Signify Health, Inc. operates a healthcare platform that leverages advanced analytics, technology, and nationwide healthcare provider networks to create and power value-based payment programs.
The company is a market leader in the value-based healthcare payment industry offering a suite of total cost of care enablement services, including among others, in-home health evaluations (IHEs) performed either within the patient’s home, virtually or at a healthcare provider facility, diagnostic and pre...
Signify Health, Inc. operates a healthcare platform that leverages advanced analytics, technology, and nationwide healthcare provider networks to create and power value-based payment programs.
The company is a market leader in the value-based healthcare payment industry offering a suite of total cost of care enablement services, including among others, in-home health evaluations (IHEs) performed either within the patient’s home, virtually or at a healthcare provider facility, diagnostic and preventive services, ACO enablement services, provider enablement services, 340B referrals and return to home services. IHEs are health evaluations performed by a clinician in the home to support payors’ participation in Medicare Advantage and other government-run managed care plans. The company’s mobile network of providers completed evaluations for over 2.3 million individuals participating in Medicare Advantage and other managed care plans in 2022.
The company’s ACO services are intended to help its clients generate and receive shared savings. These services include, but are not limited to, population health software, analytics, practice improvement, compliance, and governance. The company’s solutions support value-based payment programs by aligning financial incentives around outcomes, providing tools to health plans and healthcare organizations designed to assess and manage risk and identify actionable opportunities for improved patient outcomes, coordination and cost-savings. Through its platform, the company coordinates what is a holistic suite of clinical, social, and behavioral services to address an individual’s healthcare needs and prevent adverse events that drive excess cost. The company’s business model is aligned with its customers, as it generates revenue when successfully engage members for its health plan customers and generate savings for its provider customers. As of December 31, 2022, the company had ceased operations in the former Episodes of Care Wind-down segment.
Solutions
In-home health evaluations and related services
The company has a large mobile network of credentialed providers in the United States, which it deploys into the home primarily to conduct IHEs and to perform select diagnostic services. Through its IHEs, the company creates a comprehensive, documented record of the clinical, social, and behavioral needs of its health plan customers’ medically complex populations and seeks to further engage them with the healthcare system. Working with data from its health plan customers, the company’s operating platform and advanced data analytics help to identify the highest priority individuals for an in-home evaluation. The company then engages with those members to schedule visits to perform IHEs. The company’s software guides clinical workflows, as well as in-home diagnostic screenings, yielding a rich patient report of hundreds of data points. The duration of its IHEs is up to 2.5 times longer than the average visit with a primary care physician (PCP). In performing these evaluations, the company also seeks to engage individuals more closely with the healthcare system.
In addition to providing health plans with insights into member health without taking members out of the home, the reports the company’s IHEs produce form a basis of the Medicare Risk Adjustment Factor (RAF) scores, which contribute to health plans’ ability to effectively participate in value-based and risk-adjusted government programs like Medicare Advantage, and affect the premiums health plans receive for Medicare Advantage beneficiaries. The data the company gathers is also a resource that can be used by health plans to improve their Healthcare Effectiveness Data and Information Set (HEDIS) scores and Medicare Advantage Star Ratings (Star Ratings). The company conducted over 2.3 million IHEs (including virtual IHEs) in the year ended December 31, 2022.
Telehealth through virtual IHEs
In response to the COVID-19 pandemic and in close coordination with its customers, the company accelerated its telehealth initiatives by launching virtual IHEs (vIHEs) in the second quarter of 2020. vIHEs primarily take place via videoconference. vIHEs have allowed the company to engage with high-need, vulnerable individuals during a critical time, ensuring that its health plan customers maintain detailed insights into their members’ health and are able to coordinate services accordingly.
