And he’s changed the way he treats musculoskeletal conditions after working alongside a physical therapist. He has learned a lot from the behavioral health providers about pain science. He can walk over and ask a dietician why everyone is talking about coconut oil, or get a refresher from a chiropractor on the Epley maneuver for a patient with vertigo. The providers at Crossover don’t have individual offices, but rather work in a large space known as “the bullpen.” This make it easier to communicate and work as a team.įor instance, he didn’t get a lot of nutrition training in medical school, but frequently gets questions from patients in this realm. The fully-integrated organization allows him to learn from others. When treating someone with low-back pain, he can work with a nutritionist to create a meal plan to reduce inflammation and a physical therapist to provide core-strengthening exercises.Ĭhang considers the Crossover model a “fresh way for primary care providers to practice.” Most of these doctors haven’t worked side-by-side with chiropractors or behavioral health professionals daily. For example, if he doesn’t have a solution for a patient, he can pull a variety of providers in to create a care plan.
He calls it sports medicine for the masses. Crossover, he said, is the closest kind of practice he’s seen regarding team care. There he saw the potential for treating patients with an entire care team. In 2013, Lord worked as a chiropractor for the America’s Cup team. “The goal is to create a medical home for patients that is truly patient-centered so we can take care of a majority of their primary care needs,” Chang said. Along with chiropractors and physical therapists, they may have dermatologists, behavioral health providers, health coaches, dieticians, internists and doctors trained in emergency room care. For instance, some of their practices have sports medicine doctors on staff because they have a high number of “weekend warriors” as clients. They are also able to tailor each office to meet the client’s needs. Steven Chang, MD, said his routine office visits are 30 minutes long and a physical or annual well check lasts an hour. They can take much more time with each patient. Providers’ behavior changes because they don’t have to deal with insurance, but are paid based on outcomes and patient experience.
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“I worked in an integrated setting before, but it was a fee-for-service model, so we still had to figure out how to do enough to keep the lights on.” “If I want to spend an hour talking about how a patient can mitigate pain and give them strategies, I can,” he said. Outcome- and patient-focusīecause they don’t have to worry about insurance billing and perpetually ramping up volume, Lord said he’s able to practice closer to the way he learned in chiropractic college. The employers often have other health insurance as well, so they keep copays low to encourage employees to use the site. The businesses band together and pay a per-member-per-month fee to join. Crossover owns these, usually located within about two miles of four to six smaller employers. The other locations are near-site practices.
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The employees can visit the doctors free or pay small copays to offset the cost of the sites. Here, the employer (typically large ones like Facebook) covers the overhead and building costs. The first is on-site, housed on an employer’s campus. Crossover has since expanded to 20 clinics with two different models. They went from no patients to 30,000 in one location, and to 10,000 at another site. “Even though we had no experience, they bought our vision.” “It really resonated with them at the time and we won their business,” Lord said.
While others were pitching more traditional models of care, the Crossover team went to Apple and Facebook and described their idea of what health care should be.
The idea was appealing to industry disrupters like technology companies in Silicon Valley. Then the idea of employer-funded health care became en vogue. They tried a membership model, but it was very slow moving. The founders had a vision, but didn’t know how to pay for it, or make it work on a large scale. Shreeve and others also saw another need in the market - to deliver the care patients need, rather than what an insurance company will pay for, said Daniel Lord, DC, CCSP, physical medicine program manager at Crossover. People coming to the emergency room had problems that were preventable, but left untreated, they became major issues. Crossover Health, based in Silicon Valley, was founded by CEO Scott Shreeve, MD, an emergency medicine doctor with firsthand knowledge of how lack of preventive care costs both patients and the system.
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