MISSION FITNESS: In 2006, Medical Center Healthcare System, located in Odessa, Texas, was seeing its market share eroding as population shifted out of the City to surrounding areas. The Healthcare System needed a unique way to provide healthcare services to that area and a more progressive approach to population health management. The Medical Center’s visionary CEO partnered with Healthplex Associates to build a medically integrated health and fitness complex in an area outside of the City where growth was predicted.
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The basic idea behind the Medical Wellness Center is to shift the focus of health care from “sickness” to “health” and to provide physicians a place/program for patient referral to continue their change in lifestyle. Having a Medical Wellness Center allows the sponsoring entity to bring health back into the continuum of care. This lifestyle change has an emphasis on the root causes of disease prevention and health promotion.
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Singing River Health System broke ground for its new vision of health care in the Gulf area of Mississippi in the Spring of 2010. Located next to Singing River Hospital, the 24,000 sq. ft. medicallybased fitness and wellness center is positioned strategically close to Cardiac Rehab and Physical Therapy within the Singing River Medical Park, to strengthen clinical integration and improve the continuum of care.
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The complex initially included physician offices, physical therapy, cardiac and pulmonary rehabilitation, diabetes education, lab services, radiology, classrooms for community education, as well as a comprehensive medical fitness center. The original MCH Center for Health and Wellness and Mission Fitness opened in 2010 with over 1,200 community members. Today, the campus has grown to accommodate additional clinics, as well as the growth in the Wellness Center which now has 3200 members.
Working with hospitals, health systems, and universities across the country, Healthplex Associates works to create and manage clinically integrated fitness facilities. Healthplex Associates launched Mission Fitness in 2010.
In their 9th year, Mission Fitness still faced the challenge of converting more of the hospital’s employees into members of the fitness center. There was a disconnect between employees and the fitness center. In an effort to be more impactful with the benefits of the population’s health and have hospital employees engaging in exercise programming, Mission Fitness needed to effectively communicate the benefits of membership.
Healthplex Associates worked to create an employee wellness initiative to attract employees to join their fitness center instead of other, low cost, low service fitness options. By offering a more cost effective membership for employees, Mission Fitness was able to grow membership while offering an incentive based, usage rewarded membership option for employees.
Because of the employee wellness initiative, membership from staff members grew from only 173 hospital employees to 692, a 300% increase.
CLINICALLY INTEGRATED MEDICAL WELLNESS AS A BUSINESS STRATEGY
While Medical Wellness Centers have been around for a number of years, only recently has the concept of clinical integration been recognized to be an effective means for reducing re-admissions (reduction in penalties = real dollars), improving outcomes, as well as growing clinical volume, revenue and market share. Where properly sized, located, and managed, these facilities have been profitable and provided the sponsoring hospital or health system substantial market differentiation from competitors.
Why should your organization pursue population health through fitness?
- Position the hospital to become a life partner in healthcare choices across the continuum of care. Taking a wellness approach builds loyalty from future patients.
- Add a platform for community risk assessment of a myriad of conditions that can funnel into services for further diagnostics and treatment.
- Build a platform of solutions to offer employers that address cost and effectiveness of their health coverage.
- Help to diversify your system’s portfolio of services and contribute to overall hospital profitability.
- Distinguish the hospital from its competition. Being first to market with this strategy is key.
- Establish a larger beachhead of services in a market that can support physicians and their patients, while concurrently strengthening the ability to compete.
- Serves as another avenue to help the hospital manage its own employee health costs.
The basic idea behind the Medical Wellness Center is to shift the focus of health care
from “sickness” to “health” and to provide physicians a place/program for patient referral
to continue their change in lifestyle. Having a Medical Wellness Center allows the
sponsoring entity to bring health back into the continuum of care. This lifestyle change
has an emphasis on the root causes of disease prevention and health promotion. As
the chart below shows, the medical fitness model supports the members of your
community whose health is currently at risk or subject to rising risk for medical
Wellness centers provide the unique opportunity to expand the continuum of care, but also to improve the health status of people within the service area. Having a medical fitness center allows the sponsoring entity to empower people to take charge of their own health status in an environment that is supported with professional help. By developing clinically integrated medical wellness centers, the hospital or health system can:
- Improve community health status.
- Develop an attractive location for physicians to practice.
- Promote the development of disease management programs.
- Reduce utilization of inpatient services by expanding post discharge options.
- Provide an opportunity to increase clinical volumes and business growth.
- Tie the medical wellness center to the health system’s EMR to assure a smooth transition for clinical referrals to the center.
- Create a barrier to market erosion in key services.
- Provide much needed space for expansion of outpatient clinical services.
