By aligning the interests of consumers, providers and payors, this combination of outcomes-driven disease management with wellness and prevention programs puts Healthways at the vanguard of whole population health management
Nashville, TN (Vocus) December 18, 2006
Joseph and Carmella Gemmato never thought their Medicare benefits would lead to a healthier marriage, but that's what's happening as a result of the steps being taken in Washington, D.C., around the country and by the Gemmatos themselves.
At least five days a week, Joseph, 81, and his wife Carmella, 77, walk the half-mile from their home to the local YMCA, where they participate in The SilverSneakers® Fitness Program, a unique exercise program specifically tailored for older adults and paid for by HealthSpring, their Medicare Advantage health plan. It's a ritual that Carmella says has changed their lives.
"We go practically every day. That's the beauty of it," Carmella says of the Gemmatos' newfound fitness routine. "It gives us time together and time to socialize with other people. It keeps our marriage going. We just love it."
SilverSneakers is an innovative exercise program that's gaining popularity at fitness centers across the country. It's specifically designed for Medicare beneficiaries' unique health and physical needs and features certified fitness instructors who teach the classes.
Members like the Gemmatos can use other fitness center amenities like exercise equipment, weight training and circuit training. They can also visit any participating fitness centers and class sites across the nation when they travel.
As rising healthcare costs continue to ratchet up the pressure on insurers and consumers alike, they are increasingly turning to wellness programs like SilverSneakers as well as chronic disease management programs as a way to improve patient health and longevity while controlling costs.
Private insurers and employers aren't alone in their increasing adoption of lifelong wellness and disease management programs. State and federal governments are also embracing the value of preventive health and care support in government-sponsored plans. Services like SilverSneakers and chronic disease management programs are now offered through Medicare because of the flexibility allowed to commercial Medicare Advantage health plans. This diversity in coverage options, and the innovation in health and care support it's driving, has helped spur more older Americans than ever before to sign up for commercially available Medicare plans.
In 2005 alone, the federal government approved 163 new commercial Medicare Advantage plans, with more than five million Medicare beneficiaries enrolled. Since 2004, Medicare members like the Gemmatos have been signing up for such plans at an average rate of 50,000 new members per month.
The growth in Medicare Advantage enrollment mirrors the growth in programs like SilverSneakers. To date, more than three million seniors in 42 states at more than 2,400 fitness centers and class sites are eligible for SilverSneakers through their Medicare Advantage health plans, who increasingly see wellness offerings like SilverSneakers and next-generation disease management programs as complementary measures that meet the needs of members at all points on the healthcare spectrum - whether healthy, sick, or like most, somewhere in between.
The "in-between" category of those well enough for daily tasks, but using medications and seeing doctors regularly has never been larger or received more attention. Seniors like the Gemmatos enjoy an historically unprecedented level of health and activity, but they also use more medications and have more complex healthcare situations than previous generations.
Their unparalleled health status, driven by advances in medicine, as well as increased emphasis on wellness, nutrition, prevention and managing illness into old age, is only a foreshadowing of the level of care and health baby boomers will expect as they cross into retirement and beyond.
Statistics illustrate that the challenge of balancing wellness with complex care support and treatment protocols will only grow as America's aging population expands. A 2005 Kaiser Family Foundation study found that of the 89 percent of seniors who report taking prescription drugs in the past year, nearly half take five or more, more than half have more than one doctor who prescribes medicine, and about a third use more than one pharmacy.
The study also found that among older adults with at least three chronic health conditions, nearly three-fourths take five or more medications regularly and more than half do not take all their drugs as prescribed.
The complexity of this care -- and the potential to save money by managing it well -- is why health plans have long relied upon companies like Nashville-based Healthways to provide chronic disease management services to their members.
For the Gemmatos, and many other seniors, being well doesn't necessarily mean being free from disease, but living life to the fullest. In addition to their busy fitness routine, the Gemmatos participate in a Healthways disease management program. The program connects the Gemmatos with Healthways nurses, who help Carmella manage her osteoporosis and low back pain, and coach Joseph on the most effective ways to manage his acid-reflux.
"The calls we get are great," says Carmella of the Care Support calls they get from Healthways nurses. "Joseph gets his calls, and I get mine. They give us advice, talk to us about how we're doing and keep track of things for us."
Behind the scenes, Healthways employs an army of nurses and clinicians who use sophisticated medical, tracking and predictive technology to monitor the Gemmatos' interactions with the healthcare system, medication use and adherence to doctor's orders.
The health education and coaching they receive help ensure they can continue in the SilverSneakers program, while their fitness program helps keep Joseph moving and combat Carmella's low-back pain.
The combination of managing illness while staying well creates a powerful synergy, and it explains why Healthways recently acquired Axia Health Management, the parent company behind SilverSneakers and a suite of other wellness and prevention programs, including QuitNet, an online smoking cessation community.
"The old way of thinking was that you need to be healthy before you can begin exercising, and if you need support for your chronic illness, you must be sick," said Healthways President and CEO Ben R. Leedle Jr. "But we know that's not true. Wellness can be achieved at many points on the healthcare spectrum by people of all ages, and Healthways is able to help everyone, regardless of their place on that spectrum, by providing the support they need when and where they need it to live healthier lives."
The new company will become the nation's first to offer programs that can support consumers at all points on the healthcare spectrum -- healthy, sick, or in between. Industry insiders agree that the recent acquisition of Axia Health Management creates an entirely new kind of company ready to meet the needs of the 21st century healthcare consumer and the demands of the 21st century healthcare system.
"By aligning the interests of consumers, providers and payors, this combination of outcomes-driven disease management with wellness and prevention programs puts Healthways at the vanguard of whole population health management," said Joe Coughlin, PhD, founding director, MIT AgeLab. "This approach looks more like what I -- and many others -- envision as the future of healthcare."
For the Gemmatos, the future of healthcare has become part of daily life -- and one that has improved their lives immeasurably.
"I was skeptical at first," says Joseph Gemmato, of the Silver Sneakers program. "But when you start to get old, you've got to move around, and this has really made a difference for Carmella and me."
For the past quarter century, Healthways (NASDAQ: HWAY) has provided specialized, comprehensive Health and Care SupportSM solutions to help people maintain or improve their health and, as a result, reduce overall healthcare costs. Designed to provide highly specific and personalized interventions for each individual in a population, irrespective of health status, age, or payor, Healthways' evidence-based and proven services are made available to consumers by phone, mail, internet, and face-to-face interactions and are offered both domestically and internationally. As the recognized industry leader in the provision of health and care support programs, Healthways today provides services to nearly 2.5 million individuals worldwide.
Predicated on the fundamental belief that healthier people cost less, Healthways' programs are designed to help keep healthy individuals healthy, mitigate and retard the progression to disease associated with family or lifestyle risk factors and promote the best possible health for those who are already affected by disease. Further, Healthways' extensive and fully-accredited complementary and alternative provider network offers convenient and comfortable access to the significant number of individuals who seek health services outside of the traditional healthcare system.
615.263.7524 (o), 615.294.4771 (cell)
615.263.3571 (o), 615.627.7755 (cell)