Transforming Healthcare: From Sick Care to Well Care

Transforming Healthcare: From Sick Care to Well Care

Feature Article:

If you have been paying attention to the platforms of the current political candidates, it doesn''t matter whether you are Republican or Democrat, both parties recognize that healthcare is broken and needs to be fixed. Whatever you call it, a reform or transformation, something needs to change. In one of the debates, former Secretary of Health and Human Services Tommy Thompson summed it up by suggesting our healthcare system needs to transition from sick care to well care.

All the players in healthcare can''t seem to agree how the transformation needs to occur. For example, the health insurance industry wants all their customers/clients to buy into the well care approach because they have everything to gain (money) and nothing to lose. Squaring off in the other corner are hospitals and centers that focus on in-patient care. These entities need people to be sick — that''s how they make their money. They want more of the dollars spent on their services. Somewhere in between lies physician reimbursement issues, senior care and government programs such as Medicare and Medicaid (medical assistance). Of course, the government wants all citizens to take better care of their health because we, the taxpayers, are paying tremendously for those who make poor health choices.

Making Wise Choices Can Prevent Disease in Most Cases

Sometimes disease just happens if you are the benefactor of poor genetics. But even if you have bad genes, if you made good health choices, your road to disease could be altered or delayed. For example, take a person who has a family history of Type 2, non-insulin dependent diabetes. If you made wise food choices and exercised routinely, you may never become diabetic. But if you chose to eat lots of empty calories and live an inactive lifestyle, which may cause you to become overweight or obese, you could become diabetic earlier in life thus developing many of the problems that diabetics encounter, such as heart disease, high blood pressure, blindness etc.

Simply put, if everyone took aggressive steps to prevent diseases, such as heart disease, stroke, cancer and diabetes, then the spiraling cost of healthcare may be more controlled. Certain socioeconomic groups require most of our healthcare dollars because they simply make poor health choices.

Recently SHPS, a healthcare company, along with the Center for Health Transformation, co-wrote and published a resource manual entitled, Making Medicaid Work: A Practical Guide to Transforming Medicaid. This book is supposed to be a guidebook on how to empower the Medicaid recipient into taking better care of their health. Empowerment is the new buzzword in healthcare transformation.

Worksite and Community Health Promotion in the 90''s

In the 90''s, before I started KHF in 1997, every major corporation in the Louisville area provided health education in some manner to their employees as a health benefit. As a health educator, I personally taught weight management programs and nutrition education classes to employees at Anthem, First National Bank, PNC Bank, Jewish Hospital, Ford, Brown Foreman, Fort Knox , and many other businesses in the Louisville area. Eventually, many of the businesses dropped these support services for various reasons.

During this time, Jewish Hospital Healthcare Services, which was way ahead of its time, had the vision to open up the four Jewish Hospital Healthy Lifestyle Centers in all the major malls. The centers offered cooking classes, education classes, weight management classes (I personally taught some of these classes), a cholesterol treatment program (which I wrote for Jewish), FREE blood pressure screenings, FREE advice by registered nurses. Jewish learned a hard lesson — which was, there is absolutely no money to be made in health promotion. Health promotion sounded good in terms of providing goodwill on paper, but if you are trying to make money and establish loyal customers (patients), it didn''t fit the bill. So, they eventually closed all the centers.

Today Health Insurance Companies Are Empowering Consumers to Take Their Health to Heart

Fast forward to today. Health insurance companies have everything to gain by leading the charge for personal health responsibility. In fact, many insurance companies are promoting programs that offer health and wellness aspects of their health plans in an effort to engage the member to make good health choices. One such company locally is Humana®. Humana recently launched an integrated health and wellness program for their health plan members. They call this program personal Health Coaching. It''s an online support in six areas: tobacco cessation, weight management, physical activity, stress management, nutrition and back care.

