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In defense of for-profit medicine


Ali Khan, M.D., is a general internist in San Francisco, a clinical instructor of medicine at Yale School of Medicine, and a shareholder in Iora Health, a  for-profit primary-care startup that he used to work for.

In this STAT (affiliated with The Boston Globe) he makes a pitch for for-profit medicine.

In a April 4 article,  “How I learned to overcome my bias against for-profit healthcare,” he discusses what could be construed as revenue-and-profit  greedy actions by “nonprofit” hospitals.

He writes: “{T}here’s a rising wave of private organizations at the frontier of health innovation that are in this for more than money.”

“I spent the last three years with an Iora team caring for incredibly sick casino union members in Las Vegas. Our ‘hot spotter’ community health workers, physicians, nurses, and social workers reduced emergency department use and inpatient hospital care by nearly 50 percent and lowered the overall cost of care. Try telling my team — men and women willing to help a patient facing eviction pack up his or her belongings, or visit intensive care units on their free evenings to console families — that for-profit health care is destroying ‘the soul of medicine.’”

“Iora is hardly alone as a for-profit aiming to effect social good. Qliance, ChenMed and CareMore focus much of their work on caring for our nation’s sickest and most vulnerable individuals. Through partnerships with Medicare and state Medicaid agencies, they’ve taken on hundreds of thousands of publicly insured individuals and have seen dramatic improvements in care coordination and health outcomes.”


“When I look at the evidence, I wonder: Why did we ever think that tax status differentiates good and evil? A new narrative is emerging: profit and societal good need not live in opposition when considered thoughtfully — and driven by a robust social mission.”

“Let’s keep that in mind as we work to transform American medicine. Otherwise, trying to distinguish nonprofit and for-profit health organizations just becomes an exercise in legal fiction.”

UnitedHealth gets deep into primary-care innovation


David Chase, writing in Forbes’s online service under the headline “The Exchange Is Dead, Long Live the Exchange,”  says:

“Recently, headlines screamed about UnitedHealth threatening to leave the ACA exchanges. …United is losing hundreds of millions on the public exchanges. Meanwhile, virtually no one has noticed perhaps the smartest move I’ve seen any health insurer make—build a de novo value-based primary-care model from the ground up that is optimized for the consumer and small business market that the exchanges target.”

FierceHealthPayer reports that United’s wholly owned subsidiary, Harken Health, calls itself “a new kind of healthcare company that unites relationship-based primary care with flexible and competitively priced health insurance in a membership-based model” and  free primary-care visits at its clinics.

Mr. Chase points out that the venture is also a partnership with Iora Health, know for refusing to accept fee-for-service payments and  assigning patients health coaches to guide behavior.






‘Twice the health’ at ‘half the cost’


Healthcare Payer News reports that a new kind of health system, with insurance built in, “is trying to validate its primary-care model and disrupt a seemingly competitive regional healthcare market.”

It’s Zoom+, a  clinic network now selling insurance for the first time with a unique — indeed, anti-establishment — low-price model.

Founder Dave Sanders, M.D., likes to describe his firm as aiming “to deliver twice the health, at half the cost and 10 times the delight.”

“At 28 neighborhood clinics and ‘advanced care studios’ in Portland, Vancouver, Wash., and Seattle, Zoom patients get team-based care from MDs, NDs, NPs, and PAs, with same day appointments, telemedicine, health coaching, food and exercise counseling, parenting help, mental health treatment and basic dental services, which will all come as part of the health plans.”

“Over the past nine years, Zoom has evolved into a kind of 3.0 version of Group Health Cooperative, HealthPartners or Kaiser Permanente. It might also be compared to direct primary care networks like Qliance or Iora Health, as well the new health insurer Oscar.”

Sanders said: “As physicians, what we all know to be true are that food and movement are the soul of human health, along with relationships, stress and sleep. For some reason, our medical schools and system perpetuate the myth that health relies in laboratories, and imaging and medicine.”

“Zoom offers those condition management services, but the goal is to spread a ‘culture and ethos’  of ‘food and movement as medicine’—clinics that offer personalized activity training, diet counseling and smoothies.”

Healthcare Payer News says: “If Zoom can serve those populations and win converts from the third segment, while nurturing a strong brand and experience, Sanders said they could expand to other regions and patient populations.” But Zoom does not yet accept  Medicaid or Medicare.



A patient-friendly and simplified-billing approach



Iora Health is example of the new enterprises springing up to treat patients disenchanted by what they see as soulless and rushed physician groups and clinics. It’s not exactly “concierge care” for the rich, but it sounds remarkably pleasant.

The Cambridge,Mss.-based for-profit  runs  a total of 13 practices in six states. It provides a relatively new model emphasizing preventive care, technology, close personal attention and simplified payment, reports The Boston Globe. The last item is particularly important to many individuals and enterprises  utterly fed up with America’s byzantine, exorbitant and and  sometimes dishonest medical billing.

And patients usually get hour-long appointments.

Rushika Fernandopulle, M.D., from Massachusetts General Hospital,  co-founded Iora with entrepreneur Christopher McKown, the husband of Abigail Johnson, chief executive of Fidelity Investments — lots of  connections  for start-up capital there! Dr. Fernandopulle asserted that “We are building a brand-new version of healthcare.”

Actually, there have been similar enterprises popping up across America in the current healthcare churn, accelerated by new technology and the Affordable Care Act.


The Globe reported that “The company finds large companies or organizations such as unions that are interested in trying out a new approach. These sponsors …. have agreed to pay a flat monthly fee for each patient. Employees still carry standard insurance for medical needs beyond primary care.”

“If Iora can keep a patient healthy and provide care for less than the monthly fees, then Iora makes more money.”









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