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.