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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 had the opportunity to participate in the Founders Summit sponsored by Lynne Chou O’Keefe and the Define Ventures team. Besides the amazing Stein Eriksen Lodge setting (is there anything better than a summer evening in Park City?) and the inspiring performance by Aloe Blacc (man – I love hearing artists describe their creative process and the story behind each song) the summit brought together a great group of health care innovators, entrepreneurs, and leaders trying to advance the ball in creating health as it should be. You never quite know what you’re getting into when a group like this gathers in such a setting, but my sense was that Lynne was thinking much bigger than her current portfolio and was really working to build a network of innovators sharing stories, mixing ideas, and solving really hard problems. 

The keynote session was actually not a presentation but instead a facilitated session by venture partner AG Breitenstein,  founder, investor, and industry veteran. She asked each person in the audience to take a full 10 minutes to think in silence (imagine that!) about how they would like health to be in 10+ years. Going around the room you could see an evolving mix of not only familiar ideas (better health records, more intelligence applied to care, decentralized scoring of health care quality, removal of health disparities, health equity, care access for all, etc) but also some fresh takes on medical education, standardization of specific testing and new ways to proactively monitor health. As the conversation whirled around all these high-flying concepts, from back in the room co-founders TJ Parker and Elliot Cohen re-centered the group on the issues of pricing, value, and payment in a free market.

While many of these future health ideas raised in the session are things I believe in and have dedicated my career toward achieving, we will continue to run into an industrial brick wall until we have a better way for consumers to make value based judgements informed by true pricing in health care. As long as we have “sponsors” – third party payers (whether employer, insurance, or government) who remove the true price “signal” – we will be left with a lot of “noise”. The tempo of the conversation really picked up as the reality of the many thorny issues with payment surfaced (those who can’t afford care, those who can’t decide due to various issues, and just generally “re-training” an entire generation of people who are used to having someone else largely foot their health care bills). This is a generational issue to tackle, a cultural battle for which we need to win hearts and minds, and a financial crisis that could prove catastrophic. Unfortunately, we quickly ran out of the budgeted time for the exercise. I really wanted to keep drilling into this key topic with this particular group because I don’t really see another problem bigger in health care than tackling payment, price, and value. 

As we continue to endure the bitter winter for Digital Health, we are going to see a generation of companies which struggle to gain traction in bringing to market solutions that solve a real world problem while sustainably generating a profit (*GASP* – yes, you must make a profit to be a “real” company) when there is a complete obfuscation of market generated prices in health care. I am concerned that all the innovation in digital health will continue to miss the mark, go beyond the mark, or worse not even be aiming to make a mark as a real company solving a real problem. My experience at the conference was a microcosm of what I often see in health care innovation (lofty ideas brought back to earth by that stubborn – “Who is going to pay for this” question) and it certainly has “recentered” my own personal ambition to slay the Pricing, Value, and Payment (PVP to make it a bit more catchy!) dragon.

Which brings me back to the title of this post – “Bread and Circuses” a damning phrase first introduced by the Roman poet Juvenal around 100 AD who decried the loss of a citizenry who would actively engage in the civic process to help solve the empire’s largest challenges. By not embracing their historical birthright of political involvement, the citizens were either intentionally or unintentionally demonstrating their declining heroism to defend the ideals of the republic in the face of increasingly autocratic imperial rule. Juvenal’s satires were squarely focused on the descent of the broad populace who willingly abandoned their rich heritage to embrace an era of distraction, diversion, and de-sensitization in exchange for the very earthbound promise of “bread and circuses.”

There is such an incredible opportunity–and a compelling imperative–to unlock the PVP conundrum. Solving for PVP will be the catalyst to unleash the innovation to solve the largest problems in health care but all of us – providers, payers, patients and the innovators –  have to care about this issue first. We can’t be distracted by this new tech or that new innovation – health care’s bread and circuses – when we don’t have a payment model that signals the true value of an innovation and a willing populace who will pay a market price for the service. True Pricing, accurate Value signals, and voluntary market Payment – this is where I am “anxiously hoping” to break my proverbial pick in fixing. When we take the PVP issue head on, the circus barker’s offer of free bread will no longer distract and disorient us from solving the very real pricing problem, which will prove the key to unlock an incredible future of health as it should be

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Bonus Material for those interested in how Juvenal actually used the phrase in his writings:

“… Already long ago, from when we sold our vote to no man, the People have abdicated our duties; for the People who once upon a time handed out military command, high civil office, legions — everything, now restrains itself and anxiously hopes for just two things: bread and circuses.” 

Juvenal, Satire 10.77–81

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