An Interview with Erik Cardenas - Co-Founder and CEO of Zócalo Health

PH: Tell us a little bit about Zócalo Health’s mission and what you are building.

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EC: The mission at Zócalo Health is to improve the primary care experience for the Latino community. What we recognized is that the Latino community, and many underserved communities, have struggled with primary care access, and the COVID-19 pandemic really highlighted that. So when you think about the barriers, we thought it was very important for us to build a primary care experience that was designed to address their needs, such as social, mental and health needs, to really help improve outcomes and ultimately drive down the cost of care. 

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PH: Starting a company in healthcare is often personal. What led you to start the company itself? 

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EC: Starting this company was deeply personal. It stemmed from a recognition over my 20 year career of the challenges the Latino community faces within the healthcare system. Less than 6% of all doctors identify as Latino, which highlights a significant shortage of representation in primary care. This shortage was apparent in my own experience growing up, where visits to the doctor felt like navigating a system that wasn’t built for me or people that looked like me.

Our healthcare system operates on a “one size fits all” approach, which can be really challenging when you're unable to connect with healthcare professionals who share your background and understand the cultural nuances that are unique to you or your community. This lack of representation not only makes healthcare more difficult to access but also perpetuates disparities in care.

We also can’t overlook the impact that social drivers have on Latino health. The unfortunate part about my experience is that not much has changed in 20 years. Patients in my old neighborhood are still dealing with the same barriers today as I did when I was kid.

For me, the driving force behind starting Zócalo Health was a commitment to address these barriers head-on. I wanted to create a healthcare system that didn’t just mirror what we’re accustomed to but actively worked to dismantle these obstacles. This meant connecting patients with healthcare professionals and community resources who understood them not just in language but in culture as well. I wanted to build something that blended these cultural nuances and traditions with the modern conveniences and technologies that have become an integral part of our lives. 

Ultimately, my motivation for founding Zócalo Health was to improve outcomes for Latino communities and ensure that no one faces the same challenges and disparities that I and countless others have encountered in the past.  

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PH: Why is now the right time for a company like Zócalo? You mentioned COVID-19 as a catalyst, but the Latinx community has been experiencing these problems for longer than just 3+ years. So why now? 

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EC: You're absolutely right, and it's important to recognize that the challenges faced by the Latino community within the healthcare system have persisted for far longer than the past few years. The recent catalyst for our company, brought into sharper focus by the COVID-19 pandemic, underscores the urgency of addressing these longstanding issues.

The pandemic has underscored the immediate need for healthcare solutions that can be accessed remotely. Telemedicine has emerged as a game-changer by offering greater flexibility in scheduling appointments, reducing wait times, and providing increased convenience for patients. This convenience is especially crucial for individuals who may struggle to take time off work, find childcare, or secure transportation to traditional in-person appointments.

What’s equally important is recognizing the significant and ongoing growth in the Latino community within the U.S. population. With this growth comes an increasing demand for culturally aligned healthcare services. It's not merely about offering healthcare; it's about tailoring these services to meet the specific cultural needs of the community we serve. This demand is only going to continue to rise, making it really important for us to provide care services that are not only accessible but also culturally sensitive.

And then there’s one broader regulatory driver here. In April 2023, CMS finalized a rule that established a health equity index. This health equity index will reward health plans that provide excellent care for underserved populations. It’s an important driver, which I think is going to make us think about health equity in a real way. It’s not just a responsibility, it’s a strategy that I think we’re all going to have to incorporate in our practices. 

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PH: When we are traditionally thinking about access in healthcare, we’re thinking about something like telemedicine and being able to get to a doctor virtually, but you were just talking about the notion of access from a physical access of transportation or other access points. How do you think about access in general, particularly as it relates to tapping into some of the resources that already exist in local communities?

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EC: This model is scalable and allows us to build to the exact needs of each of our communities. 