Tobacco cessation includes providing motivation and support to address relapse prevention and also includes discounts for aids and online tools to calculate the financial impact of smoking. Weight management support includes healthy recipes and discounts for online weight loss programs. Online tools include eating assessments and tools for computing body-mass index, calories burned and body fat. Physical activity support encourages members to exercise and offers discounts for gym memberships, exercise equipment and yoga products. The stress management component teaches and encourages the use of stress management techniques and also includes discounts for massage therapy and yoga products. Nutrition support educates members about the benefit of healthy nutrition and its role in the prevention of disease and also includes discounts on dietary supplements. Back care support educates members about proper ergonomics, lifting and back exercises plus offers discounts on acupuncture and chiropractor care.

At Humana, for example, a nurse creates a care plan for each member that addresses both body and mind. The theory is that if a care plan is generated, the member then develops a relationship with their nurse. As a result this relationship can promote positive results. If this strategy works, the member and his family should spend fewer health insurance dollars because a disease could possibly have been prevented. In addition, Humana offers an Employee Assistance Program (EAP) that addresses employee personal and professional issues. Humana''s belief is that employees who face challenges such as alcohol and drug dependencies, dependent care-selection (child care), or financial issues, can increase stress levels at home and in the workplace which can ultimately create high absenteeism and “presenteeism” (present in body, not in mind). Stress is a known health debilitator. Many health insurance companies offer similar programs to their clients as well.

Research suggests that providing incentives helps keep people on task. I would like to think that everyone would want to do the things they need to do to keep them healthy, but that''s not a reality. But offering someone some type of incentive, either by winning something or giving some financial reward, seems to get their attention and keep people on track. Health insurance companies feel that if they offer personal support and incentives to their clients, they will become wise healthcare consumers.

Most of the support services offered by health insurance companies are handled over the Internet or on the phone. We''ll have to see over time if the Internet or phone is more effective than having a real person actually teach new behavior strategies.

Worksite Wellness Programs on the Rise

With health insurance companies offering businesses a discount on their employees'' premiums if they have effective worksite wellness programs, these programs are back in vogue. Worksite wellness programs might include a range of health initiatives, such as discounted monthly membership fees, health education classes, screenings and health fairs, access to an onsite fitness center, or maybe even a run/walk program sponsored by the company.

In discussing the Metro Health and Wellness Department''s Corporate Wellness Take Charge Challenge at the Mayor''s Healthy Hometown Advisory Board meetings, program administrators acknowledged that when the Take Charge Challenge was over, some employees tended to lack the motivation to continue down the pathway alone so they reverted back to previous behaviors. The Metro Health and Wellness Department developed the Take Charge Challenge. The actual challenge is to increase your activity and make good food choices during the challenge time, which is typically over 12 weeks. Each participating business needs to find an effective program administrator who can keep participants on task. For a more effective program with long lasting results, businesses may need to utilize a health professional who is trained in administering these type of programs rather than using someone from within the business.

Hospitals Should Be Role Models in Good Health Practices

Hospitals should be role models for good health practices. Recently, local hospitals embraced a smoke free environment. Once smoking and secondhand smoke was ruled unhealthy many years ago, all healthcare companies, not just hospitals, should have enforced no smoking policies — not in 2007 or 2008 but years ago. In addition, hospitals that offer employees and visitors unhealthy food choices are enabling people to make poor health choices. It''s appalling for a hospital to offer fast food, like McDonald''s®, as a food option, I don''t care how convenient it is for the patients'' and their family. Many of the doctor''s lounges in hospitals offer high calorie, high fat, high sugar items to the doctors on staff. What''s with this? In addition, it''s common to see overweight healthcare professionals and healthcare employees who smoke in the hospital environment. This segment of the population should know what the health consequences are of these negative behaviors and should practice what they preach.

One example of a hospital company locally promoting well care is Baptist Hospital East. The Baptist East/Milestone Wellness Center is a perfect example of how hospitals can promote community health not only to their employees but also to the community at large. Besides being an excellent fitness facility, the center offers many health education seminars to the community — some are FREE, others are fee based.

