We have all see the Olympic Torch lighting ceremony and the power of that particular symbolism. We are also familiar with many of the references of a “candle on a hill”, the faithful lighthouse, and the touching off of the Christmas season by lighting the tree.

Well, we were fortunate to have our own lighting ceremony today when we officially connected the lights to our new signs that were put up recently. It is a pretty cool contrast to see how it looks in the day versus  how it look at night:

Sign as seen during the day

As seen at night - crisp, clean, and beautiful. In fact, this turned out much better than we expected with much more visibility.

We were thrilled with how this turned out and very impressed with the quality of work of the entire Yesco Sign team. They were fast, efficient, on time, and on budget. We thoroughly enjoyed our association with them and would highly recommend them to others.

Now that the sign is up we can begin our advanced marketing efforts to our community as a beacon or symbol of the hope that next generation health care services can bring.

1. To hit, especially repeatedly, with or as if with a hammer; pound.
2. To force upon by constant repetition
3. To defeat soundly, to inflict a heavy loss or damage on.

It has been months in the making, years in the formation, and what seems like an eternity to finally arrive but it was finally Hammertime today! The Crossover Health vision finally bounced off the drawing board and the architectural plans into the sweet sound of concrete screws sinking deeply through metal studs into hungry cement (been reading too much Hemingway lately):

Before the studs went up . . .

. . . and with initial studs up. Unfortunately, we missed alot of this because our electrician's unwittingly cut the power without understanding what the "funky camera's" were for.

As many of you know who have been following out story, we are using some cool technology to help keep our fans appraised of what we are doing. With the help of Ek Media, we have installed two cameras that are capturing the action as it occurs and streaming it through Flickr. The Flickr stream is accomplished through out WiFi enable cameras which snap a picture at intervals we set. We also have an established direct link from our iPhones to enable any picture we want to be embedded in the stream. Want to review something with your contractor who is off site? Snap a photograph and send it via email with the added benefit that it gets embedded into the stream. Sharing a lighter moment with the electricians, snap away and it gets added to the stream as well.  Really cool and will be helpful in telling our story.

In a recent conversation with my boss Scott Shreeve, MD, we were discussing how we need to keep health care simple. He likes big words so he was using the term “succinct” to describe what he meant. Since I am much more a visual and hands on learner, I wanted to show him “succinctness personified by ordering a book from Amazon with my iPhone. He recently posted about this, but I thought I could build on that experience and translate it into how we can make everyone’s health care experience approximate what I had just demonstrated. I will be laying this out in several post, but I wanted to set the table with the first very practice way in which we can dramatically simplify the health care experience – just pay cash for all your basic healthcare expenses and don’t involve your insurance company or any other third party payer.   How simple is that?

Ok, now you can now pick yourself off the floor and stop laughing.  I realize at first pass this sounds pretty insane, right? After all, doesn’t insurance save you a lot of money when it comes to day to day healthcare?  Well maybe, or maybe not.  What a lot of people are discovering is that after paying their monthly premiums and co-pays, that they’re paying a lot more than they realize.  In addition, people are also discovering that most healthcare is dictated by what  the insurance will or won’t pay.  And then, there are the unbelievably inflated cost of drugs, laboratory tests, imaging . . . ok, ok, i’m getting way ahead of myself.

Before going any further, I need to set the record straight. I’m not advocating abandoning your insurance company.  You still need health Insurance. If you or a family member faced a catastrophic healthcare need, you will need your health insurance.  Fees for specialists and hospital stays can bankrupt you if you fail to have insurance.  Enough said.

What I am advocating, however, is to evaluate alternatives to your current health plan (typically a PPO or HMO) and look into moving toward a high deductible and more “cash for care” options.  What people don’t always realize is they could be over-spending when it comes to health care.  Let me give you a case in point:

Each of the above plans provides the same level of catastrophic (or true insurance for unknown, unpredictable, and unmanageable) protection against major health care expenses

The above example is real example from one of our employees who has a family of 6 (2 adults and 4 children all healthy) people. Remember, the above figures represent just premiums alone – they don’t account for any deductible, co-pays, or co-insurance which are additive to each one of the above plans. The point of the matter is that most people will unwittingly pay literally THOUSANDS of dollars difference to have a lower transaction cost at the doctors office. However, they don’t realize they (or their employer – subject of another post) are paying THOUSANDS of dollars for this privilege. A far better financial decision would be to take on some of the heath risk associated with paying for your day to day health care costs yourself and pocket the money in your own bank account as opposed to your insurance carrier.

