Geriatrics/long-term care

Senior fitness program builds member loyalty

Physicians say it improves health, too

Gaining member loyalty is a challenge. It’s also essential to the success of Medicare risk and cost plans. Sometimes, the best way to gain that loyalty is to offer seniors programs that set your health plan a step above your competition.

That’s what health plan administrators say the Silver Sneakers senior fitness program developed by Health Care Dimensions in Tempe, AZ, has done for them. "We were looking for a benefit that would help assist in maintaining the health of our members and improve retention for us. Silver Sneakers seems to be doing both," says George Renaudin, vice president of government programs for Ochsner Health Plans in Metairie, LA.

Most of the data on the impact of the Silver Sneakers program is still filtering in because most plans only have offered the program for two years or less. However, some of the preliminary news has health plans very excited. In fact, the program has caught the eye of the Health Care Financing Administration (HCFA) in Baltimore as well. Health Care Dimensions is on the conference circuit, and it will share results of its SF-36 scores with HCFA in upcoming months.

Some of the results that have caught the attention of both health plans and HCFA include:

• 75% of Silver Sneakers participants are more likely to recommend their health plan to others than they were before participating.

• 64% of participants report that Silver Sneakers is a reason to stay with their health plan.

• 20% of participants say that the program is their main reason for staying with the health plan.

• Roughly 50% of Silver Sneakers participants have moved from an elevated risk category to low risk due to changes in their exercise patterns.

• 53% of participants improved their functionality, and 33% improved their clinical outcomes.

Kaiser Permanente Northwest in Portland, OR, recently received a grant from the Centers for Disease Control and Prevention in Atlanta to conduct a three-year study of health status improvement in Silver Sneakers participants and link those improvements to reductions in claims costs, says Swanson. But what pleases health plans most are the success stories they hear from members and their physicians.

"I went to watch one exercise class," says Renaudin, "and a member walked up to me and asked if I had noticed what he just did. I told him I was sorry, but I had missed it. The member turned to me and said, No, you didn’t miss it. You saw it. I walked over here to you. Six months ago I couldn’t have done that without a walker.’ He was so excited by his progress."

Physicians whose patients participate in the Silver Sneakers program notice marked improvements in overall and emotional health, adds Tom Janisse, MD, assistant regional medical director and liaison to health plans for Kaiser Permanente Northwest. "We have patients who tell us that since starting the Silver Sneakers program they experience less dizziness, they can walk up the stairs again, and their blood pressure has come down," he says.

"The comment I’d make as a physician is that those three improvements translate into fewer clinic visits, medications, and lab tests," he explains. "If a patient presented at the clinic with those three complaints, the series of tests and evaluations it would prompt would add up to significant health care expenditures. These patients start to take responsibility for their own health and that’s good for them and the health plan. Our physicians also report that patients who participate in the program are less depressed."

Keep ’em smiling

Health Care Dimensions contracts with local health clubs and then trains qualified exercise instructors to deliver the Silver Sneakers program. "We download the health plan’s membership information into a software tracking system and select clubs according to density of plan population," says Mary K. Swanson, BS, president and chief executive officer of Health Care Dimensions, a trained speech pathologist who founded the company. "We select clubs that provide access within five miles of home for 90% of the health plans members."

Health Care Dimensions evaluates about three times as many clubs as it adds to its network, she adds. "We look for health and safety standards but also the club’s willingness to serve the senior population. We try to select clubs with a good array of services that appeal to seniors, such as water exercise classes."

The Silver Sneakers program itself includes free health club membership and three levels of exercise classes designed especially for seniors. The seniors stay seated for most of the class, and exercises focus on improving balance, posture, strength, and range of motion — issues that are important for maintaining independence.

"I went on a tour of senior centers and asked seniors what they wanted," says Deborah Redder, BS, ACE, national director for instructor training for Health Care Dimensions, who designed the exercise program with oversight by physician consultants. "Most seniors told me that they weren’t as interested in improving their cardiovascular health as they were in living alone as long as possible. I heard comments like, Help me keep my driver’s license and stay in my house.’ To help seniors maintain an independent lifestyle requires we improve coordination and agility."

Before participating in the program, seniors must complete an activity readiness questionnaire and an SF-36 health risk assessment. "We work with the medical directors of each health plan. Some are more stringent than others and ask us to add an additional question or two to our readiness questionnaire," says Swanson. "If any risk factors are identified, seniors must receive approval from their physician to participate." For example, if a health plan member had experienced a major heart event in the past year, they would need physician clearance to participate.

"Instructors attend an eight-hour workshop. We want to make sure the program is delivered in a consistent and safe manner," she says.

Health Care Dimensions trains instructors to deliver the program. Training covers a wide range of issues in addition to teaching the instructors the exercises themselves, Redder says:

• helping seniors recognize perceived exertion;

• medications that may be contraindicated in terms of exercise;

• consistent and articulate range of exercises designed to improve ability to perform activities of daily living;

• maintaining a fun atmosphere.

"The element of fun is what keeps these seniors coming back. These seniors become a social club," says Renaudin. "We have one class that begins and ends each [session] with a song performed by four members who formed a barbershop quartet."

In addition to training program instructors, Health Care Dimensions trains a senior advisor for each health club facility. "These advisors are the link between the program and the health plan. They are there to respond to questions the seniors have about exercise, or any concerns seniors have about the classes. They are a component of our quality assurance efforts," says Swanson.

Quality control

Health Care Dimensions has local service representatives in each area it serves who visit clubs regularly. In addition, each Silver Sneakers instructor is audited on a quarterly basis, note Swanson and Redder. "The instructor evaluations are very objective and mechanical," says Redder, who called on her experience as an Olympics judge to design the instructor evaluation tool. "There are certain standards instructors must meet for each class — seven baseline competencies we measure." Those include:

• measure member heart rate intensity a minimum of three times per class;

• instruct members on postural alignment a minimum of three times per class.

In addition, Health Care Dimensions representatives evaluate the safety and quality of the health club, Redder says. "If any irregularities are noted, a report is filled out. One copy comes to me for filing, and the other goes to the instructor and the health club."

There are three levels of risk identified in health club evaluations. Those are:

No. 1: caution notice. "This might include inappropriate lighting in a hallway or wet floor areas in a locker room," Redder says.

No. 2: health and safety risk. A No. 2 risk might include a lack of handicap access or elevators, if there is a second floor.

No. 3: immediate attention. "This might include extremely worn equipment or an instructor encouraging contraindicated exercises," she says. "I still occasionally see instructors leading members in exercises long deemed unsafe by the fitness industry," she adds.

Health Care Dimensions also tracks the number of participants in each class, the ratio of men to women, and the average age of class participants.

Of course, health plans are still looking for bottom-line evidence that the program helps them retain members while improving the health status of their senior population. "We track the utilization of every health plan member who participates in the program," notes Swanson. "Most of our health plan partners are surprised by how operationally intense this program is," she says. "We feel that the Kaiser Permanente Northwest study will provide quantitative proof that this program combines marketing acquisition and retention with a clinical benefit that can stand on its own."

[Editor’s note: A Silver Sneakers home video is available for $14.95. For more information, contact: Health Care Dimensions, 401 W. Baseline, Ste. 204, Tempe, AZ 85283. Telephone: (888) 958-4336.]