Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.

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Health Equity

Maia Anderson

Healthcare Brew delivers the latest news and trends in healthcare.

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 by the Covid-19 pandemic, tech industry veteran Bismarck Lepe co-founded a startup tailored specifically to the community, called MiSalud Health. 

The company offers Spanish-speaking people living in the US telehealth visits with health coaches in Mexico who offer a range of primary care and behavioral health services.

MiSalud has raised nearly $19 million through venture capital funding from investors including Ulu Ventures, Pivotal Ventures, and Magnify Ventures, according to Lepe. It employs 50 clinicians in Mexico, 23 clinicians in the US, and operates across 16 states.

Healthcare Brew spoke to Lepe about MiSalud’s business model, how the company is incorporating technology into care, and his hopes for the startup’s future.

This interview has been edited for length and clarity.

 from Covid, more likely to be hospitalized, and 

 to get it. We dug into that issue and we realized that it was an access issue. Many Hispanics live in 

. We thought, “Maybe we can tap into physicians in Mexico, and through technology, be able to give people in the US access to those physicians.”

We got the company started in 2021, and it’s scaled very nicely. We’re approaching 100,000 members on the platform. We primarily sell directly to employers who have a high concentration of Spanish speakers, but about 30% of our consults are done in English.

Our mission is to make healthcare more accessible and affordable for everybody. We are starting with the Hispanic population because they’re more receptive to speaking to a health coach that may be based in Mexico, and there’s an immediate need in terms of language gaps and cultural gaps. We think this near-shore model in healthcare can work for everybody.

How do patients get set up with MiSalud, and what services do you offer?

When we start with an employer, we’ll go [to their worksite] and do biometrics tests, blood draws, get people’s weight, get their BMI, and then put them in specific programs. If their goal is to lower their diabetes or if they have hypertension, they’re put into specific programs, then they meet with their health coach on a regular basis.

We have about 90% participation. If we go to a factory that has 1,000 employees, 900 will participate in the initial wellness fair. Of those, about 50% use the platform on a recurring basis.

MiSalud covers many different services, and in some cases it does step in as an alternative to a primary care provider (PCP). Sometimes we have to refer people out to go get labs done, to go get imaging, to potentially go see their PCP. We will also do some care navigation, especially if someone doesn’t understand what their insurance covers.

We’ve created our own healthcare copilots that sit alongside our health coaches and our physicians. They’re taking notes and summarizing what’s been said so it’s much faster to figure out what the person may need.

As the visits are happening, our copilots are making recommendations to the health coaches or the physicians, and when they disagree, they’ll very quickly say so, providing reinforcement learning to our AI. The goal is eventually to be able to release some of this functionality to our end users. One of the first versions of this that we’re going to be releasing is a nutrition app that’s been trained through the many thousands of nutrition consults and visits we’ve had across our platform, and that’s going to be released sometime in the near future.

What are your future goals for the company?

We want to continue to add more specialties. We’re adding women’s health and pediatrics. The key is going to be really personalizing the experience for everybody who logs in. If you have a universe of potential services that you can offer, you want to make sure that the services are being catered to the individual. We want to continue to invest in our AI agents so eventually we have a MiSalud agent that’s really monitoring and managing your health and brings in the specialist whenever they’re required.

Eventually we think there may be an opportunity for us to have clinical laboratories in places where we already have a high concentration of members, or maybe even start with our own hospitals and clinics on the other side of the border and start to build more of a holistic health system under the MiSalud brand.

A portrait of co-founder and CEO of MiSalud Health, Bismarck Lepe

How MiSalud Health tailors care to the Hispanic population 

The telehealth company offers a range of primary care and behavioral health services. 

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

A Medicare value-based care payment pilot is set to end Dec. 31, 2026, and health organizations are trying to figure out what to do about it.

What’s now called the ACO Realizing Equity, Access, and Community Health (ACO REACH) model was launched in 2021 under a different name by the Centers for Medicare and Medicaid Service (CMS) Innovation Center.

