Massachusetts-based Tufts Health Plan is contracting with Iora Health to run two new primary care clinics specifically for senior members on Medicare and Medicaid.
Iora, headquartered in Cambridge, Massachusetts consults remotely over-the-phone or via video-chat.
Backed by private equity and venture capital, Iora is looking to sell high value primary care in part by way of the acute care reduction business and in part through administrative simplification, paid by insurers to serve at-risk and chronically-ill patients and keep them living well and out of the hospital.
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Tufts Health Plan is working with Iora to open two new Iora Primary Care practices, in Medford and Hyde Park, exclusively for customers on Tufts' Medicare Preferred and Senior Care Options plans, the latter a dual eligibles plan.
"This collaboration shows how we can advance care when payers and providers work together on innovative solutions," said Patty Blake, president of senior products at Tufts Health Plan. "Iora Health's innovative care team model and increased access to care align perfectly with Tufts Health Plan's integrated care management model, which has been shown to improve our members' health and wellness."
"We believe better healthcare starts with better primary care," said Rushika Fernandopulle, MD, co-founder and CEO of Iora Health. "We are reinventing the way patients experience care with the goal of restoring humanity to healthcare. This is especially important when caring for older adults."
A Sri Lankan-born Harvard-trained internist and medical instructor who dabbled in business, Fernandopulle has been working in designing primary care for high-risk patients for around a decade, including in Atlantic City. He co-founded Iora Health in 2010, along with Christopher McKown, the co-founder of Health Dialog.
Iora's clinical models are similar to direct primary care companies like Qliance or Zoom Health, and similar to the kind of high-touch primary care some medical practices pursue unbranded.
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Iora patients are treated by a team of a doctor, health coach (often a nurse) and behavioral health specialist. "The team works closely with each patient, and spends more time to better understand each patient's life, motivations, hopes, and fears," Iora said in a press release. "Together, the patients and care team create goals to empower the person in setting the course of their own healthcare."
Similar to managed care capitation, Iora's financial model is based on streamlining administrative and billing costs, thus devoting the resources to serving patients and helping them avoid unnecessary acute interventions.
Iora's clinics do not accept patients outside of select health plans, although if more deals like the Tufts Health Plan collaboration happen, more patients, particularly seniors on Medicare Advantage, could have a choice of a health plan with a narrow network featuring Iora or other clinic networks. Across the country in Washington State, Iora has three clinics in greater Seattle serving Humana Medicare Advantage patients.