2 vs. 4 – The Patient as an ATM

17 Jan 2 vs. 4 – The Patient as an ATM

The attached script was developed in preparation for a recent talk I gave at the 12th Annual Onsite Health Conference to be held in Las Vegas on January 22-23. We develop these scripts prior to actually developing the presentations in order to flesh out the story and highlight the key messages. Its a helpful mental pre-flight to establish the meme I always hope to leave people with. I kind of like this TO vs. FOR concept which I add a little numerical and financial word play with the ATM analogy.

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Good morning. I’m Dr Scott Shreeve, CEO of Crossover Health. Crossover Health is a provider of next-generation primary care service offered on the campuses of self insured employers and their employees. We’re seeing great success with some of the most innovative companies in the world. And as we like to say, what we do is definitely bringing some sexy back to primary care.

But let me start with a personal story. I went to my own doctor a couple of weeks ago, for an annual checkup I’d put off for far too long. My doctor did all the standard stuff, saw that I had no major issues, and…well, that was it. There was nothing to do “TO me” and therefore there was nothing to do “FOR me.”

The Patient as an ATM

Think about that for a minute.

Every visit with the patient is an incredible opportunity to review the overall health status of the patient (what we call their “Health Portfolio”). Based on their gender, age, and health status there may be a variety of things that can be recommended to enhance, improve, and increase the “portfolio”. For individuals with chronic disease those things are typically spelled out in a variety of practice guidelines. For those needing preventive measures the US Preventive Services Task Force has their published recommendations.

But what about people like me?

I want to get better at all aspects of my health – fitness, nutrition, sleep, stress, and mental / emotional well being (the entrepreneurial life puts all the previous in jeopardy). What is available from traditional health care or medicine for these types of services that I would argue can be meaningful and impactful for the “corporate athlete” just as much as it is for the average Joe and Jane

The more I think about it the more ironic I find that traditional medicine does not pay to keep people healthy. Apparently, if you can’t help feed the CPT Machine you are shuttled out of the office in 7-10 minute increments.

There’s plenty to do for a patient like me. How can I get healthier? How can I sustain my wellness? What’s a great nutrition or exercise plan? What about using monitors and tracking my progress? Yet, after all the talk of wellness and prevention as the keys to transforming out of control spending, what I still see in the community is a transactional system based on doing things and patients seen as inputs, not people.

We have to change that.

We’re all here because we have some stake in the employee health market. And we are playing our part by optimizing the supply chain and reducing costs. But we actually all have a greater responsibility. We have to change people’s relationship to their provider, and to their health.

I presented last year, and the buzz was all about the blockbuster drug called “patient engagement.” I say, enough of all this talk of engagement! We need to talk about ownership. Enabling and motivating people (formerly known as patients) to take ownership and accountability for their health. To change behaviors.

That’s been the guiding principle of Crossover Health. We’re an onsite employee health care company, but really, we’re a behavior change company. And when you start approaching your business this way, it influences how you staff, how you deliver care, what you report, what technologies you embrace and, most important, how you act.

None of us at Crossover do things TO people. We do things FOR people.

Like what? Well, for starters we have a set of beliefs about the type of care that we would wants as patients ourselves and the kind of care that we will hold ourselves to deliver as practitioners. Our point of view includes the following:

Start with an awesome experience of care.
It leads to greater engagement.
This leads to a sense of accountability and ownership, which in turn leads to healthier behaviors.
Then you’ll see the costs transformed.
Easy to describe. Hard to do.

We look at every pillar that supports our intense focus on experience. In fact we have five of them that guide our care delivery model:

We create brand strategies and inspiring communication with our in-house team to integrate our centers into the culture of the employees we serve.

We’ve become facility designers, working with architects to create a new model of clinic that both enables team collaboration and also communicate to our members (yes, members) that this is their place.

Our Care Model calls for physician leaders, of but also with RNs, dietitians, physical medicine teams and even behavioral health therapists because a member doesn’t draw the same borders around types of care that healthcare has always done. She just wants to see whoever it takes to get better and be well, and having it all in one place, available right now, encourages the involvement and ownership we want.

We also focus on the overall health management of every individual patient as well as the population as a whole. We provide a wide range of personal and population data to our team members, our patients, and our clients so we can provide appropriate advise in context and in real time.

We use enabling technology building our own web-based and mobile dashboard because every record and portal we saw out there treated the patient like a guest, not the owner. We don’t have receptionists or even waiting rooms. Heck, all of that stuff is done online. Instead we have hosts, people who not only are the guides around the health center, but the expert guides as our members navigate the system outside.

Everything leads to a truly patient-centered experience.

The outcomes have been impressive. Our services have been highly adopted at all of our locations, and when there has been enough space, we have doubled and tripled the size of our teams. We’ve reduced referrals to specialists by more than half of a normal primary care practice. We are answering almost as many secure messages from patients as we are doing in person visits. We’re seeing those savings reflected directly in the cost per employee at our sites. All the while maintaining a 96% satisfaction rating, 95% of patients being room within less than 5 minutes, and 76% of patients stating that our centers are their primary location of medical care.

But what’s really important is that our members are learning that the most important driver of their health is themselves. They’re in charge, with the peace of mind that comes from a team they can access anytime that’s there FOR them, not to do things TO them.

Now, if I can just work on my own doctor* . . .

* – I have a great physician who is trapped in the Fee for Service World. Hoping to unleash him within a care delivery system like ours in the near future.

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