There is lots for us to learn in the SA private healthcare sector about a better model of delivery for patients from this excellent article in the NYT.  

Iora Health is a major success story about integrated and accountable care coming out of the USA in the era of ‘Obamacare’.

 

Iora staff recognise that in accessing the healthcare services they need, patients have complex social, clinical, financial and logistical issues. A system that deals only with the immediate clinical needs must fail them. Sound familiar?

 

Additionally, the current system is so full of efficiencies that ‘everyone – In our context Schemes companies and individuals – ends up spending more on care’.

 

Iora Health is solving both problems (i.e. better care and affordability) by improving services and so keeping patients out of hospital. They are doing this at scale with ‘mass replication of quality care’ in multiple centres around the USA.

 

The model includes daily ‘huddles’ where a multidisciplinary team meets to create proactive care plans for their patients and track the progress of the sickest. Patients are in long term relationships with their Iora Health centre, which doesn’t see ‘off the street’ patients at all. Instead patients come via their insurers and are funded for the long term by a contract based on the needs of patients and a share of savings in downstream costs (see our post on Value Contracts). Despite its relatively recent launch 3 years ago, Iora has a good track record in reducing downstream costs and achieving significant savings.

 

Minimum work standards in the model include using the proprietary electronic medical record, the design of the consulting rooms and the daily huddle. The model also emphasise the role of ‘health coaches’ (coordinators), some of who have a customer service rather than a health care background. They deal with non-clinical support and logistic issues, freeing up the clinical staff. In the model, patients are valued consumers and the staff responses to net promoter ‘satisfaction surveys’ are crucial inputs into the success of the centre.

 

Doctors also typically have much lower number of patients than in a Fee for Service payment system, because of the team arrangements and so can spend much more time with sicker patients, with a better chance of making a real difference.

 

The PPO Serve model of Integrated Clinical Consortia™ closely resembles this approach, obviously attuned to local South African conditions.

Iora Health’s progress is being closely watched all round the world because their achievements are so compelling and exciting. They are providing good quality care with high customer satisfaction that is also affordable and in a competitive market economy.

We need to reproduce these achievements here in South Africa through the Integrated Clinical Consortia™ model.