Podcasts about Iora

Rushika Fernandopulle founded Iora Health, which was acquired by One Medical and subsequently by Amazon. Could Amazon ever achieve Iora's health equity goals? In this episode we discuss what a "successful" exit looks like for health equity under our current capitalistic structures, and what happens after you exit. In Rushika's latest start up, Liza Health, he is exploring new structures to protect the purpose of his product. Liza Health leverages AI to build power for patients. Building new products is only a start, Rushika shares. We need a movement behind us — we need a revolution from consumers.

Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value. And this theme is, heads up, going to continue through a few upcoming shows as well. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We have Matt McQuide coming up, talking about patient engagement, and Christine Hale, MD, MBA, talking about high-cost claimants. And we also have an encore coming up with Kenny Cole, MD, talking about a lot of things; but patient trust is one of them. But before I get to the main theme to ponder here, let me talk about what gets selected to talk about on Relentless Health Value. I will freely admit, how topics for shows get picked, it's not exactly a linear sort of affair. And furthermore, even if it were, I can't always get the stars to align to get a specific cluster of guests to all come on like one after the other. So, for sure, it might be less than obvious at times where my head is at—and sometimes, admittedly, I don't even know. This may sound incredibly scattershot (and it probably is), but in my defense, this whole healthcare thing, in case you didn't know, it's really complicated. Every time I get a chance to chat with an expert, I learn something new. I feel like it's almost impossible to sit in a vacuum and mastermind some kind of grand insight. Very, very fortunately, I don't need to sit in a cave and do all this heavy thinking all by myself. We got ourselves a tribe here of like-minded, really smart folks between the guests and you lot, all of you in the tribe of listeners who are here every week. Yeah, you rock! And I can always count on you to start teasing out the themes and the through lines and the really key actionable points. You email me. You write great posts and comments on LinkedIn and elsewhere. Even if I am a little bit behind the eight ball translating my instinct into an actual trend line, it doesn't slow this bus down. It's you who keeps it moving, which is why I can confidently say it's you all who are to blame for this new idea I came up with the other day after the podcast with Al Lewis (EP464) triggered so much amazing and really deep insight and dot connecting back and forth that hooked together the past six, I'm gonna say, or so shows. Let's just start at the beginning. Let's start with the topics that have been discussed in the past several episodes of the pod. Here I go. Emergency room visits are now costing about 6% of total plan sponsor spend on average. That was the holy crap moment from the episode with Al Lewis (EP464). Emergency room volume is up, and also prices are up. In that show with Al Lewis, I did quote John Lee, MD, who is an emergency room doctor, by the way. I quoted him because he told a story about a patient who came into the ER, winds up getting a big workup in his ER. Dr. Lee says he sees this situation a lot where the patient comes in, they've had something going on for a while, they've tried to make an appointment with their PCP or even urgent care, they could not get in. It's also really hard to coordinate and get all the blood work or the scans and have that all looked at that's needed for the workup to even happen. I've spoken with multiple ER doctors at this point, and they all say pretty much the same thing. They see the same scenario happen often enough, maybe even multiple times a day. Patient comes in with something that may or may not be emergent, and they are now in the ER because they've been worried about it for weeks or months. And the ER is like the only place where they can get to the bottom of what is going on with their body. And then the patient, you know, they spend the whole day in the ER getting what amounts to weeks' worth of outpatient workup accomplished and scans and imaging and labs. And there's no prior authing anything down. It's also incredibly expensive. Moving on from the Al Lewis show, earlier than that I had had on Rushika Fernandopulle, MD (EP460) and then also Scott Conard, MD (EP462). Both are PCPs, both talking about primary care and what makes good primary care and what makes bad primary care and how our current “healthcare marketplace,” as Dr. Conard puts it, incentivizes either no primary care and/or primary care where volume driven throughput is the name of the game—you know, like seeing 25 patients a day. These visits or episodes of care are often pretty transactional. If relationships are formed, it's because the doctor and/or the patient are rising above the system, not the other way around. And none of that is good for primary care doctors, nurses, or other clinicians. It's also not good for patients, and it's not good for plan sponsors or any of the ultimate purchasers here (taxpayers, patients themselves) because while all of this is going on, those patients getting no or not good primary care are somebody's next high-cost claimant. Okay, so those were the shows with Rushika Fernandopulle and Scott Conard. Then this past week was the show with Vivian Ho, PhD (EP466), who discusses the incentives that hospital leadership often has. And these incentives may actually sound great on paper, but IRL, they wind up actually jacking up prices and set up some weird incentives to increase the number of beds and the heads in them. There was also two shows, one of them with Betsy Seals (EP463) and then another one with Wendell Potter (EP384), about Medicare Advantage and what payers are up to. Alright, so let's dig in. What's the big theme? What's the big through line here? Let's take it from the top. Theme 1 is largely this (and Scott Conard actually said this flat out in his show): Primary care—good primary care, I mean—is an investment. Everything else is a cost. And those skyrocketing ER costs are pure evidence of this. Again, listen to that show with Al Lewis earlier (EP464) for a lot of details about this. But total plan costs … 6% are ER visits. Tim Denman from Premise Health wrote, “That is an insane number! Anything over 2% warrants concern.” But yeah, these days we have, on average across the country, 200 plan members out of 1000 every single year dipping into their local ER. That number, by the way, will rise and fall depending on the access and availability of primary care and/or good urgent cares. Here's from a Web site entitled ER Visit Statistics, Facts & Trends: “In the United States, emergency room visits often highlight gaps in healthcare accessibility. Many individuals turn to ERs for conditions that could have been managed through preventative or primary care. … This indicates that inadequate access to healthcare often leads to increased reliance on emergency departments. … “ED visits can entail significant costs, particularly when a considerable portion of these visits is classified as non-urgent. … [Non-urgent] visits—not requiring immediate medical intervention—often lead to unnecessary expenditures that could be better allocated in primary care settings.” And by the way, if you look at the total cost across the country of ER visits, it's billions and billions and billions of dollars. In 2017, ED visits (I don't have a stat right in front of me), but in 2017, ED visits were $76.3 billion in the United States. Alright, so, the Al Lewis show comes out, I see that, and then, like a bolt of lightning, François de Brantes, MBA, enters the chat. François de Brantes was on Relentless Health Value several years ago (EP220). I should have him come back on. But François de Brantes cemented with mortar the connectivity between runaway ER costs and the lack of primary care. He started out talking actually about a new study from the Milbank Memorial Fund. Only like 5% of our spend going to primary care is way lower than any other developed country in the world—all of whom, of course, have far higher life expectancies than us. So, yeah … they might be onto something. François de Brantes wrote (with some light editing), “Setting aside the impotence of policies, the real question we should ask ourselves is whether we're looking at the right numbers. The short answer is no, with all due respect to the researchers that crunched the numbers. That's probably because the lens they're using is incredibly narrow and misses everything else.” And he's talking now about, is that 5% primary care number actually accurate? François de Brantes continues, “Consider, for example, that in commercially insured plans, the total spend on … EDs is 6% or more.” And then he says, “Check out Stacey Richter's podcast on the subject, but 6% is essentially what researchers say is spent on, you know, ‘primary care.' Except … they don't count those costs, the ER costs. They don't count many other costs that are for primary care, meaning for the treatment of routine preventative and sick care, all the things that family practices used to manage but don't anymore. They don't count them because those services are rendered by clinicians other than those in primary care practice.” François concludes (and he wrote a great article) that if you add up all the dollars that are spent on things that amount to primary care but just didn't happen in a primary care office, it's conservatively around 17% of total dollars. So, yeah … it's not like anyone is saving money by not making sure that every plan member or patient across the country has a relationship with an actual primary care team—you know, a doctor or a nurse who they can get on the phone with who knows them. Listen to the show coming up with Matt McQuide. This theme will continue. But any plan not making sure that primary care happens in primary care offices is shelling out for the most expensive primary care money can buy, you know, because it's gonna happen either in the ER or elsewhere. Jeff Charles Goldsmith, PhD, put this really well. He wrote, “As others have said, [this surge in ER dollars is a] direct consequence of [a] worsening primary care shortage.” Then Dr. John Lee turned up. He, I had quoted on the Al Lewis show, but he wrote a great post on LinkedIn; and part of it was this: “Toward a systemic solution, [we gotta do some unsqueezing of the balloon]. Stacey and Al likened our system to a squeezed balloon, with pressure forcing patients into the [emergency room]. The true solution is to ‘unsqueeze' the system by improving access to care outside the [emergency room]. Addressing these upstream issues could prevent patients from ending up in the [emergency room]. … While the necessary changes are staring us in the face, unsqueezing the balloon is far more challenging than it sounds.” And speaking of ER docs weighing in, then we had Mick Connors, MD, who left a banger of a comment with a bunch of suggestions to untangle some of these challenges that are more challenging than they may sound at first glance that Dr. Lee mentions. And as I said, he's a 30-year pediatric emergency physician, so I'm inclined to take his suggestions seriously. You can find them on LinkedIn. But yeah, I can see why some communities are paying 40 bucks a month or something for patients without access to primary care to get it just like they pay fire departments or police departments. Here's a link to Primary Care for All Americans, who are trying to help local communities get their citizens primary care. And Dr. Conard talked about this a little bit in that episode (EP462). I can also see why plan sponsors have every incentive to change the incentives such that primary care teams can be all in on doing what they do. Dr. Fernandopulle (EP460) hits on this. This is truly vital, making sure that the incentives are right, because we can't forget, as Rob Andrews has said repeatedly, organizations do what you pay them to do. And unless a plan sponsor gets into the mix, it is super rare to encounter anybody paying anybody for amazing primary care in an actual primary care setting. At that point, Alex Sommers, MD, ABEM, DipABLM, arrived on the scene; and he wrote (again with light editing—sorry, I can't read), “This one is in my wheelhouse. There is a ton that could be done here. There just has to be strategy in any given market. It's a function of access, resources, and like-minded employers willing to invest in a direct relationship with providers. But not just any providers. Providers who are willing to solve a big X in this case. You certainly don't need a trauma team on standby to remove a splinter or take off a wart. A great advanced primary care relationship is one way, but another thing is just access to care off-hours with the resources to make a difference in a cost-plus model. You can't help everybody at once. But you can help a lot of people if there is a collaborative opportunity.” And then Dr. Alex Sommers continues. He says, “We already have EKG, most procedures and supplies, X-ray, ultrasounds, and MRI in our clinics. All that's missing is a CT scanner. It just takes a feasible critical mass to invest in a given geography for that type of alternative care model to alter the course here. Six percent of plan spend going to the ER. My goodness.” So, then we have Ann Lewandowski, who just gets to the heart of the matter and the rate critical for primary care to become the investment that it could be: trust. Ann Lewandowski says, “I 100% agree with all of this, basically. I think strong primary care that promotes trust before things get so bad people think they need to go to the emergency room is the way to go.” This whole human concept of trust is a gigantic requirement for clinical and probably financial success. We need primary care to be an investment, but for it to be an investment, there's got to be relationships and there has to be trust between patients and their care teams. Now, neither relationships nor trust are super measurable constructs, so it's really easy for some finance pro to do things in the name of efficiency or optimization that undermine the entire spirit of the endeavor without even realizing it. Then we have a lot of primary care that doesn't happen in primary care offices. It happens in care settings like the ER. So, let's tug this theme along to the shows that concern carriers, meaning the shows with Wendell Potter (EP384) on how shareholders influence carrier behavior and with Betsy Seals (EP463) on Medicare Advantage plans and what they're up to. Here's where the primary care/ER through line starts to connect to carriers. Here's a LinkedIn post by the indomitable Steve Schutzer, MD. Dr. Schutzer wrote about the Betsy Seals conversation, and he said, “Stacey, you made a comment during this fabulous episode with Betsy that I really believe should be amplified from North to South, coast to coast—something that unfortunately is not top of mind for many in this industry. And that was ‘focus on the value that accrues to the patient'—period, end of story. That is the north star of the [value-based care] movement, lest we forget. Financial outcome measures are important in the value equation, but the numerator must be about the patient. As always, grateful for your insights and ongoing leadership.” Oh, thank you so much. And same to you. Grateful for yours. Betsy Seals in that podcast, though, she reminded carrier listeners about this “think about the value accruing to the patient” in that episode. And in the Wendell Potter encore that came out right before the show with Betsy, yeah, what Wendell said kind of made me realize why Betsy felt it important to remind carriers to think about the value accruing to patients. Wall Street rewards profit maximization in the short term. It does not reward value accruing to the patient. However—and here's me agreeing with Dr. Steve Schutzer, because I think this is what underlies his comment—if what we're doing gets so far removed from what is of value to the patient, then yeah, we're getting so removed from the human beings we're allegedly serving, that smart people can make smart decisions in theoretical model world. But what's being done lacks a fundamental grounding in actual reality. And that's dangerous for plan members, but it's also pretty treacherous from a business and legal perspective, as I think we're seeing here. Okay, so back to our theme of broken primary care and accelerating ER costs. Are carriers getting in there and putting a stop to it? I mean, as aforementioned about 8 to 10 times, if you have a broken primary care system, you're gonna pay for primary care, alright. It's just gonna be in really expensive care settings. You gotta figure carriers are wise to this and they're the ones that are supposed to be keeping healthcare costs under control for all America. Well, relative to keeping ER costs under control, here's a link to a study Vivian Ho, PhD, sent from Health Affairs showing how much ER prices have gone up. ER prices are way higher than they used to be. So, you'd think that carriers would have a huge incentive to get members primary care and do lots and lots of things to ensure that not only would members have access to primary care, but it'd be amazing primary care with doctors and nurses that were trusted and relationships that would be built. It'd be salad days for value. Except … they're not doing a whole lot at any scale that I could find. We have Iora and ChenMed and a few others aside. These are advanced primary care groups that are deployed by carriers, and these organizations can do great things. But I also think they serve—and this came up in the Dr. Fernandopulle show (EP460)—they serve like 1% of overall patient populations. Dr. Fernandopulle talked about this in the context of why these advanced primary care disruptors may have great impact on individual patients but they have very little overall impact at a national scale. They're just not scaled, and they're not nationwide. But why not? I mean, why aren't carriers all over this stuff? Well, first of all—and again, kind of like back to the Wendell show (EP384) now—if we're thinking short term, as a carrier, like Wall Street encourages, you know, quarter by quarter, and if only the outlier, mission-driven folks (the knights) in any given carrier organization are checking what's going on actually with plans, members, and patients like Betsy advised, keep in mind it's a whole lot cheaper and it's easier to just deny care. And you can do that at scale if you get yourself an AI engine and press Go. Or you can come up with, I don't know, exciting new ways to maximize your risk adjustment and upcoding. There's an article that was written by Sergei Polevikov, ABD, MBA, MS, MA

