Part 1: The Road to CEO
Kelsey Mellard is Crossover’s newest Board member, and the CEO of San Francisco-based Sitka, a telehealth platform that connects specialists to primary care providers in a simple and collaborative way. A self-confessed healthcare nerd—rooted in dinner table conversations growing up with two academic medical parents—she has seen the evolution of healthcare from a policy, delivery, consulting and now, an executive perspective. All of this experience and expertise led her to Crossover and ultimately “compelled” her to join our delivery of “healthcare as it should be.”
Can you share your background?
I grew up on a farm in Perry, outside of Lawrence, where the University of Kansas is located and where both of my parents were professors. I grew up in the liberal hub of Northeast Kansas and had a great childhood. My mom was a faculty member at the Medical School, as well as a practicing pediatric occupational therapist, and my dad was a researcher and a psychologist by trade. Growing up in a pretty nerdy household, with both of my parents having PhDs, was really influential, because the currency of our household was community impact and engagement. That was formative in shaping how I still think about the world today.
There must have been interesting dinner conversations at your house.
Yes. We had conversations ranging from Department of Labor grant proposals and bureaucracy at academic medical centers to individual patient care (because my mom was still practicing). These discussions could swerve into the broader issues of social impact of care and health as well, since my parents were so deeply involved in that from an academic perspective. There was a lot of discussion about equality and access, and my dad’s research focused on the kind of interventions inside a classroom setting for individuals with developmental disabilities. How do you create pathways for individuals with disabilities beyond high school and leverage community colleges and community resources to find and create sustainable employment opportunities? These were all about the Medicaid and Medicare benefit structures, topics that remain incredibly meaningful points of discussion in our policy environment today. Needless to say, all of this had quite an impact on me as an 8-year-old girl.
I assume this is the answer to the question about your choice of healthcare as a profession?
It is. My undergraduate major was in public health at the University of Minnesota. I played college soccer as well, which was really important to me. In those days, public health majors were the kids handing out condoms at school fairs—we were the nerdiest group on campus. Today, in the midst of a global pandemic, you see this massive rush of individuals who really want to get into public health. Pretty ironic but still positive change.
It seems the pandemic has significantly changed the perspective on public health?
I think that’s absolutely right. The other interesting pandemic observation around public health is how we treat our public health officials, which may change from the experience of the last couple of years. I think public health officials have both an incredibly important job that is often not reflected in how we pay them, but also an incredibly challenging job managing public opinion in a social media age. After my time in Minnesota, I went to graduate school at the University of Kansas in Lawrence, and completed my Master’s in Public Administration. Because my parents were professors at KU, there was this kind of unspoken expectation that I would get a degree from the University of Kansas at some point in my life.
You’ve had a varied career after you left Kansas. What took you in all these different directions?
When I was completing my undergraduate work, I had the opportunity to intern at Kansas Action for Children, an advocacy organization for kids. It was my first foray into the policy sphere. After grad school, I started working at the Kaiser Family Foundation in Washington, DC, right at the time of the ‘08 presidential debates. For McCain and Obama, healthcare was a hot topic. I loved it, and I got to really be on the inside, two blocks away from the White House, and thrust into the Washington scene. But I had a problem, too. I didn’t know how the state health data stats that I was crunching on a daily basis from the CDC, as well as all these other public data sources, were actually influencing people’s decisions. I decided to go to the other end of the spectrum, on the frontlines. I became a fellow at Children’s Mercy Hospital, a pediatric facility and provider in the Kansas City metro area. I got to see the intersection of Medicaid reimbursement and families bringing their children in for this incredible level of science and art being practiced at Children’s Mercy. It was great to see how all of this fit together and understand the actual ground conditions at the frontlines of healthcare.
Eventually, I moved on to the Advisory Board Companies where I continued to explore the operational complexities faced by our hospitals, working with critical access hospitals and large health systems, like Advocate in Chicago. This work led to a desire to make an impact at a greater level, and I joined the Center for Medicare and Medicaid Innovation Center as employee #5, just about the time the Affordable Care Act was passed. After a really valuable two and a half years, I wanted to go and see what this publicly traded company thing was all about, so I joined United Health Group. It was intellectually challenging to see how a company of that size, at that scale, operated in a way that allowed them to have an impact. I felt like I was earning my PhD with all of these opportunities.
I was still in the policy space, though, so I accepted a role at NaviHealth, a new company at the intersection of bundled payments, reimbursement, and frontline provider behavior change, which captured all of my previous experience in one setting. We were actually building a system of care that would benefit people like my grandmother. When we were acquired by Cardinal Health, I had some flexibility, and I decided that I didn’t want to work for a large corporation at that point in time. I was fortunate enough to get connected to Seth Sternberg and the founders of HonorHealth, the tech-enabled home care company that was focused on seniors. I strapped my bike to the roof of my car, and across the country, landing here in San Francisco. Honor kept me in both value-based and senior care, as well as introduced me to the tech, venture, and Silicon Valley approach to scaling ideas and companies.
What I find fascinating about all of these experiences is the deep correlation between pediatrics and geriatric patient populations—the patients themselves are often not the primary decision makers. The systems of care that we need to create for both of these populations have very similar characteristics in regards to the social support, as well as the delivery of clinical care and social care.
Your experience is remarkably varied. It’s almost like you planned it. How did Sitka come about?
My path was definitely not planned, I can guarantee you that!
Certain cities normalize behavior really well. In San Francisco’s case, it normalizes entrepreneurship to a degree that you never see in Washington. My confluence of experiences led me to think that starting a company was a really good idea. Sitka actually stems from something that happened when I was in college. My siblings and I all went to the same pediatrician from birth until I was basically kicked out of his practice. The continuity and the incredible comfort of that environment was something I didn’t want to leave. Fast forward to the ruckus that patients experience today, navigating the system and trying to get into specialty providers.
Sitka came about in a collaboration with an orthopedic spine surgeon. He was struggling with patient flow and expectations. Patients would wait eight weeks to see him, because he’s a really incredible clinician. He didn’t want to do inappropriate procedures, even though the system would reward him financially to do that. And his patients, after a long wait, would leave and feel it was time wasted, because the specialist told them to start physical therapy. He wasn’t going to do surgery. There was a mismatch of expectations and an absence of information.
We started Sitka so we could look at how we unlock access to high-quality, specialty providers, how we manage expectations in the patient-provider relationship, and how we bring specialty care into value-based care. Today we are a Series A company, backed by Venrock, Optum Ventures, and others—all awesome supporters who enable us to build a value-based, specialty provider network. We currently collaborate with primary care providers on the frontlines to try to upskill them and appropriately decrease the need for referring patients out.
Part 2 of our conversation with Kelsey looks at her thoughts on Crossover, and how she’d like to contribute from, as she puts it, the privileged position of influence as a Board member.
Scott Shreeve, MD 