The View from the Salt Creek Beach

I was able to attend the annual Health Evolution Summit conference held late last month in Laguna Beach, Calif.,  and feel the urge to “write home” about the experience, and some of my key takeaways. 

This particular conference features the CEOs of many of the leading lights in healthcare and policy circles, including some next gen companies  (like Crossover!) that are adding a little spark to the mix. This was our first year as an event sponsor. I was impressed with the efficient ways in which they handled the pre-conference vaccinations, on-premise testing, and general conference management, all in an obvious attempt to balance large group safety with the ability to still conduct the conference. The attendance was about ~50% of past years, but the event was a win given the quality of the content overall, and of course, the in-person interactions.

Primary care continued to be a focal point of many of the conversations, with a new emphasis on healthcare equity. The various Social Determinants of Health (see commentary below) were also addressed. One of the more interesting sessions I attended was a roundtable conversation on New Models of Care Delivery. This was a small group of really influential healthcare leaders, such as Mark McClellan (former CMS administrator), Patrick Conway (CEO of Optum Care), Jaewon Ryu (CEO of Geisinger), and others. While I believe the session hit the most relevant topics (value-based payment models, reinventing primary care, and home-based care models), I left the room thinking how unlikely it will be for large incumbents to be the ones to innovate our way to different solutions. Too many of the stakeholders in these conversations have deep, vested, structural and financial interest in preserving the status quo. I rarely see fundamentally disruptive innovations come from current players reinventing themselves (insurance companies, health systems, current winners in the system, etc.); rather, it’s the outsiders who start on the fringe while perfecting a concept and are then followed by the rush of adoption as they leapfrog flatfooted current leaders. 

This is not a disparaging comment in general and certainly not directed towards those specifically listed above. Rather, it is a recognition of the long-standing architecture of incumbency as well as a fundamental law of competitive markets—both of which were described cogently by Clayton Christensen. My big takeaways from that session, along with the conference as a whole, help frame up the opportunities that will serve as a catalyst for driving the industry innovation agenda over the next 12 months as follows:

• “The Great Reset”: COVID was like a big wave that came crashing through to reset the lineup. This represents a once-in-a-career opportunity to redraw the baseline to something new and different. We cannot miss out on the supernormal swell to not only fix licensure issues, but also move past fee for service, to demand more hybrid care delivery approaches, to reimburse for value, and to consolidate around an integrated set of core capabilities that really matter (less point solutions and more integration!). There will be a tremendous gravitational pull from the industry to return to previous orbits, stay on well-worn trajectories, and to quickly trot out the trite phrase, “the more things change, the more they stay the same.” We should be demanding a different result which will require different inputs. Primary Care seemed to surface most often as the foundation from which to build this brave new healthcare world. We could not agree more – and see “Primary Health” as the answer. 

• Social Determinants of Health/Health Equity: These are the new buzzwords. Akin to how frequently ESG shows up with “woke” corporations, we are seeing this concept become somewhat solidified. There was some interesting criticism of this terminology at the conference, with one CEO  provocatively calling out SDOH as a euphemism from “our guilt about the healthcare industry that profits richly alongside poverty and racism” (ouch!). While that might be a bit of a cheap shot, the point is well taken. Like Lisa Suennen’s plea that in 2021 we need to drop the “digital” in front of health, we should likewise drop the “social” in front of “determinants of health.” Let’s just acknowledge that an individual’s health is a complex milieu of environmental, behavioral, genetic, and related factors. We need to not only be aware of, but sensitive to, the many issues that impact our patients’ ability to follow through on health-related issues. We can all work towards a more equitable system, to root out unconscious bias in the care we deliver, and to implement equitable care practices that are more impactful, while getting involved at the community levels in simple, but often profound, ways. These frank conversations have sparked myriad discussions within our company of where we can contribute best in the communities we serve. 

• Fundamental  Lack of Trust: Many different sessions came to the conclusion that the various layers of care were all disconnected, but the most concerning finding is that this disconnection now appears at the foundation level of trust as well. While part of an overall societal trend towards a lack of trust in authority, it seems that the architecture of the payment system, the lack of care models that can pay for ancillary providers who add vital support as part of a broader health team, and the fact that many of the social issues (e.g., isolation, financial stress, substance abuse, food, housing, etc.) remain unaddressed, all combine to create a systemic failure of trust. Again, our view is that these issues of trust can not only be addressed, but resolved, when Primary Health teams (primary care, mental health, physical medicine, health coaches, and Care Navigators) partner with the members and work within a payment framework that rewards for outcomes. When done right, we find that 95% of members take our care recommendations, that 75% choose us as their medical home, and that compliance rates are in the +60% for basic screening and preventive items. Restoring trust in the institution of medicine, as well as in the relationships between providers and individual members, is a critical part of advancing any health agenda. Our ability to win the trust of our members is one of the things I am most proud about at Crossover. 

As I reflect on the conference, I am pleased to report that we are leaning into the key areas that I think actually make a difference in healthcare: 

1. Foundational Primary Health: We are building a new  model democratized for the masses. With a trusted, collaborative care team that works shoulder-to-shoulder and hand-to-hand work that makes care easy and effective, comprehensive and comprehensible, and accessible while being affordable…all requirements for members to develop trust in the care team.
2. Care navigation: Using the trusted care team to effectively navigate care to specialists, and to manage the quality of those specialists, is a key differentiator. Given that 85% of the spend happens in secondary care, this is where all the savings lies (there is really no “juice to squeeze” in Primary Health). Care navigation ensures earlier interventions, lower site of care costs, better care pathways, coordinated follow-up, and shared and informed decision-making with the member along their entire care journey. Tremendous value is created throughout this curative process.
3. Integration of the Plan Design: The plan design is a critical but often underappreciated component of high-performing care delivery. New plan designs need to be purpose built for, and aligned with, emerging care delivery models. The closer we can get to total cost of care responsibility, the better the long-term alignment and the incentives are to achieving remarkable results. Plan designs are most impactful when 1) the member voluntarily opts into them, and 2) when the plan structure bridges the connection and continuity between primary care and the network. Without these two elements, even plan design can fall short of the expected increases in performance. When aligned, the power of integrated and aligned care can be unleashed. 

At Crossover, we continue to expand our reach and dialogue with large employers and payers about these concepts. More and more people are recognizing that the answer to many of the challenging problems we face can begin with a simple and familiar concept—the right foundation upon which to build our new health system is the rock solid foundation of Primary Health.  And, that will always be something to write home about!