Iora Strategy Project Final version (3)

IORA STRATEGY PROJECTConducted by Gates Associates, LLC, a business consulting firm composed of Jeremy Gates, Léa

Serrano, Tiffanie Stamper and Zack Williford

“Serving as strategic management for Iora Health’s expansion”

TABLE OF CONTENTS

Executive Summary – Gates Associates, LLC.……………………….......….…… 3

Meet our Team …………………………………………………………………... 3-5

About IORA Health……………………………………………………………...… 5

Executive Summary of IORA Health Project………………………………....... 6-7

Statement of Problem ………………………………………………………..……7-8

Proposed Solution ………………………………………………………..…….…9-15

Conclusion …………………………………………………………………….…15-20

References ……………………………………………………………………..…… 21

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ABOUT GATES ASSOCIATES, LLCGates Associates, LLC, was established in 2016 in order to provide high quality professional

services to businesses seeking innovative solutions that analyze, identify and address potential company

issues or concerns. Our knowledgeable and passionate professionals collaborate in a synergistic

environment that enables us to provide the upmost service to our clients and has caused our business

model to thrive. We continue to deliver superior financial results to investors while contributing to the

communities in which we live and work. Our professionals specialize in using their expertise and

imagination as well as their creativity to seek ways to apply things that we, overtime, have explored in

our professional experience.

MEET OUR TEAM

Jeremy Gates

Senior executive with over 15 years of leadership and management

experience in private and public sectors including, manufacturing,

healthcare, government insurance and social service organizations.

Developed and implemented staffing strategies and programs that

improved operational outcomes and maximized the available staff

resources. Extensive experience in human resource planning and

operations, organizational change, team building, organizational

effectiveness and facilitative leadership. Performed operational and

organizational audits that aligned business requirements with staffing

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plans and processes to enhance teamwork, and team performance along

with team creativity and innovation.

Léa Serrano

Consultant expert with over 15 years of professional experience in several

countries around the globe. Fields of endeavor include but are not limited

to business growth and development, marketing, advertising and branding,

as well as employee management. Specialized in the restaurant and art

industries, Lea Serrano brings her creative and innovative approaches to

management styles to organizations all over the world. Traveling and

experiencing different cultures is her biggest passion - something she puts

to use during her consulting services in order to provide an international,

diverse and insightful environment for any organization that seeks to be

taken to the next level, all while remaining true to their brand.

Tiffanie Stamper

Accomplished and highly respected subject matter specialist in planning,

developing and implementing customer operational strategies, contact

center diagnostics, and business process reengineering efforts. Over 25

years of functional and consulting experience in the communications,

defense, distribution, entertainment, financial services, health services,

state government, transportation and utilities industries. Possesses

excellent working knowledge of overall customer management processes,

operational management processes, marketing, sales, order entry,

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distribution, collections, customer service, and face-to-face processes, as

well as in recruitment, human resource development and training.

Zack Williford

Distinguished consultant with over 12 years of management experience in

healthcare, private, not-for-profit, and international organizations.

Specializes in customer service and employee participation. Previously led

an organization into a profitable and stable international market business.

Excited to share knowledge and gain new insight.

ABOUT IORA HEALTHIora Health is an innovative health care company that emphasizes a new team approach to

primary care. Iora’s business model believes it can solve two major problems in America’s health care

system: the first is misalignment of financial incentives and social issues that hamper people’s health. In

their model, they provide care based on a flat fee per customer in contrast to the traditional piecework

model that most providers use. They are treating the patient using a care team to ensure no one falls

through the cracks and to provide not only medical care but also mental health and emotional support.

They believe their rational approach can thrive off the money currently wasted in the health care system

if successful expansion occurs using their current profit-making model (Sanger-Katz, 2015).

EXECUTIVE SUMMARY OF IORA HEALTH PROJECTReferred by professor Mark Fitzgerald, Gates Associates, LLC and their most trusted business

consultants were ask to provide an analysis concerning a specific organizational behavior problem that

Iora Health is likely to face and our strategic management solution to that problem. 5

Iora Health has retained our services in order to identify any potential organizational behavior

problems within its company and to provide strategic management solutions to that problem. They have

requested that we include clear action steps that can be taken by management to resolve this problem.

