04 Jan Passion and the Courage to Commit
I had the chance to be interviewed by Mark Tager, MD who recently published his book called Total Engagement. It details how physicians are leveraging their unique education, experience, and skill set to have impact beyond their clinical training. I was introduced to Mark by our Chairman Brett Jorgensen and we later had an extensive interview while I was driving to Sonoma County for an interview. What follows was published as part of that book and provides an interesting view of some of my experiences along the journey.
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By natural ability, I mean those qualities of intellect and disposition, which urge and qualify a man to perform acts that lead to reputation. I do not mean capacity without zeal, nor zeal without capacity, nor even a combination of both of them, without an adequate power of doing a great deal of very laborious work. If a man is gifted with vast intellectual ability, eagerness to work, and power of working, I cannot comprehend how such a man should be repressed. – Francis Galton
In our interviews with dozens of accomplished healthcare practitioners, many shared a trait we call “transferable mastery.” Prior to, during, or after medical training, they embarked on a course of mastering skills in fields outside of medicine. Prior to enrolling in medical school some of our interviewees had previous careers in engineering or even art. Others were accomplished musicians, engineers, wilderness guides, or, in the case, below, successful athletes. Mastering the necessary skills for their avocation or previous vocation allowed these doctors to identify and exercise their passion, as well as to test the power of their commitment, two ingredients essential for personal accomplishment. The need for passion and commitment are directly proportional to the magnitude of the challenges we take on.
Scott Shreeve, MD, CEO of Crossover Health traces his success to a father who instilled in him a sense of creativity and imagination that ultimately created a sense of confidence and belief that he could do and be whatever he wanted, provided he worked hard enough. This viewpoint was reinforced by Shreeve’s success in organized sports, where he led his central California high school football team as a star quarterback and captain of his basketball team. He would later play as a quarterback at Brigham Young University behind Heisman winner Ty Detmer. Exposed early and often to team physicians, he naturally gravitated toward a career in medicine. What he found, however, upon entering the clinical rotations of medical school was a shock. “I was appalled at way we practiced medicine. Every morning beginning at 4:30AM was a ritualistic paper chase gathering labs, xrays, and other reports before morning rounds. Despite best efforts, the educational instructional method was a withering, daily beat down in front of overworked interns, numb residents, and unhappy attendings who took a perverse pleasure from the trembling medical students. No one seemed to be happy. From one specialty to another, it didn’t seem to get any better. The obgyns were miserable. So were the surgeons. I kept thinking there must be a medical specialty that would provide for my vision of a creative, fulfilling, and meaningful practice. While I had set on orthopedics entering medical school, I strongly considered anesthesia and ultimately settled on a residency program in emergency medicine,” he notes.
It was during his third year of residency that Shreeve got the business bug. During one of his electives, Shreeve determined to do something different and talked his way into spending his only six-week elective as a research analyst with Delphi Ventures. The idea was to see medical innovation at its inception, the tools and technology that would eventually work its way into day-to-day clinical practice. “My first day I showed up in some guy’s garage where he was pipetted DNA fragments using Xerox print technology. At the end of a month, I got to see the entire lifecycle of the deal, and he received a $7.5 million investment to start his company. My mind was on fire. For the first time, I saw a glimpse of how my medical training and background could serve as a platform to engage in the creative freedom and innovation I personally found missing from clinical practice. I though if I could get some experience running a company, maybe I’d be able to do the same.
In 2002, Shreeve and his medical student brother co-founded a company called Medsphere Systems. The Shreeve brothers’ vision was to create an open source electronic health record that could be adopted by health systems that could not afford the much more expensive options from Epic, Cerner, and McKesson. Addressing his start up challenges, Shreeve notes:
“It was absolute insanity. We were just two kids, a couple of laptops, no money, and no investors but one really powerful idea that we were absolutely passionate about. But we knew we were smart enough and willing to work hard enough to figure it out. We learned quickly, literally having hundreds of meetings with family, friends, investors, partners, hospital CEOs, and others. We got a lot of good feedback, including that many of the people we really respected thought we were onto something. We ultimately raised $500,000 from friends and family. We spent this money as carefully as we could. It was a really lean time when we had to stare into the void and keep walking. I distinctly remember being down to our last $19 before an investor came in with a $100,000 check. Little entrepreneurial miracles like that fed and watered our dream. We ultimately closed our first contracts, implemented our first systems, and enjoyed several years of unabated growth and opportunity.”
Later, the Shreeve brothers would close in on almost $15M through a couple different rounds of venture funding.
