Frustrated with the cumbersome pitfalls of the American health care system, from its costly fee-for-service payment system to the lack of patient-centered care and the incremental nature of reform, Dr. Rushika Fernandopulle wanted to create a better way to deliver cost-effective health care that would, as he put it, “restore humanity to health care.”
The result was Renaissance Health, which Fernandopulle founded in 2004 and its successor, Iora Health, the Cambridge, Mass.-based company Fernandopulle co-founded with Christopher J. McKown in early 2011. Both practices utilized versions of the general internist’s pioneering, three-pronged system of patient-centered primary care that focuses on a new model of payment, a team approach, and a redesigned health IT system.
Iora Health partners with large self-insured employers and private organizations such as labor unions. Working outside of the health care system, Iora charges the employers a flat monthly fee for each employee enrolled in the plan, rather than a fee-for-service system, thereby cutting the time and expense of completing billing paperwork and giving patients unlimited access to clinics with no co-payments. This payment system, Fernandopulle has said, incentivizes clinicians to focus on quality service, good health outcomes and patient retention.
The fixed payment model allows Fernandopulle to implement his system’s second prong, which is providing patients with a team of care providers to help them proactively manage their health. One of the unique features is the “health coach,” a person—not necessarily a medical professional—who provides moral, emotional and technical support to help patients maintain good health. In addition to face-to-face contact, coaches communicate with patients via text, email, and video chat.
The third prong of Iora’s model is a revamped IT system that focuses on population management rather than billing and invoicing. The IT system is designed to collect useful patient data and help doctors identify patterns, and alert care providers when a patient appears headed for a health decline, allowing them to intervene earlier than they otherwise might have.
Iora has established practices in Nevada, Massachusetts, New Hampshire, and New York. Fernandopulle says they’re making a difference in the lives of patients and helping spur changes in the traditional health care system.
“We have already shown great impacts on experience, outcomes, and costs and are helping to push the rest of the industry to consider big instead of small incremental changes,” he says.
One of Iora’s New York patients praised the company for its focus on wellness and judgement-free care.
“It’s an approach that the road to good health is not traveled with just a prescription as a map,” says T.N., a Brooklyn resident who receives Iora care as a member of the Freelancers Union. “The road must be traveled with a guide, with leadership, with management, with a map, and with a companion.”
As a Schweitzer Fellow (Boston, 1993-94), Fernandopulle helped scale up a program to staff clinics for homeless people. Additionally, he helped create a training manual and internet presence for volunteer physicians specific to the health issues faced by the homeless population.
He says his time as an ASF helped him solidify his desire to increase access to care for underserved communities. With Iora Health, Fernandopulle has created an innovative model of health care delivery aimed at giving comprehensive support to help patients get and stay healthy.
“It’s refreshing that we don’t have to walk this road [to good health] alone,” says T.N. of the care he and his fellow union members get through Iora. “I’ve walked alone for so long; I’m tired and worn out but I am not walking alone anymore.”