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Delivery of Care

Apostle of disruption in primary care gives a sermon at Brown

Dr. Rushika Fernandopulle, founder and CEO of Iora Health in Boston, preaches about how his innovative practice puts the focus on care, not billing

Photo by Richard Asinof,

Dr. Rushika Fernandopulle, the founder and CEO of Iora Health,spoke recently at the Warren Alpert Medical School at Brown.

By Richard Asinof
Posted 9/25/17
Dr. Rushika Fernandopulle, the founder and CEO of Iora Health, spoke at the Warren Alpert Medical School at Brown, spreading the gospel for his disruptive approach for a better way to provide primary care that puts the focus on care, not billing.
When there are educational lectures at Brown, is there a need to be more inclusive and invite nursing students from URI and RIC to attend, now that their programs are located less than 200 yards away from the med school? Will the med school be willing to host a talk on Neighborhood Health Stations and health equity zones as alternative models of investment in health care delivery? Is the Warren Alpert Medical School willing to become a subscriber to ConvergenceRI, sharing content with students and faculty? What will happen if Congress does not renew federal funding for the Children’s Health Insurance Program, or CHIP, which is slated to expire on Sept. 30?
The foundation of much of the innovation and the investment in culturally competent medical homes in Rhode Island, with a focus on primary care for women and children’s health, derives from the leadership of the R.I. Department of Health over the past 30 years in promoting the integration of prevention programs into primary health care practices serving mothers and children. The prevention programs include childhood immunization, lead screening, and women’s cancer screening, among others. Another important component was data sharing between KIDSNET and health plans, showing where the gaps existed, and where outreach needed to be targeted.
The origins of the seeds planted to create the fruits of innovation often get left out of the story, and with it, acknowledgement of the many mothers and fathers who gave birth to innovative public health interventions.

PROVIDENCE – Dr. Rushika Fernandopulle, the founder and CEO of Iora Health, came to the Warren Alpert Medical School at Brown University on Wednesday evening, Sept. 20, to promote his vision of restoring humanity to health care through a disruptive practice of primary care.

The talk, sponsored by Healthcare in America at Brown, was pitched as “Primary Care Innovation and Startups.” The actual title was: “Learning To Fly: Building a new delivery ‘operating’ system for health care.”

The messaging was alluring: make payments focused on outcomes; put patients at the center of the practice, and build a technology platform that enables the focus to be on care, not billing.

Fernandopulle was a talented salesman, telling a story to explain the origins of Iora Health. He was working in a primary care practice in Boston, describing a cold, dark day in February, double-booked, having seen 28 patients, and now staying until 8 p.m. to enter all the data into the electronic health records. A colleague turned to him and said: “Every day I lose a little bit of my soul.”

The initial idea behind the first practice was that patients would pay directly to belong to the primary care practice, paying $40 a month or whatever they could afford. “Patients paid a flat fee, with no co-pays,” Fernandopulle explained.

That morphed into a business plan that found willing partners – businesses and insurance companies – to hire Iora and employ its innovative primary care practices, including casinos in Atlantic City and Boeing and Dartmouth College, as a way to improve outcomes and cut medical costs.

Since its founding seven years ago, Iora Health has evolved to now include 24 practices operating in eight markets with some 350 employees.

Iora Health has partnered with Boeing, with Humana, with Dartmouth College, with Tufts Health Plan, with the Freelancers Union, with the New England Carpenters Benefits Fund, among others.

Many of the practices, such as two with Tufts Health Plan in Medford and Hyde Park, the one with Wellcare in Hartford, Conn., and the nine with Humana – five in Colorado and four in the Seattle, Wash., area – are designed specifically for patients over 65 who have Medicare Advantage plans through the insurer.

In his talk, Fernandopulle described the challenge of having to innovate and improvise, catering to the needs of the community being served. Instead of a yoga club for carpenters, which was an image unlikely to appeal to those in the construction trade, the club was named “Yoga with Tools.”

Similarly, Fernandopulle described how a community health coach, interacting with a patient in Las Vegas with kidney disease, hated to go to dialysis, and often did not show, leading to expensive hospitalizations.

