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Exercise Centers Are a Good "Fit" For Primary Care Clinics

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By putting health coaches in the role of physician extenders and utilizing sophisticated information technology to guide and monitor workouts, VisionBridge has created a turnkey medical fitness model that makes safe exercise accessible to people with medical conditions while creating new revenue streams for primary care. Photo courtesy VisionBridge.

A growing number of primary care doctors are discovering that onsite exercise centers are a good "fit" for their patients' physical health, and for their own fiscal health.

Thanks to a sophisticated, turnkey model called Integrative Health Network (iH3), many more doctors will soon be able to bring exercise centers into their practices. The iH3 model builds bridges between clinicians, patients, and fitness coaches, and makes safe medically-guided exercise accessible to people who might never set a sneakered foot in a commercial fitness club.

The iH3 concept was developed by Dan Lynch, founder and CEO of VisionBridge (www.thevisionbridge.com), a medical fitness company drawing on over 30 years' experience implementing fitness centers in hospitals and clinics.

A key feature of iH3 is that it puts credentialed fitness coaches in the role of physician extenders. Not only do coaches assist patients with exercise, they can also monitor adherence with medical therapies, teach stress management, give nutrition guidance, gather vital signs like blood pressure, body mass index, finger stick glucose and lipid measurements. In short, they can do a lot of the ancillary, relationship-building that, sadly, has been squeezed out of primary care.

The coaches are health educators, exercise physiologists and clinical nutritionists, who receive special training in how to interface with physicians and other medical professionals. "Fitness instructors can see so many more patients per day than can a doctor," said Mr. Lynch, noting that some centers he's built serve more than 1,000 clients per day.

Smart Machines, Safer Workouts

The other cornerstone of the iH3 model is a radiofrequency identification (RFID) system that enables doctors to encode specific exercise programs onto each patient's "Smart Key." The patient then uses the key to program state of the art exercise machines made by a company called TechnoGym (www.technogym.com). The data on the key sets the machines for the right number of reps, tensions, weights, calorie burn targets, speeds and run times.

The system also records a host of patient vital signs and biometrics as they work out, and these are fed back to the doctors. One can quickly amass a large volume of data to track each patient's progress, and guide further therapy.

"The goal is really to help patients practice good health habits, which include exercise, smoking cessation, careful management of pharmacotherapy, good nutrition. We also want to track improvement. With this technology, we can connect directly to the patient's electronic medical record and/or provide paper reports. It all feeds back to the doctor," Mr. Lynch told Holistic Primary Care.

Flexible Options; Healthy Revenue

An iH3 fitness center can create a strong monthly revenue stream for prevention-minded primary care doctors. Patient-members pay a monthly fee, which is on par with or often lower than fees at boutique health clubs. Because it is a purely retail business in the sense that neither patient nor physician bills 3rd party insurance, the fitness centers are not subject to Stark regulations. These laws, prohibiting self-referral, only apply to reimbursed services.

VisionBridge has flexible business platforms: in one arrangement, a physician or physicians' group can own the iH3 center outright, whether part of their main clinic or at a free-standing site. VisionBridge, functioning as a partner, provides the TechnoGym machines, RFID technology, marketing and management guidance, and training for fitness coaches.

In other cases, VisionBridge holds the real estate, and the physician or group practice operates as a partner providing medical oversight and patient care. The iH3 model can work as well for risk-averse doctors as for entrepreneurial risk-takers. For solo and small group practices, the earning potential is great. "If a group of 5 doctors is seeing 2,000–5,000 patients, you can easily fill a fitness center with several hundred patients paying anywhere from $40–85 per month, depending on your location and patient base."

Before opening a new center, VisionBridge does a lot of outreach to local physicians, letting them know the new medical fitness center is on the horizon and soliciting referrals. Later they market directly to the public. "We can often pre-sell 1,500–2,000 members before a center opens." He added that 70% of those who join medical fitness centers are first-time gym joiners; most come via referrals from other physicians.

Mr. Lynch said the core idea for this model came to him while working in Mobil Oil's medical department, where he designed executive fitness programs utilizing what was then cutting edge NASA technology for heart rate-guided exercise. Since the late 1990's, he's built and marketed18 medically-integrated fitness centers in hospitals. The goal is two-fold: to generate fresh revenue for beleaguered community hospitals and clinics, and to make physician-guided exercise medicine available to elderly, impaired, and high-risk people who would never join their local Equinox club.

"There's People to Help You …"

Angelo Mallozzi, MD, is a primary care doctor based at the Stanford Hospital, in Connecticut. Several years ago, the hospital opened the Tully Fitness Center, designed and implemented by VisionBridge. Tully is a hospital-based version of the iH3 clinic model. It offers everything from cardiac rehab and comprehensive strength training, to spin classes and yoga, and logs in about 200,000 patient visits per year, returning roughly $1 million to the hospital.

Dr. Mallozzi, who does not hold a financial interest, estimated that about 10% of his patients now work out there. "I recommend it to all my patients who have issues like diabetes, high cholesterol, obesity. I also tell them to take advantage of the lectures. The ones who go tend to do well," he told Holistic Primary Care.