Over the next couple of blogs I’ll discuss Crossover’s Health’s “cash for care” philosophy (in the form of a membership) and how paying for day to day healthcare as part of Crossover Health’s network may be less expansive than you realize.  To help drive my point home, we’ll be discussing multiple scenarios – Family of six , newlyweds, retirees and single individuals – to highlight that you could be getting so much more for what your paying by getting more value for what you are paying.

My whole entire point is not to be your insurance broker, but rather, to highlight to you the value of a membership in a program like Crossover and then to show you how you can pay for it – most often for a large discount over what you are currently paying for premiums alone.

1. Characterized by clear, precise expression in few words; concise and terse.
2. Marked by or consisting of few words that are carefully chosen

The other day I was having a conversation with our Director of Membership Experience Stephen Gaines regarding how ineffective and inadequate the current health care experience is for patients.  As our conversation wound around we ended up discussing some principles from Stephen R. Covey’s book, “The Seven Habits of Highly Effective People“. I suggested that Stephen should purchase the book as it is a great read on alot of levels. Before I could even finish the conversation, Stephen had pulled out his iPhone, typed a few things into his Amazon app, and before I had finished my conversational paragraph he announced, “Cool, I just ordered it.”

It gave me pause.

I had thought he was just texting someone or taking notes but rather he was acting in real time on my suggestions right then. Since we were talking about the type of experience we want our members to have, I was struck by how seamless, how effortless, and how painless it was for Stephen to complete a transaction. I thought about the app itself how it had already obtained all of Stephen’s demographic information, his credit card, authentication; I thought about Amazon how they are organized to store, ship, and deliver the book; and I thought about the consumer experience being able to get what they want when they wanted it literally a touch of a button.

The next day Stephen sent a slight smug text that “the book just arrived” – less than 24 hours, to the right place, with the right merchandise, at the right agreed upon price, and all done in an effortless way.

Wow.

Contrast that with your typical health care experience – every turn, every step, every interaction another major roadblock or transactional barrier to get through. Think about how you make an appointment, how you pay for care, how you stand in line for medications, how you wait on hold for answers, how you can’t get what you need, when you need, for a price you can understand, and a manner that is satisfying.

Where is the health care App that could make my interactions with the health system this smooth? What organization or entity is removing these barriers, smoothing out the rough transactional edges, and helping people achieve a seamless, effortless, satisfying conclusion to their health care need? For a long time I have thought about how this could actually work, how you could create a “health care app” that would allow this type of experience to be possible.

Obviously health care is complex; it is confusing, it is a conundrum of the highest magnitude. While reducing this complexity to a “health care app” might not be possible, I think you can approximate this with a health care advisory service designed specifically to abstract all the complexities of health care into a single, succinct experience for individuals.

Crossover Health is attempting to replicate the transactional effortlessness of the above example through our membership programs which include a health care advisory service. Essentially, using our the HelloHealth software platform as the enabling technology, we build membership programs include member concierge services to begin to approach the smoothness and effortless of a health care app. If you want the opportunity to experience this type of care, we look forward to having you join us for impending launch of our Crossover Health flagship store in Aliso Viejo.

Simple. Succinct. Coming soon!

1. Passage from one form, state, style, or place to another.
2. A word, phrase, sentence, or series of sentences connecting one part of a discourse to another.

In the midst of running Medsphere I became aware that we were onto something very powerful. Somewhere along the line I finally “got it” that what we were actually doing was not implementing electronic health records but rather creating the data collection backbone that would enable future clinicians, researchers, and other interested parties to have access to large volumes of data that they could then turn into useful information and ultimately knowledge about health care delivery. This realization helped me move beyond the mere “features and functions” comparative sales pitch to a much more egalitarian view of how most any standardized information system could most likely serve as an effective tool to gather the data and transform it into clinical relevant and useful information. Since we could offer the tool at a fraction of the price of the other guys, it made perfect sense to me why the customer should select us!

