Robyn Guillen is a veteran of Crossover, having joined the company in 2012 as part of the original team that launched the Facebook (now Meta) Health Center. Like other leaders who joined in the early days, she was compelled not only by what the company was doing, but also where its vision could take it. Trained as a nurse, Robyn discovered early on her passion for building from the ground up, and it continues to be the driver as she helps push the boundaries of what is possible when Primary Health is implemented at scale.
You started with the first clinic at Facebook in 2012. You have also been someone who has maintained and passed along the company’s unique culture. Please share your background and experience as a Crossover “OG”?
I was born and raised in California and completed my nursing degree and clinicals at WestMed College in the Bay Area. I knew I wanted to pursue family medicine because you have the opportunity to take care of the whole person. I wasn’t thinking about corporate health back then, but stumbled across a listing for a corporate health clinic on Cisco’s campus. I met with the practice manager and thought this was incredible – you could create a primary care home, and do so within the convenience of your workplace. Cisco was one of the first companies to open an onsite corporate health center in 2008 and I was fortunate to be on that founding team. I realized I loved the process of building. You’re right in it from the start, you get to build your own team, you get to create new workflows and processes and then later work to improve and refine them so that every patient gets the very best experience.
What was your transition to Crossover?
In 2012, as Cisco was preparing a vendor transition for the health center,, I got a call from my previous practice manager telling me that there was a new company called Crossover Health in the employer health center space. He didn’t tell me at the time that the client was Facebook but said Crossover was going to open up an onsite center, their second location, and I should really talk to the founders.
This sounded like an exciting new opportunity, being part of another corporate health center startup, and having the opportunity to grow something from the ground up. So I took the opportunity to meet with Scott and Nate and I remember Scott was on a family vacation- in the middle of the Utah desert – but, hey, that is how you do interviews when you are the CEO of a young startup. I immediately was drawn by his passion to change healthcare and I of course took the job after that call!
What things stand out for you in the process of building out Facebook?
In 2012, there was only one campus and it was such an incredible time to be at Facebook. We were in the heart of the campus next to a popular coffee shop, and though they only had ~2,000 employees at the time, it was lively, it was loud, and you constantly felt like you were on a college campus. I remember so vividly our first open house and how incredibly busy it was. We were overbooked from that very first day, and just had to start expanding right away. From the start, and earning the confidence of our client partners, allowed us to be much more creative than we thought possible.
We were a small team of eight then – now a mighty team of more than 115 – but we came together in such an incredible way given that absolute reliance we had on each to make everything work. We were held together by a shared belief that every single member who visited us was going to have not just a good experience but a great one. Regardless of role or title, we all worked together to make it happen. One of the most memorable stories was when demand for physical medicine outpaced our available space we had to basically take over a laundry room next door. .So, our Chief People Officer at the time and I drove in her car to IKEA to pick up some curtains, file cabinets, and situated the exam beds within some that tiny little space. But somehow, someway it all came together; and, the members who came for care could feel the passion, and it was like they wanted to be part of it all as well. This is what made it special.
What created this teamwork?
Being part of a team singularly focused and united on providing great care and making it happen. We were all so excited to be there, and we got to be there with Scott, Nate and Rich and see their passion. For the eight of us, that feeling was contagious. It was never about what role you were in. At the end of the day we’re here for our members. I love that for more than a decade we have been able to maintain that same passion and focus on our members, our clients, and to be part of the greater change required for healthcare delivery. Of interest, of the 8 original members from 2012 launch we still have 7 who are employed by the company.
Now, with almost 1,400 people across the Crossover organization today, our culture still attracts the best talent; people who want to work together as a team. They want to grow, they want their ideas to be heard, not just for their role but the entire health center and for the greater Crossover organization.
A lot of people will say it’s easy being “successful” with a young and relatively healthy population like at Facebook. How would you respond to that critique?
