Category Archives: Value

Extirpating the “Health Insurance” myth

Extirpating (ĕk’stər-pāt’) v.

  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”

Understanding the components parts of our modern conception of "Health Insurance" is the our first step toward meaningful reform.

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.



Filed under Crossover, Health Finance, Innovation, Insurance, Value

Crossover Piquant: Check this out!

Piquant (pē-känt’) adj.

  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.

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Filed under Design, Health 2.0, Innovation, Open Source, Uncategorized, Value

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 65: Proof is in the Passion – Crossover Explained


Tonight I attended an awesome charity event called Savannah’s Organic Ranch. Savannah was a beautiful girl stricken with cancer whose last wish was to pass along her love of organic farming. The spark that was her life and encapsulated in her last wish has fueled a community wide passion for spreading representative organic “ranches” at local schools and in our community. I was impressed with the passion of this young girl, and how it has inspired equally vibrant passion for those who wish to keep her memory alive for a great cause.

I believe passion is an integral part of life and anyone’s life’s work. At several forks in my professional journey, I have chosen to pursue my passion instead of settling for a more secure road. It has been a defining characteristic in my life – one in which I have occasionally questioned during challenging times but have always known was my destiny. I find myself once again passionate about what I am attempting to do, and the familiar sense of being energized by both the general impossibility of the task at hand coupled with the equally strong sense of inevitability with which all entrepreneurs are endowed.

Instead of writing it out, I thought I would just capture what I am doing on video:

Saves me time, provides some strong visualization of our business, and hopefully conveys the passion I feel about what we are doing.  We will be using this blog and our other channels to tell our evolving story, as well as the entrepreneurial extremes we experience as we drive toward launch. Hope to make this a dialogue as we roll forward.

* For those of you wondering whats up with our broken down building, this video was shot by Benny Ek Media within our new space following its demolition. We look forward to introducing our new design, look and feel.


Filed under Consumerism, Crossover, Direct Practice, Leadership, Uncategorized, Value

Day 80: My take on “meaningful use”

Meaningful (mē’nĭng-fəl)adj.

  1. Having meaning, function, or purpose.
  2. Fraught with meaning; significant:

I grow exceptionally tired of the entire “meaningful use” conversation. I see multiple definitions, serious scholarly work, conferences, and an entire industry built up around or attempting to knock down this obnoxious term. Its wearisome . . .particularly when I think the term is meaningless in terms of attempting to get people paid for using specific types of technology. My contention is that the government bureaucrats will never be able to run fast enough to keep up with technology which will outstrip not only their ability to classify it, let alone dictate the terms of its use.

As an example of that, I am using HelloHealth’s EHR platform. It is not EHR certified, it is unclear if it will meet any quality or feature/function litmus test, or some of the other criteria being dreamed up. When I think of “meaningful use” I don’t have to turn any farther than the patients that we serve. Here is an unsolicited email that demonstrates the true and only relevant definition I will ever use:

Thanks for the quick response. Your team took great care of me!!!

The A1c was 5.8 and trending the right way – I’m not sure what it was before. I was 1 point away from being on the good side of the Pre-diabetic equation at 100. I’m not taking any Avandia and have not been for a while now. Based on what I know and what you guys were telling me…I’m going the right way and am right now —ON TOP OF THE WORLD!!!

This goes to show you that everyone at the practice are doing the right thing by providing this program [HelloHealth]. This program shows that if a person like me wants to get better we can control our own destiny – we are in the drivers seat (to a degree). I would have been carrying the BIG Burden that I had to be on meds with this had I not met you!!! My hats off to everyone there. You all did great – thanks for guiding me along the way. I cannot thank you all enough.

And if it was not for YOU – I’d be another prescribed drug statistic.

All the best.

Technology is an enabler that allows me as a physician to be more effective in “laying on of hands” (which has been and will always be the essence of being a physician healer). My ability to impact patients lives for the better is exactly the type of impact that we can and should have with technology. This should be the only meaning of the term “meaningful use”.

I really want everyone to experience health in this way – for everyone to have the privilege of being apart of the next generation of care. That is what we are attempting to build at Crossover Health.

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Filed under Advisory Services, Innovation, Uncategorized, Value

Open Letter to Athena: Open Up the Afterburners!

Afterburner (af·tər′bər·nər) n.

  1. A device for augmenting the thrust of a jet engine by burning additional fuel in the uncombined oxygen in the gases from the turbine
  2. The augmentation of thrust obtained by afterburning may be well over 40% of the normal thrust and at supersonic flight can exceed 100% of normal thrust

athenahealth is one of my favorite companies anywhere. I believe they have a great vision, a highly capable team, an incredible business model, and an unprecedented business opportunity before them. However, for all the amor, I have been disappointed that even with all their blistering success (Bam, Bam, and Kabam!) they have captured less than 2% of the target market since the IPO. I am not just disappointed for them but for the entire ambulatory care space which doesn’t seem to readily get the value of the collective intelligence inherent in the network.

