How Crossover Health delivers high-quality care by using the CareOps principles

For this article, we interviewed Joel Haugen, Chief Product Officer at Crossover Health, a leader in delivering value-based, hybrid care. Prior to Crossover, Joel worked for 15 years at Optum where he led product strategy for the provider market, inclusive of health systems, laboratories, medical groups and ancillary providers.

Thomas Vande Casteele (TV): Tell us about Crossover Health and the foundation of your care delivery model - your integrated medical team. How do you balance their time with other relevant activities and then with regard to burnout, for example?

Joel Haugen (JH): Our care model is definitely what sets Crossover Health apart, and the focus of our medical group on delivering health outcomes.  As such, the first important point to make is that all our providers are full-time employees. We don’t have contractors that work for other digital health companies, which helps get people aligned from day one on providing care the Crossover way. 

The second point is that our business model is not based on a transactional, visit-based model. Our clients are not paying per visit, they’re paying to manage a population and because of that our panel sizes are much smaller than others in the United States. We strive for our primary care providers to manage a panel size 1,500 or smaller, which allows them to have time to provide excellent care. 

Besides that, we highly focus on building interdisciplinary teams where everyone can work at the top of their license. This means our clinicians are not in isolation in the exam room by themselves with one nurse to support them. Our providers have a full team that they can rely on. If a patient comes in with knee pain they can just go down the hall and schedule physical therapy. Our teams are working together daily in a huddle-type model, discussing individual patients and collaboratively deciding what care plan they will set out for each and every one. 

All of these things have helped us reduce burnout and get physicians excited to work for Crossover. A friend of mine is a doctor and each night he spends hours and hours coding in Epic while he’s at home. He got a bonus last year because his panel size exceeded +3,000 patients, which is exemplary of everything that’s wrong with the US healthcare system. And that’s the difference with Crossover. Our clinicians are not billing, they don’t have to spend time at night making sure the CPT codes are right for submission to claims because our business model doesn’t require this, which is a huge benefit. 

Additionally, we also have a design team that is built around human-centered design. These are people who came from Grubhub, Uber, and Samsung - people with a lot of experience in design that have spent an extensive amount of time doing user research, shadowing the provider, and then customizing our technology around our care teams’ needs.

Rik Renard (RR): How is your tech infrastructure built to support your care team?

JH: We use Elation as our EMR, which has open APIs and is very customizable. 

If a care organization is using Epic, they can’t say “I don’t like this flow” because the vendor most likely can’t do anything about it. We also have built our own proprietary platform called XOP (Crossover Platform).  Using the combination of Elation and XOP, our doctor can say “I really wish that I was able to plug in this health screener in the middle of my conversation in the app with my member” and we can just say “Oh, that’s a great suggestion doctor. We’ll get that implemented in an agile fashion.” Because of this our care team feels like they own the end-user experience, and that’s all because of our technology stack.

TV: As a care provider, the biggest part of your cost of goods sold is your care team and your operations. How do you keep the profitability engine running with all of these things that you’re clearly doing much better than the traditional system?

JH: The book “Implementing High-Quality Primary Care” written by the National Academic of Science, Engineering and Medicine addresses this problem in such detail. 

The answer isn’t easy and the benefit for Crossover is that we work with large employers that see value beyond traditional health care. They see benefits in productivity, retention, recruitment and experience. All of that is critical for them so they are willing to invest beyond what an actuary at a health plan would be willing to pay for. 

Traditional health plans will say “I’m not going to cover your clinical costs unless you show me you reduce the total cost of care in a given plan year.” Employers, on the other hand, know that they are competing against other companies for talent. They know that having an awesome clinic experience can help them retain people, help them be more productive and allow them to live healthier. That’s one of our biggest advantages of selling directly to employers that other companies that work through insurance companies don’t have. We will continue to benefit from that and I’m sure large employers will partner with  Crossover for the long haul because we provide an amazing experience, with proven outcomes, even if it doesn’t always reduce total cost of care in the first year. 

Another advantage is the fact that we offer asynchronous and virtual care, which can have a significant impact on your total cost of care. And while I strongly believe in text-based care, I want to emphasize the importance of a true hybrid care model wherever possible. You first need to build a relationship between the care team and the patient before they are going to rely on you as their trusted source of clinical information. Without this relationship, they might text you with small issues like rash or acid reflux, but once it becomes more serious they are just as likely to go to the ER which will drastically impact your costs. And then ultimately, the member gets the choice in care seeking. What meets their needs? 

RR To what extent are those customers happy using the standard workflows that you bring to them versus needing customization?

JH: By leveraging Elation’s APIs and XOP’s front end, we have a configurable, yet largely standard experience.  And we have high most members satisfaction, including an NPS of 89. We don’t have to customize it all for them because the application is focused on building the relationship between the care team and the member. 

While we don’t have a custom app or many custom workflows for each customer, we do have a lot of other custom services, outreach and engagement for clients.  This includes not only custom on-site events or custom email blasts but also unique services for our on-site clients.  For example, one of our clients has six acupuncture beds in their on-site clinic. While that’s not part of our standard services, we’ll tailor the services to meet our client’s needs for the care of their population. Most of our customizations are in terms of the services provided, not from a technology workflow point of view. 

TV: How do you balance standardizing the clinical workflow because it needs to be evidence-based versus enabling the right amount of freedom for the clinicians to make decisions when they should have some freedom? 

JH: We use the term measurement-based care instead of evidence-based medicine here for that exact purpose. It's kind of the next evolution of evidence-based medicine, in which we don't usually dictate a specific clinical pathway, but we do measure our care team’s success in moving from point A to B. 

For mental health, we use GAD-7 and PHQ-9 standard measurements that will tell if the person’s depression or anxiety increased over time. We will suggest a workflow to the provider to improve the score, we also give them the freedom to choose the path to get to this point, but we are going to measure and hold our provider accountable from getting to point A to point B. 

When it comes to primary care, we have a whole dashboard of screeners, social determinants of health measures and typical health outcomes like hypertension and obesity, all of these are the measurements that we hold our physicians accountable to and give them the tools to improve these. Only with the use of data can we truly improve the health of populations.

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Quick intro: we’re Thomas and Rik, building Awell - a low-code platform allowing care teams to design, implement and optimize care flows in days, not months. CareOps grew out of our years spent improving CareOps at innovative providers.