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February 2: Today on TownHall, This Week Health’s very own Bill Russell speaks with Josh Builder, Chief Technology Officer at Signify Health about value-based care and providing care in the home. How does technology take on the challenge of the fragmented system used to provide value-based care? What ideas did Josh bring with him to Signify from his experience outside of the healthcare industry? What are the technology challenges in Signify’s mission to provide care everywhere/in the home?

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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

When our, provider walks through the door to get them to that threshold. Is just a ton of technology. really fascinating complexities that technology is solving at scale.

And I think having that mindset that it's not all healthcare and that's okay. There's pieces that we wanna look outwards and look at best practices

then letting the healthcare piece, kick in and being okay with that. I think has driven a lot of our success.



Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.


All right. Today we are joined by Josh Builder, CTO for Signify Health. Josh, welcome to the show.

Bill, it's great to be here. Thanks for having me.

Yeah, I'm looking forward to the conversation. Signify Health Powering value-based care. We've been talking about value-based care.

We've been doing this podcast for about five years. We've been talking about it four or five years. There's a lot of challenges in really making value-based care work, and some of those are technology related. Some of them are people related. Signify seems to have identified. Ways to really make this work.

Tell us a little bit about signify to start us off. .

Yeah, sure. And you know, you've been talking about it on this podcast for five years, and I believe people have been talking about it for longer than you've had a podcast. Right. And I certainly haven't been in healthcare that long, but they've been talking about it for a lot longer than that.

So signify has taken A really new and interesting approach to it. And that is not coming at it purely from a value-based care approach, but bringing together a number of capabilities. Some are right down the center with value-based care which we can talk about and some at the start and the outset.

A lot of what we do in the homes are not necessarily on the surface. Value-based, care driven, but actually when assembled together under one roof, create quite a powerful set of capabilities that can drive value-based care forward.

Well, since you're the C t O, we're gonna, we're gonna focus in on some of the things that you know, one of the things that signify highlights is connecting fragmented systems.

And this has always been one of the biggest challenges. In value-based care, cuz it's not only delivered by one entity, it has to flow across multiple entities typically in the delivery of care especially complex conditions and those kinds of things. How do you take on the challenge of fragmented system?

How does technology play a role in taking that on?

It's a great question and one that, was top of my mind when I joined Signify. And before I, I get into the tech piece of it, there's actually a huge. Organizational and cultural piece to it. My background is across a number of industries in technology fitness, healthcare.

Now I was in the fashion logistics industry the music industry. I've seen technology at play under a number of different growth companies who have assembled. Technology to really go at solving complex problems. And what was super important to me when joining signify, because healthcare is so fragmented, value-based care is so fragmented as you point out, was that technology was front and center to the organizational and strategic principles of signify health.

It wasn't just a cost center, it wasn't something we needed to do on the side. It wasn't in service of. It was right next to right alongside everything else that we were doing. And I know that that sounds a little soft, but to me it all starts from there. You have to look at technology as driving the solutions and not just a, thing that comes in afterwards to clean up.

And so, that has enabled us to build, really sophisticated. Technologies around interfaces, , best in practice, data, , technology stacks logistics and supply chain technologies. And really looking at these as products that drive value as opposed to coming in after the fact to try to retrofit it onto the way healthcare has worked or, an existing pattern.

And that has freed me up and the team. To be able to build some really cool things and pull in best practices from across technology companies and put them at play, in the value-based care space.

You came from other industries and we, we have these conversations a lot.

We've had some people who've come in from other industries, some CIOs, CTOs, who are actually with healthcare organizations today. And it's interesting to have the conversation around. What did you bring over? Like what, what thoughts, what ideas, when you came into healthcare, did you look at and say yes specifically?

I could, I could bring these kinds of things over because I think it will, smooth out this experience that we're having in a certain area. .

Yeah. A number of things I'm trying to, think about if one rises to the top. It is probably the concept of abstraction. And I'll, unpack that a little bit.

I, think what I've seen , in a lot of healthcare, and not just healthcare, but certainly healthcare is a lot of the technology in the. Solutions that are at play are embedded and built for a specific thing that, you know, had , a set of rules and wanted to work a certain way and, , it was automated and done, you know, done well and automated really well, but really a single pointed solution as opposed to taking these sort of abstracted concepts out and building them so that they can.

be Reused by a number of different components of the business and enhanced and been made more flexible and put on infrastructure that supports it so that, signify, as I said, is a number of different components, use a lot of the same common frameworks and abstractions that drive technology, that drive the business forward by using technology.

