Dan Oftedahl recently joined Crossover as the Senior Vice President of Payer Markets, after a career with major health plans in almost every imaginable role. You will see how he is hard-wired for curiosity, and how well that characteristic has served him throughout his career. Now, he will be leading Crossover’s entrée into the payer market, convinced that our model and our partnership is what payers need to solve a challenge they’ve struggled with for years—how to get closer to members and genuinely help them live healthier lives.
Dan, you’re new to Crossover. What has been your initial experience at the company?
I’m routinely amazed by the passion Scott has. It’s palpable in every conversation you ever have and you can see how his mind works as you watch him edit shared Google Docs on your screen. And I continue to be impressed by Scott and Nate and their global view of healthcare as an ecosystem, which is rare in entrepreneurs who often have to be so narrowly focused to succeed.
I’ll give you an example. When I left Aetna, I helped a close friend of mine who was consulting with startup organizations, connecting them to healthcare, whether it was hospital systems, providers, or payers. I would meet these amazing entrepreneurs who had really impressive ideas but their business model wasn’t built with an understanding of healthcare as a whole. They had solutions that were specific to a patient experience/outcome, or a specific solution tied to chronic disease like remote patient monitoring devices for diabetics. Most of these solutions were born from a personal connection to the problem, however, very few of these entrepreneurs understood the simple tenants like, Who’s going to pay for it? How pervasive of an issue is it? Does their product create a better patient outcome? Are any financial savings created? What truly is the differentiating value proposition? Those are the big questions Scott and Nate are constantly working to answer.
What’s your backstory?
I spent most of my childhood in a little town in southwest Minnesota. When I say little, I mean, it’s two blocks wide, four blocks long, with two bars and a Catholic church. It has a population of nearly 400 today. Both of my parents grew up on farms fairly close and my dad started his career with the railroad. He was incredibly driven, and although he didn’t have any post-high school education, he kept getting promoted, which meant we moved a lot. I lived in seven different cities by the time I was seven years old. The final promotion would have moved us to Chicago, but given my family at the time included four kids under seven years of age, my parents decided that relocation wasn’t the right decision for us at the time. So he acquired a small property casualty insurance agency in this small town and that became our home.
I was a decent athlete growing up and was blessed to be on teams from all over the Midwest, which was a big sacrifice for my parents and siblings. They often traveled along in a conversion van to all of these events, sometimes foregoing their own personal interests for mine. I graduated from St. John’s University, which is a private, liberal arts university in central Minnesota. I was the first person in my family to go to college, and while my parents were never afforded the opportunity to attend themselves, they definitely stressed academics to us. To say they had a personal relationship with nearly all of my teachers would be an understatement.
Prior to my senior year at St. John’s, I applied for a summer internship at a small company named UnitedHealthcare. They were later kind or foolish enough to offer me a position after I graduated, and that proved to be the beginning of my healthcare journey.
What roles at United were you in during that time?
I jokingly tell people my first job was one for a kid with no life and no wife. I was literally on the road for six weeks at a time. I’d come back for up to a week and then I would hit the road again. I was in the Provider Reimbursement Systems division. My job was to be a liaison between the health plan accountants, the health plan network team, and the system programmers. It was an unbelievable learning platform that allowed me to ask a lot of questions, put me right inside the financing mechanism of healthcare, and gave me visibility into the conflicts associated with each stakeholder inside healthcare.
Interesting, I am assuming this role was not for the faint of heart?
When I’m asked about my early health plan experience, I emphasize that the firsthand education they gave me into the infrastructure, the development of insurance products, and the entire delivery system was incredibly valuable. I started on the finance side, and then ended up on the provider reimbursement side. I got into sales, and ultimately into product and health plan management. All of those things have come together to help formulate a career that has continually challenged me.
You then made the leap to Humana, can you share your experiences there?
I was with UnitedHealthcare for the first seven plus years of my career. I loved everything I’d learned and been exposed to as that company grew, however I found myself with this intellectual curiosity to go on and learn more. That curiosity led me to a start-up benefits and insurance company that ended up being acquired by Humana—which is what really got me into health plan ops, health plan services, and building out infrastructure. Honestly, that’s when all of my experiences came together and I was able to take the best parts of my learnings, experience, and prior leaders to impact change in a substantial way.
Humana is a great company with great leadership, and continues to be a leader of innovation, specifically in the Medicare Advantage space. When the Affordable Care Act passed, it created so many exciting new opportunities to get into the value-based care arena. The national health plans created different strategies based on their strengths, provider and hospital systems were forced to adopt different patient care and financing strategies, and an entirely new economy was created inside the healthcare ecosystem. Meanwhile, the cost of healthcare continued to get higher and higher, healthcare literacy gaps widened, and new solutions around access and convenience were created. All of these disparate solutions, individual strategic investments, and lack of true pricing transparency has made the topic of healthcare even more divisive.
What was the opportunity you saw in the Accountable Care Organization concept?
