St. John’s Medical Center is in the process of changing its name to St. John’s Health, paving the way for a more holistic, preventative approach to health care.
“I’ve always told people doctors are horrible behavioral modification specialists,” said St. John’s CEO Dr. Paul Beaupré in a phone interview. “We can’t even get people to stop smoking!”
Regardless of where doctors stand with that ability, St. John’s is working toward behavioral change in its patients – and doctors – with its name and mentality shift.
Chronic disease is a big problem in Wyoming. Even in a perceived “utopia” like Jackson Hole, where most people seem fit and lively, it sneaks in and causes problems.
As of 2013, 60% of Wyomingites died from a preventable chronic disease: heart disease, chronic respiratory disease, stroke, diabetes or cancer. This according to Joe Grandpre, chronic disease/maternal and child health epidemiology unit manager at the Wyoming Department of Health.
The Partnership to Fight Chronic Disease said that as of 2015, 330,000 people in Wyoming – about 56% of the population – had at least one chronic disease. And more than a third of those people – 128,000 – had two or more chronic diseases.
Besides the lost lives that stem from the ill health, chronic disease comes with a massive economic and socioeconomic cost. From 2016 to 2030, Wyoming costs associated with chronic disease will soar to $74 billion. That breaks down to $3.5 billion in direct medical costs and $1.4 billion in lost employee productivity every year.
Making matters worse, Wyoming’s gross domestic product in a state with fewer than 600,000 residents only amounts to $39.3 billion. That means that about 9 cents of every dollar earned in Wyoming is going toward chronic disease costs.
As St. John’s Medical Center transitions toward St. John’s Health, it’s taking an approach to health care that might just change all that.
An ounce of prevention …
Julia Heemstra is the director of the wellness department at St. John’s. Shortly after her phone interview with the Wyoming Business Report, she was hopping a flight to the American College of Lifestyle Medicine’s annual lifestyle medicine conference in Orlando, Florida. More than 1,000 physicians were expected to attend.
Topics at the conference covered a wide array of subject matter: Gaining visibility for a lifestyle medicine program that helps practices tweak their messaging and find platforms for sharing the lifestyle medicine message. Taking care of yourself as a physician to avoid systemic burnout and the negative attitudes that lead toward practitioner suicide. Reversing Type 2 diabetes and insulin resistance with lifestyle interventions, since studies have “conclusively shown” it’s a largely reversible disease, especially early on. Changing a reactive medical system to a personalized, proactive and patient-driven version.
As wellness director, Heemstra is tasked with creating the systems the hospital will use to take a more holistic approach to health. And in doing so, she takes into account the things she learns at conferences like this, even guinea pigging the programs on hospital employees.
One such program, Beaupré said, was called “Liberate the Couch.”
“We paid employees to participate in the program to motivate them to do these things,” he said. The results? Decreased body mass and lowered hemoglobin A1c – the key indicator for prediabetes and diabetes.
That, Beaupré said, is why the hospital is using someone like Heemstra to change the whole hospital’s focus to more of the preventative side of medicine, instead of the reactive side.
“The movement toward lifestyle medicine is trending nationwide,” Heemstra said. “We’re on the cutting edge by launching our own program here in January.”
The program seeks to address behavioral change in a way that reactive medicine has never been able to address well enough. Heemstra is bringing in “true wraparound specialists” like certified wellness coaches, dieticians, physical therapists and more to sustain the mentality shift behind the name change toward St. John’s Health.
Lifestyle medicine, Heemstra said, looks at the fact that an astounding 86% of all medical costs are directly linked to lifestyle choices like sleep, connection, purpose, exercise, diet and the like. And then it tries to break apart the foundations of an unhealthy lifestyle for patients before those costs ever come into play.
In practice, this treats the underlying problems causing disease, rather than medicating the symptoms. One woman approved for geriatric surgery opted instead for the lifestyle medicine equivalent, Heemstra said. The Journal of the Royal Society of Medicine pointed out that geriatric surgery tends to be about disease, rather than age. People in line for such surgeries aim to improve their quality of life and the length of their life through the surgeries.