And I, I was surprised at how new that felt, in, healthcare where there's a lot of point hard coded point solutions. I, I mean, I can go into more detail. Was that

No, no, no. I, that's the, don't, don't wanna geek out with you. But I remember when I came into healthcare and I started talking about service oriented architecture, and people were looking at me like I had a third eye and I'm like, okay, how do I make this.

I mean, that was back in the day, but essentially what was happening is you end up with these systems that calcify over time. It's just exactly right. They were great at one point, and they don't move as you go forward.

Plus the, data gets locked up in various systems making it harder. One of the challenges that signify decided to address was really care everywhere, care where people wanted to receive care. There's certain technology challenges along with that as well. Can you talk about those a little bit?

Yeah, absolutely. It's like, you know, perfectly related, which is, there's a huge part of signify, there's massive part of delivering care where folks are at. And for your listeners, signify meets folks in their homes across, all 50 states at scale, across America.

There's huge aspects of the technology that drives that, that have nothing to do with healthcare, that are supply chain logistics, marketplace driven supply and demand algorithms and data science that are matching that are just more like, Uber like models or these, these large, sophisticated marketplaces that can, match capacity with supply and with demand, and really do that elegantly and do that to support a, number of different types of interactions, in the home.

And so, looking at technology, looking at the, the basis that you need to jump off from that as not a cost center, but frankly a huge opportunity for, Revenue growth and delivering care and building out that infrastructure is ingrained in the ethos of signify and, really supports a ton of that work.

And then you jump off of that big foundation to a lot of the clinical stuff we do when we're in the home. But, when our, provider walks through the door to get them to that threshold. When they start , to give care is just a ton of , technology. Really fascinating complexities that technology is solving at scale.

And I think having that mindset that it's not all healthcare and that's okay. There's a really, really healthcare piece. And then there's pieces that we wanna look outwards and look at best practices from an infrastructure standpoint, from a, how we've solved the nearest neighbor problem. And really bringing that.

in And then letting the healthcare piece, kick in and being okay with that. I think has driven a lot of our success. 📍

📍  All right. We're doing webinars a little different this year. As we have told. You got a lot of feedback from the community about what works, what doesn't work. We talked to our advisors, our cio, CMO advisors, and they said, Hey, Community generated topics, great contributors, not product focused. They want the questions ahead of time so that they can incorporate them into their answers. And they want a forum that is honest and open. And what we decided was once and done. If you're at the webinar, you get to hear the content. If not, it's not on demand. You don't get to download it later. We're gonna do it on a consistent date and time, and our next one coming. Is February 2nd. It is priorities for 2023, and this one is around academic medical center. So we have some great leaders who are gonna come in and discuss the priorities for 2023. We're gonna continue to just bring great content, community generated topics and keep the discussion going. If you have feedback, love to hear. And if there is any questions you have, go ahead and fill out the registration form and you have a space there to give us your questions ahead of time. We wanna make sure that we cover the topics that are of interest to you. website, top right hand corner. Sign up today. Love to see you there. 📍

  📍 so you guys are looking at more than just the clinical side. You're looking at the social determinants side, the behavioral side , and those kinds of things with, or you're bringing that data together as well.

Yes, absolutely. And, to your earlier question, that sort of speaks to the, things that signify has under one roof. So not only do we have all the logistics and that, marketplace that I was talking about, about managing, doctors out across America but we also have the ability then to connect what happens after that.

So not only do they come and The care necessary. But what happens next? What happens after that? And how do we then build the, care coordination aspects that continue to drive, you know, drive that forward and do that under a number of different payment schemes and do that to support fee for service where it makes sense, but try to move folks to value-based care where we can with all of those tools under our arsenal.

Are you guys doing anything with internet of Things and those kinds of things in the home?

Yeah. Yeah. No, it's a great question. We continue to watch it, that's for sure. We continue to watch it and we support it. We have investments in a number of companies we've partnered and.

It's a huge interest to us. We have not gone all in ourselves on us single point solution for an, an IoT T type device in the home. But rather we've decided to work, to support. And there's a number of reasons for that. One, it continues to evolve , every day, every month.

