Rushika Fernandopulle and Iora Health plan to change the way you see your doctor

Fifteen years ago, Rushika Fernandopulle had a radical idea.

A general practitioner by training, he treated patients in the usual way, with confidence. But he began to realize that it was not working and that the insurance did not cover what he wanted to do for the patients.

"In the system, you have to be blind, deaf and dumb to not realize that the system is down," said Business Insider Fernandopulle, CEO of Iora Health, 51.

So he decided to create something new. The practice originally called Renaissance Health and was based in Arlington, Massachusetts, outside of Boston.

Fernandopulle then made a proposal to the patients: it could make them pay between 40 and 50 dollars per month without taking insurance. In return, Fernandopulle could give them more doctor visits, follow-up calls and more practical care to keep them healthier.

Read more: A new type of medical office charges a monthly fee and does not take insurance – and this could be the future of the drug

While the model of charging a monthly fee worked, the person paying these fees changed. Now, instead of charging monthly fees directly to patients, Iora works with "sponsors" – mostly employers or private seniors' health plans (called Medicare Advantage) – that cover monthly fees. Iora has also established care teams of nurses and other health professionals who can assist the practice's physicians.

Iora says that the approach works. Iora explains that a group of Medicare patients has reduced hospitalizations and emergency room visits by 50% by 20% over 18 months.

GE Ventures, Khosla Ventures, Temasek Holdings and Humana, who bet that the model could be the future of health care in the United States, especially for the elderly, have raised more than $ 250 million.

How does Iora work

Suppose you benefit from a Humana Medicare Advantage diet in Phoenix. You can become a member of Iora (about a quarter of these Humana MA members do just that), and be put in touch with doctors and health coaches to keep you healthy. Because it's a membership model, you do not have to worry about copays for visits.

Physicians host about 500 to 700 patients, depending on their location and their state of health. That's a lot less than the 2,000 patients that traditional family doctors could watch.

Today, Iora has about 34 law firms in the United States, a number that is expected to grow to 50 by the end of 2019 through the introduction of entirely new practices. In March, Iora announced plans to expand to North Carolina through a collaboration with Blue Cross Blue Shield of North Carolina.

According to Fernandopulle, he and the Iora team are building something totally different from what exists today.

"We are building a radically new relationship model for healthcare, consumer-centric, which is not much different from the current transactional model of" doing things to people, "Fernandopulle said.