Population Health Exchange: Gaining from Prevention and Wellness

NCH Healthcare System has generated several benefits from disease prevention and wellness programs with its employees, including $27 million in health plan savings.

A Florida health system's disease prevention and wellness efforts are generating a healthy return on investment.

NCH Healthcare System has changed the focus of the Naples-based health system from a "repair shop for disease" to prevention and wellbeing, says Chief Medical Officer Frank Astor, MD, MBA.

"There are going to be changes in healthcare, but we think this is the right thing to do. Keeping a very healthy population is going to help us no matter what the future brings," Astor said last week during the HealthLeaders Population Health Exchange in Coeur d'Alene, Idaho.

Championed by President and CEO Allen Weiss, MD, NCH has launched prevention and wellness programs for its own employees and the surrounding community. A series of employee initiatives, which are generating impressive results, started a decade ago:

• 2009—Biometrics and preventive health screens such as colonoscopy and mammography
   
• 2010—Personal health assessment, coaching, diabetes education, and nicotine testing
   
• 2011—Stopped hiring smokers
   
• 2014—Annual labs, biometrics, health-related classes, and health deductible buy down for healthy activities
   

Starting in 2014, NCH started offering employees financial incentives to promote health consciousness and healthy lifestyles. The incentives—health reimbursement accounts (HRAs)—are being used to lower insurance costs for employees who participate in NCH's health plan.

"HRA dollars were used to buy down deductibles at the health plan," Astor says.

NCH and its employees have generated significant health and financial gains from their prevention and wellbeing efforts:

• Lowered body mass index, blood pressure, waist circumference, and lipids
   
• Overall program satisfaction is 98%, with 40% satisfied or very satisfied with offerings
   
• At the NCH health plan, costs have decreased 7.8% annually over the past five years, with no increase of employee premiums for the past four years
   
• The decrease in healthcare spending has saved the health plan $27 million over the past three years
   
• Number of days lost to injury has dropped from 381 in 2015 to 226 in 2016

Employee engagement has been a key to NCH's success in promoting prevention and wellbeing within the health system, Astor says. "Our employees became active, engaged, and happy with the new activities and lifestyle."

Community wellness
 

NCH is anticipating similar gains from the health system's prevention and wellbeing initiatives in Naples and surrounding communities, Astor says.

"We decided to have a life radius around NCH that involved engaging political and local government institutions, and civic organizations. We helped build an environment where we had parks, green areas, and bike paths."

Engaging communities has required a high level of outreach work, Astor says. "We went beyond the scale of a hospital or healthcare system, involving schools, faith-based organizations, supermarkets, and restaurants."

At NCH, a crucial element of building and sustaining wellness gains is adoption of the Blue Zones approach to health, he says. The approach includes moving naturally, having a positive outlook, eating wisely, and belonging socially such as connecting with loved ones.

"We are going to sustain these changes with Blue Zones. We started with biometrics, a change in philosophy, and the deductibles. The Blue Zones effect can maintain our gains and keep the population healthy," Astor says.