One of the boldest examples of what tomorrow’s primary care could look like is provided by Iora Health, an entrepreneurial startup founded in 2011. Iora is not a matter of tweaking traditional primary care, says CEO Rushika Fernandopulle. Instead he is trying to completely redesign it with a focus on coordination, coaching, and strong patient relationships. In the following excerpt from an interview with Tom Main, founder and leader of the Oliver Wyman Health Innovation Center, Fernandopulle describes how his team is having an impact on patient satisfaction and clinical outcomes. Read the full interview here.
The price of entry, I think, is patient engagement, and we have patient satisfaction that’s off the charts. We use a thing called Net Promoter Score to measure how people like the practice. It asks how likely you are to recommend us to a friend or colleague on a 0 to 10 scale. You take the people who love you and the people at the low end of the scale. You subtract them out and get a net number.
Airlines throw parties when they break zero. Most healthcare institutions score in the 30 to 40 percent range. Cleveland Clinic scores 51 percent. The best places in the country, the Amazons and Zappos, score in the 80s. We consistently score in the 90s.
So patients love it. And our clinical outcomes are much, much better. Take hypertension. We know for a fact we need to control people’s blood pressure. When people walk into one of our practices, only 55 percent of them with hypertension are under control. It’s embarrassing! And that’s the national average. Our number is above 90 percent.
And then there are the economics. We get independent academics to take each of the people in a practice, match them to someone who’s not in the practice, and then follow the true trend lines out. It’s what CMS does to evaluate their demos. Short of randomizing people, which is tricky, that’s the best way to do it.
We’ve done this repeatedly with Boeing in Seattle, with hotel workers in Atlantic City and Las Vegas, with Dartmouth College, different populations. We consistently see a 40-ish percent drop in hospitalizations compared to the control group. So, again, a 40 percent drop in hospitalizations, about half the number of ER visits, a big drop in the number of specialist visits—up to 80 percent in some places. Net healthcare spend drops about 15 percent in year one.
We’re not even using the data and the sensors and engaging the patients in the optimal way. We’re maybe 20 percent of the way there. So you can only imagine where it could be if we did this right. I don’t think it’s realistic to think we will get rid of 100 percent of the complications of disease, but I think for sure, we can knock 30 percent off the cost. We know for a fact that 30 percent or more, maybe up to 50 of what we do is waste.
Again, be clear about waste. Waste is things that not only do no benefit but actually cause harm. So it is an imperative that we get rid of this stuff. So we’re now at a 15 percent net drop in spend. I feel very confident we can get to 30 percent; and you can maybe imagine we could get this to 50 percent if you really play out a lot of these other things.