-2 matchups for Mauritius -1 t20 for Mauritius -1 outright for Mauritius -1 outright for PNC Championship Mauritius Open Analysis Tournament Context Key Matchups and Predictions: Ding Wenyi vs. Gavin Green (3:00 - 8:00): Ding, a rookie out of China, is favored over Green (-140). Ding's recent form: 3 top-25 finishes in 6 starts since turning pro, including a tied 5th at the Australian Open. Green has struggled, finishing 47th at the Dunhill and missing cuts previously at this event. Will predicts Ding will dominate, with Green likely missing the cut. John Perry vs. Gavin Green (8:00 - 10:00): Perry (-145) has had a resurgence, winning twice on the Challenge Tour in 2024 and finishing tied 2nd at the Alfred Dunhill last week. Perry's consistency contrasts Green's struggles, making him a strong pick. Andrea Pavan (Top 20) (10:00 - 12:00): Odds: +190 on Bet365. Pavan has two top-20 finishes in previous Mauritius Open events and showed promise last week with a 24th-place finish at Leopard Creek. Outright Winner: Angel Iora (12:00 - 15:30): Odds: 18-to-1 on BetOnline. Iora, a young and promising player, narrowly missed victory last week due to a late mistake. Will believes Iora's consistent top finishes make him a solid contender for his first DP World Tour title. PNC Championship Analysis Tournament Context (15:30 - 16:00): The PNC Championship features iconic parent-child duos at the Ritz-Carlton Golf Club in Orlando. Despite fan-favorites like Tiger and Charlie Woods (+650) and the Dalys (+400), Will advises against picking them due to health and performance concerns for the senior members. Key Teams and Predictions: Steve and Izzy Stricker (20-to-1) (16:00 - 16:30): Steve had a strong Champions Tour season, but Izzy's inconsistent college performance raises doubts about their chances. Trevor and Jacob Immelman (40-to-1) (16:30 - 17:00): Trevor's lack of competitive play since retiring makes this team unlikely contenders, despite Jacob's talent. Nelly and Peter Korda (28-to-1) (17:00 - 17:30): Nelly is coming off a stellar LPGA season, but Peter's golf skills may not be enough to secure a win. Outright Winner: Matt and Cameron Kuchar (+650) (17:30 - 19:37): Cameron's strong junior results and Matt's active PGA Tour schedule make them the most competitive team. Their performance last year (opening round 57) and Matt's recent top finishes make them the clear favorites. Quotes and Timestamp Analysis “You have a brutal field in Africa this week...” (2:20): Highlights the weak field quality, which sets the stage for up-and-coming players like Ding and Iora. “Ding Wenyi is very comparable to Ludwig Oberg...” (4:00): Establishes Ding as a rising talent with similarities to an established star, underscoring his potential dominance. “Iora might already be a winner...” (13:30): Reflects Iora's close-call finishes, positioning him as a likely breakout star. “I was shocked that Tiger decided to play this week...” (17:40): Will critiques Tiger's physical condition as a major obstacle for Team Woods. “This is a no-brainer for me...Team Kuchar...” (18:30): Emphasizes the strength of the Kuchars as clear tournament favorites. Player and Team Insights Ding Wenyi: 3 top-25 finishes since turning pro, highlighted by strong iron play and consistency. Gavin Green: Struggling with approach shots, making him a weak contender in matchups. John Perry: Recent success on the Challenge Tour positions him as a strong player this week. Angel Iora: Stellar form with multiple top finishes; a prime candidate for his first win. Matt and Cameron Kuchar: Blend of professional experience and junior talent makes them formidable. For more on the world of golf, follow Doc on X @drmedia59  Learn more about your ad choices. Visit megaphone.fm/adchoices