In mid-2006, Scott and his brother were unceremoniously escorted out of the company they had built in a painful separation that included them being served with an eight figure lawsuit. While the lawsuit was eventually dropped, Shreeve had already moved beyond the vision of changing medicine with technology and began to examine fundamental reformation of the entire system. Retreating to figure his next step, Shreeve was enthralled by Michael Porter and Elizabeth Teisberg’s book Redefining Health Care. He notes, “It was like a light shining on the crisis in the U.S. healthcare system, a totally new way to redefine the competitive landscape From that moment, I knew I wanted to be on the forefront of the movement to transform healthcare and take it to the next generation of care.
It was at this point that Shreeve realized if he wanted to change healthcare, he would need to get firsthand experience in new healthcare delivery models. A 6-month stint as an entrepreneur in residence with Lemhi Ventures provided the accelerated crash course in health care finance, care delivery, incentive management, and the emerging field of advisory services. Later, he worked with the X Prize to create a nationwide competition where cities would compete to raise the health, wellness, and vitality of their defined populations. His final preparatory consulting opportunity was working with a large San Francisco based practice to convert to a membership concept. With these combined experiences, Shreeve was ready to jump back into business.
In 2010 he took the plunge. He signed a $1M lease and obtained enough tenant improvement funds from the building owner to open a clinic in some prime retail space in Aliso Viejo, CA.
“We hung out our shingle as the first membership based primary care practice in Southern California. While there were plenty of high dollar concierge practices in our area, it was our intent to democratize the experience and service level with our $75 per month membership fee. In addition to care, we provided a health advisory service to guide people through the maze of insurance, billing, specialist network, and the other challenging aspects of navigating a totally disorganized health care system,” he notes. Nearly one hundred patients signed up at the grand opening. The patients absolutely “loved the service,” but it soon became apparent to Shreeve that for the economics to work, the population base needed to scale. “While we were thrilled with our membership growth, I could see that it was going to take years to sell our service one by one to people who were having a hard time understanding our value proposition particularly when there were no insurance products that would complimentarily wrap around our primary care service. We realized we would have to find large populations that have already been organized by some aggregator.”
Shreeve identified that large, self-insured companies were the best aggregators. Because they pay directly for their own healthcare, these self-insured companies immediately and directly benefit from any health care cost and quality improvements.
Given the increasing prevalence of chronic diseases in the working-age population, employers are concerned about the toll that these conditions take both on the cost of employer-sponsored health coverage and productivity. A recent survey by benefits consultant Towers Watson and the National Business Group on Health reported that 67 percent of employers identified “employees’ poor health habits” as one of their top three challenges to maintaining affordable health coverage . Corporate wellness programs are on the rise. A 2010 Kaiser/HRET survey indicated that 74 percent of all employers who offered health benefits also offered at least one wellness program. This percentage jumped to 92 percent among larger employers defined as those with 200 or more employees . These employers commonly offer both health screenings and interventions. The Affordable Care Act has included incentives for worksite screenings and health promotion incentives.
Taking the wellness program concept a step further, several years ago Shreeve started Crossover Health, a company built upon a next-generation health management model. He believed that by combining onsite clinics with screening, health promotion and proprietary patient management technology, Crossover Health could change the cost, quality and experience of care.
Crossover Health’s first pitch to one of the largest, most valuable self-insured companies in the United States was “surreal.” Going up against larger and more established competitors, the Crossover Health team challenged the employer to think different and select them. Shreeve vividly recalls taking the phone call notifying him that they were selected.
“It was an incredible rush, several years in the making, when all the blood, sweat, and tears of birthing your vision become tangible. Only mothers and entrepreneurs truly understand the feeling.”
This first meaningful corporate success helped Crossover Health obtain other large clients including Facebook, Applied Material and Cummins. Today, Crossover has over 100 employees, services nearly 75,000 employees, and is looking forward to extending their model to even more companies with nearsite, retail, and virtual health services under development.
Through all the ups and downs of healthcare entrepreneurship, Shreeve is clear on one thing.
“You have got to find your passion. You will never have the courage that you need unless you are passionate enough and believe enough to literally will your dream into reality. The bigger your vision, the deeper you will have to go inside yourself. It is hard to overcome the natural inertia that we all have. Don’t keep your head down and settle, fight for what you believe in,” says Shreeve. Finally, he notes that, “Crossover Health has become a magnet for awesome physicians who share this same passion, who want to spend their time, energy, and creative best selves building the future of health.”
Reprinted with Permission from Total Engagement: The Healthcare Practitioner’s Guide to Heal Yourself, Your Patients and Your Practice © 2014 Mimi Guarneri, MD and Mark Tager, MD available from www.changewell.com.