Diagnostic and Preventive Services
The company offers Diagnostic and Preventive Services (DPS) to address care gaps when coupled with an IHE. Together, these integrated services create a more comprehensive and convenient care experience for the member. DPS help health plans close the risk and quality-based gaps in care of Medicare Advantage and Medicaid plan members, through the early detection, diagnosis, and management of some of the leading causes of morbidity and mortality. In-home screenings the company offers include spirometry, peripheral artery disease screening, fecal immunochemical test, urinalysis and estimated glomerular filtration rate, hemoglobin A1c blood test, retinal imaging and bone density ultrasound.
Comprehensive Medication Review
The company’s comprehensive medication review services provide members with an in-person medication therapy management solution, as required by Centers for Medicare and Medicaid Services (CMS) for Medicare Part D providers. The company’s providers thoroughly review members’ medications and adherence, discuss prescription regimens, answer questions, and provide educational resources and referrals.
Return to Care
Powered by the company’s proprietary data and technology, its IHEs can generate actionable clinical data, empowering health plans to more effectively predict risk and quality gaps - all during a single visit. When unmet care needs are identified, it coordinates the next best action with health plan members, leading to a more connected, effective care experience that also leads to better health outcomes.
Social Determinants of Health
In 2019, the company started utilizing telephonic outreach and comprehensive, in-home evaluations to directly identify the social determinants of an individual’s health (SDOH), such as food insecurity, slip and fall risk, access to transportation, social isolation, and the financial resources to afford medications. The company combines this assessment with IHEs and refer to this combined product as an IHE+.
ACO Enablement Services - Medicare Shared Savings Program (MSSP)
On March 1, 2022, the company acquired Caravan Health. Through Caravan Health, it supports providers participating in the MSSP. Providers participating in MSSP create an Accountable Care Organization (ACO), which is a network of healthcare providers and suppliers that work together to invest in infrastructure and redesign delivery processes to attempt to achieve high quality and efficient delivery of services. ACOs that achieve performance standards established by the U.S. Department of Health and Human Services (HHS) are eligible to share in a portion of the amounts saved by the Medicare program. MSSP has different risk tracks pursuant to which providers can assume greater risk in exchange for the opportunity to receive a greater portion of savings realized. The company served over 600 thousand attributed lives in 2022 and have verified attribution of over 700 thousand lives under management in 2023.
The company’s services include the following:
Data Integration and Analytics: The company sets up secure data feeds with its provider partners and are able to receive data from leading electronic health record (EHR) systems, which allows it access to real-time EHR data in order to quickly identify individuals with high healthcare utilization, co-morbid conditions, and/or unmet needs. The company’s analytics tools also identify areas of high variability with opportunities for improvement, generate comparative benchmarks to help providers measure performance relative to their peers, and power its 340B program offering. The company’s 340B offering includes services that assist qualified healthcare providers in identifying 340B program eligible claims.
Provider Enablement Platform: The company’s provider enablement platform presents data and the results of its analytics to providers in a convenient, easy-to-use format. The platform includes performance dashboards and regional and national benchmarks, highlights high-priority patients, and identifies if they are eligible for complex care management or have conditions requiring attention.
Patient-Facing Mobile App: The company offers providers access to its mobile app for patients, which provides patients with reminders for time-sensitive tasks, allows them to record their vital signs, educates them on certain conditions and how to manage such conditions, and provides them with a HIPAA-compliant platform to message their providers.
Incentive Alignment: The company assists ACO provider participants in developing, tracking and reporting on appropriate metrics in order to align incentives and maximize realization of shared savings.
Training and Educational Tools: The company provides its clients with a wealth of training and educational resources, including training providers on population health tactics and principles, information on best practices, specialized training in transition care management to stabilize patients post-discharge and reduce the risk of hospital readmission, practice transformation resources, preventive and care management workflows and staffing recommendations, and initiatives to promote evidence-based medicine.
Annual Wellness Visit Support: The company assists providers with patient outreach and scheduling of annual wellness visits (AWVs), provide them with workflows and data to support AWVs, and collaborate with them to offer patients in-home AWVs.
Quality Measurement and Reporting: The company provides tools and resources to help providers measure and track quality, and assist with reporting quality measures to CMS.
