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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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When introducing a new concept (or new service), it is always important to be able to “see” beyond what is in front of you and project into the next two or three orders of impact to understand its true value. This is embodied in the classic work of Frederick Bastiat, and his “The Seen and the Unseen” narrative, which has made its way into the modern innovation lexicon. The best modern example of this is Elon Musk telling you about the advantage of electric cars when he is really selling you a timeshare on Mars. These are the true “see-ers,” effectively time travelers from the future, that pull us all toward their (intergalactic) view. 

The reason for this series of posts (first, second, and third thus far, with six more coming!) is to help not just draw the outlines, or color in some details, but rather to bring forward the full technicolor animation of what the future of employer-based healthcare delivery should be. Having established an expanded definition of our unique “Primary Health” mode, I will highlight the first, second, and third order value it can create for employers far #beyondtelemedicine.

Crossover believes Primary Health is one of the very best engagement catalysts that employers can put in place. Like any good catalyst, it significant lowers the activation energy to engagement while producing a desired outcome. Healthcare is one of the few benefits employers can offer that is needed by everyone, where the value proposition is relatively easy to establish, and it can impact the entire population including dependents. Even better, it is a benefit that actually has network effects—the more people use and embrace the service, the more value that can accrue to the entity paying for the benefit—a classic virtuous cycle. The reason Crossover focuses so much of our efforts on creating an exceptional member experience is that it is the precursor to enable the engagement that kicks off the cycle. Engagement gives an opportunity to develop trust—it opens the door for us as a care team to walk with members as they move beyond the first level of urgent care and make important behavioral, lifestyle, and physical changes which then allows them to live more productive, healthy, and happy lives. While this sounds over-reaching, it isn’t—without your health “asset” no other asset matters. Full stop. 

Primary Health, as opposed to conventional telemedicine,  is an incredible engagement catalyst for employers as they begin to understand the multiple orders of value that can be created:

  • First Order—Reactive Sick Care. People with acute or urgent health needs want answers and they want them now. The digital-first connectivity, care team availability, and open access scheduling as needed have always been critical features of the Primary Health model to ensure that members who need us can be cared for right away. It is not hard to see value when the need is high, the situation is concerning, and the impetus for engagement already exists. When we deliver in these situations we create a lasting impression and settle the value proposition immediately. “I have never experienced this level of care,” “I didn’t know I could connect so easily to my care team,” and “This was so efficient getting my labs and prescription in one visit,” are representative but also routine comments from individuals under our care. It is interesting that these delighted word of mouth referrals are by far the best method to engage new members—the most common answer to “How did you hear about Crossover?” is, “A colleague referred me” (email is a distant second.) Also, of those who engage with us, nearly 70% designate Crossover as their go-to medical home for the services we provide. When you serve the needs of those in real need, they return that excellence with loyalty, referrals, and trust
  • Second Order—Comprehensive Health Care. When we solve acute or urgent needs related to sickness or injury we create space for an individual to think differently about their relationship to their own health, as well as their relationships in healthcare. “If that was so easy, what else can I take care of with Crossover?” or “Man, maybe I should consider dropping those few pounds because Crossover has a health coach who can help” or “I should really address how my mood is impacting my work performance.” The comprehensive care embedded within our Primary Health model allows us to engage with more patients given the multiple entry points — more than 50% of individuals who use our care start with primary care, but 20% start with physical medicine, 15% start with behavioral health, and the remainder start from other service lines. The point is, providing the full set of service offerings allows more and more of the population to engage in coordinated, integrated, and comprehensive care that is architected to deliver better costs, higher quality, an elevated experience while building trust. This is not just great care, its next level health.
  • Third Order—Proactive Performance. This is the hardest but most impactful order to achieve in engaging employee populations. As part of any professional career or personal growth planning, individuals need to consider their underlying health and health goals. Offering a benefit to employees that allows them to plan for their health future is an incredible long-term opportunity that has compounding benefits. Getting people to change to healthier lifestyles—from nutrition to exercise to stress moderation to work/life balance efforts—is a very challenging task but one of the highest yielding investments any employer can make. Having an Annual Health Strategy, as part of and in correlation with, any other life planning allows one to get serious about health accountability. When you have a large percentage of your workforce that is engaged in health planning activities, the employer will benefit from the observer effect and see an increase in healthy behaviors. When ingrained in your culture (via employee onboarding, health promotion activities, or financial incentives) as a catalyst for engagement, you will be well on your way to being able to benefit from this third order effect.

Human Resources leaders who make care delivery decisions often underestimate or never consider the multiple orders of impact of the care model on their employee engagement efforts. Experience and engagement matter – and your should expect your care delivery selection to aid you in the engagement efforts and be sure to include this in your return on investment calculations as well. We have often been told by our members that our service is the most valuable employee benefit they receive, and that people make both hiring as well as retention decisions based on our service (better yet, we have members who only apply to other employers who offer our services!). Primary Health as an engagement catalyst can also extend to other benefits offered by the employer, especially when these other benefits are used within our care workflows, become part of our care standards, and can be leveraged in the routine course of care. When our care team “prescribes” apps, services, or other benefits offered by the employer, the engagement and persistence increase dramatically because these benefits become real, relevant, and realigned with actual care delivery and the health goals we developed together. This powers the virtual cycle that creates real return on investments, as care delivery is now tied in deeply with the overall benefit package being offered. Sorry, this just isn’t achievable in a brief, transactional telemedicine interaction with a stranger.

These second and third order impacts can catalyze first-rate employee engagement outcomes. And we are only getting started in enumerating the advantages of implementing Primary Health. Next up, Primary Health as an population management service.

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