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

1. Atlantic City Pilot Practice:
Outcomes data
Rushika Fernandopulle, M.D., M.P.P.
February 2012

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. Iora Health:
Sole focus on working with progressive sponsors to build new practices
based 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. Pilot Practice opened in July 2007 in
Atlantic City, NJ
Original partnership with HEREIU Fund- Large multi-
employee trust fund for service workers- and
AtlantiCare, a not for profit health system
Practice, called the Special Care Center (SCC), was
launched July 2007.
Patients invited based on predictive model or
accepted through application process
Patients are given incentives (through waived
copayments for visits and pharmaceuticals) to join
Initially Globally budgeted, costs shared by Fund and
Health System; move to risk adjusted pmpm for
subsequent payers
Team for 1200 pts-> 2 FTE MDS, NP, 6 health
coaches, 2 admin, part time nutrition, psych, SW
Now open to several other payers, including Horizon
Blue Cross

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. Patient Experience was improved over prior care in all domains of
CG-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. Hypertension - Systolic Blood Pressure
90.0%
82.3%
80.0%
Only 12 patients
(out of 503 with
68.4%
hypertension)
70.0%
remain in poor
Pre-SCC
SCC
control
60.0% (SBP>160) after
6 months in the
50.0% SCC
40.0%
Little variation
between
30.0%
physicians. Mean
post SCC SBP
20.0% 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. 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. Diabetes- Patients in Poor Control
30.0%
26.1%
25.0%
20.2%
20.0%
15.8%
15.0% Pre SCC
15.0%
Post SCC
11.9%
11.4%
10.0%
5.0%
0.0%
A1c>9 SBP>140 LDL>130

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. Change in Average A1c
12
11.03
•Average drop of
2.38 percent for
patients who
10
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. Smoking rates
40.0%
63% quit
rate
63% quit 35.5%
35.0% rate
29.6%
30.0%
48% quit
47% quit
25.0%
rate
rate
21.4%
19.8% Pre SCC
20.0%
Post SCC
15.0%
13.2%
11.1% 11.1%
10.6%
10.0%
5.0%
0.0%
Diabetes Coronary disease COPD All patients

13. Patients self reported productivity also rose after
joining the SCC (comparing 6 month period before and
after joining the practice)
20
18 17.31
16
14
12 10.81
Previous Care
10 8.75 8.70
SCC
8
6
4
2
0
Days of Missed work Days not productive at work

14. Continued Improvement in Outcomes
90.0%
81.2% 82.3% Post-SCC
79.4%
80.0% markers
continue to
70.0% improve for
DM and
60.0% Hypertension
52.7% markers
50.0% 46.8%
45.0% Jul-08
Jul-09
Jul-10
40.0%
30.0%
20.0%
15.5%
13.3%
11.9%
10.0%
0.0%
A1c < 7 A1c > 9 SBP <140 in Htn

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%