Q&A · POLICY AND VALUE-BASED CARE
Q&A: Mark Stephan, M.D., M.B.A., Chief Medical Officer at Equality Health
By David Raths P
hoenix-based Equality Health has added a home-based component to its value-based care solution
dedicated to serving independent primary care practices in closing gaps in care. Mark Stephan, M.D., M.B.A., chief medi- cal officer for Equality Health, recently spoke with Healthcare Innovation about the company’s ‘Medicaid-first” business model and lessons learned piloting the new home-based effort. Prior to joining Equality Health,
Stephan served as the vice president of clinical integration for physician inte- gration at Dignity Health, where he was responsible for the development and expansion of clinically integrated net- works across the enterprise. Previously he was the CMO for Arizona Care Network (ACN), the Dignity Health-Tenet ACO.
Did your role as CMO of the Arizona Care Network prepare you well for your role with Equality Health? Stephan: It did. That was my real first foray into population health work. But honestly, a lot of what prepared me for Equality Health was just being in the trenches. I practiced for 17 years and always with underserved populations. There are a lot of elements that I bring to bear every single day around understand- ing everything that the providers face in trying to do value-based contracting and manage patient panels and the challenge of working with Medicaid populations. It's a very diverse, challenged population in many ways.
Could you describe the basic business model of Equality health? Does it focus specifically on Medicaid contracts or is it broader than that? Stephan: We describe ourselves as ‘Medicaid first.’ Those tend to be the first contracts we bring to the provider network. The way we enter markets is in the Medicaid space, but we also have
Medicare Advantage contracts and we're in ACO REACH. It’s important to bring a portfolio of value-based agreements to a practice. It helps with mindshare and behavior change and practice transforma- tion when you have a significant part of your panel in a value-based agreement. We're not in commercial at this time, but we may be in the future.
As the company looks to expand, are there big differences between Medicaid programs that could make one state more attractive than another to enter? Stephan: There are elements that make states more attractive, but the saying goes: if you've seen one state Medicaid program, you've seen one state Medicaid program, right? They're all different. There are some commonalities that help us prioritize state markets to enter and a principal one is the state agency appetite for APMs and moving along. Because if the expectation isn't set, then it's not always a first priority for an MCO, as you can imagine.
You started in Arizona. What other states are you working so far? Stephan: We're in Texas and Tennessee today, and the plan is that we'll be in two more states in 2024.
How do you recruit the practices themselves? Are they ones that have an interest in value-based care, but perhaps don't know where to start? Stephan: Part of the pitch is around that Medicaid-first idea. No one's really knock- ing on their door to talk about helping them with their Medicaid patient popula- tion. So it's relatively easy to start a conver- sation. They're all over the spectrum. Some have a lot of experience in value-based contracting and panel management, but most do not. Or they're in arrangements but they're not successful. So it's been 2, 3, or 5 years and they haven't received a
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Mark Stephan, M.D., M.B.A.
check. It makes it a little bit easier to start a conversation because of the way that we engage them, and the way that we pay incentives, the way that we bring tech and services at no charge to them. It's not a hard conversation to start.
So is the business model that you guys get paid when they do well in these programs? Stephan: Yes, we are the risk-bearing entity if you will. The benefit to a plan is that we're aggregating dozens or hun- dreds of PCP practices from the smallest solo practitioner all the way up to an underperforming large group of differ- ent flavors. And we're able tie that into one value-based agreement where we can progress to taking downside risk, whereas that typically isn't something that a practice is going to take on. Or if they have struggled, it is a value to the practice because they can tie their raft to something bigger. They don't have to make the investment in technology or additional resources. They've got a reliable revenue stream to help them as they progress in their practice transformation with us.
Do some Federally Qualified Health Centers participate? Stephan: Many do participate with us. In every market, we have FQHC participants because the value proposition provides benefit to their patients fits in terms of underserved SDOH needs. Attribution methodologies are always a struggle, especially for a safety net provider. The odds are that they haven't been super suc- cessful. And that is a common theme, not because the clinicians aren't doing good work, but because being responsible for a population is really a different animal to manage.
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