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Saul Marquez:
Hey everybody! Saul Marquez with the HLTH Matters podcast. I want to welcome you back straight from the floor in the HLTH event from Las Vegas, Nevada. I want to thank you for tuning back in today. I am privileged to join with Dr. Scott Shreeve. Doctor Shreeve is a board-certified emergency medicine physician who has been actively involved in the design, development, and distribution of healthcare technologies that improve the delivery of care and enhance the quality of life. He's the chief executive officer of Crossover Health, a next-generation healthcare delivery and management services company. As founder, visionary, and brand strategist for the organization, Dr. Shreeve has been a leading advocate for the creation of a new primary health model and membership-based health services. Prior to founding Crossover Health, Dr. Shreeve co-founded Medsphere Systems Corporation, the first open-source electronic health record for the healthcare enterprise, where he led the client services team. In this capacity, he led the implementation of large-scale electronic health record implementations at community hospitals, statewide health systems, and networks of primary care clinics. Dr. Shreeve was also the founding member of the Health 2.0 Technology and Reform Movement, serving as an advisor to the conference and spokesperson throughout the country. His popular Crossover Health blog focuses on the enabling technologies that transform the delivery, finance, and outcomes of high-performance health systems. He is an incredible contributor to the health space and I'm privileged to host him here on the HLTH Matters podcast. Scott, thanks so much for joining us.
Scott Shreeve:
Yeah, thank you for the time. Look forward to chatting.
Saul Marquez:
Absolutely, so tell me something, Doctor Shreeve, you've done such incredible work both as a founder, a business builder, and now you're at it again with Crossover Health. Talk to us a little bit about what inspires your journey in healthcare.
Scott Shreeve:
Yeah, I think it actually goes all the way back to my experience through medical school and starting as an emergency medicine physician, seeing how the healthcare system works from all these different angles. And I felt as a, in the emergency department, you're really kind of the care of last resort. And I used to always wonder what, why is that, and why can't this be better, and why isn't there a relationship that a lot of these patients could go to? I also really felt that primary care could be done different, and I wanted to be a part of that innovative wave. And, you know, seeing my 30 patients a day and doing my very best for them, I kept thinking, how could I go upstream? And in fact, 300, 3000, 300,000, and I realized it would really have to be a systemic solution to do this. And, you know, we started at the foundation, which we feel is primary health, and we've been growing ever since. And so it's been quite a journey, and I've really loved to see Crossover to serve as a organizing catalyst for people who really want to change the system. We employ all of our staff, people make a career change to join us, and they're here for the change, which I love.
Saul Marquez:
That's fantastic, Scott. Now talk to me about the people. So who are the people? Are you hiring clinicians? Technologists? Help us understand.
Scott Shreeve:
Yeah, that's a great, great question. So obviously we are first and foremost a medical group. We're national in scope, we're comprehensive in the set of services we offer, so it's not just primary care, but also nursing, mental health, physical medicine, health coaches, and care navigation. So all those services and all those professionals working together as a team that's integrated, comprehensive, and accountable to the care and to the outcomes that we achieve. So again, people are making a career decision to join us. We fully employ the staff. We think the culture of care is critical. And so when people join us, they want to know that they're going to join an organization that respects the clinicians, that's trying to create a great environment for them that helps them flourish and do their best work. And I think people really enjoy working together. Disciplines that don't always have the chance, you know, nursing with mental health or physical medicine with primary care, and even adding care navigation, you know, having this full, comprehensive, holistic view, people, I didn't appreciate how much the providers would like practicing together. And I think that we see that in our retention numbers, our ability to recruit people, to kind of join us on this marry mission and to really go and try to change healthcare.
Saul Marquez:
That's awesome, Scott, and so just to level-set here quickly, brick-and-mortar versus virtual, talk to us about the breakdown there.
Scott Shreeve:
Yeah, what we love is we don't think it has to be a versus, we think it's actually an and, and we started as a provider of physical spaces, so on sites or near sites, we'd go build these physical centers. People would come in and see us and we recognized pre-pandemic that, you know what, we're never going to be able to build enough. You know, we didn't want to be Blockbuster is what we used to say. You know, you got to have a way to get to more people and have more impact. And so what we've always been trying to teach and coach our employer partners that we work with is, don't think of us as a health center company, we want to manage your entire population. And in order to do that, it can't just be the care that happens in the center. We have to be able to reach your members virtually, we need to see them in person when appropriate, and the combination or the hybrid is really what's powerful. And I think you saw the microcosm of that when, you know, pre-pandemic it was kind of 95% in-person, pandemic it was 95% virtual, and now we're settling somewhere in the middle. Some services, mental health, 75% of our visits still happen virtually. Primary care, about 40%, physical medicine about 20%. So everyone's kind of settling into what that natural flow is. But before, you know, it's totally different than it was before, and I think people see the possibility. So what we really have doubled down on is not one or the other, but actually both, the nature of hybrid.
Saul Marquez:
Yeah, fantastic, thank you for that, appreciate that. And so it's clear, but I think it's worth being clearer. What is it that your business does to add value to the healthcare ecosystem?