 (ACO), a group of hospitals and healthcare professionals that work together to provide 

 to patients with traditional Medicare. These organizations receive monetary bonuses or penalties if they save Medicare money based on historical or expected expenses. They do this through approaches like ensuring patients get primary care and reducing unnecessary treatments and tests.

The 161,765 providers within 103 ACOs participating in ACO REACH will have to decide whether to transition to another ACO model or exit the program altogether if it ends. The National Association of ACOs is lobbying for an extension, but CMS has not said whether that will happen.

“There’s a big question mark right now,” Lauren Makhoul, a healthcare regulatory consultant, told us.

ACO REACH is significant because it focuses on 

, requiring participating ACOs to make and follow an equity plan to reduce care disparities for underserved communities.

It’s also the first CMS Innovation Center model to include a track dedicated to high-needs Medicare patients, meaning patients with one or more chronic conditions that impact mobility, Makhoul said.

This track, along with a different risk adjustment structure and other flexibilities for things like telehealth and home visits, made it easier for smaller high-needs-focused provider groups to join an ACO, Makhoul said. For instance, high-needs ACOs only need 1,000 traditional Medicare beneficiaries in 2025 to participate in ACO REACH. Organizations in CMS’s permanent and biggest ACO program, the Medicare Shared Savings Program (MSSP), must have 5,000+ Medicare fee-for-service beneficiaries.

“There are many smaller, very focused, more niche provider groups that serve a much higher-need population,” Makhoul said. “[ACO REACH] made it possible for these folks to participate when they otherwise would not have been able to.”

In 2023, ACO REACH organizations were accountable for 2+ million patients, about half of them new to the model, according to CMS.

The 14 high-needs ACOs, though only accountable for 21,600 of those patients, averaged a 13.3% net savings rate in 2023 compared to a 2.8% net savings rate for standard ACOs, preliminary CMS data shows.

 If ACO REACH ends as planned, participating ACOs could try switching to the MSSP, which in 2025 has 476 ACOs with 655,725 healthcare providers and organizations providing care to 11.2+ million.

Both ACO REACH and the MSSP come with the possibility of great risk and reward, though.

 $4.1 billion in bonus payments to 75% of ACOs in the MSSP in 2024. But 16 ACOs owed a total of $20.3 million to make up for costing Medicare more money compared to past years, per CMS.

ACO REACH data from 2023 shows $948.4 million in savings for participants, but 36 of them—27% of participating ACOs—saw net losses, per CMS.

Switching from ACO REACH to the MSSP would likely still be “destabilizing” to participating healthcare systems and physician practices, Bartley Bryt, chief medical officer of Privia Health, a physician support company that manages nine ACOs known collectively as the Privia Quality Network, told us.

The programs differ in structure, quality measures, and cost targets, he said.

“Business processes—both for physician practices as well as the administrative side of the business—you’ve got to change them,” he said. “That takes time, energy, and money.”

 coauthored by Makhoul for a former employer, healthcare consulting and advisory firm Avalere Health, suggests ACOs serving high-acuity patients can also perform well in the MSSP.

Though every ACO is different, those that saw the biggest savings per patient in the MSSP served similar populations to high-needs ACOs within REACH. They had a higher proportion of beneficiaries who were dual eligible for Medicare and Medicaid and aged 85+.

“Based on the entities that are in MSSP that look the most similar to the high-needs ACO, [success] is possible,” she said.

Two hands exchanging money and a love heart with a heartbeat line running through it

Potential end of ACO REACH brings ‘question mark’ to value-based care

Accountable care organizations are asking CMS for clarity.

Nicole Ortiz

Occasionally, we schedule our rounds with Healthcare Brew readers. Want to be featured in an upcoming edition?

