Category Archives: Entrepreneurship

Hewing Away: Its all in the eye of the sculptor

Hew (hyū) v.


  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.


Leave a comment

Filed under Entrepreneurship, Innovation

Crossover Health: Welcome to Next Generation Health Care!

Crossover Health Launches New Model of Primary Care in South Orange County
Innovative membership service delivers Urgent, Primary, and Online Care

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.


Filed under Change Agents, Crossover, Design, Direct Practice, Entrepreneurship, Innovation, Launch, Medical Home, Membership, Primary Care, Quality, Value

Day 87: The New Network

The following is an excerpt I wrote to help explain to someone how the Crossover Health Concept has evolved over the last three years.

For the last three years I have been involved as a consultant in the direct practice space. I have had the privilege to work with Lemhi Ventures, companies like Current Health,  and several other “Health 2.0” startups focused on delivery of care innovations. I have met and spoken with and to people from all across the country on these topics. One of the most interesting projects I was involved with was the X PRIZE, where I helped design the framework for a $10M competition to radically alter the delivery of care. In talking to a national audience of health care innovators, it became clear to me the “medical home/direct practice” model was what was required to radically shift the payment model, which would drive delivery changes, which will ultimately impact outcomes, and lead to a great consumer experience.

For this reason, I determined to get back into the actual deliver of care. Last July, I began this process by helping a physician friend of my who recently separated from his partner. It was one of those unfortunate situations where he was left without a practice manager, without access to an electronic record, and a floundering practice. I found that I could actually help him the most on the business end while helping out with the clinical end as well. In working through the practice management issues, I ended up hiring a practice manager, implementing an EHR, remodeling the office, rebranding the clinic, and essentially retooling the entire practice for future growth. We were able to refocus and re-energize the entire practice – we doubled patient visits, the patient experience dramatically improved, and we became cash flow positive in four months. This was a team effort by a dedicated group of individuals who remained solely focused on our objectives.

While impressive, there are literally hundreds of practice management companies out there (athena helps us look like all-stars) for traditional practices. But I began to wonder, as I did when I worked in this space previously, about the opportunity to create a management company for Direct Practices. Interestingly enough, our Traditional Practice Management services have continued to flourish (three new physicians have signed on in the last six weeks), while we have simultaneously been able to build out our Direct Practice Management capabilities. I have been working closely with HelloHealth, functioning essentially as a “Practice Launch Catalyst” in getting physicians up and running on the platform. We are focused on getting 10 new practices launched in a very short time frame here in Orange County. This involves identifying physician candidates, engaging them in the project, training them on the various tools, and launching this service within their practices. It is an intense, multi-pronged effort, being done as part of a overall “surge” in a concentrated geographical area. I am fortunate that my own practice, Crossover Health, will be one of the 10 practices that launches within this time frame as well.

A natural side effect of this “OC Surge” is that we are creating a private network of physicians who are using and collaborating on a common platform. This natural network, created and enabled by the HelloHealth platform, becomes increasingly more valuable the more physicians that use it.  Crossover Health Management Services will continue to provide support and assist some of these practices after they launch as we have an array of ongoing services to help the practices be successful. We also work quite hard to get others on the platform so that the specialist, ancillary providers, and other health facilitators can also participate on the platform as well. This is actually one of the key benefits of any network, the more members and physicians that are a part of it the more valuable the network becomes. In essence, we create a natural IPA, not to the exclusion of other networks, but naturally and easily as part of self aggregation enabled by the platform. We choose to associate in this way because there is inherent value to do so – there are no contracts, no deep connections, just people collaborating in a whole new way on the platform. If the network does not provide value, then members and physicians can and should aggregate in some other way. Pretty simple concept.

I am a huge believer in the concept of membership based medicine, am a passionate advocate and tireless innovator in the space, and look forward to making an indelible impact in the local area by introducing this concept with force this summer to the OC. Given all the work ahead, it seems like an Endless Summer already!

1 Comment

Filed under Entrepreneurship, Innovation, Launch

Career Walkabout: Going On and Off the Grid

Walkabout (wôk’ə-bout’) n.

  1. A temporary return to traditional Aboriginal life, taken especially between periods of work or residence in modern society and usually involving a period of travel through the bush.
  2. A public stroll taken by an important person, such as a monarch, among a group of people for greeting and conversation.

