Clean Living

By Natalie Brandweiner, Deputy Editor

Michael Roizen knew as early as nine years old that he was destined for the world of healthcare. A home visit from a pediatrician to cure a brief, sudden illness gave him enough motivation to work toward a career in health, culminating in his current role as Chief Wellness Officer at Cleveland Clinic.

“Last year in the United States we spent one out of every six dollars, 16.3% of GDP, on healthcare”
-Michael Roizen, Cleveland Clinic

An optimist, Roizen believes in the possibility of great change – in structural reform from the current model of disease care to one of preventative care, a change championed by the new administration in Washington. This is a change so drastic that it has been met in some quarters with great criticism, with opponents claiming that it is an unrealistic policy that cannot be implemented given the funds that would be needed in the current economic climate. However, Roizen holds firm to the notion that such a change makes economic, as well as health-related, sense.

“Last year in the United States we spent one out of every six dollars, 16.3 percent of our gross domestic product, on healthcare. In eight years we’re projected to spend 19.6 percent. That obviously lowers our standard of living and makes us less competitive. We’re twice as expensive as the 10 developed countries in Europe, not because we’re more expensive per episode of care, but because we have twice the chronic disease.

“If you look at heart disease for people aged 55-65 in Europe it’s 11.4 percent. It’s 21.8 percent in America. If you look at arthritis it’s 21.3 percent in Europe, including Great Britain, but it’s something like 53 percent in the United States. If you add all the major chronic diseases up, we’re twice as expensive. There are three things that cause 70 percent of chronic disease in both the United States and Europe: tobacco use, physical inactivity and food choices. Not to criticize sick care – a lot of improvements have been made because of a great sick care system – but it makes more sense and is much less expensive to have great preventative care. There’s no reason in the United States why we can’t reduce our total healthcare budget by 50 percent, or at least not increase it, as long as we focus on those three areas,” explains Roizen.

Incentives
In order to bring about a system such as this, Roizen proposes that instead of paying physicians solely for treating patients who are ill, incentives – both monetary and otherwise – should be made to favor prevention. “We need to make people understand that they control the quality and length of their lives, and that they can influence their genes if they want to. It is much less difficult than most people assume,” he says. Cleveland Clinic has begun a program, under the leadership of CEO Toby Cosgrave, to take a tough stance and propel the clinic into the limelight for preventative care, as Roizen explains.

“We have banned smoking on campus, along with offering a free smoking cessation program to the community and our employees, and we will cease hiring smokers. We’ve started with something relatively tough but that was the biggest and most immediate thing.” Cleveland Clinic’s strategy has been successful so far, with nearly 16,000 people in the community quitting smoking, and an additional 4000 employees and 1000 of their dependants quitting.

In order to bring about such a high rate of reduction, Cleveland Clinic initially used two programs. It now has 12, and one of the ways in which it encourages its employees to quit is through the support of family health centers. The practices are run by between three and 20 people, offering internal medicine offices with some sub-specialties distributed in various places in Northeast Ohio, and a few located internationally. There are now smoking cessation programs in 10 of those locations rather than just one at the main site.

The clinic’s main site is a 1300 bed inpatient facility and cares for around two million outpatients a year. Roizen explains, “We did a number of things to encourage smoking cessation at the main site, one of those being reimbursement. “It costs roughly $600 for us to get someone to quit smoking, and most smoking cessations were not covered by health insurance. With our own employees we paid the dollars for it. In most programs the employee has to pay and then gets reimbursed.

“Smoking is a very interesting thing, as are most habits. Most people hold pleasure money in the left pocket and medical money in the right pocket and the two don’t mix. The savings from not buying cigarettes would have easily paid for the program, but the smokers don’t consider those interchangeable pockets. Our method was brilliant because it allowed us to do things that meant all the employees responded very positively.”

This was not the only method Cleveland Clinic used to rid the workplace of toxins. In the various vending machines located around the clinic, all available snacks were made healthy, with a clear labeling of foods. Baked chips replaced fried, chocolate bars were made from cocoa and not milk chocolate – with no more than four grams of sugar per bar. Nuts, fruit and fruit drinks were also introduced.

Community care
A farmer’s market was also started on campus, referred to as ‘community-supported agriculture’, located at the outlying hospitals and sourcing locally grown vegetables for both staff and patients. Roizen notes that for each of the first 5000 visitors to the market, the clinic donated $1 to a community food bank so it could to buy fruit and vegetables for people using the community-supported grocery and food items. “Therefore, although a lot of it was to invest in our employees to help them get healthier, help them walk the walk of health, it was also to invest in patients in our communities and show that we can make this area of the country more competitive, lowering not only our own health costs but the health costs for everybody in our community,” says Roizen.

