1. To make or shape with or as if with an ax
2. To cut down with an ax

 

“In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” – Michaelangelo

An unfinished Michealangelo sculpture.

I just re-read this quote – I think it is a powerful metaphor for any innovator that is out there trying to change the world.They are the ones that can see the fully defined, fully articulated, and fully functional end product within the building blocks that others pass off as mere landscape material. I think this gift of vision – this ability to “see” what others cannot – and the doggedness to stick to the mindless chipping away until others can see it enough to give you the tools you need to finish it off.

We are privileged to be working on a HUGE project right now with a highly innovative company that sees the value of what we are doing and wants to be a part of changing health care. It has been fun to work with them to begin the process of “hewing” away and to literally see the game changing product we have always seen begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding fingers. The process of discovery and refinement is almost as fun as seeing how the end product will move people.

For some reason it struck a nerve with me . . . which led me to fire off the response below:

Bill,

I thought we already saw this movie?

My question for you . . . besides banding together in some megagroup – what are these physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword excuse to aggregate physicians under a new moniker and a supposed new model.

I am highly suspect that these physicians are doing anything to change the relationship with their patients, to use enabling technology to create team based care, or actually be accountable for the outcomes they produce. What systems are they using to tie themselves together? What financial alignment do they have? What measures are they using to demonstrate superior outcomes? What about the patient experience – 7 minute visits that push pills as the “treatment” won’t get it done in the future.

I think your closing statement, “Representatives from Summit and Optimus were unavailable for comment” says it all.

Am I seeing this the wrong way? Is there anything new about this model this time around? Am I getting old enough to see these things cycle through?

PS – and no, I don’t mean a wolf. The sheep get nervous and band together waiting to get pounced on by wolves.

1. Having to do with the matter at hand; to the point

I read with amusement Susanna Fox’s redux review about the relevance of Health 2.0 in general and in changing patient’s behavior specifically.  Here questions reveals her bias in a very limited definition of Health 2.0 that I attempted to abolish originally in some of my bantering with Matthew Holt. I always saw Health 2.0 as a “movement” that would not be defined so much by its technology but rather enabled by it. As an “enabler”, the technology can help people do new things in new ways but I never believed technology in and of itself  had the power to truly change health, health behaviors, or health care delivery in and of itself.

That is why my definition of health 2.0 was always more expansive and contemplated an entire “movement” to the next generation health care “system”. This new system must include new delivery models, new financing mechanism, and the new tools and technology that bring all of this together in a simple, efficient, and affordable way.  Clearly this next generation of care would include technology, the new tools, but until we had a new delivery system that is financed in a new way we are going to continue to have the same behaviors across the patient, physician, provider, and payor continuum.

So Susanna, I don’t think your version of Health 2.0 (Tools and Technology) do much to get us to the behavior change you seek. In fact, getting to the root of behavior change requires almost a religious experience. Interestingly enough, the health care industry provides plenty of “religious” experiences including passing close to death, unbelievably poor customer experiences that invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we currently enjoy. So while the tools and technology show us what is possible, health care delivery and health finance are the catechismal doctrines we must reform first that actually incent the behavioral change we all seek.

So is Health 2.0 Relevant?  I think it depends on your definition!

1. To pull up by the roots.
2. To destroy totally; exterminate.
3. To remove by surgery.

I recently took a great road trip with my two boys. We rented one of the new Kia Soul’s which my boys recognized from a very funny commercial developed to highlight its hipster (hamster?) vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy between two distinct choices.

This modern reinvention of that age old contrast struck me because it is something that I deal with everyday in explaining Crossover Health to people. It all stems from a pervasive misconception about the term “Health Insurance”

The challenge is that “Health Insurance” is a confused term which most people equate with both Health Care (care delivery) and Health Finance (how you pay for it). Our current employer based system (wherein your employer provides and in most cases pays for your insurance) as well as a third party insurance payment system (we have the insurance pay for us) creates all kinds of weird incentives but also results in no accountability in terms of cost, quality, or outcome. It is currently imploding before our eyes.

