As health care costs rise due to increasing rates of obesity and chronic disease, preventive care is becoming a hot topic. How does fitness fit in?
Matt Grindstaff stopped smoking in 1998. He attends his work's onsite gym three to four times a week, walks with coworkers over his breaks and lunch hour, and stays current on regular checkups at the doctor. The result? He has taken fewer sick days since increasing his activity level.
“Catching health issues early reduces my health care costs,” says Grindstaff, a 35-year-old business analyst at Anthem Blue Cross Blue Shield of Colorado. “Since I exercise a lot, I now have to watch the amount of junk I eat, and I could never go back to smoking now that I'm active because it gets in the way of the fun things I now do.”
Anthem Blue Cross Blue Shield of Colorado, which is also Grindstaff's insurer, largely supports his active lifestyle. Anthem initiated walking clubs that reward employees for hitting weekly mileage goals, and the Colorado office has an onsite gym with group exercise classes and personal trainers.
Wellness programs and initiatives such as Anthem's are becoming more common as rates of obesity and chronic disease continue to rise. More than 60 percent of American adults don't get the recommended amounts of physical activity, and the majority of the U.S. population has a poor diet. It's no wonder health care premiums have risen 87 percent since 2000, according to the Henry J. Kaiser Foundation. The average annual premium for employer-sponsored insurance coverage is $4,242 for individuals and $11,480 for families.
The fitness industry is poised to help lower those numbers. The Centers for Disease Control and Prevention estimate that increasing physical activity levels among the more than 88 million inactive adults in America has the potential to reduce medical costs by $76 billion a year.
“The situation keeps getting worse on every level,” says Helen Durkin, vice president of public policy for the International Health, Racquet and Sportsclub Association (IHRSA). “You keep hearing things like Starbucks pays more for health care than for coffee beans, and you have a lot of pressure coming from businesses saying that something has to change. The climate is increasingly better all the time for activity and the health club component.”
The ways that fitness facilities can help are practically limitless. Some health clubs work one-on-one with insurance companies via reward programs. Others participate in physician-referral programs, and some facilities bill their services to members' respective insurance providers. Some club operators offer programs to support weight-loss efforts or increase the activity levels of children. Manufacturers are helping, too, by producing software programs that track health markers and members' fitness progress.
These efforts are all pieces to the puzzle, Durkin says.
“Certainly there are programs out there, and there are more all the time,” she says. “The good news is that there's a few competing models for which way this whole thing could go, and that gives clubs more options.”
Two large health club chains offer examples of the benefits of reward programs. Life Time Fitness, Eden Prairie, MN, has teamed with Medica, a health insurance company headquartered in Minneapolis, for a rewards program in which participants receive a $20 monthly credit from Medica toward their monthly membership dues as long as they exercise at least eight days per month at their chosen Life Time Fitness center.
Life Time Fitness members who had a financial incentive to exercise regularly decreased their average claim cost by more than 33 percent on a per member, per month basis, according to a two-year study released by Life Time Fitness and Medica of 3,249 Life Time Fitness members. (For more study results, go to www.fitnessbusinesspro.com/mag/LifeTimeResults.) The study's results are encouraging, says Glen Gunderson, vice president of the business-to-business division at Life Time Fitness.
“Through the innovative partnership we started with Medica in 1999,” Gunderson says, “we have demonstrated that people who decide to make a positive change in their lives through regular exercise and sound nutrition not only are healthier but also achieve real, quantifiable financial benefits, both as a result of the membership dues credit they receive and through reduced health care costs paid either by their insurer or out of their own pockets.”
Spectrum Athletic Clubs, Los Angeles, is also finding financial success by working with an insurance provider. The club, which has 12 facilities in Southern California and 10 in San Antonio, partnered with insurer Humana Inc. and a rewards program provider. The program, Health Miles (similar to reward programs that airlines offer to regular customers), has helped increase Spectrum's revenue by $40 million in three years, Matthew Stevens, CEO of Spectrum Athletic Clubs, told Club Industry's Fitness Business Pro in May.
Enrollment in the program doesn't require membership to Spectrum, but Health Miles members who are not Spectrum members or employees of corporations participating in the program pay $20 per month to participate. Rewards for exercising include gift cards or free personal training sessions. The companies plan to roll out the program to other clubs soon.
While some club companies are creating an insurance and fitness partnership, other clubs are finding working with health care providers is difficult, especially when it comes to reimbursement.
Greg Mack, 2003 IDEA Personal Trainer of the Year and CEO of Physicians Fitness in Columbus, OH, has three club locations: a stand-alone private facility, a facility located within an outpatient physical therapy office and a location inside a local health club. Mack created his facilities with an atmosphere similar to a clinical setting because his clients felt more comfortable there than at a traditional club. However, because he's a non-licensed provider of health services, Mack says he's never been able to receive insurance reimbursement for his work.
