Hospitals Are in the Business of Prevention

Last year, Shelly Stroud of Charlotte, North Carolina, 61, was on her way to developing Type 2 diabetes, the disease that puts her father, brother and 29 million other Americans at higher risk of heart attack, stroke, blindness, amputation and kidney failure. “I was overweight – obese – and was considering weight-loss surgery,” she says. So when Carolinas HealthCare System offered a free diabetes risk assessment at her local YMCA and other places in the community, she was one of 53,000 area residents who jumped at the chance – and one of nearly 7,700 who got a big wake-up call.

Stroud found out that she was indeed prediabetic and immediately signed up for a 16-week course offered by Carolinas that included exercise at the Y, classes on healthy eating and lifestyle change, and coaching to help break entrenched habits. “This program helped save my life and changed my life,” says Stroud, who dropped 45 pounds by this past spring and lowered her blood sugar to normal levels.

Welcome to the future of hospital care, where the point, increasingly, is to prevent people from getting sick in the first place. “We’re moving quickly to a world where most care, and the ability to impact health, does not take place in the hospital,” says Roger Ray, chief physician executive at Carolinas HealthCare. Providers have long been paid based on the number of tests and procedures they perform, naturally driving an emphasis on critical rather than preventive care.

Now, as Medicare and other payers migrate to a “value” system in which providers get a set amount of money per person or per medical issue, for example, hospitals will lose money if they can’t keep the medical care to a minimum while still producing good outcomes. Earlier this year, federal health officials set the goal of making 30 percent of Medicare payments by the end of 2016 through alternatives to the fee-for-service model, rising to 50 percent by the end of 2018. Private insurers and state-based Medicaid programs also have embraced payment changes.

[READ: Patient of the Future]

The result: Hospitals are rescripting their role in all sorts of ways to keep people out of their emergency rooms and beds. They are emphasizing primary care, putting mental health specialists out on the front lines to lessen the burden of unhealthful behaviors, and making house calls and using telemedicine to head off return visits. Some are even opening fitness centers. Hackensack University Medical Center in New Jersey, for example, teamed up with the New York Giants to open a fitness and wellness center that boasts state-of-the art exercise equipment, an indoor pool, 150 group classes, personal trainers, a track and turf field – and nurse-provided health assessments and weight management programs.

The Carolinas HealthCare diabetes program, which includes stationing nurses and dietitians at 15 Charlotte-area Y’s, is making real headway; the first year, for example, 40 percent of the folks wrestling with high blood sugar got it back into the normal range within 16 weeks. Similarly, Florida Hospital for Children in Orlando has seen engagement in its Healthy Kids 100 program pick up since it decided last year to team up with YMCA of Central Florida and move the program out of the hospital and into three Y’s.

“We wanted to improve outcomes,” says Angela Fals, medical director of the hospital’s pediatric weight management program, of the effort to educate families of children struggling with weight and help them make changed behaviors stick. “We needed a partner that was already child and family friendly.” The program languished when it was housed in the hospital; more than 2,000 families now take part.

[READ: Is Home Health a Solution to Rising Health Costs?]

Perhaps there is no better place to witness the impact of the changes taking place than the Morris H. Blum Senior Apartments in Annapolis, Maryland. “I used to look out my window, and constantly ambulances were coming,” says resident Brenda Williams, 60, who in recent years has been affected by arthritis, high blood pressure and “borderline diabetes.” That was before Anne Arundel Medical Center started a walking club at the 154-unit complex, opened a one-doctor clinic there and began offering six-week courses on managing diabetes, heart health and hypertension and other topics. Five mornings a week, Williams walks around the high-rise for 45 minutes in her red sneakers. “We’ve had some seniors with wheelers and canes,” says Williams, who has lost 28 pounds and no longer takes blood pressure medicine. If it were not for the interventions, she says, “I would probably be on insulin for diabetes, I’d still be on high blood pressure medicine, and I’d be obese and incapacitated. I believe prevention is the way to go.”


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