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Atlantic City Pilot Practice:Outcomes dataRushika Fernandopulle, M.D., M.P.P.February 2012
About Iora Health• Founded in Nov 2010;  predecessor company  Renaissance Health founded  April 2004• Goal is to work with...
Iora Health:Sole focus on working with progressive sponsors to build new practicesbased on our model  Provides benefits to...
Pilot Practice opened in July 2007 inAtlantic City, NJOriginal  partnership with HEREIU Fund- Large multi-employee trust ...
Not the Usual Processes •Comprehensive assessment and shared care plan •Daily huddles with entire team •Lots of non visit ...
Patient Experience was improved over prior care in all domains ofCG-CAHPS Survey (nationally validated survey created by A...
Hypertension - Systolic Blood Pressure90.0%                                           82.3%80.0%                          ...
Average Drop in Systolic Blood Pressure 200                                                      •Average drop of 180   17...
Diabetes- Patients in Poor Control30.0%                        26.1%25.0%        20.2%20.0%                               ...
Diabetes- Patients in Excellent Control 80.0%                                 70.8% 70.0%                                 ...
Change in Average A1c12     11.03                                                        •Average drop of                 ...
Smoking rates40.0%                                             63% quit                                               rate...
Patients self reported productivity also rose after joining the SCC (comparing 6 month period before and after joining the...
Continued Improvement in Outcomes90.0%                                                                    81.2% 82.3%     ...
Total spending dropped a net of 12.3%; Driven mostly by  large decreases in hospital admissions, ER visits, and  outpatien...
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Iora Health

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Iora Health's breakthrough model of primary care results in lower costs and better outcomes

Transcript of "Iora Health"

