In Iowa, the Blue Zones Project has community buy-in
This year, employers plan to spend $521 per employee on wellness programs, up from $460 in 2011, to get employees exercising and eating healthier, according to Fidelity Investments and the National Business Group on Health. In addition, in January, the Patient Protection and Affordable Care Act will allow employers to offer employees up to a 30% incentive on the cost of their health coverage for wellness program participation.
Improving the health of a whole community population is more challenging than engaging health-plan members individually in wellness, but several large payers have undertaken ambitious community efforts to encourage healthy behaviors. Such wellness programs require collaboration with local governments, employers, schools and restaurants, and could benefit thousands of residents-even those who do not have coverage or pay premiums. Moreover, community wellness programs are long-term endeavors with outcomes that often cannot be measured after one or two years.
"It’s happened because of a combination of public policy, funding, employers, coaching, payer programs, and providers engaged in education."
-Barbara Ladon, Newpoint Healthcare Advisors
Regardless, payers are investing in community wellness programs because their leaders believe early evidence shows that over the long-term, community populations will be less costly overall.
“Another model that was multi-modal and successful over the long-term is smoking cessation,” says Barbara Ladon, managing director of Newpoint Healthcare Advisors. “We’re not talking about zero percent, but smoking has decreased at every age group. It’s happened because of a combination of public policy, funding, employers, coaching, payer programs, and providers engaged in education. That’s the kind of approach we’re going to need to tackle the big issues like obesity.”
One such community program, The Blue Zones Project, combined efforts of Wellmark Blue Cross Blue Shield, Iowa’s largest insurer, in partnership with Blue Zones founder Dan Buettner and Governor Terry Branstad, as part of his administration’s Iowa Healthiest State Initiative.
Buettner is an author and researcher who created the “Blue Zones” community-health model based on eight years of research in communities around the world where residents live comparatively longer healthier lives. His firm, Blue Zones LLC, and Nashville-based wellness company Healthways are working with Wellmark, policymakers, employers, schools, restaurants and individuals from Iowa cities and towns to become Blue Zone certified.
The program launched in 2011, and Wellmark conducted web seminars that attracted 800 participants, mostly from municipal governments. Leaders also visited four towns around the state to meet with residents, schools, business and government officials to talk about the changes required for such large–scale wellness participation.
Wellmark received Statements of Interest from 84 communities, which were narrowed to 18 demonstration sites-10 communities with populations of more than 10,000 residents and eight smaller communities.
In the Blue Zones Project, a certain number of stakeholders-schools, local restaurants, local grocery stores, workplaces, citizens, as well as the municipal government-must complete pledge documents describing what actions they volunteer to take to fulfill different criteria for Blue Zone certification. For example, governments are asked to improve streets for biking and walking, and restaurants are asked to offer healthier meal options. Likewise, schools pledge to remove junk food from vending machines-just one of the pledge choices among several included in the model.
In turn, Wellmark and Healthways are helping stakeholders overcome obstacles in developing and implementing the infrastructure, policy and social changes with technical and logistical support. The companies do not offer specific financial support, however.
Although only about a year into the project, many of the early demonstration sites in Iowa have made progress in completing their pledges and passing resolutions in local governments, says Sally Dix, Wellmark’s Blue Zones Engagement Manager. Crucial to obtaining community acceptance of the project was Wellmark’s ability to respond to the unique challenges of each town, says Dix.
“They all came to the Blue Zones Project with really different experiences,” she says. “Some are very strong with volunteer mobilization, while others are strong in policy and investment in environmental change, but may need more help with the engagement. One thing that benefits the Blue Zones Project is that many of the items that have to be completed are low or no-cost, but they do require time and community [collaboration].”
Although it is too soon to tout health outcome improvements, the state did move from 16th to ninth place in the 2012 Gallup-Healthways Well-Being Index, a state ranking based on life evaluation, emotional health, physical health, healthy behavior, work environment and basic access to healthcare.
Another statewide, but community-focused program is LiveWell Colorado(LWC), which is sponsored in part by the Kaiser Permanente Colorado. Founded in 2009 as its own nonprofit company, LiveWell Colorado is a spin-off of a separate grant-making organization focused on community health.