Scott Shreeve:
We think the most important dollars that you spend in the healthcare system should be around primary care, and we actually use the term primary health to imply more than just the physician and the nurse. We think adding mental health, adding physical medicine, adding health coaching, adding care navigation allows us to open the aperture of influence of the number of people that we can see. Once someone comes in for any one of those services, about 80% of the people who use our service say, this is where I want to establish my medical home, regardless of which service they come in. So however you start with us, you typically will stay for the rest of the care model that's there. And so that's where we think we can have that, that really big impact is providing these care teams, the set of services, and so forth.
Saul Marquez:
Thank you, and so where are you guys located?
Scott Shreeve:
Great, great question.
Saul Marquez:
And who can access you, right? So people across the nation are listening to us.
Scott Shreeve:
Yeah, so we actually are a national medical group, so we do offer virtual care in all 50 states. We typically work with a sponsor and so that means typically an employer and now more recently payers, they will offer our services to a defined population of members and then we provide care for them. That can be done near, onsite, physically on campus, it can be done near site, or it can be done virtually, or it can be done in combination. And so that's what we actually love, is to have clients who actually can access multiple ways. We do have a retail product that we offer and more of an experiment and to, when we have access that we can have people do that, but we typically sell through some type of a sponsor. That's been the model we've chosen, it's the way for us to get the most leverage initially, and ultimately, we'd like everyone to have this.
Saul Marquez:
Beautiful, well, there you have it, folks. It doesn't matter where you're at, it is available to you, so make sure you take a look at it. And if your employer is not giving this to you, maybe you should ask them to consider it. In the show notes, we're going to leave links to Scott's company, Crossover Health, and the amazing work that they're doing. You know, the innovators in this space, in primary care, are the ones that are going to make a difference. They're the ones that are going to get care to us as consumers in the way that we want to receive it, not dictated to us. So thank you for that, Scott. Now, this thing on primary care, you know, it's been around for ages. Why is it so ripe for innovation?
Scott Shreeve:
I think Justin Timberlake actually said it best, you know, we're bringing sexy back. So we want to make primary care back to the foundation of where it should be, which is what it really comes down to, it's not a business model, it's not a care model, it actually turns out to be a relationship. And relationships take time, relationships take care, relationships take trust. And in the primary care setting, when you can establish those type of deep relationships, we can take care of the basics, we can take care of the prevention, we can take care of the chronic conditions. More importantly, we can take care of that holistic view when you go out into that secondary care system. So we really think people are recognizing the value of primary care. And I think what a lot of the innovation over the last decade is showing is that the proper order and place of where primary care is, it should be the foundation, it can be an organizing catalyst for the rest of the way the healthcare system is used, and we think because that's where the relationship is centered, it's a great place to invest. And I think that's why people have really returned to the value, particularly in this economy. We're going to big crunch to demonstrate value and some of the things that just, you know, are interesting and nice and shiny, it's going to get back down to bare metal, and what's the bare metal, is primary care.
Saul Marquez:
Yeah, you know, I love that, Scott. And just thinking about the impact that the services you've selected to include as part of the entire care journey, coaching, I mean, all of these things avoid the thing that has been happening, which is episodic care. And so now you're present across the continuum of being because our lives are not episodes, it's life, and so I think you're on to something big here. It seems that in order to make real change in healthcare, you have to tackle the payment model. So what are you seeing when it comes to payment reform?
Scott Shreeve:
Yeah, I think this is great. So, you know, historically, primary care has just seen the reimbursements and how you're getting paid and the value of the service really diminished because there's not little widgets you can attach. How do I ascribe a CPT code to the relationship I have or, and, you know, an ICD-9 to the prevention? And in fact, I can't really get paid to do a lot of these things, right, they're just kind of assumed. And so payment reform has to recognize that you have to pay more and different for primary care as a way to pull down overall cost. So let's do some math together. So if you take a $1 bill, if $0.06 to $0.08 are spent towards primary care, the other $0.92 to $0.94 is spent on other services. Yet that small investment in primary care, if you slightly expand it to add it, to get it to 8% to 10%, now we can start to add these other things that actually allow the coaching, that allow the steerage, that allow the behavior change, that allow the time necessary to really pull down these other costs. and we can start wiping out some of the secondary care costs where all the money is spent. And so what we tell people is you're not going to save on primary care when you invest with Crossover, we're actually going to spend a little bit more, but that little bit more is going to pull down all the secondary care costs. And what's great is it's not very hard to show that return on investment, to show that math equation. And what I always tell people is I don't want to be a great salesperson, I just want you to be able to do math, and if you can add the math and see how it all works together, this is going to show to be a great solution, to drive value, and to create a differentiator for any organization that selects this.
Saul Marquez:
That's awesome, Scott, I mean, it doesn't get any clearer than that. So thank you for simplifying a very complex issue. You know, really taking a look at this, we're working in a health plan and a health space where we do need companies like yours to make a difference. So how are you making this all work?
