanded reach in this post. The ability of Primary Health to have a cross-continuum clinical span, to provide multichannel delivery options, and to be offered in multimodal payment models, demonstrates its flexibility to meet and serve the foundational care needs of any defined population aggregator who is seeking accountability for specific clinical, financial, and experience outcomes. It also highlights that the purchaser of Primary Health must also be aligned with these goals in order to justify the investment in this type of service. Furthermore, the capabilities of Primary Health to achieve these specific outcomes is inherent in its architecture—it is designed to manage populations, to produce improved health outcomes, and to deliver true value (outcomes/costs) that is objective, measurable, and repeatable.

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