Growing up in Indonesia gave Anthem’s Geoffrey B. Crawford, MD, a firsthand look at how a health care system shouldn’t operate.
He’s successful, handsome, and seems like a genuinely nice guy. Even his dog is cute. (He sent pictures.) So, as much as the Green Monster, (we’re talking jealousy here, not Fenway Park), might want to nudge you toward disliking Geoffrey B. Crawford, a medical director in Anthem’s office of medical policy and technology assessment, it just can’t be done.
Crawford, who has dual U.S./Canadian citizenship, lived in Jakarta, Indonesia, from ages 4 to 14 and a lot of other places growing up. They included Scotland and Calgary, Canada. His family moved around so much because his father worked in the oil and gas industry while his mother taught at international schools. The years in Indonesia were a major influence: They sparked an interest in medicine and population health “given my inevitable exposure to the gross health inequalities of a nonfunctioning health care system.” (Another young man who got there in a hurry also spent part of his childhood in Indonesia: former President Barack Obama.)
Crawford crushed it in school, graduating with distinction from McGill University, earning an MD magnum cum laude from Albany Medical College, and then topping it off with a master’s degree in epidemiology from the University of Maryland. He completed his internship in internal medicine at Stanford and residency at the University of Maryland.
So make no mistake: He’s ambitious. He also knows his limitations. “For something as complicated as health care, I don’t believe that any one person understands the system in its entirety,” Crawford says. “You have to try to see as much of that as you can while focusing on the one expertise that you’re trained in.”
He’s also capable of the pithy and insightful quote like: “Engineers have saved more lives in medicine than physicians.” When Crawford praises the work of engineers, he’s talking specifically about chlorination of the water supply, which indeed has saved millions. He is board certified in public health and general preventive medicine (population medicine), which reflects his interest in the overall health care system.
He thinks wellness proponents should make that an example—the best wellness programs would be those in which active patient participation is least.
“If you want to keep people healthy, if you can do it in a way to engineer health, you are more likely to be successful,” Crawford says. “Growing up and later, in medical school, I discovered how complicated the health care system is and I wanted to be involved in a way that’s meaningful to me.”
Crawford became increasingly concerned about the entire health care system.
“As meaningful as it is to impact patients’ lives on a daily basis working in a clinic or daily practice, I wanted to have influence on hundreds, thousands, even millions of people and can do that through the work we do at Anthem,” says Crawford. “I get satisfaction from impacting health processes at the system level.”
That may have a lot to do with why he is now a medical policy director for Anthem, which creates medical policy for all the company’s affiliated commercial, Medicaid, and Medicare medical plans nationwide. Crawford has been at Anthem for more than six years, first in clinical analytics, where he worked to bolster member engagement in evidence-based care, and now in the office of medical policy, where he works on clinical coverage policies used to determine utilization management and formulary decision making.
Wellness “ties into the evidentiary component of my position—evaluating the scientific literature to support evidence-based medicine.”
Crawford thinks that creating a team atmosphere is one of the more important aspects of being a physician manager. “Clinicians are particular types of personalities, so they’re going to try to solve the problem that’s in front of them,” he says. “And many of the problems in health care, if not all of them, are impossible to solve as one person.”
Wellness is a topic very much on Crawford’s mind. It “ties into the evidentiary component of my position—evaluating the scientific literature to support evidence-based medicine; as well, I provide clinical leadership for evaluation and implementation of preventive health service recommendations.” He appreciates the common criticism of wellness programs: They haven’t really been shown to improve health, let alone save money. “There haven’t been a lot of great studies that have shown that wellness intervention will ultimately lead to the type of health outcomes that we are looking for,” Crawford says. “Part of the problem is human nature. People think they’re healthy when they’re not feeling unwell.”
In wellness, as in the rest of health care, technology is not always the answer, in Crawford’s opinion. The person who could most benefit from IT-based solutions is probably the least plugged in. “I think those are solutions that make a lot of sense, but they’re really something that’s probably only going to be utilized by the young and healthy, or the curious.”
Still, technology could give wellness programs a boost. As an example, Crawford mentions a conceptual app that would use data about demographics, health care records, and consumer purchases to match behavior against evidence-based care. Digital reminders would tell people when they need health screenings and follow-up visits.
Wellness may be a somewhat nebulous term, but traditional medicine is always about the numbers. “We’ve developed a process at Anthem,” says Crawford. “All coverage decisions are based on evidence made by our medical policy and technology assessment committee, a majority of whom are external physicians from various specialties, practice environments, and geographic areas.”
That doesn’t necessarily lead to easy solutions. “It gets more challenging with the gene therapies that are on the horizon,” Crawford says, citing a study by the Institute for Clinical and Economic Review this year that states that the cost of gene therapies will equal the approximately $3 trillion a year that we currently spend on all health care. “There has to be a balance between affordability and care,” says Crawford. “Start with evidence and you’re in a good position to think about various solutions and strategies.”
Crawford also sees another shift on the way. “Everybody before the 20th century used to be cared for in the home,” he says. We now get care in the hospital because hospitals house the technology. But what if homes housed the technology? “We can go back to providing care in a way that makes sense, and that people enjoy, and that may end up being less costly, and utilizing technology to sort of bring back care to a human level,” Crawford says.
ACOs? While eyes in other heads may glaze over, ACOs are what excites Crawford most these days. Some details still need to be hammered out, he says, such as exactly how reimbursement should work in a pay-for-performance system. But he sees them as the nearest big chance of ushering in a new way of providing and paying for health care: “The ACO is where the data are being freely shared, where impediments are minimized, and where, as a clinician, you can hopefully see all of your hard work manifest itself in patients getting better.”
And, yes, Crawford is not spared the ubiquitous: Where do you see yourself in five years? He laughs, then responds: “In five or 10 years, I hope I’m doing exactly what I’m doing now, with more experience and more knowledge. Because there is so much to be learned.”