Share PostLinda Miller, manager of infection control at Methodist Charlton Medical Center, spent Christmas Day 2010 having her gall bladder removed in an emergency department. Prior to the surgery, she wept —because she knew what was coming. She could not believe she was in this situation. Her weight had crept up to 240 pounds. She decided it was the wakeup call she needed.
She began eating healthier and exercising right after the procedure. However, her return to work meant the return of the weight she lost.
In late January 2011, she received an invitation to be part of Methodist Health System’s patient-centered medical home pilot project aimed at employees with biometrics consistent with metabolic syndrome.
At first, Miller was devastated that she qualified for the program. But she soon realized it was an answer to a prayer.
She did not have a family physician. The program connected her to Jennifer Bang, M.D., and the two agreed on a prescriptive weight-loss program, half of which was paid for by Methodist. The weight began to fall off. After six months, her cholesterol dropped 68 points without medication.
Miller, 50, now weighs 146 pounds. She and her husband are planning a trip to Hawaii this winter, where she plans to go horseback riding and hiking near volcanoes—activities that would have been prohibitive at her old weight.
Methodist this month received the initial results for the pilot’s patients. The results were an unqualified success.
Nearly two out of three lost weight, 43 percent drove their elevated blood pressure levels
into the normal range. Of the 165 participants, more than 9 out of 10 had normal blood pressure levels. The average LDL cholesterol level fell from 150 to 131. At the end of 2011, participants in the MPCMH also had a 56 percent decline in ER visits, compared with an 8 percent decline
for those eligible for, but who opted out of, the voluntary program.
“The results we accomplished were so good, we sent them back to our insurance provider to run them again, just to make sure they were correct,” said Tim Kirby, Methodist executive vice president of system alignment and integration. “The program has been very successful in a short period of time, and we look forward to seeing the positive impact it will have on our employees’ health as it continues.”
Kirby, also a pilot project participant, also lost 15 pounds.
Methodist invited 800 employees in spring 2011 to participate in the pilot. About 200 accepted the invitation, although about 50 eventually dropped out. Methodist expanded the criteria and issued a second invitation to 1,100 in the fall 2011. Enrollment eventually settled at about 450—a three-fold increase attributed to positive word-of-mouth from the participants. Nearly three out of four of the larger group lost 10-20 pounds and achieved or maintained normal blood pressure.
Employees and their primary-care physicians jointly agree on three health goals for 90 days, such as lowering blood pressure, weight, or blood glucose. If the employee fails to meet the goals for two quarters, they are dropped from the program. The identity of program participants remains confidential, known only to clinicians and supporting staff.
Medical home participants can earn discounts on their health plan premiums based on the defined categories. In addition, the program helps cover the cost of qualifying prescriptions, medically managed weight loss programs, and exercise programs among other benefits.
The pilot program is part of Methodist’s eight-year plan, developed in 2008, to improve employee health. Methodist employees can earn up to $1,700 in discounts on their health insurance premiums if they undergo health risk assessments and keep their biometrics in the normal range and refrain from smoking.
About 80 percent of employees on the company health plan have participated in the Methodist wellness program. Of the 3,600 participants, nearly one out of four used a health coach. About half qualified for the maximum health-insurance discount.
Opportunity for Employers
After seeing its in-house results, Kirby said Methodist is now planning to offer the program to local employers. The system is finalizing a contract with its first client to work with its highest-cost employees.
“We wear hats as an employer and a provider,” he said. “We pull those together in this program. We started with our employees before we offered it to a broader group of patients.”
Melissa Gerdes, M.D., assistant vice president and chief medical officer for outpatient services and acccountable care strategy, said the nearly five dozen primary-care physicians in the program were already practicing coordinated care. The physicians are part of MedHealth, a nonprofit subsidiary that operates Methodist Family Health Centers.
“A lot of what we do is not that new,” she said. “What’s different is developing the personal relationship with the patient and honing down the individual care plans. This is a model that could create payment for this kind of work. Insurance companies don’t always pay us for this.”
Gerdes said focus-group and online surveys show that medical-home participants place a high value on their relationship with physicians. She said she was surprised that many employees did not know what a primary-care physician did, and how many did not have one.
The program also underscores how difficult it is to change health behavior.
“The health journey is a long-term pathway,” Gerdes said. “This (pilot) program is scripted and very heavily incented financially. But human nature is human nature. Sometimes employees need a break. If they need to lose 100 pounds and they lose 20 or 30, we encourage them and make them champions when they make gains.”
A recent Thomson-Reuters study found that hospital employees spend 10 percent more on healthcare, use more services and are often sicker than the rest of the U.S. workforce.
“We were not an exception to those statistics,” said Stephen Mansfield, Methodist president and chief executive officer.”We found that approximately 80 percent of our health care costs were
being driven by 20 percent of employees, and we wanted to partner with our most at-risk employees to help them improve their health and lead healthier lives.”
Miller is certainly a believer. She has recruited a half dozen colleagues into the program and recommended her physician.
“I’ve really become a spokesperson,” she said. “My success has motivated others to make changes. That motivates me, too.”
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.