Equality Health deploys a whole-person care model that helps independent practices adopt and deliver value-based care for diverse, underserved communities. The company is a leader in value-based care and is characterized as an “enabler” that offers tech, care coordination, and hands-on support to optimize practice performance under the new care delivery approach and payment model. Pulse 2.0 interviewed Equality Health SVP of Enterprise Product Claire Zimmerman to learn more about the company.
What Equality Health Does
What does the company do? Zimmerman said:
“Equality Health is a leader in value-based care (VBC) operating in five states. VBC is an important movement in the U.S. health system that prioritizes enhanced patient experiences, better health outcomes and reduced healthcare costs. VBC shifts away from the traditional model of fee-for-service, where healthcare providers are paid based on the volume, not the quality, of services they deliver to patients.”
“We are among many organizations driving this important change. Equality Health is a VBC ‘enabler’ with a Medicaid-first business model and a focus on helping independent primary care providers (PCPs) thrive in VBC, particularly those serving historically marginalized communities. We support PCPs with proprietary technology, which we call CareEmpower, as well as in-practice coaching to help with change management and reshaping clinical workflows toward proactive care, an activity-based financial model, and community-based, wrap-around member support, including community health workers that act as extensions to PCPs.”
“Equality Health Foundation extends our reach by reinvesting in the community and offering programs and events that improve community health and well-being. We believe this model drives a best-in-class delivery system for improved cost, quality, and health outcomes.”
Primary Responsibilities
What are your primary responsibilities at the company? Zimmerman shared:
“As senior vice president of enterprise product, I drive product strategy and ensure successful delivery and adoption of our model with the PCPs in our network, along with our member patients. My team is the bridge between strategy and operations; we work closely with clinical leadership across the organization to shape the strategy behind our care model, and then pull that through to the design of our PCP offerings and requirements for our technology platforms. I also oversee the roadmap for our technology products.”
Favorite Memory
What has been your favorite memory working for the company so far? Zimmerman reflected:
“This is a significant departure from the day-to-day reality of my job, but in the summer of 2020 our Foundation hosted a series of COVID testing and vaccination events that I and other leaders were fortunate enough to participate in.”
“As someone whose job typically leans very back-office, it was incredibly meaningful to interact with patients in our communities and understand in real-time the challenges that they face in getting access to high-quality healthcare. It’s not an exaggeration to say I think about those events every day throughout the course of my work. Whether we’re designing a new PCP offering or working through requirements on a technology product – I can keep the patient and the PCP at the forefront as a result of that experience.”
Core Products
What are the company’s core products and features? Zimmerman explained:
“Our model is built around the idea that independent PCPs need help navigating the transition from the traditional fee-for-service model to VBC. Equality Health helps them make the shift successfully through the tools, technology, people and financial support necessary to deliver enhanced services to Medicaid members and others. Our solution set is all about enablement to drive them through the change and into VBC success.”
“One of the key pillars of our offering is our VBC platform, CareEmpower. It demystifies what can be a very complicated VBC environment for PCPs and makes it easy for them to do the work that will drive improved outcomes for their patients. We consume a broad set of data, whether that data is coming from a health plan, a health information exchange (HIE), or from the practice’s own EHR, then we incorporate sophisticated analytics to make that data simple and actionable for the providers and staff in a PCP’s office.”
“Of course, we know that even the best technology needs wrap-around support, especially when we’re talking about a shift as challenging as VBC. So, on top of the technology, we layer a full suite of PCP supports to ensure primary care practices can succeed. These include:
- Dedicated practice performance managers who deliver in-office training on CareEmpower and work with each PCP practice on workflow design and other practice transformation initiatives.
- Extended support from Equality Health’s community-based care teams, which are led by community health workers and nurse practitioners to support practices’ most complex patients.
- Access to Equality Health’s proprietary cultural care curriculum, which provides training for providers and practice staff on various social and cultural factors most directly impacting patient outcomes in historically marginalized communities.
- An activity-based financial model to create transparent, predictable earning opportunities for PCPs and their staff. Payments are connected to activities related to preventive care, transitions of care, and chronic condition management.
In addition, the Equality Health Foundation enriches culturally diverse and historically marginalized communities through such measures as health education fairs and screenings and distribution of healthy food. Its goal is to expand access to care, accelerate health education, and eliminate healthcare inequities so that everyone has the opportunity to lead longer and healthier lives.”
Challenges Faced
What challenges has Zimmerman faced in her sector of work recently? She acknowledged:
“Driving such significant change in our nation’s health system has always been challenging, but we’ve seen a material shift in recent years as PCPs struggle to get back on their feet post-pandemic. Staffing challenges in a primary care setting are real and incredibly impactful these days.”
“We hear all day long from practices that are still struggling with provider and staff burnout, who can’t keep medical assistants employed due to inflation, etc. It’s truly more challenging than ever to be a PCP in this country, and particularly to be a safety-net provider in the communities we serve. It’s helped us understand that we need to do more than ever before to support PCPs as the industry evolves around them.”
Evolution Of Equality Health’s Technology
How has the company’s technology evolved since launching? Zimmerman noted:
“In response to the challenging environment we’re seeing for PCPs, we’ve focused for the last year or two on making our model even simpler for practices to work. That’s changed how we think about our roadmap for CareEmpower, how we think about the financial model we offer to practices – really all aspects of our business. We’ve invested heavily in additional data so that we can reduce the administrative burden for our PCPs and their staff, partnering with a company called Datavant to support a robust EHR integration initiative.”
