St. John Providence lowers costs by removing obstacles to optimum health
Three years ago, Jim Fisher was facing a variety of health challenges. He was overweight, had high blood pressure and high cholesterol levels, and suffered from anxiety and depression.
Today, Fisher, 47, a cook at St. John Macomb-Oakland Hospital, Macomb Center, in Warren, Mich., says he "feels great, both physically and spiritually." He has lost 30 pounds and follows a weekly exercise schedule that includes weight training, calisthenics, walking and jogging. He prepares family meals that include baked or grilled fish and chicken and lots of fruits and
vegetables — many harvested from his own garden. And he's been able to eliminate several medications from his daily regimen, including those that once helped to stabilize his moods.
"I don't think my lifestyle will change now; my new habits are embedded in me," he says. "I just came back from vacation, and my favorite part of it was being able to jog around the lake and ride a bike!"
Danielle Wilder, 39, is an administrative assistant in the public relations and marketing department at St. John Providence Health System, the Ascension Health subsidiary that is parent to Macomb Center hospital. She has a similar tale to tell. Eighteen months ago, as a single mother, she worked full-time, went to school full-time and faced multiple health issues. "I was very stressed out. I have diabetes, high blood pressure, and I knew I needed to lose 100 pounds to have a healthy BMI," she says.
In May, Wilder, now 24 pounds lighter and following a workout regime that includes exercising to DVDs like "Hip Hop Abs" and Zumba, completed a 5K walk in just under an hour — and she plans to participate in another one soon. "I'm learning to take time for myself to make my health a priority, whether it's keeping a food journal, getting enough sleep or scheduling a night off to see the new Harry Potter movie," she says.
Both Fisher and Wilder are participants in St. John Providence's health enhancement program, a voluntary plan launched in 2006 that offers employees with chronic conditions resources such as personal medical coaching from specially trained nurses, disease education and access to clinical social workers.
Toppling obstacles
The program was designed by Dr. Andrew Vosburgh, St. John Providence's corporate medical director for associate health and wellness and medical advisor for the system's self-funded health plan. It was implemented after an analysis of health care claims found that 3.4 percent of St. John Providence's 17,000 associates were responsible for 50 percent of the system's health care spending.
"I studied the claims and determined that while some were due to unanticipated single events — auto accidents, premature births — about 550 of these associates were struggling with multiple health concerns that somehow were not being addressed through our regular health plan," says Vosburgh.
Armed with an initial $500,000 in funding, Vosburgh set up the health enhancement program to address whatever obstacles people were experiencing that kept them from accessing better care in appropriate settings and achieving optimum health.
"If someone was using the emergency room for primary care, we wanted to identify a physician for him — and provide rides to the doctor's office, if needed. If someone had multiple hospital admissions for severe asthma attacks because there was mold in his basement, we wanted to hire a firm to remove the mold," he says.
Initially, Vosburgh invited the 550 associates with chronic disease to participate in the program; and, at first, about one in four took him up on the offer. Like Fisher and Wilder, each volunteer was assigned to a nurse case manager, who performed an in-depth health assessment and helped set initial goals. Weekly or twice-monthly follow-up phone calls serve to keep associates on track, direct and coordinate care, and redefine goals depending on problems or successes.
Proof of concept
After four years, in addition to helping an estimated 1,000 participants attain a better quality of life, it became obvious that the program also was improving the financial health of St. John Providence. The group's health care costs were lowered 22 percent, and net health care costs per employee have remained flat at a time when many systems have been conservatively experiencing 8 percent annual hikes.
"Until now, very few organizations have lowered health care costs by improving medical service. The focus has been on cutting or rationing them instead," says Vosburgh.
Two years ago, St. John Providence's health enhancement program was expanded to the four other health systems that are part of Ascension Health in Michigan — Genesys Health System in Grand Blanc, Borgess Health in Kalamazoo, St. Mary's of Michigan Medical Center in Saginaw and St. Joseph Health System in Tawas City.
It also has turned into a potential source of revenue. Employee Health Solutions — a new business modeled after the program — has inked contracts so far with three metro Detroit corporations — including a union trust fund for retired police officers.
The program's success has certainly not gone unnoticed at St. Louis-based Ascension Health. Plans are to eventually replicate the program at Ascension Health facilities nationally, according to Dr. David Pryor, chief medical officer at Ascension Health. Last winter, it was implemented at Sacred Heart Health System in Pensacola, Fla. Plans are to offer it at five or six additional Ascension Health sites by January 2012.
"This program is part of the fundamental approach to providing health care that is driven by our mission. We feel that health care should be available to all our associates," says Pryor. "As health care expenses continue to rise, most people talk about shifting the burden of contributions to employees. Dr. Vosburgh has shown that we can control the overall increase in costs in a different way — and in a way that improves outcomes for individuals who would likely need significant services in the future without this kind of intervention," he says.