Pat Nolan has spent a life time in publications, many related to tourism which evolved from a long standing and wide interest in family history He started his own organisation Irish Origins Research Agency. (IORA) as focus on providing a professional service to legal and corporate clients, often relating to estate and legacy matters. Has also developed sources useful for those undertaking their own family or local research anywhere in Ireland especially focused on the South East of Ireland. He has lectured in America, Australia, New Zealand, many parts of Europe and the UK and Ireland A Graduate of NUI Maynooth, and recipient of the Kilkenny Chamber of Commerce Lifetime achievement award. He left Clongowes in 1959

Peter Hagan is the Digital Health Director at Commonwealth Care Alliance, and former team member at Iora Health. Iora was a start up that created a new model for value-based care, to improve health outcomes and lower costs. Ten years after launching, it was acquired by One Medical, a primary care provider, which was later acquired by Amazon. Peter initially started out as a patient at one of Iora's first pilot sites, and later became a health coach, playing a critical role in Iora's team-based care model. His third role before leaving Iora to pursue his MPH was to work on the backend of Iora's digital health products, which included a patient-friendly electronic health record system that allowed each patient and their care team to seamlessly coordinate care. In this episode, Pete and I discuss the challenge of shifting from the dominant fee-for-service care model in the U.S., to the value-based care model which focuses on improving people's health rather than profiting from their care needs. Rather than waiting and hoping for existing players to make these changes, could it be the new entrants into the field that disrupt and transform it?

The healthcare space has long been a transactional one, seeing patients as numbers instead of human relationships. In 2004, Dr. Rushika Fernandopulle began to challenge the status quo and create an entirely new model of care delivery that finally put patients at the center of healthcare. Rushika Fernandopulle is the co-founder and former CEO of Iora Health, a value-based primary care group based in Boston that was acquired by One Medical in 2021, where he served as Chief Innovation Officer. One Medical was acquired by Amazon earlier this year for close to $4 billion. Rushika currently serves on the staff at the Massachusetts General Hospital, on the faculty of Harvard Medical School, and on the boards of Families USA and the Schwartz Center for Compassionate Care.In this episode, Hercules Capital's Katie Segien is joined by Rushika Fernandopulle to discuss how he created a new delivery model for medicine, Iora Health's business model evolution, going from bootstrapping to six rounds of funding, and other topics.Topics Include:Rushika's mission and experience in transforming healthcareHow he created a new delivery model for medicineIora Health's business model evolutionGoing from bootstrapping to six rounds of fundingRushika's process for building an optimal teamAdvice for entrepreneurs who are struggling to raise capitalAnd other topics…Dr. Rushika Fernandopulle is a practicing physician who has spent decades improving the quality of healthcare delivered to patients. He was co-founder and CEO of Iora Health, a value-based primary care group based in Boston that delivers better quality, lower costs, and improved satisfaction for both patients and providers. Iora was acquired by One Medical in 2021 for over $2 billion, which went on to be acquired by Amazon earlier this year for close to $4 billion.Rushika was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement and Managing Director of the Clinical Initiatives Center at the Advisory Board Company. He serves on the staff at the Massachusetts General Hospital, on the faculty of Harvard Medical School, and on the boards of Families USA and the Schwartz Center for Compassionate Care.

www.facebook.com/deadbeats www.instagram.com/deadbeats www.twitter.com/deadbeats www.deadbeatsofficial.com DNMO x HEYZ - TURN THE TIDE Odd Mob, OMNOM - Losing Control salute & Sammy Virji - 'Peach VIP' Sully, iORA feat. Jessy Covets - Shades Of Black DirtySnatcha x Smoakland - Escape Ivy Lab - Ghost AG - DEADLIFT RL Grime - Keep You (Close) ENiGMA Dubz x Hypho x PAV4N - You Are Not a Badman Numa Crew - Bun Dem Down feat. Killa P & Long Range Skream - My Body Machinedrum & Holly - Blueshift saka - wanchai w jianbo Nika D & ENiGMA Dubz - FWD Jack Beats & MNNR - Reasons Deathpact - SOOTHSAYER (Jon Casey Remix) IMANU & LIA - Temper Soki - Infinite Shlump, Xotix feat. King Lung - Loudboi K Motionz - Vino Bandit Chase & Status, Hedex, ArrDee - Liquor & Cigarettes Jauz - Dreaming Dirt Monkey x Jantsen - Full Circle (feat. MC Spyda) Big Gigantic, Ahee - Oh Dang!

An hour of tunes uploaded by ERNIE, IORA, JONO WRIGHT, LAST OF THE FREE & many many more.

Today, we're excited to get to know Dr. Andrew Schutzbank. Andrew spent almost a decade at Iora health, where he held the esteemed positions of Medical Director and Senior Vice President, overseeing clinical operations and product development. He was also the Chief Product Officer at Cricket Health, an organization dedicated to value-based kidney care. He was the Corporate Development Operating Partner at SCAN and now contributes as a board member, advisor, and investor for multiple startups. He is also a clinical instructor at Harvard Medical School. Dr. Schutzbank completed his residency at Beth Israel and holds an MD and MPH from Tulane University, along with a BA in neuroscience from the University of Pennsylvania.  In this episode we talk about his journey to medicine, experience with Iora and Cricket Health, what he looks for in a healthcare pitch, tips/tricks for founders, and insights on the high burnout rate among clinicians.

Today, we're excited to get to know Dr. Rushika Fernandopulle, previous Chief Innovation Officer of One Medical, an organization dedicated to providing human-centered, technology-powered primary care to people across every stage of life.  In an acquisition that shook the healthcare industry in September 2021, One Medical completed the purchase of Iora Health - a primary care organization that prioritizes human-centered, value-based care. The deal, which amounted to a staggering $1.4 billion, was a testament to Iora Health's success in delivering high-quality care at lower costs, while improving patient satisfaction. The visionary behind Iora is none other than Dr. Rushika Fernandopulle, who spent decades improving the quality of healthcare delivered to patients. He was the Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and Managing Director of the Clinical Initiatives Center at the Advisory Board Company. He also serves on the staff at the Massachusetts General Hospital and on the faculty of Harvard Medical School.  In this episode, Dr. Fernandopulle talks about his path to medicine, describes how he started and grew Iora Health, the acquisition by One Medical, and the future of primary care.

