Case Studies in Care: Iora Health & LeBron James’ I PROMISE School
The LeBron James Family Foundation is behind Akron, OH’s I PROMISE School, which represents an extraordinary investment in students often deemed lost causes. The approach has important lessons and parallels in healthcare.
Akron, OH’s I PROMISE School recently kicked off its second-ever school year, and if you are in need of encouragement, I encourage you to take a look at their Instagram account. You’ll find posts about empower hour, dominating testing, morning high fives, teachers who believe, new bikes, swim lessons, and kids conquering fears — all accompanied by the #WeAreFamily hashtag (I’m not crying; you’re crying). It reads as a utopia, amid a seemingly endless sea of news about our country’s moral failings and deep racial and economic disparities. And it’s made possible through a donation by a partnership between the LeBron James Family Foundation and the city of Akron’s public school system.
It also got me thinking of another bright spot in a broken landscape, one we hear a lot about and like to doom: healthcare. That would be Iora Health, founded by CEO Rushika Fernandopulle, on a mission to restore humanity to healthcare. (Disclosure: my employer Polaris Partners is an investor in Iora.)
Fernandopulle and James wouldn’t typically be compared side by side, but I thought it would be interesting to reflect on the shared traits of I PROMISE and Iora, both extraordinary attempts at overhaul in systems that deeply need it.
First, a quick background on both organizations
I PROMISE started in fall 2018 as a public school for third and fourth graders and expanded to fifth graders this year to continue serving its original student population. It’s run as a public school, not a charter school, with roughly the same per-pupil funding from the district as others. Additional donations from the LeBron James Family Foundation (about $600,000 in year one and over $1 million this year) has helped bring on additional teachers for smaller class sizes and adds after school and summer programming. Organizations like Wal Mart also help support a food pantry and other services (more on those below). James was born and bred in Akron and is reported to have been an at-risk student himself, so the investment is deeply personal and extends on his existing philanthropy in the school district. The New York Times did an excellent profile on the school in April, which I will touch on a few more times below.
Iora Health is a for-profit, venture-backed company playing in what’s commonly referred to as value-based healthcare. It charges insurers or self-insured employers a flat-fee for caring for populations of patients, and therefore is incentivized to keep its patients healthier and its costs down, not simply render a high volume of services. It focuses on high-quality, proactive, and relationship-driven care and systems, and by the end of this year will operate about 50 primary care practices across all continental U.S. time zones. Fernandopulle’s role is also deeply personal, as a longtime physician who wanted to see things change.
Below are a few elements that unite the two efforts and should be celebrated.
A recognition that medicine isn’t just medicine and school isn’t just school
Iora Health has reimagined primary care to embrace the social determinants of health, a term growing increasingly buzzy in the industry. Housing, employment, family support, transportation, food access — all elements that a traditional primary care appointment isn’t designed to tackle, but are forces that have outsized influence on a person’s health and ability to care for themselves. To address this, Iora puts a care team around each patient, centered on a health coach who helps them with tasks like medication adherence, securing rides to appointments, and nutrition guidance. The clinics’ software is less focused on reimbursement and more on facilitating connection between patient and practitioners and making health information easy to understand and access for both parties.
Similarly, I PROMISE is focused on investing in the whole student, not just the one that shows up for the classroom from 9am-5pm (note the school’s extended hours). Its curriculum incorporates social emotional learning, an approach that helps students manage and understand emotions, develop empathy, and set goals. I PROMISE focuses on building up parents, with services such as a food pantry, GED counseling, legal and social services, healthcare access, and even a quarterly barber — things that not only remove stress from home but restore dignity to the parent and student.
A lavish customer experience created for the “lost causes”
Customer experience is a topic that comes up often in tech and consumer companies (and is a given for the “haves”), but it’s largely an afterthought in institutions like healthcare and education. Just think of the stark walls and fluorescent lighting we’ve all experienced in both settings. Both Iora and I PROMISE have succeeded in turning traditionally onerous destinations into special clubs. And they do so for constituent groups that have been traditionally disregarded.
Iora’s mission to reshape healthcare is immediately focused on Medicare patients, a group plagued by chronic health conditions. Its primary care practices offer programming such as classes in meditation, Reiki, chair hip hop, and managing chronic diseases such as COPD. We’ve spoken with an Iora patient who said proximity to an Iora location was a key factor in deciding where she would live next. All of this has helped Iora earn a net promoter score (NPS) of 90. For reference, the average primary care NPS in the U.S. is a 4. Even Apple’s tops out at 72.
In addition to the social services offered to parents, I PROMISE students receive cheers from staff when they walk through the doors each day. LeBron James’ image, quotes, and shoes line the halls and he speaks encouragement at the school’s “opening ceremonies” and other video messaging throughout the year.
The school is drawing from a similarly high-risk group as Iora. I PROMISE identified second graders that were performing in the 10th to 25th percentile on assessments — and were considered at risk of not graduating at the tender age of 8 — and then selected on a lottery basis from this group, according to the Times.
Both approaches ultimately recognize that improving the lot of these groups would send ripples through the system. An investment in an I PROMISE student isn’t simply a shot in getting them in a great college vs. a good one, it’s a move to keep them from falling out of the system and into the margins altogether. For Iora, the upfront investment of providing high end, proactive health services is a bet to keep its patients out of the emergency room with more acute health issues that sharply increase costs.
And both approaches are rooted in a belief that all people are worthy of being cared for and treated with dignity, because, well, it’s the right thing to do.
They just might be onto something
The success of each institution isn’t limited to warm fuzzy feelings and great word of mouth marketing. They’re showing progress against their core metrics. Iora reports that its patients have seen on average a 40% reduction in hospitalizations and a 20% reduction in ER visits. Baseline hypertension management for its patients is at 78% on average, up from 59% when these patients join Iora practices.
I PROMISE’s signs of success are early and incremental, but widely regarded as promising. The Times article centered on this very fact. The third grade students moved from the first percentile in reading to the ninth, and the fourth grade students moved to the 16th. In math, the third graders started in the first percentile and ended up in the 18th, while the fourth graders went from the second to the 30th. Officials said this puts I PROMISE’s improvement rate in the 99th percentile, relative to other schools in the district. An Akron public school employee interviewed in the article said something “extraordinary is happening” to be able to move in this direction in such a short period of time.
On one hand, this improvement rate underscores just how far these groups have to go. But we shouldn’t be all that surprised at the successes Iora and I PROMISE are showing. Both organizations embrace the obvious in their respective sectors: that social factors play a bigger role than genetics in determining health and lifespan, and the stress that accompanies poverty detracts from a child’s ability to succeed in school.
And ultimately, both approaches come down to empathy. They take previously transactional frameworks that have enormous influence, recognize the odds that their constituents face, and tackle those forces head on. They treat their customers like people and not like problems. They’re succeeding in their small but mighty spheres of influence. Let’s hope this caring goes a long, long way.
The Fine Print
This is not an advertisement and should not be construed as an offer of investment advisory services by Polaris Partners or an affiliate thereof or a solicitation or an offer of interests in any private fund sponsored by Polaris Partners or an affiliate thereof (collectively “Polaris Partners”). The views expressed above are educational in nature and do not constitute investment advice. To the extent companies are mentioned, they have been selected by the author on an objective basis to illustrate views expressed in the commentary and do not represent all recommendations for advisory clients.