Our reaction, both opportunistic as well as obligatory, is to do something totally different by blowing up the current Health Insurance model and separating out Health Care from how you pay for it (Health Financing). We say that there is a better way to do BOTH – pay your physician directly for the care you need and then get smart about how you pay for it with the right insurance product. In fact, you should “self insure” with the highest deductible plan you can find and then take responsibility for your health for all the small stuff or hire someone to do that for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate with a parasitic organizations that are taking your premium dollars and wasting it on overhead, fancy offices, mindless phone trees, and my all time favorite “this is not a bill” disinformation pamphlets.

As people begin to take this in (they always get how the practice model is a radically improvement), they immediately revert back to the combined “Health Insurance” concept.  Does Crossover Health want to replace my current “Health Insurance”? The answer is slightly nuanced, but a resounding YES!  I want to replace what you call “Health Insurance” with a direct “Health Care” product (Crossover Health) and a smarter Health Finance product (highest deductible you can get).

We believe there are large and significant opportunities to roll this into a single product that can be purchased by employers, families, and other organizations seeking fresh alternatives that can demonstrate not only trend bending improvements but trend busting outcomes.

1. Appealingly provocative
2. Charming, interesting, or attractive

One of the great promises of technology is to make things simpler, easier, and more affordable for end users. In the medical practice, we have so much complexity, difficulty, and cost in most of our processes that when we find something that actually works as advertised we fall in love.

I had one such “appealingly provocative” experience this weekend. While attending a high school football game in support of one of my member patients (leading passer in Orange County by the way!), the player was injured. I initially thought it was a concussive injury but the reason he remained down was the he knew he had severely rolled his ankle. His father called me from the field (I was in the stands) and I followed along by text messaging as he was treated initially by the trainer and later by the team orthopedic surgeon. He was unable to continue playing due to the injury and it was iced and wrapped overnight.

The next morning I met him at our clinic, fired up our new TRX GP-5 machine (all digital x-ray machine), and took some beautiful images. These were captured on our PC based OmniView rendering software (proprietary and expensive) and fed to our OsiriX viewing software (open source and free!). I was able to manipulate the image at will, contrast and enlarge as needed to highlight all the structures, and automatically send the image to a remote radiologist for reading. No films to carry, no chemicals to purchase, and no storage required – ever. Simple, Efficient, and Affordable.

But I was just warming up.

The process we are using at Crossover Health to acquire an x-ray image to the iPad

The piquant was my ability to wirelessly transmit the image from my MacBook (serving as a server) to the iPad. This process is made possible by the fact that I have can move the standards based DICOM image from a PC to a MAC (using OsiriX), and then push it out to my iPad. While I thoroughly enjoy technology, I often get frustrated because I lack the technical expertise and patients to work out all the kinks. I was pleased to see that I was able to point and direct all the connections where they needed to go and the images appeared neatly onto my iPad without any problems.

From the patient experience, all they knew was that the image was shot, its being read by a board certified radiologist, and they are seeing, touching, and experience the iPad as a new device in our patient-physician relationship.  The patient was intrigued, impressed, and engaged (entertained?) by the whole process. I dare say it was a “fun” visit (why does the typical health care experience have to be so lame anyway?) for them to participate in this process, see their physician pushing the technology barriers, and engaging in the diagnostic process in a way they never have before.

The piquant experience certainly piqued the interest of their family who had the family.

1. Marked by blithe unconcern; nonchalant
2. Happily unconcerned; carefree.
   

Its a funny thing to start a brand new medical practice completely from scratch. To be completely unfettered, unbound, and perhaps a little unhinged to do things every way that you thought they can be done. It is actually quite a rare opportunity at Crossover Health for us to completely reinvent, redefine, and reimagine health care delivery, finance, and experience. Its an awesome endeavor – one that we enter into with humility realizing the challenges ahead, some confidence given our unique approach, and some swagger because what we are doing has very little precedent.

It reminds me of these guys:

Going down the rapids raw – despite the years of preparation, the preliminary surveying, and all the other typical preparations for any great adventure, at some point you just have to push off into the unknown and figure it out on the way down. Crossover Health has been in the works ever since I got my medical degree and finally having the opportunity to fully control the delivery system and to have free reign, nay, a mandate to innovate as much as possible, I look forward to the unknown possibilities with great anticipation.

