MARCH 24, 2015 – Primary care practices often seem to follow a set of unwritten rules: a patient enters the clinic, checks in with the receptionist, and then waits for the nurse or doctor. Many questions are asked, data is collected, a physical examination sometimes occurs, some advice is given, and then the patient is told to make another appointment in six months to a year.
Iora Health proposes that we do things a little bit differently.
Rushika Fernandopulle, MD, and Christopher McKown founded Iora Health in 2011. They hoped to change the way we look at primary care as a model, says Kathleen Haley, Iora Health’s Director of Marketing and Communications. Fernandopulle had been practicing in primary care for over a decade and he didn’t like what he saw in the system. According to Haley, he realized that doctors were very good at some things, but also very bad at others – and he wanted to use that realization to change three things about primary care.
“We had to change how we get paid, find the technology to support a model that doesn’t base treatment around billing and coding, and then we had to create a care team,” Haley says of Iora Health’s mission.
New Payment Models
Today, Iora Health has clinics all over the United States. These clinics feature per-patient, per-month payment plans rather than a fee-for-service model, allowing the company to work unimpeded by billing codes and authorization requirements, saving on administrative costs and giving care teams free reign to do whatever they need to do to keep their patients healthy and satisfied.
Regarding electronic health records, Haley explains that Iora’s model proactively manages a patient panel. “We can work on specific issues within a broad range of patients,” she says. “It could be something like looking up how many of our patients aren’t managing their diabetes, and we can sort and reach out to those patients to manage that specific part of their heath better.”
Innovative Care Teams
Another of Iora’s innovations is that it allows patients to become active members of their own care team with the goal of “restoring humanity to healthcare.” In addition to employing doctors, nurses, and behavioral health specialists in their offices, Iora also employs health coaches. These men and women come from a variety of backgrounds and are chosen because of their ability to relate and connect with the people they treat.
“Normally, if you go to a doctor and you’re overweight and have diabetes, they would tell you to lose weight and exercise and come back in six months to see how you’re doing,” Haley says. “This is where the health coach comes in as such a big part of the system.”
Here’s Iora’s reimagined version of a primary care visit: When a patient walks through the door, they’re greeted by an operations assistant and offered a cup of coffee or water while they wait. Instead of a nurse or a doctor meeting the patient, a health coach brings them into the room to start a dialogue. According to Haley, the health coach is looking to “break the ice” of the sometimes awkward and uncomfortable wall between a patient and their healthcare provider. What hurts? How’s the winter treating you? Seen any good movies? How’s life at home? Health coaches help patients feel comfortable and engaged while also gathering valuable information about a patient’s physical and mental wellbeing. Patients can even come to a clinic specifically to see their health coach.
“This saves time because the doctor doesn’t have to engage in all of the initial questions and data collection,” Haley says. “We’re allowing for more time for patient – doctor interaction. If they were struggling with stress or depression, we would invite the behavioral health specialist into the room, too.”
Mike Jeudy, a health coach at Iora Primary Care in the Boston area, found the position after spending several years as a mover and shaker at his local YMCA, where he spearheaded programs that supported clients in creating their own health and wellness plans. While working at the YMCA, Jeudy was contacted by a fellow graduate student who told him about Dartmouth Health Connect, an Iora Health clinic. That student connected him with the program manager, and two weeks later he was an Iora Health employee.
“A regular day would start off with a team huddle,” Jeudy says. “It’s with the whole care team, including the operations assistant, behavioral health specialist, doctor, nurse, and health coach.” During this huddle, Jeudy says that the team discusses patients who are coming into the office that day and those on the concern list, too.
Looking forward, Iora Health plans to double in size in the coming year. They’re always looking for organizations that will allow them to grow and spread their model to new markets, Haley says. They’ve also just announced a partnership with Hartford Healthcare – the largest health system in Connecticut and a leader in healthcare reform – and with Humana, which has enabled them to launch four more practices in two growing markets.
Despite these expansions, the focus of Iora will always be on improving patient access and care. “The beauty of our system is that we still have the traditional primary care model but we also have the flexibility to be creative and make appointments more pointed to our patient’s goals,” Jeudy says.
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