Facebook is a population unlike any other. While they may not carry the heaviest disease burden, they certainly have plenty of opportunities for health improvement. At the heart of population management is identifying the needs of the group as well as every single individual. You also have to effectively partner with the client who needs to share your vision for how to increase the population’s health status. And, this is where our “care creativity” really started to shine. We began by creating classes, like Dan Lord’s “Posture Hack” series that was really popular. Our health coach would do tours of the cafeterias and micro-kitchens to help our members select healthy food. We saw a rapidly growing need to address mental health early and brought this service line into our core care model. We did the same thing with Care Navigation because we knew to control total cost of care you would need to get members to the right services and specialists in the community. We helped them locate, schedule, followup, and ensure all the data made it to each appointment. This “closed loop” process was incredibly effective in guiding care. That’s what made us different then and continues to make us different now. We’re making it so easy to access care and closing the loop so that not only our members but also our clients get maximum benefit from our care model.
You have subsequently transitioned from Facebook and now you are in Texas. Can you describe your role and what you are doing?
After eight years with Facebook, the pandemic presented a new opportunity for my family. At the time I was beginning to hear about several opportunities with the Amazon partnership. I had never considered the possibility to move with the company, but true to our Crossover values to “Be Fearless” I decided to take another leap of faith. We were going to have the largest expansion with five new clinics in the Dallas area which up to that point I had never visited before. I said to my husband, “Let’s go check out Texas” (a place I had never been to in my life) and see what it has to offer. It was back to my personal preference of really enjoying the excitement of building from the ground up. We have now been in Dallas for nearly two years, have really enjoyed the city, the opportunity for home ownership, and the challenges of the new role.
Can you describe that role as well as the Amazon Neighborhood Health Center?
I initially took on the assignment as a market leader which quickly transitioned to the much larger role overseeing the entire Neighborhood Health Center program in all five “markets” including Dallas, Phoenix, Detroit, Louisville, and San Bernardino. The project was all about providing our comprehensive primary health services but to do so not on a corporate campus or even near one, but in the neighborhoods where the Amazon Operations and Fulfillment Center employees live. The project was massive, was completed during the pandemic, and we ended up opening 16 new centers across 5 states, in about 13 months, while hiring about 400 people. My role is responsible for the operations and performance of all 5 markets from a clinical perspective as well as helping to ensure our clinical staff are successful in meeting that original mandate of always delivering an exceptional experience.
The role is heavy on the operational side, given the national scale, and we are constantly working to ensure that we are efficient, effective, and we deliver on the outcomes that we have committed to our clients. As you can imagine, I travel a lot to different sites, solving the root cause of challenges by asking the right questions, and trying to be the inspiring type of leader that I had when I first started. Because of our strong principles-based foundation, I find we can get to solutions pretty effectively.
What stands out about your Amazon experience?
Besides the opportunity to build something new, what attracted me the most was the population that we’re serving. My husband works for UPS and so I know about working in the warehouses and fulfillment centers, and I also know that this population really needs our care. When they seek care in the community they just feel like a number, they are rushed, their questions aren’t answered, and they leave without knowing what is the next step in their care. What we continue to see with our Crossover model is that our members are literally blown away by the care and services that we provide, and we are able to make a positive impact in their healthcare journey. While Social Determinants of Health is a nice buzzword we hear at conferences, we are literally living it every single day on the ground floor where our care impact rubber hits the health outcomes road. WE get to see what happens when members can get shelter, when we can guide them to financial resources for their families, when we can address transportation or food issues, and what happens when you have built a relationship and earned the right to their trust. It’s not magical how this happens, but it is certain magic when it does!
We have systems in place that allow us to follow up with members and help them navigate the healthcare system. I never really appreciated how difficult the healthcare system can be, and our care navigators just take care of all that complexity. Our members are always so grateful to feel like someone is finally on their side. Our metrics show that we’re already seeing substantial and meaningful positive outcomes in the two years that we’ve been here. It’s fascinatingfasinating to see our care model shift over the years to really be able to do this type of work.
What hasn’t changed, fortunately, is our culture. I see it here in Amazon; and, even as we’ve grown to several sites across the US, you still see and feel it when you walk into our centers. You know that it’s different. People are passionate and motivated to be here, and they’re working together to serve our member population and provide them with great care and service experience.
