Can Healthcare Be Accessible, Exceptional, and Low-Cost? A Glimpse at Iora Health

Iora Health paves the way in redesigning primary care delivery.

A key challenge in healthcare today is the growing problem of spending, fueled by misaligned reimbursement incentives. As an MD/MBA student, I’ve often wondered: are exceptional, accessible care and financial/operational efficiency mutually exclusive? Iora Health, a novel, for-profit healthcare delivery company founded in 2011, is one practice that is starting to show me the answer: no. They are restructuring primary care delivery to be team-based and patient-centric. Strong alignment between their business and operating models allows them to generate success on key outcome metrics.

The Business Model

Iora’s business model has three synergistic arms, grounded in a common mission: to provide low-cost, patient-centered primary care.

  • First, they offer a unique patient experience in which a team of healthcare professionals offers collaborative, goal-oriented care.
  • Second, they offer a risk-adjusted capitated payment model through strategic partnerships with insurance companies.
  • Third, they develop technologies such as transparent medical records that facilitate patient-centered care.

Ultimately, Iora aims to capture value through its focus on preventative care; fewer emergency room visits, reduced per capita expenditures, and reduced administrative costs through a capitated model drive improved quality and outcomes. Iora expects to receive “some sort of shared savings off expected total health care costs” to drive profitability.2,4,6

The Operating Model

Iora’s operating model parallels its business model in 4 unique ways:

  • “New patient experience:” Iora delivers team-based care with nurses, physicians, and behavioral health providers. They have 4 features providing competitive advantage in the patient experience.
    • Each patient is connected to a health coach who is a dedicated patient advocate “screened and hired for their ability to connect deeply with people…they are confidants, cheerleaders, and friends.”1 Health coaches are locals in the community, which promotes trust.2
    • Hour long visits (vs. 15min traditionally) allow patients and their families to get to know their providers, share concerns, and set mutually achievable health goals.1
    • Iora provides “integrated health and wellness” programming including support groups such as “Diabetes Club,” yoga sessions, and grocery shopping assistance.2
    • Finally, Iora staff conduct home visits for particularly ill patients who may others be “lost” to the healthcare system.3

Iora Quote

  • “Fully integrating behavioral health:” Unlike most primary care practices, Iora provides on-site behavioral health screening and care1; they view behavioral health to be crucial to overall health. Traditionally, separation of behavioral health and primary care has created barriers in access to mental health services, which has tangible effects on outcomes.7
  • “Say goodbye to paying by transaction:” Iora develops partnerships with insurance companies willing to try a capitated payment model compared to a fee-for-service “transaction-based” model.1 This affords care teams the flexibility to engage in care that is best for the patient, versus care that will reimburse well. Insurance companies pay a premium ($50-$60/mo) which covers an unlimited number of patient visits and required medical tests.4 Typical primary care practices cost $15-$25/mo for insurance companies, plus patient co-pays; this excludes the cost of frequent Emergency Department visits and expensive tests. 4
  • “Our technology is inspired by our care:” Iora has developed technology to support its unique care delivery model:
    • Text-based patient progress-tracking allows care teams to monitor patients with common chronic conditions. For example, patients with hypertension can measure their blood pressure at home, and text results to Iora for real-time advice on medication and lifestyle changes.1
    • Second, the move away from a fee-for-service reimbursement model has allowed Iora to develop a patient-centered medical record which focuses on patient experience rather than documentation for legal purposes around billing criteria. Based on these data, each patient is assigned a “Worry Score,” and physicians are automatically alerted when their patients experience higher-than-expected scores, or concerning events such as hospital admissions. This prompts outreach from Iora staff to generate a tight feedback loop. Moreover, patients always have access to their medical record, further achieving the goal of patient-centered care.3,4

This video highlights some key features of Iora:

Performance & Summary

In just 4 years, Iora has achieved “35-40% drops in hospitalizations, and 12-15% drops in total health care costs relative to matched controls.” 5 Patient enrollment in their clinics far outpaced anticipated growth, with 25% patient engagement compared to the 2% industry average.1,6 The results are astounding.

Each component of their operating model returns to the central mission driving their business model: exceptional, low-cost, patient-centered care. Although Iora has not shown financial profitability yet, these early successes have secured them considerable venture funding to pursue growth strategies. It is only a matter of time until Iora achieves the scale necessary to experience independent profitability.

Works Cited:

  1. http://www.iorahealth.com/model/
  2. https://www.bostonglobe.com/business/2015/05/03/iora-health-pioneers-new-primary-care-model/kc7V4W5V8OJ0gxFqY4zBrK/story.html
  3. http://www.bizjournals.com/boston/blog/startups/2012/08/iora-health-boston-primary-care.html
  4. http://www.xconomy.com/boston/2015/01/26/primary-care-provider-iora-health-takes-in-28m-to-fuel-growth/
  5. http://www.forbes.com/sites/ashoka/2015/10/23/why-our-health-system-talks-up-but-actually-fears-disruptive-innovation/
  6. http://healthaffairs.org/blog/2015/08/17/breaking-the-fee-for-service-addiction-lets-move-to-a-comprehensive-primary-care-payment-model/
  7. Institute of Medicine,Primary Care: America’s Health in a New Era (Washington, D.C.: The National Academies Press, 1996.)

 

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5 thoughts on “Can Healthcare Be Accessible, Exceptional, and Low-Cost? A Glimpse at Iora Health

  1. Interesting post! I am curious about what their patient mix is. I’m assuming it will be difficult to take on financial risk if you’re patient population skews towards more complicated and geriatric. Also, very curious about the revenue opportunity for physicians in the IORA network. Under this model, it would seem that they would likely be revenue negative when compared to a traditional FFS model. This could have direct implications for the talent they’re able to hire and retain.

  2. Great post, I really enjoyed it! Iora’s model is a really inspiring example of how process innovation can improve quality and efficiency of healthcare. The team-based approach is an effective way to give the patient more individual care while using less expensive staff time, by pushing some of the education and support work to health coaches as opposed to doctors or nurses.

    It was interesting to hear that they offer one hour appointments instead of 15 minute appointments, and I would be curious to know how that appointment time breaks down. Is it still 15 minutes with the doctor and 45 minutes with a nurse or a health coach? Are mental health professionals responsible for conducting the screening, and is that part of the one hour visit, too?

  3. Iora’s model has achieved impressive results. I wonder whether its cost structure is sustainable over time given how labor intensive it is. Over time insurers who work with Iora may wonder if the extra premiums are worth the outcomes in cost savings, especially as competing primary care providers become more sophisticated in patient management, through technology. Another interesting thing to consider is whether Iora’s model is best-aligned with the overall provider business, vs. the payer side (i.e. Clover Health).

  4. Great analysis. The business model makes a lot of sense, but how does Iora attract top talent to come work there, in order to provide the highest level of patient care?

  5. Great post. I really like how Iora Health is creating a difference in the healthcare industry. I have 2 questions:
    1. As Kbouks also pointed out, how sustainable is the model in terms of attracting the top talent, esp. given that human capital is one of the most critical resources in ensuring patient-centered service?
    2. Why is this approach so new? Why have other players not been able to do that? And how is Iora addressing those concerns to be able to be successful here?

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