A number of companies have been emerging in U.S. healthcare in the past several years that can broadly be categorized as “enablement companies”; they straddle the gap between traditional “bricks-and-mortar” providers (hospitals, medical groups, and integrated health systems) and health plans, and provide care management, and population health management services that support traditional provider organizations. One of those organizations, which operates on a “Medicaid-first” model, is the Scottsdale, Arizona-based Equality Health, which began operations in 2017 in Maricopa County, Arizona, and now operates in Arizona, Texas, Louisiana, Tennessee, and Virginia.
The company’s website explains it this way: “Proudly established in Medicaid, Equality Health is a dynamic value-based care platform dedicated to transforming the current state of healthcare and empowering providers and health plans to focus their work on those individuals and communities that need it the most. We help ensure that our members receive the highest quality of care and service – no matter their situation, status, or circumstance. By fusing technology, coaching, clinical expertise, financial support, and a deep understanding of value-based payment models, we facilitate the improvement of whole-person care.” And, the company notes, “We extend our reach into the community through our nonprofit, Equality Health Foundation. Through the foundation, we reach directly into communities to expand access to care, accelerate health education, and eliminate healthcare inequalities. Our goal is for everyone to have the opportunity to lead a healthier and longer life.”
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Sherri Onyiego, M.D., Equality Health’s senior market medical director, regarding the company’s broad strategies in the Medicaid market, and what it’s like to enable providers focused on serving that market. Dr. Onyiego is personally based in Houston, and has been with the company since it entered the Houston market in 2021. Below are excerpts from their interview.
Tell me about Equality Health’s Medicaid-first model and how all of you apply it to success in care management work.
We started in 2017 in Arizona and from conception, had a focus on underserved communities—to help to empower primary care practices in Arizona with cultural training to help them better support their patient population. Evolved to helping practices perform in value-based contracts. From our inception in Arizona through our expansion into Texas and Louisiana, we continue to see primary care practices at the core of our care model. I joined the company in 2021, when it expanded into Texas.
Do you define yourselves as a care coordination company?
We are a tech-enabled primary care platform and a primary care enabler. We enable primary care providers to be successful in value-based care. Care coordination is one component of that. We’re supplying them with the people, technology, and processes to help them become successful. We offer CareEmpower as our tech platform, and it comes free with our services.
Can you tell me about the mechanics of this?
We sit in the middle of it all, like a convener. Upstream from our relationship with our providers in our network, we have our relationship upstream of that with more than 20 payer partners across the five states in which we operate: Arizona, Texas, Louisiana, Tennessee, and Virginia. We take on a high-risk, high-reward, value-based agreements with our payers, and are responsible for the total cost of care and quality. Downstream of that are our providers in our network, with one network in each state.
You take on contracts with payers and fulfill them through the medical groups?
Yes, that’s correct, and they’re diverse in scale and scope and we’re focused on Medicaid-first. So it’s the highly vulnerable patient populations in those communities that we focus on, recognizing that the medical practices need help.
How many practices do you work with across the five states in which you operate?
Across all those markets, we have well over 800,000 patient lives we’re co-managing with our practices. We have upwards of several thousand primary care physicians. They’re all different sizes. Urban, rural; some are FQHCs [federally qualified health centers], some are academic medical centers. So the scale and scope are quite diverse. And as the practices are more and more engaged in value-based contracting, the more contracts we can be involved in, the more of a win it is for particular practices.
How do you approach these patients? And what are the biggest challenges involved in managing their care?
What we’re bringing to these practices with our model is to help to understand the population. There are so many non-medical drivers influencing their health. So a lot of what we’re bringing in these relationships with providers is that we’re helping to be extensions of their practices. We have a really robust care team that’s looking to address a lot of those barriers. Also, we’re designing our care models around things they’re already trying to do, such as preventive care, including immunizations; and helping patients to avoid utilizing the ER. We’ve seen a 10-11-percent reduction in ER utilization. And in terms of patients with chronic diseases, we’re making sure the primary care providers are appropriately managing their diseases. We’ve been able to obtain five-star ratings around the care of patients with diabetes, asthma, and cardiovascular diseases. What we’ve seen in our data is that if they’re engaged with their primary care physician two or three times a year, that reduces ER utilization and cost. Those are all things we’re doing, supporting the practices with the people, processes, and technology. And we help them to directly to engage with those patients.
Tell us about your analytics.
Yes, part of what we do is that we have a robust team of actuaries and analysts, looking at the overall population in given markets. And we take in different types of data sources, whether around eligibility… We look at their claims history, so we look at utilization—ER, hospitalization—from previous claims. That helps us to determine the risk level of each patient. And we translate that into actionable insights. And we put all the claims data along with ancillary data, such as lab data, onto our CareEmpower platform, so they can see which patients on their panel are high-risk, and can design their workflow to be able to manage their population from a true population health perspective. A lot of practices might have EHRs with some sort of pop health design in it, but a lot of practices don’t have the level of actuarial support to truly understand their patients. They know whom they’re seeing, but may not know that they have a certain percentage of patients assigned to them that they haven’t seen.
What have the biggest challenges been so far in all this work?
Each community is unique, and each practice is unique. One of the things we’re wanting to make sure about is that we’re responsible to the needs of the community. We don’t want to go in with an approach that works in one market but not another. And we want to make sure we have actionable and timely data to share with our practices and providers. Those are challenges that we are faced with, but our model helps us to support those issues and overcome them. And we’re continuing to refine them.
How is your work dovetailing over time with the shift in the physician culture away from the historical lone-wolf culture to the team-based care culture that has been evolving forward?
It’s important for us to do that. In the end, primary care providers cannot do this work alone. We recently had a discussion about this with an interested party, and we articulated this point in that moment, that this work does not depend on individual physicians having to figure out the complex social needs impacting the care and health of patients. And because we are really trying to enable practices across the spectrum of our markets—because we have robust care team support, we’re able to take some of that pressure off providers and unlock community-based resources that providers might not even be aware of, and we can go into the home. And we embed chaplaincy support into the primary care environment, and that also creates opportunities for families.
How will your company change in next few years?
It will continue to be responsive to communities’ needs. As we continue to understand different communities’ needs, and what the needs of our practices and providers are, we’ll continue to iterate our care model. In TX, the vast majority of our Medicaid members are moms and babies and children, so we need to evolve our model forward to address that market slice. So we’ll continue to be responsive to our providers and members.
What have been the biggest lessons you’ve all learned so far in your work?
One of the biggest lessons is that health is super-local, hyper-local, in terms of where people are whom we’re serving in various communities. It really is hyper-local, and we’re trying to ensure that we’re quipping our practices with the people, processes and technologies they need.
