Do you remember the fitness craze of the 1980s when Americans bought the Jane Fonda Workout, spandex leotards became the rage, and fitness experts stretched their way onto our television screens?

Maybe the fashion and TV shows were laughable, but the idea behind the movement is alive in managed care. The latest wellness programs don't include leotards and legwarmers (thankfully), but wellness is no longer just a fashion statement or way of life. It has become a business model.

The terms "wellness" and "population health" are everywhere in managed care. In fact, I recently talked to a number of disease management experts about their expectations for 2008. A common subject was integrating wellness into disease management.

While wellness programs gain popularity, there are studies that show the benefits of one option, fitness programs. A Centers for Disease Control and Prevention-funded study of Healthways' SilverSneakers, a fitness program for Medicare Advantage beneficiaries, revealed healthcare costs increased at a smaller rate among SilverSneakers participants than a control group. The program for Medicare Advantage beneficiaries enjoyed savings in inpatient admissions.

Another recent study of Highmark, Inc., workers showed that a comprehensive employee wellness program resulted in a positive ROI. In fact, researchers found healthcare expenses per person per year were $160 lower for wellness program participants than non-participants, inpatient expenses were $184 lower per year for participants, and the estimated net savings from the program were $1.3 million, which produced an ROI of 1.64:1.

Studies like SilverSneakers and Highmark show the financial benefit for companies, but experts are also quick to point out that just providing gym membership discounts and stapling wellness posters in the employee lunch room doesn't cut it. Today's wellness programs offer tailored communications, incentives that lead to greater fitness, and utilize behavior change sciences.

I recently spoke to Ron Z. Goetzel, PhD, who co-authored the review of Highmark's employee wellness programs, about what is needed to create successful wellness programs. He gave me seven tips:

1. Health risk assessment--HRAs provide immediate feedback to program participants and highlight areas that need improvement, allow a company to reach out to people who need help, and provide an effective measurement tool. The rest of the wellness program is built upon the HRA foundation.
2. Good methods for triaging people into risk-reduction programs. 
3. Good incentives--"Incentive structures that seem to be working more effectively are those where you reduce participants' medical premiums if they engage in programs."
4. Theory-based behavior change methods--"There is a whole body of literature in the social-psychology domain that shows how to change people's behaviors more effectively than just telling people to change their behavior."
5. Tailoring communication to a person's preferred learning style, such as one-on-one coaching, mail, telephone or e-mail. "A program that doesn't engage a large proportion of the population in some form or fashion is not going to be successful."
6. Measurement and evolution by building metrics that allow you to access and fine-tune wellness programs. 
7. Leadership support--"[Leaders] need to model healthy behaviors. They can't say, 'everyone live a healthy lifestyle, I'm going to continue to live my unhealthy lifestyle.' "

New wellness programs go beyond reduced gym memberships that are commonly offered by employers. As more wellness studies show positive ROI, employers will demand these services. Managed care companies will either have to offer the services, contract with companies that do, or potentially lose business.

The question is then: Will your company get ahead of the wellness movement or will you get left behind much like the spandex leotard?

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Les Masterson is senior editor of managed care with HCPro, Inc. He may be reached at lmasterson@healthleadersmedia.com.

There's nothing more comforting to consumers than an assurance of attention to detail. Speaking directly to a consumer's need for conscientious care, Exeter (NH) Hospital launched a new campaign that reinforces their level of commitment to their patients in an artful way.

The campaign is actually a continuation of Exeter Hospital's 2007 "The Art of Wellness" initiative. Though the same tagline is still carried throughout the 2008 elements, Exeter decided to focus this flight of the campaign on a more consumer oriented approach.

According to Winsper Inc, Exeter's agency located in Boston, "The 2008 campaign continues with the tag while adding new elements to demonstrate the continuing commitment of Exeter Hospital and its staff to provide care without compromise, and to grant not only positive clinical outcomes, but also positive consumer experiences."

With the consumer experience as their inspiration Exeter Hospital, working with Winsper Inc, chose TV spots as the mediums for conveying their message. Exeter Hospital's vice president of strategy, Mark Whitney, felt that TV was the "powerful medium" they needed to fully conveying Exeter's promise of care without compromise message. TV also provided Exeter Hospital with extended reach for hitting its target audiences.

The spots take an unusual creative approach by not pushing their equipment or medical professionals on the viewer. Instead, they use light music and non-medical imagery to get their message across. An example of this can be seen in a spot with a woman making a bed. Though the voiceover explains Exeter's mission for excellence the perfect, skillful, detail that the person making the bed executes delivers the message in an unconventional and very effective way. Using a subtle and creative approach also reinforces the message of 'art' that has been a continued focus throughout the campaign.

More information on the campaign can be found at www.exeterhospital.com.

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Kandace McLaughlin is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kmclaughlin@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.

For the past 30 years, the U.S. healthcare system has been powered by baby boomer physicians, many of whom are now considering retirement at a younger age than prior generations due to burnout, deteriorating practice economics, and disillusionment with the logistical challenges of practice. I don't believe that a majority of these physicians will cease to work in the near future; rather, they will find new roles inside and outside the health system that are more satisfying and less stressful.

As these busy physicians retire, often on very short notice, their patients are cascading down onto a new generation of physicians--a large number of whom are women--with fundamentally different goals, work styles, and values. This new generation has already gravitated toward medical specialties that mesh better with family and work-life balance priorities, and they evince a desire to practice medicine 40 hours a week or less. They are also much less ideological than their elders about medical practice and its prerogatives and less likely to remain in the same community for their entire practice.

