In Part 2 of our interview, Dan talks about his interest in playing a role of creating unique provider solutions and ultimately, how he got to Crossover. Working from a Provider-centric focus, seeing the opportunities to engage directly with members, eliminating friction inside the ecosystem, and creating a more connected system of health were key catalysts to joining the company now. Bringing a career full of experiences to the table at a critical point in the company, Dan will lead a unique payer strategy aimed at rapid growth and national scale.
How did you hear about Crossover? And, why did this seem like the place to move right now?
I originally heard about Crossover when one of their HR leaders reached out to me through LinkedIn. They were looking for someone with a health plan background who could possibly take their 10 years of amazing results and create some solutions that could allow Crossover to partner with health plans and TPAs. I talked to Nate and Scott for a significant amount of time before I ended up here. To be honest, the direct primary health, onsite/nearsite solutions that I had been exposed to during my career did little to change the overall member experience and financial outcome of the plans I had worked to create. If anything, they added more cost, more segmentation and more frustration for employers and their employees. That created some bias on my part. Once I was able to understand the XO care delivery model and the fact that Crossover was doing it on a capitated model, outside of the traditional claims world, I became more curious about it. I then became convinced that this is the exact model that health plans need to invest in.
Crossover has been a population health company at scale, while delivering individual, actionable pathways for success to each member who engages with our care teams. They’ve built trusted relationships, and they deliver this care through the conduit of trust—so whether virtually through a phone call or secure message, or in person at a nearsite or onsite center—they can be incredibly impactful. And because they maintain these trusted relationships, they can ultimately influence the best outcome and most efficient delivery inside that model.
Health plans have invested mightily in care programs and services that are either diagnosis-specific or polychronic condition management programs. When I was with health plans, we struggled with member engagement inside those programs, regardless of how much marketing we did. The relationship was with the doctor, but we tried to continually insert our care managers and nurses into the mix.
Crossover’s ability to create a trusted relationship with the member, and to serve as the primary educational conduit for the member, will allow us to connect with payers, their care teams, and their care management programs to create a better experience and more connected system for our members. The Crossover care model is not in the way of payer-member engagement—it IS the primary source of member engagement.
I am always surprised how little insight many large employers have into their spending, how their solutions work, and what return on investment they are actually getting. What is the narrative you share with prospects of how Crossover can help to solve this issue?
This is not the fault of the employer at all. And it certainly wasn’t due to a lack of asking for more information either. This question alone could create a month of conversation around all of the reasons for it. For years, the health plans and hospital systems have been playing a game of “keep- away” from the employers. The lack of pricing transparency and cost-shifting by hospitals is a prevalent issue. While some recent legislation around transparency is trying to address that, it’s safe to say it won’t close the information gap. Innovation from health plans as recently as five years ago, meant the creation of insurance products that centered around individual copays and financial exposures to incent care utilization to “value-based” partnerships, i.e., narrow networks, PCMH, higher out-of-pocket when you go to the emergency room versus the same care at a primary health center. And when you did seek care at those places, the health plan would send you an explanation of benefits that did very little to explain the benefits of what you had done. It’s still incredibly difficult for people to decipher if it’s a bill or not when it shows up in your mailbox.
The employer needs to be the central hub of health delivery innovation. This is why large employers initially invested in nearsite and onsite primary health clinics. It allowed them to have some control of one aspect of their spend. It also gave them great insight into some claims and utilization data that wasn’t dependent on their health plan finance company to deliver.
Crossover has been helping our employer clients reposition to a much more proactive stance. While our care model has always been able to address episodic, seasonal, and annual components of primary health, what is often unappreciated is our ability to simultaneously address specific screening or condition specific issues proactively. We have created educational and engagement campaigns to get those employees who need more attention on their health journey, before they do end up in the ER or hospital. Our care teams are dealing with whole health, not just attempting to quickly fix a member’s condition.
What will be the nature of the product or solution that your team will bring to the payers?
Specifically, we can help payers get closer to their members! That is accomplished on many levels. Let’s start with growth, this certainly is a tool for new sales and retention around key and marquee accounts with our proven ROI. We can set up convenient pockets of care, in confirmation centers or nearsite centers, for those who need individual interaction with a physician. But we also have the tools to be met in any form the member may want—whether virtually, in person, or telephonically—because everybody has a different comfort level with how they access their trusted source of information.
This seems obvious, but if you recall what I mentioned before, Crossover is fully dedicated to managing a single type of member in a single type of financial arrangement. We are not a fee-for-service organization trying to maximize billing codes inside that visit. Because of that, our providers are able to focus all their energy on delivering an exceptional experience, proactively engaging members in their care, and ensuring that we are referring and managing downstream spending appropriately. All of this is done in partnership with payer’s care management teams, product teams, and network management teams. We become an extension of their team and help them achieve their strategic goals.
