Daniel Lord, DC recently moved with his family to Colorado for his new role as Medical Director for Crossover’s Central Region. He joined Crossover in 2012, initially as the chiropractor for the Facebook (now Meta) Health Center and has taken on increasingly strategic leadership roles while helping craft our growing integrated care team capabilities and overall corporate journey. In part 2, he speaks to leading the organization of the Crossover Guild infrastructure including the evolution to measurement-based care.
Tell me your origin story, both before Crossover and how you joined the rocket ship.
I grew up in Madison, Wisconsin. Lots of Badgers in my family. For college I wanted to venture a little further from home and experience living in a bigger city, so I went to the University of Wisconsin in Milwaukee, and I became a Panther. I loved Milwaukee and in fact, full circle, I’m going back to pitch to a local school district in the area for Crossover. It will be interesting to win something on my home turf.
At UW Milwaukee I earned a degree in Biology and then moved to the Bay Area in California, to attend Palmer College of Chiropractic West. I chose Palmer West because of its integrated approach—a physician taught us about physiology, a PhD took us through anatomy, a physical therapist taught us about rehab, and a nurse showed us first aid. I got a very holistic education there, much more than I felt I would receive at other schools, plus there was a huge focus on evidence-informed care. Having a multidisciplinary staff teaching the students was a very different and very defining experience. When I got out of school, my number one goal was to work in an integrated care team environment. It was a focus of the leadership of Palmer West to get chiropractors into these kinds of mainstream, combined care environments. They were very forward thinking in this regard and believed that solo practice was not the only way for chiropractors to deliver care.
Chiropractors add a lot of value in the musculoskeletal (MSK) domain. Partnering closely with physical therapists and mental health providers expands the toolbox of options to help patients. Together we are able to treat more people, solve a more diverse set of problems, and impact major challenges like the over-prescription of opioids and the amount of low-value surgical interventions—both of which are still massive issues in our healthcare system. The team at Palmer West saw that they could expand their integrative vision and their value as educators by placing chiropractors on teams with primary care doctors. It started in the Veterans Administration where chiros were placed on the integrated care teams and quickly demonstrated their value within the VA system.
The next area where this approach was pursued was employer-funded corporate healthcare. One of the first companies that introduced the team-based approach at its onsite health center was Cisco, whose first center opened up in 2008 before Crossover was even founded. The center’s chiropractor was actually one of my professors at Palmer—ironically, I was in his last class before he went to work full-time at Cisco. Then, a few years later, the person who had managed the opening of the Cisco clinic was managing the opening of the Crossover Health Center at Facebook. As he knew my former professor from Cisco, he asked who he would recommend for this new facility, and my teacher pointed him in my direction.
What happened between school and Crossover?
I started my career in San Francisco, working in an integrated sports medicine facility. Its model was pretty similar to Crossover‘s—the same integrated care team with primary care, nursing, acupuncture, mental health, and a big physical therapy space. We did a lot of rehab and sports medicine given our location in San Francisco’s financial district. We saw high-powered executives as well as high-caliber athletes, professional triathletes, San Francisco Giants players, and Oracle Racing Team USA. I was hired as Oracle Racing’s sports chiropractor and helped build Team USA’s sports medicine program for the America’s Cup, which led to some very interesting stories regarding sailors, Larry Ellison, and related shenanigans. We miraculously came back after being down 8-1 in the best of 13 race series against New Zealand, the biggest comeback in America’s Cup history. While it was an incredible ride, it wasn’t really the end goal for me. That opportunity emerged when I got an email from Scott.
Tell me about your experience launching the Facebook Health Center in 2012?
I think a few things led to a very quick start. One, I started seeing people in the Facebook gym about a month before we opened the clinic. My office was actually a small working closet in the gym. In fact, I was the first provider who saw the first members for Crossover in the Bay Area. This small jumpstart was critical, because it allowed me to start to embed within the Facebook community. That approach then became a hallmark for how we practiced and engaged the population when we officially launched.
Secondly, when we opened the “real” health center, we were located right in the middle of the campus off the main campus square. Facebook wasn’t a big company at the time, maybe 1,500 people. So when you’re in the middle of everything, you are accessible to everyone. The center was really visible and there we were, eating lunch on the park benches, playing hockey in the square, meeting people in the everyday back and forth on campus, and so the engagement happened quite organically. Most importantly, the word spread rapidly about the new health service because nobody had seen healthcare like this before: physicians with access and time to meet your needs, a wide range of services, and your own personal care team.
