Throwback Thursday to Transform

Guest Post Written by UMR Senior, Kate Scheffler.

Editor's Note: Rushika Fernandopulle, M.D. was a speaker at the 2012 Transform Symposium at Mayo Clinic, Rochester.  

In response to the rising cost of healthcare, Dr. Rushika Fernandopulle, M.D., Co-founder and CEO of Iora Health, and a team of experts developed an innovative approach to the delivery of healthcare that not only addresses the issue of cost, but also aims to improve the overall patient experience.

Detailed Synopsis:

A 60 year old female diagnosed with chronic obstructive pulmonary disease (COPD), diabetes, hypertension and a number of other ailments spent 3 quarters of the year in and out of the hospital system. Throughout this process she cost the system $200,000 and got passed from physician to physician, none of which are able to treat her never-ending conditions. The patient continued traveling through this revolving door, with virtually no medical plan until she joined a unique, innovative healthcare practice. With the hope of improving the outcomes of patients such as these, Dr. Rushika Fernandopulle M.D., Co-founder and CEO of Iora Health, envisions health care innovation that not only drastically lowers the overall cost of healthcare, but also strives to improve quality and service.

Realizing that the current healthcare system has many flaws, Dr. Fernandopulle and a team of experts began brainstorming innovative ways of shifting healthcare to provide better care. Dr. Fernandopulle explains the needed shift in healthcare as the following:

“Crossing that gap [between the healthcare that we have and that of which we could have] is more like trying to get across the Atlantic in a day and not a week. Maybe what we should do is go beyond studying the tides and streamlining the hulls, and building faster engines for our boats and actually spend some of our time building airplanes.”

Rather than attempting to alter the existing model, Dr. Fernandopulle’s approach involves developing an entirely new business model that centers around three key components including altering the current payment model by shifting from a “fee for service” payment to a flat rate for primary care, transferring healthcare dollars towards primary care, and discontinuing co-payment fees. Following these changes, the way in which healthcare is delivered must be altered towards building a health team around the patient. In order to promote the patient to manage their own health, a team of health coaches help to bridge the gap between patient and physician by providing a support system for patients. Health coaches work with patients one on one to help them create a health plan and to manage their illnesses. In addition to these changes, Dr. Fernandopulle’s practice involves co-managing patients across multiple disciplines by being involved in conversations between other healthcare professionals that patients encounter, providing the physician with a complete picture of the patient.

In order to test the new practice, they began seeking out patients with difficult health problems, such as the 60 year old with chronic illnesses. What began as a prototype program outside of Boston 10 years ago has since grown into projects with a number of progressive health systems spanning from Virginia Mason and the Ever clinic in Seattle to Atlantic Care in New Jersey and Atlantic City. For the last year, Dr. Fernandopulle and his team have been building their own practices from scratch. Currently, they have practices in Nevada, New Hampshire, and New York. Dr. Fernandopulle not only runs the company, but also serves as one of their practicing physicians at several of the sites.

This innovative approach to healthcare has received criticism. For example, critics accuse the practice of raising expectations, making other practices look bad, and upsetting the status quo. Dr. Fernandopulle does not deny those accusations and instead comments, “We forget often that the point of healthcare should be to serve our patients, not ourselves.”

Throughout these prototype programs, the new approach has received outstanding reviews from patients. Under the new system, physicians saw better patient outcomes with results showing a drop in total outpatient care by 25%, Emergency Room care by 48% (relative to control group), hospitalizations by 41%, and net spending down 15%. All of these percentages were dropped by delivering better care.

As stated by Dr. Fernandopulle, “Between the healthcare that we have and the care that we could have lies not just a gap, but a chasm. If we want to cross this chasm, maybe it’s time we stop putting all of our attention into studying the tides, streamlining the hull, or building better boat engines—maybe it’s time we get the courage to learn how to fly.”

Registration for Transform 2014 is now open! Find out more here.

Kate Scheffler

Kate Scheffler is a contributing writer from the University of Minnesota Rochester.