Iora Health desires to expand all while keeping customer satisfaction in addition to profits at an all-time

high. Iora’s expansion plan’s mission is to develop a standard formula and to allow its professionals to

experiment and adapt to local conditions. They have requested that the company’s proprietary

electronic medical records, the design of the consultation rooms and the daily huddle itself are not

subject to change.

Gates Associates created and managed a synergistic team in which all members played a

significant role and made worthy contributions. Our synergistic team, gained insight into motivation,

goals, values, personality, communication and work habits. We collectively identified useful tools such

as useful assessments for employee selection, training, motivation, productivity and/or job assignment,

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Gates Associates, LLC.

Syngergistic team consisted of experienced professionals

Corporate Analysis and Insight

MotivationGoalsValuesPersonalityCommunicationWork Habits

IORA HealthWill be provided a Performance Management System that will be useful for the followingEmployee SelectionTrainingMotivationProductivityJob Assignment/TransferThese usefool tools will solve corporate problems and guarantee safe and successful development and expansion

and identified effective management tools to solve the specific business problem faced by the company

in the case study: Iora Primary Care.

STATEMENT OF PROBLEM

Iora has set organizational goals that it hopes to achieve in the medium-to-long-term future

(Raymond, 2013). A main goal is to disrupt the current model of primary care delivery and to reduce

health care spending by placing a greater emphasis on primary care which prevents costly emergency

room visits and hospital admission along with fixing the inefficiencies that occur in traditional health

care practices here in the United States. The founder Dr. Fernandopulle’s strategy is to take something small

and effective and reproduce it in office after office (Sanger-Katz, 2015) but in order to accomplish this you must

seek to gain a competitive advantage through your employees and must be able to manage the behavior

and results of all employees (Raymond A. Noe, 2013). Doing so will ensure that Iora’s current

expansion strategy effectively and successfully transform the health care system throughout the United

States in the ideas of its founder.

After careful analysis and with extensive collaborations with human resources, our business

consultants, as requested, have determined that Iora’s great ideals are feasible. However, implementing

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Desire to expand

Pressure from corporate to comply to fixed and replicated rules

Problems faced along

the way

Disassociation between corporate desires and actuality of local environment and individuals at each IORA medial office locationEmployees’ misalignment with organizational goals and objectives

Decreased productivity

an unconventional practice throughout the United States will require strategic management. In today's

competitive markets, organizations must engage in strategic planning to survive and prosper (Raymond

A. Noe, 2013).

We as your business consultants have thoroughly performed an SWOT analysis and have

foreseen a problem that will need to be address in order for Iora to transform health care. We will clearly

address both the problem and the steps to liberate the foreseen problem. Here is what our research has

shown. There have been several innovative and successful new primary care models, but few have

grown beyond 1-2 clinics (Sanger-Katz, 2015). However, we see a key distinction that separates Iora

from the rest. You have fundamentally changed your operating models. Your operating model is aligned

with your business model, and that is – the “triple aim” of improving patient experience, clinical

outcomes, and affordability of care – through its unique delivery model. Since you have provided such

beautiful architectural work, we feel only right to provide you with a solution to get the best out of your

constructors.

IORA faces productivity issues that arise as expansion occurs in regards to the disassociation

between corporate desires and the actuality of local environment and individuals at each IORA medial

office location. More specifically, in order to solve the problem of the employees’ misalignment with

organizational goals and objectives, Gates Associates, will organize and implement a performance

management system favoring strategic congruency.

Strategic management is a process, an approach to addressing the competitive challenges an

organization faces. It can be thought of as managing the “pattern or plan that integrates an organization's

major goals, policies, and action sequences into a cohesive whole” (Raymond A. Noe, 2013).