For LWC, Kaiser Colorado has partnered with the Colorado Health Foundation and the Colorado Department of Public Health and Environment, which target projects to increase healthier eating and physical activity. Also similar to Blue Zones, the program received endorsement from the governor and statewide interest with 24 communities participating to earn the “Healthy Community” designation.
LWC offers a funding mechanism to support local projects, such as helping school cafeterias learn how to prepare and supply healthier foods. To date, LWC has invested $2.5 million in the participating communities.
Kaiser Colorado, through LWC, also provides logistical assistance to stakeholders, which include local governments, on policy changes such as redesigning a city’s development plan for improved bicycle and pedestrian traffic and healthier grocery store options. Despite Kaiser Colorado’s access to national and local expertise, the company has discovered that listening to community leaders about their challenges with improving healthy behaviors has been most beneficial in advancing local projects.
Quarterly, LWC gathers the representatives from the participating communities to discuss and share lessons learned from local projects. Several community leaders have formed networks based on challenges unique to their area, such as public safety, for example.
“We don’t walk into communities tell them how to do it,’” says Jandel Allen-Davis, MD, Kaiser Permanente Colorado’s vice president of government and external relations. “These projects come out from these communities being at the table and identifying where and how they want to focus, which creates capacity that you can’t achieve when you walk in with the answer. You’ll not only get better buy-in, but ownership and accountability from the program if the community feels engaged and invested.”
While it is still a new concept, the results from several community wellness pilot projects have been encouraging to payers.
For example, a Blue Zones pilot project in Albert Lea, Minn., in 2009 increased residents’ projected life expectancy by 2.9 years, while employers in the city reported a decline in healthcare claims cost and a drop in absenteeism, according to Blue Zone. In a two-year community wellness pilot project by Humana in Bell County, Ky., “Team Up 4 Health,” 97% of participants improved on one of the targeted measures, while 90 percent improved on more than one measure.
Some wellness programs such as Blue Zones, LiveWell Colorado may seem risky. The companies MHE spoke with, however, say that incrementally changing environments, in the long-term, is a safe investment and are encouraged by the community response.
“Healthier communities are the path to more affordable healthcare,” says Dr. Allan-Davis. “Go into these projects with a sense that there is going to be an investment that a business has to make, but you also go in from day one thinking how will you sustain these projects. Sustainability is critical because otherwise all you’re doing is continuing to give handouts and you’re not giving folks a hand up.”
EmblemHealth covers 3.4 million lives, mainly in New York City. In 2012, the payer launched a hybrid care-coordination and wellness program called Neighborhood Care, which included opening two Neighborhood Care Centers in the boroughs of Harlem and Queens.
The centers, staffed with a registered nurse, behavioral health specialist and pharmacist, offer health guidance, referral assistance, medication support, and connections to government and social services, but they also offer wellness programs such as food shopping advice, exercise classes and farmer’s market sponsorships.
“We’re eliminating barriers,” says Dan Shur, EmblemHealth’s Director of Strategic Planning. “What we heard from consumers is that there’s no good food in their neighborhood, or they can’t afford $1 for an apple. So we partner with these organizations so they can get five apples for $1.”
Based on two years of market research with residents, community leaders, social service organizations, local physicians and their practice staff, the Neighborhood Care Centers serve all residents in the community, not just EmblemHealth members. Shur estimated that 25% of the more than 7,500 consumers who have visited the centers are not plan members, but receive an average 19 minutes of service.
EmblemHealth will measure the efficacy of the program through emergency department utilization, prescription fulfillment, hospital admission and readmission rate among members who visited the centers. The payer will also monitor its customer loyalty Net Promoter score on the centers, which, as of August, was charting 92%, according to Shur.
“The model that we’ve come across is resonating very strongly with people and they appreciate it,” Shur says. “It’s not just about their gratitude, but people taking better care of themselves. That’s the important part.”
To be certified a Blue Zone requires:
• At least 20% of citizens sign the Blue Zones Personal Pledge and complete one action.
• At least 50% of the top 20 community-identified employers become a Blue Zones Worksite.
• At least 25% of independently or locally owned restaurants become a Blue Zones Restaurant.
• At least 25% of public schools become a Blue Zones School.
• At least 25% of grocery stores become a Blue Zones Grocery Store.
• Each stakeholder needs to choose among certain pledge actions to complete to earn Blue Zone designation.