Hey, thanks so much to kwebs14 for your super nice review on iTunes the other day. Kwebs wrote: [I have] learned so much, shared so many episodes with colleagues, clients … and gained so much value from regularly listening to [Relentless Health Value]. … Thank you … for providing the platform for so many that believe that we can consistently do better in healthcare. Thanks much for writing this. I think our Relentless Tribe is a unique group, and every day of every week I admire your willingness to hear some things that might be pretty hard to hear because they may hit pretty close to home. Dr. Benjamin Schwartz was talking about the podcast on LinkedIn the other day, and he said he doesn't always agree with guests or the discussion but he always learns something and each episode stimulates and challenges his thoughts and opinions. Yes … to all of this. This is our goal in a nutshell: to help those who want to do better in healthcare to have the insight, the information, the other side of the story, the differing opinion, whatever you need to conceive of the action that you want to take. So, thank you so much to everybody who listens. You are the ones who are going to make a difference, and I thank you from the bottom of my heart for doing what you do every day for patients and communities. Alright, so in this healthcare podcast, we are going to answer an FAQ—a listener question I have gotten a lot lately in various forms. Let me common denominator the inquiry: What does it mean to be clinically integrated, and how does a provider organization/practice/CIN (clinically integrated network) know if they are actually clinically integrated or not? Also, the corollary to this question, which is how do CINs—or anybody, really—know if they are clinically integrated enough to start thinking about taking on downside risk? I asked David Muhlestein this question, and then we talk about his answer for 25 minutes. So, like most things in healthcare, it is filled with nuance; but if I was going to oversimplify his answer in one sentence, it's this: Did the practice change how they are practicing medicine in order to drive predetermined outcomes? This is the litmus test for whether care is integrated. Did practice patterns change within participating entities from whatever they were before to a new way of working? Did the team(s) reorient with a goal to attain some documented patient outcomes, be those outcomes patient satisfaction and/or clinical endpoints and/or functional endpoints? If no sort of fundamental change happened, probably it's a no on the clinical integration question. Another litmus test question I've also heard is this: Is the practice looking to get paid more for successes they've already had in upside risk arrangements with kind of little or no desire to transform the practice into a new practice model? If yes, then again, it's gonna be a no on the clinical integration question. The thing is with all of this … well, let me quote Dr. John Lee, who said this pretty succinctly on LinkedIn recently. He said, “Downside risk fundamentally changes how you have to think as a physician and how you manage your patient cohort. You start thinking about team-based care and using analytics.” Yes … interesting. The point Dr. Lee is making — which is kind of inferred, actually, in the listener questions, so let me just state the obvious, which is so obvious it could easily be overlooked — if you are able to take on downside risk and succeed, you're probably clinically integrated. If you're not, you probably aren't. Said another way (this might get a little chicken and egg-y), do you clinically integrate so that you can get the kind of risk-based contracts that enabled Iora, for example, to represent 5% of One Medical's patient base and 50% of its revenue? I have heard similar profitability stories about ChenMed and Oak Street. They all have capitated downside risk accountable care contracts. And have you seen what some of their leadership teams are minting? Obviously, the capitated downside risk when you're integrated gig can be highly profitable. But ... seems like also the community and outcomes are kind of great. Are they doing well by doing good? I'll grant you I might be convinced based on what I've seen. Galileo is another one. Cityblock. But the fundamental question is, do you integrate first and then go after the contracts? Or is it best to wait until there's a decent accountable opportunity on offer and then, sufficiently incented, change the practice? I do not know. I do know, however, what Scott Conard, MD, said in episode 391. I will poorly paraphrase. He said that if better patient outcomes are desired, there must be clinical integration and practice pattern changes. He said his practice went ahead and instituted these changes to improve patient care and did so within a pretty full-on FFS (fee-for-service) environment. My conclusion with all of this? It takes strong leadership with team-building skills and a strong family/community-centric mission to pull off a successful foray into accountable care with downside risk. These same talented and mission-driven leaders probably could manage to improve patient care and lower costs in an FFS environment as well. The converse of this is also likely true: Weak and ineffectual leaders can make a quadruple nothing burger mess in even the best VBC (value-based care) model. Yes … lots to unpack there. I am interested in your thoughts. In this episode, as mentioned, I am speaking with David Muhlestein, who is the chief research and innovation officer with Health Management Associates, or HMA. He has spent the past decade-plus studying ACOs (accountable care organizations) and value-based care, trying to understand what works, what doesn't, and how you change the business models to be successful under these new models of payment. Here is a short version of David's advice to clinically integrate and be ready for downside risk: ·       Step 1: Understand where you are—this includes doing a very clear-eyed self-assessment. ·       Step 2: Assess the needs of your patient population and focus on things where your capacity meets the needs of the population that you serve in the most impactful way. ·       Step 3: Take the outcome of step 2—which is basically whatcha gonna do to fix the most consequential problems that your patients have—and identify the processes by which you will do this. ·       Step 4: Do not boil the ocean. Start with a subset of patients and figure out the exact plan to do better to manage that population—easier said than done, of course. (Betsy Seals, by the way said something along these exact same lines in the shows giving advice to Medicare Advantage plans. And Karen Root [EP381] also alludes to something similar as she talks about how to socialize innovation. So clearly, this advice can be universalized.) You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.     David Muhlestein, PhD, JD, is chief research and innovation officer for Health Management Associates (HMA). He is responsible for the firm's self-directed research and supports strategic planning and innovation. David's research and expertise center on healthcare payment and delivery transformation, understanding healthcare markets, and evaluating how the broader healthcare system is changing. He is a self-identified data nerd and regularly speaks and writes about healthcare system evolution. David joined HMA via its acquisition of Leavitt Partners in 2021, where he was the chief strategy and chief research officer. Additionally, David is a visiting policy fellow at the Margolis Center for Health Policy at Duke University, adjunct assistant professor at The Ohio State University College of Public Health, and a visiting fellow at the Accountable Care Learning Collaborative. He previously served as adjunct assistant professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College. David earned his PhD in health services management and policy, JD, MHA, and MS from The Ohio State University and a BA from Brigham Young University.   07:57 What does it mean to be clinically integrated? 10:23 How does changing practice patterns count as becoming clinically integrated? 11:11 How do you change the delivery of care to get better outcomes? 12:05 What does it mean to see better outcomes when becoming clinically integrated? 14:46 EP176 with Dr. Robert Pearl. 17:42 “Their structure is dictating what they are going to prioritize.” 19:02 “How do you care for the patients that have yet to come and see you?” 20:16 EP391 with Scott Conard, MD. 22:38 “When you're integrated, you realize you're not alone.” 25:50 Why does clinically integrating require a significant mindset change? 28:55 What does this country need to do from a policy perspective for this change? 30:24 EP326 with Rishi Wadhera, MD, MPP.   You can learn more by emailing David at dmuhlestein@healthmanagement.com and by connecting with him on LinkedIn.   @DavidMuhlestein of @HMAConsultants discusses #integratedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375)      

