Latest / StartUp Health NOW Podcast / EqualityMD’s Pre-Insurance Strategy to Reduce Care Avoidance and Lower Healthcare Costs

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EqualityMD’s Pre-Insurance Strategy to Reduce Care Avoidance and Lower Healthcare Costs · StartUp Health NOW Podcast

• 0:00
  [on-hold music] Welcome.
• 0:05
  My name is Unity Stokes, co-founder at Startup Health, and it is my pleasure to connect with longtime health transformer and Startup Health Justin Ayers, who is the CEO and founder of Equality MD.
• 0:18
  We're gonna be learning about how much progress they've been making, the innovation, how they've evolved their model, and dig into what they've learned and how they're employing that in today's market. Stick around.
• 0:31
  [upbeat music] Hey, Justin. Unity, how you doing? It's great to see you. How are you? I'm doing all right. I'm so happy to be reconnecting with you today, and I know you have
• 0:43
  been making so much progress at Equality MD, and I'm happy to check in, and I wanna get all the updates. But first of all, how are you doing? Uh, what's new in your world?
• 0:56
  And then I wanna dig into all the progress you've been making at Equality MD. Generally speaking, I'm in good spirits.
• 1:05
  I am excited about what I'm calling the repositioning of our company to be able to achieve our mission-driven goals faster, more effectively, and more cost efficiently, and deliver results that not only benefit our stakeholders, but also have an impact on what I'm calling America's broken insurance-based healthcare system.
• 1:31
  [clears throat] Well, let's dig into that because I want to hear how you describe your mission today, 'cause I think it's a really important one. And
• 1:41
  I think you've been very innovative from when you've launched through today and what you're really offering the market. But how do you describe the mission of Equality MD today?
• 1:52
  America's most affordable and inclusive healthcare solution for employers. And we came about this decision when we launched mid Q1 of this year.
• 2:05
  We primarily had a direct-to-consumer approach, and primarily targeting underserved communities, particularly LGBTQ, 'cause that's how we identify.
• 2:15
  But LGBTQ represents every other demographic out there, from racial minorities to military veterans. And it's that information, sexual orientation, gender identity, coupled with social determinants of health, that really
• 2:29
  are needed by health companies so they can do things like build robust patient models that help them generate predictive analytics for enhanced disease trajectories and even financial risk scoring.
• 2:43
  Being able to capture this data, create AI-powered insights, sell them to health companies will hopefully give them the ability to more authentically engage historically underserved markets
• 2:57
  and build trust amongst them such that they no longer are avoiding preventative and maintenance care and only relying on emergency care in the emergency department at the hospital or in an urgent care clinic.
• 3:12
  'Cause when people avoid care, health costs go up for everyone, no matter where you are in the country. The data gaps about the very diverse American patient population, they grow.
• 3:25
  It becomes harder and harder for health entities to do anything about their institutional approach to engaging new markets and encouraging patients to proactively engage
• 3:42
  and reclaim control, feel empowered to reclaim control of their own health journey and not use our healthcare system as a sick system, but as truly a health and wellness system. Yeah, I love that.
• 3:58
  You've always had that lens of, let's focus on prevention, let's give access to care, let's go into markets or serve people who may not have had access before.
• 4:10
  So you started as direct-to-consumer, and was that more of a membership model where people could come and just buy a membership to get access to care? How did that work, and then how has it evolved? Yes.
• 4:23
  Anybody in the country can still sign up as an individual, regardless of their insurance status, and utilize our national insurance-free, culturally competent network of providers in all 50 states, regardless of what their insurance status is, whether they're uninsured, they use the Affordable Care Act and are paying way [chuckles] too much for that, or they have, as most Americans do, insurance through their employers.
• 4:52
  So the pivot came because, uh, and we're non-partisan, 'cause in healthcare you really should be non-partisan. It sh-shouldn't matter who you vote for, and [chuckles] that determines what kind of care you get. But
• 5:05
  since the current administration took office, we
• 5:08
  transitioned our thinking from needing to have a direct-to-consumer model that we could then capture really powerful testimonials and then switch to our ultimate B2B and B2B2C marketing goal and activating our decades-long channel partner networks that would allow us to grow and scale
• 5:31
  very rapidly. And that changed when partisan health policy started taking shape in the nation's capital. Nonprofits lost funding for healthcare research or even caring for patients across the country.
