By Joel Haugen
The U.S. spends dramatically more per person on healthcare than any other country in the world, but has lowest life expectancy and some of the worst health outcomes among other high-income countries, according to recent findings. In other words, our healthcare system is failing.
From failure has emerged an era of “hyper-innovation.” New solutions promise to change the way healthcare is delivered and experienced. As someone who’s been in the industry for 20 plus years, I’ve had the opportunity to witness how different organizations approach the healthcare conundrum and the solutions they’ve bet on (i.e. automated care, chronic disease management with wearables, etc.).
I come with the perspective that fixing our broken healthcare system and achieving optimal outcomes must start with primary care. After all, primary care is the single medical specialty with the greatest opportunity to drive health outcomes and the only healthcare component where an increased supply is directly associated with better health outcomes.
The Constellation of Health Outcomes
Given the unaffordability of healthcare in the U.S, a reduction in the total cost of care has become a North Star for healthcare entrants and remains a key focus for employers and health plans. However, I’d argue that change is not going to happen unless we look beyond cost reduction, as there are many other crucial stars in the constellation that need to be tended to; real changemakers are factoring in access, patient experience, employee productivity and retention and employer satisfaction to their notions of success.
An advanced Primary Health Model that seeks to address the entire constellation of healthcare outcomes, through comprehensive, coordinated and accountable care delivery, is the best path forward toward fixing our broken system.
Driving Change with Comprehensive, Coordinated & Accountable Care
Comprehensive Hybrid Care
Firstly, the fragmentation that exists in the current healthcare experience is inefficient, costly and unpleasant for all parties, including payers, providers and most importantly, patients. At Crossover Health, we offer our members a comprehensive suite of services inclusive of primary care, physical medicine, mental health, health coaching and care navigation. We handpicked these services to ensure the most comprehensive member experience possible, so members can access foundational services to achieve better health outcomes while minimizing the need for outside referrals. This also means having this suite of services available in-person, as well as virtually, enabling a choice-first approach for care seekers.
Coordinated Care with a Proactive, Tech-Enabled Approach
Second is the importance of a highly coordinated team-based approach to care delivery. The burden of communication and data sharing should never be placed on the patient. At Crossover, our team based approach to care management ensures our providers can easily collaborate across disciplines to proactively achieve the best health outcomes for our members. Our in-house technology promotes both provider-to-provider and provider-to-member connectivity – the ability for members and care teams to communicate with each other via messaging, alerts, reminders, scheduling and referrals in real time and asynchronously. Capturing as much health data as possible enables us to identify at-risk members within the population and predict health risks before they develop into illness. It also lets us seamlessly manage a closed loop care navigation process. Coordinated care ensures the member is never alone even when they go beyond Crossover to receive care.
Accountable Care with Outcomes and Value Based Focus
The topic of accountability is a key component to any health outcomes conversation. For so long, there has been so little accountability in healthcare, especially when it comes to driving meaningful outcomes. An ironic and unfortunate reality. The fee-for-service payment structure has made sure of this, as providers and health systems have always been rewarded on the basis of visit volume versus health outcomes. Therefore, it is not surprising that these mega players have continued to invest in the infrastructure to support this dated payment model. At Crossover, we’re accountable first to our members–and so we do not measure our success on visit volume but on our ability to make our members healthy and keep them that way. And, all of our employer contracts have performance incentives that are aligned to the various aforementioned outcomes (i.e. total cost of care, access, patient experience, employee production and retention), because we believe we should be paid based on our ability to enable our members to live their best health–this is Health As It Should Be.
The Path Forward
Driving meaningful health outcomes requires the industry to look beyond the North Star of cost. This challenge demands a comprehensive, coordinated and accountable approach to care delivery that delivers not just cost savings, but better patient satisfaction, physician retention and overall health outcomes. And the most effective way to drive health outcomes across the entire constellation is to invest in Advanced Primary Health.
But we must go a step further and hold healthcare delivery solutions accountable when it comes to outcomes reporting. While every solution on the market seeks to solve healthcare’s problems, very few are transparent about whether they are successful in doing so. Complete outcomes transparency is a key element of repairing our system and establishing trust once again.
About the Author
As Chief Product at Crossover Health, Joel Haugen is responsible for developing and executing the strategic product roadmap, including scaling the solutions portfolio from design and tech enablement to delivery and optimization. Joel’s expertise in product strategy is seen in his long history of successful large scale system implementations during his 15-year tenure at Optum, with significant experience in aligning client needs with the right solutions across the provider and payer markets.