  1. 1. Atlantic City Pilot Practice:Outcomes dataRushika Fernandopulle, M.D., M.P.P.February 2012
  2. 2. About Iora Health• Founded in Nov 2010; predecessor company Renaissance Health founded April 2004• Goal is to work with progressive sponsors (payers) to build these new models of care• Co-founders Rushika Fernandopulle MD and Christopher McKown• Based in Cambridge MA• Venture Funded, Series A closed October 2011
  3. 3. Iora Health:Sole focus on working with progressive sponsors to build new practicesbased on our model Provides benefits to hotel and Purchases health coverage for Building practice for its own casino workers in Las Vegas, independent contractors in employees, near campus NV Brooklyn, NY Open to all adult beneficiaries, 55K members, 140K lives 90K members, 26K lives but try to recruit sicker ones Pilot practice for sickest Opening dedicated Practice opened 3/13/2012 patients opened on the Strip Freelancers practice in Already over 250 patients Feb 2012 Brooklyn, in early summer enrolled, seeing 10-15 pts/day 2012 After first 2 weeks of operation over 600 patients enrolled, Also offering as bundle with seeing 25 pts/day HD plan Goal is not just better value care for the patients in the practice, but to raise the bar in general in the market
  4. 4. Pilot Practice opened in July 2007 inAtlantic City, NJOriginal partnership with HEREIU Fund- Large multi-employee trust fund for service workers- andAtlantiCare, a not for profit health systemPractice, called the Special Care Center (SCC), waslaunched July 2007.Patients invited based on predictive model oraccepted through application processPatients are given incentives (through waivedcopayments for visits and pharmaceuticals) to joinInitially Globally budgeted, costs shared by Fund andHealth System; move to risk adjusted pmpm forsubsequent payersTeam for 1200 pts-> 2 FTE MDS, NP, 6 healthcoaches, 2 admin, part time nutrition, psych, SWNow open to several other payers, including HorizonBlue Cross
  5. 5. Not the Usual Processes •Comprehensive assessment and shared care plan •Daily huddles with entire team •Lots of non visit based care- email, text, video •Extensive use of groups- including Stanford Chronic Care Curriculum in 3 languages •Integrated Mental health, nutrition •Real time data for management, including daily hospital, ER feeds, pharmacy fills •Co-management with hospitalists, other specialists •Proactive care (DM/CM)- based on registry queries, event triggers
  6. 6. Patient Experience was improved over prior care in all domains ofCG-CAHPS Survey (nationally validated survey created by AHRQ,administered at intake and then after 1 year in SCC) 100% 96% 96% 96% 92% 90% 81% 80% 70% 70% 58% 59% 60% 52% 52% Pre SCC 50% SCC 40% 30% 20% 10% 0% Access to Care Time and Respect Physician Staff Care Communication Communication Coordination
  7. 7. Hypertension - Systolic Blood Pressure90.0% 82.3%80.0% Only 12 patients (out of 503 with 68.4% hypertension)70.0% remain in poor Pre-SCC SCC control60.0% (SBP>160) after 6 months in the50.0% SCC40.0% Little variation between30.0% physicians. Mean post SCC SBP20.0% for Dr. Digenio= 125.93; for Dr.10.0% 8.5% Patel= 125.49 2.4% 0.0% Poor control (>160) Good control (<140)
  8. 8. Average Drop in Systolic Blood Pressure 200 •Average drop of 180 174.84 42 points in SBP 156.76 for patients who 160 enter with SBP>160 140 132.81 130.06 120 Pre SCC 100 In SCC 80 •Average drop of 60 26 points for those who enter 40 with SBP>140. 20 0 SBP start > 160 SBP start > 140
  9. 9. Diabetes- Patients in Poor Control30.0% 26.1%25.0% 20.2%20.0% 15.8% 15.0% Pre SCC15.0% Post SCC 11.9% 11.4%10.0% 5.0% 0.0% A1c>9 SBP>140 LDL>130
  10. 10. Diabetes- Patients in Excellent Control 80.0% 70.8% 70.0% 64.0% 60.0% 55.1% 54.1% 52.5% 50.0% 40.8% Pre SCC 40.0% Post SCC 30.0% 20.0% 10.0% 0.0% A1c<7 SBP<130 LDL <100
  11. 11. Change in Average A1c12 11.03 •Average drop of 2.38 percent for patients who10 enter with A1c 8.95 over 9 8.65 7.99 7.89 •Average drop of 8 7.39 almost 1 percent for those who enter with A1c Pre over 7 SCC 6 Post SCC 4 •For all patients with diabetes, (including those 2 who enter with excellent control), average drop of 0 0.5 percent A1c over 9 A1c over 7 All Diabetics
  12. 12. Smoking rates40.0% 63% quit rate 63% quit 35.5%35.0% rate 29.6%30.0% 48% quit 47% quit25.0% rate rate 21.4% 19.8% Pre SCC20.0% Post SCC15.0% 13.2% 11.1% 11.1% 10.6%10.0%5.0%0.0% Diabetes Coronary disease COPD All patients
  13. 13. Patients self reported productivity also rose after joining the SCC (comparing 6 month period before and after joining the practice)2018 17.31161412 10.81 Previous Care10 8.75 8.70 SCC 8 6 4 2 0 Days of Missed work Days not productive at work
  14. 14. Continued Improvement in Outcomes90.0% 81.2% 82.3% Post-SCC 79.4%80.0% markers continue to70.0% improve for DM and60.0% Hypertension 52.7% markers50.0% 46.8% 45.0% Jul-08 Jul-09 Jul-1040.0%30.0%20.0% 15.5% 13.3% 11.9%10.0%0.0% A1c < 7 A1c > 9 SBP <140 in Htn
  15. 15. Total spending dropped a net of 12.3%; Driven mostly by large decreases in hospital admissions, ER visits, and outpatient procedures -12.3% Total spending For all SCC patients -37% Hospital days enrolled in 2009, relative -41% Hospital admits to control group created Rx fills 40% using propensity -23% Outpt procedures matching. -48% ER visits -4% Office Visits-60% -50% -40% -30% -20% -10% 0% 10% 20% 30% 40% 50%

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