• 5:48
  For-profit companies are bracing for this astronomical jump in health prices.
• 5:55
  It's the highest jump in health benefit costs in 15 years, up to nine point five percent per employee in twenty twenty-six and growing on average of five point four percent every year thereafter through twenty thirty.And the question employers have, the dilemma, do we as the employer absorb these costs?
• 6:13
  Which no employer would want to do, but they also don't wanna pass them on to their employees.
• 6:19
  But more often than not, that's what happens, and the employees are stuck with higher premiums, deductibles that are practically unreachable, higher co-pays, and even more in-network restrictions that limit their access to care.
• 6:35
  So while employees are burdened with these higher costs, they are looking for employer-sponsored insurance alternatives, avoidance solutions, because when an employee utilizes their employer-sponsored insurance plan for in-person care,
• 6:51
  it actually costs the employee money, and it costs the employer money. And so we position the company to meet the needs of these companies, both for non-profit, that were coming to our
• 7:05
  inbox unsolicited and asking for help. So now we have the unique advantage of being an insurance-free national telehealth platform with two in-house pharmacies able to dispense over a thousand medications for free.
• 7:22
  Not even Teldoc can do that. And we are a fabulous tool for startup companies, any company that has fewer than fifty employees or even have to have insurance. It's a great talent acquisition retention tool.
• 7:35
  But it's a fantastic opportunity for businesses to save money when they use our system in conjunction with their in-person insurance plans.
• 7:43
  We can divert employer-sponsored insurance claims by resolving employees' diverse health needs, saving em- employers in annual healthcare costs and employees. Tap on both those. So it's really interesting.
• 7:58
  So you're finding that obviously you, you still have the direct to consumer people can go get access to this membership. Sure. That's-- but that's become but less than five percent of our revenue. Okay.
• 8:09
  And now you're focused on, which I think is very exciting, the employer market.
• 8:14
  But what's interesting about what I'm hearing is you have the small employers to medium-sized employers that you serve, and many of those organizations might not even have a health plan for their employees.
• 8:28
  So now there's a benefit that they can offer that might be more cost-effective, but also provide some service to their-- some health benefit to their employees.
• 8:41
  And I'm hearing you're also gaining traction with the medium to larger size employers because for them,
• 8:50
  if by complementing the plan they already have, they can now reduce the expense of their overall healthcare costs. Is that what you're learning, or what are you learning? Absolutely. It's both a cost-saving mechanism
• 9:06
  as well as a value-add tool, and that's something that is really unique in how we go about doing it. Because we are not...
• 9:19
  We don't operate within the insurance-based health system, we don't take any insurance, we're not-- we're basically immune from any partisan health policies, including government shutdowns.
• 9:31
  And i-if payers have these volatile health plans pulling in and out of markets, raising rates arbitrarily, none of that affects us.
• 9:41
  As we say on our website, if you need to go in for, uh, an operation or even just routine care, then use your insurance 'cause that's, that's obviously [chuckles] not what we do.
• 9:53
  But for everything else, seventy percent of health issues can be addressed via telehealth, especially if there are culturally competent clinicians on the other side that people from all walks of life, no matter how you identify, really appreciate because that gives the patients a sense that the provider has a greater sense of empathy and really care about them as a person in treating their whole health, and not just a number through the system and see the next patient looking at the clipboard not knowing who it is they're talking to when they walk in the room.
• 10:20
  Can you describe a little bit about the specific types of things that are included i-in your membership, may-maybe versus what's not? So mental health, for example, or primary care visits.
• 10:34
  You mentioned prescription access. What are some of the things-- And it seems like you put together...
• 10:40
  It's not a hundred percent comprehensive, but it covers a lot of the things that people need that if they have nothing, they just end up doing nothing, and that could lead to worse issues.
• 10:52
  So what have you packaged together, and how have you been able to do that?
• 10:56
  With this push from business entities, nonprofits, and professional organizations in Q2, in June, we added, in addition to our single membership plan, it's a SaaS-based platform, and we added employee plus one, couples, and a family plan, which includes two adults and up to five dependents.
• 11:18
  All members of all tiers get thirty-six virtual visits with culturally competent clinicians per year, which is divvied up between twelve full mental health sessions, twelve primary care visits, and twelve urgent care visits.