“We’re also investing heavily in infrastructure, breaking that data down into the simplest possible guidance that we can present to our PCPs and their staff.”
Significant Milestones
What have been some of the company’s most significant milestones? Zimmerman cited:
“This past year was full of milestones and was one of the most momentous in Equality Health’s nine-year history. In 2023, we expanded our services to Virginia and Louisiana, extending our reach to five states total (the others are Arizona, Texas and Tennessee). The Equality Health network now supports 3,500 PCPs and 700,000 lives.”
“Equality Health was recently recognized as a leading VBC enabler in a report from PitchBook, a capital market research firm. PitchBook called out the distinct nature of our business model: Medicaid-first and supporting independent PCPs.”
“Equality Health also collaborated with the Arizona Coyotes National Hockey League team to provide physical activity opportunities to youth in the Phoenix metro and to broaden access to the sport of hockey – leveling the playing field in health and hockey. This partnership is regarded as a unique VBC community enrichment program and expected to engage more youth than any other NHL youth program to date – targeting 10-15,000 across the annual program.”
“In addition, Equality Health became a founding executive council member of Accountable for Health, a nonpartisan national advocacy and policy analysis organization founded in 2023 to accelerate the adoption of effective, accountable care. Also, prominent Washington D.C. strategist, communications expert, and influencer Stephanie Cutter joined our board of directors.”
Customer Success Stories
After asking Zimmerman about customer success stories, he highlighted:
“Happy Kids Pediatrics and Feliz Care Centers is a 23-year-old, independent pediatric practice and associated family practice in Phoenix. The largest family-owned pediatric practice in Arizona has worked with Equality Health since 2017, was among the first to join the Equality Health Network, and recently signed a new five-year partnership with us.”
“Happy Kids/Feliz Care Centers initially engaged Equality Health to help the practices retool their workflows and processes to align with VBC, to help ensure access to care, and to assist patients with non-medical factors, such as social determinants of health (SDoH), which challenge individual health and care access.”
“Equality Health provided Happy Kids/Feliz Care with access to payer contracts with the major Medicaid, Medicare Advantage, and other payers; risk bearing and a value-based financial model; a dedicated performance practice manager who helps the practice connect to SDoH resources such as housing, food and transportation; and the VBC tech platform, CareEmpower, which helps the practices track patient populations, trigger proactive care approaches, and report for the new VBC quality metrics.”
“Jose Francisco Carrazco, M.D., F.A.A.P., founder and medical director of Happy Kids/Feliz Care, said: ‘Equality Health has been a tremendous strategic partner and a significant driving force in our successful shift from fee for service to quality, value-based care. From the easy-to-use technology, CareEmpower, to the people who act as extensions of our practice in the community, Equality Health provides a comprehensive solution set that enables our clinics to be successful in value-based care and unburdens our clinic teams of administrative work in the process.’”
Total Addressable Market
What total addressable market (TAM) size is the company pursuing? Zimmerman assessed:
“As an organization, we are rooted in Medicaid; we call this a ‘Medicaid first’ approach. We’ve found that helping the healthcare ecosystem adopt VBC in Medicaid requires different skills and knowledge (compared to, for example, VBC for Medicare).”
“It’s really important, because there are more than 85 million Americans covered by Medicaid and Children’s Health Insurance Program (CHIP) – nearly 20% of the U.S. population. We continue to expand in state markets and today, Equality Health supports nearly 3,500 PCPs and 700,000 individuals across Arizona, Texas, Tennessee, Louisiana, and Virginia.”
Differentiation From The Competition
What differentiates the company from its competition? Zimmerman affirmed:
“The shift to VBC creates a great need for PCP support. There are many players in this space and all of us are needed to support the shift, but Equality Health truly stands out. Equality Health is unique as a VBC enabler because of its Medicaid-first approach. We start where the need is greatest – in Medicaid – and our cultural care model is customized for each community we serve.”
“We also work closely with the Equality Health Foundation, which enriches underserved communities through such activities as health education and healthy food distribution. In addition to the community support, our PCPs benefit from an activity-based payment model, and in most cases, Equality Health assumes the downside risk, creating a steady stream of income for the practices. Finally, we’re local to the communities we serve. In each market we enter, we bring in teams who live in the community and understand its needs. Our leaders are local, our community health workers and nurse practitioners are local, and our in-practice team is local. We know your community – and we’re a part of it.”
Future Company Goals
What are some of the company’s goals? Zimmerman pointed out:
“To drive the successful and complete shift from fee-for-service to VBC in the U.S. We do our part state by state and one independent practice at a time as we scale our proven model. We expanded into Virginia and Louisiana in 2023 and are targeting additional states to enter this year. The shift of our nation’s health system from fee-for-service to VBC is accelerating and we are making strong progress. We want to help as many independent PCPs as possible to successfully navigate the transition and not only survive but thrive in this new model. All of this advances health equity so that all people, no matter their circumstance, have equal access to the health and wellbeing resources they need.”
Additional Thoughts
Any other topics to discuss? Zimmerman concluded:
“Health inequity is a major and growing problem in this country. VBC can help alleviate the crisis – it’s the antidote. As an organization and a team of dedicated individuals, Equality Health is committed to helping providers succeed under VBC, close care gaps and address health inequities in America.”
