While many people and institutions are trying to make small, incremental changes to health care to increase engagement, we decided to build a completely different primary care model from scratch to build a new and compelling vision of what is possible, and stop others from being able to make excuses why they cannot do the same. Our practices serve the sickest and most vulnerable, and have demonstrated much better patient engagement and experience, team happiness, and clinical outcomes, all at lower total health care costs. We have been accused of raising expectations, moving too fast, making others look bad, and upsetting the status quo- all of which we plead guilty to. We believe every patient delivers this sort of care, and they deserve it now.
The mission of Iora Health is to transform the delivery of primary care by simply building and demonstrating a new model which better engages patients and improves experience, outcomes, and affordability. Instead of making small incremental changes to existing practices, we start from scratch and build new practices from the ground up, with a radically different business model, staffing model, IT platform, process, and culture.
We start with changing the payment model- we believe primary care ought to be about continuous healing relationships, and fee for service is the wrong way to pay for this, so we only take a risk adjusted primary care capitation fee for caring for our patients, and remove all copayments for interactions with us.
That allows us to completely build a new delivery model geared not at pushing more widgets off a line like typical practices, but that we have a population of patients who are our responsibility, and our job is to literally whatever it will take to engage them, improve their health, and keep them out of trouble. We built a robust team around our patients built on what we call health coaches, people from the community who speak the language and live the life of the people we serve and help patients with all the hard work to improve their health including learning about their condition, knowing what to track, someone to hold their hand, and to keep them accountable. We have 4 health coaches per doctor, and they are chosen mainly for their empathy. We start each day with a 45 minute huddle where we discuss our patients who we feel need our help, not just the ones coming in, and make plans to reach out to them. We are able to interact by email, text, and video in addition to visits, and have many groups where patients can learn from each other as well as from the health care team. We integrate mental health with a LICSW in each practice, and find a small group of willing specialists to work with us to help our patients navigate the whole health care system. We also invite active participation of our patients in advisory dinners held several times a year.
We have also learned that the current Electronic Health Records (EHRs) on the market are built to help you document, code and bill higher, and are not helpful to mediate this completely different sort of care, so have had to build our own collaborative platform called ICIS (the Iora Clinical Intelligence System) to help us truly engage our patients, track and improve our performance, and manage our teams.
We build these sorts of practices for payers who are willing to pay us differently. As of March 2014, we have six practices up and running, serving populations as varied as complex chronic hotel and casino workers in Las Vegas NV, faculty and staff of Dartmouth College in Hanover NH, freelancer workers in Brooklyn and Manhattan NY, and Carpenters in Boston MA.
While we have built a completely different payment, staffing, process and IT model, what we believe is most important is the radically different culture these allow. Our teams truly are enabled to do whatever it takes to engage patients- whether it is visiting them at home, going for a walk together, going grocery shopping with them, or even spending an hour painting their toenails.
We have been able to make incredible change in the lives of hundreds of our patients. For instance , Jose is a 13-year-old young man who came to us weighing over 300 pounds, and had recently been diagnosed with diabetes with an A1c over 8.5, even on metformin. He would spend his afternoons after school on the couch eating junk food and playing video games. We were able to engage him in setting a goal to make the football team, start eating better and going to the gym with one of our health coaches, and reading books and making friends instead of sitting on the couch. In just six months, he lost over 50 pounds, got off his medications and reversed his diabetes completely, made the high school football team, and had a new confident glint in his eye.
Jose is not alone; we also have a lot of data that we are able to radically improve performance overall in our practice. We have made dramatic improvement over prior experiences for patients in patient satisfaction scores, both on CG- CAHPS surveys and net promoter scores. Our teams are also happier, with extremely high happiness scores and virtually zero voluntary turnover. We have improved clinical outcomes for patients. For instance at entry, only 55% of our patients with hypertension have their pressure under control (<140/90), but after just six months we can get 88% within the right range. And all this leads to lower downstream costs in our Las Vegas practice. For instance in one year, we have seen reductions in hospital admits of 37%, and total spending reductions of 12% net compared to well matched control groups, and our 30-day all-cause readmission rate fell from 21% to 12%.