• 11:32
  And looking at the family plan, for an example, with two adults and five dependents, that's seven people. If you sign up for the family plan, each member gets thirty-six visits per year.
• 11:44
  And we also, because of our in-house pharmacies, that membership fee, depending on what tier you come in, all of them include access to over a thousand free prescriptions in our growing list of formularies.
• 11:59
  And if the medication you take is not included, we give you a discount card that gets you up to eighty percent off of that prescription at over seventy thousand pharmacies nationwide.You get an AI healthcare and wellness companion and a host of wellness resources so people can feel empowered to really take ownership of their journey and not rely on the health entities for which
• 12:25
  no one's really like them, but after the tragedy of the UnitedHealth Group CEO being murdered, people are really starting to have those kitchen table conversations about healthcare. How are we gonna afford this?
• 12:39
  What are we gonna have to give up so that we can have our child or g- have care or address mental health issues I'm going through as just a human being?
• 12:49
  We wanna make sure that this is accessible to anybody who needs it, regardless of where they come from, what walk of life they've had, the challenges they're experiencing, or whatever their insurance status is, and that's really an enviable place to be in this current macroeconomic climate, as well as the political climate.
• 13:10
  What have you learned, and where do you see this going? What are people, families, patients leveraging? What matters to them today? What are you seeing? And we are in a really interesting time.
• 13:25
  I think there's a lot of dynamic change going on all over the world, but certainly specifically within the healthcare market here in the US. Where do you see this going, and how are you focusing?
• 13:38
  How does this solution serve where you see it going? I think once people realize, and when I say people, the employers, 'cause they're...
• 13:48
  the small- and mid-sized businesses are really our target market, but certainly we're in talks with some large corporations to do pilot programs as part of their cost cutting efforts.
• 13:58
  We see this as a response to a wake-up call that people have had about the fact that they really don't know anything about how their healthcare works. It's, it's confusing by design,
• 14:10
  and even some of the brightest people within healthcare can't answer every question about it.
• 14:15
  So having a clear, transparent understanding of what we offer, how much you can save from it, how at peace you can be knowing that no matter what background you have, you can speak with a clinician who has greater empathy through training that we have them go through, and really have the ability to receive the care you deserve on your own terms.
• 14:40
  And employers love that because then they save money too.
• 14:43
  They don't have to bear those unreasonable financial administrative burdens, and it leads to a happier, healthier workforce where people are more productive, there are fewer sick days, and you have a diverse group of folks getting hired and retained that really impact the company's bottom line in a positive way.
• 15:02
  It's just, it's a win-win. And, uh, how has, you mentioned AI in, in our last part of the conversation, how is technology evolving your ability to
• 15:16
  innovate, deliver new solutions, new benefits to your members? What are you noticing, and where do you see it going in practical terms?
• 15:25
  Yeah, that's a good question because, as I mentioned earlier, pretty much insurance companies dictate everything, and health costs are going through the roof, and people are avoiding care 'cause they can't afford it. So
• 15:41
  being able to
• 15:43
  capitalize on this moment and our unique ability to deliver culturally competent care prescriptions, save money for employers and employees, we're also able to, through our platform, capture new patient journey data that has up until this point not been collected.
• 16:01
  And we're filling data gaps that health companies are really keen to, to have.
• 16:07
  Data that will allow them to be able to engage more markets and change how people perceive and receive care, knowing that it's accessible, affordable, and they have the ability and the wherewithal to really own that.
• 16:24
  And we went through a seven-month data science program with UnitedHealth Group, the big bad of them all, if you will. They're not all bad, but it's not well-regarded [laughs] generally speaking.
• 16:35
  And they told us what data points from a patient journey perspective that they needed but they couldn't obtain because of communities, particularly historically underserved communities in healthcare, were unwilling to divulge to them.
• 16:50
  And without that data, they can't make the institutional reforms that can help them authentically engage, communicate, and understand that the very demographics they're trying to bring into the fold.
• 17:02
  Because when they have that information, suddenly people are more proactive in their healthcare journeys and feel a sense of ownership and empowerment, and people are s- going to the ER less, and all of this can reduce care costs for all Americans.