Loneliness epidemic. Mental health crisis. These terms are often used to describe the state of mental health in the US, all while the country is also experiencing a behavioral health 

These mental health professionals provide counseling without going through the traditional state licensure process. One group, the 

 (LCA), is helping train groups like social workers, legal aid staff, and community health workers to become lay counselors.

Co-founder Alli Moreno brings her own expertise as a defense investigator and lay counselor to provide guidance for others interested in a “nonconventional pathway.”

After leaving the legal field when she started a family, she told us she was looking “for something that would be intervening or making a meaningful difference in people’s lives.” She joined up with co-founder Elizabeth Morrison in 2021 to see how Morrison’s psychology background and Moreno’s experience could help shape the field.

Healthcare Brew spoke with Moreno about her career and what people might not know about lay counseling.

What do you think are some of the biggest misconceptions about lay counselors?

One that comes to mind is this misconception that mental health counseling is only being provided by licensed professionals. The reality is that, as we all know, the mental health crisis is acute, and the 

 is severe, so there’s that ongoing barrier to access.

There’s tons of different ways to approach this issue, but one of them is to acknowledge that mental health counseling is happening. Really pour in rigorous professional development like workshops, training, practice opportunities, adding weekly clinical supervision and support, all of that to make structural adjustments so that counseling that’s already happening is more effective and the people providing it are more confident in doing so.

[Another] misconception is the idea of a triage, or the idea [lay counseling] is a cheaper way to provide care. Our hope is that it is equivalent in terms of value.

What are the biggest challenges you’re trying to address through the LCA?

It’s really access to quality mental health support. The need is so severe, and it’s only increasing as more marginalized, vulnerable communities are targeted in government policies and 

. It’s already affecting young people and immigrants and LGBTQ+ community members; it’s already affecting people in 

There are so many competent, skillful people who are nowhere in this conventional licensure pipeline. But they have skill, and they have community connection, and they have the desire to be helpful. So, bridging that gap of helping folks, who are already in connection with people who need the help, to help them be able to do that even better and more competently and confidently and feel acknowledged is the biggest challenge.

What are the ways health equity plays into how you’re approaching this?

When you think about people who have lower resources, have lower social power, they’re less likely to be able to get care that they need. When we’re supporting people who are already in those communities—who already have relationships to meaningfully respond to those needs and to do so in a way that’s supported and there’s continual learning and growth—we’re responding to people who have the least access. That’s where we’re gravitating toward first.

What’s your biggest achievement in your career so far?

These [cohorts] are hearing these mental health struggles from people, which means that they’re doing something to indicate to the people that they’re safe. And that means that they have some sort of skill. And then not only is that person telling them, but they keep coming back.

I always feel so proud and happy to be able to elevate and amplify and acknowledge that skill in other people who come through our course and who are on our team, too.

A portrait of Alli Moreno, co-Creator of the Lay Counselor Academy & Counselor.

Lay Counselor Academy's Alli Moreno discusses lay counseling and reaching underserved patients

Through the Lay Counselor Academy, Moreno is addressing a provider shortage in behavioral health.

Alli Moreno discusses lay counseling and reaching underserved patients

When you think of healthcare innovation, you may think of 

artificial intelligence (AI)-powered medical devices

 that can diagnose diseases quicker than a doctor or devices that can 

But if you ask Kyu Rhee, president and CEO of the National Association of Community Health Centers (NACHC), the “most innovative part” of the healthcare system is one that’s already been around for 60 years: 

Established in 1965 as part of President Lyndon B. Johnson’s War on Poverty, CHCs provide primary healthcare services including chronic disease management, cancer screening, dentistry, behavioral health, and more to patients regardless of whether they can pay or are insured.

Today, CHCs treat nearly 1 in 10 people across the US. As head of NACHC, which represents the roughly 1,500 CHCs across the US, Rhee has big plans to expand that number to 1 in 3.

“I do believe when you look at the broader system, there’s no better model of primary care,” Rhee said. “Our model is very focused on those communities that need us the most, and in many ways, it’s defined by people who are low income or poor.”

