The Time and Money To Find Health - Mayo Center for Innovation - Healthcare Design

The Time And Money To Find Health

Post Written By Pritpal S Tamber

Finding new business models takes time. And time is money. How much time and money might we need to turn health into a sustainable business that might offset the growth of the sickness industry that we call ‘health care’? No one really knows but in Michigan the Chelsea-Area Wellness Foundation has a cool US$25m to experiment with. I was lucky enough to speak with its Executive Director, Amy Heydlauff, about their vision to make their Midwest community eat better, move more, avoid unhealthy substances, and connect with others in healthy ways.

Pritpal S Tamber: How is it that you have such a well-endowed wellness initiative in your area?

Amy Heydlauff

Amy Heydlauff: In 2009 our local community hospital merged with a large hospital system. During the merger the Board of the community hospital felt an obligation to leave in place some kind of entity that would think about the health and wellness of the population it served. As part of the negotiations, the hospital system agreed to establish a US$25m fund that could operate independently of the hospital system. And so the ‘Chelsea-Area Wellness Foundation’ (CWF) was born. It serves five towns in southeast Michigan and its mission is to create a culture of wellness and sustainable improvements in health.

PST: Wow. That’s a sizable chunk of change! What a unique position to be in. So how does the Foundation know what the people in the five towns want?

AH: We ask them. In 2010 we helped the towns build ‘wellness coalitions’. We invited representatives from local government, schools, libraries, senior and service groups, churches, health care providers, and others to represent their demographic on a coalition. The first order of business was to empower them to take responsibility for their own community’s health. Then we worked together to hone a process for each of the towns to develop an annual wellness plan. The steps in the process are:

  1. They review any available data that demonstrates local health and need
  2. They then determine how those needs are currently being met in the community
  3. If there are needs not being met people within the coalition develop ‘interventions’ which they pitch to other members of the coalition; the interventions that the coalition jointly agree upon make it into the town’s wellness plan, including their costs
  4. The wellness plan is then sent to a committee within the CWF for review
  5. The committee sends feedback and the coalition finalize the plan
  6. Representatives of the coalition present the plan to CWF’s Board of Directors who decide whether to approve it or not

By the time the wellness plans are presented to the Board of Directors they’re in good shape so, to date, all plans have been approved. As soon as the plan starts being implemented the process for the upcoming year’s plan is started.

PST: That’s a neat process. So how do the area coalitions ensure they have all sectors of the community involved?

AH: Generally, representatives are eager to populate the coalitions because they have a passion for their constituents and health. But in some communities there is a challenge with one sector or another. Coalitions identify who else they want at the table and we work with them to find a representative. If no one from a sector is willing to serve we work around them. It isn’t ideal but you work with whoever is willing.

PST: Sounds like it can get difficult. Tell me, though, what do you do if the town coalitions want something that doesn’t quite fit in your four areas of focus?

AH: Umm. That actually happened in the very first year. One community wanted skills training to improve their employment prospects but this doesn’t fit into our vision. We suggested they write it into their wellness plan anyway, since it was a legitimate need in their community, and promised to help them find other sources of funding for it. That way we can help, but not directly with cash. We do, however, believe that some of what we fund improves economic conditions and employability for some citizens. For instance, the group counseling that we fund likely contributes to a person’s ability to get and hold a job. It’s subtle and anecdotal but I have been told by a representative of a coalition that its very existence, and the resulting unity in the community, has created a greater sense of self which is contributing to a rise in community confidence and energy.

PST: Indirect and subtle are two words I always hear about the value of wellness. Anyway, how do you know if any of these wellness plans are working?

AH: We think it will be at least twenty years before we can demonstrate real reductions in chronic diseases like heart disease or diabetes. In the short term we look for changes in behavior for which there are four sources of data:

  1. The Behavior Risk Factor Surveillance System operated by the Centers for Disease Control and Prevention
  2. The  Healthy Youth Survey from which we gather data on the rates of substance use amongst local youth.
  3. The Michigan-wide Promoting Active Communities Survey
  4. And the Michigan-wide Nutrition Environment Assessment Tool

Each coalition is required to measure impact of its individual interventions, although resources aren’t expended on scientifically valid measure of the interventions.

PST: That seems like an odd thing to say. Why aren’t you investing in more valid forms of measurement?

AH: We use the above, validated sources of data to track the long-term health of the communities and their environment, overall. But evaluation is expensive and our volunteers don’t generally have the capacity to engage in scientific data collection and analysis. We ask those that pitch individual interventions to have an evaluation plan but they we tend to focus on things like participation rates, pre and post-tests, BMI or some other simple, affordable measure volunteers can manage.

PST: Interesting. Ok, so how do you pull all this data and information together?

AH: I wouldn’t say we have it all together, yet. We’ve adopted a collective impact model, which we’ve adapted to meet our local circumstances. The Foundation serves as the backbone organization, the entity that tries to pulls all the data together. Every day presents an opportunity to learn how to do this better. One thing I’m certain of, though, without a backbone organization we couldn’t do what we’re doing. And that backbone better not have ego because you have to be able to graciously cede decision-making and credit to the constituents. At the same time, community members who take time out of their real lives to serve, don’t have the capacity to keep the process moving forward without substantial support. That’s why a backbone organization is critical.

PST: While this is a great local story its uniqueness makes me think it’s hard for other to learn from it. I mean, without an initial US$25m windfall how can others copy what you’re doing?

AH: Pritpal, we recognize our unique opportunity. That’s why we’ve been ambitious in using our money to create town coalitions, wellness plans, and the whole approval procedure. We want to experiment, innovate, work out what works so that other communities can learn from what we’ve tried and then adopt and adapt the lessons to their circumstances. The fact is, though, most of the interventions pitched by our coalitions are  inexpensive to implement. The real assets are the people willing to champion and implement them. Good and committed people can be found everywhere.

PST: Ok, fine, but surely for wellness to become the norm we need to find ways to sustain it, especially financially. I’m not sure you’ve got anything anyone can really ‘adopt and adapt’ for that yet, do you?

AH: Not yet but we believe culture as well as money is critical for sustainability. One driver of economic feasibility will be through grass roots organizations. If there are enough of them, thousands of them, perhaps hundreds of thousands across the world, the market won’t ignore those kinds of numbers. Somewhere along the way the ground swell will become large enough that the market will hit upon a way to capitalize. I wish I had a more concrete answer for you. If we hit upon it in our work I promise you’ll be one of my first calls.

PST: One of? Surely, the first! Only joking. It’d be great to touch base again as you start to dream up and test new business models. I can’t help feeling it’s an important part of the journey for this whole space.

AH: It is truly my pleasure, Pritpal. Those of us in our little part of the world are watching your work, closely.  Best of luck.

While Amy watches the work of the Creating Health Collaborative, we, paradoxically, will be watching them. For all the growing rhetoric about creating a ‘culture of health’ few are thinking about sustainable business models and even fewer have the capital to experiment. The Chelsea-Area Wellness Foundation is uniquely placed to do both but it will have to enhance how it measures success for other communities to ‘adopt and adapt’ what they learn.