Lessons Learned About Population Health Management in the Gym

29 Sep Lessons Learned About Population Health Management in the Gym


running-manAs a hobby, I work as a personal trainer on the weekends. I work for a gym that runs a free introductory program that involves challenging members to “lose 20 lbs in 42 days”. Those needing to lose more than 20 pounds to get into the healthy zone may complete successive challenges. My long-term involvement in this program has revealed some interesting lessons which might be applied to Population Health Management.

Lesson Number 1: Skin in the game matters. Currently about 80% of those (thousands) who take the challenge succeed. To participate the “challenger” makes a deposit or “bets” about $500 that they can meet the challenge. Before the requirement of the deposit, the success rate was much lower!

The other day, as our current challenge completed, one of our challengers — who began his journey with more than 100 pounds to lose — did not meet one of his successive challenges.   As a result, after 24 weeks and losing around 80 pounds, he would need to make another deposit/investment to continue. I was deeply saddened to hear that he could not afford another challenge.

The next I heard, he was considering the alternative of gastric bypass because insurance would cover the procedure. I couldn’t help but think how flawed our system is that health coverage will pay for gastric bypass but not an effective weight loss program based on fueling and working one’s body. Of course, we would still have to solve the issue of needing “skin in the game”.

So what if an employer wanted to lower the incidence of absenteeism, presenteeism, diabetes, and high blood pressure? In essence, place a “bet” that this would reduce the company’s overall health costs? Could an employer effectively duplicate such a program, incentivizing its employee population with some monetary token to improve their numbers using targets like healthy BMI, blood pressure, cholesterol or other measures?

Lesson Number 2: It takes a village. The challenges run for a six-week period and people come in and out of challenges as a group. There is a private on-line group they can participate in and they are required to publically acknowledge their participation in the challenge as well as the workouts via Facebook posting. For some, this acknowledgement begins with embarrassment but ends with pride.   Hell YES, I worked out 30 times in the last 42 days and LOOK at what I was able to achieve. This creates a community – a group driven toward a common goal.

Clearly, it is easier to move toward a healthy lifestyle surrounded by those who also seek out the same. Again, could employers duplicate this type of support? Walking lunches? Mini cooking classes? Such a small expense, the potential benefits are large.

Lesson Number 3: People want immediate gratification. Success breeds success. The challenge runs for a set time-frame and the challengers bite off 20 pound goals at a time.

How many times have you lost a few pounds only to have an event throw you off track? The challenge works because the time frame is discrete, the results are noticeably fast and there is reward at the end of the rainbow.

Lesson Number 4: Keep it Simple!!  The program has a very narrow nutrition plan.

Sometimes in our desire to solve a complex problem, the solutions become so terribly complex. But knowing that obesity is at the heart of so many complex illnesses from diabetes to depression, could we not just start with diet and exercise?

Lesson Number 5: Moving your body is a necessity!! The program also requires that people attend a high intensity interval training (HIIT) class 30 of the 42 days of the program. Most HIIT programs can be performed with little to no equipment. Compliance can be tracked with a wrist band heart rate monitor.

I love this program and have seen the results of getting people back on track with their health. Some come and lose 20, some come and lose 100. Everyone makes new friends and builds relationships with people who are going after similar goals. The environment is incredibly supportive. I have seen people not need their CPAP machine anymore, be allowed to ditch diabetes and high blood pressure meds…..all in the space of 42 days. Okay, sometimes it takes 84 days, but you see the point. What a difference a couple of months can make.

As we talk population health and some of the “techniques” to engage, I continue to wonder what can be done to engage people to manage their own health? How can employers get involved? How can insurers get involved? How can there be a benefit for healthcare providers to be proponents of this strategy? Some of this must be financial.   We must find a way to create a need for people to manage their own health and have skin in that game!