The, the advances there are huge two. , it's still tough, in a senior population , to get in and get those devices to work the way that they're supposed to to get them connected to the internet, to make sure they stay on, to remember the wifi pack. Like, just the real basics of having that stuff work in our population service is just difficult.

I want to talk to you about data and analytics and probably it's two separate topics. First, I wanna talk to you about data. you know, One of the biggest challenges in population health in value-based care has been getting the, data that you need in order to gain the insights that you need.

Because a lot of that stuff is either in non-integrated systems, disparate systems, siloed systems, fill in the blank. And those all might be synonyms if I thought about it, but at, at the end of the day, it's, hard to get that data. How have you been able to sort of, , get access to that data and make that available to garner the insights that are necessary to drive value-based?

I didn't realize when I first started, how rare of an opportunity signify had. And now I've come to see it as really something special , and something we don't squander. And I, I'll get to that. , but first, I mean, we do all the, basics that you would imagine, right? We're pulling in data from everywhere and everything that we can get and we're cleaning it and storing it , and making it available.

So, to me it's like we're right on par with getting all the, cleaned and readily available, data. The question for me and us is like, well, what do we do above and beyond that, right? And how do we, continue to enhance that data to make it. interesting and insightful on an individual level, but also a population level.

And that gets back to, a little bit of the secret sauce, which is when you go and you spend time with someone in their home, you learn all kinds of things. It is a massive opportunity out in the world to sit with another human being and see things with your own eyes. Ask them questions and just really have conversations and learn.

About things that don't come in feeds or, have changed over time, et cetera. And I think we have. Squandered that opportunity. And so we've made sure that, we empower our clinicians out in the field through our technology, but also, you know, our technology empowers them to use their skills to ask the right questions, observe the right things, and then we get to collect that data and lay it up alongside to really paint these whole pictures and make that, incredible, incredibly valuable from a longitudinal stand.

And I think it's really hard to get that stuff unless you walk into someone's living room and have a conversation.

There was this concept we were working on when I was at the health system back in 20 12, 20 13. We were talking about the whole patient profile and how important it is to the clinician to have that whole patient profile.

Not only obviously the clinical data, but all the other data that goes along with it because we're, able to be more specific about how we help them be more targeted about how we help them. Some people might need clinical care, but some people might need other kinds of care. Do you find that the, insights are driving a more relevant care path for the patients that you're serving?

And how do you do?

Yeah. Absolutely. And in two way I'll get to the how, , but in two ways. I mean, sometimes if all we learn is that the information that we had is correct. That's actually a pretty big insight in and of itself. Just validating what we know.

And then we learn, de novo things when we're, in a visit. And that's, that's really great. And then, this is actually a really fantastic. Bridge between the sides of our business in terms of the, capabilities to go into someone's home, but then the capabilities to, manage what happens after that in a total cost of care, a more value-based like scenario.

And what are the actions you can take after a visit to drive savings, right. To drive savings and to drive outcomes. And, how do you bring one, you. Bring those insights forward. And a lot of, what we're working on now is the connective tissue , between those so that we can scale it, we do it.

But really to your point, how do we use data science in the right places? How do we use, the right decision making and analytics capabilities? How do we empower that so we can glean the learnings to help us build those next pathways? . That's stuff we're hot in pursuit of, but we're also continuing to do it manually now in some areas, cuz we learn a lot from just seeing what happens from point A to point B to point C.

So I think we're pursuing both of those. And again, operating under a number of different payment constructs, the fee for service world, but also the value-based in the various types of value-based arrangements. We get to see all kinds of things and how that plays.

Lot of exciting things happening at Signify Health. Josh I really appreciate your time and thanks for, sharing. , Uh, the journey that Signify Health is on, really appreciate your work.

Great, bill. Thank you so much, much appreciate it.

  📍 gosh, I really love this show. I love hearing what workers and leaders on the front lines are doing, and we wanna thank our hosts who continue to support the community by developing this great content. If you wanna support This Week Health, the best way to do that is to let someone else know about our channels. Let them know you're listening to it and you are getting value. We have two channels This Week Health Conference and This Week Health Newsroom. You can check them out today. You can find them wherever you listen to podcasts. You can find 'em on our website this, and you can subscribe there as well. We also wanna thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.


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