It’s interesting how COVID has also brought so much transparency to healthcare spend. Many of these newer services may have increased convenience or access, but haven’t taken on the total cost of care equation, and now everyone can see that. For instance, telemedicine might be great for some episodic incidents, but it doesn’t help build a relationship that can manage member’s health conditions over time, nor does it enable the health plan to get more insight into the actual healthcare journey of the members. Both of these limitations are why those who have rapidly adopted these solutions will also rapidly move on to more comprehensive and complete solutions—like Crossover—that are intended to manage total cost of care and be accountable for long-term health outcomes. There are a lot of companies playing a short-term, transactional game—instead, we are a long-term partner who builds relationships that can be accountable to specific outcomes by design. I love that we are now getting to scale and we can now have the impact that our founders imagined 10 years ago.
I anticipate that Crossover’s Commercial Advantage product will really fill a market need, as well as strongly resonate with health plans, given their success with its cousin, Medicare Advantage. People know about the success of the Oak Street, Iora, CareMore, Devoted, Chen-Med, and all these other innovators. I think we will be able to draft off these successes and go even deeper in what we see as a very green field in the commercial space, where payers have never had a product like this. What will make Crossover unique will be our national, tech-enabled care model that is purpose built for the non-Medicare members.
The vision is powerful, but how will you be able to execute in an increasingly competitive environment?
It is really powerful—you can see why I am so fired up. The team that’s been assembled is all equally passionate about executing Crossover’s vision. Think about those companies that we started early with—Facebook, for instance. They bought into the vision early on. But you don’t maintain a relationship with a client inside our portfolio without having a proven ROI. Everybody’s calling on Facebook, everybody’s calling on Apple, Microsoft, Comcast, Amazon, etc. If we don’t have the data to prove the results and the outcomes, and keep demonstrating our value through all these evolutions, we’re not going to be around very long. And yet, we’ve had a 10-year runway with those clients and they continue to trust us not only with their healthcare, but with their health innovation. Part of the bet that each of these companies makes is that we are also going to be their partner in continuing to improvise, adapt, and overcome, which is something that we take very seriously. So the execution has to be flawless, and the track record seems to bear out that we have met their needs.
What are your thoughts on building your team to take Commercial Advantage to market?
It’s an entirely new division. We need people who come in with experience in payer operations, understand all of the headwinds we will encounter, and have some appreciation for how healthcare has ended up where it is currently More importantly, I want them to be intellectually curious about the possibilities of a different model, and willing to try something new or different that might not have been tried before. We want people who can learn to fail quickly and pivot to make it work the right way. We need to bring on people who understand the complexity of the ecosystem, but who still ask, “What if.” We need people to see this big, challenging problem in a totally new light with new possibilities. People who are willing to challenge their beliefs, and find some early adopters along the way that want to go with them down a positive disruption journey. That is who I am looking for, that is who I want on my team, and that is what we are going to build.
I am hoping those who see this interview can just feel the heat coming through and want to do something really big, really hard, and really impactful. As my kids would say, “HMU DM’s Open!”
Part of building the team is not only aligning around objectives, but also around the culture of the company. What are your first impressions of the culture of “XO Magic”?
I think the magic starts with Scott. He has an infectious energy about him that makes you believe that if one person says no, he’s going to find somebody that says yes. And he’ll go back to that first person, not in an ‘I told you so’ manner, but in a ‘look what I can show you’ manner. There’s an inherent leadership skill in that type of person that, frankly, brings people like me on board. When you get to a certain stage in your life, you want to work with amazing leaders and amazing people. Everybody coming in needs to understand the urgency of what we are doing, but simultaneously be resolute in the storm while projecting calmness—just embracing the change as well as the challenge. You have to live in the gray area, because the rules aren’t defined. There are new entries and constant pressures, and if you don’t like change, this will be a very hard place to thrive. It’s ironic, because generally healthcare is full of a lot of people who don’t like change. Not here. Not now. Not ever. That type of attitude doesn’t work here around all these Inévitables.
What would you want people to know about Dan Oftedahl?
The small town perspective, taking care of your community, especially those who are the most vulnerable, has framed everything I’ve tried to do in both my personal life and professional career. I grew up with a sense of empathy towards those who had less. My dad and mom always gave, not with money, but with their time and resources, and that has influenced not only my leadership style, but also my sense of what kind of people I like to surround myself with. I have no interest in just blending in. I want to challenge myself and the people around me to change what we deem as acceptable.
My entire life has been one of competition. I have competed to make the top teams, been the first in the family to go to college, had great jobs, and provided opportunities for them in ways that constantly challenge their internal fortitude as well. My three boys are past the age at which I have the skill to coach their sports anymore, but I still love to see how they react after a loss, far more than the way they react after a win, because I would always tell them to win with class and lose with humility. And then—and here’s where my competitiveness is—let’s figure out a way to never lose that way again. What are you going to do to have a different outcome next time, and all the times after that? I wake up every day thinking about my boys and I go to bed every night thinking about my boys. Everything that happens in the middle is just gravy.
Many thanks to Peter Heywood (one of our long-standing brand advisors and business consultants) who helped conduct these interviews. You can search for Peter’s other Crossover Leader Series Interviews here.
Scott Shreeve, MD 