Rhee took the helm of NACHC in July 2023 after a healthcare career spanning both public and private roles, including chief medical officer of CVS Health’s Aetna division and chief public health officer at the Health Resources and Services Administration, a division of the Department of Health and Human Services that focuses on providing care to vulnerable populations.

Rhee told Healthcare Brew he took the role as president and CEO of the nonprofit organization because he thinks, in addition to being the most innovative, CHCs are the best and “most resilient” part of the healthcare system.

Part of what makes them so is the fact that they “save lives and save money,” he said.

Though CHCs treat about 10% of the US population—that’s nearly 34.7 million people—they only cost about $55 billion, or 1% of all healthcare spend, according to NACHC. That’s because they’re efficient, affordable, and local, according to Rhee.

Plus, CHCs are required by law to be nonprofits and serve their communities, so they can’t be scooped up by giant for-profit corporations like Optum or CVS Health.

Another factor that keeps costs low, Rhee said, is that CHC boards are required to be made up of at least 51% patients, meaning the people they treat get a say in how the clinics are run.

However, it’s not easy to treat so many people while keeping costs down.

The two biggest challenges on Rhee’s mind at the moment are 

The NACHC says half the patients treated at CHCs are on Medicaid, which Rhee calls the “lifeblood” of the clinics. CHCs get roughly 42% of their revenue from the public payer, “so we need Medicaid to be protected in order to do the work that we do in saving lives and saving money in communities across this nation,” he said.

The Trump administration’s One Big Beautiful Bill, which was signed into law on July 4, reduces federal Medicaid spending by an estimated $990 billion over 10 years, according to 

Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County—which represents the more than 450 CHCs serving about 2 million people across the region—told Healthcare Brew the organization is bracing for “seismic shifts in the healthcare landscape in Los Angeles and beyond” because of the cuts to Medicaid.

“We’re looking at 3.4 million Californians falling out of coverage, and an estimated loss of $30 billion in federal funding for California,” McCarthy said. “If these folks don’t have coverage, how are we going to get them access to specialty care, to hospitals? We’re probably going to see a lot of hospital closures, and we won’t have places to send our patients.”

Staffing is also a big challenge, Rhee said, noting CHCs typically have a team of 10 providers to treat 1,000 high-need patients, who often live below poverty level.

McCarthy echoed that sentiment, saying it’s “really, really hard” as a nonprofit to “recruit and compete against larger, more resourced organizations.”

Though he’s only led NACHC for a short time, Rhee already scored a major win in March 2024 when CHCs received the first increase in federal funding in nearly 10 years, bringing the total to $4.4 billion annually.

Rhee said he considers this one of his biggest accomplishments during his tenure at the nonprofit.

“The fact that we’ve been nonpartisan and gotten bipartisan support is part of what I’m very proud of in my first couple years at NACHC,” he said.

Looking ahead, in order to meet NACHC’s goal of treating 1 in 3 people by 2045, “we need funding, we need workforce…we need to protect Medicaid,” Rhee said.

“We need to demonstrate that we’re a core part of making America healthy.”

National Association of Community Health Centers’s Kyu Rhee on the future of community health centers

These clinics rely heavily on Medicaid funding, which was slashed in the One Big Beautiful Bill. 

Kyu Rhee on the future of community health centers

The first year of a new presidential administration is always busy, but so far 2025 seems to have past years beat, as President Donald Trump has signed a record number of executive orders in just his first 100 days.

Now that we’re a little over halfway through the year, we wanted to look back on what has happened in the healthcare industry so far.

With a new administration comes the appointment of new department heads. That has included 

 being named secretary of the Department of Health and Human Services (HHS), 

 tapped to lead the Centers for Medicare and Medicaid (CMS), 

 as director of the National Institutes of Health (NIH), Marty Makary to run the FDA, and Susan Monarez to head up the CDC.

