Everyone can agree that our current healthcare model is broken. But the question is, can we fix it from the inside? or do we need to start from scratch?
My next guest, Dr. Rushika Fernandopulle believes in order to best address the looming crisis, we need to reimagine health care from the ground up, and build new primary care models from scratch. He is the founder of Iora Health, a next generation primary care practice designed to restore the humanity in healthcare.
In recent weeks, we have seen similar primary care models like Qliance and Turntable Health fold under unsustainable business models. By what makes Iora Health different and successful to date?
On this episode, Dr. Fernandopulle will share his secret sauce to success, what he believes is broken in primary care, what the future holds for quality medical care, and the inspirational backstory that led him to start Iora Health. All this and more on today’s episode.
Now, That’s Unusual.
About Dr. Rushika Fernandopulle
Dr. Rushika Fernandopulle is a practicing physician and co-founder and CEO of Iora Health, a healthcare services firm based in Cambridge MA whose mission is to build a radically new model of primary care to improve quality and service and reduce overall expenditures. In 2012 he was named an Ashoka Global Fellow, and is also a member of the Albert Schweitzer and Salzburg Global Fellowships. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and Managing Director of the Clinical Initiatives Center at the Advisory Board Company. He is co-author or editor of several publications including Health Care Policy, a textbook for physicians and medical students, and Uninsured in America: Life and Death in the Land of Opportunity. He serves on the staff at the Massachusetts General Hospital, on the faculty of Harvard Medical School, and on the boards of Families USA and the Schwartz Center for Compassionate Care. He earned his A.B., M.D., and M.P.P. (Masters in Public Policy) from Harvard University, and completed his clinical training at the University of Pennsylvania and the Massachusetts General Hospital.
Key Interview Takeaways
Although innovations in technology continue to evolve the healthcare space, the way we deliver care has remained stagnant. Healthcare is a series of fragmented transactions, and outcomes are not the focus.
Dr. Fernandopulle’s motivation to tackle this issue came from a colleague’s plea, “Every day, I lose a little piece of my soul.” Most enter the medical profession with the intention of helping people, but the system gets in the way.
“Half-ass, incremental change doesn’t work.” Dr. Fernandopulle had the simple insight that starting over was the only approach, and Iora seeks to rebuild healthcare from the ground up, starting with primary care.
Dr. Fernandopulle set out to replicate the Southwest Airlines paradigm: Show up in the market, break the rules, and compel others to change in order to keep up. His mission is to transform healthcare by building a different model and demonstrating this new approach for others to follow.
Iora operates on the idea that the doctor’s job is to radically empower her patients, giving them the tools to improve and maintain health in a system that keeps learning and adapts quickly.
The most difficult part of developing the Iora model was designing the payment system. Dr. Fernandopulle rejects the fee-for-service model, and he sought payers (employers, union trusts, etc.) who were willing to pay for the relationship rather than individual transactions.
The Iora system has been cost-effective in terms of patient/team experience, clinical outcomes, cost of care, and economic sustainability. Iora practices have 96-98% retention rates, and they have experienced 40-50% drops in hospitalizations.
Behavior change is a slow process. The Iora model invests more money in patients early on, but typically sees big savings in healthcare costs by year three.
In the Iora model, intervention is about building relationships – and the appropriate action may have nothing to do with medicine. In the case of an isolated patient whose health was deteriorating, the team developed a plan to help her become more engaged in the community.
The health coach is the most critical piece of the Iora healthcare team – the cultural glue of the practice. They are selected from the community they will serve based on empathy and creativity, and medical training is not required.
In an Iora practice, the doctor’s role is fundamentally different. He is responsible for a population of people, using available resources (health coach, social worker) to keep people out of trouble, and his performance is tracked based on patient/team experience and clinical outcomes.
“When people tell you that you can’t do something, it’s because they can’t do it.”
Uninsured in America: Life and Death in the Land of Opportunity by Susan Sered and Rushika Fernandopulle
Connect with Dr. Rushika Fernandopulle