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Navigating Healthy Lifestyle Program Offerings!

Updated: Dec 26, 2019

Background

Programs designed to help populations learn about and adopt a healthy lifestyle have been broadly recognized as achieving significant clinical benefits for the participants. Public health lifestyle change initiatives funded by organizations like the Federal Agency for Community Living (ACL), various State Governments, and not-for-profit foundations have funded academic organizations to develop such programs. They currently support tens of thousands of Community-based Organizations (CBOs) to deliver these offerings.

In addition, self-insured employers, and health plans have adopted a wide variety of lifestyle change programs in their health benefit offerings as a means to improve their members’ health and related personal quality of life as means to reduce medical costs. As a result, there are a large number of offerings that have overlapping content (i.e., diet, exercise, and regular sleep are examples) that have inconsistent quality and outcomes. Practicing physicians, well aware lifestyle change can be important therapy, are overwhelmed and do not know how to proceed.

The Center for Disease Control and Prevention (CDC) is supporting efforts to improve the situation by clinically validating a selection of existing offerings (i.e., Arthritis) and developing standardized solutions where there are underserved needs (i.e., Diabetes Prevention). It is expected that the CDC will be introducing lifestyle change programs in a variety of clinical areas. Their goals are:

1. Have self-insured employers and health plans buy the CDC-reviewed offerings and include them in the benefit offering. This reduces the lifestyle change program variation in the marketplace and makes it possible for physicians to become engaged with so they can identify qualified patients and prescribe these solutions.

2. If the lifestyle change programs are included in the majority of benefit plans, the eligible patients can select the CBO or commercial delivery alternative most attractive to their needs.

3. CBOs generate revenues based on their ability to attract paying patients to their program(s) which increases their ability to sustain their delivery capabilities beyond cyclical grants.

In summary, the result would be integrate clinically-proven lifestyle change programs into the traditional healthcare delivery system.

The Challenge

Changing the immense healthcare ecosystem is difficult. Although there is a great need to engage physicians, ensure program quality, increase participant choice to enhance participation and retention, and to reduce a variety of administration costs, many stakeholders will have their current business models disrupted and not all will benefit from the changes.

The CDC is built on the foundation of clinical exactness without ridged ROI expectations. Funded by specific legislative acts, their efforts are divided into specific project areas. The political nature of a Governmental organization requires that they spread their efforts into as many as geographies possible including rural and urban settings.

The CBOs have been sustained historically by grants and are also project oriented. There are also cultural mismatches where CBOs simply do not have the experience or desire to change their grant-based financing model. Both group have focused on underserved members of our society who need help. Many individuals in this population are older, have existing disabilities, and are often financially constrained.

Self-insured employers and health plans are committed to maintaining a healthy workforce. Because their employees have jobs, they have a lower average age, and fewer disabilities. While there are significant variations in these organizations (i.e., white collar or blue collar), all of them want to insure their spending is achieving measurable financial results. The majority of these organizations are built with a recurring, not project oriented, infrastructure to sustain their business(es).

The current CDC project focus does not work well in the commercial marketplace. These buyers want longer term relationships from organizations built to meet their needs. Commercial buyers expect an infrastructure that can support more than one lifestyle change offering to simplify contracting (one deal) and reaches a larger part of their overall population. They have been moving to integrated offerings for more than a decade for this reason.

For the typical CBO this creates organizational issues and requires major organizational restructuring. CBOs wishing to enter this market have to support multiple programs on a continuing basis and be able to compete against commercial sellers used to providing strong customer implementation and ongoing support.

These challenges are impacting the effectiveness of the CDC’s multiple efforts.

The following recommendations are offered to significantly improve results across many current and future lifestyle change initiatives. MedWorks is available to discuss these suggestions in greater depth.

Recommendations

1. Define what is meant by “sustainability.” MedWorks believes the CDCs goal is to have the CBOs generate positive cash flow from the promotion, sale, delivery, and support of the lifestyle change programs. It is important to specify the required characteristics of the CBO organization to achieve this goal. Large commercial buyers want to be sure the organization with whom they contract has the ability to fulfill the commitment. Generally, larger organizations are better positioned to sustain personnel turnover and other related business challenges. The delivery organization moving to sustainability needs to add new functional capacity to support program sales, program delivery, medical billing, and client services. To do it effectively, there is a need for functional expertise. Adding these new functional roles increases costs, which increases the need for more sales to achieve breakeven or profitability. Actively model what is needed for “sustainability.” Use this model to identify qualified CBOs (will be needed infrastructure) to insure they understand the long term the commitment. Again, it is likely the organization needs to be large enough to support multiple programs promoting all of them to the same buyer community.

2. CBO participants need to build local “delivery networks.” Affiliate relationships already exist in the public health space. Promoting this activity gives the smaller CBO the opportunity to participate while leveraging the larger organizations’ sales, support, billing, etc., infrastructure.

3. Focus several related lifestyle efforts in the same geography. Commercial buyers want integration. Proving the overall model is effective allows for tools to be built that are controlled by the CDC (or the NACDD) so they can be used once validated in other geographies. Establishing too many locations results in many of the CBOs building different solutions for the same problem. A ‘few” alternatives will allow the CDC to identify best-of-breed options or to provide choice to other CBOs later. The tool set developed could be shared with other government organizations ranging from the State Public Health Department to the Agency for Community Living. Proven tools can be funded and rolled out rapidly with the CDC processes.

4. Geographic focus supports stronger initial partnerships. Groups like the National Alliance of Healthcare Purchasing Coalitions have been supportive partners linking the community to the commercial organizations. Like everything else in healthcare, all Coalitions have unique characteristics. Identifying the right Coalition partner(s) to achieve maximum early results builds a model that can be adopted by the other coalitions.

5. Expand the project focus to at least two years but preferably three years. Commercial benefit buyers are generally working two years out in their benefit designs.

There are other ideas to discuss. MedWorks is currently building a model to categorize the various Business Coalitions. A similar model could be used to categorize the CBO organization. This understanding of major industry players should be used in future project partner decision making.


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