I have been off the grid for the last several months heads down on a project which is the cumulative result of my last three year walkabout. Each of the experiences I had along the way provided a stepping stone and preparation for the path that I have recently embarked on.

After a couple of years of talking about health deliver reform (starting with Redefining Health Care), health care financing (Health Equity), health plan innovation (Lemhi Ventures), new practice models (Current Health), and health care reform (X PRIZE), I was left feeling like I was nibbling around the edges without having anything to sink my teeth into. The X Prize proved to be the catalyst, as I had to think about which side of a competition I wanted to be on (Administration vs. Competition). As a former collegiate athlete, there was never a question that I would choose to compete. As my contribution to that project wound down late in the fall, my decision was made – it was time to hang up the Blue Blazer and Khakis and put the stethoscope back on.

I used to think that I had moved on beyond being “just” a physician. I always respected and appreciated the work that went into becoming a doctor. But along my journey, I somehow lost the appreciation for what it means to be a physician – a trusted heath advisor, a healer, and someone who people turned to with confidence during some of the most difficult times in life. Perhaps the shift work in the ER, the patient population I dealt with on a daily basis, and certainly the shiny objects flashing on the always greener side of the fence were contributors to the reasons I chose to pursue other interests outside of the practice setting.

Ironically, those same interests have led me on a walkabout journey that has come full circle. When we founded Medsphere, the market was at a tipping point for implementing EHR’s. Those were the days we had to convince people that EHR’s were a good idea, that the VA was a benchmark for automation, and that open source was actually a viable development and business model. Our thought was always that the implementation of the EHR was the first step, that you absolutely needed to get an information gathering infrastructure in place in order to even consider improving health care delivery. We often talked about our second company, which would be a data analytics powerhouse that could create actionable work plans to turn the data into information and ultimately knowledge about health care performance. Health care delivery is where the action is, because that is where the monetary and resource allocation decisions are made. Its also where the rubber truly hits the road. I have since become convinced that no matter how fast your rev your RPM’s (health care hype), it is in the friction, heat, grime, and gristle of contact (physicians “touching” patients) that true progress can be made.

Its also where we need the most help with innovation.

Health care delivery is woefully behind most other professional service industries in nearly every measurable criteria. Our customer service is atrocious, our efficiency metrics don’t even register, and we certainly can’t provide very good guidance to our patients when we practice in a data free environment. Beyond just being a typically conservative industry, our cottage nature is confounding and for a profession that highly leverages the peer review process in sharing knowledge, we take a parochial perspective when sharing best practices. As a result of these and many other factors, the way our profession is compensated has morphed in negative ways to the exclusion of some, the short term gain of others, and ultimately to the demise of all.

I think we can do better; I know we can do better; and I look forward to being a contributor to the required change. Given my cumulative experiences, I believe the way that I can have the most impact is in the actual “rubber meets the road” delivery of care. As a physician, it is my privilege to touch patients through practice delivery innovation that incorporates the best thinking, technology, and talent that can achieve the best outcomes. All that I have learned, experienced, and seen during the last several years is going to be leveraged in the creation and implementation of Crossover Health.

I look forward to having you join me for the journey.

1 Comment

Filed under Change Agents, Crossover, Entrepreneurship, Innovation

Healthcare Pioneer: EHR Vendors start their outreach

Pioneer (ə-nîr’) adj.

  1. Of, relating to, or characteristic of early settlers
  2. Leading the way; trailblazing

When I worked shifts in the ER, I was trained and learned to be weary of people who were overly complimentary or attempted to become too familiar. It is a personality defect seen in those with borderline personality and often in drug seeking behavior. The appeal to the ego can provide a tug into the deep waters, but that natural hesitancy and wariness kept me in the safe shallows more than once. The often innovative ways these people appeal to the ego is almost as interesting as the sudden shift into the vicious when you don’t give them what they want.

So it is with that familiar wariness in which I review alot of incoming email I have been receiving as of late. The traditional EHR vendors are getting more and more innovative with their marketing approach. Take note of the interesting email from a company that I actually respect for a solid product – Greenway Technologies (see below). I evaluated them very thoroughly in late 2008 and noted that they have a very solid, traditional  system specifically tuned to the current quagmire in which physicians practice. They have a decent EMR, decent practice management, solid PHR, and an interesting twist on population management with their clinical research (glorified registry) functionality.

