Posts Tagged: Primary Care

Scott Jacobson

One Coffee at a Time

The work we do is challenging and sometimes it is easy to succumb to feelings of doubt, thinking that all our hard work is in vain. However, there are examples that highlight the difference we make. One such example is one of our Health Coaches, Vero’s, most challenging patients.

She is a 23 year old patient. When she came to us it was clear that she was suffering. She has type 1 diabetes, difficult enough for a young adult to handle yet she also suffers from ulcerative colitis. After an extended hospital stay and major bowel surgery, she was left with an ostomy, a difficult situation for anyone and particularly debilitating for a 23 year old.

Her surgeon told her she would have to get her sugars under controlled before they would reverse the ostomy. Dealing with an ostomy bag was not only a hindrance on her social life, it limited her job opportunities.

Not surprisingly, she also suffered from major depression which became a compounding factor in managing her multiple medical problems. She tried talk therapy but never really felt comfortable opening up. Antidepressants didn’t make a dent. She was mired in despair and despite our efforts to engage her in managing her blood sugars, Vero’s texts often went unanswered. We knew she would spend days in her room, crying and isolating herself. She would frequently break down while at work. We begged her to come in to talk to us.

Finally, one day without prompting, she did. We could tell she was on the edge and didn’t know where to turn. She had decided to put her trust in us as a last resort. She opened up to us and all her emotional and physical traumas began to trickle out. It was a very emotional meeting and it was only the beginning. We offered more therapy from a professional, but she really just wanted to talk to her Health Coach. We decided that coffee with Vero every other week would be a start. She left that meeting only a step back from the edge but she was moving in the right direction.

And then, Vero received a gift of beautiful flowers.

One Coffee at a Time Vero

The note reads:

I HONESTLY WANT TO THANK YOU FOR EVERYTHING THAT YOU HAVE DONE FOR ME EVEN THOUGH I AM A PAIN IN THE BUTT I’M SO GRATEFUL THAT YOU HAVEN’T GIVEN UP ON ME YOU TRULY ARE A GODSEND

Over the past couple of months Vero’s coffee meetings have been a huge success. She has shared some of her deepest secrets that have clearly been weighing her down and blocking her from moving forward. She has felt comfortable enough to establish care with Nina, our social worker, so she can get the trained help she needs in dealing with her significant past traumas. From a medical standpoint we are still working on her sugars with the goal of reversing her ostomy. She is by no means a picture of health, but we are taking baby steps, in the right direction.

This patient has been a huge reminder to me that despite the monumental task we have in front of us, we do make a difference in people’s lives, everyday. Because of the unconventional resources we have to help us connect with our patients, we are able to continue to find creative ways to make breakthroughs and put our most challenging patients on the track to leading healthier and more fulfilling lives. I know that there are times we feel like no matter how much we try to help our most challenging patients, that they can’t or won’t change. It is so wonderful to be reminded that by showing our patients that we truly care about them and that we won’t give up on them, our positive attitude can have an impact. Great job Vero!

Andrew Schutzbank DSC_4708 2

Building a Company on Culture

At Iora Health, we wake up every day with one purpose—to restore humanity to health care. Through our ever-evolving model of delivering health care, we are able to build meaningful relationships with our patients that allow us to support them on their journey toward health. Every day, in practices across the country, our teams of providers, Health Coaches, nurses, behavioral health specialists and administrative support come together to solve the unique, complex medical and social concerns of our populations in ways we never thought possible. Whether we are caring for casino workers in Las Vegas, Carpenters in Boston or seniors in Seattle, anyone who walks into an Iora practice will experience the same something remarkable—true relationship-based primary care. How is this possible? Culture.

Many of us have come from ‘typical’ health care. We left a culture that we knew could not become what it needed to to care for modern patients. We had to select the best that modern health care culture has to offer—a deep sense of responsibility toward patients, incredible technical competence and knowledge, a tremendous work ethic but leave the rest behind. We created a culture around a core set of values not often found in health care: to feel Empathy, to bring Creativity, to act with Passion, to demonstrate Courage, and to serve with Humility. And then we found people that already embody these values, regardless of their background, and brought them together to form amazing teams.

We define culture as a common set of values that allows every member of the team—clinical, operational, technical, to know how to approach any problem regardless of its novelty. Rather than operating our business from a set of top down policies and procedures, drilled into our teams to create uniformity, we have focused on creating a culture first. Our core values inform every aspect of our work. Embedded in every act, whether it’s how we greet you at our practices, how we build our software, how we treat diabetes, or how we raise funds for the business, is the Iora culture. From this culture spring our strategies, policies and process that make it easier to do what we do best—help our patients solve their problems.

Building a culture-based series of radical primary care practices is not easy — and not for the faint of heart. We are used to falling back on the rules of big health care which are comfortable, but false. However, we know where the old way will get us—to the old place. No perfectly crafted set of rules, no brilliantly designed provider incentives, no amount of quality committee oversight will get us to where we need to be.

Imagine you are the primary care provider on call for your practice. It is 1am and your well-known patient with advanced lung cancer on chemotherapy is calling with fevers. What do you do? Typically, you would gruffly mumble “go to the ER,” if you even received the call. Not at Iora. First, you calm the patient and his wife. You then tell them to sit tight and you will call them back. You call the oncologist (thankfully it is 10pm local time) that you have selected for that patient because of the amazing service that oncologist provides, consistent with our values, to see if this can be managed with antibiotics and an office visit in the morning. When you decide together that it cannot, you call the ER nearest the patient, speak with an attending to prepare them for the patient’s arrival, send what records you can through the antiquated fax system plaguing modern medicine. You call the patient back, (who is shocked to actually get a call back) and let them know the ER is waiting. You also let them know that their Health Coach will call and check up on them in the morning. And at 8:15am they receive a call from their Health Coach who is able to find out exactly what is happening and work with you to plan the next move. Why do you do all of this? Because you love your patients, your work and don’t really need sleep? On the best of days. Because you are paid for every middle of the night well-facilitated ER visit? Hardly. You do it because that is what you do, why you signed up, and because your team would tolerate nothing less from you but excellence. That is the power of culture.

Culture means that even when the way forward is unclear, you can count on each other to build the map to get where you need to go. It means that whether you build software, market Iora Health, or decide where to open new practices, that you work off of the same standards, the same criteria, and seek to optimize the same things. When we think of it, we couldn’t imagine how to build a company on anything but culture.