Posts Tagged: healthcare

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The Economics of Patient Focused Care

“Inpatient admissions were 5% higher, or favorable, compared to the prior year” reads a quote that appeared in a recent report for a nonprofit hospital. This sums up the fundamental problem with the U.S. healthcare industry; incentives of the system, providers and payers under a fee-for-service construct are not aligned with those of the most important person: the patient. While it’s noble for hospitals to care for someone during their time of need, a higher volume of admissions is not good for actual patients or the economy. The “healthcare” industry has in fact become a “sickness” industry in which medical costs and industry profits have spiraled out of control, while quality and health outcomes have severely lagged.

The challenge is: how do we create a system that aligns the incentives of patients, providers and payers while focusing on optimizing health?

A solution starts by changing the system from the ground up. Instead of operating under a fee-for-service structure, we need to invest in value-based primary care that puts an emphasis on keeping people healthy, rather than simply reacting when they’re sick. There are a few companies that are doing this and making a noticeable difference in this space – Iora Health is leading the charge and that’s what attracted me to join the company three years ago.

Iora’s high-impact, relationship-based care model is brilliantly and simply built around the patient and is tackling the enormous societal and economic problems of the U.S. healthcare system. By combining people, process and technology, Iora is able to save money, bring joy back to the practice of care, and improve the health of all patients (especially the most vulnerable – older adults).  

The first question people often ask me after learning about what Iora is working to achieve is, “How do you do this?”

It takes starting from scratch in built-for-purpose primary care practices that serve patients under value-based care arrangements with sponsors that share our vision of transforming healthcare. Rather than buying an electronic medical record off the shelf, we support these practices with our proprietary technology platform, called Chirp, that integrates population health workflows and clinical documentation. What you get is a care team and technology that support a care model that is built around people rather than billing codes.

The second question asked of me: “Is it working?”

Results have been amazing so far. Iora’s average Net Promoter Score for patients (a measure of customer satisfaction, with  a range of -100 to 100) is around 90, while the typical primary care doctor’s office hovers around 4. Our care teams love taking care of patients under this model, and hospital admission rates have dropped by 30-40% for patients who have had Iora’s care for a year or more. All of this shows that the Iora model is working by being able to keep patients happy, healthy, and out of the hospital.

This is the solution for the misalignment of incentives in today’s healthcare industry.  By spending more time and building deeper relationships with people, Iora is proving that we can educate and empower others to optimize their own health, while also encouraging health systems to follow suit. At the end of the day, we all want what’s best for people and that means focusing on the one part of the equation that matters most: the patient.

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“What I Will Take With Me”

Dartmouth Health Connect, an Iora Health practice serving employees and family members of Dartmouth College, New England Carpenters Union, and King Arthur Flour, recently received a note from a patient who unfortunately was leaving the practice due to a life change. In her note, this patient described what she will be taking with her as a result of being cared for by the team at Dartmouth Health Connect:

“What I Will Take With Me

  1. I am primarily responsible for my own health with the help of a physician/Health Coach, etc. (collaborators)
  2. Mindfulness is key to addressing/mitigating health issues
  3. Sharing challenges to health issues and weight loss is helpful
  4. If you are sick, believe that you can get better and ask for help quickly
  5. Healthcare is a loving endeavor
  6. The Iora Health care model works”

This letter iterates why the Iora Health care model was created in the first place. We aim to meet people where they are so they can become advocates for themselves in their personal health journey.

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Why Iora Is My System Fit

The first time I walked into an Iora Health clinic, I knew it was different.

This tangible difference was seen in how the team discussed the people they were caring for, not patients. What the company really stands for was demonstrated in the team’s morning Huddle – every team member sitting at a table, hierarchy flattened, creating a mission driven, healthcare family pushing the limits and challenging the status quo.  It was seen in giving people (patients) hugs when they walked through the door and meeting them where they are, in a way that fit their values.  

Iora Health was created to transform healthcare, which is not a small venture. In order to do this, it requires thinking outside the box each and every day.  

