Real Healthcare Reform: A Community based in Well-Being: The evidence is in RiseVT
In the northwest corner of Vermont, a unique movement is integrating wellbeing, lifestyle modification, and prevention into the healthcare delivery system in an effort to keep Vermonters healthier and to reduce costs and sustain these cost reductions. RiseVT is spearheading a comprehensive, community-based approach to promote good health and prevent health problems before they happen. Coaching a village to health ……..to change the environment at the community level and to build community resilience. The real health care reform strategy is to channel the resources for a long- lasting impact where healthy living is the norm.
Chronic Disease is driving the cost related to healthcare expense. The story tells us that this is directly controlled by our lifestyle habits and behaviors. An approach at the individual level once the diagnosis is present is difficult for success. Despite multiple attempts we are still as a population declining in our health. The action at the community level has this snowball effect accelerating e the impact of the action of lifestyle change and wellbeing of the population. Eighty percent o of our annual healthcare costs could be avoided by changing lifestyle practice. This needs to be our mission as nation (Milken Institute). 7 out of 10 deaths are from preventable diseases (Health Affairs).
RiseVT is an evidenced based community-wide initiative to embrace healthy lifestyles. The aim is to motivate, inspire and work with individuals, families, businesses, schools, and municipalities to help them make small changes in their lives that will have a big impact on their health. The project has been in development for over five years, and implemented in 2015 in Grand Isle and Franklin Counties as a community collaborative spearheaded by Northwestern Medical Center and the Vermont Health Department, St. Albans, Vermont.
Since RiseVT’s inception it has engaged over, 20,000 individuals in a region of 55,000 residents. To ensure individuals are surrounded by a culture that supports their efforts to make healthier choices, RiseVT is involved with 46 businesses, 15 schools, and 9 municipalities, and 4 child care sites as of this writing.
Incorporating the medical community is essential as the medical home/primary care is the center of the healthcare delivery system. Through Lifestyle Medicine we are conducting a pilot with Family Medicine and Pediatric practices to insert evidenced based health coaches into the office based practice. Meeting individuals where they are at whether with their primary care physician, their place of work, or their community is key to the comprehensive community care management strategy. Keeping people healthy – a strategy of health coaching.
Upon analysis of our community based scorecards (www.risevt.com) we launched an “active play” campaign in February 2018 to engage in a community wide intervention campaign for 9 months in order to entrench lifestyle changes with our first focus related to movement. Mobilizing a community where movement is the norm and an environment that embraces this healthy option as an available option…making the choice easy.
The governor of Vermont (the Honorable Phil Scott) attended our “active play” kickoff event of over 500 participants. As the governor states: “The whole idea is to make sure we are focused on taking charge of our own health. And RiseVT does that by helping each community meet its own goals. Because as we know, every person and every community is unique – one size does not fit all. Here’s something you may not have heard: RiseVT is working so well here in Franklin County that hospitals across Vermont are expanding it statewide. This way, other communities will be able to come together and have fun events like this to promote better health and more activities. RiseVT will be an important part of keeping our state moving and focused on keeping you healthy., Because by preventing illness everyone feels better, and it helps to lower healthcare costs., I am delighted, as Governor, to sign this proclamation officially declaring today, February 10, 2018, “Active Play Awareness Day.”
As a core strategy and sustainability level for RiseVT, evaluations of evidenced based national and international programs were conducted for alignment with best practice . EPODE (Ensemble Prévenons l’Obésité Des Enfants; Together Let’s Prevent Childhood Obesity), is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address childhood obesity. If we impact obesity rates, we have a direct impact on the prevalence of chronic condition which is the fundamental driver of healthcare costs. Using a research-based approach, EPODE has over a 20-year history of success in reducing childhood obesity in over 29 countries worldwide and provides a foundation to scale up statewide expansion of RiseVT. Vermont is the first in the United States to use this community-based approach.
The key to RiseVT is the EPODE methodology based on five pillars: political commitment, public and private partnerships, community-based actions, evaluation, secondary prevention. The multi-stakeholder approach provides a valuable model that is applicable to other lifestyle-related diseases. Results showed that long-term achievements are possible when mobilizing not only schools, but also the whole community to touch, not only school-aged children, but the entire family including adolescents. A Fleurbaix Laventie Ville Sante’ (FLVS) study results showed a significant BMI reduction in the prevalence of childhood obesity from 17.8% in the control group to 8.8% in the intervention group.
Using the EPODE Pillar of Monitoring and Evaluation we established a Scientific Advisory Board made up of researchers, pediatricians, exercise physiologists, etc. We are proud to be one of the first in the nation to implement measurement in the school of height and weight. The baseline results are remarkable in the initial group of 12 schools measuring grades 1, 3, and 5. It is clear that the focus on reducing childhood obesity is a priority as it clearly impacts total health of the generations to come Re-measurement will happen every two years with expansion to the state level. A sample of our goals:
Increasing the overall health of our residents by:
Decreasing the prevalence of overweight and obesity
Increasing number of employers offering a wellness program with at least 50% employee participation
Expanding biking and walking resources
Increasing the proportion of residents who report no exposure to secondhand smoke
Increasing fruit and vegetable consumption
Our Vermont state wide vision is “Vermont will be recognized as the healthiest state in the nation with healthy living the norm” We have a story to tell….a story that is replicable, sustainable, and the answer to real healthcare transformation… Putting community health back in healthcare.