We got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater' and bloviating versus driving real change, it's a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself. And then there's another review from mattiw2002, who says, “For anyone trying to stay abreast of developments in the healthcare space, there's none better than … Relentless Health Value.” Thank you so much to the two of you who took the time to write a review—could not appreciate it more. There have been two inbetweenisodes this year where I get deep into the why behind the “why collaborate.” And when I say collaborate, what I mean is anybody in the healthcare industry working together with and for the patients that we're supposed to be serving here. It's creating alignment amongst stakeholders around what's best for the patient. Here is the nutshell version of the two previous shows. First point: Patients fall into one care gap after another. You hear this from any PCP you talk to who's working in a care setting when there's little, if any, collaboration effort on the front end to ensure a non-fragmented patient journey. So then, all these care gaps wind up getting surfaced, which, by the way—let's not forget this—these care gaps were there all along negatively affecting patient outcomes. It's just, in the past, we didn't know about them. But now that we know about them, it becomes the fee-for-service PCPs' job to mop up all the care gaps while the faucet is still running. So, that's the situation analysis, and if we're going to put an end to this, it means that payers have to align with providers and give enough incentive for those providers to create a non-fragmented patient journey (ie, making sure that the care gaps don't happen to begin with). This also means providers need to talk amongst themselves and collaborate. Keep in mind that a multi-morbid Medicare patient sees something like 5 to 13 doctors, on average, depending on what study you look at … 13! If anybody thinks that a patient can see 13 doctors not collaborating with each other and coordinating care and not wind up with some polypharmacy adverse event or materially conflicting advice … I don't know. Call me. I just do not understand how consistent excellence in patient outcomes or patient care even could be achieved. That whole cliché the left hand doesn't know what the right hand is doing? That's a cliché for a reason, and I seriously suspect the entire field of medicine isn't weirdly excluded from it. So, first point: Collaboration/alignment is required amongst healthcare stakeholders for patients to get decent outcomes, especially patients with multiple chronic conditions. Payers gotta pay for the right stuff, and providers have to coordinate care. Otherwise, you wind up with all of the care gaps that PCPs currently working in systems with fragmented patient journeys are seeing. Here's the second point from earlier episodes: Financial toxicity is clinical toxicity. Patients are forgoing care they need and not taking drugs they need because they cannot afford them. This is not speculation. Trilliant Health just released a report that showed this. Healthcare utilization, if you subtract COVID care and behavioral health, might be permanently down. Other reports speculated that by 2030, a leading cause of death might be nonadherence due to cost concerns. Wayne Jenkins, MD, in episode 358, talks about a whole constellation of negative effects when patients can't afford care; and yeah … here we are. Patients cannot afford their care. They cannot afford premiums, deductibles, out-of-pockets. These are insured patients a lot of times we're talking about here. Also, this is not a “Medicaid” problem, as Dan Mendelson put in episode 385. So, go back and listen to the earlier shows for the who and the what and the why of the above and much more context; but nothing I've just said is stuff that I personally would regard as my personal opinion. There is one study after another that bears all this out. There is just one anecdote after another. Fragmented patient care and care that is way more expensive than a patient can afford is going to result in outcomes that are not, let's just say, super. Alright, all of this being said, does then aligning payers and providers, and providers collaborating with each other and coordinating care … if these things are done, do patient outcomes improve? Do care gaps reduce? Are patients more satisfied with their care? Said another way, when physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Why, yes. Yes, it does. Why do I say this? First of all, this very much seems to be the conclusion of CMS. Here's from the Center for Medicare & Medicaid Innovation (CMMI). They released a report updating their strategic vision for implementing value-based care. One of the key new strategies focuses on creating greater care coordination between primary care doctors and specialists. What might be some of the success stories that precipitated the CMMI focusing their strategy on exactly what I've been running around squawking about for one to three years now? The ChenMed Case Study: ChenMed focuses on the most vulnerable patients and dramatically improves access for those patients, which has led to a 30% to 50% reduction in hospitalizations. They published there's been a 20% to 30% reduction of stroke. They've doubled six-month cancer survival rates and, in some cases, reduced heart failure readmissions by 50%, 70%, up to 90%. They see evidence that they are extending lives five or more years. How? By the providers being aligned with the payers and then also making sure that there is very coordinated care going on there. Johns Hopkins has a paper in JAMA that concluded that a care coordination model can be associated with improved outcomes, including substantial cost reduction. I was talking to Larry Bauer from FMEC, the Family Medicine Education Consortium; and he sent me probably a 40-page PDF of really great patient results when care is coordinated and payers are aligned to pay for health. As just one example, Dr. Daniel Hoefer from Sharp HealthCare, they have created what they call their Transitions program. And the idea is by moving aggressive care upstream via community-based palliative medicine, they have proven that the vast majority of people never need to see the inside of a hospital during the last year-ish of their life. The revolving door of hospitalization should be considered an archaic residual of a bygone era, as they put it. Again, this is very well-coordinated care with payer alignment. Do patients actually want this stuff? Before I get into our evidence here, just let me remind you that Kaiser is a payvider with a narrow network and also that Centivo is an innovative TPA (third-party administrator) pulling together narrow networks. On the podcast the other week, Dan Mendelson (EP385) from Morgan Health said that 40% of new employees are choosing lower-premium plans with either Kaiser or Centivo benefit designs. They are choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages. This is what happens when payers and providers are aligned. Nobody gets in the middle there. Heard a similar story from Nick Stefanizzi (EP383) from Northwell Direct. They're doing direct contracting with customers like Whole Foods. Everybody I talk to here is surprised how many employees are electing these kinds of plans. So, yeah … The Nuka System of Care in Alaska (EP312), where I get into this with Doug Eby, MD, MPH, CPE, in great detail. But wow, just wow there. With the Nuka ecosystem, they went from basically a failing mess into the health system that many consider to be the best or one of the best in the country at something like half the price per patient than in mainland US. They have this whole thing where they integrate specialty care into primary care. They have established an agreed-upon referral patterns and also an agreed-upon way to work with specialists that very much involves PCPs talking to specialists so that the whole person, the whole patient can be considered. They structure their whole program around paying for health and getting paid for health. Also, Nuka has a 96% patient satisfaction rate. So again, patients are certainly on board with this. If I was gonna sum up these five examples, I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done. After that, work to collaborate with fellow providers. All of these entities that we just talked about who can brag about their patient outcomes and care quality are doing both of the stuff that we just talked about: aligning and collaborating with payers and other providers. They are also, at the same time, folding three other things into their strategy. And this other stuff is required because you kinda can't align with payers and you can't collaborate unless you're doing these three things at the same time: standardizing best-practice care, getting and using data, and using good technology in conjunction with that data. All of this in the service of this last thing, which is turning transactions into relationships. Human relationships. Relationships with patients. As Rebecca Etz, PhD, and her team at The Larry A. Green Center have shown quite crisply (discussed in episode 295), no relationship with a patient means worse outcomes for patients. End of sentence. But then there's also having relationships with colleagues and relationships with other docs who have patients in common. It is really tough to coordinate care without relationships, and it's also not very fulfilling. Alright, moving on to another question: Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? Well, I can tell you a couple of things. ChenMed has been named to Newsweek's “Most Loved Workplaces” list. Nuka System has a 93% employee satisfaction rating. Considering that elsewhere one out of two family practice docs are burned out, this is pretty striking in contrast. Also, here's another quote from a physician leader about good accountable care where health is being paid for. He said, “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” I'm really sorry I can't remember who said that because it's a great quote and so true. Larry Bauer from FMEC also told me the other day that DPC (Direct Primary Care) conferences have never had a session on burnout. Larry says he tells people if they want to see what 350 happy primary care docs look like, they need to come to a DPC summit. They're happy as clams. Now, while DPC isn't the “be entirely responsible for downstream costs” kind of accountable care, what is going on in DPC is, these docs are accountable to their patients and for the care that they are providing. Here's another anecdote which I think, in sum, adds up to a “yes” if the question is “Do docs really like this stuff?” I had a long conversation with Scott Conard, MD, the other day about his work with clinics in Queens. What I learned was, these clinics, they used to have waiting rooms overflowing with patients who had been waiting the entire day to be seen and just ... it wasn't good for anybody. Fast-forward a few years—high-risk patients get seen fast, and there's time for care coordination. Patients are happy; outcomes are better. But here is why I inferred that the docs are happy in this model: There was a new office manager. New office manager starts trying to go back to the old way, the “normal” way that practices are run. And it was mutiny on the bounty. No way no how were those docs going back. I took that as a pretty solid testimonial if I ever heard one. So, I don't know if anybody has done any sort of global physician satisfaction studies to determine if physicians who are in pay-for-health models where they're collaborating with one another are happier and less burned out than doctors in the current fee-for-service (FFS) environment. But I can tell you that if somebody did do this, there's gonna be one really big confounding factor … and this is what it is: There's a world of difference between a well-functioning accountable care model and a very terrible one. I have had a series of (as I said earlier) pretty heartbreaking, honestly, conversations with PCPs around the country who think value-based care pretty much sucks. For the big why on this, listen to the show with Dan O'Neill (EP359). But in short, in “not quite there yet” value-based care models, one's still in the two canoes messy middle (ie, they've got one foot in the value-based care world and one foot firmly in the FFS world). Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets. There's not really great population health. Nobody's figured out how to defragment the care journey. And then there's the whole measurement industrial complex that gets piled on top of their day. I cannot stress this enough. Alright, so let's just check off our last big question here for the money motivated. This especially comes up when talking with especially specialists, who are doing very well, thank you very much—financially, I mean—in the current FFS status quo. So, let's not avoid the elephant in the room. Is taking on risk, getting paid for value, being accountable to deliver great results, deliver health … is it worth it from a financial standpoint? Alright, let's take a look at this. Here's from show 343 with David Carmouche, MD, when he was at Ochsner. He said, “Anything that we can do to convert the effective reimbursement in the Medicare space to something greater than Medicare fee-for-service rates, we think that this is in our best interest. So, we have gone very heavy into moving as much of our Medicare business into risk as we can. And we will take full capitation under a couple of Medicare advantage contracts.” So, that includes primary care as well as specialist care. Let's talk about One Medical for a moment. Five percent of One Medical members account for 51% of the company's revenue. You know which 5% account for that 51% of revenue? Right, the at-risk ones that are part of the Iora value-based medical group with a capitated model. That is a pretty strong financial endorsement there. There's a whole show with Brian Klepper, PhD (EP335), about why private equity is willing to pay $55,000 per patient in a capitated model. So, some actuaries somewhere think this is a very financially sound way to go. I am not sure if I would die on this hill, but I'd also say there's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow. Everything I've just said, not a secret. Not at all. You see CMS moving in the “making providers accountable” direction. I already mentioned this and what CMMI is up to. But this is very much an overall strategy. Currently, 44% of traditional Medicare beneficiaries with parts A and B are in a care relationship with some accountability for quality and total cost of care. CMS aims to boost that number to 60% by 2024 and 100% by 2030. In sum across the industry, it looks like 19.6% of healthcare payments were risk-based in APMs (Alternative Payment Models) that include upside and downside. This is a couple points higher than in 2020, but it's not like it's skyrocketing. So, that might be a curb to our enthusiasm. However, in 2022 here, looking forward to 2023, you know who besides CMS is going heavy on trying to pay for health and not sick care? I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals. Here's something that Jeff Hogan called out from a McKinsey report: “VBC [value-based care] models that show promise in the employer context include high-performance provider networks with cost- and quality-based metrics, episode-based payments for standardized patient-care journeys … , and risk-based contracts for end-to-end management of high-cost conditions.” You know what all those things have in common that I just rattled off? Only high-performing docs are in network—and this includes specialists. I say all this to say, I don't know, if I were a practitioner of healthcare and I knew that all this data was floating around about my practice patterns and given that doctors that don't perform well as per that data are being excluded from networks … I don't know, just given all of the signs that are pointing in a risk-based direction, learning to take on risk just seems like—I was never a Boy Scout, but the whole “Be prepared” seems pretty sound advice right now, especially given how long it takes to get good at this.   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here. Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   05:03 When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? 05:46 What is the ChenMed Case Study? 06:26 Can a care coordination model be associated with improved outcomes, including substantial cost reduction? 06:38 Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? 07:29 Do patients actually want this stuff? 07:46 Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? 08:29 What is the Nuka System of Care in Alaska? 09:25 “I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done.” 10:45 Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? 11:16 “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” —Physician leader 13:25 “There's a world of difference between a well-functioning accountable care model and a very terrible one.” 13:59 “Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets.” 14:43 Is taking on risk worth it from a financial standpoint? 16:05 “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” 17:11 “I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals.” 17:54 “Only high-performing docs are in network—and this includes specialists.”   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here.   Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the ChenMed Case Study? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Can a care coordination model be associated with improved outcomes, including substantial cost reduction? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Do patients actually want this stuff? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the Nuka System of Care in Alaska? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care?” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's a world of difference between a well-functioning accountable care model and a very terrible one.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Is taking on risk worth it from a financial standpoint? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Only high-performing docs are in network—and this includes specialists.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington  

We could all do with a bit of Christmas cheer at the moment and this episode has it by the bucket loads! In a special Christmas edition of The TV That Changed Me, Beth is joined by the musician Iora as they discuss all the Christmas specials that have made their Christmases over the years. Expect chocolate fountains, a naked Alan Davies and a whole load of reasons we've gone off James Corden.  Content warning This episode contains discussion of homophobic slurs. Credits Produced by: Beth Watson Edited by: Beth Watson Music by: Iora Find us on the interweb Beth Watson: @b.wott on Instagram & @bwatson19 on Twitter The TV That Changed Me: @tvchangedme on Instagram & @tvchangedmepod on Twitter  

Dies ist die Ursprungsgeschichte des Planeswalkers Gideon Jura, wie sie auf https://magic.wizards.com/de/articles/archive/magic-story/gideons-ursprung-kytheon-iora-von-akros-2015-07-01 veröffentlicht wurde. Dies ist ein reines Fanprojekt und ich werde nicht von Wizards of the coast gesponsort

Today on Health in 2 Point 00, Jess pokes fun at Matthew because my primary care provider has acquired a Medicare provider – One Medical buys Iora Health for $2.1 billion in stock. This deal is curious because these are two very different organizations. Next, HumanFirst (formerly Elektra Labs) raises $12 million in a Series A, bringing their total to $15 million, working on distributed clinical trials. Medallion raises $20 million in a Series A to address barriers for digital health providers around state licensing rules, and Aunt Bertha raises $27 million working on the social determinants of health and getting social care resources to patients. Finally, Grand Rounds and Doctor on Demand acquire Included Health, an LGBTQ+ focused care navigation platform.