Third, physical medicine as a service was uniquely well-suited for this population. Think about it—there were all these engineers, sitting there coding for long hours every day, so there were plenty of postural neck, joint, and back stresses. In addition to that, it was a very active population so we treated our share of sports-related injuries, too. This mix of issues was effectively my bread and butter already so it felt like we had every opportunity to be successful out of the gate.
It speaks to what Crossover is as a company that a non-MD is now the medical director of a large operating region. Tell us about this phase of your journey?
We’re at a place where I don’t think anyone minds at all, as long as the actual leadership is provided. We have integrated care teams, and primary care providers are the quarterback of those care teams; while I have MDs that report to me now, I don’t need to question their clinical judgment. I never worry about that because I’m managing to the clinical standards that Stephen Ezeji-Okoye, MD (Crossover’s Chief Medical Officer) has already established which are known company wide. Now, we have the Guild Quality Operating System (gqOS) to help guide the quality of our care for every provider and I feel like I am able to use these tools to really understand how our care teams are performing. That’s how we get to the very highest performance from our teams. After that, the role is about managing people and organizing great-team based care, and in our egalitarian and meritocratic company culture, no one is asking about my credentials as a leader.
It’s good to have non-MD leadership sprinkled in, because you gain different perspectives, and you can get to the right answer quicker, not only at the care team level but also on all the levels of the company. I think we’re going to see more leaders who are not physicians in our company. I realize you couldn’t have a chiropractor-led medical group, but it would be great to find the right balance of non-MD directors leading throughout our company. To be clear, I’m not in a position where I need to make emergency clinical decisions. The physicians that I lead are the ones who are doing that. But, I am able to understand the role of our core values, our clinical principles, and our general leadership approach to be able to address issues as they come up. It has been a fantastic experience so far and I look forward to all the learning and growing personally and professionally.
What do you imagine the future will be at Crossover? What would you like to see?
I want to have our care model available for everyone. When we started, our member base was at Apple, Facebook, and Microsoft in Silicon Valley—a pretty privileged group. Now we help manufacturing and logistics populations who are in a different compensation bracket, and have limited access to care. I love that our model is able to have an impact on both groups. Everyone needs and deserves great access to care and we can provide that no matter your circumstance or geography. What interests me is providing the right type of access to a larger population in the country. As I mentioned, we’re going to be pitching to a school system—they’re an example of a group that doesn’t always have access to high-quality primary healthcare team like Crossover.
How do you scale and shift the Crossover model to make better care accessible to more people?
We’ve become much more flexible, deploying the same care model with the same attributes, but with some different licenses and a different collection of people onsite. In the Central Region where I am, we have a whole range of health center models, from very large facilities with many providers and all the bells and whistles, to smaller centers led by nurse practitioners. In the future we’ll find the sweet spot, mastering what’s really important in person and what works best virtually, while reducing costs and maintaining the same—or better—outcomes.
You are more than 10 years into your Crossover journey, which I understand has involved your family quite a bit. Can you share your family’s experience as well?
From those humble beginnings at Facebook working out of a closet, to being able to take on more responsibility at the clinic level, then the guild level, then the national level, and now taking on a new and different leadership role, it has been quite the ride. Since you brought up family, I should mention that I met my wife at Crossover when we both worked at Facebook in the early days. She was also promoted to leadership positions, taking the helm of our clinical operation team, and now she’s in charge of Member Engagement at Crossover. We feel incredibly fortunate to have had so many close friends and co-workers, as well as a very supportive work community over so many years. Our two girls, a 3-year-old and 1-year-old, have many Crossover “aunts” and “uncles” across the country.
After moving from the Bay Area down to the corporate offices in San Clemente which we loved, we felt the itch again to set out on a new adventure in Colorado. I love California dearly but let’s be clear, I don’t feel we moved away from it. Instead, we moved towards the next part of the journey! I think Colorado is great because of the opportunity to challenge myself with this new leadership role as well as be closer to family. My brother has kids the same age as ours and we wanted to try and live near one another. He moved from California to Colorado at the same time and bought a house literally across the street from me, which ironically, was not planned at all, but has been awesome.
Professionally, I’m excited because I’m getting back into clinical practice after a few years off. It is the standard expectation that all medical leaders still see members regularly. I had a steady practice when I was Guild Manager, but with the move to San Clemente coinciding with the pandemic, my clinical work was put on hold. Now I can get my hands back to the proverbial plow again, not just by visiting all our clinics but by being back on the schedule and building my own clinical practice. It really feels like it has all come full circle. It’s a great new challenge and another excellent adventure.
Please see the continuation of the interview in Part 2 where we learn about several key initiatives Dan has been leading including the development to Crossover’s unique guild structure and the Guild Quality Operating System (gqOS) that enables measurement based care.
Scott Shreeve, MD 