As part of that discovery process, I always wondered who would be the very first patient at Crossover Health. I wondered who would be the person, what would be setting, the diagnosis, and how would this great journey begin. Well, I am pleased to report that we had two back to back visits by young patients who wanted to get their picture taken, sign our new patient poster, and show off their “sit-chi-ations”:

Some of our first few patients. All photographs used with permission by parents.

Two down, two decades to go!

Aliso Viejo, CA (PRWEB) October 1, 2010

Crossover Health Medical Group announced today the launch of their flagship membership-based, primary care practice in Aliso Viejo, California. The new clinic will offer urgent, primary, and online care services directly to individual members, families, and employer groups. Membership based health care is a new health care finance and delivery innovation that has gained widespread popularity as the cost of health insurance and ongoing service deficiencies have plagued the current health care delivery system. The Crossover membership model decouples health care from health insurance, and allows individuals and organizations to purchase primary care directly from health care providers who offer increased access, enhanced services, and an exceptional service experience.

“The membership-based practice model allows Crossover Health to fundamentally change the way health care is practiced, delivered, and experienced,” according to Chief Executive Officer Scott Shreeve, MD. “Crossover has been specifically designed to restore and enhance the patient-physician relationship, increase access and convenience, reduce the cost of health care, and deliver an unprecedented patient experience.” The membership fee pays for access to the technology enabled practice and wellness services, as well as affordable prices for office visits, specialty consultations, and ongoing health management followups. A health concierge is assigned to each member to assist in overseeing follow-ups, proactive health maintenance, and care coordination. Crossover also provides health advisory services to guide patients in financial decisions related to the management of their health.

Crossover Health introduces two key innovations to the membership model. First, Crossover members have direct access to their physician via Crossover’s unique online, anytime, from anywhere technology platform that includes options for email, text, and video chat consultations. Second, the technology also enables a direct financial, administrative, and clinical relationship between the patient and their personal physician and the extended Crossover care team of medical specialists, diagnostic testing centers, and other licensed professionals. This inherent connectivity enables the creation of the Crossover Health Network™, a network of specialist providers who commit to deliver to a specific service level, make their prices transparent to members, and communicate on a common platform. The result is a simple, efficient, and affordable care experience.

“Many people, including employers, are surprised to find out how affordable exceptional health care can be when purchased directly from the physician,” said Chief Medical Officer Richard Patragnoni, MD. “Members can typically save a significant amount of money while enjoying a broader range and higher quality of personalized service to meet individual, family, or corporate health needs.” Crossover offers a variety of individual and corporate memberships that provide essential primary and preventive care services as well as targeted wellness programs like medical weight loss, executive health programs, health portfolio management, and virtual clinics.

Crossover Health memberships appeal to individuals looking to establish a personal relationship with a physician, families whose care requires a higher service level, and busy professionals who need flexible access to their physician. Membership care is particularly attractive to employers facing annual double digit health care cost increases. Employers using this model have consistently shown significant reduction in inappropriate utilization, dramatic improvements in satisfaction, and cost savings of up to 50% when bundled with lower premium insurance plans. Crossover Health is currently accepting new members throughout the Orange County area.

1. To make indistinct and hazy in outline or appearance; obscure.
2. To smear or stain; smudge.
3. To lessen the perception of

As those who follow this blog know, we have been counting down from the 90 day mark toward our grand opening. The actual countdown has been expanded by the time-space continuum in that as you approach the speed of light time actually slows down.

Crossover Health Showroom feature wall and self check in area.
Crossover is all about a simple, affordable, and efficient health care experience.

However, the last 35 days have zoomed by without me providing the regular updates so here you go:

• Finished buildout
• Finished finish work
• Completed cement work in Showroom
• Build out of furniture (we did it all at Ikea!)
• Worked out workflow issues with new software, new site, and new team
• Build out XR room
• Completed marketing campaign
• Finished new website
• Repainted extra space
• Cleaned up, hauled out, polished up, rubbed off, and general spitshine
• Invited friends and family to join us in Opening!

The good news is alot of it was captured on video or time lapse and I will be making some pointed comments in future posts regarding several aspects of our buildout and preparations for launch. Needless to say, it was a fabulous experience and we worked with an amazing high end retail builder – Display It – to create a space that is equal to the opportunity that we are pursuing. So take a long look . . . its all a blur to me.