Da qualche tempo l'Italia rivolge un interesse crescente verso l'Oceano Indiano, attraverso la partnership con lo Iora, associazione che raggruppa gli Stati rivieraschi di questa regione. Ne parliamo con Mario Vattani, Coordinatore UE-Asia-Pacifico del Ministero degli Affari Esteri e della Cooperazione Internazionale.

Da qualche tempo l'Italia rivolge un interesse crescente verso l'Oceano Indiano, attraverso la partnership con lo Iora, associazione che raggruppa gli Stati rivieraschi di questa regione. Ne parliamo con Mario Vattani, Coordinatore UE-Asia-Pacifico del Ministero degli Affari Esteri e della Cooperazione Internazionale.

What’s the way forward for Syria a decade after war broke out? Why is the IORA not a strong collective? On episode 76, host Hamsini Hariharan answers questions about the state of the world.If you have questions about international relations or foreign policy, send them to us via email ivmstatesofanarchy@gmail.com or DM us on Twitter @HamsiniH (https://twitter.com/omeriHamsini) or on Instagram @statesofanarchy (https://www.instagram.com/statesofanarchy/). Your question can be featured on the new QnA segment of States of Anarchy which appears every fortnight!Reading List:1) IORA Charter - https://www.un.org/en/ga/sixth/70/docs/iora_charter.pdfJakarta Accord, IORA Summit - https://www.iora.int/media/23699/jakarta-concord-7-march-2017.pdf2) The Indian Ocean Rim Association (IORA): Replace, Reduce or Refine? - https://www.futuredirections.org.au/wp-content/uploads/2014/03/FDI_Strategic_Analysis_Paper_-_The_Indian_Ocean_Rim_Association_IORA_-_Replace_Reduce_or_Refine.pdf3) Indian Ocean Rim Association concludes First Ever Leaders Summit - https://thediplomat.com/2017/03/indian-ocean-rim-association-concludes-first-ever-leaders-summit/4) Indian Ocean Rim Association and India’s Role - https://mea.gov.in/Portal/ForeignRelation/IORA_new.pdf5) Why has the Syrian War lasted 10 years?- Why has the Syrian war lasted 10 years?6) Syrian Civil War: A political solution is the only way forward-https://www.nationalheraldindia.com/international/syrian-civil-war-a-political-solution-is-the-only-way-forward7) The Way Forward in Syria - https://carnegieeurope.eu/2019/10/16/way-forward-in-syria-pub-800978) On International Human Rights Day: Millions of Syrians robbed of “rights” and 593 thousand killed in a decade -https://www.syriahr.com/en/195385/You can listen to this show and other awesome shows on the IVM Podcasts app on Android: https://ivm.today/android or iOS: https://ivm.today/ios, or any other podcast app

Dr. Kevin Spencer, Medical Director, Texas at Agilon Health, is passionate about improving the health care delivery system. He believes that by enabling physician-led organizations with technology, proven processes, and human capital under global risk capitation models, we can transform care for patients and physicians alike. With a deep understanding of the local market, combined with extensive health care experience, Kevin Spencer, MD  oversees the strategy, operations, and growth for the Connected Senior Care Advantage program, the unique Agilon Health risk-bearing entity (RBE) partnership model in the Austin, Texas market.  As the former Managing Partner and CEO of Premier Family Physicians, the Austin-based physician network that joined Austin Regional Clinic in the Agilon Health RBE joint venture, Dr. Spencer takes his leadership and understanding of how to effectively partner with primary care physicians to build sustainable success in global risk capitation models in Medicare Advantage. In this episode, Dr. Kevin Spencer shares important insights about the business of Medicare Advantage and how full-risk payment in primary care can lower costs and improve clinical outcomes within a senior population.  This interview is not to be missed for anyone wanting to understand how to build value-based care success over time in a physician-led environment that embraces full-risk capitation within a market that is still heavily entrenched in fee-for-service.  Dr. Spencer demonstrates a superior understanding of population health with a business acumen of Medicare Advantage that makes for a thought-provoking conversation on how MA may be the future of payment model reform.  Given the success of global risk capitated models in the senior space, could Medicare Advantage-For-All be a viable health policy in the years to come? Episode bookmarks: 4:38 Lessons learned in the early years of physician-led Accountable Care 9:08  “Health care is better delivered in a value environment. I believe that putting the premium dollar in the hands of the physicians that are taking care of patients will empower them to do the right thing, for the right reason, at the right cost.” 10:40 Choosing the right capital partner to form a Risk Bearing Entity 11:40 Agilon Health's approach to physician partnership 12:50 Dr. Spencer referencing the excellent work done by other disrupters in the senior space (e.g. Oak Street, ChenMed, Iora) 18:00 “Medicare Advantage risk will only work if we deliver a much superior product to our seniors in America. The care they have been receiving up to now, in many cases, has been fragmented, disjointed, and not always aligned with their belief systems.” 18:55 Dr. Spencer discusses Connected Senior Care Advantage, the outward facing brand of his physician-led JV with Agilon Health 20:00 Medical management program investments (transitions of care, care management, home visits, and pharmacy programs) 21:00 Building patient trust so physicians can effectively quarterback care and how the pandemic has affected the patient-physician relationship 23:00 Medicare Advantage risk and its impact on physician burnout and physician/patient Net Promoter Scores 24:40 Marrying Risk Adjustment to Quality and the appropriate documentation needed to fuel the Population Health engine 25:20 Prospective chart reviews to improve coding documentation of disease burden 24:37 Annual Wellness Visits to improve coding documentation, screening effectiveness (mental health, fall risk), and care gap closure 28:00 The Economic Model of the Stars Rating in Medicare Advantage 30:00 Why the higher Stars-Rated MA plans actually cost less 31:20 Implementing a Playbook for Quality Improvement aimed at QM performance and improving patient experience/clinical outcomes 35:20 Capital Investment in Primary Care and how PCPs can maintain autonomy through interdependence with the right partners

Sept. 28, 2020 The party explores Am-Karrak and their own desires before trying to find body guards for Essera and Iora.    Notable Quotes: Iolanda “Plainswalker...how does it feel to be a boy?” Plainswalker “I don't know the difference between being a boy, and just being awesome. I'm just me.”   Calree “I was the one who hid all the chocolate, so then I found all the chocolate, and ate it, and got sick.” Iolanda “That's what you get for cheating.”   Jared “Could it put claws on your boobs?”   Iolanda “My friends are being blasphemous again, and they were wondering if gods were still gods if they're not worshiped?”   Plainswalker “Hey guys important follow up question...do nuts have souls?”

This week, Veerle is joined by Darshana Baruah, Visiting Fellow at the Sasakawa Peace Foundation in Tokyo and non-resident scholar with the South Asia Program at the Carnegie Endowment for International Peace, and Dhruva Jaishankar, Director of the US Initiative at the Observer Research Foundation in New Delhi and Non-resident Fellow at the Lowy Institute in Sydney.  Together, they explore the view of the Indo-Pacific from New Delhi. Driven in part by an evolving foreign and security policy trajectory within India and a changing regional security environment, India is set to take on a stronger role within the Indian Ocean Region and seek opportunities to assist partners in other parts of the Indo-Pacific.  Darshana and Dhruva discuss traditional and non-traditional maritime security in the Indian Ocean Region, the future of regional multilateral architecture, the role of small island states and middle powers, and new areas of cooperation and competition. The road ahead for UK-India cooperation in the Indo-Pacific, while promising, is not without its challenges. It will take political will on both sides to move this relationship forward.  