Where do you see the care model evolving? All this work on population health where does it take the care you provide in general and the direction of the company specifically?
The SDOH screeners have helped our care teams see what we can do for our members, specifically related to housing concerns, financial instability, food insecurity, and other health care basics. We are currently evaluating bringing social workers formerly into our care teams to uncover all the issues as well as to steer to the resources that are available to our members in each community. In the end, caring for people, helping them where there are needs, and ensuring that we stay connected through the entire care journey.
We are now moving beyond just reacting to the members in front of us, but to now proactively outreach to those who need us. Our metrics showed that getting breast cancer screening can be a challenge for our members, not only because of the cost but also getting the time off. We got together as a team and asked ourselves, why couldn’t we bring it to our members? So on a weekend, we brought mobile mammography to our clinics, and it was highly successful. This is just one example of things that we think about to help serve our population, based on barriers that we’ve seen that are in place for them. Finding cost effective drugs is another. And in the future, social workers could be another way for our model to remove barriers and close an even bigger gap..
For so long healthcare has had the feeling of being transactional rather than relationship-based. How do you get past this barrier and get members to not only engage but develop trust with their Crossover Care Team?
The key is to create a trusted relationship because you have to have confidence your provider is there for your best interests. And also to your point, you ask them all these questions, some of them quite sensitive, and then the member is going to ask, “now what”? For example maybe they’ve had migraines for a week and these aren’t getting any better and the usual experience is that the provider has five minutes, puts you on medication, and then says to come back in a month to evaluate how the medication is working. Well, that’sthats not really care nor is it all that caring. At Crossover, the team takes the time to dig deeper, tries to understand the “why” behind the migraines. As a team we work together to see if something else is going on that might be the root cause. What if they’re having severe neck pain and not sleeping? Well, we can get them in with the Physical Medicine provider or maybe they needed to see an Mental Health provider given their lack of sleep was due to anxiety. It’s really this entire team that surrounds each member and works together to achieve measurable health improvement. In the end, this is what has led us to be successful.
Nurses in healthcare are generally undervalued, I believe. Has the guild been used as a way of helping Crossover nurses especially the newer ones understand how they are valued?
Absolutely. We celebrate our nurses all the time. We not only provide education, but we give our nurses the opportunity to educate others, because that’s one of the primary functions of nursing. We are also working to get each of our nurses, based on their background and education, opportunities to practice at the top of their license. We’re natural educators and healers, but we are also pretty good at systems, processes, and scaling great health. I am so proud of all of our nurses and the great care they provide every single day.
What do you see as your future at Crossover Health?
Having the experience, services, access, health outcomes and metrics that we have in place, our virtual platform and our culture at the root, I see continued growth and success for Crossover. We grew Facebook on site, as a team, from an idea to a massive entity taking care of almost 90,000 people. In this new role, I am constantly challenged to manage so many different clinics across so many markets, but I am learning how to lead by not being there in person. That means the key to growth is really about training the next level of leaders, showing them how to manage with the same principles-based approach to solving problems, being proactive instead of reactive, and always staying a step ahead of the issues. I’m always looking at that next layer of leadership and getting them to where they need to be as that just makes my job so much more rewarding (and easier!). I find a lot of our team members are passionate about our culture, the model, and taking care of our members that they’re ready for that next step in their career and I want to mentor them the same way so many mentored me along in my own Crossover journey. It’s so important for our growth and future as a company.
Tell us something unique about you personally that our readers would not know?
I am a mom to 3 beautiful girls (who I plan on raising as strong and independent leaders) so I don’t have much free time on my hands, but one thing about me is that I am obsessed with is true crime documentaries. If I didn’t end up going into nursing I probably would have been a detective!
Many thanks to Peter Heywood (our long-standing brand advisor and business consultant partner) who helped conduct this interview. Please read Peter’s other Crossover Leader Series Interviews.
Scott Shreeve, MD 