In 2022 I wrote a story about digital health startup Fold Health, which was working to develop an interoperable digital health operating system for direct primary care. One of Fold’s partners I interviewed at the time was Erik Cárdenas, CEO of Zócalo Health, which was launching a virtual primary care offering targeting underserved Latino communities. Fast forward four years and Zócalo has announced the close of $15 million in Series A funding, bringing the total raised to date to $22.75 million. I spoke to Cárdenas again this week about the company’s evolution to date and plans for future expansion. 

Healthcare Innovation: When we spoke four years ago, you were launching a virtual primary care offering targeting underserved Latino communities, starting in California, and with plans to launch in Texas. So what’s happened since then? 

Cárdenas: Things have changed quite a bit. We started the company back in 2021. We spent the first couple of years working with underserved populations. Ultimately, we launched in three states — California, Texas and Washington. We understood that there was a major problem with how health plans were serving some of the most costly and complex members. We used a lot of that early data to go to health plans. It wasn't until 2024 that we started to really working with Medicaid plans in California. Our first Medicaid managed care organization customer, the Central California Alliance for Health, signed on in late 2023 and we went live in 2024.

That's what allowed us to demonstrate how effective our care model was at engaging, assessing and taking care of some of the most costly and complex members in their member base. Our model was really purpose-built to address these complexities. We started working with our second health plan by the end of 2024, and then 2025 was really the breakout year where we started to really see a lot of growth. We saw expansion across the state. We moved into Maryland, and now we're seeing some additional market pull into new new states that we'll be evaluating this year. 

HCI: Is the focus still primarily on the Latino community? 

Cárdenas: Yes. With the launch in California, we knew that we wanted to build something that was going to be familiar for the Latino community. Right now, about 70 percent of our patients identify as Latino. About 30% do not, and it's primarily because our health plans are responsible for feeding us patients that they want us to engage, and they themselves don't know who's Latino and who's not. We just look at the communities that we serve and drill in on specific Zip codes. Right now, in most of these communities, two out of three Medicaid recipients are going to be Latino, so we wanted to build a brand that was familiar to folks. Our community health workers are from the communities that we serve, and that has really served us well. We’ve been able to establish trust and connect with our our members and their families and their community.

HCI: Were you able to demonstrate some real impact with that initial Medicaid managed care plan in California that led to working with bigger ones like Health Net?

Cárdenas: Yes. There’s a program in California called Cal-AIM, which is really focused on addressing the fact that 5% of the member population for any of these managed care organizations will typically represent about 50% of the cost. The programs that we are a part of are the Enhanced Care Management and Community Supports, programs, where we’ve really seen our model thrive. Health plans value our ability to drive engagement. The way that we use our community health workers as the entry point has been a significant anchor in our ability to do that. They have been effective in helping address a lot of the unmet social needs that oftentimes are the real barriers that prevent people from prioritizing their health. And because we've been able to also augment provider networks with our own doctors and our own therapists, we've been able to shorten wait times for these important appointments.

HCI: Is that clinical work mostly virtual, and the then the community health workers make the in-person connections?

Cárdenas: That's right. Part of the initial model was to prove out that we can create value, and we did that in a very capital-efficient way. We hire community health workers who are from the community that they serve, and they're trained to meet patients where they are, whether that means doing something over the phone or through a telehealth visit or meeting people at home or in the community or at work. We do whatever it takes, and then we connect them to our virtual network of doctors and therapists.

HCI: What if someone needs specialist or hospital care? How do you connect with those organizations and share data about work you've done with patients?

Cárdenas: Continuity of care is a really big part of what we do. Our community health workers work with a multidisciplinary care team. If things escalate clinically we pull in registered nurses and therapists, our physicians or nurse practitioners. We have pretty standard electronic health records. We're also building technology that promotes interoperability. What we're really good at is developing a strong care plan and doing the closed-loop referrals. If that care plan involves coordinating care with with specialists, we track all of that using our platform.

We make sure that we have the proper documentation and everything that is required for prior authorizations. That's where we really move the needle, where patients sometimes are frustrated because they don't know how to navigate that. Our team is really there to help bridge that gap.

HCI: Have you continued to work with Fold Health on your infrastructure?

Cárdenas: We're still a customer. With this round of funding, we continue to invest in a lot of the technologies that are going to be required for us to be able to scale this model.

HCI: Are there some other things that this funding announcement will allow you to do? 

Cárdenas: We have a lot of opportunity to continue to expand the model. The capital gives us a lot of runway to support the continued growth. The value with our health plans is continuing to grow, but we're also expanding. Not only are we expanding across the state of California, we're evaluating some key opportunities in other states. It shows that the model that we've created in California can be replicated in other states. There are some national health plans in California that also have Medicaid in other states. It's great to see the desire to prove that this can work in other states. This capital gives us the flexibility to embrace some of that expansion. We're growing our team to keep up with demand. There's a lot of innovation happening around AI that can help us improve our back office and admin overhead that you see in a lot of practices. We want to make sure that we continue to be capital-efficient and invest in technologies.