Since Sue Kirk started working out with a personal trainer a year ago, she has lost more than 47 pounds and dropped her cholesterol from 212 to 156. Those results didn't come from your average gym membership, however. Kirk, 57, joined a fitness center run by Akron General Health System in Ohio. At the spiffy 218,000-square-foot facility, one of three such centers run by the hospital system, she has access to exercise physiologists, nutritionists and a wealth of wellness programs as well as state-of-the-art treadmills, ellipticals, weight machines and a 25-yard-long swimming pool.
Besides lifting weights and running on an indoor track at the center with her trainer two mornings a week, Kirk has been on a weight-loss plan that included a seminar on good eating habits. "I made a commitment to get on board with exercise and nutrition, and I've had remarkable results," says Kirk, a regional quality manager for Fresenius Medical Care, an international provider of kidney dialysis services. "I'm going to continue. I want to lose 30 more pounds."
A few years ago, the idea of turning to your local hospital to get a good workout may have seemed ludicrous. Not anymore. These days, health systems are actively reaching out to their communities with all sorts of programs designed to lessen the impact of chronic diseases, and, by extension, to keep people out of the hospital. Why now? One reason is that health care reform is forcing hospitals to focus on getting and keeping people well or face serious financial ramifications. Medicare is now charging penalties to hospitals with high readmission rates, for example. The fees will increase from up to 1 percent of the offending hospitals' Medicare revenue this year to as much as 3 percent in 2015. At the same time, more hospitals are joining accountable-care organizations, networks of health care providers that are paid flat "bundled" payments by insurers based largely on the quality of care they provide. That puts a value on keeping covered members healthy, and it also forces hospitals to look for new sources of income – retail services they can offer not just to their patients, but to the community at large.
As bundled payments for quality care replace the old fee-for-service model, through which hospitals were paid based on how many patients had how many procedures, more hospitals will look seriously at wellness, experts predict. "The benefit for the future is, if you keep folks well, you're going to keep more of the bundle," says Anthony Cirillo, president of Fast Forward, a health care consulting firm in Huntersville, N.C. "Wellness programs will play an even bigger role because they're affecting your reimbursement."
Indeed, hospitals that don't start paying attention to prevention and wellness are going to fail to thrive under health reform, predicts Akron General CEO Thomas "Tim" Stover. "Every congestive heart failure patient should be put in an exercise program when they leave the hospital," Stover says. "It should be the diagnosis at discharge. That's how you prevent readmissions."
Each member of an Akron General LifeStyles center gets a fitness assessment and "exercise prescription," along with a nutrition analysis from a registered dietician. A medical director and advisory board oversee the centers, which are equipped to serve everyone from completely healthy members to recently discharged patients. "It's the norm to see a physical therapist working with their patient on one treadmill, a cardiopulmonary rehab nurse working with someone who has an oxygen tank on the next treadmill, and an exercise physiologist working with a [healthy] member on the third treadmill," says Doug Ribley, senior vice president of health and wellness services for Akron General. Members pay monthly out-of-pocket fees that range from $55 to $111.
Whether or not they go so far as to open gyms, many hospitals have launched fitness programs targeted to specific patient populations. Holy Cross Hospital in Silver Spring, Md., for example, runs Senior Fit, 68 classes per week for elderly people focused on increasing strength, flexibility, balance and coordination. Fitness and Wellness Professional Services, which operates gyms for nine hospitals and is working on 25 more, offers exercise classes for people with multiple sclerosis as well as fitness plans tailored to individual members based on information from their medical records.
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.
At Osborne Medical Center in Scottsdale, Ariz., the menu of wellness programs includes HeartMath, a relaxation-training program that's offered to cardiac-rehab patients and people in the surrounding community who may be at risk of developing heart conditions and other diseases exacerbated by stress. Osborne funds part of the cost of the program, with the rest coming from class fees and sales of a device students can use to monitor their heart rhythms at home.
Once a year, William Rowley spends a day at the Cleveland Clinic getting a soup-to-nuts physical exam that includes multiple blood tests, vision and hearing checks, and if he chooses, meetings with nutritionists and exercise physiologists to review his lifestyle choices. Two years ago, his physician at the Cleveland Clinic Executive Health Program, Richard Lang, discovered Rowley had signs of prostate cancer. The disease was detected so early that surgery was the only treatment needed.
"They're proactive. They identify issues before they become major problems," says Rowley, 63, president of Mercury Plastics in Middlefield, Ohio, and founder of Healthnetwork, a nonprofit in Chagrin Falls, Ohio, that facilitates medical care for executives. The Cleveland Clinic was one of the pioneers of executive health, having launched its first program in the 1940s. The program has since evolved to include a battery of offerings that go way beyond a normal annual physical. Patients with a family history of serious diseases, for example, can get genetic tests designed to predict their risk. Stressed-out execs suffering from insomnia can talk to psychologists and get referrals to sleep clinics. And many can get advanced imaging tests to detect clogged arteries and other risk factors for disease.
The pricetag: $1,000 to $4,000, depending on the services patients choose. Often employers will kick in all or part of the cost. "Companies ask for this as a way of protecting their assets," says Lang, who is the Cleveland Clinic's department chair of preventive medicine. "They look at this as a life insurance policy for people that they can't afford to lose because they're not taking care of their health."
Some experts worry that people are not aware of the potential risks of submitting to many advanced imaging tests, such as radiation exposure and the possibility of finding something that looks abnormal but turns out to be no big worry. "Often things will be picked up that are either not relevant or can lead to other tests or treatments that may not be indicated," says Steven Weinberger, executive vice president and chief executive of the American College of Physicians in Philadelphia. Lang responds that his approach is to only recommend imaging tests consistent with each patient's individual health risks, and to fully disclose the risks of those procedures. "This is always something that should be discussed with patients when they're going on a screening protocol," he says.
The executive health program has grown so popular that the Cleveland Clinic began offering it at its Weston, Fla., campus in 2003 and its Toronto facility in 2006. Other hospitals with similar programs include Robert Wood Johnson in New Brunswick, N.J., Johns Hopkins in Baltimore, and the three Mayo Clinics. Hackensack University Medical Center in New Jersey will include a corporate wellness program in its new fitness center, which is slated to open by the end of this year. The center will become a one-stop shop for wellness, with everything from smoking cessation programs to cooking classes for people with diabetes, heart disease and other chronic conditions.
As health reform takes root, look for more hospitals to expand their wellness offerings as they seek to "build relationships for the future," Cirillo predicts. When prevention is a key aim, he says, institutions "have to think about owning more of the continuum of care."