The farmer’s market program must certainly make the farmers happy, as the clinic guarantee full sale of all their products: any product not bought by staff is purchased by the hospital’s cafeterias, which use the food over the next few days. The reaction was overwhelmingly positive from patients, employees and the community. Only one negative comment was recorded regarding wheelchair access, which has since been rectified.

Labeling is also a major focus of Cleveland Clinic, in an attempt to meet the peer-reviewed criteria they have set, such as decreasing saturated fat and trans fat, and the removal of simple sugars and syrups. Sales from vending machines fell during the early stages of the healthy criteria implementation, but increased as both patients and staff became used to the changes. The same thing happened with inpatient meals.

“We went through a serious menu makeover and worked with our vendors and within the hospital to break down the line between what most people consider healthy food on one side of the line and great tasting food on the other, so that great tasting and healthy could be the same.

“The purpose of the whole program is to allow us to be more competitive for jobs by driving healthcare costs down, and also to enrich the lives of all the people we touch by letting them live longer and healthier lives, with a higher quality of life,” explains Roizen.

Healthy living
There are 21 chronic diseases in which lifestyle changes have a bigger effect than drugs. However, the majority of Americans tend to be quick to take a pill to make themselves well, rather than pursuing a better lifestyle – eating healthy, exercising and reducing stress levels – and this is why the clinic has responded with a program of lifestyle change. Along with the benefit of a program that is more compelling and fun than a simple dose of medication, there are the added advantages of a less expensive option when avoiding the outcome of treating a chronic disease.

Cleveland Clinic’s commitment to providing this healthy program to their staff is displayed by the free access it provides to the Weight Watchers program. “We sent 31,000 full time employees covered by our health plan, and in six weeks 7200 employees had signed up for Weight Watchers either at work or at an offsite location. In the first four weeks roughly 3000 people lost a little over 12,400 pounds,” says Roizen.

The only criticism of the program came from male participants, who felt overwhelmed by the number of women in attendance compared to men. “As a healthcare organization my guess is we’re probably 60-70 percent female, so we started some male-only classes in Weight Watchers.”

The impressive results generated by the program have continued with the non-Weight Watcher employees who are encouraged to attend sunrise-sunset yoga classes on campus. There are currently six at the Cleveland Clinic sites, with 47 classes each week, with 1000 employees participating.

Changing habits   
The clinic has also launched Realage.com, a free website available to everyone with information that can help each individual ingrain themselves with at least one healthy living habit. Roizen explains the purposes of the website, the first being a ‘do-over’: a focus on the good genes that determine a healthy life. He notes the function of genes is to make proteins, which invariably govern your life, and it is the changing of both the quantity and quality of these genes that can affect your health.

“Second, walking 30 minutes a day and calling a buddy after doing so keeps you motivated. Third is to avoid the five aging foods: saturated fat, trans fat, simple sugars, syrups and high fructose corn syrup. The fourth one is talk to your doctor and see about taking five pills and flossing. The pills are DHA, which is the omega 3 that’s active in the brain. Calcium, magnesium and vitamin D, that’s the second pill; the third pill is a multi-vitamin, the fourth pill is aspirin, and the fifth pill ensures the right amounts of calcium, magnesium, and vitamin D are delivered. Flossing is important because the periodontal disease causes inflammation in your arteries, in your immune system, and leads to both heart disease and more serious conditions,” says Roizen.

Cleveland Clinic’s success is found not only in the statistics of pounds lost or the number of people no longer smoking; its employees are demonstrably happier, according to Roizen, and as a result, patients are better served. Employee health costs are also coming down due to healthy employee living. The clinic is consistently rated in the top five best hospitals in the US, so it’s easy to see why how employee wellness can make a positive impact.

Michael Roizen was named Chief Wellness Officer at Cleveland Clinic in 1997. Prior to that he was CEO of the Biotechnology Research Corporation of Central New York before accepting the position of Chair of the Anesthesiology Institute at Cleveland Clinic. Roizen is also the Cofounder and Chair of the RealAge, Inc.

This article was originally published in Executive Healthcare magazine: www.executivehm.com/article/Issue-7/Patient-Care/Clean-Living