Best Practices: From the bottom up, Iora Health helps providers build ACO framework

Accountable care organizations are viewed as the leading government-backed approach in the transition from volume to value. Boston-based company Iora Health is helping providers invert ACO models and deliver strong results.

Rushika Fernandopulle, the company's co-founder and CEO, describes the typical ACO framework as “top-down,” starting with health system changes that will hopefully trickle down to benefit patients.

“What we're doing is building bottom-up ACOs. Start with primary care and then build on top of that—some specialty care, relationships with hospitals, etc.,” Fernandopulle said on the sidelines of the World Health Care Congress in May.

The venture-backed company offers a redesigned care and payment model that more closely resembles a subscription plan (think Netflix) than the conventional fee-for-service approach. Its model has expanded quickly over the past four years and data suggest patients are satisfied with the care. Their health is improving, too.

Since 2012, the company has partnered with employers, unions and insurance companies. Iora Health provides the care—pairing patients with a care team consisting of a doctor, a nurse and a health coach. The company also emphasizes behavioral health—each market has at least one specialist—and the primary-care teams receive training on behavioral health basics.

Dartmouth Health Connect, an Iora Health primary-care practice in Hanover, N.H., for example, sees patients sponsored by Dartmouth College, King Arthur Flour and the New England Carpenters Health Benefit Fund.

The results at Dartmouth are promising. The proportion of patients with high-blood pressure who achieved guideline-defined control increased to 86% in 2016 from 64% in 2013.

The proactive approach to primary care is also paying off by preventing costly emergency room visits. Dartmouth Health Connect patients had a 35% reduction in hospitalizations and 23% reduction in ER visits when compared with matched control patients outside the practice.

Patient satisfaction is another key piece. Iora Health conducts regular patient surveys using Net Promoter Scores, a customer experience metric with scores that range from -100% to +100%. High-performing providers typically score around +30%. The Dartmouth practice scores +89%.

Iora Health's results are getting noticed by stakeholders who praise the company's process and outcomes, and by investors who believe the model is sustainable and scalable.

The company raised $62 million in external funding to support aggressive expansion. It currently serves 45,000 patients in its network of 29 clinics across 11 markets and plans to double in size this year. But the focus is now on going deep—building multiple clinics and practices in the same areas.

Last month at the National Patient Safety Foundation's annual congress, the company was recognized as one of two winners of the 2016 John Q. Sherman Award for Excellence in Patient Engagement.

“They built their work from the ground up to focus on relationships and partnerships with patients and included a variety of tactics to reach their patients with the right information at the right time to influence behavior and achieve improved outcomes,” said Mark O'Leary, president of Taylor Healthcare, a marketing and communications company that served as a co-sponsor of the award. O'Leary was on the panel of eight judges, which included medical leaders from the Cleveland Clinic and Beth Israel Deaconess Medical Center.

A significant problem with the fee-for-service model is that it encourages reactive care delivery and doesn't allow primary-care practices the time and flexibility to pursue preventive care and follow up with patients, said Dr. David Judge, Iora Health's chief medical officer.

Iora Health's patient-coach encounters don't happen only in medical offices. Coaches sometimes do “walking visits” in parks or meet patients at the local grocery store to help with healthful and affordable food shopping. Staff members also interact with patients via email, texting and video. The practices also use Iora Health's own electronic health record system because the company concluded that other EHRs were primarily transactional—built to accommodate coding and billing.

“The relationship between our care teams and the patient is what drives overall satisfaction and fosters healthier outcomes,” Judge said.