Innovators in Healthcare Break the Rules

There really is innovation in healthcare. And it's not just being driven by reform.

One example is Rushika Fernandopulle, founder and chief executive officer for Cambridge, Mass.-based Iora Health, who started from scratch in 2012 to rework the primary care experience.

At this year's Medical Group Management Association (MGMA) Conference in Nashville, Tenn., Fernandopulle said he spent three months writing a business plan before he launched his practice, Renaissance Health, which later became Iora. You could say his mantra is: First, break all of the rules. Rather than using today's fee-for-service system of copays and billing codes, Iora charges patients a monthly flat fee of about $150, often covered by insurance. The concept is designed to save consumers in the long run by cutting down on ER visits and long-term care for chronic conditions. Iora raised over $42 million in venture capital since its inception and has 11 clinics in seven states with an additional 30 locations planned for 2016.

Iora's approach is more bottom up than top down, meaning the approach doesn't try changing laws but working around them, according to Fernandopulle. For example, Iora earns their money by taking care of their patients, not by billing for every service they provide, which is how the vast majority of primary-care doctors are paid. Fernandopulle said he wasn't sure his new approach would work, but he did know the current system wasn't working well, so he needed to simply try new things. Fernandopulle admits Iora hasn't gotten it all right, but the only reason it has progressed is that the health system is learning along the way. 

"The problem with healthcare in this country is we have turned it into a series of transactions," Fernandopulle said.  Instead, he said, Iora rebuilds the healthcare system on the only thing that matters - the patient-provider relationship.

Outside of its care approach, Fernandopulle said that what also fascinates people about Iora is the technology behind what they do, which gets away from the traditional vendor-created EHR associated with most medical practices and health systems, and instead focuses on a "true collaborative care platform for improving health" through the uniquely created Iora Clinical Intelligence System. The system combines the traditional EHR data with other patient information, such as claims, to engage patients and drive proactive care to narrow physician attention.

Fernandopulle said the takeaway from his successful approach for other medical practices is that there are better ways to practice, and the current system isn't the only way.

"By changing the payment model, delivery system, and IT platforms we can make things better both for patients and ourselves, and create better economics," he said.