“Even licensed providers have a hard time getting paid,” he says. “Every doctor has told me to avoid accessing the system. The overhead equipment required to just connect yourself to it is ridiculous.”
Mack even tried hiring medical doctors and billing under them, to no avail.
“The amount of reimbursement is so low,” he says. “There are too many fingers in the pie, and by the time the money is divided up, there's not a lot of profit left.”
Randy Cook, founder and CEO of Excel Health Associates Inc., also has not been able to bill services to insurance companies. The management company has operated the Hancock Wellness Center at Hancock Regional Hospital in Greenfield, IN, for seven years. Many of the center's members are referred to the program from their health care provider.
“Although we have fully credentialed physical therapy, we are unable to bill [using] CPT or ABC codes,” Cook says. “In fact, in Indiana, a well-known insurance provider does not allow physical therapy for any diagnosis for pain. It's more fiscally fit for them to just deal with it or accept [prescriptions] for medication.”
ABC billing codes have been developed for personal trainers by ABC Coding Solutions (formerly Alternative Link). The codes include 15-minute in-office personal training assessments and 120-minute work conditioning exercises. Some fitness organizations have been interested in the new codes, although the company doesn't track how many facilities use the codes, says Michael Mullen, legislative research director for ABC Coding Solutions.
Insurance billing in fitness facilities is probably in its infancy, Durkin says.
“Health care varies dramatically from state to state, and it's so complex,” she says. “Unfortunately, preventive health is not true religion, but it's usually a benefit that comes from the marketing department of insurance companies.”
“It works great when an insurance carrier can help an employer reduce coverage or benefits while using a fitness membership as a balance,” he says. “And while the insured gets the opportunity to help lower the health risks for the insurer, it's the fitness facility that is paid 30 cents on the dollar for the program.”
The fitness industry is doing more than just working, or attempting to work, with insurance companies. Clubs are also reaching out to external organizations.
In May, a new coalition of lawmakers, health care groups, pharmaceutical companies and health-related organizations (including IHRSA and the YMCA of the USA) formed to develop the Collaborative Campaign to End Obesity. One of the legislative priorities at the National Summit on Obesity Policy was to require insurance coverage for the prevention, screening, diagnosis and multi-treatment programs for obesity that are coupled with measurement of health outcomes. The coalition also seeks the establishment of diagnosis codes and the requirement of insurance coverage to prevent obesity.
Another group, the Partnership to Fight Chronic Disease (PFCD), also looks to address rising health costs. The national bi-partisan group of patients, providers, community organizations, business groups and health policy experts seeks to decrease the number of Americans with chronic disease through the education and promotion of prevention efforts such as exercise. Joe Moore, president and CEO of IHRSA, is a member of the advisory board for the PFCD.
“We must create a national environment that supports health — long before illness sets in,” Moore says. “That means good nutrition, diet and exercise, and preventive screenings and care. And it means access for all Americans to the tools that allow for healthy lifestyles.”
The fitness industry has also been a strong supporter of recent legislation. In May, clubs rallied on Capitol Hill for the IHRSA Legislative Summit that involved nearly 200 meetings about the Workforce Health Improvement Program (WHIP) Act and the Personal Health Investment Today (PHIT) bill. The WHIP Act would allow for the balanced tax treatment of health club memberships as an employee benefit, allowing employers to deduct the cost of providing health club benefits to their workers and excluding the wellness benefit from being considered additional income for employees. The PHIT bill would expand what can be paid out of a person's pre-tax health investment account, including health savings accounts, flexible spending accounts and medical savings accounts, to include the cost of fitness programs and exercise equipment. Both pieces of legislation are ongoing, but Durkin says the level of responsiveness on Capitol Hill is better than ever.
“While everybody may have a different slant on what health promotion is,” Durkin says, “I've yet to meet anyone in the industry who really doesn't believe in the industry as the solution to the whole world's health problems, not just the country's.”
Anthem's Grindstaff sees the payoff — more energy and less time spent sick. It hasn't hurt his pocketbook, either.
“The benefits of the wellness measures I'm taking directly affects the money I have in my wallet,” he says, “and if that isn't incentive enough to maintain this lifestyle, I'm not sure what is.”
How to Get Involved With Preventive Care
Contact your local insurance providers. Programs vary from state to state and even city to city, so see what your area's insurance companies offer and how you can help.
Hire a full- or part-time person to lead your facility's preventive care efforts and work with insurance companies and local employers.
Get involved with your state and city wellness initiatives.
Measure your results. The medical community wants to see markers of health. Track your members' BMI and weight, along with blood pressure and body fat percentage.
Know the lingo. Take courses or buy books on how the medical system works. Once you know how to communicate with doctors and other medical professionals, they'll be more likely to work with you.