Scott Shreeve:
It's a great question. Now it's a lot of blood, sweat, and tears. I do think one thing about primary care, it is, it's a marathon, not a sprint. Many times it feels like walking through the desert and the mirage is out there, And the closer you get, the mirage seems to kind of keep going. But I think for anyone who's been in this space, you've got to come in with pure intent and some patience and some persistence. But what we're seeing is I think there's an accretive effect for all the innovation, all the dollars that have been shifting into primary care. We're seeing which models really work and have impact. And I think the time is really now, there's so much momentum around this. You know, there's a phenomenal book, I just have to mention it to readers called The Implementing High-Quality Care put out by the National Academy of Science and Medicine. And, you know, their whole thesis is around foundational primary care as the basis of great health. And they go through and it's not, you know, designing high-quality primary care or thinking about it, it's implementing, and they create a blueprint for how you go through and do this. And what's interesting is we map what we're doing, we are exactly trying to follow that playbook. You have to have the care model change, and that means a comprehensive set of services with the integrated team that works together, that has accountability for the outcomes. They're proactive in nature, they deal with chronic conditions, and they also steer, guide, and navigate you to the rest of the healthcare system. That team needs to be diverse, that team needs to be in person, it needs to be online, you need to use technology, and as you start to combine all these things, one of the biggest blockers in this whole thing is payment. And so now you need to start paying differently for primary care, realize you're going to spend a little bit more for this broader set of services, but you're going to fully expect and hold that team accountable to drive down costs. So marrying the care delivery with a payment model. And then we also think tying it to the benefit design really breaks this through. So our partnership with Aetna is really intended to do exactly that. We create a benefit design, people opt into it, it naturally creates accountability. They get better copays, better premiums, and then now we're accountable to really hold their hands and to make sure that they get the care they need for the quality that they deserve at a price that they can afford. And so now you start to combine these things and that synergy is actually what we are most excited about. People are finally seeing that it's not primary care in isolation, it's not payment in isolation, it's not benefits, it's not that, it's putting it all together, and that takes patience, persistence, and just like fearlessness to make it happen.
Saul Marquez:
I love it, Scott. And look, I mean, I give you and the team kudos for seeing it and for doing it, and here for sharing it, because half the battle is getting the word out. And for everybody listening to this episode, I want to make sure that you guys, gosh, I mean, you've got to just take action because it's not about just listening, it's about taking action to make a difference, whether it's for you. If you're a sponsor of a plan like this and something that Scott said resonated with you, click on that link below, Crossover Health, and take action on it, don't just listen.
Scott Shreeve:
Yeah, there's one thing you know, we just love talking to benefits leaders and plan design and sponsors. We want to hear what people are thinking, we want to design solutions for them. And I think that we hope it's a conversation, it's not just us pitching what we think is right. We actually really like to do that. And so my other co-founder, Nate Murray, we love, you know, whiteboard sessions with people, thought leaders, you know, plan sponsors, benefit design to just sit down and start talking about these issues. What I will tell you is there's no magic, there's no AI unicorn chatbot that's going to solve this thing. It turns out to be one-on-one, individual relationships, good blocking, tackling, core things that everyone knows. But that's why we like to say we're bringing sexy back because, you know, this is not, this is a simple, basic stuff, but it's the combination of the things together in a single kind of solution that makes it happen, and that's where the region by region, state by state, and all across the country, we're going to get this thing done.
Saul Marquez:
That's awesome. Hey, so like, I just kept thinking about this, quote, measure twice, cut once. And this whole idea of investing more in primary care, I think it'll get us there, Scott, and so I'm really encouraged by the work that you and the team are doing there. I could have a part two with you on this and actually, let's do that. You up for that?
Scott Shreeve:
Absolutely.
Saul Marquez:
Okay, we're going to do a part two with you. And so on this session, folks, truly value-packed, but before we close with Scott, share a closing thought with us and the best place the listeners could get in touch with you and learn more about what you're doing.
Scott Shreeve:
I've got lots of thoughts. I'll just share one to pick up what you just said. So it's not only, measure twice, cut once, but we also think, you know, what you measure improves, but what you measure and report improves faster. And so we really believe in this concept of measurement-based care, the accountability payment, you know, tying it together with the care model. And I think when you align those incentives, when you align the payment, when you measure these things and objectively share them, we're all going to get better. And our hope is actually not to beat and dominate everyone, our hope is to be a catalyst for change, to show people what's possible, to do it at a big enough scale that people can see it for themselves. And our hope is that we can be bringing a tidal wave of primary care innovation, and we would love to surf that wave all the way in.
Saul Marquez:
Love that. Well, usually, I'll tell people to drop the mic. You keep the mic in your hand, Scott, because you got to keep sharing this. And folks, by all means, make sure you check out the website. Well, what's your website, Scott?
Scott Shreeve:
It's just CrossoverHealth.com, and love to see you guys there.
Saul Marquez:
So make sure you check that out, folks, and subscribe to the podcast, because that's the only way you're going to keep getting these interviews as they come into your podcast feed. Thank you all so much, Scott, really appreciate you.
Scott Shreeve:
Thank you. Will see you guys soon.
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