There was a real opportunity to get on the ground floor of building true provider-payer partnerships focusing on common goals that removed some of the friction of the stakeholders. For me, it was the right time in my career to reignite that intellectual curiosity. I was going to insert myself into this world of positive disruption that created better outcomes for the individual member. That ultimately led me to Aetna, where they were partnering with integrated provider systems on an ACO product strategy in several markets. The evolution of several of those ACOs arrangements were joint ventures. Each one of the joint ventures was a new health insurance company, owned 50% by Aetna and 50% by these integrated provider systems. These joint ventures moved the needle tremendously in member experience and physician engagement, while attempting to remove some of the inherent friction found inside the delivery system now. These arrangements also fundamentally changed the levels and degrees of transparency between the payer and the provider. We no longer kept separate data that was used to negotiate against each other. Rather, we shared data to create programs, products, and experiences that achieved common goals. It took patient-centered medical homes, bundled payment structures, risk arrangements, value-based care financing, etc., and rolled them under one umbrella, which accelerated the Triple Aim.
But I saw major gaps and flaws too. We definitely put way too much on the physicians. For instance, we asked them to alter their clinical processes, and to manage their treatment style to focus on specific health condition outcomes, but didn’t necessarily incent them to treat for whole person care. We asked for all of that while only 35% of their patients were in our programs. They still had to spend 65% of their time seeing patients from other health plans that had different, sometimes competing, value-based arrangements and compensation processes. In the end, I could see it was going to be impossible to ask a physician to change their practice style to suit each model and for all the different patients that walked through the door. We had unwittingly put them into a very unfair position because most of the adjudication and claims recording were after the fact as opposed to in advance. It was a game they were never going to win.
It always seems as though the primary care physicians are caught in the middle of a much larger game, with much bigger players, and with ever-changing rules. What did you eventually do?
To your point, if you go back 20 plus years, when hospital systems started to purchase independent physician practices, one of the intended benefits was supposed to be efficiency in the referral pattern into their hospitals. However, hospitals didn’t necessarily invest in the infrastructure around these primary health providers. To this day, many primary care practices under the same “integrated” system are still on different Electronic Medical Record platforms or different versions of the same platform. We have made it too difficult for Primary Care physicians to do what they need to do. And we’ve misaligned the reimbursement models, so that many who would be family healthcare providers, end up choosing a specialty career path instead.
The creation of concierge health practices, on-demand medical consultations, and the building of urgent and convenient centers are a direct result of this.
Part 2 of our interview with Dan will dig into his role at Crossover, and how the company’s vision, model, and its results with innovative employer customers has created an incredible foundation for new Commercial Advantage plans to finally create the right aligned incentives to achieve the Triple Aim.
A Conversation with Dan Oftedahl
Senior Vice President, Payer Markets at Crossover Health
Part 1: Driven by Curiosity
Dan Oftedahl recently joined Crossover as the Senior Vice President of Payer Markets, after a career with major health plans in almost every imaginable role. You will see how he is hard-wired for curiosity, and how well that characteristic has served him throughout his career. Now, he will be leading Crossover’s entrée into the payer market, convinced that our model and our partnership is what payers need to solve a challenge they’ve struggled with for years—how to get closer to members and genuinely help them live healthier lives.
Dan, you’re new to Crossover. What has been your initial experience at the company?
I’m routinely amazed by the passion Scott has. It’s palpable in every conversation you ever have and you can see how his mind works as you watch him edit shared Google Docs on your screen. And I continue to be impressed by Scott and Nate and their global view of healthcare as an ecosystem, which is rare in entrepreneurs who often have to be so narrowly focused to succeed.
I’ll give you an example. When I left Aetna, I helped a close friend of mine who was consulting with startup organizations, connecting them to healthcare, whether it was hospital systems, providers, or payers. I would meet these amazing entrepreneurs who had really impressive ideas but their business model wasn’t built with an understanding of healthcare as a whole. They had solutions that were specific to a patient experience/outcome, or a specific solution tied to chronic disease like remote patient monitoring devices for diabetics. Most of these solutions were born from a personal connection to the problem, however, very few of these entrepreneurs understood the simple tenants like, Who’s going to pay for it? How pervasive of an issue is it? Does their product create a better patient outcome? Are any financial savings created? What truly is the differentiating value proposition? Those are the big questions Scott and Nate are constantly working to answer.
What’s your backstory?
I spent most of my childhood in a little town in southwest Minnesota. When I say little, I mean, it’s two blocks wide, four blocks long, with two bars and a Catholic church. It has a population of nearly 400 today. Both of my parents grew up on farms fairly close and my dad started his career with the railroad. He was incredibly driven, and although he didn’t have any post-high school education, he kept getting promoted, which meant we moved a lot. I lived in seven different cities by the time I was seven years old. The final promotion would have moved us to Chicago, but given my family at the time included four kids under seven years of age, my parents decided that relocation wasn’t the right decision for us at the time. So he acquired a small property casualty insurance agency in this small town and that became our home.
I was a decent athlete growing up and was blessed to be on teams from all over the Midwest, which was a big sacrifice for my parents and siblings. They often traveled along in a conversion van to all of these events, sometimes foregoing their own personal interests for mine. I graduated from St. John’s University, which is a private, liberal arts university in central Minnesota. I was the first person in my family to go to college, and while my parents were never afforded the opportunity to attend themselves, they definitely stressed academics to us. To say they had a personal relationship with nearly all of my teachers would be an understatement.
