Is This Startup the New Model for Health Care?

Iora Founder, Dr. Rushika Fernandopulle, Was Frustrated With the Way Insurance Companies Dictate Care

Iora Health (PRNewsFoto/Iora Health)

American health care may be a mess, but many founders clamor to fix it. Among them: physician Rushika Fernandopulle, whose Boston-based company, Iora, reworks the primary care experience. Iora charges each patient a monthly flat fee–about $150, often covered by insurance–instead of using today’s baffling and complex system of copays and billing codes. Iora also pairs each patient with a health coach to ensure that he or she follows doctor’s orders. This model, while more expensive up front, addresses problems early on to save consumers and insurers money in the long run, by cutting down on emergency-room visits and long-term care for chronic conditions. Fernandopulle launched Iora in 2012, with one clinic in New Hampshire and another in Nevada. To date, Iora has raised more than $42 million and opened 11 more clinics. And Fernandopulle is planning for 30 locations by 2016.

A lot of people are trying to fix health care from the top down. We decided to start from the bottom–with primary care, where the real relationships begin.

If I say, “Eat a low-carb diet,” and my patient doesn’t understand what that means, how can she improve her health? Each of Iora’s patients has a dedicated health coach who discusses the individual’s issues before the doctor arrives. The coach then stays during and after the exam to translate the doctor’s recom­mendations into an actionable plan.

When we meet a patient, we assign him or her a worry score–a number from zero to 10. We start each day by huddling with the doctors, nurses, and health care coaches to see who is having problems. We focus on the 10s: “Is anyone in the hospital? Or in trouble with their blood pressure? Any ER visits last night?” We get data about patients whenever they see a specialist or visit the hospital, and we know when they fill prescriptions. If they don’t, the health coach follows up to see why not, and how we can help. It’s amazing what we learn: The pills were too big, or the patient has no way to get to the pharmacy. These are easy problems to solve.

Our core proposition is to increase the funding that goes into primary care in a smart way. We work with sponsors–either self-insured employers, or unions that pay for health care, or progressive health insurers, most of which pay that monthly fee. We earn our money by taking care of our patients, not by billing for every service we provide, which is how the vast majority of primary care doctors are paid.

Through our website, patients have full access to all their medical records, doctor’s notes, and lab reports. They can book an appointment online, and choose it to be in person, by phone, or by video. We also ask patients to personalize their page–to put up a photo, and write a headline like, “Working dad wants to run a marathon.” The best way to manage is to make sure each person has a goal– and is acting on it.

This business model is another response to the concern of the cost of healthcare and insurance and the lack of provider to patient education. The personalized education model of Iora is something that would be potentially beneficial within hypertension patients. Often, healthcare providers quickly tell patients their blood pressure without explaining what it means. Other times, they may not even tell the patients at all. Being able to understand what the readings mean is the first step to managing it.

A health coach would be able to fill the gaps where healthcare providers do not fully explain an issue or the instructions to patients. Having a health coach limits the time doctors have to spend explaining plans and diagnoses to patients, which increases the number of patients they can see. Further, the health coach is trained to be empathetic and to make the patient feel comfortable coming to them with questions that they might have been too scared or embarrassed to ask.