In order to accomplish realignment, Gates Associates performance management system will

provide a clear understanding of job responsibilities and expectations, which will result in increased

productivity and better information available to corporate to use for training, job experiences, and

developmental activities, thus allowing desired effective corporate expansion. It can also be used as a

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basis for compensation, pay increases, promotions, transfers, and assignments. It is imperative that

corporate executives understand and apply this performance management system thoroughly in order to

for it to be effective. This system will be overseen and managed by a corporate liaison who will be in

direct contact with both corporate executives and employees at all IORA medical offices locations.

PROPOSED SOLUTION

With no other elaboration, Gates Associates is concerned about some productivity issues that

may occur with regards to you expanding. We see this all the time. A company has great ideas. It works

within their current chain of stores, so they seek to expand. Attempting to manage the additional store or

facility they lose sight of their original ideas because it’s a lot tougher communicating and tracking

nonnegotiable job requirements in facilities in an expansion mode than in your current state. Thus, as

Professor Milstein points out, running one unconventional practice and keeping it great is very different

from running 100 (Sanger-Katz, 2015). In continuation, by this being an unconventional practice, our

business consultants are concerned that a dissociation between corporate desires and actuality of local

environments and individuals will eventually occur as Iora expands into new territories and opens new

medical offices.

We are proposing a solution in the form of a strategic congruence plan that will increase

productivity and prevent this dissociation from occurring. A strategic congruence is the extent to which

a performance management system elicits jobs performance that is congruent with the organizations

strategy, goals and culture (Raymond A. Noe, 2013). Since Iora’s emphasis is on its unique delivery

model that is centered on monthly fees as opposed to the conventional way of billing patients, we have

put together a plan that focuses on those important elements. Our plan encourages workers to positively

view those elements by implementing a reward plan that encourages those behaviors. Our plan increases

productivity, prevents employee misalignment, and could save you money because our performance

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management system provides for clear understanding of job responsibilities and expectation that can be

implemented on a large scale. Our plan facilitates Iora’s ability to transfer something small and effective

and reproduce it in office after office. In addition our plan can also be a basis for pay increases,

promotions, transfers, and individual assignment rewards. We have laid out the particulars, and it is

imperative that corporate executives understand and apply this performance management system

thoroughly. In order for this performance management system to be effective, this system will be

overseen and managed by a corporate liaison who will be in direct contract with both corporate

executives and employees at all lora medical offices locations.

Our plan is centered on Iora’s care teams’ expectations. A team of a doctor or nurse

practitioner, nurse, behavioral health specialist and a health coach works with each person. They set

goals with the patients, enabling them to become active participants in their own well-being. They

should know people by name, but more importantly by their dreams, fears and challenges (Iora Health,

2016). “We believe it’s easier for patients to manage their lives when mental health is also prioritized

and seen as integral to one’s overall health. At Iora, our patients can access their own behavioral health

specialist in the comfort and privacy of their doctors’ office (Iora Health, 2016). Individual team

members also have goals:

Doctor/ Nurse practitioner: Individual clinical assessments of each patient through

examination and communication to provide medical health goals.

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Care Team

Doctor/Nurse Practitioner Nurse

Behavioral Health

SpecialistHealth Coach

Nurse: Cares for patients, administers medicine and supports communication between doctors

and patients.

Behavioral health specialist: Provide short-term counseling, assessments and referrals, as well

as consultation to other team members.

Health coach: Build relationships between the patients and their care teams by connecting

deeply with patients by becoming their confidants, cheerleaders, and friends (Iora Health, 2016).

CARE TEAM PLAN

Patient satisfaction is determined based on three factors: How the patient rated their provider,

how much time they felt the provider spent on them, and how well their health care goals were

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Elements of Strategic Congruency Plan to be oustandingly met by Care Team

Patient experience

and satisfaction

Reward>80%=Team Dinner

Iora Avg > Performance =

Corrective actions

Industry Standard > Performance=

Termination, Job Transfer,

Assighnments, reduced

Engagement

Reward>25%=Non-Financial


Corrective actions




Access

Reward> Iora's standards

Non-Financial


Corrective actions




Clinical outcomes

Reward> Iora's Standards

Non-Financial


Corrective actions




Coordination of care

Reward> Iora's Standards

Non-Financial


Corrective actions




discussed.

