Over the last month, I have had the opportunity to speak to well over 50 different groups who are learning about the Crossover Health story for the first time. At multiple conferences, industry events, and in private conversations, those hearing the narrative are consistently and uniformly impressed by both the work we are doing and the opportunity for impact in Primary Health. Part of the resonance is from two graphs that I love to share in these types of meetings which highlight the big opportunity:
#1—The Prediction of a Virtual Future
In February 2019, we acquired Sherpaa, an asynchronous virtual care platform, to both accelerate as well as transform our vision of what healthcare should be. We knew that our in-person-only model was robust but had some limitations, in particular the ability to surround an entire population. This became apparent as we started engaging with bigger clients which had more widely distributed populations (we discovered a full ⅔ of our potential eligible members were geographically remote [>25 miles] from a health center). We accurately predicted that we would need to move to a “virtual first, strategically in person” future, that over time we would be doing more remote care, and that our physical health centers would need to adjust their footprint, operations, and service offering to become “confirmatory centers.” We shared the following chart (based on experience with a client’s population) broadly with our employer clients and our consultant partners to illustrate our vision of Future Health:
Our assumption at the time was that the high cost of ER, Urgent Care, and specialist visits could be addressed by building an onsite or nearsite center; then, by engaging large numbers of employees in our care model, we could demonstrate the convenience and positive experience of virtual care relationships which would gradually shift the care mix to more of an online focus. It would follow that physical visits in the health centers would decrease, and the use and adoption of virtual care would dramatically increase. Our thought was that a new equilibrium would result in about 70% of care being delivered online, with about 30% still requiring an in-person visit to confirm the diagnosis, draw blood, give a vaccination, or to perform some other in-person only procedure. And we thought this would be achieved over 3–4 years.
That was then . . . but this is now:
#2—The Virtual Transition in Real Time
In March 2020, the pandemic made its way to America, with lockdowns following shortly thereafter, and then the country roiled circuitously through a highly political and contentious fall election cycle. This created an amazing background for our care teams to really begin to demonstrate their value as they went about doing their best work. I am so proud of how they responded to the crisis by Running into the Fire, embracing Pandemic Primary Care, Refusing to Let Go of the Dream, helping our clients Return to Work, or simply doing amazing work with our rapidly evolving care model (here, here, here, here, here, and here). We demonstrated that our culture was antifragile, that our care teams and care model were resilient, and that our “inevitable” spirit would always find a way forward. Simply awesome.
The graph that best sums up the ensuing major transformation we went through as a company is shared below:
This chart dramatically shows the profound transition we underwent as an organization this year and helps both visualize and conceptualize the future of our care model. In January and February we were operating our very successful and effective onsite and nearsite care model. In-person visits made up 85-90% of the total, and while we were doing a moderate amount of messaging, we only did about 5% of our visits virtually.
Within a matter of 3-4 weeks after the pandemic hit and lockdowns were mandated, we were compelled to pivot to virtual engagement. Our percentages flipped, and 85-90% of our visits were being conducted online instead. Then starting in early June, as the virtual visits continued to expand, you can see the return of physical visits as people began to engage again in person. As we headed into November it became clear that a new equilibrium was being reached with about 40% of our care online and another 40% in person. I personally believe we will not be going back to where we were pre-pandemic, and current patterns are likely to persist as the “new normal.”
The equally observant will notice the gray and green areas of our chart, representing new types of activities that will be a critical part of our care model moving forward. These areas chart our proactive outreach, care gap closures, clinical reminders, clinical programming, and personalized check-ins with members. During the months of April through July, we sent over 100,000 messages to our members, we conducted nearly 10,000 COVID tests, and we took care of over 350 members who were positive for the virus with our 30-day COVID Care program. These activities demonstrated to our clients that our care teams could actually monitor the health of their employees and our members on a daily basis, something that they had heard us say before, but for the first time they got to see it in action. It was amazing to hear all the stories about how our teams checked in on our members to make sure they were safe, had transportation, medication refills, and—an unobserved but nonetheless critical part of our job as primary health providers—had someone to connect with, talk to, and just listen. We encouraged people who were tired, comforted those who were scared, and buoyed up our own team members when they were down. The data on these points is clear—you can see all the touchpoints, the many connections beyond our center walls that were made possible through our technology, and the relationships maintained and increased via the “conduit of trust” through which our care is always delivered.
As I think about the year 2020 as well as the holiday season, my first thought and strongest emotion is one of gratitude. I have been able to see firsthand what courage looks like, what long hours in the trenches do to build trust, and the many acts of kindness, service, and the extra mile the Crossover team has delivered (over and over)—all of which has been noticed and felt by so many. These efforts are exemplified by our hosts going above and beyond, the acupuncturist reinventing their speciality on the fly, our recruiters sifting through hundreds of candidates to find the exact right fit, our payroll never skipping a beat, developers working weekends to push code, our credentialing team obtaining >2,000 licenses, and so much more.
This year has tested the resilience and ability of our care model and payment models to flex (both passed with flying colors!), the ability of teams to adapt, improvise, and overcome (XO Marines? Huzzah!), and the creativity of so many who consistently found new and better ways to stay connected and relevant to our members and to each other. So, if you ever wonder what Inevitable looks like, you just have to picture our team, who made our vision a reality in an incredibly challenging year, and imagine that same passion and energy being a permanent part of our future.
Enjoy the season and light it up with the spirit of Inevitable Gratitude!
Scott Shreeve, MD 