Iora Health, a 3-year-old Cambridge, Massachusetts-based startup, has six private practices taking a novel, patient-centric, technology-driven approach to care. At McKesson's Better Health Boston event this week, chief operating officer Alexander Packard spoke about the healthcare needs driving Iora's model.
"The experience of getting primary care in the United States is actually terrible," he said. "It's hard to find a doctor, and if you do find a doctor it's hard to get an appointment, and when you do get an appointment you wait for a long time. ... When you finally do get to see a doctor it's only for seven minutes, so it's kind of a race. Then the doctor's gone and [maybe] two of your questions got answered. And what we don't know as patients is your doctor had a terrible experience as well. That's not why they got into medicine, to get on the hamster wheel and see 30 patients in a day."
Iora works with self-insured employers and unions to create special private practices for their highest-risk, highest cost members. Those patients -- which now number about 8,000 strong at six practices spread out across the country -- don't pay a copay and don't have a doctor as their primary contact point with the care system. Instead, Iora employs health coaches who work with patients.
"We think that a lot of what patients need is compassion, someone to listen to them and understand them," Packard said. "As we know, about 75 to 80 percent of healthcare cost in the US is driven by 15 percent of patients. If you look at the job that they need done, it's about helping them navigate an incredibly complex world. More often than not the folks that are high cost have a lot going on in their lives, whether it's two jobs, or low income, or single parent, or loss of job, or loss of coverage, you name it."
Iora's approach is care team based -- the patient's doctor, coach, and behavioral health specialist all work together, and technology and data are a big part of how they do that, Packard said. In the company's Cambridge office, 10 engineers and developers continuously iterate what the company calls "ICIS" -- the Iora Clinical Intelligence System. The system combines data from an in-house designed EHR and the patients' claim data and brings it to the doctor in a way that, in Packard's words "tells a narrative story over time of what that patient's experiencing, not a series of episodes."
The current development project is opening the system up to have more online patient-facing functionality. The first step will be setting up online appointment booking, followed closely by an open notes initiative.
"Increasingly, we're going to build in more and more visibility of the notes, because the more patients are engaged -- [Asking] what drugs am I on? What is my blood pressure, What is my HbA1c? -- the more they know the answers to those questions or even what questions to ask, the more they care about themselves, and the more they have agency or self-efficacy," Packard said. "So we're on a path to create transparency with the medical record so the patients really feel like they own it, too."
Iora currently works with Dartmouth College employees in New Hampshire, hotel and restaurant workers in Las Vegas, carpenters in Massachusetts, and freelancers in New York City. The company is now hiring doctors, nurses, and coaches in Phoenix, Arizona.
Packard said control group studies have shown that their model decreases a patient's cost of care from 12 to 15 percent per year. The dramatic decrease is partly because the model is focused on caring for the highest-cost patients, however. It's unclear exactly how the savings would scale to a wider group of patients. In any case, Packard is bullish on the prospect of continuing to grow the model.
"We feel this is the future of how healthcare ought to be delivered," he said. "We feel primary care is the lever to change the rest of how healthcare gets delivered. So right now, this is the top of the first inning. We think that in probably five years we'll have 50 to 75 practices around the country taking care of 100,000 or 150,000 patients. And that's a drop in the bucket. What's really going to change how healthcare works is if we can prove this model works and get other people to emulate it."