Crossover Health, a tech-enabled medical group, is expanding its national footprint of brick-and-mortar clinics and plans to open new health centers in Seattle and Austin, Texas.
The company also plans to open a new clinic in New York, where it already has a presence, executives told Fierce Healthcare in an exclusive interview about the expansion plans.
Crossover Health, as the name implies, offers a hybrid model of medical care that includes health services that can be accessed virtually as well as clinics that are set up in conjunction with self-insured employers and in near-site health centers that are shared by employers and health plans.
These new clinics, which will average about 5,000 square feet, help advance what Crossover calls its "advanced primary health model" that combines primary care services, mental health, physical therapy, health coaching and care navigation, Crossover's chief medical officer Stephen Ezeji-Okoye, M.D., told Fierce Healthcare.
These locations also will feature on-site lab testing capabilities to make it more convenient for patients to get lab work done and will have some prescription medications available on-site.
"We're really taking a very holistic approach to care and we're really striving to provide members with a full care team. We have a traditional primary care provider and the nursing staff there but we also have the physical medicine staff and chiropractic services," Ezeji-Okoye said.
He added, "We want people to get most of their needs met by coming to one place, so we're offering that comprehensiveness and convenience. We really can cover the full scope. Our overall goal is really to be focused on the health and wellbeing of people and that means taking a more expansive view of them that maybe what's traditionally done in a primary care practice."
Crossover Health is among a crop of privately funded healthcare companies trying to shake up the $260 billion primary care market. Other companies in the space include Forward, One Medical, Iora Health, Oak Street, Privia Health, VillageMD and Advantia Health.
Primary care has become a hot spot with tech-enabled startups, drug store retail chains, health insurers and investment firms also looking to get a piece of the market. U.S. companies focused on primary care raised about $16 billion from investors in 2021, according to unpublished research by Harvard scholars, Bloomberg reported.
Ezeji-Okoye says Crossover Health stands out in the market by taking a more holistic approach to care. That approach is what attracted him to the company, which he joined in 2019 after 26 years with the VA system. He previously worked at the Veterans Affairs Palo Alto Health Care System, where he served as deputy chief of staff. His primary focus there was population health initiatives, disease prevention and social determinants of health.
"My previous experience in integrative medicine and population health shaped my decision to join Crossover. I knew I believed in a social and holistic model of care, and was enticed by the opportunity to work at an organization that was implementing this on a larger scale," he told Fierce Healthcare.
"Crossover’s advanced primary health model is designed to drive meaningful health outcomes rather than visit volume through comprehensive, coordinated and interdisciplinary team-based care delivery. Having had the opportunity to help build this and lead the team that delivers it, I am hopeful about the impact we can have on the state of healthcare in this country," he said.
The company was founded in 2010 as a solution for self-funded employers to help curb healthcare costs by ensuring their workforces received well-coordinated care aimed at improving outcomes and reducing costs.
The company has raised $281 million to date, according to Crunchbase, including $168 million in a series D round last year backed by Deerfield Management Company and a number of other investors. The company did not disclose its valuation.
Crossover provides virtual care in all 50 states and also delivers in-person care at 41 health centers in 11 states.
The company operates 33 on-site clinics, which are private health centers for clients who have invested in on-campus options, as well as eight near-site health centers, or shared clinics for multiple employers in a particular market. The company's near-site clinics are located in Texas, California and New York. The Austin and Seattle clinics will open later in 2022, and the additional New York location will open this fall.
Crossover currently services over 400,000 eligible employees and dependents throughout the country.
The company struck a high-profile partnership with Amazon in 2020 to open clinics near its fulfillment centers to cater exclusively to Amazon warehouse employees and their families. Last year, the two companies expanded their "neighborhood health centers" to Detroit and two California metro areas. Amazon and Crossover have now launched 17 health centers in five major regions, including Dallas-Fort Worth, Phoenix and Louisville, to serve Amazon employees and their families.
