"If you help someone face the demons that make them susceptible to weight gain and all the health consequences of that, and it also makes them feel better and how they're viewed in society … you've really done something that has a major impact on their lives, and I think you get a lot of devotion and appreciation that you seldom see in other types of healthcare."
Key No. 4: Make it multidisciplinary
The gift of time is one way to up the value patients get from a wellness or weight loss program, but that isn't the only factor that affects satisfaction. Patients often want, and pay for, a fairly wide range of options. Although wellness or weight loss programs benefit from a foundation in a reimbursable field of medicine, the fields and providers involved often run the gamut.
At the Johns Hopkins Weight Management Center, behavioral therapists counsel patients to address underlying behavioral issues that contribute to weight gain. Dietitians and nutritionists explain the details of nutritional health, an area that physicians are often undertrained in, says Cheskin. Exercise specialists, often with a degree in physiology or fitness, teach classes and help patients develop workout routines. Then there are bariatric and primary care physicians to take care of other patient needs.
"I think it's important to individualize care. That's another thing an institution-based program that is multidisciplinary can do better. It's not one-size-fits-all, and you need to be able to step back and see what is working and what is not and change plans midstream if that is what's needed," says Cheskin.
Northwestern goes beyond wellness, even, with the diversity of its offerings. Its program was recently combined with the integrative medicine department. In addition to smoking cessation, exercise programs, and health psychology, a nurse practitioner addresses sexual health, a naturopathic physician offers homeopathic treatments, and acupuncturists, massage therapists, and other nonphysicians round out the care team.
While some of the services may seem ancillary or even unnecessary now, there is a lot of patient interest and pent-up demand. If the reimbursement model changes, hospitals with already-built wellness programs could be well positioned to tap into a new revenue stream.
If insurers begin paying for wellness services, both patient and physician interest in the programs will explode, says Trad.
President Barack Obama has hinted at shifting healthcare's focus toward wellness. When he began building momentum for healthcare reform this spring, the president held roundtable discussions with a variety of stakeholders, including business executives from around the country who have demonstrated cost savings through corporate wellness programs.
While praising the results of the programs, Obama suggested that wellness initiatives—such as smoking cessation, healthier eating, and exercise—could be adopted at a federal level.
"You have companies like Safeway that have been able to hold their costs flat for their employees at a time when other companies have been seeing double-digit inflation in their healthcare," Obama said. "Now, if we can do that in individual companies, there's no reason why we can't do that for a country as a whole."
But how important will wellness and weight loss be in the context of broader healthcare reform?
There are a couple of possible approaches. Congress could simply focus on strengthening the employer-driven wellness movement. Sen. Tom Harkin's (D-IA) Healthy Workforce Act of 2009, which would offer tax breaks to employers that implement wellness programs, already seeks to do that. Alternatively, Congress may look to integrate wellness more fundamentally into the healthcare system.
Sens. Ted Kennedy (D-MA) and Max Baucus (D-MT) seem to favor the latter approach and have suggested strategies such as eliminating copays for recommended preventive services provided by Medicare and Medicaid and providing grants for communities to develop wellness programs. Both approaches may receive more support. But ultimately, it will be difficult to consider healthcare reform legislation successful if it doesn't include payment for physicians and hospitals to prevent, rather than just treat, chronic diseases.
Sources: Remarks from President Obama: http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-after-Roundtable-with-Business-Leaders-on-Health-Care-Costs/
S. 803: http://www.thomas.gov/cgi-bin/query/z?c111:S.803: