What clinicians see in the home vs. the office

Paymon Farazi, President, Signify Health, discusses the benefits of In-Home Health Evaluations and how they help simplify care for members, their primary care providers and health plans.

• Signify Health maintains the trust of its health plan clients by connecting their members to care where they are most comfortable and accessible, Paymon says.

• Paymon shares the story of his recent “ride along” with a Signify Health clinician, and how he observed her documenting a range of social and clinical data points during an In-Home Health Evaluation.

• Signify Health clinicians are physicians, physician assistants and nurse practitioners. “Their capabilities … would surprise a lot of folks,” Paymon says.

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Matt McGuire

A lifelong writer, editor and content strategist. Senior Manager, Enterprise Communications, CVS Health

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Big Questions Answered helps us understand important CVS Health initiatives by taking a closer look at new products, powerful innovations and the big changes the company is making to achieve its strategic imperatives and build a world of health around every consumer. The company's senior leaders answer big questions from host Matt McGuire.

Matt McGuire
Signify Health believes that one of the ways to bridge gaps in care and remove barriers to care is through In-Home Health Evaluations. Last year, Signify clinicians saw more than 3 million health plan members across the U.S. with the goal of improving their lives and health outcomes. These clinicians are physicians, physician assistants and nurse practitioners.

In this episode, we'll learn about the information clinicians can capture during these in-home visits, what clinicians see during In-Home Health Evaluations that physicians can't during in-office visits and how Signify Health helps simplify care for members, their providers, and health plans.

Welcome to Big Questions Answered, a podcast that helps us understand the important initiatives at CVS Health. I’m Matt McGuire from the Enterprise Communications team. I’ll be your host as we take a closer look at new products, powerful innovations and the big changes we’re making to achieve our strategic imperatives and build a world of health around every consumer. Thanks for joining me today as we get our big questions answered.

I'm here with Paymon Farazi, President of Signify Health. Paymon has been with the company since 2022, and was named president in 2023, the same year CVS Health acquired Signify. In his role at the company, Paymon works with health plan clients, clinicians and colleagues to bridge gaps in care for millions of health plan members across the U.S. through In-Home Health Evaluations. Paymon, thanks for joining me today.

Paymon Farazi
Thanks, Matt. Pleasure to be here.

Matt McGuire
So, let's start by talking about how Signify Health works with health plan clients and how the business engages members across commercial, Medicaid and Medicare Advantage plans. Can you tell me what are some of the opportunities health plans have when it comes to improving the health of their members? And how does working with a company like Signify help?

Paymon Farazi
Sure. It's a great place to start because, honestly, our whole business hinges upon our ability to earn and maintain the trust of our health plan clients. And our health plan clients come to us for a variety of reasons, but probably the easiest way to describe it is they're trying to connect members to care in more meaningful ways — in ways that meet those members where they want to be met.

Oftentimes, we're given lists of people who have no connection to a primary care provider or specialty care. That can be very problematic for a health plan. And not just for the health plan, but also for the member themselves, and that they're not taking care of themselves in a proactive way. To be more specific, roughly, you know, 20 to 40% of membership, and that's a range depending on the health plan, does not have a primary care provider they see on a regular basis. So, Signify Health can help fill that gap for health plan clients to go see those people and not just sort of reach out to them and schedule an appointment which itself is one act, but, more importantly, meet them through the modality that makes the most sense for them.

So, that home modality or that virtual modality helping increase the reach to those people again who are not connected to care. And besides that, even if you do have a primary care provider, we're oftentimes able to provide additional value to the plan simply by doing the work that oftentimes gets missed in the primary care setting. And what I mean by that is that in the home, you're able to see a lot more than you could see in an office. You could see falls risk, you can see food insecurity issues, you could see transportation issues in a more meaningful dialogue with that person. So, that gives you some sense of the various ways in which we can help paint a broader picture and which brings health plan clients coming back each year.

Matt McGuire
Yeah, that's interesting. So, with advance approval from health plan members, you've actually had the chance to tag along as an observer with Signify clinicians to see how they complete In-Home Health Evaluations. Based on your first-hand experience, can you walk me through Signify’s In-Home Health Evaluation?

Paymon Farazi
Sure. One of my favorite things to do is to do ride alongs, which is the phrase we use to describe joining a clinician. And I would say that this stems from an ethos of mine and the company’s, which is all around customer obsession. And customer obsession is of course applicable as we shape the current and future state of Signify Health.

So, I was able to do a ride along, I don't know, about two weeks ago. In this particular case, I'll just give you a specific example we'll call the member Mike and the doctor will say it was Dr. Brooke.

So, we walked to Mike’s home, and Mike lived with his wife in the basement of his stepdaughter's home. And you could tell right away that there were mobility issues, immediately, kind of, bringing to life like why we're there.

So, Brooke starts out by, you know, basically sitting Mike down, asking him some basic questions. One of the first steps we often take is we ask them for all of their prescriptions and supplements. So, he had a relatively large cardboard box full of different drugs that he had been given. And Brooke the whole time is, of course, trying to make sure that there are no sort of indications of problems where two drugs might be conflicting with one or the other. And then we move to a more detailed history of all the different diagnoses of what Mike could have been experiencing. So that that should give you some flavor of what those visits are like.

