Armed with the results of a successful wellness pilot, Florida's NCH Healthcare System sought and won the support of local officials. That was just the beginning.
Think of Naples, Florida, and images of fit and thriving people come to mind. But Collier County, where Naples is located, incorporates a widely diverse population with specific health needs and challenges—including the elderly, snowbirds (retirees staying during the winter months), a growing segment of young mothers, and migrant workers in the county's interior.
Allen Weiss, MD
In an effort to provide quality care beyond its patients, NCH Healthcare System is extending its population health efforts to achieve a healthier overall community. Within the population of 350,000 there are many serious health challenges.
So after an experiment of promoting wellness proved successful in improving health and decreasing costs with its own controlled groups, Allen Weiss, MD, president and CEO of NCH Healthcare System, decided to take this concept county-wide.
One of every two adults in the NCH's community has a chronic condition or disease and the county's interior includes migrant workers and other economically disadvantaged populations. Collier County also lists more fast food restaurants on average than other Florida counties, and physical activity level is lower than the rest of the state.
"Half of the kids in the inland part of the county come from non-English speaking households, and many children participate in free lunch programs," Weiss says. "We can't move the needle in this county unless we get these folks on board."
Armed with data demonstrating NCH's financial savings, Weiss approached the local government and Chamber of Commerce to secure their buy-in. He pointed to a September 2014, article in USA Today that listed Naples as one of the healthiest places to live in the U.S., and proposed that if they could collectively work to establish Collier County as the healthiest place in the country, they could attract people and jobs, thereby fostering a recession-proof region.
With endorsements from local government and the business community, Weiss began researching wellness programs and came across the "Blue Zones Project" from the bestseller, "The Blue Zones" by Dan Buettner. The book identifies areas where people live the longest, healthiest lives.
"Blue Zones identifies common denominators in five places in the world that have established a healthy community—where you have 100-year-olds who are happy, active, and useful," says Frank Astor, MD, MBA, FACS, Chief Medical Officer of NCH Healthcare System.
"We're becoming a Blue Zone, and spreading a dialogue with government and industry, particularly with restaurants, supermarkets, urban planning, and schools, so we can look at elements that bring wellness and health."
Geriatric-certified Clinicians For the geriatric cohort, NCH runs a program for healthy aging out of its 54-bed rehab facility. Seminars raise awareness about how seniors' homes can be outfitted to promote staying in their home.
Michele Thoman, RN, MBA
"We work with Collier County emergency medical services, who will go to people's homes, do a safety check, and give tips, such as removing carpets that could promote falls, or adding grab bars," says Michele Thoman, RN, MBA, system chief nursing officerof NCH and chief operations officer of theNorth Naples Hospital campus.
NCH also launched a service line specific to its geriatric population that includes a geriatric-certified advanced nurse practitioners and geriatricians. Its goal is to create a center that will not only see seniors on the outpatient side, providing counseling and education and medical care, but also on the inpatient side.
The migrant population presents special challenges, including people not seeking treatment in time. Also, most are not fluent in English, so NCH must take this into account in any outreach efforts. One strategy is placing Spanish-speaking staff in the community and coaching employees on cultural differences. Another tack is locating nurses in schools and providing Spanish-language health literature for children to take home to their parents.
"Since most migrant workers don't seek [preventive] healthcare, when they present to the organization, they usually have a higher incidence of tuberculosis," Thoman says. To address this, the organization partners with the county health department to identify those afflicted with the disease.
This segment mostly consists of young families, so to encourage prenatal care for expectant mothers, NCH works with the federal WIC (Women, Infants, and Children) program to reach new mothers and to emphasize breastfeeding, early intervention, and seeking medical care during pregnancy.
"We also hold baby fairs to educate them on our services, and we're creating a 24/7 pediatric emergency room," says Thoman.
Buttressing all efforts is the organization's use of its electronic medical record, because it provides a single chart for each patient, whether on the inpatient or the outpatient side. The tool helps NCH drill down on specific metrics around quality, complications, and cost.
Beyond its patient population, NCH is developing wellness initiatives for the community at large through the Blue Zones Project, which is owned and operated by Healthways, the Franklin, Tennessee–based global provider of well-being improvement solutions.
The program's goal is building healthier communities by targeting individuals, worksites, schools, restaurants, grocery stores, faith-based organizations, and community leaders to establish policies that support wellbeing—such as promoting more vegetables and foods lower in fat and salt, and investing in walking routes and bicycle paths, for example.
Launching the Blue Zones Project in fall of 2014, NCH brought together community forces and asked residents to pledge to participate.
"You also need to involve population health techniques and technology—meaning, you need to look at the entire group and measure group outcomes and how they're distributed amongst the entire population, not just the individual," says Astor. "Then, you need to involve every stakeholder in the community as possible."
Taking on Blue Zones is an expensive, eight-year contract, Weiss admits, noting that the hospital is underwriting the venture. He convinced his board of directors to take the risk, using savings from NCH's reduced insurance costs to invest in the initiative.
But Weiss expects its population health model, combined with the Blue Zones program, to be financially rewarding because a healthier community translates into cost savings for the healthcare system.
"We have to change our business plan from fee-for-service to value-based reimbursement, in which you're better off with healthy people," says Weiss. "Ultimately, we want to change lives in a big way, long-term. My vision is that our hospitalwill be considered a failure in 10 years. We're getting out of the repair shop and into prevention."
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