Best Life

Healthfirst’s Best Life Initiative supports primary care teams to improve blood pressure, diabetes control among underserved patients

The Challenge

Race-related health disparities contribute significantly to morbidity and mortality among Black people in America. Black people are more likely than any other race to die early,[1] and they are more likely to suffer from high blood pressure, diabetes, and stroke.[2] Chronic diseases such as hypertension are commonly managed by primary care physicians (PCPs). However, PCPs and their teams are challenged by burnout and stress[3] and need additional support to help their underserved patients to reach their health goals.

Our Goal

We wanted to set up systems to reduce hypertension and improve diabetes management that would work in conjunction with our primary care teams, but outside of the clinic to reduce their workload and cognitive burden.

The Healthfirst Solution

The Best Life initiative was created to help primary care providers and their practices address the patients’ stress and social needs. If their primary care practices opted in to participate, Healthfirst care coordinators would reach out to eligible Healthfirst members share relevant resources for each person such as health coaching and social services.

Population Health Improvements

Our pilot program shows promising results. Practices that enrolled in the initiative were more likely to control high blood pressure (61% vs. 52%) and meet hemoglobin A1C measures (61% vs. 45%) compared to practices that did not enroll. Notably, there was significant change in blood pressure control among our Black members that enrolled who began at 45% control (far below the Healthfirst average) and jumped to 60% control (exceeding the Healthfirst average).


Combining traditional in-patient primary care with health plan and community support systems can reduce provider burnout and lead to measurable improvements in the management of chronic disease among marginalized populations.

[1] Pierre, Errol. Ethnic Concordance between the Physician and the Patient and What it Means for the Future of Healthcare Disparities. CHCANYS21 Virtual Annual Conference. 19 October 2021.

[2] Behavioral Risk Factor Surveillance System, 2015.

[3] Arnetz BB, Goetz CM, Arnetz JE, Sudan S, vanSchagen J, Piersma K, Reyelts F. Enhancing healthcare efficiency to achieve the Quadruple Aim: an exploratory study. BMC Res Notes. 2020 Jul 31;13(1):362. doi: 10.1186/s13104-020-05199-8. PMID: 32736639; PMCID: PMC7393915.

[4] Nundy, Shantanu, Lisa A. Cooper, and Kedar S. Mate. "The quintuple aim for health care improvement: A new imperative to advance health equity." JAMA

327.6 (2022): 521-522.