The Veterans Health Administration clearly has led the way in this regard with their implementation (begun in 1996!) and utilization of an enterprise wide electronic health record to radically alter their outcomes. I was fortunate to help  transition this technology to the private sector with OpenVista implementation at Midland Memorial Hospital (and have followed with interest their successes with interest).  Kaiser Permanente also endeavored to initiate one of the largest ever civilian deployments of an EHR to the tune of ~$5Billion dollars across their 35  hospitals. This massive investment has paid off in spades, and we are now just far enough along that we are going to start seeing some of the incredible results enabled by a system wide electronic health record (regardless of variety).

Case in point: An embargoed article was just sent to me by my friends at Kaiser who are just publishing a new article in the Clinical Orthopedics and Related Research journal of the Association of Bone and Joint Surgeons. The paper demonstrates how an EHR-enabled, large-scale total joint replacement registry has enhanced patient safety, quality of care, cost-effectiveness and research, and how a national registry could improve clinical practice and reduce revision rates in the U.S.

Key points from the article include:

• More than 600,000 total joint replacement procedures are performed each year in the U.S., and the volume and costs associated with these procedures are projected to increase dramatically over the next 20 years
• Kaiser Permanente’s Total Joint Replacement Registry– the nation’s largest such registry with 100,000+ hip and knee replacement cases – allows caregivers to analyze specific data from standardized forms and Kaiser Permanente HealthConnect (Epic software), the world’s largest private sector electronic health record, to help identify best practices, evaluate risk factors for revision surgeries, assess the clinical effectiveness of implants, and study patient demographics, implant characteristics and surgical techniques related to post-operative infections, revisions and re-operations.
• Data from the registry has been integrated into a risk calculator that surgeons and patients use to make decisions about treatment. Research from the registry on implants and surgical techniques has influenced changes in clinical practice and optimized both techniques and implants.

The article features some of the authors, surgeons, and even a patient case study of how the registry was used to make an informed clinical decision (my friends at Dartmouth would be proud!).  We are clearly just at the front of this curve wherein we actually start getting into outcomes, accountability, and real shared medical decision making with legit data on the various treatment options. It is going to be an exciting journey to be a part of this data to information transition.

1. Possessing distinctive qualities that produce unaccountable or baffling effects.
2. Of, relating to, or invoking the supernatural

The California Health Care Foundation does some really good work. I listened to their President Mark Smith give a speech at the Microsoft conference last June and came away really impressed with him and what the organization is all about.  They also generate quite a few solid reports on issues affecting Californians but also as representative of what the rest of the nation can look forward to as well.

An interesting report that was recently issued related to the supply of California physicians.  The report is basically a powerpoint, which is really smart, because in our world of information overload a powerpoint is about all the detail you can swallow on a quick scan through. Four of the slides really caught my attention as they told a compelling story of what has happened to primary care.

We begin our review by noting that general physician supply has been flat for the last 15 years. There are a variety of reasons for this including economic alternatives, fixed number of medical schools, and the length of training versus the end payoff during the career.

Medical Graduates has remained flat in the CA for last 15 years while population has grown 40% during that time.

The flat physician supply is bad enough, but coupled with more than a decade of medical school graduates choosing specialties (less than 10% remain in primary care), we see a growing disparity in the numbers going into these safety net fields. The multifactorial reasons why graduates don’t pursue care in primary medicine relates to revenue model, business model, intensity of work, and job satisfaction among others.

California barely meets the nationally recognized standard for numbers of primary care physicians.

This is demonstrated in the attached slide showing the payment disparities between specialties. While primary care has enjoyed a recent increase it salary it has only moved from a running joke to a one liner. the 20% increase still puts it dead last in compensation and ~$15K lower than the next closest specialty.

While primary care has enjoyed a 20% increase, it is still $15K lower than the next lowest paid specialty.