One crucial aspect of our model is our commitment to connecting patients and their families with healthcare providers who can genuinely engage with them. In addition to our physicians, we recognize the value of community health workers. These individuals possess shared lived experiences that enable us to establish, earn, and retain trust within our community. Their local presence significantly enhances our virtual-first approach, filling the gaps in care access caused by the shortage of doctors.

While we initially begin as a virtual-first solution, we've been receiving increasing interest from health plans that see the potential in leveraging our community health workers and our community-focused approach to develop a hybrid model. We're genuinely excited about the possibilities of extending our services beyond the virtual realm. This expansion could entail meeting people in their communities, homes, neighborhoods, or facilitating services like home visits, pop-up clinics, and brick-and-mortar establishments. These avenues represent significant opportunities for us, and it's encouraging to see health plans embracing this direction.

Notably, in communities where primary care physician wait times can stretch to eight months, the demand for accessible and culturally competent care is really high. As a startup, it is really motivating to find (health plan) customers expressing increased interest in your model.

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PH: Can a person get access to your services today? Or how will they interact with you in this virtual-first model? 

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EC: Today we are available in three states: California, Texas and Washington. We do offer a direct-to-consumer model where anyone can visit our website and enroll in one of our plans whether they have insurance or not. 

We will be making some announcements in October and November around some of the work that we’ve been doing with health plans. In the three states we currently serve, and in additional states starting in 2024, more people will be able to access our services through their health insurance. This will apply to various types of plans, including commercial, Medicaid, and Medicare. We're thrilled about broadening our reach beyond those who directly use our service to include individuals who already have coverage and seek a healthcare solution that suits their needs through their health plan.

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PH:  Well we’ll be keeping an eye out for those! In the meantime let’s shift gears to the company building part. The mark of any great company is the team you’re able to build so you can execute on these “think big” goals you alluded to. I’m sure that there is a special way in which you’re trying to build up the team at Zócalo, so if someone would want to join the team, what kinds of traits, characteristics, mindsets are you looking for that would be additive to the culture at the organization? 

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EC: That’s a great question. When it comes to team building, it’s so critical to find the right team members at these early critical stages of building a company. The one thing that I would probably highlight first and foremost is the fact that we have a really good founder-market fit. We all have shared lived experiences that speak to the mission of Zócalo Health. We really care about hiring people who are not just looking for the next great opportunity with an emerging company, but that are really truly mission-aligned with what we are trying to do. We’re trying to reverse generations of systemic barriers in healthcare and we want to find people who are just as passionate about addressing and reversing some of that. So first and foremost, we just want people who are mission-aligned with what it is that we’re building and with what it is that we’re trying to do, because it’s hard and it’s going to take time. 

As you know I spent some time at Amazon - Mariza, my co-founder, did as well - and the one thing we learned was to really index on hiring individuals there that index on these three qualities. 

• The first is being obsessed with the patient experience. We want to make sure that we put our patients at the center of everything we do and build around them. So having this kind of patient obsession is really important. 
• The second is bias for action. This means individuals who really have the ability to make things happen and not wait until they're told. I can't highlight how important it is to just have people who can operate with this level of independence and high judgment. That's critically important. 
• The last is delivering results. It's important to not just go out and do work, but actually get the work done and really help move the ball. I think once we start to bring people together that sort of meet these three levels it really helps us feel confident that we're building and delivering on the right things. 

So those are the things that we look for. Obviously, as a growing company we're going to index on bringing people in who can help us with growth, who can help us start to bring some efficiencies to our operations, and can help really think big about changing our one-size-fits-all healthcare system. 

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PH: What’s been the most surprising or illuminating aspect of building a company like this? 

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EC: Building a company is hard. While I’ve had extensive experience in healthcare, this is my first role as CEO, guiding us from founding, to funding, to seeing actual patients. Each day brings a fresh set of challenges and opportunities. 

