Scouting Report-Crossover Health: Building Primary Care Relationships to Drive Differentiated Care
In late March Crossover Health raised $168M in a Series D round to expand it’s employer-based primary care model, including a recently announced agreement to expand its partnership to build primary care clinics for Amazon workers. According to the company the funds will be used to expand their data intensive “Connected System of Health” across the U.S. and to build out centers for the Amazon partnership.
The Entrepreneurial Insights:
Founders must be willing to take a step even if they can’t see a clear outcome...you can’t sit around and wait for inspiration, the inspiration comes from putting the work in
You must have a clear vision and build towards that. Healthcare is very difficult and it will outlast you. You can’t be impatient and think everything will turn in two years, there are too many twists in the road.
We realized from day one that our model had to work outside the [existing] system. We knew we didn’t want to be fee-for-service and we were going to go all in on that.
Today’s world is focused on instant fixes, you must have a long-term vision, don’t get distracted by what is cheap, convenient or easy. Outlast the noise, outlast the rumor and have enough conviction to stay with it...you can affect lives.
Founded in 2010, Crossover Health provides an integrated care model primarily for self-funded employers including Apple, LinkedIn, Comcast, Amazon and others. Crossover’s model which began with on-site clinics and now includes virtual care, behavioral health, health coaching and patient navigation which the company refers to as Primary Health. The company has approximately 400K lives under management served by 48 in-person health centers in 11 states. In addition, the company delivers care virtually in all 50 states. In July 2020 Crossover announced a partnership with Amazon to build clinics for Amazon employees, near fulfillment and operations centers and the partnership has since been expanded to a total of 20 clinics. The company claims to save their clients approximately 15% on average by emphasizing coordinated primary care. Unlike other models where patients just have a single primary care physician (PCP) , Crossover patients are assigned to a dedicated collaborative care team which has the ability to share patient data. Crossover patients can choose on-site or virtual care and can connect with care providers via synchronous or asynchronous options which according to Crossover CEO Scott Shreeve allows them to build deeper relationships with their patients whereby they “leverage technology to extend the capabilities of the care team to augment the clinician/patient relationship, not displace it.” Along those lines Crossover uses an in-house data analytics platform to which Crossover can access a patient’s medical history, recommend evidence based treatments for high risk patients or those with high cost chronic conditions.
Crossover employs all of it’s physicians. Physician compensation is composed of salary plus outcome based incentives in order to keep the clinicians’ interests aligned with those of its employer clients. According to CEO Shreeve, employing physicians, creating coordinated care teams and even the physical design of the clinic facilities is part of a top down effort to “have that relationship with the patient” and use it as a competitive differentiator. Shreeve added that each patient care team can manage a “maximum of 10,000 patient lives to maintain a consistent quality of care”. Unlike many other models, Crossover also gets paid by employers on a subscription basis per employee per month (PMPM) or on a per population basis which improves employee access, the depth of the relationship with care teams, removes the transactional nature of the visit and helps lower costs. As noted by CEO Shreeve, “you can’t control costs unless you control healthcare delivery”.
The Big Picture:
Despite the tremendous increase in the use of telehealth during COVID the quality, convenience and level of customer service surrounding the transaction did not noticeably change. However, providers like Crossover which focus on creating and maintaining a relationship with the patient, where the patient is at the center of the relationship have the potential to improve the level of customer engagement and satisfaction with care and by doing so improve outcomes and lower costs. For far too long, healthcare has lagged behind most other consumer facing industries in the quality and convenience of its relationship with consumers, often making the location of care or the clinician the focus of attention at the center as opposed to the patient. Moreover, by failing to create this relationship physicians have likely failed to leverage their talents to the fullest. For example, according to the Accenture Digital Health Consumer Survey 2020, when asked “which of the following would motivate you to take a more active role in managing your health”, more respondents answered “a trusted healthcare professional who works closely with me to manage my wellness” (55%). In addition, as empowered by more convenient and more accurate technology consumers are increasingly taking charge of their own care. As such they are more willing to share their health data and embrace virtual tools to help them accomplish their goals. For example, According to the 2019 Global Health Care Consumer Survey, almost 60% of respondents are willing to share health data with their doctor to help provide better care, while 44% of respondents would be willing to use an at home test to identify a health risk and 47% of respondents would be willing to use an app to track changes in their vital signs. All of these imply that provider organization and individual clinicians are increasingly going to have more personalized and more strategic relationships with patients through vendors such as Crossover who can build relationships and leverage technology to improve care.