It is hard to argue with younger physicians' desires for a more balanced life. After observing the wreckage that 24/7 medical practice has left among their elders--divorces, intra-professional conflict, disability due to stress, even suicides--younger physicians are entirely justified in wanting to organize their lives differently.

However, this generational changing of the guard in medicine is wreaking havoc on hospital-physician relationships and may herald a crisis of access, particularly for primary care physicians and rural specialists, as baby boomers begin to enroll in Medicare starting in 2011.

Here are some of the likely outcomes of this generational transition:

1. Surge in physician employment. We can expect a sharp rise in the number of physicians employed by hospitals. Unlike multi-specialty physicians groups, many of which are thinly capitalized, hospitals have enjoyed five years of record profits and have the financial resources to absorb the economic losses associated with starting up and sustaining medical practices. They also have the capital resources and IT infrastructure to facilitate the digital conversion of a medical practice. In rural areas, the hospital will likely become, by default, the employer of last resort for a majority of the community's physicians.

The current generation of hospital executives is wary and uncomfortable about assuming a larger role in organizing medical practices in their communities. This is due to the large economic losses, political disputes, and poor relationships engendered by their last foray into physician employment in the 1990s. Many hospital CEOs acknowledge that they failed to add value to the practices they acquired during that period. The result of these concerns will be far fewer practice buyouts than we saw in the 1990s, as well as less generous compensation packages focused better on clinical productivity.

Hospital executives are unlikely to pursue physician employment to increase profits or obtain health plan contracts (two strategies that had limited success in the 1990s). Extending the hospital's imperial dominion into the physician sphere is not what this new wave of "integration" will be about. Rather, hospital involvement in physician practice operations will be, in most places, an exercise in damage control and loss avoidance. Transparency, wide consultation in the broader physician community, and guidance from statesmen in that community are all essential to navigating the potential landmines in this delicate process.

2. Fewer hospital-dependent physician practices. We can expect a more definitive separation of hospital-dependent and hospital-independent practitioners in adult services, with hospital-based services increasingly provided by hospitalists and intensivists. Many younger physicians who have ambulatory practices are turning away from the hospital and searching for new ways of interacting with colleagues, including online (as evidenced by the explosive growth of Sermo, the physicians-only online community).

I believe this tilt away from hospital-centered practice accounts for the declining rate of growth in hospital admissions over the past four years and the surprisingly rapid acceptance of hospitalists and intensivists in many communities. Practicing physicians in many areas have asked, even pleaded with, hospitals to staff up to manage their hospitalized patients. The shift to intensivists is happening a lot slower than the shift to hospitalists, but is driven by the same factors. While the hospital's economic gains from this shift have proven elusive, markedly improved quality of care and reduced malpractice risk provide ample justification.

An important political consequence of this movement is that the hospital's medical staff will represent a shrinking percentage of the total physician community, and the hospital's real power, its power to convene the community's physicians, will diminish. Creating online clinical communities through clinical IT, digitizing billing and collections, and collaborating to improve clinical quality under pay-for-performance plans present new opportunities for the hospital to add value for physicians who do not directly admit patients.

3. Conflict over call coverage. We can expect intensified conflict with private physicians over the hospital's 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.

As fewer physicians depend on the hospital for practice income, however, this arrangement will probably give way, in larger hospitals at least, to hospital employment of general surgeons, cardiologists, and others to cover the evening and weekend service demands created by emergency surgery and cardiac intervention. This transition is also politically perilous and fraught with the potential for conflict. However, hospital spending on stipends has soared, and continued rapid growth in these expenses appears unsustainable. Shifting to employment or economically accountable contract relationships will eventually replace most stipend arrangements.

4. Widening physician shortages. Unless there are major changes in how primary care physicians are paid, particularly by Medicare, we can expect a growing shortage of primary care physicians. Some rapidly growing sunbelt communities are already experiencing this problem. Surveys suggest that close to 30% of Medicare beneficiaries experience difficulty in finding new physicians, and this number will increase as baby boomer physicians retire in the next decade. Reforming and substantially increasing physician payment for primary care services, through the "medical home" or other models, is essential to avoiding a catastrophic shortage of physicians over the next two decades.

Regardless of what Washington policymakers do about reforming payment, primary care practitioners must also develop a new operational model, which hospitals can help "midwife." Information technology must play a major role in this transition, with larger amounts of non-clinical or minimally-clinical interactions with patients either automated, through voice response technology, handled online through e-mail exchanges (e.g. prescription renewals, office visit follow-up), or supported by nursing personnel (who will also be in scarce supply). Finally, movement to end-to-end electronic adjudication and payment of medical claims will be vital to reducing practice overhead, a process which Medicare could markedly accelerate if the program's managers made the right policy choices.

There is a wide gap between policymaker perceptions of physician need and those that are increasingly apparent in many communities. Hospitals are going to play a major role in filling the widening gap in physician coverage in their communities. They will also have to advocate more aggressively in Washington and with private health plans for physician payment reform. With a larger stake in the physician enterprise, that advocacy will make greater economic as well as political sense. The changing of the guard in medicine will widen the hospital's role in the larger medical community, even as it is exposed to new economic and political challenges.

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Jeff Goldsmith is President of Health Futures, Inc. and Associate Professor of Public Health Sciences at the University of Virginia. He is the author of The Long Baby Boom which will be published in May, 2008 by Johns Hopkins University Press.

The California Board of Pharmacy has delayed the implementation of a law requiring electronic tracking of all prescription drugs to reduce the chance of counterfeits entering the supply chain. This is the second major delay for the law, which was passed in 2004. The law would make California the only state in the country to have approved such a stringent drug-tracking requirement.