A man jumps rope during an outdoor CrossFit workout in Oceanside, New York on July 20, 2020. Credit - Al Bello/Getty Images
CrossFit CEO Eric Roza would like to know if I have a primary care doctor. When I sheepishly tell him that I do not, he grins. I’ve just helped prove his point that the traditional primary care system, the one rooted in doctor’s offices and hospitals, isn’t working as it should.
My lack of a doctor is “indicative of the problem,” he says. Traditional primary care “takes time, it takes money. You’re not seeing the value, right?”
That problem is what CrossFit—a fitness company famous for high-intensity workouts that combine weight lifting and cardio, and infamous for a string of controversies related to its prior CEO—is trying to solve with its latest offering, CrossFit Precision Care. Roza says the subscription-based telemedicine program is meant to replace traditional primary care, offering clients access to both a physician and a health coach who can help patients draft and follow personalized plans in pursuit of their fitness, nutrition and overall health goals.
CrossFit boasts that it is the first fitness company to offer its own primary care services, but its program fits into a wider trend in the medical space. Private companies are increasingly cutting out the middlemen—namely health insurers and health systems—and connecting patients directly to doctors, sometimes charging a monthly or annual fee in lieu of insurance to finance the operations and keep the patient-to-doctor ratio lower. Forward Health, which recently raised $225 million to expand nationally, charges patients $149 per month to work with doctors who create personalized plans for maintaining long-term health. (TIME owner Marc Benioff is an investor in Forward Health.) One Medical—which, unlike many medical startups, accepts insurance for visits—offers easy-to-make appointments and on-demand virtual care to members who pay the $199-per-year membership fee. And for those who want truly white-glove service there’s Private Medical, a by-referral-only service that caps its doctors’ patient loads at 50 families—all of whom are reportedly willing to pay at least $40,000 per year for their services.
While their exact models differ, all of these businesses aim to deliver better care with fewer hassles and less waiting. They also take primary care beyond the hospitals and family practices where it has existed for decades and wedge it squarely into the startup ecosystem. The disruption economy has come for health care, recognizing that the $260 billion Americans spend on primary care each year is a massive business opportunity.
The success of these businesses demonstrates that people are willing to pay to skip the line and receive individualized attention, says Evan Cole, a research assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health. But improving access for the wealthy isn’t the same as fixing primary care.
“My big concern, at a system level, with membership fees is you’re going to systematically exclude individuals with limited income,” Cole says. “Right there, you’ve got an issue with health equity.”
It’s not hard to understand why entrepreneurs and their investors are eager to jump into the primary care space. In the traditional primary care world, it’s not uncommon for a patient to wait weeks for an appointment with their doctor, then spend more time in the waiting room than the exam room. A primary care physician may have more than 2,000 patients on their roster, meaning it’s highly unlikely they’ll remember your specific health history and concerns—particularly when they have only about 20 minutes to spend with you, due to packed schedules and administrative demands. As of 2015, 25% of Americans didn’t have a primary care physician at all, according to a JAMA Internal Medicine study—a problem that may get worse in the future, since the U.S. is projected to be short up to 48,000 primary care doctors by 2034.
But primary care doesn’t seem like the most obvious match for CrossFit. To start, it hasn’t been part of the health care system until now. The company has also never shaken the perception that its intense workouts, which often involve grueling cardio circuits and Olympic weightlifting moves, can push people too far and become dangerous. Former CEO Greg Glassman, who left the company last year after making offensive comments following the death of George Floyd, told the New York Times in 2005 that CrossFit “can kill you.”
Roza, a longtime CrossFit fan and tech entrepreneur, bought CrossFit shortly after Glassman stepped down, and says one of his top priorities is making it a healthier company, both culturally and for its gym goers. He says the lingering perception that CrossFit is dangerous “vexes” him, and maintains that its workouts can be safely modified for anyone.
The Precision Care program is part of Roza’s effort to make CrossFit healthier, partially inspired by his own experience with direct care, which he says is more convenient and effective than traditional primary care. “That people deserve better than today’s primary care model is an honest statement,” he says. “I don’t say that to be controversial.”
CrossFit’s program was developed by CrossFit-loving doctors in partnership with the relatively little-known personalized medicine startup Wild Health, which counts two doctors among its co-founders and claims to provide individual health recommendations based on patients’ DNA, blood tests and lifestyle habits. In addition to personalized medicine, the Kentucky-based company also dabbles in COVID-19 testing and ketamine therapy.
CrossFit Precision Care has not officially started up yet, but it is currently allowing people in eight U.S. states to join its waiting list. Dr. Julie Foucher, an avid CrossFitter who helped design the program, says it will expand to the rest of the country next year, gradually adding more doctors depending on how many people enroll. Clients will fill out a slew of surveys about their health, habits and goals and go through a battery of blood and DNA tests, Foucher explains. They’re then matched with a doctor and health coach, who develop a personalized health plan for each patient and are available for virtual appointments to help their charges stay on track. Though Roza describes it as a replacement for primary care, there are limitations: since the whole thing is virtual, you couldn’t go for a flu shot or a physical exam, for example.
Foucher says the opportunities far outweigh the limitations. “We want to try to set up a system that actually addresses those root causes [of health problems], which most of the time come from our diet, from the ways that we move, from the ways that we sleep, from the ways we interact with people, and the ways that we recover or manage our stress,” she says.
The program is largely focused on correcting those issues with individualized recommendations about sleep, fitness and diet, based in part on the client’s blood and DNA test results. Personalized medicine of this sort is a promising field, but it’s also a new and largely unproven one. For years, experts have warned that promises of personalized diets and other lifestyle fixes have been monetized before the science is ready.
With subscriptions priced around $100 a month, CrossFit Precision Care is, indeed, a money making opportunity, whatever its underlying motives. Even the recommendations its physicians offer can contribute to the bottom line. When listing examples of lifestyle fixes that might come up as a result of the program, Foucher mentions new rest-and-recovery routines, dietary tweaks—and, unsurprisingly, CrossFit classes. When I ask Foucher what she’d say to someone skeptical about receiving medical care from a company with an incentive to push its own services, she says she “hadn’t thought about it previously.”
“Obviously we love CrossFit and we’d love for more people to do CrossFit,” she says, “but we’re not trying to push it on anyone.”
Dr. Anupam Jena, a professor of health care policy at Harvard Medical School, guesses that the program’s affiliation with CrossFit means it will largely attract people who have disposable income and are already fit and health-focused. “It’s really designed for people who are affluent…and who probably would have done just fine anyway,” he says. “I don’t know that that’s the place where we have a primary care problem.”
For that matter, Jena says he isn’t confident any of the primary care startups currently operating in the U.S. have fixed systemic problems. While they can streamline the appointment-making process and cut out wait time for patients who can afford to pay, he hasn’t seen much data to suggest they lower health care spending or lead to significantly better outcomes for patients. Since many direct care clinics do not accept insurance, eliminating the insurance claims that researchers rely on for data, it’s hard to track the care they’re delivering, Cole explains.
In Cole’s view, policy fixes to the existing primary care system would go further than launching startups that many people can’t afford to use. Enabling nurse practitioners and physician assistants to practice independently could make it easier to get appointments, he says, and establishing higher minimum insurance reimbursements for primary care could incentivize doctors to practice in—and improve—the field.
CrossFit’s Roza sees it differently. In his view, the traditional system has had its chance and failed—and he wants to be the outsider to step in and fix it. “We know how to keep people healthier than the traditional health system,” Roza says. “So let’s give it a try this way.”