In November 2007, I attended a technology conference with Jonathon Bush in the LA area. Jonathon was in rare form that day (probably trying to get psyched for his WFC battle with Allscripts CEO Glen Tullman which never materialized – Glenn was a no show) and I challenged him to get serious about getting his software in the hands of as many physicians as possible. We had an animated 45 minute banter on how this could actually happen. He asked me to write up the proposal I drafted on the back of a napkins that were doubling as our ad hoc whiteboard.  I think he briefly considered it, but the business focus and the upcoming IPO made it just a passing interest. Now, nearly two years later, I still think what I wrote is highly relevant and could be highly very useful in helping athenahealth rapidly expand their current book of business.

My pitch to athenahealth, then as now, is to turn on the AFTERBURNERS by opening up the platform:

November 6, 2007

Provocative Quotes

Business Case

AthenaHealth is the hottest health care information technology on the planet as I write this. The recent oversubscribed IPO has been sequentially followed by exceptional national press coverage, impressive recent customer wins, and an ongoing run up in the stock price.

This unprecedented public launch is another confirmation of Athena’s compelling business model. Athena provides back office automation software that leverages a proprietary claims database and workflow engine that dramatically reduces the inefficiencies of medical practice finances. As a result of this technology, Athena has been able to provide medical practices with real-time information on claims, cash flow, and financial optimization. By focusing on the revenue cycle management service, Athena knows first hand how relevant clinical information is the creation and management of financial information. In order to more effectively capture that information, Athena recently launched AthenaClinicals, their web based EMR which complements their web-based AthenaCollector software.

Because Athena’s business model is based on revenue cycle management, and the clinical software is a means to acquire better financial data, Athena does not have to charge money for the software itself and choose to sell it as a service. In fact, since the revenue model at AthenaHealth makes money off the increased collections, Athena is willing to go at risk on implementations.

This representats one of the new school business models and an evolution of the Software Value Chain evolution. Furthermore, due to its architecture of participation, each new practice becomes a contributing member of the Athena Network. This Network effectively creates a natural “collective intelligence” and collective experience around best practices, insurance rules, and financial optimization. 

Because Athena was conceived as a “Software as a Service” company and because the revenue model does not involve software licenses, the value of AthenaClinicals does not reside in the features/functions, but in its ability to gather bits and bytes. The greater the ability to gather bits and bytes, the greater the ability or opportunity to generate revenue streams. It therefore stands to reason that the more broadly your bits and bytes gathering ability is distributed, the more opportunity you will have to generate revenue. Why not have as many doctors as possible using AthenaClinicals by making if freely available for their use?

This decision would allow you to reap the whirlwind of innovation, while still protecting all your proprietary knowledge and intellectual property within Athena Collector and Athena Enterprise applications. Access to the Network would continue to be on a subscription basis but you would open up development and collaboration opportunities which you have not previously contemplated. The Athenista’s will be celebrated as hero’s, an appreciative community would form and become a veritable “army of messengers”, and I believe you would continue to force disruptive change within the industry.  Based on your successful business and your successful brand, I believe that you could accelerate the creation of a public good that you have previously discussed by engaging a worldwide public of developers, users, and potential customers.

Specific and tangible additional benefits would include:

  • Get the benefit of solidify your message that “Software is Dead” and the “Network is Nirvana”
  • Get the benefit of a huge branding and buzz opportunity
  • Get the benefit of expanding the number of potential developers of the software
  • Get the benefit of expanding the number of potential users of the software (decrease adoption impedance)
  • Get the benefit of having a larger installed user base to upsell your professional version and access to AthenaNetwork
  • Get the benefit of collaboration from partners, players, and payers that you have currently not contemplated
  • Get the benefit of co-announcing and co-branding with Red Hat and/or Ubuntu to leverage up on the ongoing buzz associated with Linux
  • Get the benefit of creating a community, neigh an entire nation of Athenista’s, who plug into the network effect which you have amplified.

I have struggled to find a compelling reason not to do it. Most companies struggle with the decision due to their business model reliance on software licensing. Not your problem. Others struggle because they are so conservative or do not want to disrupt current partners. Not your problem. Still others don’t make this decision because they do not have the corporate resolve or insight to see where the market is going. Not your problem.

Again, I realize this will have the flavor of a religious conversation, but I believe in there is a valid business proposition in this proposal. I honestly believe you guys can accelerate your current trajectory – opening up the afterburners by opening up your software.


Filed under Innovation, Open Source, Value

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