- Create a new source of “retail” revenue for the hospital, thereby reducing dependency on Medicare and Medicaid reimbursement.
- Provide a facility that can assist in physician recruitment.
- Offer new and innovative health promotion and wellness services to area employers.
- Improve medical capabilities and physician practice opportunities in the areas of physical rehabilitation, cardiology, women’s services, occupational medicine, senior health care services, and cancer care.
- Reposition the hospital with an image focusing on “health” rather than on “sickness”.
How a Medical Wellness Center Fits in the Continuum of Care
EXISTING MEDICAL WELLNESS CENTERS
If your organization has an existing Medical Wellness Center, ask yourself if it is profitable and part of your population health strategy. If the answer is no, it’s time to take action.
Turning around an existing center requires a fresh, professional look from a team that knows what it takes to succeed. An audit performed by the HPA team looks at the entire operation to give the organization actionable recommendations on how to make it financially viable and to be the asset it should be. A management audit should include the following:
REVIEW AND ANALYSIS OF CURRENT OPERATIONS:
- Marketing efforts: greeting and sales approach, marketing plan, closing rates, incentives, sales program.
- Financial performance.
- Policies and procedures.
- Billing practices and operating system.
- Pricing structure (membership dues and fee for service).
- Physical facility concerns: condition, suitability, layout, cleanliness, maintenance, décor.
- Equipment concerns: quality, variety, maintenance, and suitability.
- Staffing patterns.
- Staff qualifications: training, quality, and compensation system.
- Programming structure, creativity, quality, and suitability.
- Key operating metrics such as sales closing rates, non-dues revenues, attendance, costs per class, etc.
- Member satisfaction: turnover rates, feedback/survey results (if available), staff responsiveness, attendance patterns.
- Population Health/Clinical integration efforts.
- Center’s sales approach to community prospects and other important corporate entities in your area.
FINAL REPORT ELEMENTS:
Analysis and opinion of:
- Operating policies and procedures of the centers.
- Billing practices and financial reporting systems of the centers.
- Marketing and sales practices of the centers.
- Clinical integration levels achieved.
- Pricing policies.
- Customer service levels, both actual and desired.
- Services offered.
- Range of equipment and layout.
- Short term strategies.
- Long term strategies.
- Recommendations and action plan.
Like any new venture, proper planning and market research can spell the difference between ultimate success and failure. Hospitals and health systems that don’t take the time and make the investment to properly research and understand the market, operations and clinical potential for a wellness center by commissioning a feasibility study are destined for problems. HPA’s feasibility study recommendations provide the necessary answers to how this concept fits into a health system by including the following:
- Review of proposed site
- Description of project and rational
- Compatibility with the Client’s strategic plan
- Project cost estimate for a model facility
- Demographic analysis of the site selected
- Competition analysis
- Interviews with key stakeholders
- Preliminary sizing and design (including site and floor plans)
- Discussion/recommendations of clinical service component
- Preliminary medical office space analysis
- Preliminary wellness center financial pro forma
- Project cost summary
- Space requirements
- Service offering analysis
- Five-year operational summary
- Membership summary (suggested rates and membership volume estimates)
- Final recommendations
- Education of key stakeholders
A Medical Fitness Center is much more than the exercise equipment found within the four walls of the building. It must have innovative and creative exercise programs and education programs both inside the Center and in the community The American College of Sports Medicine (ACSM) has long been promoting the use of exercise regimens as an essential part of the healthcare continuum for treatment of conditions that range from heart disease to neurological disorders, orthopedic issues and even oncology. From a patient care standpoint, offering programs that appeal to special needs populations with chronic conditions is as important as meeting their therapeutic needs. An attractive level of entertainment and facilities equipped to deliver high-quality programming is essential to the success of the program offerings. This is part of what will make the medical wellness center a preferable medical treatment and service location than what is provided by competitors. The following list offers a sampling of programs that have been shown to have a direct link to improving the care and outcomes for patients:
- Senior Health
- Balance programs to prevent falls & increase confidence
- Maternal Health
- Pre-natal and post-partum fitness
- Disease Related Programs
- Cancer recovery
- Cardiac rehabilitation
- Heart disease- (early intervention and prevention)
- Physical rehabilitation
- Occupational medicine
- Neurological disorders (MS, MD, Cerebral Palsy)
- Diabetes (prevention and maintenance)
- Smoking Cessation
- Weight reduction and control
Most health care providers who focus on orthopedics ought to be considering how fitness and wellness mesh with their continuum of care. This is because movement, joint health and musculo-skeletal functions are central to this discipline. From the most basic elements of orthopedic practice to the most esoteric, a wellness center can enhance the quality of care, the patient experience, recovery and the physician’s practice. Some of the potential touch points include:
- For many patients, a program of “pre-hab”, i.e., pre-surgical physical conditioning can enhance their results from a surgical procedure.
