Health Evolution | March 15, 2021
When Kyle Armbrester assumed the CEO role at Signify Health his reasoning was to move closer to actual health care.
After seven years at athenahealth, Armbrester stepped into his role at Signify Health in April 2017 and a little more than one year later the Company acquired Remedy to combine the worlds of home and community services with episodes of care as the industry transitions to value-based payments. Last month, Signify Health celebrated a significant milestone when they listed on the New York Stock Exchange under the symbol SGFY.
Health Evolution interviewed Armbrester about how Signify is integrating two different businesses, what to expect in the immediate and 3-5-year future, his advice for other CEOs, and more.
Coming from athenahealth, including serving as its Chief Product Officer, what attracted you to Signify Health?
Armbrester: Over the last five plus years, there have been a number of shifts in healthcare that led me to Signify. First, data is ubiquitous in the market now — digital connectivity, including the interoperability standards pushed forth by the government, and access to clinical and claims data is much more commonplace than 5-10 years ago. Second, costs are just so out of control. We’re spending $4 trillion on healthcare in the United States, and the growth rate is outpacing even GDP. Medicare is in bad financial shape, employers can’t afford health care anymore, and there’s a lot of waste in the system — people are looking for alternatives, but not everybody has the answer. We need economic incentives with financial transparency to really make any meaningful change. On top of all that, we are seeing a shift back to the home. Healthcare was born in the home, and is now returning as a key part of the care continuum. The home is where people are the happiest, least stressed and most comfortable. By opening the aperture to have recovery in the home, we can cut out tremendous waste, lower costs and drive better outcomes.
When we formed Signify Health in 2017, we wanted to be a catalyst for changing the facility-centric, break-fix model of healthcare that leaves far too many clinical, behavioral and social care needs unaddressed. We’re helping our clients – health plans, employers – achieve real outcomes for their members and employees, and we’re sharing in the cost-savings that come from ensuring patients are getting care in the most appropriate settings. I am so proud to be a part of this team.
What are one or two of the most distinctive aspects of Signify Health?
Armbrester: The first is that we have a physical presence with members. We are not engaging with people in the cloud. We’re in the community and in the home. The second is our scale. We work with almost every major health plan and all the large value-based health systems in the country. Our role is helping to connect the dots between those two rapidly converging worlds. We have a unique platform based on a long-term commitment to R&D that is driving value for plans, employers, providers and members. So we have an incredible ability to drive new technology-enabled services out of our core technology platform to continue to deliver value to customers. And it’s when we create value-based care with our commercial episode clients that we’re at our best and doing something truly unique.
On the face of it, you have two different businesses — home community services and then episodes of care. How do you bring those both together?
Armbrester: They are different but equally necessary to achieve the holy grail in health care: to be able to engage people in the home, to be able to take care of their needs holistically – physical, behavioral, social — and to do this within a value-based framework to achieve better outcomes. It’s through our Home and Community services that we are able to help push through the colloquial “last mile.” I feel strongly that it is critical to bring together the clinical capabilities we offer along with our deep partnerships with social service organizations to address all of the factors that ultimately determine a person’s well-being.
Our Episodes of Care business addresses the cost and value of that care and provides the framework to align clinical and financial incentives to drive the behaviors that will lead to the best outcomes. We are the platform enabling the shift from fee-for-service to value-based care for all who bear financial risk. We partner with those entities and share the risk with our partners. If an episode results in a bad outcome, such as a readmission or deterioration in health and costs go back up, we lose money right alongside our partners. All of this is powered by proprietary technology and analytics, but we go way beyond technology alone. It’s the combination of our platform and what we learn from direct engagement with patients, face-to-face that separates us from the other players in this space.
Kyle Armbrester, Signify Health
The trend of more care moving into the home began long before 2021 but we have certainly seen an uptick in activity since the pandemic. How has COVID-19 changed your strategy?
