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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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In Part 1, we learned about Joels background experiences. In Part 2, Joel speaks in more depth about his responsibilities as Chief Product Officer, his plans for the Crossover product line, his view on how the company is evolving and his role in helping it on this journey. And he concludes with a surprising passion, especially for a company steeped in surfing culture. 

What have been your initial impressions of Crossover?

I’m impressed by the energy here and the willingness to explore options to grow. This is a company that has a bit of a blank slate, conceived as a medical group that doesn’t bill in a traditional fee for service model, with infrastructure instead built around total, whole person health. I’m excited about the health outcomes work that Crossover is doing to prove the efficacy of the model and it’s my job and our leadership team’s job to find, ideally, an at-risk outcomes based way to get paid for that work. 

At the end of the day, we’re not really focused on how much we need to bill, we’re not looking for neurosurgeons to hire because that’ll drive the most revenue to our system. We’re very intentional about identifying the relevance of mental health and physical health to primary care, incorporating health coaches, having embedded care navigators, and practicing as a full care team to drive lifestyle improvement. Figuring out how we can do that with large employers, how we do that with health plans, and how we do that with consumers is a challenge that I’m energized by and humbled to tackle.

How do you define what the “Product” role is at a company like Crossover?

Historically a lot of companies will define product narrowly as the platform or as the technology itself. If I had to define what our product is at Crossover, it’s our care model. The work we have to do within the product group will be to understand how our technology—including measurement, data, analytics, and care insights—can improve our care model’s performance. This is so much more than a “tech enabled service,” as we are building a framework for creating whole person health.

What will be your specific responsibilities as Chief Product Officer?

My accountability extends to four teams. One is the traditional technical product management team. We’ve got a great group of people that have developed and leveraged our own internal assets to create our member experience platform, Switch, and that platform will continue to be a core part of our tech-enabled service offering. That team, managing the platform roadmap and releases will be a part of my accountability, making sure that it represents the voice of the customer to support a specific type of experience for our members that Crossover is well known for. 

A second responsibility will be toward our exceptionally talented design team that historically has really been focused on user interface (UI) design, and now will be working more broadly to define user experience (UX) in partnership with our medical group, operations team, and others within the company. 

The third group that will report to me is the health outcomes team. We have a great foundation of peer reviewed research assets and thought leadership that needs to both continue but also significantly expand. If our care model is our product, we need to be constantly acknowledging and evolving our model to address evidence-based feedback. And what better way to find evidence-based feedback than to do some of that ourselves? The real question is how we use that information to change our care model more effectively, market it more intentionally and take risk on it where possible. To support this, we’re going to expand the health outcome team’s mandate to include pre-sales analytics and broader population health analytics, because as we shift more to outcomes-based risk arrangements, we need to build that infrastructure to be successful in that arena. This will include 1) pre-sales analytic work to help our potential customers better understand our value, 2) care insights that my team will be generating to increase engagement and outcomes through the great care delivery work our medical group does, and 3) enabling new value based payment models that support increasingly complex risk arrangements.

The fourth arena, which really circumscribes them all, is product strategy which will be based on specific understanding of our clients’ needs as well as general understanding of the increasingly competitive landscape. I think we can improve the way that we look and project three to five years in the future where we need to be going. Healthcare is ever-evolving and we need to innovate to stay ahead of the game. I’ve been constantly impressed with how quickly we can build a clinic and recruit talented medical staff or pivot to virtual care. Our product strategy team needs to maintain that nimbleness; constantly looking at what our competitors are doing, what the market needs will be multiple years down the road and adapting our technology and our services approach to stay ahead.

How does the future viability of virtual care figure into product strategy?

I suspect the pendulum will swing back to more in-person care as the pandemic subsides but we will always continue to provide virtual care and asynchronous communication with your care team along with the ability to access both onsite and nearsite clinics in strategic local markets. The importance of that integrated multimodal approach is critical for both experience and clinical outcomes.

I think we have an opportunity at Crossover to improve on the great work we’ve already done. We’ve got a great foundation but now, how do we drive better site of service optimization? How do we create more self-service capabilities for our members? How do we engage better, especially through the lifestyle work that we’re doing? And finally, how do we ensure that when members need onsite care that they’re getting it at the appropriate locations, ideally at one of our health centers or one that we are confident can deliver high quality? How can we become more effective at referring and navigating outside of our own network?

How are you able to get members comfortable with a narrow network?

A narrow, curated network will work brilliantly based on members’ trust. The members aren’t thinking they need as many options as possible. Instead, they’re thinking “the Crossover team said you need to go here and this provider has already been vetted. Based on that, I’m on my way.” That simplifies their experience, it creates a default network through curation, solidifies these extended care relationships, and of course greatly simplifies billing.  