If a team exceeds the patient

satisfaction (average of three percentages

on website) IORA’s average of 80%, then

the patient care team will receive a team

dinner within one week of the quarterly

report, which increases corporate morale

and increases employee satisfaction and

motivation. If performance falls below

IORA averages/standards corrective actions in the form of developmental activities and training will

take place. The consequences if performance falls below industry averages/standards could be

termination, job transfer, additional assignments, or reduced compensation.

If a team’s patient engagement exceeds

Iora’s average of 25%, a non-financial

compensation such as recognition that leads to

increased motivation and employee satisfaction

will be rewarded. If their performance falls

below Iora’s averages/standards, then

corrective actions will be implemented in the

form of developmental activities and training.

The consequences if performance falls below industry averages/standards could be termination, job

transfer, additional assignments, or reduced compensation.

If as a team they provided their patients access to useful resources, produced clinical outcomes or

had coordination of care that exceeds Iora’s averages or standards then a non-financial compensation

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Pr o v id e r R a t in g o f 9 o r 1 0

Sa id P r o v id e r A lw a y s Sp e n t En o u g h T im e

D is s c u s e d H e a l t h C a r e G o a ls

18%

35%

21%

75%

89%

77%

Patient SatisfactionIndustry Standards Iora Averages

Industry Average

Iora

0% 5% 10% 15% 20% 25% 30%

2%

25%

Patient Engagement

Series 1

such as recognition that leads to increased motivation and employee satisfaction will be rewarded. If

their performance falls below Iora’s averages/standards, then corrective actions will be implemented in

the form of developmental activities and training. The consequences if performance falls below industry

averages/standards could be termination, job transfer, additional assignments, or reduced compensation.

If a team manages to achieve the quarterly bonus reward for all 5 elements of our strategic

congruency plan, across three consecutive quarters an additional bonus may be rewarded in the form of

3 extra paid days off that can be taken at the individual team member’s discretion.

INDIVIDUAL TEAM MEMBER PLAN

An individual team member’s performance assessment is based on provider ratings, time spent

with patient, and discussed health care goals. This information is received by the corporate liaison and is

provided through customer surveys.

If a team member’s patients rate them a 9 or 10 for the quarter then that member will receive

recognition in their practice and receive a small financial incentive such as a gift card or voucher. If the

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Individual Team Member

Performance Assessment

Provider rating Time spent with patient

Discussed health care goals

member is rated a 9 or a 10 throughout all four quarters the team member will receive an end of the year

bonus according to team member’s merit. If a team member is a 6 or 7, they will receive training in

order to prevent member from falling below average. If member is rated lower than a 5, member will

receive warnings that can result into termination if performance does not improve over time.

Individual team members will receive recognition in team huddles and entered into special

drawings for financial incentives if their time spent with patient exceeds Iora’s standards. If member is

at or falls below Iora’s average then they will receive training in direct relation to level of customer

satisfaction concerning time spent with their patients. Meaning the higher the score the less training, the

lower the score the more training the team member will be required to attend. Consequences if member

falls below healthcare industry average is verbal warning with additional training and if continues across

multiple quarters may result in termination.

The reward for team members who discussed health care goals with their patients and exceeded

Iora’s standards will be recognized in team huddles and entered into to win special financial incentives

in the form of a drawing. If a member is at or falls below Iora’s average they will receive training in

direct relation to level of customer satisfaction concerning health care goals. Meaning the higher the

score the less training, the lower the score the more training the team member will be required to attend.

Consequences if member falls below healthcare industry average is verbal warning with additional

training and if continues across multiple quarters may result in termination.

CORPORATE LIAISON

We also more clearly defined the corporate liaison’s responsibility within and outside the

organization. The corporate liaison will work from Iora’s existing headquarters where they will provide

technical, staffing, and operations support to practices across the country. The liaison will go into

branches when there are specific problems to be dealt with that have been consistently reported to

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corporate and resolve them, as well as evaluate corporate performance standards. Based on these

standards, they will be able to enforce the rules of the congruency plan.

