Iora Health — Working Together to Improve Health
Iora Health’s team-based, patient-centered care model is putting the focus of health care back on the patient.
Iora Health is a health care provider focused on patient-centered care. Utilizing a team-oriented approach, the Boston-based company provides support and coordination throughout the entire continuum of care, forming teams of doctors, nurses, and health coaches whose primary responsibility is to work together in order to best serve each of Iora Health’s patients. The company’s vision for the provision of care is holistic in nature, encompassing both traditional primary care services such as physical exams and other services such as mental health services, peer support groups, and nutrition counseling (1).
Iora Health is an example of a company that is effective at driving alignment between its business model and operating model.
The Institute of Medicine defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (2). This value lies at the heart of Iora Health’s mission. Traditionally, health care has been provided on a fee-for-service basis; doctors receive discrete payments for each service they provide. This type of health care system can lead to a misalignment of incentives, encouraging unnecessary or low value-add tests and procedures. Iora Health seeks to be part of the evolution of our nation’s health care system towards value-based care – care that focuses on maximizing health outcomes while minimizing the associated cost.
Under Iora Health’s business model, the company captures value through its version of a capitated payment system. Iora Health is paid a lump sum for each patient’s care; it is thereby up to the company and its doctors, nurses, and health coaches to determine how to best provide care and simultaneously manage costs. Should Iora Health be able to effectively manage care at a cost lower than the lump sum payment received, then the company will successfully capture value through the profit they make. At the same time, Iora Health creates value because its payment system incentivizes the company to focus on preventative care while averting poor health from spiraling further downward. Iora Health’s goal becomes improving patients’ baseline health to reduce the risk for costly emergency procedures (3).
Iora Health’s operating model supports its business model, giving the company a competitive advantage in the traditional fee-for-service environment. At its core are Iora Health’s people. Iora Health’s physicians, nurses, behavioral health specialists, and health coaches drive the company’s value proposition of providing quality care. By building relationships with one another and with their patients (appointments can last more than one hour), Iora Health’s care teams are the patient’s advocate, supporter, and defender, driving overall better health and reducing health care costs in the process. Particularly unique are Iora Health’s health coaches. These coaches oftentimes hail from non-health care backgrounds; they focus on catering to patients’ non-medical health needs such as diet changes, finding the right supportive socks, and arranging transportation for senior citizens. In addition to the importance of human capital, Iora Health is also incredibly data-driven, utilizing patient health information and predictive analytics to prevent health emergencies before they arise (4).
Performance is promising. Since the company’s first clinic opened in 2012, Iora Health has meaningfully improved clinical outcomes in hypertension and diabetes control, compared with the national average (5). Iora Health’s success is also catching the attention of payors, having established partnerships with both Humana and Tufts Health Plan (6, 7). While the company is only three years old, its prospects are promising. There is hope that Iora Health, and other companies seeking to disrupt the traditional health care model, will help to improve the health of our nation’s overall population.
Student comments on Iora Health — Working Together to Improve Health
Very interesting perspective on the health care space. I’m happy to see payors getting on board with this model, but I worry about some of the incentives created. While creating incentives for preventative care are great, if a patient is beyond that and the team has to choose between treatment A and B for their disease, will the price play a greater role than the efficacy of the procedure? What is Iora doing to ensure that their team is choosing the best treatment for the patient, even when it isn’t the best for their bottom line? The old model had higher prices for more expensive procedures, what can Iora do in their model?
This is a great idea and I’m excited to see how capitated systems change healthcare costs. I wonder if this kind of system would incentivize hospitals to target patient sub-populations that have historically had better outcomes. For example, target diabetics that have the personal financial resources to manage their weight more easily and therefore enjoy more of the lump sum profit. Is there a way to mitigate this risk?