• 17:19
  So the AI component is really the data that we're capturing using the HIPAA compliant AWS ecosystem and some data architects and scientists to help us create the data,
• 17:30
  AI powered da- proprietary data insights that we'll then sell to groups like UnitedHealth Group, Cigna, Aetna, and uti- utilizing the formula that they [laughs] basically gave us.
• 17:42
  How does, what's the reaction of the patient or the member knowing that obviously health data is very important to everyone? I would say financial data, health data are- Oh, yeah... the two most important.
• 17:56
  How do you manage that, protect that, think about that in terms of the... You're describing, I think, a full cycle of value that ultimately that value should come back to creating better care for the patient-
• 18:14
  YesIs more personalized, it's more relatable, it's more useful. But how do you do that? How do you...
• 18:23
  It's one thing for an insurance company to leverage that, but how does that ultimately benefit the patient and the member, and how do you care for that?
• 18:35
  Representation matters, and there are many historically marginalized communities in this country, especially when it comes to healthcare, even facing discrimination from providers and payers. Knowing
• 18:50
  as patients from wherever you are in the country, from whatever background you come from, that
• 18:56
  an entity like Equality MD, as opposed to an entity like a major health system like Kaiser or Permanente or UnitedHealth Group or Cigna, there's a lack of trust in those big corporate health entities.
• 19:11
  But there is more trust when they do their homework on who we are at Equality MD, and we found that patients are more willing to share information about their journey, about themselves, that we capture in HIPAA-compliant ways, and are able to, once we have a
• 19:29
  statistically significant amount of information, start producing some AI insights and go back to our friends at UnitedHealth Group and CVS, Aetna, and say, "Here's what we're getting so far.
• 19:42
  Sort of help us understand how we can get the data you need so that you can make the reforms that will help these communities feel seen in a healthcare perspective, and therefore more likely to engage proactively with providers rather than practicing care avoidance, which hurts them, hurts the economy, and just drives up health costs year after year."
• 20:06
  Yeah. Just there's a lot of that. Healthcare avoidance is a good way to say it. I think one thing it's worth just talking about for a minute is, and going back to your name, Equality MD,
• 20:18
  the whole purpose of why you even started the organization and that mission and getting back to cultural care and competency and diversity and all these things.
• 20:33
  I know it's a strange time to be using a lot of these words, unfortunately, but how it seems so central to your purpose, the trust you're building, the people you serve. What have you learned?
• 20:47
  How have you really fostered that vision, mission, purpose? And has it changed since you started or what has changed, and how are you continuing to carry that forward? The underlying mission
• 21:04
  hasn't changed. We had initially set out to be basically telehealth and prescription company for LGBTQ patients and their allies, and that played well.
• 21:17
  But then we started hearing from individuals, but mostly businesses, that we could do so much more and have such a greater impact on diversity writ large if we expanded that to include other demographics within the cultural competence training that our providers are required to complete so that
• 21:41
  it would have an exponentially greater return on investment in terms of mission as well as brass tacks, and that's exciting.
• 21:53
  And it wouldn't have happened but for a confluence of macroeconomic stagnation. Let's not even talk about fundraising. Ugh. But also in people waking up to realizing that our system is broken, there has to be other ways.
• 22:12
  And with fifty-nine percent of employers actively seeking employer-sponsored insurance avoidance solutions, we're excited to be taking the inclusive mission that is the foundation upon which we were built and apply it to corporations so that they can achieve their objectives.
• 22:31
  We can serve more patients faster,
• 22:34
  which allows us to capture more data more quickly, which we can then spin out into AI-powered insights, sell to health companies so that they can make institutional reforms that over time can lower costs for all Americans.
• 22:47
  It just really, the confluence of these things over the past, even just this calendar year, has allowed us to really step up our game and leverage the unique position we're in
• 23:02
  to not be beholden to any entity, be it governmental or insurance company. Candidly, we were laughed at for years for not building our own thing from scratch, but we are in a sense with the data analytics.
• 23:17
  Uh, and it's just having a partner to help us get there from a care delivery standpoint, and they understand what we're doing, and they train their providers using our materials, really allows us to take our message to a broader audience faster, impact more people, and hopefully change how people even perceive healthcare, let alone receive it.
• 23:41
  So a lot of important stakeholders are listening. Who should be calling you, and how do they, how do they reach you? Where do they find you, and who are you trying to meet?
