Iora Health CEO Rushika Fernandopulle thinks the United States government is focused on the wrong things, as it seeks to fix a broken, unsustainable health system. In a talk for TEDxJNJ, a collaboration between the non-profit talk series and conference organizer TED and health care giant Johnson & Johnson, Fernandopulle took a swipe at two major health care investments by the federal government: the $19 billion investment in electronic health record implementation, and the $10 billion investment in CMMI, the Center for Medicare and Medicaid Innovation.
The CEO’s Cambridge startup, which was launched in 2011 and has so far raised about $20 million to build a new kind of primary care practice, doesn’t use electronic health records.
“Electronic health records advance a broken system,” Fernandopulle said, speaking at the J&J Innovation Center in Cambridge. “(EHRs) recreate paper charts. Well, that’s dumb.”
Fernandopulle said EHRs are doctor-centric documents, and what’s needed is a collaborative platform that gathers patient data from doctors, wearable fitness devices and other sources to form a complete picture of the patient and serve to engage them in their own care.
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“We are meant to serve the patients, not those who work in the health care system,” Fernandopulle said. “We forget that at our peril.”
Fernandopulle recounted the story of a Revere woman his company treated, who had a variety of chronic illnesses including COPD, diabetes, heart disease and osteoporosis. She had had 12 specialists, was taking 27 medications, and had cost the health care system $200,000 in the past year. Yet her health outcomes, and her quality of life, were terrible. An Iora Health team was able to whittle down her medications to seven and reduce her legion of specialists to just two.
One of the tenets of Iora’s team approach is that patients don’t pay any co-pays because, Fernandopulle said, it discourages them from seeking care on a regular basis.
Fernandopulle said that when Iora Health applied for a grant from the CMMI, he was rejected. The exasperating reason, he said, is that Medicare programs require co-pays for doctor visits.
“This is supposed to be a program for innovation,” he said.
Iora Health does not receive reimbursement from any government health programs or private health insurers. This is because most public and private health payers are still paying on a fee-for-service basis, and Iora Health only works in a global payment environment where the company is given a lump sum to treat each patient.
So Iora’s niche, for now, is with self-insured employers, who pay their employees’ health costs directly, not through an insurer. Fernandopulle said the company is currently working with six such groups, including the New England Regional Council of Carpenters, and is talking to a number of other employers about implementing the health practice for their workers.
Date: Feb 26, 2014