To add insult to injury, California Primary Care Physicians are not just economically under appreciated as a specialty, they are also under appreciated geographically when compared to their peers. In one of the most expensive places in the country, they only make about 88% of what their peers make in other states.

When comparing CA PCP's against their peers in other states, they earned about 90% of national average.

Putting this all together paints a pretty tough picture for primary care – flat physician supply, only 5-8% of grads going in primary care, as a result of low pay, and for those choosing to stay in California they are rewarded with even less relative pay comparing to their PCP peers in other states.  These are all big macroeconomic trends that will take a long time to correct.

However, in the short run, at Crossover Health we believe that we give PCP’s HOPE that there is a better way, HOPE that there is a brighter day, and HOPE that they can either once again return to the medicine they loved to practice or forge ahead in creating an entirely new type of health care based on membership business model, using a powerful technology platform, and creating a new value network of specialist and ancillary providers. We believe we can raise the bar through each of these innovation singly, but when synergistically applied, we think we have something magic. 

The Disney Influence

Living in Orange County, California, it’s next to impossible not notice the “Disney Influence.”  Most of us at one time or another have had annual passes (I have mine) to Disneyland and Disney’s California Adventure.  We’ve visited the resort to Celebrate birthdays, family reunions and even an played an occasional day of hookey from the office.  We’ve spent an evening or two at Downtown Disney and have been mesmerized each night at by the 9:30 fireworks.

The thing that makes the Disney Experience so magical is what happens behind the scenes.  Everything from the architecture to the ride engineering are the brain-children of Disney Imagineers.  Imagineers are a diverse group of individuals with over 140 different job titles – all working for one important goal of “telling great stories and creating great places.”

At Crossover Health, we to want to tell great stories and create great places.  In my last blog I discussed the benefits of Membership.  Today, I’d like to take it a step further and discuss my role as Crossover Health’s Director of Membership Experience – in short I’m a key member of Crossover’s Imagineering Department.

Healthcare Re-Imagined

I realize on first pass, my title sounds very different. Who’s ever heard of a Director of Membership Experience anyway?  It sounds a little esoteric.  However, once you look at what the Crossover Experience encompasses, it completely makes sense.

Like Walt Disney’s vision of a new kind of amusement park, our founder Dr. Scott Shreeve, Imagines the possibility of Healthcare in a completely different light.  He envisions a “patient-centered primary care network that remove the barriers of how care is practiced, delivered, and experienced.”

What does this vision look like?

Like 99.9% of the population, I too have frustrating stories to tell when it comes to healthcare. My healthcare experience has, like many others, has been a reactive experience to whatever ails me at the time.

I will be an advocate for improving the day to day member experience.  Everything from the way members intact with the Crossover Team to the extended Crossover Network to the many benefits offered as part of membership will be imagined and re-imagined.

Our Healthcare model takes on a customer-centric feel of a fine retailer.  “Patients” will be referred to as “members.”  Customer care will centered around what’s best for them as apposed to what’s best for their insurance company.

Crossover Members will soon have the benefit of a proactive approach to healthcare.  Imagine being able to interact with your doctor the way you’d interact with any other professional.  Taking part in personalized healthcare blueprint that creates goals specific to the needs of it’s member.  Member specific services and events like a Member Concierge, interesting workshops and field trips.

My Background

My professional background is a mixture of Retail Leadership and technology.  Most recently, I had the opportunity to serve for nine years as a Store Leader for Apple, Inc. The genesis of Apple Retail was core to the very survival of Apple as a brand. But the result was the creation of a retail standard that didn’t exist then and is rarely experienced now.  As a store leader, I helped create and implement that retail standard.

From that experience, I firmly believe that:

• People are passionate about how they spend their money
• Customer service is key
• People have questions and concerns – address them!
• People want to be heard
• Don’t forget the follow-up
• Use of technology is crucial
• Don’t forget to apologize when needed

Like Walt Disney and his Imagineers, we’ve envisioned a reality that doesn’t exist.  My intention is to help Dr. Shreeve and our growing team create and implement a new healthcare standard.  One that I might add, is desperately needed.  I’ll be bridging my retail experience and customer service philosophy with the Crossover team to help bring this vision to reality.