Schools Can Help Promote Health, Too

KHF has featured many of the programs that schools offer to teach healthy lifestyles to the students. The Health Promotion Schools of Excellence has been an ongoing program for many years in the Jefferson County Public Schools. Some of these participating schools have more success than others. The Tap into Fitness Program has been a success for the schools involved. But my question to the school district is, if one school can find the time in the curriculum to get the children exercising during the school day and learning about new foods by tasting them, why can''t all the schools find the time to fit it in?

In fact, KHF has done stories about FREE active lifestyle resources for schools such as , , to name a few. We have done stories about local programs like TEAM Assumption and TEAM Mercy, Fit Kids, Fit 4 Me, and Girls on the Run. I could go on and on. In addition, we have featured run/walk programs at Newburgh Middle School, Iroquois Middle School, and Mezeek Middle School to name a few. Why can''t all the schools develop a run/walk programs for the students, staff and teachers — not just a handful of schools?

I know many parents expect the school lunch program to help improve their children''s health by offering healthier food choices but really empowering the children to make healthier food choices is only part of the health connection. Parents also have to buy into this practice as well. Our children need to become more active. Since the school district is probably not going to mandate daily exercise for all students, creative planning in this area is essential. I applaud the schools that engage their students in healthier activities.

Last month, Beth Bierbower, with Humana, wrote a story about the New Albany-Floyd County School Corp. adopting the HealthMiles™ program through their health insurance. When I learned about the program I asked her to detail the program in KHF. I am hoping after a year of their participation in the HealthMiles program, Humana can report many positive health outcomes as a result.

Mayor''s Healthy Hometown Movement Has Helped to Jump Start Our Community

The Mayor''s Healthy Hometown Movement has been successful in that it has implemented a number of strategies for attacking the obesity problem. From the Lose It to the Move It campaigns, more people in our community seem to be joining our health squad. The Mayor''s Hike and Bikes are becoming more popular. We have seen a dramatic increase over the past two years in the Triple Crown of Running Series as well as the miniMarathon.

Churches Need to Step Up to the Health Promotion Bat, Too

Overall health includes physical, mental, and spiritual health. Dr. Troutman, director of the Metro Health and Wellness Department, has discussed in detail at the Mayor''s Healthy Hometown Advisory Meetings, the importance of reaching out to the faith-based community to help promote the wellness movement. Some churches offer an array of health education programs from weight management classes to running and walking programs with teams who participate in many of the run/walks around town. A number of churches in our community have fitness centers on their church campus.

Some Neighborhood Associations Have Jumped on the Active Lifestyle Wagon

Some neighborhoods have organized run/walks in their community. In the neighborhood where I live, there are a number of groups that walk together. In addition, our newsletter includes the where''s and when''s of joining a neighborhood walking/running group. They meet in the mornings and in the early evening. Participating in a group, or at least exercising with a companion, helps to keep you on track and it''s more fun, too.

It Takes a Village to Transform A Nation''s Health Philosophy

If our country is going to be successful in transforming healthcare and controlling healthcare costs, all the players who make up the healthcare entity, such as hospitals, health insurance, doctors, and even lawyers, are going to have to come to the table and realize we will all have to make some concessions. Even though each entity has its own agenda and no one wants to take a financial hit, it''s going to take compromises from all the players to control the costs of healthcare and it''s up to our citizens to take more control of their health to make the transition.

Barbara Day, M.S., R.D., C.N., is the publisher and nutrition editor of Kentuckiana HealthFitness and Kentuckiana Healthy Woman. She is the former sports nutrition consultant to the University of Louisville Athletic Department and the United States Navy SEALs. She is the author of “Fast Facts on Fast Food For Fast People” (ISBN 0-9631538-6-2) and “High Energy Eating Sports Nutrition Workbook for Active People” (ISBN 0-9631538-5-4). In addition, Barbara has a private practice specializing in sports nutrition and has a weekly health and fitness radio show on WKJK 1080 AM. She serves on the advisory board of the Mayor''s Healthy Hometown Movement Advisory Committee. She is a member of PE4Life, Coalition for a Healthy and Active America, the American Dietetic Association, NAWBO and Greater Louisville, Inc. She is a runner, cyclist, hiker and grandmother.