Meanwhile, the number of hospital-run fitness centers has doubled in the last 15 years, and there are now 1,700 such facilities opening each year in the U.S., according to the Medical Fitness Association in West Palm Beach, Fla. Becoming "multi-purpose athletic clubs," says Ken Germano, CEO of the association, "is now seen as a viable and sustainable way for hospitals to develop retail cash-flow streams."
When chronic disease has already taken hold, preventing the complications that result in a crisis is increasingly at the top of the wellness agenda. Boston Children's Hospital, for one, is so determined to keep its young asthma patients out of the emergency room that it's sending staff members to their homes to help families prevent attacks. (Asthma causes 1.75 million emergency-room visits per year nationwide and costs the healthcare system $18 billion annually, according to the Asthma and Allergy Foundation of America.) The hospital's Community Asthma Initiative, which has enrolled more than 1,000 children since it was launched in 2005, is focused on eliminating the common causes of asthma flare-ups and teaching parents to be proactive when it comes to managing their child's disease.
During a series of home visits, nurse case managers teach parents the ins and outs of asthma drugs, and even go so far as to help them eliminate common causes of attacks, such as pests. "We find ways to reduce cockroaches and mice, and work with landlords to control pests with the minimum amount of toxic pesticides," says Susan Sommer, a nurse case manager for the Boston Children's program.
Zakia Camillo says that since she entered the program a few years ago with her now 6-year-old son, Kevin Mason Jr., their nurse case manager has brought them mousetraps, mattress and pillow covers to control dust mites, and a vacuum cleaner with a special filter to clean the air. "The Community Asthma Initiative has helped me figure out ways to minimize his symptoms," Camillo says. She has also learned the importance of giving Kevin his daily preventative medicine, a steroid. "I was leery about giving him that every day. Now I give it to him on a regular basis, and it does make a difference."
Families that have participated for 12 months have experienced a 56 percent decrease in emergency room visits and a 42 percent drop in missed school days, Sommer says. For every dollar spent on the program, which is funded by Boston Children's and government grants, the health care system saves $1.46, the hospital estimates.
For now, Boston Children's isn't reaping financial rewards from the program, says Elizabeth Woods, director of the asthma initiative. The hospital is "helping pay for the program, but we don't have as many admissions," so that reduces a traditional revenue stream. Yet "health reform embraces a population-based orientation to health care delivery and incentive systems that promote prevention," says Gary Young, director of the Northeastern University Center for Health Policy and Healthcare in Boston. "There will be more payment systems that reward providers for doing less."
That's already happening at Montefiore Medical Center in the Bronx, one of the nation's earliest accountable care organizations in an area where some 12 percent of adults have diabetes. The insurers who partner with Montefiore to cover 200,000-plus people in the surrounding region are paying for the system to coordinate care to keep those people healthy. Montefiore's outpatient Clinical Diabetes Center offers counseling and educational sessions with nurses and nutritionists to 4,000 patients throughout the Bronx. The goal is to prevent emergency hospital visits, and amputations and diabetes-related heart attacks, by improving patients' diet and medication use.