CONCLUSION Interpretation of Findings

In supposition, Iora an innovative health care company that emphasizes a new team approach to

primary care seeks our expert advice as they expand. Moreover, Iora’s goal is to disrupt the current

models of primary care delivery and reduce health care spending by placing a greater emphasis on

primary care to prevent costly emergency room visits and hospital admission. Iora seeks to accomplish

this by aligning their business model with their operational model, which is – the “triple aim” of

improving patient experience, clinical outcomes, and affordability of care – through its unique delivery

model approach.

With that approach, Iora seeks to fix the inefficiencies that occur in traditional health care

practices here in the united states by taking something small and effectively reproduce it in office after

office, which in theory would solve two major problems in America’s health care system: the first is

misalignment of financial incentives and social issues that hamper people’s health.

In their unique business model, Iora provides care based on a flat fee per customer in contrast to

the traditional piecework model that most providers use. Iora’s aligned business model allows its care

team members to fully focus on its patient, and provide a service that is incomparable to the less stellar

practices provided through traditional practices.

Implementation of Findings

To better understand the Iora’s expansion leading mangers and Iora’s operational managers’

ability and limitation we had all managers answer a few self-assessments which can be found in Stephen

P. Robbins Self-Assessment Library “Insights into your skills, interest and abilities”. These assessments

give insight on Iora’s abilities to expand while keeping their “triple aim” approach. We chose the

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assessments which would be the most helpful and aid our business consultants in customizing our

solutions plan to the strength of Iora’s employees. Here are those assessments:

How good am I at disciplining others? (Page 62)

This test is used to provide insight into how effective a person might be in practicing

discipline in the work place (Stephen P. Robbins, 2012). It contains eight disciplining

practices, managers needed to read the statements and select the answer that best

described them. They were asked to respond as they have or would behave and not as

they think they should behave. (Stephen P. Robbins, 2012). The following scale was

used to express their response: 1= Usually, 2= Sometimes, 3=Seldom.

The ideal manager that provides effective discipline would provide ample

warning, act in a timely fashion, use a calm and serious tone, be specific about the

problem, keep the process impersonal, and use disciplinary action that is

progressive and consider the circumstances (Stephen P. Robbins, 2012). An ideal

manager would score 22 or higher, with anything below 19 possibly needed

additional training.

Results: Iora managers scored an average of 18 and this means that on average

managers in an Iora health care facilities do not have the best practices for

disciplining its employees on a local level.

Based on these results our business consultants felt strongly that Iora needed an

outside contact to provide training and support on a regular basis to branch

managers. These support task would include technical, staffing, and operations

support. This translated into the corporate liaison position we recommended to

Iora.

How good am I at building and leading a team? (Page 64)

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In this test managers used a rating scale to answer 18 questions on building and

leading an effective team. The following scale was used: 1= Strongly disagree, 2=

Disagree, 3=Slightly disagree, 5=Agree, 6=Strongly agree (Stephen P. Robbins,

2012).

This assessment assumes that teams develop in 5 areas: diagnosing team

development, managing the forming stage, managing the conforming stage,

managing the storming stage, and managing the performing stage. The results can

estimate where a manager is compared to others with the top quartile being 95 or

above and the bottom quartile being below 60 (Stephen P. Robbins, 2012).

Iora’s managers scored an average of 84 and this means they know how to build

effective teams, which will be extremely important as Iora expand. According to

Robbins & Judge, 2012 a team generates positive synergy through coordinated

efforts. The individual efforts result in a level of performance greater than the sum

of those individuals inputs making it extreme important that Iora continues to

increase its abilities to build such great teams as they lead and build new

established care teams throughout the expansion process.

Based on these results Gates associates wanted to encourage the teams to continue

to work with excellence and strive to be better as a whole. We built into our

congruency plan specific rewards and consequences to the patient care team based

on their team performances.

