On Monday, November 16, the 2015 Connecting to Transform Communities Conference kicked off with a motivating and compelling keynote presentation from Zubin Damania, MD. Dr. Damania’s energetic style brought humor and satire to the vast challenge of transforming our health care system. In his opinion, the antidote to that broken system is relationships.
Today’s health care system doesn’t allow primary care physicians the time they need to deeply understand a patient’s situation. Instead of focusing on what they can do for a patient, they are incentivized to look for what they can do to a patient. To truly make a change, you have to look at the patient’s ecosystem and the community influences that are impacting their health.
Dr. Damania shared the risks he took to begin changing health and health care, one community at a time. He and his family relocated to Las Vegas to make bold changes in the heart of the city, where community health was poor. Turntable Health came to life after Damania observed trends over a three-month period, approached community stakeholders and ultimately established a patient-centered facility that raised the importance of primary care.
Fee-for-service care was replaced with a flat fee concept that provides unlimited access to medical services, health coaching and healthy lifestyle initiatives such as yoga and cooking classes. By creating a model that lengthens patient-physician interaction time, uses health coaches, looks at the patient’s environment and encourages health accountability, they are changing outcomes. Inpatient admissions and ER visits are down almost 50 percent, overall costs have decreased 12 percent, and patients are more satisfied. “Healthcare 3.0 requires doctors and patients to be on equal footing so both can ask questions and hold each other accountable for outcomes,” Dr. Damania said. “It also requires key stakeholders to be involved…those who truly have skin in the game in ensuring people become healthier in the long-term.”
Following the morning keynote was an informative panel discussion on successful collaboration between public health and health care, and several breakout sessions on topics such as communication, community organizing, county health rankings, collaborative networks, peer education and the large-scale community health improvement efforts in Allen County, Kansas.
Oklahoma City Mayor Mick Cornett closed the day with the afternoon keynote, sharing how he put his entire city on a diet. After being rated as one of the fattest cities in the United States, he set the ambitious goal for his city: to lose one million pounds. This sparked new conversation about being overweight, instead of just accepting the city’s situation as fact. Residents took the challenge head on: more than 150,000 people visited the weight loss website in a single day to learn more. And after just six months, the city had collectively lost 250,000 pounds!
This miraculous change resulted from concerted, widespread efforts to make the healthy choice easier. The city had been designed for cars instead of pedestrians, and as a result, the built environment fostered inactivity. Why would anyone do anything but drive their car? A key part of the solution was beginning the dialogue, changing the accepted norm and motivating the entire city to make simple changes in what they eat and how much they move.
After the six month mark, enough traction existed for the city to take on the built environment and adopt initiatives with wider potential for impact. Fast food chain Taco Bell started testing healthier menu options. Many restaurants became offering the “Mayor’s Special” to spark healthier eating. Everyone began rallying around the idea that “you can’t lose one million pounds by yourself.” The city planning department created narrower streets with wider sidewalks and bike lanes, and added gymnasiums to inner-city schools. They also recognized changing demographics and began building senior wellness centers.
The collective, citywide efforts have transformed the city. It is now on the list of fittest – no longer fattest! – cities, and is attracting a new workforce that is eager to embrace a healthier lifestyle. This exciting story inspired all Connecting participants to think differently about how they approach community health across an entire population, offering new ideas that can start conversations and ultimately make change.