Mark Nelson, Crossover’s Chief Financial Officer, joined the company just over three years ago, at a time when a significant financing round propelled the company to a new level of growth. Mark began his career in auditing and investment banking , and later spent 15 years guiding high-growth organizations through their growth. He is very clear, “Finance is all about the future.”
What’s your background?
I was born in New York but raised in Northern California, near San Jose. My dad was a mechanical engineer and my mom was in sales. I take after my dad the most—he was all about the intricate details and deep analysis. It’s therefore no surprise to me that I ended up in a profession like finance which focuses on exactly those things.
What is your background and experience in finance?
My career started right out of undergrad at one of the “Big 6” accounting firms. After auditing a variety of firms over the course of a couple of years, I wanted to do something more exciting which led me into investment banking. Investment banking covers a number of banking-related services, mergers and acquisitions (M&A) being one of them. After a number of years doing this on the West Coast, I was fortunate enough to work on a project alongside a premier Wall Street bank. They took a liking to me and hired me away from the investment banking role to join their M&A group in New York City. This was an exciting opportunity full of amazing M&A deals and learning experiences for me. Together, the auditing background and the several years of banking experience, created a great foundation to continue to build upon, and the new role in New York gave me incredible experience at a premier bank; I was looking at deals from every angle and working with all kinds of companies, leaders, and entrepreneurs.
Soon thereafter, I became drawn to the idea of getting my MBA, and was so happy when I was accepted into a top business school—the University of Chicago. I developed much more depth in the skills I needed, and a fantastic framework that I knew I could use to add value to any company I worked with in the future.
After business school, I’d had enough of the cold weather (I didn’t know it could get colder than New York until I moved to Chicago!) and moved back to Orange County to work in finance at a PE backed healthcare/education company. My role covered all of finance, but the position was heavily weighted to M&A work. After a great experience and fantastic exit for our investors, the CFO of that company brought me over to VIZIO (the TV maker) where I spent over nine years helping to grow and optimize the company, which was massively expanding. We ended up filing to go public which was a fantastic milestone in my career, but given the choppy public markets at that time, we ultimately paused. In the meantime, we were approached by a company interested in acquiring us, and although we worked on that deal for a year, unfortunately that didn’t materialize either.
After VIZIO and all these other great experiences, I was ready to move into a CFO role. That was when I learned about Crossover Health’s story and mission, and I was at once impressed with both. Just as VIZIO had disrupted the mature US television market and grown to be a leader in the industry, I felt Crossover would similarly grow to become a leader and an innovator in the mature healthcare industry. I was excited to take the step up, work with a great team, and have a strong PE partner backing the company.
What were your big takeaways about your experience at VIZIO?
My biggest takeaway at VIZIO was that Finance can add tremendous value to any company in its operations. It cemented my view that Finance is not a cost center but rather a profit center. There were a number of projects where we as a team were able to shine a light on certain business processes and save millions of dollars per year. In one case my team and I came upon $19 million that the vendor owed us. In another, we found a very complex way in which one of our large retail customers had double deducted us almost $10 million which we were able to collect back, and in another case we analyzed our logistics and came up with a potential of $20m to save annually on more efficient shipping, with $10 million of that achieved within the first several months of working on this.
How did you find Crossover?
Crossover had initiated a search for a CFO after the investment from Gurnet Point Capital at the end of 2016. As happens so often after a round like this, there was a new level of sophistication needed, new areas of growth were expected, and the senior leadership in this critical function needed to be in place, particularly from our new financial partners’ perspective. For me, it looked like a great opportunity to take a step into the CFO role, build out my team and the necessary processes, and optimize the business.
How has the company changed since you joined three years ago?
Our private equity fund investment in 2016 was a bright line. The PE fund wanted to accelerate maturity in all the different departments and create a sustainable and fast-moving set of departments to provide the right kind of support for our Medical Group. A common and repeated theme in all of our initial meetings was to prepare and build the company for scale. We had achieved almost $40m revenue the year before I got there; our projections called for an almost 600% growth rate over the following several years, and we needed to have much more mature processes and controls in place in order to achieve this. It really fell to me and my team to get the financial house in order and we jumped right in. We’ve added a number of capabilities in our corporate overhead with senior executives rounding out the departments. We’ve also added new departments with developers and designers for our virtual services. The last several years have definitely been a story of scaling from a startup and introducing corporate capabilities.
What is your role as Chief Financial Officer?