Hi ho, here we go!

In 1958, American Express redefined the “Charge Card,” by introducing the American Express Card.  The card was a far cry from today’s modern Credit Cards.  It was made of paper and had the card members name typed on it.  The membership fee was $6 a year and required the member to pay the balance in-full each month.  What made membership so popular was the worldwide network of offices, travel agents and associated banks that were available to card members.  Before it’s release date of October 1, 1958, American Express had issued more than 250,000 cards!

As American Express Card evolved, it earned a reputation for the having the highest customer service standard.  AMEX employees were regularly encouraged to go above and beyond the call of duty.  One representative hand delivered a card in the middle of the night to a stranded cardholder at Boston’s Logan airport.  Another instance involved a representative in New Delhi who arranged for another representative’s brother (a military helicopter pilot stationed close to the caller) to deliver cash to an AMEX Gold cardholder who was stranded in a remote village in the Himalayas.

History is about to repeat itself. Starting this fall, Crossover Health will redefine healthcare as we know it by introducing a new standard in healthcare.  Like American Express, Crossover Health will feature a membership based experience that rivals fine hotels and retailers.  Imagine having care that allows your physician to practice medicine independent of insurance companies while offing unprecedented access.  And best of all – it’s affordable!

When did going to the Doctor become so negative?

Today, visiting a physician’s office is rarely a pleasant experience.   We’ve all grown accustomed to reading back issues of People Magazine while we wait for our notoriously late physician.  Once inside, we’re lucky if we have 10 minutes and a full conversation.

Back in the day, physicians were held in high esteem.  Changing doctors was unheard of because people stayed with their doctor long-term.  Doctor’s offices were a place of community not disharmony.  The result has left most patients feeling blasé about there healthcare experience.   Bad customer service, insurance coverage complications, and the inability to cross compare service pricing have resulted in high patient defections.

The truth of the matter is, we’ve become so accustomed this type of medical treatment, that we don’t expect anything different.

Membership Privileges

This fall, Crossover Health will introduce a new standard in membership focused healthcare.  Crossover Health will combine world class customer service, straight-forward pricing, and a suite of healthcare tools, services and resources that will be exclusive benefits for its members.

Physician Interaction

Physician interaction has traditionally been limited to office visits.  However, Crossover Health intends to change the way we interact with our physician.  Imagine attending weekly workshops, benefiting from a tight partnership between a third-party healthcare provider or taking part in a special field trip to a local organic supermarket – all lead by your physician!

Proactive Goal Setting

Most physicians today only see patients when there is a urgent need.  Rarely if ever are patients seen outside of an illness or injury.  Crossover Health intends to change this experience by seeing patients before something happens.  Members will have the ability to create Annual Healthcare Blueprints in partnership with their physician and a trusted third-party providers such as personal trainers and nutritionists.  These blueprints will create a framework and set goals fort he coming year.

Better Communication through Technology

Although, physicians tools have changed a lot over the years, patient communication is still limited.  Patients are demanding communication standards that are used in regular forms of business like: email, instant messaging and video chat.  Crossover Health will employ all three methods for it’s members.

As American Express did in the 1950’s, Crossover Health will define a higher standard in healthcare – one that will be affordable, accessible and patient focused.  Keep an eye out for Crossover’s new location opening this fall in Aliso Viejo, California.

1. Caught or fixed
2. Baffled

* This article was submitted to us by one of our summer interns. Their name is being protected because they currently are in a health care start up protective witness program *

Have you ever felt trapped when deciding your health insurance options?  I have.  Each year I study my health insurance options closely to determine which insurance plan type will provide me with the most value, the best quality and the easiest access to my health providers for the lowest cost. You could say that I am a value (outcomes/price) shopper.

