Primary Health Care

Today’s New York Times had an interesting article featuring Iora Primary Care, a startup with a business model more like Starbucks than your current primary care facility (except that you can’t walk in off the street and buy a cup). You can read the article, A Starbucks for Medicine, in the Business section.

Iora is a subscription service that only works with employer partners (not with individual patients), so your company has to buy in. The value proposition to the partner is lower costs that are more or less fixed. The value proposition to the patient is more individualized customer service, and, sometimes, service that goes well beyond what we have come to expect from primary health care providers.

One of the features of their model is a “health coach”, a much lower cost person than any of the medical staff, whose function is to help the patient with not-necessarily-medical, peripheral issues, such as transportation, diet, exercise and advocacy—at least within the practice office.

Iora is a startup, and there are still many issues to be resolved. They aim for a large number of practices instead of the one, or a few, that most innovators expect to have. Some things in the model scale well, such as knowing what to stock when a new practice opens. Some things scale poorly, such as the CEO interviewing most of the new staff. It isn’t clear yet whether they will actually be able to reduce costs for employers (mostly by trying to provide care that will head off trips to the hospital and ER, I think). On the other hand, the kind of care described in the article seems attractive from the patient point of view, and finding ways to move in that direction has got to be good.

From the provider’s point of view, they aim at far fewer patients per provider, allowing the provider more time with each patient. And, (here’s a note for you Victo) they have a staff of about 20 engaged in building their own proprietary EHR system. On the one hand, that means that individual providers will have more input into how it works, and more influence when it doesn’t. This could also be a cost reduction idea—EHR/EMR systems are already a very big business. On the other hand, as the number of small practices increases, this effort may be hard to sustain—another area that doesn’t scale particularly well.

On the surface, Iora looks like a good idea. I currently get primary care through a corporate entity. While I like and respect the providers and other staff, the corporation stands in the way of getting to them and pretty much controls what I get from the providers. I admit I haven’t yet had much interaction, and so far, I’m glad because the interactions have been painful or at least irritating. I’m interested to hear what others of you think of the Iora idea or other innovative delivery ideas, particularly those in the health care industry.