Community Lessons from a Global Village

Many of you who have spoken to me on the phone or in person during my tenure at Oxeon know (through aggressive conversational positioning or otherwise) that I have a passion for global health. Don’t get me wrong, I love chatting about hospital readmissions, risk-based contracting and reimbursement rates as much as the next Oxeonite, but there are times when I read an article on emergent malarial treatments and want to wax poetic about said article. This usually happens before realizing abruptly that X financial executive at Y healthcare technology company doesn’t necessarily want to play that game with me. I would be remiss if I didn’t explain that these emotions have certainly waxed over the past few months; it can be hard to give credence to the challenges our healthcare system faces when global crises crowd the news. The resultant human suffering seems to bring a new meaning to the word “acute.” Accordingly, I sought to use October’s newsletter to reconnect with the deep relevancy of Oxeon’s client base. Not only are these companies poised to solve a billions-a-year-problem in the US, but their models—efficient and human-centric as they are—are certainly applicable in a global context. Moreover, many of these organizations were borne out of a distinctly international experience set.

After conversations with Jeff Butler, CEO of Privia Health, and Dr. Rushika Fernandopulle, CEO of Iora Health, the proverbial line between global and domestic was appropriately blurred. Iora and Privia epitomize the striking parallels and possibility inherent in healthcare innovation today: their models are relevant everywhere and they have been built on the premise of scalability.

Iora liaises with self-insured employers and payers to provide patient-centric primary care services. The lynchpin of their offering is a strong relationship with a health coach—not an NP or a clinically-trained professional, but an empathetic, culturally-competent partner that more often than not comes from the community served by the clinic. According to Rushika, it is integral that the health coaches have less “social distance” from the patients—the clinical piece is far less important than interpersonal skills and the ability to connect.

Rushika knows this model works because he has seen it employed elsewhere. During his medical school and residency days, he worked and practiced alongside community health workers in rural Dominican Republic and Kuala Lumpur, Malaysia. Both settings saw a reliance on laypeople within the communities; within poorly-resourced settings, this happens out of necessity. However, what Rushika saw in Kuala Lumpur would stick with him—one woman in every village was educated by government health workers and tasked with monitoring all pregnancies within a ten minute radius (by foot) from her home. The means by which this happened were not complex: a chalkboard with each pregnant woman’s name, due date and vital signs. The community worker was trained in a system of triage—when to call a nurse, when to send the patient to the regional hospital, when to simply deploy the universally curative power of empathy and a kind ear. Rushika’s takeaway: “The outcomes were simply unbelievable. Better than our outcomes, in some poorly resourced areas. The key was the relationship. These women had amazing relationships with the women they served.”

Iora—and its foundational beliefs—hinge on the commonality of this theme across populations. Patients love the services provided by Iora; this is true for patients working in Las Vegas restaurants and professors lecturing at Dartmouth. Iora just signed a national contract with Humana to work with Medicare Advantage members in choice US cities. The same day, they publicly announced the opening of their first clinic with Grameen America: a partnership with the renowned microfinance organization to provide primary care to low-income immigrant women in Queens. The first step to success for these two clinics that will serve vastly different populations? Hiring health coaches—sharp, empathetic health coaches.

If you think the parallel here sounds crazy, let’s look at Privia. Privia was founded as a practice management and care coordination solution for primary care physicians. More recently, they have pivoted to a high-performance physician group and ACO model that enables better, more efficient care for patients across the care continuum. Privia just landed $400m in capital from an investor group backed by Goldman Sachs to fund its national expansion, a massive financing that makes the company one of the most highly capitalized physician organizations in the country. Before founding Privia, Jeff was one of the founders of BroadReach Healthcare, a global health organization headquartered in Johannesburg. BroadReach’s original charge was to bring some systemic order to Botswana’s national antiretroviral program. The program had financial support from the Gates Foundation and Merck but effective implementation lagged. BroadReach, co-founded by Jeff and two physicians, organized private physicians into a managed treatment network, trained and deployed extended care teams and engineered all of that via care coordination technology. At the time of BroadReach’s initial work in Botswana, the country’s HIV prevalence sat at over 40%; the world’s highest infection rate. BroadReach’s patients were arguably some of the world’s most vulnerable. Privia’s patients at the time of its founding were certainly not.

Yet, Jeff is quick to highlight the similarities. “We based Privia’s model on that work…we leverage the doctor-patient relationships and get the patient to engage in their care.” In humanistic terms, this means relying on the underlying similarities in humanity: people want agency and often just need the tools to employ it. This is particularly salient in healthcare. “People are generally the same. No matter how much money they have in their pocket, it’s hard to follow through on recommendations around wellness and care management.” How many of this newsletter’s readership has been referred to a specialist but hasn’t followed up? Because the issue wasn’t that pressing or you didn’t really know what the right next step was? Fair point, Jeff. If successfully following up to every doctor’s recommendation is a measure of education, my Middlebury degree has failed me.

Not surprisingly to any healthcare veteran, the system itself is culpable in inhibiting this individual agency.  “You see a doctor for fifteen or twenty minutes and it’s hard to follow through on that.” This is comforting knowledge given the track record I alluded to above. More importantly, it highlights the opportunity for businesses like Privia and Iora to impact change on systems both domestic and global. Jeff will be the first to admit that he gets excited by big, scalable opportunities—those that have “the ability to reach a lot of people in a quick period of time.” Rushika, too, is evangelical about the potential for scale inherent in Iora’s model: “The idea is to transform healthcare through a model that evades the status quo.” He often alludes to the customizability of Iora clinics—“we aren’t building a chain of Starbucks”—but the fact that Iora caters to such vastly different populations in the US bodes well for global scale.

It makes sense. Privia and Iora were founded in the wake of pivotal global experiences. Their models have taken hold and grown in the US across diverse patient populations. It doesn’t feel presumptuous to think that iterations of these models will make their way back across oceans. They are solutions that will adapt  across cultures and challenges as a result of their strong and replicable backbones.

The majority of people reading this article have probably leafed through a Delta Skymiles magazine (or the equivalent) and stopped to examine the page where the airline shows a map of all flights offered. Candidly, I do this for fun; I imagine most executives who find themselves in this position landed on this futile activity as a direct result of non-functioning plane WiFi. Nonetheless, we’ve all seen it. We look at the thick blue lines arcing across the Atlantic, swooping down coastlines, landing in cities foreign to our senses. I always feel dizzy with possibility when I look at this map; the places and the people of the world seem so reachable.  More recently, I’ve begun to feel that same fervor around our client base—how incredible to think that one day, iterations of these companies will touch many of the places on that map with compassion and high hopes for positive change, just as they have done here.

Iora Health and Privia Health are portfolio investments of Oxeon Investments LLC.