To kick off his workday at Crossover Health, clinical psychologist Ross Nelson, PsyD, huddles with seven other health-care providers at the integrated medical group: a primary-care physician, nurse, physical therapist, health coach, chiropractor, acupuncturist and optometrist. Together, they discuss patients’ physical and mental health needs and exchange their knowledge about such conditions as depression, stress, vitamin D deficiency and lower back pain. When they aren’t with patients, the team spends the rest of the day working in a large, open-concept “bullpen,” trading notes about individuals and treatment plans.
“The bullpen is where a lot of the magic of integration happens,” says Nelson, the behavioral health program manager at Crossover Health, based in Northern California. “It’s a special opportunity to collaborate—literally elbow to elbow—with a really diverse team of providers. It doesn’t get much more patient-centered than that.”
Founded in 2010 by Scott Shreeve, MD, Rich Patragnoni, MD, and Nate Murray, Crossover Health provides comprehensive health-care services to employees of large technology companies in Silicon Valley—including Apple, Facebook and LinkedInopens in new window—on or near their campuses. The company now has 19 clinics in the Bay Area, Texas, Idaho, Seattle, New York and Boston and several more opening in 2019.
Providers at Crossover Health say their integrated approach takes care to a new level.
“Many groups say they have an integrated model, but the providers are all housed separately,” says Leslie Gerber, RN, a market practice manager who oversees nine Crossover clinics in the Bay Area. “But in the way our physical space and our sessions are designed, we actively facilitate, encourage and promote that collaborative piece to occur every day, all day.”
Homing in on employee stress
It’s no secret that employees of technology companies often work long hours and experience stress on the job. In 2015, a New York Times exposéopens in new window of Amazon revealed a highly competitive company culture, and in a subsequent survey of tech workers by Open Sourcing Mental Illnessopens in new window, a nonprofit dedicated to raising awareness about mental wellness in the industry, 71 percent of respondents said their productivity is affected by a mental health issue.
Crossover caters to the needs of this fast-paced community by making care more accessible. LinkedIn and Facebookopens in new window, for example, have custom-built Crossover clinics on campus, while other companies’ employees go to nearby clinics via free Lyft rides provided by Crossover Health.
In another effort to meet the needs of its tech-savvy patients, Crossover has woven technology into each step of its operations. Patients book appointments, message providers and monitor health scores such as depression and anxiety assessment results using the medical group’s online portal. Crossover also delivers behavioral health services virtually when employees can’t get to the clinic.
The group’s behavioral and mental health offerings are tailored to the needs of these employees, whose top concerns include anxiety, depression, occupational stress and relational conflict.
“There are also some specific stressors that come up around working for tech companies, like a lot of pressure to perform and perfectionism,” says Nina Kalus, PsyD, clinical psychologist at one of Crossover’s shared clinics in Mountain View, California. To meet those needs, Crossover hires and trains psychologists to treat workplace stress and anxiety, relationship conflict, workaholism, achievement addiction and imposter syndrome.
Practitioners use a combination of cognitive- behavioral therapy, acceptance and commitment therapy, dialectical behavioral therapy and mindfulness-based interventions in their work. For example, to treat imposter syndrome, Nelson helps patients challenge negative beliefs and distorted thoughts (such as “Others think I’m a fraud” or “I’ll never be successful”) using cognitive strategies including David Burns’ externalization of voices framework, the role-playing exercise that identifies distortions and encourages behavioral strategies such as self-disclosure.
Psychologists and other providers also rely heavily on Crossover’s internal referral system to optimize care. When one patient complained of ongoing back and joint pain along with other obesity-related difficulties during a primary-care visit, she received referrals for physical therapy, acupuncture and health coaching—and her work with those providers revealed that she was likely experiencing depression. After receiving psychotherapy, the patient reported an elevated mood, improved diet and exercise routine and eventually an end to her joint pain. “She really navigated the integrated-care model in a beautiful way,” Nelson says.
Kalus says many of her patients share similar stories—they’ve been struggling with depression or anxiety for years but never received treatment. “We’re working to both decrease stigma around mental health and to increase accessibility,” she says. “One thing that’s great about our behavioral health program is that it’s so normalized as just one of the many services we offer.”
Paying for care
At Crossover, contracted companies finance their employees’ health care rather than charging patient visits to insurance. “We’re not constrained by our providers being paid only when their patients continually come in for treatment,” says Nelson, adding that patients are typically more willing to access care when they don’t pay a fee for each visit.
As a result, the group offers an array of specialty offerings, including “lunch-and-learn” sessions on such topics as improving workplace communication. Some providers teach regular classes on sleep, postpartum recovery, and stress and anxiety. Others offer group therapy sessions, on-campus wellness workshops, and grief or trauma support groups.
Crossover recently began offering hourlong educational webinars—a session Nelson teaches on managing stress and anxiety is particularly popular—and will soon launch a virtual therapy orientation to educate new patients about the treatment process and to share self-help resources. “This can be really useful for reducing concerns around stigma or the anxiety that tends to come up when treatment begins,” Nelson says.
Where possible, Crossover tailors its offerings to dovetail with the priorities of its member companies. When several clients announced mental health as a 2018 company focus, the medical group amped up relevant class and seminar offerings on campus.
“These companies’ willingness to take a stand to help their employees has provided a great opportunity for us to partner up and emphasize the services we offer in the area of behavioral health,” says Gerber.
Data show that Crossover’s integrated model is popular, with a patient satisfaction rate of 96.3 percent.
“Ultimately, the biggest need that we meet is for access,” says Gerber, explaining what makes Crossover so popular with its members. “We have in-network, available, high-quality, cost-effective providers, care and resources for all of the services that we offer. We save people time and we empower them to get care that they otherwise may never receive.”
The Monitor’s “Adventures in Integrated Care” series explores the work psychologists are doing as members of interdisciplinary teams. If you have a story to share, contact editor Sara Martin at smartin@apa.org.