- For joint replacement, the wellness center can supplement post-surgical physical therapy. With insurance reimbursement declining, more onus is placed upon the patient to work out independently to achieve optimum
results. In addition, low cost access to the wellness center (or in some cases no additional cost) while in active therapy can enhance the patient’s experience and compliance.
- For patients with spinal problems, a program to strengthen the back muscles can often help to prevent re-injury after surgical repair.
- Sports medicine connections are an obvious tie to a wellness center. Many orthopedic practices are delving into the entire gamut of sports performance from weekend athletes to college and professional performance enhancement.
- The presence of a wellness center provides access to equipment and facilities that would be unrealistically expensive for a typical practice; equipment such as state-of-the-art circuits or facilities such as pools become realistic with the revenue generated in a successful wellness center.
Why a Hospital/Health System should be in the business of wellness? Consider the following observations:
Finding #1 – Survey Research
Healthplex Associates’ own consumer research has found the following medical wellness center membership trends:
- 51% of more than 13,000 respondents indicated that a connection to the sponsoring hospital was a factor in joining a medical wellness center.
- 73% of more than 23,000 wellness center members indicated that the connection to the hospital/health system was seen as a clear advantage.
- The vast majority of members in hospital affiliated centers are over 40 years of age with average ages typically well into the 50’s. This is not the crowd that populates typical commercial centers, but it is certainly the prime market for hospitals.
- 28% of consumers in HPA’s studies had never belonged to any fitness center prior to joining the medical wellness center.
- 25% of the membership should be from clinical integration efforts.
- HPA’s surveys indicate that more than one third of the members self-report that the reason they joined the wellness center was for some specific health concern.
Finding #2 – Medicare Advantage Plans
For systems with a Medicare Advantage Plan, having a wellness center makes a critical difference in several areas:
- A wellness/prevention benefit can help to boost the plan’s “Star Rating”, an important factor in success of the plan.
- Members who stay active and fit utilize expensive health services far less than those who are sedentary, affecting plan costs.
- HPA has found that the marketing of the plan is much easier with an affiliated wellness center. We have seen significant plan growth when the benefit was added.
Finding #3 – Lifestyle Modification Works!
An actual case study from a Healthplex Associates managed medical wellness center demonstrated a significant reduction in disease related claims among system employees who participated in a lifestyle modification program. The wellness center designed a program to improve health and prevent disease among at risk people. The healthcare system rewarded eligible employees at the collective (not individual) level for improvements in overall health data and claims reductions.
The chart below demonstrates the actual impact that lifestyle modification had on employee claims:
A strategic goal of the Health System was to move patients efficiently from clinical services to supervised exercise programs. Another factor in the decision to build the medical office/wellness center building was to create a hub for community education and wellness. The additional departments within the medical park include Speech/Occupational Therapy, Radiology, Rheumatology, Pulmonology, Sleep Center, and Women’s Wellness.
Healthplex Associates takes pride in working with our partners to help achieve their goals. A high priority goal for SRHS is the emphasis on clinical to membership conversion rate, a measure of the effectiveness of the integration of services. This rate is defined as the number of memberships generated from clinical services and physician referrals. Healthplex Associates worked with SRHS to establish a specialist position (Clinical Integration Coordinator) to facilitate the relationship with clinical services and to serve as a liaison to create an exercise program for the patient. After opening, Singing River Healthplex struggled to meet the goal that was set. Referrals from Cardiac Rehab and Physical Therapy weren’t enough. A new strategy needed to be developed.
To achieve Clinical Integration, for patients, the path to fitness and wellness programs must be easy and convenient for both the referring provider and the patient. Whether it’s a primary care physician, physical therapy or the cancer center, every element of the continuum must work in concert to provide an optimal patient pathway. At SHRS, an innovative part of the solution was to set up a referral mechanism within the Health System’s EMR (Electronic Medical Records). Coupled with both an internal communication campaign to educate physicians and other health professionals about the ease of the process and benefit to their patients, and a respected Clinical Integration Coordinator the program has led the way to a more effective patient experience, exceeding expectations.
The System set what it believed was an aggressive goal of a 30% conversion rate; by early 2020 that goal was exceeded and the growth trend continues!
Partnering with hospitals, health systems, and universities across the country, Healthplex Associates works to create and manage clinically integrated fitness facilities. Healthplex Associates has been a proud partner of SRHS from the beginning planning phases in 2010.