However, these departments also saw major staffing overhauls. The NIH saw top officials 

 in mid-February, with hundreds of layoffs following. HHS announced in late March it would lay off 10,000 employees—on top of 10,000 who had resigned already—which has impacted specific research areas like 

Across all agencies, funding has also been 

, impacting the industry from developing research to funding grants to keeping 

One of the concerns that came up frequently during RFK’s confirmation hearings was his past associations with vaccine disinformation and skepticism. Since taking over HHS, he has vowed to 

 that would analyze private medical records.

The spike in proliferating misinformation has public health and pharma experts 

. In particular, mRNA has come under fire (again), and some researchers are worried cuts might 

Previously, the Biden administration had also implemented a program that allowed CMS to negotiate drug prices directly with drugmakers. Trump took that a step further by signing an executive order that would 

 to be more in line with the lower costs other countries pay.

And speaking of more transparency around pricing, he also signed an executive order in late February that updated a ruling from his first administration, requiring hospitals to 

Before the election, experts were speculating about how Medicare and Medicaid 

Since cutting federal spending was a major goal of this administration, it perhaps comes as no surprise that one of the 

But, canceling out any potential savings made there, CMS announced in early April it would 

 average Medicare Advantage payments to 5.06%—a $25 billion increase—from 2025 to 2026.

Then on May 22, the House of Representatives passed a 

 that called for significant Medicaid cuts (nearly $800 billion, according to KFF) and a revamped 

, potentially leading to millions without insurance coverage. Before it was passed in the House, a report found that Medicaid cuts of this scale could lead to more than 

Across the board, diversity, equity, and inclusion (DEI) initiatives have been targeted by this new administration. Healthcare has been no different, with 

While Trump signed an executive order in late January to ban clinicians and defund institutions providing 

 for young patients, a legal expert told us the law 

. (Though that didn’t stop some institutions from pausing this type of care, at least temporarily, 

Collage of the Capitol building and hands wearing medical gloves holding pills and a vaccine bottle, arranged within abstract shapes.

Here are some of the healthcare policy highlights from the first half of the year

Because the news cycle has been so slow these last six-ish months, amirite?

Cassie McGrath

It hasn’t been easy to be an LGBTQ+ health facility in 2025. From 

 to recent HIV prevention funding cuts, LGBTQ+ healthcare has been going through a tumultuous time.

 in a 2022 study of 6,442 adults, including 958 LGBTQ+ people, that 50% of queer respondents had an “ongoing health condition” but were more likely to report a “range of negative provider experiences” and less likely to have a regular doctor compared to non-LGBTQ+ patients.

This Pride Month, we asked health experts working with the LGBTQ+ community about what challenges they’ve faced in the last six months, how they’ve changed strategies to adapt, and their goals for the rest of the year.

These interviews have been lightly edited for length and clarity.

Liana Douillet Guzmán, CEO of Boston-based LGBTQ+ provider Folx Health

Over the past six months, we’ve continued to navigate a wave of anti-trans legislation, executive orders, and harmful rhetoric—much of it intentionally misleading and meant to cause confusion around care options. Our goal is to provide resources and remind people that Folx is still here providing gender-affirming care. We’ve shifted our strategy to focus more on rapid response communications, community events and partnerships, and education efforts to help people understand their rights and access to care.

Our top priority is making sure LGBTQIA+ people can access the care they need, especially as threats to trans healthcare continue. That means expanding services that treat the whole person and offering as many options as possible for affirming, accessible care. We’re growing our partnerships with insurance providers so more members can use their plans to cover clinical visits, lab work, and hormone treatments. We’ve also expanded our therapy offerings to 17 states, with more to come.

Gaurang Choksi, founder and CEO of New York-based LGBTQ+ provider Violet

Our mission has always been clear: to make healthcare more equitable, effective, and human so that people can find providers who really see them, whether that means understanding their gender, race, background, or any other facet of their lived experience. That part hasn’t changed.