We think of how we can create a community for health, not just care for a patient panel. We partner with patients to design classes for their community, and help us redesign how we deliver care. The structure of our model allows teams to make sure that we are measuring the things that matter most to patients, while maintaining high levels of medical quality.  At Iora if it makes sense to coordinate transportation for patients when they can’t get to appointments on their own, then we do it. I have never worked in a healthcare system that designs care based on community needs, rather than what what will be paid for.  

I found myself comparing Iora to my prior experiences in traditional systems; I began to think deeper about the moments when I hadn’t had a chance to huddle with my team every day, or collaborate with patients and their families to change the course of care due to their wisdom and experience. Not having the time for any of this was due to seeing upwards of 30 patients a day and all of a sudden, I knew I had found my system fit.

Today I get to witness and be part of a culture that is passionate about team development and breaking down the barriers of our legacy healthcare system. Iora Health is an organization that many wouldn’t believe exists due to their frustration with the current system.  Before joining Iora, I questioned how I managed to drift so far away from why I went into healthcare in the first place, but this experience has breathed life back into why I’m here and what healthcare is supposed to be. I feel honored to be a part of my team.  I hope others frustrated by the current system see Iora’s view of care as a sustainable way to create the change we are all looking for.

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An Uncommon Answer to a Common Question

“What do you do?” Over the years, I have answered that question hundreds of times. With over 20-years in healthcare (I think I need to stop counting!), the answer has changed: “I assess the causes of maternal and child mortality”, “I consult with companies regarding benefits strategies”, “I sell health insurance”,  or “I help people get second opinions.” In each company, I have always been in some type of external role, representing healthcare solutions to companies and individuals to solve industry “problems”.

However, since May 2016, my answer to that question has been: “I help restore humanity to healthcare.” “What does that mean?” is the common response. It inevitably starts a conversation about people’s experience with the healthcare system. As a mother of two daughters with some minor health concerns to monitor, to watching one of my closest friends undergo treatment for an inoperable cancerous brain tumor, to being the health advocate for an aunt who lost her brave battle to lung cancer, my personal experiences over the last few years have dramatically shifted my perception of an industry that I’ve built my career in. When you are put in the most vulnerable and compromising position of watching someone put their lives into the hands of another human being, it is humbling. I have been to dozens of other patients’ doctor visits. I’ve sat through multiple chemotherapy treatments. I’ve watched how the system treats not only the patient, but also those of us surrounding the patient. With all of my “industry” knowledge and access to the “best” medical minds, I still felt there was little I could do to impact the way that people actually receive care. What matters most when you have no control of your medical condition is receiving treatment from people with empathy, dignity and respect.  

I was fortunate to meet Iora Health’s CEO and co-founder, Rushika Fernandopulle, MD, many years ago when Iora was just starting. While I was immediately taken by the mission and vision, it was hard to appreciate how a completely new healthcare model could make a lasting difference. After being my family and friends’ patient advocate, I believe that most of the healthcare industry focuses on creating band aids rather than solving major systemic issues. As part of the Iora Health interview process, I visited our practices and experienced firsthand how Iora teams treat patients – and their health advocates – with a kindness and empathy unlike anything I’d ever seen. One gentleman while walking out of the practice with his daughter said to me, “I am down to one medication from five because of Iora’s help.” I left feeling strongly that this model should be the standard in healthcare, not the exception. Because of that feeling, I accepted the offer to lead the Business Development team in order to help make this a reality for as many people as possible.


Leading Business Development for Iora Health is a unique role. I am once again in an external role presenting a solution, but this time it’s for a massive healthcare issue: the desperate need for high-impact, relationship-based care. Now the end of that conversation that starts with “what do you do?”, ends with: “how can I receive my care through Iora?” It is privilege to be part of a team that makes a positive and lasting impact on people’s daily lives.

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The Iora Values Cube and My First Day

“What can we do to help?” asked a care team member at our Wicker Park office, as I stood thinking of next steps for my first patient on my first day in Chicago. Only two weeks prior, I had been finalizing work with my patients at Iora Primary Care in Seattle and here I was, feeling what true team-based care is….AGAIN. How is this even possible? One word sums it up: values. An organization that applies a set of values in every aspect of its operations is one where a unified culture is created, no matter what US time zone you’re working in.