"If we just put more dollars into prevention, not just disease care, we'd save a lot of money, and that could be re-invested in more promotion of wellness and health. I'm hoping the Obama administration will take a serious look at this."

On a crisp December afternoon, the gym downstairs from Dr. Mallozzi's office was humming with clients many of whom were clearly dealing with significant health challenges. Liz, a retired nurse in her 70s, who struggles with pulmonary problems, and works out regularly at Tully, said she feels reassured by the Center's coaches, and the fact that her doctor stays abreast of her workouts.

"I wouldn't go anywhere else. I've been to other places before, and I would often hurt myself, because there was nobody to guide me. Here, they have everything. There's people to help you, and your doctor knows everything you're doing."

Beyond inertia, the biggest hurdle for many patients is cost, said Dr. Mallozzi. Tully charges $82 per person per month. While that's less than many commercial gyms, it is still beyond the budget of many poor, elderly, and health-challenged people who could really benefit from regular, guided exercise.

Bringing Fitness to the "Corridor of Shame"

Mr. Lynch said he's well aware of the financial barriers to exercise medicine, and he's actively working with public and private sector partners to subsidize clinic-based iH3's in some of the country's poorest, sickest communities.

VisionBridge recently obtained roughly $9 million in special Treasury Department loans earmarked for development in poor, rural areas. The money is funding new IH3's around Lake City, SC. The town is located in the Pee Dee River valley, known to some as the state's "Corridor of Shame," for its staggering rates of poverty, obesity, diabetes, heart disease and early death. The majority of Lake City residents are poor, under-educated, and under-employed. They have little access to health care in general, let alone fitness centers or wellness clinics.

"We're the home of the high-salt, high-fat barbecue pork stand, and we have the highest stroke incidence in the US. About 800,000 of the 4 million people in this area are uninsured, and another 800,000 are on Medicare or Medicaid," said Albert Mims, MD, who's practiced comprehensive primary care in Lake City for nearly 30 years. He will head the new IH3 center currently under construction, and slated to open in November. Two others will follow in 2010.

Dr. Mims hopes the centers will become hubs for low-cost, high-return preventive medicine among people at very high-risk. It's the precise approach that health insurers and policy makers so often advocate but so seldom fund. He and his colleagues will collect heaps of outcomes data, in the hope of convincing state Medicaid officials to pay for this kind of fitness program.

The Lake City team is also working with the local IGA grocery stores on a corporate wellness plan for employees, as well as a consumer education program in the stores. The latter involves a simple food labeling system from A (fresh produce, whole grains, minimally processed foods) to F (high-fat, high sugar, junk foods). The goal is to teach people to eat more "A," and less "F." iH3 fitness coaches will reinforce this message as they work with patients.

The iH3 team is also working to create local farmers' markets and encourage consumption of fresh, local produce. "Much of the land down here is agricultural. Local food is much healthier and should be much cheaper. We just need to get the people eating more of it," said Mr. Lynch.

Down-Home Healthcare Reform

Dr. Mims sees the iH3 model as an opportunity for primary care doctors to once again become patient advocates. "Managed care wants us to be gate-closers, not gate-keepers, and this created an adversarial role with patients rather than an advocacy role. We should be their advocates all through the healthcare system," he told Holistic Primary Care.

He also sees it as a way for doctors to be proactive about changing health care, a grass roots healthcare reform of sorts. "I don't think we can leave it to insurance executives to fix it for us. About 42% of every premium gets diverted into reserve funds, high management costs, or payout to stockholders. They have no incentive for prevention. They just pass the buck until it gets to Medicare. It's a mindset we really need to change."

Mr. Lynch said he is trying to interest corporate leaders in making iH3 centers part of employee wellness programs; he hopes to put "WorkWell" fitness centers in industrial parks. "For every dollar a company invests in wellness, there's a $3 return. It's great for self-insured companies."

VisionBridge is part of a broader exercise medicine movement. The Medical Fitness Association (www.medicalfitness.org), the American College of Sports Medicine (www.acsm.org), and Harvard Medical School's Institute of Lifestyle Medicine (www.instituteoflifestylemedicine.org) are trying to move fitness from the periphery to the center of the healthcare dialog.

VisionBridge is among a number of companies actively promoting clinic-based fitness models. Among them are: Power Wellness (www.powerwellness.com); Healthtrax (www.healthtrax.com); Healthplex Associates (www.healthplexassociates.com), and Five Star Unlimited (www.fivestarunltd.com).

Mr. Lynch says he sees a bright future for iH3 clinics, and the doctors who quarterback them. "I can envision hundreds of these. They're small and easily reproducible. It's not rocket-science. It's a template that can be recreated in many places." He is already scouting future IH3 sites in other parts of South Carolina, Florida, North Carolina, Georgia and Virginia, but he is open to working with doctors anywhere in the US.

"Our interest is in ultimately creating networks of primary care doctors who have iH3 fitness centers, and to link them together, so they can learn from each other and share best practices."

For more information about iH3, visit www.visionbridge.com.

 

 

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