Armbrester: The pandemic, with the increase in use of telehealth and remote monitoring tools, certainly accelerated the move towards the home, and we believe this is a long-term trend that is here to stay.
With the expanded use of telehealth and remote monitoring tools, health systems also realized they could safely discharge people home to recover and help keep them home. Their eyes have opened to the possibilities of care beyond just facilities.
In addition, health systems saw first-hand the flaws in the fee-for-service model as patients stayed home in droves while payments from value-based contracts stayed intact. Over the course of the pandemic, we saw more and more of our partners leaning into episodes as value-based care proved to be more reliable than fee-for-service. Some of them dramatically expanded their total episodic volume with us in the middle of really tough times for the U.S. healthcare system.
I am proud to be part of the healthcare community’s rapid response over the course of the current public health emergency.
Looking a bit into the future, what should existing and prospective Signify clients expect in the next 18 months?
Armbrester: We’re going to continue expanding the scope of our network. We are already the largest convener of bundled payments for Medicare and we expect to keep building within that program. We will be deepening the stack of additional value-added services we can offer to the individuals who we touch. We’re bridging the gap between providers and patients with a focus on post-acute care that activates the home as an alternate site of care. Everything we do continues to be focused on lowering costs and improving outcomes.
And a little further into the future, what about the next 3-5 years?
Armbrester: Our goal is to continue to bring new entrants into value-based care by using our network and our payment alignment capabilities to show them the strong business case for a value-based model. We view ourselves as the engine behind value-based care and plan to be on the front lines of the shift from fee-for-service. With our extensive clinical network and access to the home, we’re also working closely with life sciences companies to support clinical trials and provide in-home support for patients requiring complex drug regimens.
Which accomplishments are you as a CEO and founder most proud of?
Armbrester: Every action we take at Signify is focused on leaving a positive impact on the world. I want to make sure that each and every thing I do is something I am proud to tell my kids about and proud to share with our employees. We’re connecting patients with healthcare resources to ensure they are getting proper rehabilitation and not ending up back in the hospital unnecessarily. We call them ‘mission moments,’ where we are helping them spend more time at home where they are happiest
Signifiers, as we call them, are one of the most engaged groups of individuals I’ve had the pleasure to work with. From the management team to the providers who are out in the field doing the hard work every day — we are all focused on improving healthcare outcomes.
What is the most difficult challenge you have overcome on the road to success?
Armbrester: The pandemic certainly was a major curveball for everyone. We moved to working remotely from home virtually overnight. We virtualized our entire operation and we scaled to hundreds of thousands of virtual patient encounters. We were called upon to provide workplace COVID-19 screening in a partnership with the CDC. We are at the forefront of helping to protect our patients from this virus while also charting a course for the future of healthcare.
What advice would you give to other CEOs and founders?
Armbrester: I always say this: Don’t be afraid to get your hands dirty and take on the biggest challenges. And, in healthcare, there are plenty to go around. Patients have suffered with an antiquated healthcare model for far too long. I’d advise other CEOs in healthcare to think long-term with an eye toward building a better healthcare system that will be a legacy for generations to come.
Last year obviously was a tumultuous year. What are you anticipating in 2021? Any expectations, predictions for the year ahead?
Armbrester: I think we’re going to see a ton of pent-up demand for elective and other procedures that have been delayed. Utilization will spike back up at some point. Consumers will be more engaged and they’re going to have expectations for convenience and access like they do in all other services that they receive. If I told you, “Your Uber is coming. I’m not sure when and I’m not sure how much it will cost,” you wouldn’t sign up for that service. Healthcare has to enable an Uber-type of customer experience – something that just has not been the case in the past.
I think that because of the pandemic, personal, public, and population health will be the conversation at every kitchen table this year. People want more convenience, better quality, greater competition, and price transparency. The same is true for employers. It’s been a long time coming. However, I believe we are close to the tipping point for a new model of healthcare that better serves us all. I’m excited to be part of that new world.
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