I’ll start from the beginning; I joined Iora as a Fellow in Primary Care Leadership and Innovation two years ago. I had learned about what makes our health system so complex, but the remedies to these problems come down to designing a truly patient-centered experience. In starting from scratch, Iora Health has realized the role team happiness plays in the healing process for patients. An investment in people and culture permeates everything from our hiring process to the design of each of our practices.  

It’s fitting to talk about my patient Rachel’s* first visit through the lens of something that sits in each practice from Boston to Seattle: the Iora Values Cube, which is a concrete depiction of what we value most.

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Rachel walked in with lightheadedness and heavy bleeding. She hadn’t been seen by a doctor in over a year because the system was “too complicated”. Because of extenuating circumstances at home (child care and finances), Rachel made it clear that there was NO way she would go to the hospital, despite the heavy bleeding and dehydration. Conventional primary care (hearing her preferences, looking at her vitals and ultimately, sending her to the ER anyway), wasn’t going to cut it. Without even thinking, the Iora values came into play:

Bring Creativity

Though this was not a scenario we would normally come across, the team turned on support mode, in the same seamlessness I’d seen our Seattle team demonstrate. There were Health Coaches making Rachel feel supported, providers helping me get Rachel stabilized and finding the right medication at the lowest price possible.

Serve With Humility

No matter the task at hand, each teammate stepped up to get things done for Rachel and help me, a doctor that was new to the Chicago team.

Act With Passion

The unconditional way each teammate became a part of a process to help me and Rachel, speaks to Iora’s collective passion. The team manager coordinated with Rachel’s husband to get her clothes, locate her local pharmacy, and kept the clinic open late enough so he could make it to the center during rush hour.

Feel Empathy

Rachel’s story required a sincere human touch and compassion. An additional layer of empathy was the understanding the team had for me on my first day at a new practice.

Demonstrate Courage

Respecting Rachel’s wish to not go to the ER and coming up with an alternative plan required courage. I can’t imagine this scenario playing out smoothly in a conventional health care setting, especially on my first day.

When Rachel’s husband arrived with a fresh pair of clothes, she was no longer bleeding, dizzy or anxious and there was a prescription waiting for her at the pharmacy near her home. The team has been following up with Rachel ever since, ensuring that she continues to get the care and support she needs. Such is the norm here where a common set of values unify us no matter which clinic we work in under one culture: One Iora.  

*Name has been changed to protect patient privacy.

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Why Iora = Comprehensive Primary Care

Janice* joined Iora Primary Care after moving to the Seattle area from Idaho. In Idaho, Janice had several specialists who she had to see for her many medical conditions. She was pleased to learn that at Iora we do as much care in the practice as possible in an effort to streamline care and save patients from paying unnecessary copays.

Janice came to us with a long history of multiple complex medical conditions, which included chronic pancreatitis, diabetes, vascular disease and long term pain medication usage. Fortunately, one of the gifts that Iora gives their staff and patients is time. We have time to think about our patients from a comprehensive perspective and we ensure that the patient has time with their care team to feel heard and supported on their journey. Janice’s health care team, consisting of a doctor and Health Coach, worked with her to create a plan that would meet her complex health care needs.

We set up a schedule of routine appointments to see the doctor and address Janice’s multiple concerns. In addition, we  set aside time for her to meet with her Health Coach to address diabetes education and customize her medications to better fit her lifestyle. Even though she had been on insulin for years, no one had taken time to teach her about diabetes and how her other medical conditions affected her blood sugar. Through these coaching visits, Janice was able to stabilize her blood sugar and learn about the warning signs associated with it being too high or too low. She called whenever she had questions and, over time, became much more confident in managing her diabetes on her own.  