The importance of Humana's consumer focus, care in the home, technology, and other strategic imperatives related to value-based care have been amplified by the novel coronavirus (COVID-19) pandemic. As COVID-19 presses onward, this week Race to Value presents an industry perspective from Mike Funk, Vice President for the Office of Health Affairs and Advocacy.  Mike Funk believes that the transition to value-based care is inevitable. In his role with Humana, he leads the organization's commitment to ensure that Humana providers are well equipped for the transition to value, especially during these unprecedented times. From stabilizing physician practices, increasing access to care, creating a high-touch primary care model, improving interoperability, and more, Humana has been a leader in the race to value. In this episode Mike reveals Humana's efforts in value, including outlining impressive partnerships with the DaVinci project, OATS, Epic, Oak Street Health, Iora Health, Kindred Health, and the University of Houston, to name a few. Mike Funk is responsible for thought leadership at Humana in transforming the industry to value-based care, as well as serving as the voice of the provider, infusing clinical thinking and leadership across the enterprise. His prior experience includes; executive positions in hospital administration, physician practice management, managed care, insurance products, and health and wellness services. Mike most recently spent the last several years in the Provider Development Center of Excellence, where he focused on developing value-based programs, and assisting physicians with the tools, capabilities, and best practices for transitioning from fee for service to value. Mike is a fellow of the American College of Healthcare Executives and a Certified Medical Practice Executive. References for more information: https://www.humana.com/provider/news/value-based-care http://valuebasedcare.humana.com/ Bookmarks: 5:45 “Unprecedented times call for unprecedented actions” 6:24 Primary focus of Humana during the pandemic has been to improve access to healthcare services 6:45 Pandemic was the catalyst for jumpstarting and mainstreaming telehealth 8:01 5-10 years of technology adoption progress happening in 2-3 months 8:30 The “genie is out of the bottle” when it comes to telehealth 9:10 Limitations with technology and telehealth access in rural areas 9:30 Older Adults Technology Services (OATS) investment by Humana Foundation to launch national digital engagement consortium for older adults 10:11 Recognition by CMS of increased need for telehealth 10:20 Mike shares a story of a practice leveraging telehealth visits in an innovative way 12:40 Lack of interoperability held back the healthcare system in navigating the pandemic crisis 13:20 Need for interoperability COVID-19 test results 13:50 Humana's participation in the HL7 Da Vinci Project to support increased data sharing by leveraging the FHIR Standard 14:20 Humana's work with EMR companies to advance interoperability (Epic, eCW, AthenaHealth) 17:00 Humana's goal to ensure stabilization of physician practices 18:00 Risk-based payment models providing stability in cash flow 21:00 Humana has evolved its value-based product portfolio to include specialty bundles (e.g. joint replacement, spine, maternity care) 21:10 Humana's omni-channel approach to create a value-based care ecosystem that is “personalized, proactive, and predictive” 21:40 Increased demand in home care services and Humana's recent investments in Kindred and Heal 22:00 Humana's partnership with high-touch primary care practices (e.g. Iora, Oak Street) and their own practice (Partners in Primary Care) 22:20 Moving from a health insurance company to a health company with elements of insurance 23:45 Humana's Bold Goal initiative and other strategies to address social determinants of health and support whole-person care

On B-Time, we bring guests to the show who refuse to accept the status quo.  Our guest today, Dr. Rushika Fernandopulle is taking on the primary care delivery system.  His mission in life is to transform healthcare by building a new model of care. Rushika is a primary care physician, CEO and co-founder of Iora Health, a primary care delivery organization dedicated primarily to serving older adults.  Iora is unique in that it focuses on helping patients overcome the barriers that get in the way of their health.  Show Notes: Books: Anti-Fragile: Things That Gain From Disorder by Nassim Nicholas Taleb; Manifesto For A Moral Revolution: Practices To Build A Better World by Jacqueline Novogratz; The Second Mountain: The Quest For A Moral Life by David Brooks.  Favorite Podcasts: B-Time (of course!), Revisonist History; How I Built This; This American Life; A Second Opinion, A Healthy Dose; Zeev Neuwirth: Creating A New Healthcare.

Links:1. Observer Research Foundation2. Stable Seas3. Stable Seas: Bay of Bengal4. BIMSTEC5. IORA

For our first Open Forum of the decade, we explore the vast theme of home, tackling issues of homelessness, the environment and immigration, all through the medium of debate and artistic performance. In this month's edition we had music from IORA, BOA and Emmanuela Yogolelo and spoken word from Scarlett Rose. The show also features advice from our resident psychotherapist Dan, as well as information about housing and homelessnes from De Paul UK. As always, thanks to the Audio Content Fund and all those who came through to have their say.

On PopHealth Week our guest is Rushika Fernandopulle MD co-founder & CEO Iora Health. Dr. Rushika Fernandopulle is a physician who has spent decades improving the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University. He completed his clinical training at the Massachusetts General Hospital. Iora Health changes primary care as we know it. Iora's care team, includes a dedicated advocate for each patient, works together to treat the whole person. ==##==      

On PopHealth Week our guest is Rushika Fernandopulle MD co-founder & CEO Iora Health. Dr. Rushika Fernandopulle is a physician who has spent decades improving the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University. He completed his clinical training at the Massachusetts General Hospital. Iora Health changes primary care as we know it. Iora's care team, includes a dedicated advocate for each patient, works together to treat the whole person. ==##==      

"They're picked for one thing only which is empathy, being able to connect to another human being." Empathy, connection and humanity are at the core of how Dr. Rushika Fernandopulle is disrupting healthcare, one clinic, one patient at a time. The attributes described by the Co-Founder and CEO of Iora Primary Care are prerequisites to being a Health Coach in any Iora practice, working along side doctors, nurses and an entire team dedicated to each patient. Dr. Fernandopulle literally got sick and tired of delivering healthcare to his patients the same old way, so he threw out the old model and created something new. Eight years later, Iora has more than 700 employees, 48 practices from coast to coast, and is delivering primary care to tens of thousands of patients in 12 cities...and growing. Iora's mission of leading with humanity is right up our alley at Our Voices Matter which is why I couldn't wait to sit down with Rushika to get his backstory. Enjoy!Support the show (http://patreon.com/OurVoicesMatterPodcast)

Hi friends, I'm yoshiislander and you're listening to Vorthos Audio Files, the podcast where I read to you Magic the Gathering stories for your relaxation, while flavoring your knowledge of the multiverse.Welcome to episode 11, and the fourth installment of Magic Origins, a series dedicated to the origin stories of the founders of The Gatewatch, including Chandra, Liliana, Jace, Gideon, and Nissa.If you like this series, you'll probably like playing Magic with me, live on Twitch, Sunday evenings, Pacific Standard Time, @yoshiislander. Our fourth magic origin story takes us to Theros. "Before he was Gideon Jura, a young man named Kytheon learned about honor and loyalty on the streets of Akros." Cue the story.Play Magic with me on Twitch: https://www.twitch.tv/yoshiislanderRead along FREE on the official Magic the Gathering site: https://magic.wizards.com/en/articles/archive/uncharted-realms/gideons-origin-kytheon-iora-akros-2015-07-01Support the show (https://www.ko-fi.com/yoshiislander)

This week we are joined by Andrew Schutzbank, the Vice President of Product and Technology at Iora Health. His passion for revolutionizing health care began as a medical student at Tulane in pre- and post-Katrina New Orleans and continued during his Internal Medicine & Primary Care residency at the Beth Israel Deaconess Medical Center. He writes at schutzblog.com and joins us today to talk his work at Iora Health. We discuss how the idea of completely starting over brought him to Iora Health after his residency, how Iora Health’s model works and how they navigate risk, the central role of Health Coaches in the care team, what challenges Iora is still grappling with, about Iora Health’s novel EHR, Chirp, and finish up with his reflections on how software development and patient care are similar. Please rate and review us on itunes or stitcher, and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems. Please drop us a line at contact@rospod.org. We’d love to hear from you.

The Night Snails have just taken down one of their biggest foes to date - but they did it in enemy territory and EXTREMELY loudly. Not to mention that that foe swallowed two of them before they killed it! How will Vezz, Tombs, De'Marko, and Iora get out of this one? And will they be able to do the job before getting caught? Tune in to find out! The post s1e18 Derek and Fluffy appeared first on Geekspective.

Wilker is gone!  For good!  Say your farewells.  And in his absence, The Night Snails need to find a replacement!  With applicants waiting at the ready, it's time for Vez, Nuks, Iora, and De'Marko to put on their interviewing hats and find a new member of the crew! The post s1e15 New Help Wanted appeared first on Geekspective.

Iora drops some hard truths on The Night Snails before they are approached by definitely-not-a-Vampire, who has a new score for them. Will The Night Snails change their ways and successfully take down the score without making a ton of noise and blowing things up? Do they have any concerns working for a vampire? Find out... now! The post s1e13 An Uncomfortable Situation appeared first on Geekspective.

0Episode 10 - Undead Gillik finishes his chat with Iora, the Many Pennies continue their fight with the Zombeholder, and the Death Lord is still fueled up. Also, Gillik still can't speak. Follow us on twitter @AdventureIncPod Like us on Facebook facebook.com/adventureincpodcast Check out our website adventureinc.podbean.com Check here for NPC information. Don't forget to rate/review/subscribe!

The Night Snails split up to get to the bottom of what went wrong with the Underhill exchange.  Vez and Iora follow Willow Underhill to get answers, Wilker tries to find a way back into the Party, Bug's relationship with Matilda gets even weirder, and De'Marko runs into someone from his past who could ruin everything. The post s1e10 A Party of Oddities appeared first on Geekspective.

The Indian Ocean Rim Association (IORA) Council meetings continue in Durban, KwaZulu Natal with women empowerment through blue economy as one of their core focuses. The meetings aim to encourage trade among its 21 member states in a range of sectors including the tourism industry. At least one bed and breakfast owner in the host city says the challenges they face extend further than just policy. Sithakazelo Dlamini filed this report from Durban….

The Indian Ocean Rim Association (IORA) Council meetings continue in Durban, KwaZulu Natal, with women empowerment through the blue or maritime economy as one of their core focuses. The meetings aim to encourage trade among IORA's 21-member states, in a range of sectors, including the tourism industry. At least one bed-and-breakfast owner in the host city says the challenges they face extend way beyond policy. Sithakazelo Dlamini filed this report from Durban….

