Sandra Cavanah recently joined Crossover Health as our Chief Financial Officer at a critical juncture in the company’s evolution. With a background in tech, biotech and digital health, she has played a central role in the rapid growth of companies, products and services. She is well suited to help steer Crossover through the unchartered territory of 2022 and beyond.
Can you share a bit about your background, education, and experience?
I was born and raised in California, in the Bay Area. We’re a long-time California family. Even my grandmother was born here, in the 1800s. I went to Berkeley as an undergrad, then Harvard for my MBA. After that, I returned to San Francisco where I pursued my career – in private equity, internet tech, two biotech startups, and healthcare. Most recently I was Chief Financial Officer at Vida Health. It’s also here in San Francisco where I met my husband and raised our three children, now all grown and out of the house.
You worked in the biotech industry. Can you share more about that experience?
Twenty years ago, as Silicon Valley suffered the dot-com collapse, a friend introduced me to two biotech scientists who needed help with an antibody-based drug development platform they were developing. I joined them in building a company that we ultimately sold to Roche. We then reunited to launch another company, based on the next generation of their science, named Open Monoclonal Technology (OMT). Of course we sometimes joked that “OMT” really stood for One More Time. We started this company at my kitchen table and ran it together virtually for nine years, so this Covid-era “work remote” concept is nothing new for me. In 2011, we sold OMT and the shell companies we spawned from it to various pharma buyers, including Genentech, Amgen and AbbVie. It’s very rewarding to see how “our” platform today is used to develop some of the most innovative biologics coming to market to treat cancer and infectious diseases.
What led you into digital health?
I’m not a scientist, and often I’d find myself in meetings about gene splicing and DNA knockout technology that were way above my head. I used to joke that over the many years I worked with these brilliant scientists, they managed to learn from me much of what I knew about finance – and yet they never managed to teach me quite enough about the science. In digital health, the technical discussions and the impact of the product or solution are much more accessible. I can see directly how the solution is going to make things better.
Finance people often think of their skills as agnostic, applicable to any company anywhere. But I like to be the type of CFO who has a detailed grasp of the business, its markets, its products, the tech platform, and the way in which it resonates with customers. That’s why I’m excited about Crossover.
My first foray into digital health was a diabetes management company called Glooko. More recently, Vida Health, targeted chronic disease more broadly. I really enjoyed learning about treating illness with virtual care platforms, but I’m especially drawn to Crossover’s hybrid approach that combines human in-person care with digital engagement.
What led you to Crossover and out of the purely digital health businesses?
What attracts me to Crossover is my belief that primary care needs to drive all healthcare. To me, the primary care doctor should be the quarterback of a person’s healthcare decision making. With a lot of digital health businesses, that primary care physician is not in the picture. It’s a missing link. These digital health solutions are often on the outside looking in, rather than within the care delivery itself. I want to devote the next years of my career walking right alongside the member.
How did you hear about Crossover?
Through a recruiter. But long before that, a doctor friend told me about giving up her private practice to join Crossover, and she spoke so highly of the company. It was hard to leave my previous job because I had a really good team, and I was so deeply embedded within the company. But I felt like Crossover was an excellent opportunity for me to join a company that worked more closely with members.
There’s definitely something about the locus that a care team provides that transforms the impact of these digital technologies.
I’m 100% in agreement. You can’t just have a better digital tool, right? You often have to support the member through difficult clinical circumstances, help create more efficient workflows, and manage all kinds of information and interconnections as part of the routine course of care.
Healthcare is prone to so much jargon and so many acronyms, but when you cut through it, there is a big focus on the value that can be created – or often is not. How do you think about healthcare’s value?
I really dislike jargon. In business discussions, I try to speak plainly. It’s vital, if you expect people to follow you. There are certain things I understand as a CFO about the way one looks at or talks about businesses, and the ways you measure how those businesses operate. You may use different denominators, but at the end of the day, you’re just looking for ways to judge the effectiveness of the business; to see where there are advantages as well as weaknesses, and how we might look at a situation or the results differently to generate new insights about how we should operate. I always encourage people on my team to look outside their role and learn as much as they can about our company. Also, I prompt them to look at other businesses and other industries to see how they’re measuring their effectiveness and how they talk about their business. Bring this knowledge back to our team and share it. Constant learning makes us better at our jobs!
We all think we know what a CFO does on paper, but how do you see your role at Crossover? How would you like your role to be perceived in the company?