Prior to my senior year at St. John’s, I applied for a summer internship at a small company named UnitedHealthcare. They were later kind or foolish enough to offer me a position after I graduated, and that proved to be the beginning of my healthcare journey.
What roles at United were you in during that time?
I jokingly tell people my first job was one for a kid with no life and no wife. I was literally on the road for six weeks at a time. I’d come back for up to a week and then I would hit the road again. I was in the Provider Reimbursement Systems division. My job was to be a liaison between the health plan accountants, the health plan network team, and the system programmers. It was an unbelievable learning platform that allowed me to ask a lot of questions, put me right inside the financing mechanism of healthcare, and gave me visibility into the conflicts associated with each stakeholder inside healthcare.
Interesting, I am assuming this role was not for the faint of heart?
When I’m asked about my early health plan experience, I emphasize that the firsthand education they gave me into the infrastructure, the development of insurance products, and the entire delivery system was incredibly valuable. I started on the finance side, and then ended up on the provider reimbursement side. I got into sales, and ultimately into product and health plan management. All of those things have come together to help formulate a career that has continually challenged me.
You then made the leap to Humana, can you share your experiences there?
I was with UnitedHealthcare for the first seven plus years of my career. I loved everything I’d learned and been exposed to as that company grew, however I found myself with this intellectual curiosity to go on and learn more. That curiosity led me to a start-up benefits and insurance company that ended up being acquired by Humana—which is what really got me into health plan ops, health plan services, and building out infrastructure. Honestly, that’s when all of my experiences came together and I was able to take the best parts of my learnings, experience, and prior leaders to impact change in a substantial way.
Humana is a great company with great leadership, and continues to be a leader of innovation, specifically in the Medicare Advantage space. When the Affordable Care Act passed, it created so many exciting new opportunities to get into the value-based care arena. The national health plans created different strategies based on their strengths, provider and hospital systems were forced to adopt different patient care and financing strategies, and an entirely new economy was created inside the healthcare ecosystem. Meanwhile, the cost of healthcare continued to get higher and higher, healthcare literacy gaps widened, and new solutions around access and convenience were created. All of these disparate solutions, individual strategic investments, and lack of true pricing transparency has made the topic of healthcare even more divisive.
What was the opportunity you saw in the Accountable Care Organization concept?
There was a real opportunity to get on the ground floor of building true provider-payer partnerships focusing on common goals that removed some of the friction of the stakeholders. For me, it was the right time in my career to reignite that intellectual curiosity. I was going to insert myself into this world of positive disruption that created better outcomes for the individual member. That ultimately led me to Aetna, where they were partnering with integrated provider systems on an ACO product strategy in several markets. The evolution of several of those ACOs arrangements were joint ventures. Each one of the joint ventures was a new health insurance company, owned 50% by Aetna and 50% by these integrated provider systems. These joint ventures moved the needle tremendously in member experience and physician engagement, while attempting to remove some of the inherent friction found inside the delivery system now. These arrangements also fundamentally changed the levels and degrees of transparency between the payer and the provider. We no longer kept separate data that was used to negotiate against each other. Rather, we shared data to create programs, products, and experiences that achieved common goals. It took patient-centered medical homes, bundled payment structures, risk arrangements, value-based care financing, etc., and rolled them under one umbrella, which accelerated the Triple Aim.
But I saw major gaps and flaws too. We definitely put way too much on the physicians. For instance, we asked them to alter their clinical processes, and to manage their treatment style to focus on specific health condition outcomes, but didn’t necessarily incent them to treat for whole person care. We asked for all of that while only 35% of their patients were in our programs. They still had to spend 65% of their time seeing patients from other health plans that had different, sometimes competing, value-based arrangements and compensation processes. In the end, I could see it was going to be impossible to ask a physician to change their practice style to suit each model and for all the different patients that walked through the door. We had unwittingly put them into a very unfair position because most of the adjudication and claims recording were after the fact as opposed to in advance. It was a game they were never going to win.
It always seems as though the primary care physicians are caught in the middle of a much larger game, with much bigger players, and with ever-changing rules. What did you eventually do?
To your point, if you go back 20 plus years, when hospital systems started to purchase independent physician practices, one of the intended benefits was supposed to be efficiency in the referral pattern into their hospitals. However, hospitals didn’t necessarily invest in the infrastructure around these primary health providers. To this day, many primary care practices under the same “integrated” system are still on different Electronic Medical Record platforms or different versions of the same platform. We have made it too difficult for Primary Care physicians to do what they need to do. And we’ve misaligned the reimbursement models, so that many who would be family healthcare providers, end up choosing a specialty career path instead.
The creation of concierge health practices, on-demand medical consultations, and the building of urgent and convenient centers are a direct result of this.
Part 2 of our interview with Dan will dig into his role at Crossover, and how the company’s vision, model, and its results with innovative employer customers has created an incredible foundation for new Commercial Advantage plans to finally create the right aligned incentives to achieve the Triple Aim.
Scott Shreeve, MD 