Today’s episode is the second episode in our series on new models of Primary Care! Our guest today, Rushika Fernandopulle, MD, is  Co-Founder and CEO of Iora Health. Rushika is a physician who has spent more than ten years involved in efforts to improve the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his MD and Masters in Health Policy from Harvard University and completed his clinical training at the Massachusetts General Hospital. In 2011, Rushika Co-founded Iora Health; Iora Health is building a different kind of health system to deliver high-impact, relationship-based care, helping patients manage their health and navigate the healthcare system.   In this episode we cover: Rushika’s background and where his interest in improving healthcare delivery came from How the Iora Health model works What early iterations of the business model look like and what did Rushika try before arriving at what Iora is today As the company grows, how Iora Health continue to embrace innovation Iora Health has  raised over $123M in funding to date; Rushika discusses the crucial inflection points in knowing when it was time to bring on new capital How Rushika responds to the criticism that these standalone primary care models could create more fragmentation in the system As Iora Health continues to expand and to raise money, besides capital, what Rushika looked for in his initial investors and what he looks for now in the later rounds Iora Health launched an Accountable Care agreement with Humana in Arizona and Washington for their Medicare Advantage population beginning in 2014. Rushika explains how Iora works with Humana and other insurers and where he sees possible opportunities moving forward What Rushika thinks about partnerships with health systems  Where Rushika sees the future of these New Models of Primary Care heading  Connect with Rushika: LinkedIn Twitter Connect with Iora Health: Website Twitter  Connect with Healthbox Follow us on Twitter and @ChuckFeerick Subscribe and leave a review in iTunes Have guest suggestions or topic ideas for the podcast? Send them to us at ideas@healthbox.com Listen to this episode on iTunes, SoundCloud, or Libsyn

Everyone can agree that our current healthcare model is broken. But the question is, can we fix it from the inside? or do we need to start from scratch? My next guest, Dr. Rushika Fernandopulle believes in order to best address the looming crisis, we need to reimagine health care from the ground up, and build new primary care models from scratch. He is the founder of Iora Health, a next generation primary care practice designed to restore the humanity in healthcare. In recent weeks, we have seen similar primary care models like Qliance and Turntable Health fold under unsustainable business models. By what makes Iora Health different and successful to date? On this episode, Dr. Fernandopulle will share his secret sauce to success, what he believes is broken in primary care, what the future holds for quality medical care, and the inspirational backstory that led him to start Iora Health.  All this and more on today’s episode. Now, That’s Unusual. About Dr. Rushika Fernandopulle Dr. Rushika Fernandopulle is a practicing physician and co-founder and CEO of Iora Health, a healthcare services firm based in Cambridge MA whose mission is to build a radically new model of primary care to improve quality and service and reduce overall expenditures. In 2012 he was named an Ashoka Global Fellow, and is also a member of the Albert Schweitzer and Salzburg Global Fellowships. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and Managing Director of the Clinical Initiatives Center at the Advisory Board Company. He is co-author or editor of several publications including Health Care Policy, a textbook for physicians and medical students, and Uninsured in America: Life and Death in the Land of Opportunity. He serves on the staff at the Massachusetts General Hospital, on the faculty of Harvard Medical School, and on the boards of Families USA and the Schwartz Center for Compassionate Care. He earned his A.B., M.D., and M.P.P. (Masters in Public Policy) from Harvard University, and completed his clinical training at the University of Pennsylvania and the Massachusetts General Hospital. Key Interview Takeaways Although innovations in technology continue to evolve the healthcare space, the way we deliver care has remained stagnant. Healthcare is a series of fragmented transactions, and outcomes are not the focus. Dr. Fernandopulle’s motivation to tackle this issue came from a colleague’s plea, “Every day, I lose a little piece of my soul.” Most enter the medical profession with the intention of helping people, but the system gets in the way. “Half-ass, incremental change doesn’t work.” Dr. Fernandopulle had the simple insight that starting over was the only approach, and Iora seeks to rebuild healthcare from the ground up, starting with primary care. Dr. Fernandopulle set out to replicate the Southwest Airlines paradigm: Show up in the market, break the rules, and compel others to change in order to keep up. His mission is to transform healthcare by building a different model and demonstrating this new approach for others to follow. Iora operates on the idea that the doctor’s job is to radically empower her patients, giving them the tools to improve and maintain health in a system that keeps learning and adapts quickly. The most difficult part of developing the Iora model was designing the payment system. Dr. Fernandopulle rejects the fee-for-service model, and he sought payers (employers, union trusts, etc.) who were willing to pay for the relationship rather than individual transactions. The Iora system has been cost-effective in terms of patient/team experience, clinical outcomes, cost of care, and economic sustainability. Iora practices have 96-98% retention rates, and they have experienced 40-50% drops in hospitalizations. Behavior change is a slow process. The Iora model invests more money in patients early on, but typically sees big savings in healthcare costs by year three.

Rushika Fernandopulle, CEO of Iora Health, discusses how his desire to fix the "stupid system" that is healthcare led to the creation of Iora health and lets us in on what he believes is the secret to better patient care: empathy. He shares the lessons he has learned as a trailblazing entrepreneur and explains how he sought to turn traditional patient care on its head by transforming a transactional system into one based on relationships. Trevor, Steve, Rushika, and Iora's CFO Dave Fielding work through what it takes to survive in the evolving primary care space, how CMS will shift under the new administration, and where we are today in the value-based care movement that Iora helped pioneer.

Episode 1 of 4 - Manhunter The Many Pennies finish up their business with the Church of Iora and head back to Mughamara where a mysterious visitor waits with an important message. Also, Clyde has a really bad day. Special guest star Jon Hofe of Botched Podcast as Jator Sakesh. Follow us on twitter @AdventureIncPod Like us on Facebook facebook.com/adventureincpodcast Check out our website adventureinc.podbean.com Don't forget to rate/review/subscribe!

All heroes have an origin story, even the Gatewatch. Though for some, the story is more tragic than others... Original Story: http://magic.wizards.com/en/articles/archive/uncharted-realms/gideons-origin-kytheon-iora-akros-2015-07-01 Voice Credits: Kytheon: David Ford Drasus: Grace Guard 1: Gategeek https://twitter.com/GateGeek Guard 2: Diego Domenici http://magus-of-the-color-pie.tumblr.com/ Ristos' Thug: Rhythm Bastard http://rhythmbastard.rocks/ Hixus: J.W. Forsyth Https://twitter.com/pragmatticus Wall Guard: Christina Eddleman https://twitter.com/christieddleman Zenon: Gracen Atkinson http://surrak-the-hunk-caller.tumblr.com/ Heliod: Cal Quirk http://ugin-the-spirit-dragon.tumblr.com/ Moukir: Gamer Dragon https://www.youtube.com/channel/UCZi0rNlmMuEf6ILtnOBoElg Sound Credits: Sound Editing by Grace "Cambodian Odyssey" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/ Sounds from: https://www.audioblocks.com/

Episode 4 of 4 - Blood Rites The Many Pennies square off with a corrupted angel of Iora as Dungalaris attempts to escape Also, Gillik has a crazy plan. Follow us on twitter @AdventureIncPod Like us on Facebook facebook.com/adventureincpodcast Check out our website adventureinc.podbean.com Don't forget to rate/review/subscribe!

Episode 2 of 4 - Clergy Clash The Many Pennies make a move against Dungalaris' forces in the Church of Iora. Also, Jennuvera gives up and turns invisible. Follow us on twitter @AdventureIncPod Like us on Facebook facebook.com/adventureincpodcast Check out our website adventureinc.podbean.com Don't forget to rate/review/subscribe!

IORA’s co-founder and CEO Rushika Fernandopulle, MD, has spent the past decade trying to improve primary care. Hear how IORA Health is delivering on that long-time pursuit.

Episode 20 of the Unspoken Realms podcast, featuring Gideon’s Origin: Kytheon Iora of Akros by Ari Levitch, the fourth of the five planeswalker origin stories written for the final core set, Magic Origins.

Listen NowMuch of the health care industry's effort to improve health care payment and delivery centers around improving primary care. This is largely because Americans suffer more disease/disease burden throughout their life spans compared to individuals in other industrialized countries.   This therefore makes obvious sense since primary care is the foundation upon which an effective and efficient health care/medical care program is built.  When done well primary care promotes wellness, prevents disease onset, progression, exacerbation and prevents premature death.  Primary care also moderates the need for higher cost specialty care and improves population health.  For numerous reasons, not least of which is inadequate reimbursement, primary care delivery has been sub-optimal.   New models of primary care are emerging, one termed direct primary care (noted in the ACA under Section 1301 (A) (3) and now recognized in 13 states) is showing promise in improving quality, improving patient satisfaction and lowering cost growth.      During this 21 minute conversation Dr. Judge discusses moreover the impetus for the creation of Iora Healh, how Iora's primary care delivery model works or how it is different from traditional primary care delivery, how Iora's model is staffed, IT supported and reimbursed, with whom and how it contracts and what Iora's performance data demonstrates to date. Dr. David Judge serves as Iora Health's Chief Medical Officer.  Dr. Judge joined Iora in 2014 to continue his work in improving and redesigning of primary care.  Priorto , he helped found and was the Medical Director of the Ambulatory Practice of the Future at Mass. General Hospital.  David received his undergraduate degree in biomedical engineering and public health studies at Brown University and attended University of  Mass. Medical School.  He completed his residency training in internal medicine at Columbia Presbyterian Medical Center in New York City. For more on Iora Health go to: http://www.iorahealth.com/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com