by Rob Brough,
Agility Founder and CEO
The Beginning
It’s the 2000s in the middle of the Bush era, and business is booming. I was Co-CEO of a durable medical equipment “DME” in Southern California with my best friend of 15 years. Robert (yes, another Robert) and I met as next-door neighbors in the warm and friendly suburb of Thousand Oaks on a cul-de-sac full of families, where our kids walked themselves to school and rode bikes every night until the sun went down.
Years past and the kids grew up, and so did our business. At peak we had ~200 staff serving all functions of our DME which provided equipment and services to people suffering from sleep apnea. Our secret to success was focusing on the “service” part of Patient Services – providing best-in-class proactive patient support with industry-leading outcomes. Robert suffered from sleep apnea himself and had direct experience with how poorly the medical industry can function – this fueled our goal to far exceed the norm.
We were always future-focused and began to expand into ancillary services such as providing at-home sleep testing and cash-pay sleep products not covered by insurance; as well as ancillary markets like servicing patients with COPD utilizing our national network of respiratory therapists and relationships with medical equipment suppliers.
One of my ideas was to develop a phone app that aggregated patient sleep data into easy-to-read graphs and tables. A patient could log in and review their last night of sleep and statistics overtime – like one of those consumer sleep apps, but with medical data from their CPAP. The data could also be reviewed with our respiratory therapists during appointments and exported to share with the patient’s extended care team.
We interviewed local developers, both individuals and agencies, and the quoted prices were… let’s say, not cost-effective… for a program that was not directly generating revenue.
Around the same time, we were having issues retaining accountants in our core business. This was back when all work was 9-5 in a physical office, and due to our regional location we attracted a lot of young accountants as a first job out of college. They would generally be with us 6-12 months before using the experience to springboard to a larger company. This left us in a perpetual hiring and training cycle that was draining on HR and the business overall.
I had experience with business in Asia (I previously owned a web development company in Thailand, and taught strategic management at Thammasat University Bangkok) and reading online, was intrigued by the boom in outsourcing services in the Philippines.
Below: Robert and I with the team in our Southern California office.
Expanding
With no connections in the country, I boarded a plane from Los Angeles bound for Manila, the bustling capital of the Philippines.
My first task was to secure a suitable office space to accommodate the small IT development and accounting teams I intended to assemble. Conveniently, I quickly stumbled upon KMC Solutions, a reputable provider offering business process outsourcing “BPO” and serviced offices for newcomers like myself. Their location in Bonifacio Global City “BGC” proved to be an ideal starting point.
Beginning with a modest five-person office, KCM provided the office space, equipment, and access to their HR team for recruiting. We hired our first five and quickly expanded to a second 20-person office to accommodate additional staff.
We later referred to this as our “pilot program” and it was a resounding success, we developed the patient phone app and maintained a steady department of accountants for years to come. Fun fact: Oliver, one of our first five hires, started as a Graphic Designer is now the Country Manager of Agility over a decade later.
Below: our first five-person and 20-person offices with KCM.
Surviving
I could see it coming six months out. The news was reporting on Medicare Competitive Bidding and the changes that were coming for reimbursements for healthcare services. Essentially, for small-to-mid-size DMEs like us, the writing was on the wall as Medicare was switching to a model wholly based on price without considering patient outcomes. Giant national and multi-national corporations could essentially underbid for the Medicare contract, take a loss and make it up by bundling and cross-selling additional services.
My partner was not as concerned as I was, as Medicare only made up a fraction of our business. I thought we should begin moving jobs, or at least replacing jobs lost through natural attrition to the Philippines as we had proved the talent and cost-savings were there. I understood where he was coming from though, we ran a family-style business with a focus on company culture and the thought of layoffs was difficult to swallow.
At that time, we negotiated to add an additional five employees in the Philippines in what we called “Patient Pay” to try and improve our paid-to-patient collection rates. In a high friction move, insurance companies sometimes sent payment for our services direct to patients. Not understanding what this is for, or incorrectly assuming it is a refund, patients often cash the cheque and spend it, making it near impossible to collect. The new team focused on proactive communication warning patients a cheque was coming from insurance and that it needed to be forwarded, tracking the arrival, and eventual remittance (this program was a success – we increased the collection rate from 15% to 93%).
Then – it happened. Medicare Competitive Bidding started, rates dropped, we lost our Medicare patients, and in a total shock wave to the industry, private insurance payers followed the rates down and our total revenue dropped by 47% overnight.
Now in total agreement that we needed to offshore to save our business, I headed back to the Philippines. I sought larger office spaces at a more cost-effective rate. Through an online forum, I connected with an American entrepreneur who had a 200-seat office McKinley Hill, adjacent to BGC. We struck a deal to share the space, fostering not only a business arrangement but also a genuine friendship.
It was difficult, but the process of moving 80% of our US workforce to the Philippines saved us and we learned a lot about company culture, training, and the sheer audacity of the human spirit along the way.
Below: our 200-seat office with McKinley Hill.
Thriving
We kept our doors open while competitors closed. With 18 months remaining on the McKinley Hill lease, and with our team expanding, I began the search for a more permanent solution for our own branded office. Located in Ortigas Center, Pasig, our new 120-seat office space boasted ample room for growth, featuring dedicated areas for training, administration, and staff amenities. Signing a 10-year lease, we set our sights on establishing a lasting presence.
The year of 2020 provided one too many obstacles in the respiratory business and we decided to sell the DME. We could see the future in helping other businesses overcome the odds that we had – and this paved the way into a new venture in offshore staffing. We launched Agility to provide high-quality offshoring services and share our knowledge with people just like us.
As our client base expanded, I recognized the opportunity to operate in a city with an improved quality of life for our employees by relocating outside of Manila. Angeles City, a two-hour drive north of Ortigas, emerged as the preferred destination. Leveraging the services of BPO Seats, we initially established an office that grew to 200-seats and seamlessly transitioned to remote work during the COVID-19 pandemic.
By 2023, the need for a dedicated office space became apparent. Securing an office in downtown Angeles at the top floor of the Entec 2 Building, we created a vibrant workspace with 350 seats and modern amenities to foster employee satisfaction. With demand steadily rising, I find myself once again exploring new possibilities for our next office space, propelled by the ongoing evolution of our business.
Below: our brand new 350-seat Agility office in Entec 2 Building penthouse in Nepo Center, Angeles, Pampanga.
If you’re reading this, whether you’re in the expand, survive, or thrive stage just know we’re here to help and excited to work with you!