What has changed is how we speak about the work we’re doing. Over the last six months, we’ve had to navigate an increasingly politicized landscape—where words like “equity” and “inclusion” have started to create unnecessary roadblocks, especially for our partners working in Medicaid and other government-funded programs.

So we’ve evolved. Instead of focusing on labels, we’re doubling down on what matters most: whether providers have the skills to deliver care that is personalized, effective, and compassionate.

Our main goal is to ensure all Americans can access the personalized healthcare we deserve; we are reaching this goal by enabling health plans to identify and increase the amount of providers that are best equipped to serve key patient populations with better, more effective care. And in markets where gaps in access to person-centered care exist, we help health plans close access gaps with targeted clinical education.

Chris Viveiros, director of communications at Boston-based community health center Fenway Health

In the last six months, we’ve faced dual pressures: increasing political threats to LGBTQ+ healthcare—particularly 

—and financial constraints that challenge the sustainability of 

. In response, we’ve doubled down on coalition-building across sectors, expanded legal partnerships, and invested in rapid-response work to protect access and affirm our communities. We’re also reimagining how care is delivered, moving beyond traditional clinic walls to meet patients where they are and working to grow telehealth to stay nimble and ensure continued access to care.

We are building infrastructure that makes care more accessible, especially for trans and nonbinary patients, BIPOC communities, and young people. We’re also restructuring our medical leadership team to better support clinicians and streamline decision-making, with an emphasis on innovation and wellness. At the same time, we’re working to deepen community trust through local partnerships and culturally responsive care while protecting gender-affirming services at the policy level.

Healthcare worker holding transgender and rainbow pride symbols while advocating for inclusivity in medicine

How LGBTQ+ providers are maintaining access this Pride Month

Leaders at providers Fenway Health, Folx Health, and Violet share thoughts on LGBTQ+ care.

Remember the beginning of the Covid-19 pandemic? (How could you forget, right?)

The illness has so far caused 1.2 million deaths in the US, according to the World Health Organization, and cost the national economy an estimated $16 trillion to date.

 and the ongoing mental health effects, especially on 

 due to Covid as well and have faced ongoing challenges in the years since the WHO declared Covid-19 a pandemic, including 

 may be one of the best ways to prevent infectious disease outbreaks and pandemics, according to a 

 from the University of Georgia and Oklahoma State University.

“Understanding some of the factors that lead to disease outbreaks is really important because we want to understand how to control them, how to manage them, how to prevent them,” Payton Phillips, lead author on the study and postdoctoral researcher at the University of Georgia, told Healthcare Brew.

 To conduct the research, Phillips and her team looked at the 100 biggest outbreaks of zoonotic pathogens, or diseases spread through animals, like tuberculosis, plague, and salmonella between 1977 and 2017.

The team pulled information from the Gideon Pathogen Database, which tracks disease online across the world. They also used previous research by Patrick Stephens, assistant professor at Oklahoma State, another author on the study, to reach their conclusions.

Stephens’s research pulled the 100 biggest diseases, and in this more recent study, the researchers broke each down by 48 different disease drivers—like food and water contamination, livestock production, sewage management, and deforestation—and sorted them into either 

 like climate change, weather patterns, and 

 were more likely to cause viral diseases. Meanwhile, socioeconomic factors like antibiotic use, contaminated water and food, sewage management, and public health infrastructure were more likely to cause bacterial outbreaks.

The data showed a large outbreak was more likely to be bacterial if a socioeconomic condition was reported compared with an ecological condition.

“But then we ended up finding an interesting pattern where the viral outbreaks would end up being bigger if there were more socioeconomic drivers,” Phillips said. “So they weren’t triggered by those socioeconomic things, but they would grow because of them.”

One of her key takeaways from the research, Phillips said, was that addressing socioeconomic factors is key to preventing disease.

“Preventing that from the get-go would save a lot of lives, probably save a lot of money, and at least prevent people from getting sick,” she said.

Close-up of a faucet with a large water drop hanging from spout, the water drop has a virus inside.