What the health coach discovered was the noise of the dialysis was causing great anxiety for the patient, who also had an anxiety disorder. The solution: provide the patient with an iPod Shuffle, program it with the music he liked, and then give it to him by saying he had won a prize as patient of the month. [Instead of purchasing a new iPod Shuffle, Fernandopulle bragged that they had found a used one on eBay for $35, and the intervention that cost the practice a mere $35 had saved some $200,000 in avoided hospital costs a year.] Did it matter that they had lied to the patient?

The one part of the talk that Fernandopulle did not go into great detail on was how Iora had built out its own population management health IT system with private equity investors.

No patient-centered medical home model, Fernandopulle claimed, can compare with the results and outcomes achieved by the Iora Health model.

Cultural conflicts
One of the key takeaway messages from Fernandopulle was his emphasis on building primary care practices with a culture based upon relationships with the patient, putting a strong emphasis on investing in cultural competency and community outreach.

As such, Fernandopulle told the story of how he tried to hire a woman in a key position for the practice serving a casino in Atlantic City, only to be rebuffed by the human resources folks, who kept telling him that the woman was unqualified for the position. Finally, Fernandopulle said, hire the woman or else. The woman was hired.

It was surprising, then, that neither Fernandopulle nor Eli Adashi, the faculty advisor for Healthcare for America and the former dean of Medicine and Biological Sciences, had recognized that the talk was scheduled to occur on the first night of Rosh Hashanah, and that could be considered a cultural no-no in some circles in Providence.

Even more remarkable was the fact that Fernandopulle did not recognize that the majority of those attending his talk were physician assistant students from Johnson & Wales University, all wearing distinctive fleece jackets with the school’s insignia clearly displayed, rather than Brown medical students. By ConvergenceRI’s count, there were about 30 Johnson & Wales physician assistant students in attendance out of a total of about 50 people in the audience. [It seemed, in all likelihood, that the talk had been a class assignment.]

When one of the Johnson & Wales physician students asked Fernandopulle about exactly whom Iora Health was looking to recruit to become part of the practice team, Fernandopulle mentioned primary care doctors, nurses, nurse practitioners and community outreach workers – but no physician assistants.

Breaking down the silos
During the question-and-answer period following the talk, when asked by ConvergenceRI if he was aware of the Neighborhood Health Stations that had been launched in Central Falls and Scituate as a community-based approach to delivering health care, in partnership with community health centers, Fernandopulle said he was unfamiliar with them.

As a follow-up question, ConvergenceRI asked if he knew Dr. Michael Fine, and Fernandopulle said yes, but he hadn’t talked with Fine for a number of years. [Fine, currently the director of Senior Population Health and Clinical Services at Blackstone Community Health Care, will receive the Barbara Starfield Primary Care Leadership Award from the Patient-Centered Primary Care Collaborative on Oct. 11 in Washington, D.C.]

ConvergenceRI urged Fernandopulle to pay a visit to the Central Falls facility, where the goal is to provide primary care to 90 percent of the residents in Central Falls, keeping the focus on community health needs.

After the talk, Adashi, in recognition perhaps of the gray hair that indicated ConvergenceRI was not a medical student, asked where ConvergenceRI practiced. In response, ConvergenceRI explained that he was editor and publisher of the digital newsletter covering the convergence of health, science, innovation, technology, research and community, writ large. Adashi admitted that he had never heard of or seen the newsletter.

ConvergenceRI followed up with an email, sharing a number of stories about health care and research that touched the Brown ecosystem – including the new national hub for brain research funded by NSF at Brown, led by Christopher Moore; an interview with Dr. Rebekah Gardner, an associate professor of Medicine at Brown about analysis about what doctors really think about electronic health records; making health equity zones part of the Rhode Island vernacular; and how UHIP has damaged the ecosystem of long-term care in Rhode Island, among others. [Many of these stories have been diligently retweeted by Brown Life Sciences @brownlifesci.]

Adashi wrote back, saying: "Much appreciated. I learned a great deal reading your note."

Still, there appeared to be a lack of “convergence” in sharing information within the Brown medical community, something that needs to be remedied, as an effort to break down the silos.


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