After $15B in care, Norwalk firm readies for hiring push

July 29--In a state like Connecticut where the four largest health insurance carriers employ thousands, including Aetna, which nearly moved to New York City, a summer hiring push by a newfangled insurance startup might not be top of mind for many.

But when the hiring push is by the man who created more than 3,000 jobs in a previous go-around, that company is about to get a fresh dose of attention -- in both Connecticut and New York.

Under founder Steve Wiggins and CEO Chris Garcia, Norwalk-based Remedy Partners is nearing the close of a contracting cycle that Wiggins and Garcia expect will double the size of the company, which has 380 employees today including 120 in Norwalk and about 150 in New York City.

Remedy to date has raised more than $100 million from investors to push ahead with Remedy's insurance model centered on "episodes of care" in which doctors work with patients to define a sought-for outcome to a medical treatment for a specific ailment, with Remedy then negotiating prices covering the full arc of that treatment. Teams then work throughout with patients, physicians and carriers to achieve that result.

If a simple premise, behind the scenes it is a complex undertaking to structure insurance coverage for individual episodes of care and manage cases to their conclusion. And Wiggins estimates at more than a year the time it takes to land a hospital or clinic as a client, train their staff and launch the platform.

"Patients have a right to understand what of set of health care services should cost," Wiggins said. "Our job is to help each of those parties -- physicians, hospitals and patients -- to improve the communication and the outcomes and the relationships between them, so that you get better faster and you get back to your regular life faster.

"It just so happens that we do that around a patient's condition -- the same way that people engage with the health care system, when they have a big event in their life," he added. "Our business is built around defining those events, putting a framework around what services are included, what the price should be, what's a fair (or) unfair price, and trying to encourage efficiency."

November worries

The antecedents of Remedy Partners extend back to the 1990s, when Oxford Health participated in an experimental trial in purchasing bundles of services with the Mayo Clinic, creating fixed-price coverage for patients undergoing organ transplants.

Wiggins had founded Oxford Health Plans in Norwalk in 1984 and ran it until 1997, with the company moving its headquarters to Trumbull and getting bought out in 2004 by UnitedHealthcare for $4.9 billion, which continues to sell insurance in Connecticut under the Oxford name.

After leaving the company, Wiggins began investing in health startups, including Norwalk-based HealthMarket, which was the first health insurance plan to rely upon episodes to define and manage risk as its core business.

Wiggins created Remedy in 2011 in Darien, where he lives, with the company moving to Norwalk early this year -- it is still working to complete its office at the 800 Connecticut Ave. building that is home to Booking Holdings.

The Remedy approach germinated during the administration of President George W. Bush and was subsequently planted in the Affordable Care Act by the Obama administration. Garcia estimates Remedy Partners has generated about half of the coverage to date for medical treatments since the program debuted, or roughly $15 billion in total across 300,000 treatment episodes.

"Obamacare had two principal components: it had this idea of getting insurance to more people through (state) exchanges, and then it had payment reform as another part," said Garcia, who lives in Fairfield. "Payment reform has continued to track on from the previous administration through this administration."

Wiggins said the company became profitable in 2016.

With then-candidate Donald Trump promising to dismantle the Affordable Care Act before being stymied after taking office, Wiggins admits the rhetoric had him worried about the future of Remedy given its early dependency on the ACA experiments with bundled payments, but the program remains intact and interest is gaining in the health-care sector.

Remedy Partners is now nearing an August deadline for a new round of renewals and new program entrants. Wiggins said 92 percent of Remedy's customers are renewing the program this year, representing 97 percent of the total volume of patient care it helped underwrite.

Law of large numbers

In Connecticut, Stamford Hospital and Western Connecticut Health Network have received reimbursement for services under the Remedy platform, the latter's hospitals including Danbury Hospital, Norwalk Hospital and New Milford Hospital. Yale New Haven Health has used a rival bundled payments service, with the hospital group's affiliates including Bridgeport Hospital and Greenwich Hospital.

If Remedy doubles its customer base as Wiggins and Garcia expect, Remedy will require more people, with the company already listing a handful of jobs in Norwalk and New York City. Wiggins did not rule out seeking state incentives to sway hiring toward Norwalk.

Even as Remedy pushes ahead with the newest government contractual cycle, last month the nonprofit National Alliance of Healthcare Purchaser Coalitions announced it is working with Remedy to make more employers aware of its platform. The National Alliance represents some 12,000 entities that purchase insurance to cover 45 million people, with annual premiums of $300 billion.

In an industry where insurance actuaries are paid for their ability to forecast the laws of big numbers, in Norwalk an alternative method is growing that focuses on each individual's case.

"We are just trying to get to the point where you can pay for and measure health care the same way you (use) it," Wiggins said.

[email protected]; 203-842-2545; @casoulman

___

(c)2018 The Hour (Norwalk, Conn.)

Visit The Hour (Norwalk, Conn.) at www.thehour.com

Distributed by Tribune Content Agency, LLC.