What I enjoy most about the CFO role is the collaboration with functions across the company. It gives me a special lens and broad perspective into the workings of the business. As part of the leadership team, I want us to be seen as a unit that is highly effective. I’m here to support Scott and the entire company. In my previous companies, many have told me that they always knew they could come to me for advice because they knew I’d always balance their interests with those of the company and come up with a fair solution. I want to be seen as a trusted, thoughtful leader. That’s what really matters to me and gives me career satisfaction.
There’s often a view among health providers that business side of care is a necessary evil, and that finance is all about budget approvals and return on investment. How do you humanize the role of finance and make it relevant to the medical group while helping them develop their own financial acumen?
One thing I find fun in finance is “unit economics”. In our case, this is where you try to understand the care delivery process and how much you’re spending through the member journey. You need to get involved with the providers, understand their constraints, where they feel blocked, or where they feel that they’re super efficient. The objective is for them to see you as a partner trying to make their jobs better through new tools or resources that help them be more effective and efficient.
I sincerely want to improve healthcare and so I need to know what’s in the way, and then I need to be a problem solver and financial partner to help figure out better ways. The part of the job I love is digging into operations, which I’ll have to balance with my other duties.
That perspective then goes hand-in-hand with the idea that to succeed in your role you will really need to understand the details of the business. How do you plan to do that?
Absolutely agree. I have been in healthcare for a long time, and my career path has gotten closer to the member. Crossover brings me right to the heart of care delivery, to the edge of innovation in this field, to see where we can push the model. There are so many puzzles to solve – How do we staff most efficiently? How do we adjust caseloads and member panels for optimum efficiency? How do we maintain our pricing in a highly competitive environment? How do we best invest in our future growth and capabilities?
I have thought about each of these quite a bit and already have some ideas. I still have a lot to learn. Getting into care delivery, spending time with our care teams looking at the systems in use, and really seeing where and how care is delivered and how what we do is so different is going to be both fun and challenging. Can’t wait to unpack and see first hand what the team calls “Crossover Magic.”
What do you describe as unique about Crossover?
I would say the incredibly strong NPS scores. It’s fascinating how consistent these are across varied clients and services, which shows what we’re doing is working for the members. You only have to look at our onsite and nearsite health centers to see that there’s so much thought that goes into the member experience – how you enter the building, the technology we deploy, how our care teams work, and how we deliver the member health insights. The more I learn, the more I want to amp up communication about the Crossover difference. We have such a great story to tell!
A great one-on-one clinical experience is awesome but what do you think are important facets of the scale of the business?
I think the “leverage” in the model comes from intelligent decision-support tools. Member engagement is not just in the clinic visit. The model has to scale in many other ways. I hear the team talk about “tyranny of the visit,” which implies the constraints that exist when care is human-to-human. For our growth and real-time decision making, how we’ve been paid in the past is less relevant than what we’ve learned in order to grow, the tools we’ve developed, how we’ve built facilities better, faster and cheaper, and getting to significant economies of scale to drive continued growth over time.
We have to be clear about the long term potential and system wide impact. Look at our model of Primary Health – we need to reinforce to people that it is not just primary care, it’s basically primary care “plus” which includes mental health, physical therapy, care navigation, and health coaching. Without continual reminders, people tend to think, “oh, it’s just primary care” and then they don’t get the rest of this beautiful concept that brings so many things together. We have a unique way of thinking of things such as the lifetime value of a member, and how we create long term value through compelling unit economics and objective improvements in health outcomes.
Crossover has placed great stock in its core values, and unlike many companies where these are mere words on a wall, Crossover’s values underpin the organization’s culture including decision making. How have you experienced that so far?
The values guide employees and provide a roadmap for the company’s future. I was drawn to the open, inclusive, and fast-paced environment at Crossover. I have found it hits a sweet spot between demanding performance and feeding my passion to be involved in something meaningful. The company’s values make our culture pheneomenal, which in turn attracts great people, and supports the growth and success of the business.
Are there any hobbies or personal interests that might surprise someone reading this interview?
My biggest passions are road biking and backpacking. Last summer, my son and I backpacked ~50 miles over five days and climbed Mount Whitney, the tallest peak in the continental U.S. For my 30th wedding anniversary, my husband and I backpacked from Yosemite to Mammoth, which is about a 40 mile trip. Both were incredible outdoor adventures.
In backpacking, you get into a rhythm that helps overcome the pain and the challenge. Sometimes, all you can think about is the physical pain, but then you take another step and take stock: “Isn’t this beautiful?” I suppose the reason I really love these walkabouts is you get to fully and completely unplug. You can’t be contacted. It is a great psychological relief not to feel the constant pull of text messages and emails. It’s a new found, perhaps modern type of freedom, that I certainly do not take for granted. Backpacking is my “freedom pass” from my inbox.