The employee health centers provide services to more than 115,000 Amazon workers and their dependents.
The expansion of near-site health centers will enable more people in high-density markets to access Crossover Health's hybrid model of care that combines virtual and in-person services, Ezeji-Okoye said.
"It also makes Crossover's services more portable. Ideally, you can go anywhere in the country and be under the Crossover umbrella, both in person and virtually," he said.
Moving beyond traditional primary care
Like many other companies looking to disrupt primary care, Crossover Health has invested in building modern health centers with a front desk that looks more like a hotel lobby than the waiting area at a doctor's office.
The exam rooms are designed to be comfortable and feature state-of-the-art medical equipment and technology. There are behavioral health rooms on-site if patients need to see a mental health professional. Some locations also offer acupuncture, chiropractic and massage services as well as a vision center.
The administrative areas include a "bullpen" where care teams huddle to coordinate patient care.
Patients interact with the same care team whether they connect with providers virtually or in person and this helps to build longitudinal relationships, executives say.
During the past two years of the COVID-19 pandemic, the company learned key lessons about how Crossover patients access care and the opportunities for a team-based, integrated approach, Ezeji-Okoye said.
"The care model, the idea of the bio-psycho-social model of care, the need to be able to take a more holistic approach to address the challenges that people face, that was really validated during the pandemic. There were new pressures like social isolation and increases in things like alcohol use, stress, anxiety and depression that don't lend themselves to quick transactional events like coming in and being treated for a urinary tract infection," he said.
"That really requires that there be a relationship between the provider and the member and I think that's one of the things that Crossover excels at. We generally have longer appointment times than you will see in the community. Our standard appointment time is 30 minutes," he added.
Why Crossover is betting on hybrid care
The near-site health centers are both the anchor and the catalyst for the success of Crossover's hybrid offering, he noted. When in-person and virtual care are combined, Crossover members experienced a much higher care gap closure rate with a hybrid approach than a virtual-only approach, according to the company.
Patients can get critical health screenings when and where they are needed most, Ezeji-Okoye noted.
As an example, patients seen by a Crossover physical medicine provider in person can get their blood pressure checked and can then be referred to primary care for a follow-up visit either virtually or at a clinic.
Between January 2020 and July 2021, 1 in 10 patients seen in primary care were diagnosed with depression or anxiety and then seen by a behavioral health specialist on the team, according to a study of 330,000 Crossover patients during the COVID-19 pandemic.
The pandemic also highlighted the need for patients to have a choice in how they access care, Ezeji-Okoye said.
Industrywide, virtual care visits currently make up about 13% of medical appointments, but at Crossover, virtual visits account for 30% of the care providers deliver, he said. "We're seeing a much higher or much more consistent uptake of virtual care and the use of hybrid care," he said, noting that uptake for virtual behavioral health services continues to be very high as compared to in-person appointments.
The explosion in demand for telemedicine during the pandemic fueled not only a frenzy of interest in virtual care but also in virtual primary care models. Many telehealth companies and insurers have rolled out virtual primary care services. But neither virtual-only nor in-person-only care can meet all the needs of an employee population, according to Ezeji-Okoye.
Crossover is seeing increased interest from employers and health plans in its approach. While executives wouldn't provide names of employer clients, the list includes some of the world’s most widely recognized organizations, including four companies in the Fortune 500.
Employers want their members to have a better care experience that's geared around keeping them well, according to Ezeji-Okoye.
"We're proactively engaging members and changing their behaviors in a way that not only will reduce long-term costs, but should reduce the burden of disease that allows people to have a better quality of life. I think that's where the interest is coming from," he said.
When asked whether Crossover would open up its clinics to the general public under a membership model, Ezeji-Okoye said it was a "potential opportunity in the future."
"We have a small retail offering that people can sign up for. Depending upon market demand, we're focused on expanding the number of clinics we have and opening up our services in more markets across the country," he said. "Our goal always has been to try to provide great care to everybody and we're just starting out in the employer area."