The market has thrown us a few big surprises. We embarked on this journey in 2021 when there was a lot of money in the market, and the landscape was more favorable for founders. However, in the past year, things have tightened up considerably. This shift has posed a significant challenge, compelling us, and many other entrepreneurs, to create value quickly. We've had to rethink our approach to building a capital-efficient operation, which has probably been the challenge or surprise we've encountered.

I have to add that we have been fortunate to collaborate with some exceptional early-stage investors who have supported us throughout these surprises. It's invaluable to have a network of advisors and investors by our side, ready to guide us through these uncertain times. Their support has been a true blessing as we navigate the evolving market conditions.

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PH: What have you been most proud of achieving thus far? 

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EC: I'm extremely proud of what we've achieved over the past year. While there have been many accomplishments, I believe the most significant one is the positive impact we've had on our patients' lives.

We've successfully delivered care for a year, and the most rewarding part of this journey has been the heartfelt feedback we've received from our patients. We've had patients reaching out to us through text messages, emails, and phone calls, expressing their sincere gratitude for the care we've provided.

One aspect that particularly stands out is our ability to forge partnerships that have enabled people to save money on important services like lab testing and medications. What truly touches me is when patients share their personal stories. Many of them have not seen a doctor in years, and our platform has given them the opportunity to connect with healthcare professionals who not only speak their language but also understand the unique challenges and traumas they have faced in their communities.

These are often issues that aren't discussed enough, but our team has been able to bridge that gap and provide compassionate care. Our patients appreciate having a doctor and Promotora who connect with them, guide them, and genuinely care about their well-being. 

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PH: And as you look out into 2024, what are you looking forward to the most and what are you most excited about? 

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EC: We have some exciting developments on the horizon for 2024. One of the aspects that truly excites me is our continued growth and the recognition of the value we bring to underserved communities. It's not just about providing access to our doctors; it's about how we engage with patients in these communities.

One exciting development is the continued interest from health plans and community based organizations to host more of our Cafecito, Cumbia, & Salud Mental events. These events are designed to engage the community while embracing and celebrating their culture. We host them in Latino-owned coffee shops, providing coffee, pastries, and a dose of music to create a welcoming atmosphere. But what sets these events apart is the programming focused on mental health.

We aim to raise awareness and tackle the stigma surrounding mental health in a culturally sensitive and meaningful way. We've already conducted a few events, and the response has been overwhelmingly positive. Health plans have recognized the value of these events and are eager to support more of them, which is a testament to the impact we're making.

While these events are set to kick off next year, I can't wait to announce them and share the incredible experiences we're creating within these communities. It promises to be an enjoyable and impactful journey, and I'm thrilled about the opportunities it will bring to further engage and support our Latino communities in addressing critical mental health issues.

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PH: Certainly sounds like it. And a bonus question: can you tell us the meaning behind Zócalo? The word itself and why is the company named this way? 

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EC: Healthcare is more than just a clinical service; it's a deeply rooted connection to the heart of a community. When we were conceptualizing the name for our company, I wanted it to reflect the very essence of what we stand for — a commitment to fostering a sense of unity and support within the communities we serve.

Zócalo, the central square in Mexico City, holds a special place in my heart. It's not merely a physical space; it represents the lifeblood of a community, a gathering place where people come together to celebrate, to share, and to support one another. Whether it's a joyful celebration, a call for change, or a simple moment of connection, the Zócalo embodies the spirit of togetherness and solidarity.

In naming our company 'Zócalo Health,' I wanted to evoke the image of this central square, reminding us that we are at the very heart of our community's healthcare journey. Our mission is not just about providing medical services; it's about creating a supportive and vibrant healthcare ecosystem where every individual feels embraced, heard, and cared for.

So, while 'Zócalo' may have started as a placeholder, it has become the soul of our organization. It serves as a constant reminder that we are here to build a healthcare community that celebrates life, advocates for change, and, most importantly, supports one another through every health milestone. Just as the Zócalo in Mexico City is the beating heart of a community, we aspire to be the heart of healthcare for our communities."

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PH:  Thank you for sharing your story with us!

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