However, I couldn’t pull the trigger on them because they were tuned for the traditional. I didn’t see that they were leveraging the concept of the network, or their EHR as a platform, or that their UI technology was fluid or as modern as I wanted. I didn’t get a sense for the flexibility and freedom found in the notion of clinical groupware. And finally, I didn’t get the sense that they were going to take me to the next level. Please – don’t get me wrong,or  attempt to outKLAS me, or bang on their numbers which are impressive. They are a solid player who will do well – but it wasn’t for me or the network of primary care clinics that I am wanting to build.

Needless to say, I found their marketing approach to be quite pioneering:

Healthcare Pioneer,

You are probably wondering how you became designated as a Healthcare Pioneer by Greenway.  We define such an influencer as an organization or individual who is involved in leading the development of the Health IT community, implementing EHR’s at the point of care and optimizing the opportunity at hand presented to us by The American Recovery and Reinvestment Act of 2009/specifically the HITECH Act.  We polled our employee base and asked: “Who in your respective region/professional arena do you hold in high regards and value as it relates to our mutual $45+ Billion market place?” You were nominated for your leadership and dedication to creating the most efficient and effective healthcare transformation through Health IT.  As we grow our network of influential leaders, and jointly capitalize on the media driving our Health IT sector, we extend a gratuitous “Thank You” to you for being a part of our success.

In an effort to provide continued educational awareness, as well as provide mutually beneficial opportunities, we will begin disseminating periodic, customized Corporate Communications outlining current Industry news, industry achievements & milestones, Webinars, as well as pertinent Health IT Transformation and Healthcare Reform activity from Capitol Hill.

Did You Know?

  • 27,000 Healthcare Providers and Professionals call upon Greenway’s integrated EHR, Practice Management, Interoperability and Clinical Research solution everyday … denoted by the name PrimeSuite®.
  • 315 plus dedicated Greenway employees have driven over 30% annual revenue growth the past 3 years consecutively.
  • Over 19 Million Electronic Records are managed comprehensively and efficiently throughout 49 states (and the Nation’s Capitol) by highly satisfied Greenway customers.
  • Over 1,375 unique interfaces from 115 plus 3rd party vendor participants find themselves internally managed via Greenway’s PrimeExchange® interoperability engine producing hundreds of thousands of transactions monthly and creating a simplistic workflow for our thousands of customers.
  • Best in KLAS, our industry’s “Consumer Reports”, has ranked Greenway Best in KLAS three consecutive years in a row.  In 2008 Greenway was awarded Best in KLAS in 3 categories, including 2-5 Ambulatory EMR, 6-25 Ambulatory EMR and 2-5 Practice Management, making Greenway the only Ambulatory-focused organization to receive multiple Best in KLAS awards in 2008.
  • Greenway is a leading national speaker on how the current EHR “meaningful use” and Certification criteria are evolving. We have testified and/ or addressed Congress as well as both Presidential Administrations on twelve occasions regarding Health IT.

To Learn More:

Without question, there are some remarkable, opportunistic and exciting times before us and
Partnering with you will continue to be a Privilege. Thank you again for thinking Greenway!

Call today at 866.242.3805 or email us at


Filed under EHR, Entrepreneurship, Industry, Quality, Value

Health Care Moonshot: The Health Care X PRIZE Development Project

Moonshot (mūn shŏt) n.

  1. Description of the audacious attempt and the subsequent race to place a man on the moon
  2. Used as an analogy to describe similarly gigantic challenges under competitive influence

The best health care book I have ever read, is ironically the first one I was fortunate to pick up. “Redefining Health: Creating Value Based Competition on Results” literally became a life altering experience for me as I read it at a time when I was seeking to redefine my career path. The notions of health care value (outcomes/price), the organizational principles engendered by this approach (focus on the medical condition across the full cycle of care), the competitive forces that this framework unleashes (virtuous cycles of innovation), and the overall promise for improving our deliver system (increased access, lower costs, and high quality) absolutely resonated with me and framed where I wanted to take my professional career.

After reading the book, I immediately set about to capture the key concepts and ideas visually, and to weave the story of value based health care. This effort launched me into the emerging Health 2.0 movement, and illuminated for me a clear path to move toward next generation health care (this is why I always argue for an expanded definition). As the tools and technologies of Health 2.0 began to be introduced into the health care conversation, I also observed that a more systematic approach was being taken to quality, cost containment, health care disparities, payment reform ideas, and the design of a high performance, connected health systems with built in pricing, incentive, and quality transparency.

