The new Seattle practice has a Medicare plan as its partner. The huddle gives the team time to talk about the patients who will be visiting that day and ones who aren’t coming in but whom the clinicians are worried about. A patient like Ms. Schock is a good example of one who would have a high Iora “worry score,” a metric that is half clinical formula and half instinct. Patients with the highest scores are talked about the most in an attempt to think about their problems before their health deteriorates.

The huddle is also an old-fashioned staff meeting. There was a report, for instance, on the customer satisfaction surveys that the practice gives each patient after every visit. Patients are asked to rate their experience from one to 10 and to answer two other questions about their experiences. Iora’s management and its partners often point to this “net promoter score” questionnaire, which is intended to measure how likely patients are to endorse or promote the company, as evidence of the company’s success.

Similar surveys are conducted in other industries. Apple scores a 72. The health insurance company Kaiser has the highest score in its industry, a 35. An Iora practice, on average, scores above 90. Use of the questionnaires is one of the company’s basic principles. Staff members review the previous day’s answers at every huddle.In Seattle, Dr. Marty Levine questioned whether it made sense to ask the patients, most of them over 65, to answer three questions every time they visited. Geriatric medicine involves a lot of questionnaires, Dr. Levine said, and the patients might get fatigued. “Have we thought about just doing one question?” he asked.

There was discussion, and voting. In the end, the team voted 6 to 5 to keep the questionnaires the same as those in the other Iora practices.

The moment brought out a tension in Iora’s expansion plan: Its mission is at once to develop a standard formula and to allow its professionals to experiment and adapt to local conditions. Certain elements — the company’s proprietary electronic medical records, the design of the consultation rooms, the daily huddle itself — are nonnegotiable.

But other details are up to the individual practice staff. Group classes, for example, differ by site. The Medicare-only practices feature aerobics classes. The New Hampshire practice holds a popular mindfulness meditation session. The carpenters’ union practice in Dorchester, Mass., has a class called “Hammer Time,” essentially yoga with tools.

Focus on Venture Funding

Iora was founded three years ago, but Dr. Fernandopulle began developing his model for medical care years before. His basic insight is aligned with a big concern in health reform circles: The system is in many ways designed around providing hospital treatment, the most expensive form of health care.