August 13, 2009

Hospitals That Don’t Want Your Head in Their Bed

Are hospitals turning away patients?

Are hospitals turning away patients?

Ten years ago a hospital system in New York City opened several public diabetes clinics to help people better manage their disease. From insulin injection assistance to nutrition education, diabetic consumers could gain the knowledge they needed to change their behaviors. Within seven years, these clinics closed. Did the public need the clinics? Of course. Were they underutilized? Not at all. The hospital was forced to close the clinics because the services did not increase patient volume for treatment procedures due to diabetic complications. The issue here was not the execution, but the intention.

The hospital administration wanted heads in the beds and when that wasn’t happening soon enough, the clinic was considered a fiscal failure. People who were benefitting from the onsite assistance to live healthier lives were left with limited resources. The American healthcare system has spent years rewarding those who fix problems when presented—be it in surgical procedures or pharmaceutical prescriptions—as opposed to those who help prevent the problems in the first place. Fortunately there is a new trend in hospital services that are paved with much healthier intentions.

The recent health issue of Time magazine focuses on preventative care in the hospital setting. The issue features hospitals such as the Cleveland Clinic that have adopted prevention-based models of care focusing on wellness, not sickness. Their intention is to keep the heads out of the beds.

Since the diabetes clinics had to close throughout Manhattan, one must wonder, what’s in it for hospitals that adopts such a model?

1. Hospitals can keep people from getting sicker- and sicker means they pay more in the long run.

If a health system were dedicated to providing assistance for behavior modification— such as nutrition classes, cooking classes, spinning classes, tobacco cessation meetings—and the physicians focused on helping patients find the motivation to use these services, there would be a phenomenal opportunity to prevent chronic disease.

Let’s take Joe Public. He’s 47 years old and 30 pounds overweight. When hospitals and health systems help Joe lose weight and maintain a healthy Body Mass Index, they may be helping Joe control other risk factors such as high blood pressure and cholesterol. However if they do not help Joe lose weight, then the risk factors associated with being overweight could lead to heart disease and diabetes.

By the time Joe presents with a TIA or cardiac event in the emergency department, he’s not just sick, he is sicker than he was back when he could have used help achieving a healthy weight.

Hospitals around the country are now beginning to connect the dots between prevention and ROI. The Cleveland Clinic learned directly from their own employees how prevention services benefit their bottom dollar. Employees are encouraged to take advantage of Clinic offerings such as the Lifestyle 180 program, designed to reverse the effects of chronic disease by focusing on nutrition, exercise, stress management and the Tobacco Treatment Center’s cessation services.

As a result of employee participation and lifestyle changes, the Clinic’s HR director anticipates that employee premiums will not increase in 2010. Since employees are leading healthier lives, the prevention efforts save the clinic “between $5,000 and $10,000 a year per patient on claims they would have otherwise filed for treatments such as dialysis, angioplasty or bypass.”

By providing these prevention services to consumers in their communities, hospitals can also avoid future expenses due to patients who need the dialysis or bypass but who have limited insurance coverage.

2. Hospitals can become a comprehensive health home.

Hospitals are businesses, and every business has a brand. What good is a brand if customers are not loyal to it? Healthcare consumers want to be loyal to a brand but they need to feel a hospital is worthy of that affinity.

By providing communities with a spectrum of services that focus on keeping consumers healthy, hospitals can build trust. Healthcare consumers who have been empowered by these services are far more likely to turn to the hospital when treatment is needed.

Joe Public, who lost weight through the Lifestyle 180 program and quit smoking with the Tobacco Treatment Center’s support, will likely choose the Cleveland Clinic for future care and treatment if necessary. Three factors ensure this—relationships have been formed between the Joe and the hospital, he has witnessed the effectiveness of previous services and, as a result, trust has been established between Joe and the institution. It is this trust that actualizes the hospital brand and builds loyalty and, eventually, a return on the hospital’s investment in prevention.

One has to wonder how loyal diabetic consumers in NYC feel toward the hospital that cut off its resources because they were actually learning to live healthier lives.