There are many emerging value-based care models in healthcare that are shifting the definition of what professionals have understood it to be. Equality Health is one example of a VBC success story to tell that offers a different view of value-based models – and holds some lessons that healthcare executives can learn from.

Equality Health labels itself a VBC "enabler" with a Medicaid-first care model that provides technology and people support to independent primary care practices in underserved communities with the aim of making them successful in VBC.

The "VBC enabler" built its Medicaid-first care model and business approach on this intent: aligning healthcare delivery incentives with the interests of patients to improve patient outcomes and create real value in healthcare.

Equality Health is not a vendor in the traditional sense. It has technology, but it doesn't sell it to providers. It gives it away for free when PCPs join the Equality Health Value-Based Care Network, now in five states.

Dr. Michael Poku is chief clinical officer at Equality Health. We spoke with him to try to find a definition of value-based care for all of healthcare. We asked him to elaborate on Equality Health's VBC model, to explain the value proposition for primary care providers joining the Equality Health Value-Based Care Network and to highlight results the organization has achieved for its member physicians.

Q. There are various value-based care models and definitions in healthcare that are morphing the definition. What do you say should be the definition of value-based care?

A. The traditional fee-for-service [FFS] system rewards the volume of services over quality care and improved health outcomes.

In contrast, VBC takes a holistic approach to patient care with the goal of improving outcomes and eliminating unnecessary spend. So, from a definition perspective, I like to think of VBC as a model of care that emphasizes proactive and preventive care, encouraging providers to understand patients from a comprehensive biopsychosocial perspective, beyond just their illnesses.

This approach often involves addressing additional factors, such as social determinants of health, which may hinder patients from accessing or learning about necessary care.

Ultimately, VBC is a more equitable and financially sustainable model compared to FFS, though it demands greater coordination and involvement from a broader range of stakeholders.

Q. Equality Health has a Medicaid-first care model and business approach aimed at, according to the organization, aligning healthcare delivery incentives with the interests of patients to improve patient outcomes and create real value in healthcare. Please elaborate on this and on how Equality Health works.

A. Equality Health is 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. This often means concentrating on Medicaid beneficiaries, the providers who serve them and the health plans that cover them.

We start by establishing contracts with health plans around value-based care. It's important to note that – particularly for Medicaid, which is governed mostly at the state level – this can be complex.

Next, we recognize both VBC and Medicaid are best delivered locally by highly engaged primary care providers. They know their patients best and are in the optimal position to learn more and coordinate care. However, the average PCP serving Medicaid patients needs to see about 24 patients a day just to break even financially.

This is incredibly challenging to manage with a complex patient population, multiple payer contracts, quality goals and infrastructure needs that may be out of reach for independent providers. Therefore, Equality Health focuses on providing the support that PCPs need, such as proprietary technology that identifies patients requiring care (regardless of their insurance plan), best practices for streamlining workflow and a financial program based on clinical activities they perform today.

And then, we "wrap" the services provided by the PCP with support outside the four walls of the practice. Our local team of community health workers, nurse practitioners, care specialists and chaplains serve as an extension of the provider's office, connecting directly with patients to help them access services they need, such as wellness and chronic care visits, facilitating transitions of care, home visits, care coordination, and connecting patients with food or housing resources.

Our goal is to enhance the patient-provider relationship, always directing patients back to their primary care provider. Equality Health is here to support – not replace – the primary care provider.

Q. What is the value proposition for primary care providers joining the Equality Health Value-Based Care Network, which is now in five states?

A. Working in primary care is a higher calling, particularly for those who primarily serve Medicaid beneficiaries. These patients often have complex needs, both clinically and due to non-medical drivers of health. Simultaneously, the administrative burden of primary care practice has become nearly untenable. Equality Health addresses both aspects of practicing primary care today.

We help providers activate VBC in a meaningful way that actually works. This translates into streamlined processes, more time with patients, better outcomes and additional financial opportunity – all at no cost to the practice. This means we can all deliver on the "value" in value-based care.

Q. What role does health IT play in Equality Health's value-based care model?

A. Our model is built around the idea that PCPs need help navigating the transition from the traditional FFS model to VBC, particularly with technology infrastructure that may be difficult or impossible for smaller or independent practices to develop.

Equality Health helps practices make the shift successfully by providing the technology at no added cost, and then supporting them through its implementation and in-office usage. Our solution set is all about enabling providers to drive through the change and achieve VBC success.

One of the key pillars of our offering is our proprietary platform called 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 or from the practice's own EHR. We then incorporate sophisticated analytics to make that data simple and actionable for the providers and staff in a PCP's office, presenting it in the form of worklists, reporting and data exchanges.

Q. Equality Health reports an 11% reduction in emergency department usage among member patients and five-star outcomes for patients navigating chronic diseases. Explain how Equality Health was able to achieve these results for its member PCPs.

A. This might be best articulated through a patient example.

Let's take a patient in her mid-40s living in a historically marginalized community. She might be unaware of a recommendation for colorectal screening, especially if she has previously struggled with accessing ambulatory care services.

Under a VBC model, her PCP would conduct a thoughtful patient interview – a meaningful discussion with the primary objective of delving into the patient's history (medical and otherwise), overall circumstances, and personalized attitudes toward health and healthcare. Other professionals, such as community health workers and behavioral health specialists, may also be involved.

The interview might reveal our patient is effectively housebound as the sole informal caregiver for a senior family member, lacking reliable transportation for a colonoscopy but keen on getting the screening done after discussing some myths she had heard.

Social services professionals within her VBC team could coordinate additional caregiving support and transportation, not only for the colonoscopy but also for routine clinical visits and respite from caregiving in the future. Alternatively, the patient might be offered the option to complete a stool-based study at home.

Now, extrapolate this type of care to the population level, where preventive, complex and chronic care needs are all addressed – ideally before they escalate into acute crises requiring higher-level care, such as emergency department visits or hospitalizations. This approach results in better patient care; helps providers consistently deliver high-quality, evidence-based care; and leads to long-term cost reductions.

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