Subsequent consulting projects in management of health/wealth, direct to consumer laboratory services, new payment models, and ultimately new models of health care delivery, led me to create a new concept of care called “personal health advisory services”. These concepts are now being introduced to a small group of private clients, but more importantly, the notion of new types of health care organizations (Accountable Care Organizations) being created within the construct of a new type of health system (based on value and focused on health vitality as the metric that matters) are infinitely more promising. As part of these developments, I have become convinced that we aren’t going to get there incrementally, with modest improvements, with limited vision, or paralyzed by the “inevitability” of our current staggering national and health sector problems.

I have always dreamed big, and sought impossible challenges, and for this reason I am excited to announce my association with the X PRIZE Foundation as a Senior Health Advisor. This very discrete project (through June 2009) is solely focused on defining a Health Care X PRIZE that can leverage a well described competition as the catalyst for transformative change. Over the coming months, I will be meeting with corporate executives, policy experts, government officials, thought leaders, patient advocates, and others interested in engaging in this work to to define the “health care moonshot”.  The X PRIZE framework has specific competition constraints, a unique investment multiplier effect, and holds the promise of organizing many of the best and brightest reform efforts currently underway in our country. I look forward to working with Dr. Peter Diamandis and Robert Weiss on this very exciting project.

I will also look forward to speaking with many of you, sharing our findings and research as we proceed, and engaging the broad health community and ultimately our entire country to join in the inspirational effort to transform our health care system.  Please feel free to contact me directly with your interest, your X PRIZE ideas, or to discuss how you can help be a part of the “Health Care Moonshot”.

1 Comment

Filed under Advisory Services, Change Agents, Entrepreneurship, Innovation

Personal Health Advisor: The Perfect Care Coordinator

Coordinator (kō-ôrdn-ā’shən) n.

  1. The act of coordinating
  2. The state of being coordinated; harmonious adjustment or interaction.

I am finishing up some more of my postings related to the Innovators Prescription, but prior to do so I wanted to highlight a key insight mentioned when evaluating the disruptions required to help the Primary Care system to become more effective:

“We have concluded that a personal adviser of some sort truly needs to be available to direct patients who may not know where to go, so they can find the care they need, and receive that care through the appropriate business models. Many of those who write and speak about reforming health care have called this adviser an Accountable Care Organizationone whose perspective enables it to orchestrate the health care that individuals consume.

Dr. Elliott Fisher and his colleagues at Dartmouth College have played a leading role in promoting the concept of the Accountable Care Organization. It is an entity that can guide each patient to the right provider at the right time, given the job he or he needs to get done, linking the more focused and specialized care providers together with the personal electronic health records.  Some have likened this adviser as a medical “On Star” button, referring to the button in General Motors cars that motorist can press whenever they get lost or need help.

Still others have encouraged the notion of a patient-centered medical home, a model of care in which a single individual, – most often a physican – serves as the first point of contact for the patient, coordinates the entire team of providers, and integrates care across all institutions to ensure quality and safety.

We have concluded, however, that assigning this role to an independent primary care physician’s practice is a bad choice. It forces those practices into comingling business models, with the result that they are integrated inadequately for the jobs pateints need to do, and imposes accountability for areas of care that are often beyond the coordinator’s control. Furthermore, the information, skills, and perspective required to play the role of an effective advisor are not uniquely instilled in physicians.  With this burden placed on others, primary care doctors can practice medicine, which for most is the career they thought they had chosen in the first place.

I find this so insightful because this line of thinking was the exact job that  Crossover Health was designed to perform for individual consumers. The service concept behind Crossover (aggregate, analyze, and advise) appeals to individuals and sponsoring organizations  who value their health as an asset and want a trusted advisor to help personalize and assist in managing it as such. The technology that Crossover is developing/evaluating will also help make this mass personalization scalable to address what I perceive will be a large and growing need among consumers as the health care system continues to fragment in the coming years.

Stay tuned for some announcements from Crossover in the coming weeks.

1 Comment

Filed under Advisory Services, Consumerism, Crossover, Entrepreneurship, Innovation, Transparency, Uncategorized, Value