Nationally, seven of 10 Americans die from chronic diseases — primarily heart disease, cancer, and stroke. Low-income and minority groups tend to have higher risk factors for those diseases, like high blood pressure, according to a 2012 statistical update from the American Heart Association. The update also found that African-Americans and Hispanics were less likely than whites to receive all the suggested care for addressing those risk factors.
"Iora health was never meant as a health-disparities reduction effort, but it turns out that actually by doing primary care right — which we do — you are actually able to reduce disparities considerably," Fernandopulle says. A practicing primary care doctor and former health-care consultant, he founded Iora Health in 2011 because he wanted to reinvent the way basic health care is delivered.
Typically, says Fernandopulle, primary care accounts for about 5 percent of total health-care spending. Iora Health asks insurance companies sponsoring a practice to double that amount. The company also pays doctors fixed salaries, a change Fernandopulle says leads doctors to recognize that "my job is to take care of this whole population, and to help them no matter what it takes."
Iora health-care teams are also organized very differently than the average medical office. A typical Iora Health practice includes two doctors, a nurse, a social worker, and more than a half-dozen health coaches. Each patient is considered the responsibility of the entire team. Depending on the services patients want and need, additional health-care professionals might round out the team — a nutritionist, say, or a personal trainer.
Iora Health patients can drop by without an appointment, and they are encouraged to stay in touch with health coaches and doctors by email, text messages, phone calls, and video conferencing. The company hires staff who speak the languages and reflect the cultural backgrounds of the patients they serve. At the Culinary Extra Clinic, where 73 percent of patients are Hispanic and the average age is 56, patients tend to favor face-to-face meetings and phone calls.
This new approach to health care requires partnering with insurance providers willing to pay more for primary care. The Culinary Extra Clinic is sponsored by the Culinary Health Fund, a plan that covers members of the local culinary workers union and their dependents. "It was expensive for us in the beginning," says Kim Voss, senior director of health care networks and advocacy at the Culinary Health Fund. "But it was a long-term commitment to improve participant health and to be fiscally responsible."
Other practices — such as a clinic for Dartmouth College employees in Hanover, N.H., and clinics for members of the Freelancers Union in New York City — serve all adults covered by the sponsoring insurance company. Because they tend to serve healthier populations, those practices can reach many more patients.