As CFO, my role is to create and lead a team that will handle the growing needs of our business and to be a financial advisor to other executives, business leaders, and our board of directors. My role is to ensure that on the Accounting side we have accurate and timely books and records within an environment of good controls, and on the Finance side my role is to ensure that the team is properly forecasting and planning for the needs and growth of the business, and that we act on these needs to obtain the lowest cost of capital to run and grow the business.
It could be said that Accounting deals with facts and actual transactions dealing with matters that are already contracted or settled. Finance, on the other hand, deals with future events that have yet to occur. As a team, Finance works on budgeting and financial forecasting, pricing, contracting, and ad hoc analysis. We work with banks and investors to make sure that we have enough capital arranged to handle our operating and investing needs. We also work with our board to set expectations and goals for what the management and business will do for the next year and many years, so that we can reflect later on if the goals were achieved.
Are the trends in valuation changing?
We’re in an interesting time right now. With the pandemic, we’re seeing trends in valuation that are going the wrong way. Commercial real estate, tourism, airlines, restaurants, retail—they’re all plummeting. There are cycles and trends you’ll see where one sector is favored over another, and in this time of COVID-19, investors are flocking to safety, to consumer staples, and to things that are in high demand. Healthcare is definitely one of the sectors that is considered safe. We have certainly seen the valuations go higher and higher during this time with companies like Livongo, Health Catalyst, Accolade and others being valued with revenue multiples as high as 10-20x next year’s revenues. These are incredible valuations—and the public market is definitely responding to what it sees as continued growth and growing demand in the general health industry, as well as specific growth in technology-enabled healthcare. Crossover sits right in the crosshairs of this positive valuation growth.
Healthcare companies are rarely given the valuations of tech companies. How do you think about Crossover—as a services business or a technology-enabled service?
The characteristics of a tech company are 1) high growth, which we have seen in both our core business as well as our new business lines; 2) high margins, which are much harder to obtain in healthcare but leveraging technology does get you some efficiency advantages; and 3) high scalability wherein these businesses have a lot of inherent “operating leverage” (meaning as more and more users join the platform, the operating leverage actually increases, rather than decreases). We have seen at Crossover that we can move much more in this direction with the introduction of our technology-enabled virtual services, population health approaches, and getting into some of the new economies of scale with a national footprint. A good example is in the traditional brick and mortar world—there, we’ve had to construct sites, which would take months, but in the virtual world we can turn on ten thousand lives very quickly and easily.
We can also demonstrate a story of high growth. We’ve achieved it, and are within it now—and this really resonates with investors who want to be able to predict and project our revenue growth in the future. Revenue growth has become increasingly more important because the multiples for businesses like ours have shifted from a revenue or margin per site operated (which is a traditional view), to now being valued purely on revenue. That growth becomes inevitable when our revenue and margin overcomes our corporate overhead and we get into that sweet spot of generating profits, giving us more optionality as a business, and the opportunity to set our own course.
What are the unique aspects of Crossover’s financial model as a tech enabled health service company?
The unique aspects of our financial model have really come to light when you consider the last 90 days of the COVID-19 crisis. Community-based practices that are reliant on the fee-for-service model are experiencing a lot of pain right now. We’ve created a business model that is specifically not fee-for-service and we’re not going to prosper by having more visits or suffer because of less visits. We’ve created this longer term business model by not only focusing on the triple aim and overall population health and management. This model comes in a couple of varieties including cost-plus, PEPM, or fixed fee, and it’s based on the relationship between care teams and members, as well as the clients.
In the long term, what our financial model is really doing is aligning our priorities with those of our payer—in this case, the employer. When our priorities are aligned, we can then row in the same direction, have the same objectives, and have a much better basis of partnership to go deep into healthcare delivery innovation. What I have appreciated is that it is really hard work to get into the details of care delivery to drive efficiencies, to have a medical group with standards of care that can be implemented into workflows, and then to teach, train, and measure how we are doing in our efforts to improve clinical outcomes. It’s all doable—we have made tremendous strides—and this is where I think the partnerships between the various functions of the company have really created value. And, as I mentioned earlier, we have to do all of this while we maintain an exceptional experience and achieve high engagement in order to have the impact we intended. It’s been quite a ride to see the progress.
In Part 2 of our interview with Mark, he speaks about integrating financial conversations deeply into the DNA of Crossover operations, how the “digital first” model enables scale, and how core corporate values have helped the company grow.
Scott Shreeve, MD 