Matt McGuire
Yeah. So, Dr. Brooke or other clinicians who document visits like these, they're putting together a report. And I'm kind of curious, who are these reports being shared with after the visit?

Paymon Farazi
So, the visit itself is a moment in time that then requires coordination across the system. And this is an area that we've been investing more in to become better at, basically. So, very simply, we fill out this form and it is a lot. I mean, this is comprehensive as a form can get in terms of an assessment of a person's health. So, think of like a thick packet of information. We share that data with their health plan. We also share referrals. Twenty percent of our visits result in some sort of referral, whether it's the PCP visit or they need, you know, help with food or something else.

The last thing I will say that we share is at the end of the visit, we have a write-up that we share with the member. And then we ask the member to take it to their primary care doctor and talk about the next steps they might take.

Now what's on the form could be something like a de novo diagnosis, it could be something around, you know, you need a prescription refill, or you could need somebody to take another look at your prescriptions and decide whether they're at the right dosage level. What we’ve been investing in more and more over the last couple of years is the ability to take that a step further. And what I mean by that is how do we help actually coordinate care? How do we help actually schedule the appointment? How do we help share the data with their primary care provider in a more seamless and effective way? And so that you'll see more and more of from us as we continue to evolve and invest in our capabilities there.

Matt McGuire
So, Paymon, the Signify Health model is powered by a strong national clinician network. Can you tell me more about who is a part of this clinician network and how they enable Signify’s success?

Paymon Farazi
Yeah, the clinicians are, I mean, we have obviously lots of important members of the Signify team, but they are the experience for the member, obviously, right? The member sits in front of that clinician for that meaningful visit. And that clinician is everything in terms of earning the trust of both Signify and our health plan clients. So, they're, an obviously a really important constituent to Signify's success. It's oftentimes like misunderstood who they are. They have to be either an M.D., a nurse practitioner or a physician assistant. Those are the only three credentials that are allowed in our network. And then those folks go through a pretty rigorous application process and become members of our network. And then we have standards that they have to meet on an ongoing basis.

It often surprises people, the variety of folks that have decided to work with Signify. It really is quite a variety of humans, and again would surprise a lot of folks in terms of their capabilities and their connection with the system. So it's it's much broader and sort of at a much higher level of people would realize.

Matt McGuire
From what you’ve shared with me so far, it sounds like one of Signify Health’s core priorities is simplifying health care for members, primary care providers and health plans, and I'm wondering if you agree and if so, could you walk me through how Signify Health does that?

Paymon Farazi
Yeah, that is exactly the goal, right? I keep talking about the North Star as the customer. Obviously, the best way to serve our customers to solve more and more of their problems or to simplify what is a very complex industry from their perspective.

So, there's a lot of ways that can be done. I mean, I'll pick the primary care provider because you mentioned that as one of the constituents. Today these folks are asked to do an inordinate number of things while in the 15-minute office appointment. This is simply not reasonable. Signify has the ability to go do things in the home setting, see more information. Let us do that data collection on your behalf. Send to the primary care provider and help solve their acute problems or their chronic conditions. You'll see us do more and more with primary care partners in that regard to help make it easier for them.

Similarly on the health plan side, I go back to, like, connecting somebody to care is where they're missing the ability to take care of these people. And not just connect them for an in-home visit but then connect them to care management or connect them to the follow-up care. I mentioned a lot about how we're developing capabilities in that direction. That's making things easier and easier for health plans. Another click of detail there is obviously gap closure. Gaps in care is a really important focus area for health plans. We get a lot of questions around, “OK, you're there, how can you help me close gaps around whether or not somebody's adherent to taking statins for cholesterol lowering drugs?” for example. So, there's even more we can do to help simplify things for the health plans.

And then on the member side, I often think of it as what would I do for my parents, right? Because they they're at that age where they could certainly use these in-home visits, and it's very similar to what I've described so far. I want somebody to come visit them once a year that takes a comprehensive view of their healthcare, like, what's going right, what's going wrong. And really, like, I almost think of it as like a second opinion but really like a second viewpoint on what it is that you're doing. And say, yeah, you're on the right track or you should ask these questions. Like, it's always helpful to get another perspective on what it is that you're doing to take care of yourself and making that something that we've built already but make it easier and simpler for them. And then again, as I said earlier, not just doing that for them, but making the next step easy. How can we allow you to activate that care journey and keep going down the path of taking care of yourself is a key area of focus for us going forward.

Matt McGuire
That's that's excellent. So if I could ask you to take a step back and kind of look at the horizon. Could you tell me what lies ahead for Signify Health?

Paymon Farazi
Yeah, it's similar to the themes that I've touched on so far. For the member, as I said, the North Star there is solve their problem. That's how I put it very simply. Or or to be more specific, solve their health care problem. And there's a large number of ways in which they experience friction today with the industry, whether it's getting a card from their insurance company, or finding access to transportation to a doctor's appointment. There's a variety of ways in which they deal with us as an industry that are difficult. And our job as our North Star is how can we solve more and more of those problems.

Matt McGuire
I love that. Paymon, thank you for stopping by. I've had a great time talking with you.

Paymon Farazi
Anytime. Thanks, Matt. I appreciate it.

Matt McGuire
And a big thanks to you for tuning in to this episode. Until next time, I'm Matt McGuire. I look forward to joining you again to get more big questions answered.