Beyond diabetes management, we also started working with Janice to address her chronic pain; at Iora we work to balance the need to treat people’s pain with the importance of doing it safely.  Sometimes that means we recommend changes in how people use pain medication and Janice was challenged by the compromises that this process requires. One day after she missed an appointment, I called her and learned that she had left Iora for a different primary care practice. As a team we were sad to lose someone we cared about and who we felt was truly making positive progress and life changes to better herself.

The Turning Point

About four weeks following her departure from Iora Primary Care, we received a call from Janice asking to speak to her former doctor. On the call she said that she realized she had “made a big mistake” and asked if the doctor would be willing to take her back as a patient. She went on to tell us that her new physician told her that in addition to her primary care doctor she would have to see two different specialists to manage her conditions and “I kept hearing in my head my Iora doctor saying ‘we can manage that for you here in the clinic.’ I didn’t want to go to all those other doctors!” Of course we were happy to welcome Janice back to the practice and resume the work we had been doing together towards a healthier, empowered life.

Over the next six weeks, after rejoining Iora, Janice gained new insights into how her choices in life affect her health through participation in one of our chronic disease self management classes. With options like classes, personal meetings with her Health Coach, and visits with her doctor, Janice grew optimistic that her life could become more than just one health crisis after another.

*Please note patient name has been changed to protect identity and private health information.

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This is a question that we hear constantly at Iora Health from investors, Care Teams, and especially from electronic health record (EHR) vendors. Why not buy an EHR off the shelf? Why not work with another developer to build what we want? The short answer is, prior to Iora, Rushika Fernandopulle, MD, MPP, CEO and co-founder of Iora Health, tried all of the above; he and Neil Patel, MD, published a paper detailing their poor experience with eClinicalWorks in supporting the type of care we have at Iora today. So with this in mind, why build our own EHR (or as we call it, Collaborative Care Platform) to which we affectionately refer to as Chirp?

Simple. No one else has built what we need and here’s why:

  1. Other systems are too focused on billing, coding and encounters. Modern EHRs are abstractions of the paper record, with an innate focus on a given encounter and the notes/billable claims derived therefrom, rather than the clinical story of a patient.  Each time a patient and doctor meet, every piece of information must be documented in a way that a third party reading it could understand the patient in their entirety. The most crucial elements of care, anything that occurs outside of a visit, any synthesis done by providers, or any changes over time, are effectively lost in the modern EHR.
  2. We lose the story and the relevant data. Within EHRs, data is either too structured, with infinite checkboxes replacing sentences, or insufficiently structured. For example, errors such as a patient’s son who has been listed as seven years old for the last five years are easily overlooked amidst the clutter of the traditional EHR. This structure results in a jumbled patient story, no ability to analyze clinical data, errors propagated with each copy, and a worsened chance of making good clinical decisions.  

OK. How is Chirp different?:

  1. Chirp is designed to support a clinical team that cares for a population of patients. By first emphasizing communication about the administrative aspects of health care (faxes, follow ups, lab reviews, check ins, etc.), teams are able to accomplish everything necessary for their individual patients within one workflow. Chirp shifts us away from encounter-based care, hunting through multiple software systems, toward a work task structure, so that the care of a population can blend in seamlessly with an otherwise busy clinical day. Teams can spend their time in relationship-based primary care, rather than in an endless stream of seven minute visits. Other EHRs have the care of individuals and populations as two separate systems for two separate audiences and completely miss that a population is comprised of individuals who need care.
  2. We need the ability to innovate constantly. The Iora Clinical Model is always evolving. Decisions that made sense in 2012 make less sense in 2016 as we grow and learn. With a third party product, we have no hope of convincing someone else to build what we need. With our own software and amazing team, we have the ability to test things and move forward with changes in real time based on real world experience. This process replaces the slow, usually inaccurate, large changes done in one sitting to a software platform.

At Iora we are building an entirely new model of care delivery; we have been able to innovate payment, team composition, physical space, workflows and of course, our software.  It is the ability to grow all of these elements at once that has led us to create a model of care that lets us truly connect with our patients and help them solve their problems, each and every day. Chirp is a vital part of the puzzle that makes that possible.