But lifestyle medicine can think past the need for surgery. Instead of surgery, this patient lost 70 pounds, reversed Type 2 diabetes by cutting her blood sugar levels, and is now enjoying “her highest quality of life ever,” according to Heemstra. All without the need for invasive surgery.
“We have some incredible success stories,” Heemstra added.
The mindset shift
Currently, most people view a hospital as a last resort – a place to get fixed when you’re sick or broken, Beaupré said.
“Lifestyle medicine emphasizes choices you make to prevent long-term diseases,” Beaupré said. “That really resonates with us.”
But that no longer fully defines the hospital. In fact, hospital may even be a misnomer in the coming years.
“Now a big part of who we are doesn’t necessarily see itself as a hospital,” said Chief Communications Officer Karen Connelly. “Our wellness clients and the whole community we work with on wellness don’t see us as a medical center. We have evolved, and it was just time to indicate who we are and [put our name] in sync with what we are doing.”
To arrive to this point, St. John’s has undergone significant testing and studying. Community-level focus groups. One-on-ones with community leaders. External and internal research that was both quantitative and qualitative.
“Once we did the research, we developed an internal brand platform to drive some of the decisions made,” Connelly said. “We know what makes us unique and valuable; how do we express that?”
Though medical practitioners have long known the ingredients for a healthy lifestyle – things like diet and exercise that don’t require surgery – physicians have always lamented their inability to cause the mindset shift that brings about positive change for patients.
“If it were easy, we’d all be walking along fit and well,” Connelly said. “Our lifestyle medicine program looks at how we deliver care, resources and support for people that could benefit from having lifestyle changes. That’s not part of how traditional medicine has worked.”
The shift the hospital hopes to see in the future is one driven by a desire for change – before it’s too late.
“The diabetic that shows up in the ER is not good for the hospital, the patient or the patient’s employer,” Connelly said. “It’s a win across the board to have a strong wellness program and be healthy enough as an organization to invest in these services.”
According to Beaupré, the CEO of St. John’s, the shift will refocus the hospital’s energies on partnering with the community to journey toward greater health. It’s a challenge often overlooked in a community seen as fit and healthy overall to the point of being the healthiest county in the state and one of the healthiest in the country.
But that status also has a marginalizing effect on the people who don’t fit the Jackson Hole norm.
“Part of our role as a provider of health for the whole community is getting people out of a depressive state and getting them back into functional stage where they adhere to a diet or do a simple exercise program,” Beaupré said.
But that’s a hurdle for the hospital, since only intrinsic motivation can provide a lifestyle medicine cure.
“That’s an individual process, and we can’t enforce that on anyone,” Heemstra said. “It needs to be a voluntary program, because intrinsic motivation to change is more powerful than extrinsic motivation.”
Leading the horse to water, and getting it to pay
But Beaupré said it’s “hard to get the horse to the water,” even with the new tools and techniques the hospital is using. Currently, anyone who comes in for a wellness screening as an outpatient or at a primary care clinic run by St. John’s gets a mental health screening, as well.
“We’ve found a significant amount of people looked functional in society with depressive symptoms,” Beaupré said.
The shift toward lifestyle medicine is about a year and a half old at this point, Beaupré said. It currently is a cash-based system, skirting the insurance system for now that could potentially cut 86% of its costs through preventative medicine.
“Reimbursements are really starting to move in this direction,” Heemstra said. But they’re not there yet. So currently, the hospital provides scholarships for anyone with the motivation to make the lifestyle changes.
“We have never turned anyone away because they can’t pay,” Heemstra said.
Beaupré thinks the reimbursements will come as data backs up what St. John’s Health is already beginning to find anecdotally. He said that preventative treatment for hypertension and Type 2 diabetes are behind the curve of something like smoking that was studied for ages before people realized that yes, it caused lung cancer. And yes, cessation allows marked improvement for anyone.
The Centers for Medicare & Medicaid, Heemstra said, are starting to engage in the lifestyle medicine conversation. And where they go, Heemstra said, other insurance companies will follow. And once reimbursement plans are in place, more hospitals like St. John’s are likely to shift in that direction.
Maybe even with name changes of their own.
“We want to make this more than just a name change,” Beaupré said. “Lifestyle medicine seems like a really good fit as we evolve on the journey, but we’re young in this.”