The Chicago-based insurer picked up a $140 million funding round in September. The company was born out of Health2047, the innovation lab at the American Medical Association, which backed the company in its latest funding round.
The insurer has 13,000 members, primarily in the Chicago market. Most of its members are in chronic special needs plans, which cater to the needs of those with diabetes, end-stage renal disease and other conditions.
Zing Health CEO Andrew Clifton sat down with Becker’s to explain the company’s growth outlook at the challenges and opportunities in the chronic special needs market.
Editor’s Note: This conversation has been lightly edited for length and clarity.
Question: You said you plan to use this funding round to expand. What does expansion look like?
Andrew Clifton: A lot of what we’re looking to do is get deeper penetration in the three markets we’re in, especially Detroit and Indianapolis. In 2025, we’re also expanding to Memphis, Tenn., and Cleveland, Ohio, which are markets we’re excited about. We really focus on urban areas with diverse populations and a high prevalence of chronic conditions. All these markets are ones that we see as real opportunities that have the population and the need that we are best built to serve.
These can be very challenging populations. There are folks that have a lot of health conditions, have a lot of needs from a medical, pharmaceutical and social aspect as well. When you’re trying to be the conduit to coordinate all this care and provide these benefits, every member is different and their needs are different. Our technology, our member services and our data to enable all this, and our partnerships with providers, frankly, will always be evolving to get to the next level and get the best results possible. Those are the two areas this capital will be funding.
Q: What are the challenges and opportunities for chronic special-needs plans? Do you expect to see these plans grow in the coming years?
AC: The challenge for a health plan is, if that’s your primary clientele you’re serving, you’re essentially purposely taking on a higher-needs population. You know when a member joins you, they have real conditions. Some of these, if properly managed, they can live very normal, healthy lives. Depending on the severity of the conditions, there’s others that will continually have high needs. With that, comes a lot of access issues. Unfortunately, the hardest part is that these populations often have many providers they’re seeing. One of the real systematic problems we have in this country is the coordination of care. Trying to fill those gaps as much as possible is a real challenge for any plan.
I do think Medicare Advantage has gone through a lot in the past few years. It went through a growth period where plans were putting out all kinds of benefits. Candidly, I think a lot of those benefits weren’t always good for people’s health and wellbeing. They might have been attractive benefits, but were they really contributing to the overall outcomes of care? What I think is really exciting about chronic special needs is since we know something about these beneficiaries, it allows us to build a plan and experience around these needs. It’s not for everybody under the sun. It’s for a specific group of people, which happens to be a higher-needs population.
As the competition continues in this space, my hope is that we do see a proliferation of these types of plans out there. Healthcare is by no means one size fits all, and I think specialization is the best way for seniors to have options that benefit their health outcomes. It also is a real vehicle for payers to actually accomplish those possible outcomes, because it takes focus to execute in healthcare, especially in this country.
Q: What are the biggest challenges being a startup in the Medicare Advantage market? How do you confront these challenges?
AC: It’s really hard to be small in healthcare. We work with big hospital systems. We work with broker agencies. There’s a lot of stakeholders. A good health insurance company is made up of really strong partnerships. It’s hard to build a partnership when you don’t have tons of numbers, and frankly, when you’re competing against entities that have huge volume and huge leverage across the industry.
I think having a very clear purpose and knowing what you do differently and better is critical to success and has enabled us to grow so much over the past few years. Indeed, as we’ve grown, we’ve seen that get a little easier and a little easier, every month, every year.