You’ve mentioned risk-based models often. How can Crossover move into true risk sharing or risk based contracting, and with who?

First, to effectively manage a population, we need access to data. This requires client partners that are willing to share that level of data with us to let us know what’s holistically happening to each member wherever they are getting care. These data, used with the members permission, allow us to  navigate a member’s journey more effectively. 

Secondly we have to find the clients that are innovative and willing to think outside the box and take some risks with us on engaging in new payment models. Then we have to take our infrastructure to the next level to support these new payment models and the accountability expectations inherent in value based care. For example, we will now be responsible for knowing the status of various members with specific conditions, or we will need to track internal and external referrals in new ways, or we may need to be able to measure the different types of interactions we have with our members. These will all be enhancements to our current infrastructure. 

In particular, I am focused on deepening and scaling how we measure and risk stratify our patient populations to enhance how we prioritize outreach to those patients with the highest need. I tend to find the health plans understand this much more than employers because they are built to manage risk from the beginning. Of course, self insured employers are also taking risks on the medical costs of their employee population, so they are playing the role a health plan has historically played, but they don’t think about it that way. We’ve seen in early conversations that a lot of health plans see the value in our model and I think that’s a good opportunity for us to continue to move into risk-based models.

You manage risk based on metrics you understand. What sort of metrics do you think are needed in risk-based models?

It’s my job from a product perspective to figure out how we price risk. There are some easily quantifiable measures like avoidable admissions, medication adherence, ED visits per 1000, all traditional measurements that we can and should be measuring our success against. But Dan Lord and the Guild teams have done an exceptional job of identifying other measurements that can be used as proxies. Some of those outcomes right now are difficult to measure, things like physical health and mental health. How do we measure that someone is happier, that someone is more engaged, that someone’s lifestyle has changed?  We then need to figure out what those measurements are, how we take risk on them, how we prove value around them and how we contract for them. 

There are a number of areas that we know impact the total cost of care and can be measured by patient-reported or provider-reported measures. As an example, we know that every score of mental health improvement typically correlates to X dollars of productivity and Y dollars of medical cost reduction. Can we use that as a proxy for us to get into some forms of at risk modeling? And as an intermediary step, can we use those measures to get agreement from employers and payers that this is a good proxy? If we can prove that out with our research and activities, then it makes a simpler progression to more meaningful risk where ultimately we are leveraging massive claims databases to quantify our total cost of care output.

When we figure this out, it will be quite disruptive. We’ll have a multi modal approach that doesn’t have anything, culturally or infrastructurally, holding us down around a traditional medical group mentality or legacy financial model, meaning we don’t have a billing department that’s driving large claims denials, management or revenue cycle management technologies, or any of the other vestiges of the old fee for service regime. It’s really quite liberating! 

What would you be doing if you weren’t at Crossover?

I have one golden rule and that is to be a good dad and husband. It’s what is the ultimate energizer for me. I am very thankful for my wife and three daughters and the chance to be with them, make the world a better place for them, and spend time as a present partner and parent for them. If I didn’t have to work, that would be a wonderful full-time job.

With that said, I do have to work. I suffered several months of “paralysis by analysis;” vetting and designing what I wanted my life to look like. I’m sure Scott and team were slightly annoyed by my lengthy decision making in accepting this position, but when I made it, I was all in. I was 100% invested in the future of this company, for as long as it takes to change healthcare, so I can genuinely say the role I’m in now is exactly where I want to be. If I wasn’t here, I’d try to find a company just like Crossover to try to do this same role and I’m just not sure there’s one out there.

How have Crossover’s values manifested for you in your first few weeks?

I have never been in a meeting here at Crossover where even people who may be skeptical aren’t coming into the meeting with a sense of curiosity and interest. I’m the new guy who’s probably asking a lot of questions, and usually there’d be a lot of smirks and people telling me, we tried that five years ago and it didn’t work. But no one has said that to me at Crossover. I think that’s a testament to a general willingness to challenge the status quo, to think outside the box, and not get comfortable. By and large, almost without exception, the mission-driven focus of our organization is to fundamentally change healthcare, to be a lifestyle company, to drive home the importance of “Be Well”, and I have seen or heard this in every meeting I have been in to date. I’m thankful for how welcomed I have been and the willingness to embrace my thinking out loud as I try to get up to speed and contribute as early as I can.

Is there anything about Joel Haugen that would surprise the reader?

I absolutely love curling. I’m in a curling club here in Minnesota and play on a regular basis. I’m trying to get my children to play as well to pass on both the traditional and the legacy. I just love the sport. And, as my team and new colleagues are already finding out, I’m notorious for really bad dad jokes.

Many thanks to Peter Heywood (one of our long-standing brand advisors and business consultants) who helped conduct these interviews. You can read more of Peter’s work in the Crossover Leader Interviews series.

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