• 23:50
  I think what you're doing is very important, and we need to get the word out. Who should be calling you? And then I've got one last follow-up question. Sure. Any for-profit, nonprofit, or professional organization.
• 24:05
  By professional organization, that can be a chamber of commerce, it can be an organization like the Virginia Rural Health Association, which we're gonna be starting to work with.
• 24:13
  And reaching out to us to see how we can-Come in and help them if they have no solution yet, or augment what solutions they have to save money and reach more people and encourage again that preventative and maintenance routine care rather than just emergency care so the care avoidance decreases.
• 24:33
  In terms of who I would like to reach out to, it's those small- and mid-sized businesses, preferably those with under five hundred employees, and also investors who are angel investors.
• 24:45
  We're raising seven fifty K now, hopefully to close by the end of the year. We have quite a few matching funds secured, but we need to get that first hundred K that starts the dominoes falling.
• 24:55
  They've all been lined up, and that's very exciting to, to see that. But that first check or first series of checks to get to that hundred K, it can be painful. So- It's an interesting fundraising journey.
• 25:08
  It always is- Yeah. Yeah... no matter what stage you're at, what size you're at.
• 25:13
  And kudos to you for just your perseverance, your ongoing ability to navigate change and innovate while sticking, not just staying true to your core mission, but in a lot of ways carrying it forward and expanding it, I think, in meaningful ways.
• 25:33
  So last question, what are you most excited about over the coming years? What's, what are you optimistic about as it relates to people's health, healthcare, what you're building, wherever you wanna take that question?
• 25:47
  High level, I think we have the potential, properly funded, to be able to really challenge people's perception of what healthcare in America is, and have them realize that
• 26:02
  no, you're not crazy for seeing prices at the pharmacy for your copay being more expensive than if you pay cash.
• 26:10
  Things are just turning upside down, and if we can encourage people to think outside the insurance-only box, they'll find that they have more options, more accessibility, and more freedom to reclaim that autonomy that had been lost for so long.
• 26:30
  And in terms of the short-term thing,
• 26:34
  I jokingly say I've been building this with, with of course my team, but me personally as a former healthcare trial lawyer and now health tech founder, I've been building this my entire life just by going out into the world, showing up, building, cultivating, and nurturing authentic relationships based on mutual respect and trust.
• 26:52
  We can now leverage those relationships, turn them into channel distribution partners to accelerate our growth even faster, creating repeatable flywheels, and become trusted community anchors in each new market we enter as they promote us throughout their communities.
• 27:10
  That's exciting.
• 27:11
  I've been wanting to activate our vast preexisting network for a while, and now we have an understanding as to how we can best do that in a way that has clear milestones, they're measurable, they're time-bound, and translate that into a solution that
• 27:28
  goes towards achieving the goal of reshaping how Americans even think about healthcare because if we s- even just start thinking about it, questioning it, we are doing something right.
• 27:39
  Justin, thank you for everything you're doing as a health tech founder. By the way, how has it been being part of... You've been a longtime health transformer in StartUp Health. What's your experience been like?
• 27:49
  What's it like working with other health tech founders, other founders who are on that journey just like you are, building, scaling, innovating? What's your experience been like?
• 27:59
  What would you tell other people about building together, kind of building alone? Building alone never works. I shouldn't say never.
• 28:07
  Maybe it can certain things, but in the world of healthcare, it's one-fifth of our economy.
• 28:12
  It's not going anywhere, and we need to leverage each other, be there for each other, both personally and professionally, to see how we can work together if possible to alleviate some of the pain points.
• 28:28
  We are not a vitamin. We're a pain pill, and we solve an immediate need for a lot of people.
• 28:35
  And I think that is something that not only excites me, but is a path towards achieving our objectives for our company, for bottom line, uh, but more importantly, for getting more people to engage with healthcare rather than avoid it.
• 28:53
  Thank you, Justin, CEO, founder of Equality MD. See you soon. Thanks, Unity. [outro music] And finally, an invitation to all of the extraordinary health transformers.
• 29:08
  Whether you are a startup, someone building the future of health, or whether you are an investor, funder, or buyer of the solutions out there in the marketplace, this is an invitation to you to join the StartUp Health member community.
• 29:23
  Learn more at startuphealth.com. Look forward to hopefully seeing you soon. [outro music]