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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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I have been reading an interesting book by James Carse on Finite and Infinite Games. I heard about the book when listening to the CEO of Shopify describe his approach to innovation and enabling structural shifts in how people live, shop, and transact. Simon Sinek picked up on this same theme and expanded it in his book called The Infinite Game as well as in his lectures on the same topic. 

The basic premise of Carse’s book is that there are two types of “games” individuals play and they have fundamentally very different consequences: A finite game is played for the purpose of winning, while an infinite game is held for the purpose of continuing to play. A finite game has known players, known rules, a known objective with known boundaries (time and space), and an ultimate objective to beat the competition. An infinite game is the opposite—it has both known and unknown players, no rules, no specific objective, and no boundaries, with the ultimate objective being to keep the game going. Awareness of the type of game you are playing is critical to reaching your potential as a person, as an organization, and as a nation. And as both Carse and especially Sinek emphasize, you can’t change the world when you play a finite game.

And isn’t that the challenge in healthcare? Far too often, those who claim to want to innovate in care delivery treat it as a finite game, played with a transactionally narrow perspective, bounded by a fee-for-service architecture, and significantly limited by the ability to see new possibilities. The existing medico-industrial complex (the network of corporations – insurance, hospitals, diagnostics, suppliers, and more – which supply health care services and products for a profit) is defined by equal parts complexity and inertia, and given the dollars involved (blowing past $4 trillion), it is not surprising to find the entire industry well entrenched, highly sclerotic, and competing to win on feature proliferation and price. In this realm, the game is played, won, and done.

This is the opposite of the infinite game mentality that we should be playing within the healthcare arena. We should keep playing in order to be better at serving patients, make care more effective, see a population’s health improve, and bring more and more people to a state of better health. Playing the long game—or better said, an infinite game—seems to be a much more appropriate and impactful framing for healthcare delivery and innovation. There are many organizations leading the way with this unique view–some large like Kaiser, Geisinger, Intermountain Healthcare, and the Veterans Administration; and others smaller like ChenMed, Cityblock, Aledade, etc–to name a few. When they know they have their patients for an extended period of time, their long term thinking translates into care, services, and cultures that are focused on what truly moves health forward. They make investments with payoffs measured in years and develop an ethos of caring that is palpable (my favorite quote I saw when rotating through the VA – “we care for heroes who remind us that freedom is not free”).

In healthcare, the winner of the infinite game should be the recipient of care and caring. The member. The individual who is receiving the better experience. The improved health outcomes. The lower costs. The “winner” shouldn’t be the firm with the fastest short term growth, the business models that eschew fundamental care models, the quick profit grabs, or those whose timing allows them to draft off “irrationally exuberant” valuations. There should be no room for business transactions based on a profit and loss arbitrage when the ethos of trust and transparency should be the foundation from which rational and reasonable care models evolve. This is the opportunity for purchasers and providers of healthcare to “vote with your feet” by seeking out and paying for care delivery from people, companies, and organizations that play an infinite game. I believe you will be able to recognize them by both an absence of short term transactional thinking as well as a quiet resolve to play the infinite game in health care. Forever. 

At Crossover, we have always aspired to play healthcare innovation as an infinite game. Winning one day is simply an invitation for us to make our care even better the next. We aren’t distracted by the noise in the marketplace or by competitive offerings. We don’t see the limitations that are always around us; instead, we see the opportunities to push through to the next peak for improved outcomes and lower costs. We don’t chase the news, we choose to make our own. We are betting on ourselves to keep winning for our members through our ability to keep playing. We choose to operate and execute in a way to both outwork and outlast finite thinking; and ultimately, to find joy not in comparison but through advancement of our just cause—to design “health as it should be”. 

We have been playing the Infinite Game for a very long time . . . our Cause of Health circa May 2014.

After all, “Infinite players are not serious actors in any story, but the joyful poets of a story that continues to originate what they cannot finish.”

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