Existential Opportunity:  Primary Care Led Navigation

In 2021, at the height of the pandemic valuation bubble, we began down the long road to a public offering. It was a heady experience to build a syndicate of top tier bankers, to work through the org meetings, to develop our narrative and value proposition for professional investors and of course to anticipate “ringing the bell” on Wall Street. Well those glitzy days soon gave way to the harsh market realities that grounded those plans (for now). 

However, it introduced me to an entire financial and banking ecosystem built on understanding, anticipating, and betting on healthcare innovation. I began regularly reading analyst reports on the industry, rapidly gaining both an appreciation for the work they do as well as how the “market” reacts to the various announcements, financial performance, and other vagaries of the quarterly reporting cadence of public companies. I quickly gained a newfound respect for the CEOs and CFOs that run publicly traded companies and the constant scrutiny they face as they guide their business through the ups and downs of the various business cycles and related whims of the market.  

Therefore I read with interest, and am surprised that I did not see more commentary about, a statement by the widely respected Stephanie Davis of SVB Securities regarding the only public health navigation company Accolade:

“ACCD’s inaugural investor day framed the company’s evolution since the IPO, with the business evolving from standalone (and often concentrated) care navigation and into a broader, diversified, advocacy-led benefits platform. We noted that the conversation around the story has evolved  as well—many of the questions centered on how ACCD will look a decade from now vs whether or not ACCD conceptually needs to exist.” 

Wow. Talk about an existential moment when investors and analysts question your need to conceptually even exist. 

I know Raj and the Accolade team well, we work with them on multiple shared clients and everyone in the industry would agree they are a top notch team, with a proven public company track record doing solid work for clients. Respect and props to them for even being in the arena while people like me are commenting from the safety of the stands.  However, I find Stephanie’s comments to be incredibly provocative and they have just been left ringing in the air, unanswered. Why DOES a company like Accolade even exist? What problem has the navigation industry been created to solve? And, is there an alternative approach to solve that problem in a more impactful, cost effective, and aligned way?

The Cost, Complexity, and Confusion Problem

Our healthcare system is fiendishly difficult to access, to understand and to navigate. Human Resource departments have long been overwhelmed by the challenge of answering health related phone calls from employees, responding to questions about what’s in coverage and what’s not, taking the 50th call from someone losing their insurance card and the myriad other mundanities of administering health benefits. The genesis of navigation companies was a desire to outsource this complexity and burden and these companies quickly evolved to be central places where employees could get other advice, better understand benefits, plug into an ecosystem, find the “right provider”, and use the health system more “effectively.” It begged the question: could the outsourced navigator become the trusted entity at the center of the ecosystem to steer, guide, and navigate employees effectively through their own health benefits ecosystem and their local health system? On the surface, the answer appears to be a resounding yes as this segment has grown rapidly over the last decade, with different flavors of “navigation” services offered and different levels of “success” claimed (I always get a bit itchy when every vendor in the ecosystem takes credit for the cost savings – if any – that are achieved). 

To Manage Health Care Cost You Must Manage Health Care Delivery

But in the end, steering someone to get a new insurance card, referring them to an employer program, and being a friendly voice to answer an EOB question is one thing; but actually entrusting your care and care decision-making about your health is quite another. This is especially true when the entire fulcrum of navigation’s ability to drive value is not in customer service but in the actual reduction in expenditure of cost at the point of care delivery. This explains why we repeat the mantra often in client settings that “if you want to manage health care costs you have to manage health care delivery.” And, in those tight quarters, who is the person, entity, or organization that is best equipped to do this work?

Who has the most trust?

I have written about this ad nauseam (here, here, here, and here) but the question of “trust” is THE question that must be answered when discussing personal health matters. Who is the most trusted person, entity, or organization to help your employees get the care they need? Is it a navigation company? Is it a technology platform? Is it your insurance plan? Is it your local health system? Is it an independent, national medical group? Who is most aligned? Who has the right incentives? Who is most capable? Who do you trust?

Primary Care Led Navigation

As a result of that single question, I believe there will be a new category of care services called Primary Care-led Navigation. This will also be the fulfillment of The Great Consolidation series (written in 2021) where we predicted the combination of care delivered physically in person, augmented by comprehensive care teams virtually, that can also provide full scope navigation embedded within care will be THE winning model.  It will be the COMBINATION of the assets and capabilities, led by an ever increasingly CAPABLE national medical group that has the technology, the scale, and the member relationships to bring this together. Primary care is naturally situated at the top of the funnel (best foundation), has the most invested (and trusted) relationships, is the most cost efficient for the system, and if it were more capable (and its practitioners candidly more willing to both assume leadership and shoulder the responsibility), would be the obvious choice of where the members should turn first and frequently throughout their health journey. 

This commitment to earn the trust can’t be a side show and can’t be a bolt on. To be effective and authentic, it needs to be a foundational commitment from an organization to achieve this. Slapping together virtual urgent care and expecting it to be full scope primary care is just naive (speaking as an emergency medicine physician who runs a primary care organization). Primary Care isn’t just a separate board certification, it is both a mindset and a mental framework from which not only the physician but an entire care team operates equally committed to the cause. It is hand to hand combat in the trenches, not hand waving from 30K feet or 3,000 miles away from a call center. This is truly holding someone’s hand, opening your heart, and earning the right to be there for the vulnerable moments when life altering and health defining decisions need to be made. Is your gig working, outsourced, virtual team signing up for this?

Why does Crossover exist?

Which brings me back to Stephanie Davis’ opening point – should navigation as a “feature” be enough of a core offering for a  stand alone “company”  to exist?

Navigation in isolation is the weak sauce to the magic elixir of navigation embedded properly within a robust, high performance, and advanced primary health model. Particularly when that care model can be delivered in person, online, and anytime with the same care team, driving the same clinical results, and doing this at a member, provider, clinic, market, regional and national level. 

Crossover exists to serve a specific type of payer – the self insured employer – that has a primary business other than healthcare. Employers trust us to help them spend, manage, and deliver primary health that is of lower cost, higher quality, and better experience for the members they sponsor. In order to be successful, we have designed physical care centers, virtual care delivery, and are now moving more seriously into navigation to be able to manage the entire top of the funnel so that more members get into a comprehensive, integrated, and accountable care model. Once engaged, we build relationships with our members through prevention, screening, annual health planning, and a direct connection through our proprietary technology. And, by creating primary care led navigation, we can now be our members’ first call, on the back of their insurance card, and be there when the inevitable complexity and confusion of health care confounds them. We are here for the easy things, the hard things, and everything in between.

And we wouldn’t, and you shouldn’t, have it any other way!