Lets review the options:

The HMO. Alternatively, I can select an HMO plan for my family for about $600/month, a savings of >$650/month when compared to the PPO.  The HMO includes affordable copays when visiting the doctor or hospital and manageable total out-of-pocket costs in the case of a major healthcare expense.  But, the HMO has its own limitations.  First, the HMO doctor network is small and restricted, with no out-of-network benefits.  Second, HMO docs are paid to “manage costs” and this management all-too-often results in long patient wait times, antiquated facilities, pre-authorizations to visit specialists and typically shorter than 10 minute face-to-face visits with the doctor.  Third, although I’ve never experienced it first-hand, we’ve all heard the HMO horror stories that a disease or condition not being managed well because of the excessive focus on controlling costs (which could also be applied to the PPO option).

The HSA. Another affordable plan is the High Deductible PPO tied to an HSA. HSA’s continue to make steady, albeit small but gaining, increases each year. In this model, I pay about $300 / month for my premium and come out of pocket for the first $7,000 of medical expenses. This could include small stuff (simple visits for cough/colds are all out of pocket to me) as well as big stuff (we actualy like having the babies because it served as the medical “jackpot” in the rest of the year was “free”). But for all its cost savings (resulting from financial incentive of using your own money), it still does not provide steerage, care coordination, enhanced communication, or any of the other proactive health and prevention features required to truly keep costs down and you health up.

The answered seemed simple: select an inexpensive insurance plan (i.e., affordable premium) that provides catastrophic insurance coverage at a level (deductible) with which I’m comfortable and for everything else, pay cash.  I naturally thought about selecting a Health Savings Account plan with a very high deductible.  This would make a lot of sense if I lived in any other state except California, but California has a unique phenomenon whereby HMO plans are still very affordable.  In fact, of the health insurance plans available to me, including a high deductible PPO plan with an HSA, the best/cheapest catastrophic plan is the HMO.  In other words, although my HMO plan covers primary care and preventive visits, I only plan on using my HMO plan in the case of a major medical emergency.  With the savings from not choosing the PPO plan, I’m going to spend that money to pay cash to the doctors I choose to visit.  If it happens that I need to visit the doctor 5 or 6 times this year then I might expect to pay $1,500 in out of pocket costs for seeing the doctor on my terms.  If my health is worse than this, then I have my insurance that will step in and help me–after all, isn’t this what insurance is meant to do…pay for unexpected events?  If my health is better, then I can save those dollars for the next rainy day.

Isn’t that funny – essentially using an available HMO product as the lowest cost catastrophic plan but paying cash for all primary care services. This certainly highlights the opportunity for some enterprising and innovative health insurance plans to develop a new catastrophic plan that can carve out risk to some tolerable level that I choose. Sounds like a real winner . . . particularly when wed with the new products that Crossover Health is bringing to market.

Next article will discuss that product and how we “add it on” to the current mix while we wait for someone to develop a specific major medical plan for us (hint hint all you insurance companies out there!).

1. Something that suggests the presence or existence of a fact, condition, or qualit
2. A displayed structure bearing lettering or symbols, used to identify or advertise a place of business
3. A portentous incident or event; a presage

The march toward the grand opening of the flagship Crossover Health clinic continues. We are operating along a different time continuum but wanted to keep our followers abreast of all the updates. The big news last week was that our exterior signs were finally placed on building where our flagship clinic wil be.  This was a big deal for a variety of reasons – primarily it was the first visible sign for members of our team that this is really going to happen.

Laying out the logo and lettering

Fixing the sign to the building

Half way done putting up sign

It was actually a bigger thrill than I expected to see the sign actually up on the building. So much of what we do is in the future – what is going to happen, how things will roll out, and how we plan and visualize our objectives. In fact, even the process of creating the sign involved us creating visual representations of the sign on the building to test a couple of different layouts. From those visualizations the Yesco team went to work and did a fabulous job exactly representing what we had created mentally, then in renderings, and ultimately on the building itself. Participating in this creative process gives real meaning to the term “whatever the mind of man can conceive and believe, it can achieve.” (attributed to W. Clement Stone).

We have conceived of a game changing model of health care to introduce to south Orange County and beyond. We look forward to introducing the model in more detail in the coming months through all of our various communication channels (here, here, and here).

Stay tune!