Distribution of Shared Savings: The company calculates, pays and distributes shared savings to participants in collaborative ACOs.
Compliance: The company offers providers and collaboratives ACOs assistance with training, advice and assistance in meeting MSSP and related regulatory compliance requirements.
Patient Education/ER Avoidance: In addition to the educational resources contained within its mobile app for patients, the company reaches out to attributed ACO patients to educate them on disease and condition management and available healthcare resources in order to reduce unnecessary emergency room utilization.
ACO Enablement Services – Non-MSSP ACOs
In 2022, the company launched its non-MSSP ACO service, and began offering health plans collaborative ACO programs. The company’s service offering includes designing and administering, such ACO programs, as well as recruiting and contracting with participating providers. The company leverages its relationships and credibility with providers participating in its MSSP ACOs to recruit providers for these health plan ACOs. Participating providers receive a suite of services similar to the company’s MSSP service offering, and it also shares risk with these providers, thereby aligning incentives and building trust.
Competition
Among the several pure-play companies, the company’s primary competitor is Matrix Medical Network, another pure-play company providing IHEs and other health risk assessments nationally. Some of the company’s key competitors operate nationally, such as Aledade, Collaborative Health Systems, Evolent Health, Vytalize Health, and Stellar Health. Other competitors, such as Equality Health and Physicians of Southwest Washington, are more geographically focused. Competitors that focus on analytics and software include Innovaccer, Arcadia and Cedar Gate. Other key competitors include Premier, Imperium Health, Main Street Health, and Hometown Health Centers.
Sales and Marketing
For each of the company’s primary service offerings (IHEs and ACO management services), it focuses its sales and marketing initiatives on three primary dimensions of growth: sales to new customers, cross-sales to existing customers and product expansion with existing customers. In order to successfully obtain new customers and to cross-sell solutions to existing customers, the company has a strong sales team that is organized by product/service offered. For example, the company has representatives dedicated to selling its ACO management services to new providers.
Intellectual Property
As of December 31, 2022, the company exclusively owned 19 trademark applications and registrations in the United States, including for the core Signify Health trademark. As of December 31, 2022, the company had two issued U.S. patents and one pending U.S. patent application.
Customers
The company’s customers consist primarily of health plans and providers. Revenue from the company’s top ten customers accounted for approximately 88% of its total revenue for the year ended December 31, 2022. With respect to its IHEs and related services, the company’s customers are primarily Medicare Advantage health plans and managed Medicaid organizations. The company serves 51 health plans in the United States, including 26 of the 50 largest Medicare Advantage plans. The company’s ACO enablement services are primarily directed at providers participating in (or seeking to participate in) CMS’ MSSP. The company’s non-MSSP ACO enablement services are directed at health plans and providers looking to launch programs centered around care redesign.
Government Regulations
A variety of laws govern various aspects of its business relationships and the company’s relationships with physicians and others who either refer or may influence the referral of patients or certain business or are the recipients of such referrals. These laws include, but are not limited to, the federal False Claims Act (FCA), federal Anti-Kickback Statute (AKS), the federal Physician Self-Referral Law (Stark Law), the Civil Monetary Penalties Statute, other federal civil and criminal fraud and abuse laws and similar state laws.
In addition, various states in which the company operates has adopted their own analogs of the FCA. The company is subject to federal and state laws and regulations that are designed to protect the uses and disclosures of certain types of individually identifiable data. These include the federal regulations promulgated under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that require the company to provide certain protections to individuals and their health information.
The HIPAA privacy and security regulations also require the company to enter into written agreements with its covered entity customers and its subcontractors, also known as business associates, to whom the company discloses protected health information.
A number of ACA (the Patient Protection and Affordable Care Act, as amended by the Health Care Education and Reconciliation Act of 2010) provisions impacted and continue to impact the company’s business and operations.
History
Signify Health, Inc. was founded in 2017 as a Delaware limited liability company. The company was incorporated in 2020.
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