Steven Chang MD is a veteran of Crossover, having started as a practicing physician in the Applied Materials health center in 2011. In In his Part 1 Interview, we looked at his focus on developing care standards for Crossover. In Part 2, he speaks about how his work bridges clinical practice with medical group operations where he both leads and contributes in bringing our standard of care to life consistently for all of our care teams.
You wear many hats. One has been a leadership role in the Clinical Council. Could you describe that role and your experience?
It’s complex running a multidisciplinary practice, let alone a nationwide network of health centers with more than a thousand care team members. To help with the standardization of care and operations, I started Crossover’s Clinical Council, a group consisting of key stakeholders tasked with the responsibility of standardizing care across the enterprise. On a weekly basis, I lead the group in fielding issues which arise from all of our clinics. The best solutions are then communicated to all of our care teams via streamlined communication channels.
How does this differ from the work of the Primary Care guild? I still believe the Guild concept is quite novel in this space and can you provide further definition of how the Guilds work?
The concept of “guilds” formed around the realization that we wanted each type of provider in our integrated care model to have a sense of belonging and a representative voice. This was evident from the very beginning of Crossover’s approach and the basis of our company culture. Each guild is composed of providers from the same service line, led by a guild leader. We support each other clinically and professionally within our own discipline which in turn contributes to how the multiple disciplines consistently work together across the country.
The guilds formed around the realization that we had these groups of different kinds of providers that we were hiring and we needed a voice, representation and leadership from each service line. Unlike the Clinical Council, which is focused on standardizing operations, the primary care guild is much more informal. Providers reach out to their managers for clinical operations questions, but I am available for pretty much any questions, whether they’re clinical, operational or cultural. As a physician leader, I see myself as a confidant for the people in my guild. Perhaps I’ve accumulated some wisdom about how things work over the last 10 years, and I want to empower those who reach out to me and make sure they’re set up for success, whatever situation or issue that may arise.
This past year, I spun subject matter expert groups off of the primary care guild. We now have more formalized groups of individuals with niche knowledge in certain topics such as men’s health, women’s health, pediatrics, LGBTQ+ health and as well as a clinical education group. They are responsible for bringing to our attention, any new care guidance or standards that are out there and participating in clinical decision making on how we operationalize those new standards. Its purpose is to keep us on the edge of the latest in clinical practice.
One of the big challenges as an organization grows is how stay fresh and connected as the organization necessarily has to scale. How do you help maintain the edge and the personal connections?
We’ve been able to maintain a relatively flat hierarchy within Crossover. Any one of our primary care providers has a direct line to me and a direct line to their clinic, market, and regional managers as well. For our guild, I function like an ombudsman, where I’m privy to a lot of personal questions from our guild members, and since a lot of them haven’t worked in a corporation I help them navigate their situations from a personal perspective. The guild brings a less formal aspect and personal touch to our relationships, which I think is the value of the guild managers.
A big part of how we build and maintain our edge is how we onboard our providers. One of the things that Crossover uses to measure or compare ourselves to other organizations, large and small, is the Net Promoter Score. I often say to our new providers that we’re not here to teach them how to get a high NPS score. We’re here to teach them our thought process and how that translates into how we manage our centers and our workflows, and how we think about member experience. We essentially teach them how we do things, and that just miraculously turns into these amazingly high NPS scores.
Switching gears to another hat your wear, can you explain your role within the Clinical Operations team? What is your role and responsibility there?
I have one foot in the Medical Group and one foot in the Clinical Operations part of the MSO. The Clinical Operations team’s main function is to support the operations of the Medical Group. It’s the team that jumps in and gets a new health center up and running, getting all the supplies ordered and the clinic stocked, and training all the new providers and staff, and when the clinic is ready to fly on its own, it provides all of the ongoing operational support. How do we best manage inventory? What systems do we need to use to dispense medications? How do we meet certain regulations? What are the workflows that we need to meet those demands? We have to make sure that our clinics are up to code and are running smoothly, based on operationalizing feedback from teams on the ground from our quality and compliance teams and from our legal teams.
How have the actual health center designs over the years?
Our clinic design flows from our care philosophy and in line with all of our interdisciplinary workflows. Over the years, we’ve definitely refined the footprint of our centers based on input and our evolving model. They probably look a little bit different than what you would have seen years ago, but they have remained essentially true to the original intent. I recently had a chance to be a patient last year when I stopped by to get a COVID vaccine and I have to say, from the member’s perspective, I was still pleasantly surprised at the entire management of the experience from walking in through the doors, getting my shots and then leaving. It is a very different experience from a traditional clinic.
What’s your vision for Crossover in the future? How do you see it continuing to evolve?
The pandemic has driven and accelerated the adoption of telemedicine, which has always been on our roadmap, and we are quickly rolling out our own patient communication platform that allows for hybrid care. The dream is to allow our members to go seamlessly from in person to to virtual care and back and get care wherever, whenever. Part of this is moving to asynchronous communication when that makes sense, so we can take the time in synchronous in-person and video visits to really get to know the member – what stresses are in their life, what motivates them, what are the barriers. Traditional care doesn’t have the time for this.
I also hope that we can better demonstrate the outcomes that come about because of our integrated model of care. Right now, it’s difficult for anybody to track outcomes attributed to multiple team members working with a member. For example, if I have a patient and I refer him to a health coach for goal setting and dietary consultation, or he gets referred to physical medicine, to kickstart his fitness program, and he comes back to me and his blood pressure is better, we want to be able to show that it’s not just me contributing to his success. How do we show that it really is this team approach that leads to better care and better outcomes for the member, not just the medicine that they’re on?
I would also really like to redefine the concept of a preventive visit. For years, we’ve called it an annual physical exam and it has devolved into patients coming in with all their issues that they’ve accumulated over the course of the year, and wanting to talk about and hopefully get a resolution. But I really would like to focus on the idea of prevention, rebranding our approach to preventive care that way. For example, our Men’s Health Group wants to redefine what happens during the men’s health visits, so we are focusing on issues like stress management, life satisfaction, fitness, all these things that we know are important to one’s health, and overall life satisfaction.
Is there something about Steven Chang that might surprise the reader?
I’m an advocate for animal rights, participate in animal rescues, and I’m in the process of setting up a nonprofit to help stray animals in Tibet. I met a woman who works with a particular monastery, and asked if I could start something after seeing the strays at the monastery during a lecture. That has really been a source of happiness and satisfaction to me in a totally different endeavor than my medical career.