How confident am I in my abilities to succeed? (Page 102)

Managers were to indicate the extent in which they agreed or disagreed to 8 different

statements. The following scale was used: 1=strongly disagree, 2=disagree, 3=

neutral, 4=agree, 5=strongly agree (Stephen P. Robbins, 2012).

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People who are confident have high-self efficacy that generalizes across a variety of

situations (Stephen P. Robbins, 2012). Confidence or lack of it can have influence on

many things we do (Stephen P. Robbins, 2012). The scores on this assessment can

range from 8 to 40, higher the score, high the confidence you have in yourself to be

successful.

Iora’s managers scored an average of 34. Meaning although you have some outliers

the group as a whole are confident individuals.

The goal of Iora to expand means it needs confident individuals to make up their

patient care teams. A confident individual will set goals for themselves and push

harder in the face of failure. One other key feature of a confident person is even when

they receive negative feedback they respond by increasing their effort and self-

motivate to do better (Stephen P. Robbins, 2012). If an individual is not confident it

doesn’t mean they cannot become more confident. Managers can use trainings and

tasks to increase confidence in a team member.

Using information gathered through this assessment about Iora’s existing managers

and about the role confidence plays in an individual’s ability to succeed we came up

with our congruency plan concerning the individual members of each patient care

team.

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Recommendation from Findings

Strategic congruency plan- the extent to which a performance management system

elicits jobs performance that is congruent with the organizations strategy, goals and

culture (Raymond A. Noe, 2013).

It rewards and punishes a care team based on their performance in core

areas of Iora’s expectations and high standards:

o Patient experience and satisfaction

o Engagement

o Access

o Clinical outcomes

o Coordination of care

Individual performance rating will be based on:

o Provider rating

o Time spent with patients

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Strategic Congruency

Plan

Rewards and punishes care team based on their performance in core areas of IORA's expectations and high standards:Patient experience and satisfactionEngagementAccessClinical outcomesCoordination of care

Implementation

Encourages workers to positively view the above-mentioned key elements by implementing a rewards plan that encourage those behaviorsIndividual performance rating will be based on:Provider ratingTime spent with patientsDiscussed healthcare goals

Increased Productivity

Prevents employee misalignmentIncrease corporate moraleSaves money

o Discussed healthcare goals the appropriate actions

Rewards/consequences.

Implementation of the corporate liaison - Because Iora’s managers on average scored

less than what we would have liked to have seen, we have determined that one of the

requirements for the corporate liaison position is to have scored a 22 or more on “-How

good am I at disciplining others”? Assessment because he or she is to oversee and

manage our entire congruency plan. The corporate liaisons will be in direct contact with

both corporate executives and employees at all Iora health locations.

Reward system-is a strategic tool that will motivate Iora’s employees to willingly meet

Iora standards. According to Robbins & Judge, 2012, motivation is the process that

accounts for an individual’s intensity, direction, and persistence of effort towards

attaining a goal. Our rewards plan was implemented to incentivize employees that met

or exceeded company standards, which eludes any misalignment between corporate

desire and individuals as you seek to expand.

It highly favors representative participation. According to Robbins & Judge,

2012 representative participative is goal that redistributes power within an

organization, putting labor on a more equal footing. Thus, ensuring that your

doctors continue their rolls as intended by you and ensuring they don’t

become too dominate.

We recommend that every detail in the above-mentioned plan be followed as laid out. Following

our strategic congruence plan will lead Iora to competitive advantages such as:

Prevention of employee misalignment (Resulting in increased productivity)

Increase corporate morale

Saving of money

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REFERENCES

Iora Health. (2016, March 10). Retrieved from Restoring Humanity to Health Care- Iora Health: http://www.iorahealth.com/

Raymond A. Noe, J. R. (2013). Human Resource Management: Gaining a competitive advantage. New York: The McGraw-Hill Companies.

Sanger-Katz, M. (2015). Company Thinks It Has Answer for Lower Health. The New York Times, 9.

Stephen P. Robbins, T. A. (2012). Essentials of Organizational Behavior. New Jersey: Pearson.

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Documents

Iora Strategy Project Final version (3)