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Restoring
Humanity
to Healthcare
Iora Health
Ali Khan, MD, MPP
November, 2014
Restoring humanity to healthcare
PEOPLE AT
THE CENTER
TOOLS THATENABLE CARE
PAYMENTSFOCUSED ON
OUTCOMES
Restoring humanity...starting from scratch
Restoring humanity to healthcare:
Change anything
PEOPLE AT
THE CENTER
TOOLS THATENABLE CARE
PAYMENTSFOCUSED ON
OUTCOMES
PEOPLE AT
THE CENTER
Endorse people’s natural ability to care for themselves
Restore Humanity:
A different kind of care team.
Restore Humanity:
PEOPLE AT
THE CENTER
Restore Humanity:
“I don’t feel rushed, patronized or unimportant. I’m still getting used to not having to fight for an appointment or to feel visible. I’m a respected customer with choice and dignity. That makes me feel like my health is important and encourages me to take the best care I can of myself.”
Patient, Brooklyn practice
PEOPLE AT
THE CENTER
PEOPLE AT
THE CENTER
PAYMENTS
FOCUSED ON
OUTCOMES
Restore Humanity:
Start with trust, then align payment with outcomes• Capitation, not fee for service• Increase investment in primary care• Incentivize humanity, pay for outcomes
TOOLS THAT
ENABLE
CARE
Restore Humanity:
• Tools to work together as a team: Huddle, cuddle, triad visits, tasks
• Tools to work together with patients: groups, movement, headline, shared care plans, online scheduling, email and phone 24/7
• Tools to record stories and thoughts, not bills and codes
• Tools to manage the health of a community
Iora Worry Score• A clinically meaningful stratification tool for targeting patient recruitment
and population health management
• Consistent use across populations, practices, and processes
• Multiple, independent data sources (e.g. subjective; clinical, claims,
patient-reported data) to lead to consistent scores
• Transparent, straightforward algorithm - Not a black box
PEOPLE AT
THE CENTER
TOOLS THATENABLE CARE
PAYMENTSFOCUSED ON
OUTCOMES
Restoring humanity to healthcare
It Works
TOOLS THATENABLE CARE
14
It works: Patients are rapidly signing up
Patient enrollment since Feb 2012Now over 8,000 patients in 6 practices
Hanover, NH
Brooklyn & Manhattan, NY
Boston, MA
Las Vegas, NV
Hanover, NH
Las Vegas, NV
Patient enrollment since Feb 2012Now over 8,000 patients in 6 practices
15
It works: Access and outcomes improve
93
0
20
40
60
80
100
Amazon.com
76%
Kaiser
Permanente
33%
Net Promoter Score = % Promoters – % Detractors
Question: “How likely is it that you would recommend
Iora practice to a friend or coworker?”
Patients love the practice
94
0
20
40
60
80
100
Patients are engaged
%
% patients with >1 visit
Average 4.5 visits
per year at Iora practice
Typical payer
care mgmt program
9%
“Before I didn’t go to the doctor much. Now I feel like I am going to see my friends. I am not joking.”
-50 y/o patient who has lost 32 lbs in 6 months
%
23%4%
32%
6%
25%
19%
20%
72%
0%
20%
40%
60%
80%
100%
Intake FU
Primary care provider was informed
about visits to specialists they referred?
Intake n = 689; n/a = 347;
blank = 152. FU n = 275;
n/a = 167; blank = 98. 8% 3%
25%
4%
40%
14%
27%
79%
0%
20%
40%
60%
80%
100%
Intake FU
Got an urgent appointment with
primary care provider?
Intake n = 696; n/a =
286; blank = 146. FU n
= 271; blank = 96.
Always
Usually
Sometimes
Never
Key
6681
0
20
40
60
80
100
Initial BP Most recent BP
Hypertension ControlInitial vs. Most Recent Blood Pressure
<140/90(at practice enrollment)
National average= 47%1
<140/90>= 3 mo enrolledN = 659
%
Patient Experience results: Based on CAHPS survey at one Iora practice
Hypertension benchmark: CDC. Vital signs: prevalence, treatment, and control of hypertension. MMWR. 2011;60(4):103-8
%
15
It works: Downstream utilization & costs decrease
16
At SCC, total spend fell a net of 12.3% Driven by large decreases in hospital admissions,
ER visits, outpatient procedures
Data from Special Care Center Practice, Atlantic City
Population was high risk/cost
Total spending, -
12%
Hospital admits, -41%
Rx fills, 40%
Outpatient procedures, -
23%
ER Visits, -41%
Office Visits, -4%
-60% -40% -20% 0% 20% 40% 60%
Restoring humanity to healthcare
PEOPLE AT
THE CENTER
TOOLS THATENABLE CARE
PAYMENTSFOCUSED ON
OUTCOMES
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