The Medical Fitness Difference to Improve Population Health

Population health. What does that mean exactly? Frequently I am asked this question as I explain what some of my responsibilities are as the Medical Director of the Hancock Wellness Centers.

I explain that Hancock Health has three medical fitness centers, at which point the person usually interjects with, “Medical fitness? Now, wait a minute, what does that mean?”

I describe how patients are referred to our fitness centers by their physicians—yes, their doctors, even their specialty doctors—for various programs, including:

• disease-focused education,

• health and behavior coaching,

• social connection, and

• exercise as an intervention and treatment for numerous medical diagnoses.

Even though I have been doing this work for many years now, there are instances when I find it difficult to explain these concepts. When we started this endeavor, my practice partners and colleagues on the medical staff were not familiar with terms like medical fitness, population health, and lifestyle medicine. Some had a hard time grasping the notion that our hospital was investing in operating a fitness center and planning to make it part of the healthcare continuum; some were even opposed and thought it irresponsible. I find it best to explain the medical fitness difference by starting with some background and definitions.

The Start of the Hancock Wellness Centers

First, Hancock Regional Hospital is a mid-sized community hospital in Greenfield, IN, about 15 miles east of Indianapolis. What started as a small hospital on 12 acres of land in 1951 has grown into a comprehensive health system with multiple locations that serve the county and the growing surrounding areas. Hancock Health employs approximately 1,800 people, is financially stable, and is respected and recognized locally, regionally, and nationally.

To promote health and wellness in the community, Hancock purchased and operated a small fitness center in the early 1990s in the heart of town. Due to the growing population and growing health and wellness needs, they relocated the fitness center to a 33,000-square-foot building in 2000 and renamed it the Hancock Wellness Center.

Originally, an outside management company operated the gym as a traditional fitness center. Then, with the ever-changing landscape of healthcare and value-based reimbursement on the horizon, Hancock Health leadership decided to shift their healthcare delivery strategy from reactionary disease-related care to whole-person wellness and prevention.

Thus, in 2009, the first Hancock Wellness Center became certified as a Medical Fitness Center. Enter the Medical Fitness Model: healthcare organizations and fitness centers working synergistically to deliver care and improve population health outcomes.

Establishing Programs to Promote Wellness and the Prevention of Chronic Diseases

Improving population health outcomes is accomplished by professionally administering programs and services to clients with chronic diseases and multiple risk factors and promoting prevention and wellness. It's vital to engage with clients at a low-risk stage of developing a chronic disease to prevent progression to becoming high risk for the development of chronic disease, which tends to happen over time. Medical fitness centers have proven they can provide:

• a continuum of care,

• fulfill the mission of their sponsoring institution, and

• be financially viable in a variety of communities.

Hospitals partner with fitness centers to improve the health status of the communities they serve. Preventing disease and progression of an existing disease is the key to creating a sustainable healthcare system for populations in the future.

Defining Population Health and How to Achieve It

This brings us back to our first question, what exactly is population health? The "Triple Aim" defines population health as:

1. improving the health of populations,

2. improving the patient experience, and

3. decreasing the per capita cost of healthcare.

What do we know about the American population's current state of health and the cost of healthcare? In a nutshell, over half of U.S. healthcare spending—which is higher than any other country in the world—is spent on those at least 55-years-old with largely preventable chronic diseases. Yes, these diseases are preventable. But how? Primarily through lifestyle interventions, to name a few:

• getting adequate sleep,

• managing stress effectively,

• getting physical activity every day,

• eating a plant-rich diet,

• staying connected socially, and

• decreasing use of nicotine and alcohol.

Is that all it takes, just lifestyle changes? Research shows a resounding yes! In the U.S., we determine health quality by the following factors: 10% access to healthcare, 20% genetics, 20% environment, and 50% health behaviors. What doctors prescribed a century ago prior to the tremendous medical advances of today—for which we are all very thankful—was, in fact, the best medicine for preventing and treating chronic disease. Adequate sleep, healthy food, stress management, and avoiding any substance in excess, for example, are stronger predictors of population health outcomes than genetics and environment combined!

Investing in the front and proactive end of healthcare is a powerful way healthcare systems treat disease and decrease spending. (Otherwise known as early intervention with lifestyle measures to treat and prevent disease.)

Thankfully, Hancock Health, and now many other organizations around the globe, are doing just that. Organizations are building and operating healthcare centers that offer the full array of traditional fitness offerings—group exercise classes, personal training, state-of-the-art equipment, etc.

These centers also provide on-site physician offices, physical and occupational therapy, community education, nutritional services, Culinary Medicine instruction, Arthritis Foundation and Parkinson’s Disease programming, massage and mind-body offerings for stress reduction, Cancer Fitness, and disease-specific Physician Referral for Exercise, all as part of the continuum of care.

Hancock Health now has three state-of-the-art medical fitness centers which are helping to transform the health landscape of our county, region, and, hopefully, state by paving the road for health policy change. Even though we had to shut down the centers during the first COVID-19 surge, now, our membership exceeds our pre-COVID-19 numbers with over 10,000 members. We have established best practices for safety and are keeping people engaged and moving. We have even been a COVID-19 vaccination and testing site intermittently.

I have one final note about the third arm of the “Triple Aim” patient experience. In my 16 years as a Family Physician and resident in Hancock County, I have found that people appreciate a hospital that genuinely invests in keeping people well and making our county one of the best places to live.

Our Wellness Centers have allowed us to provide a customer experience that is so much more pleasant than what people have traditionally experienced receiving "sick" care. From our Cancer Center to our CrossFit affiliate, everything we do is about investing in well-being, which I discovered has inspired others to more readily invest in themselves and the community in which they live. The Medical Fitness Model is an excellent strategy for improving population health.