Fierce Q&A: Cleveland Clinic wellness program gets results

 Michael Roizen

As Cleveland Clinic's wellness program hits its five-year anniversary, Chief Wellness Officer Michael Roizen says the program is showing real results and returns. FierceHealthcare spoke with Roizen about how the program has affected the patients, the community and employees--plus previews a patient wellness widget that's in the works.

FierceHealthcare: Cleveland Clinic has been a target of criticism for its strict wellness program, with rules against smoking and a ban on sugared drinks, for example. How do you respond?

Michael Roizen: We want to do things that will help our employees be healthy and don't want to do things that will help employees to be unhealthy.

It's clear, for example, that sugared beverages have no redeeming health value. They only inhibit health, so there's no reason to have them on campus. Tobacco is a toxin; there's no reason to expose our community, our patients or our employees to tobacco smoke or cigarettes.

Our goal is to help our employees be as healthy as they can be, which obviously will drive down our costs, which drive down the community's costs, which make our communities competitive for jobs.

It's not "Big Brother" to foster health. It's not that we say to an employee, "You can't bring a sugared beverage on campus and drink it." We just don't want to be the enabler for bad health habits.

FH: How have employees reacted?

MR:
The employee engagement--which is our way of judging employees' happiness with work--went up about 33 percent over the most recent two years for which we have data.  A large number of the comments (maybe as many as 50 percent) that were positive reflected the joys of participating in the wellness program.

FH: What kind of results have you seen?

MR: together, employees have lost around a little over 330,000 pounds. The usage of the fitness clubs has gone up from about 2,500 hours a month to 25,000. The number of smokers self-reported to physicians has gone from 15.4 to 6.8 percent. 

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"It's not 'Big Brother' to foster health."
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FH: Cleveland Clinic has been vocal about not hiring smokers. Has the smoker-ban affected recruitment?  

MR
: No. In fact, less than 2 percent of job offers since we put [the program] in place--300 of the 20,000 job offers--have had to be rescinded because positive nicotine tests.

We were actually concerned the policy would restrict recruitment, but in fact, when we've done surveys, we think we get 17 more applicants because of the policy than we get people who stay away because of the policy. There are a few people who have chosen to apply for jobs because they want to quit smoking and know there is a free smoking cessation program.

To my knowledge, no employee has been fired because they use tobacco.

FH: Aside for smoking cessation, what other aspects of the wellness program does the Clinic promote?

MR:
We've done 56 things, everything from helping schools in the community, changing their education about nutrition and their food offerings in breakfasts and lunches to making patient food more nutritious. We offer more nutritious choices in vending machines for employees. We have free fitness centers, stress management classes for the nurses, free yoga classes, free Weight Watchers, free Curves memberships. We have our own program called Shape Up and Go, which is a gamification of wellness. Plus free smoking cessation and tobacco cessation  programs, a raft of other physician activities, signage to encourage healthier behavior or healthier choices. And we're gradually changing the food offerings and the food labeling to make them healthier.

FH: What results have you seen in the employee population? And does employee wellness translate into patient wellness?

MR:
The employees themselves, more than 50 percent of those with chronic diseases are now in a disease-management program, as opposed to the national average of less than 15 percent. More than 90 percent of our healthy patients participate in a program. That has resulted in a bending of the healthcare cost curve for our employees. We have broadened the program and we have a number of efforts that we've spread to all of our patients and to the wider community.

We have done a free smoking cessation for everyone in our county for a six-month period, reaching roughly 16,800 people. We have done a free three-month program with the YMCA and Curves for community members who couldn't otherwise afford it. We've done a lot of things for the community.

As we gradually educate our physicians, they are talking to patients about their lifestyle changes when they leave the hospital.

FH: What initiatives is the Clinic working for patient wellness?

MR:
We're working on a pilot program that we call a wellness widget, which assesses patients in five areas before they see a physician, once a year, every year: tobacco and alcohol, stress, sleep, food choices and portion size and physical activity. Then, we can recommend programs for them in their community or at our facilities if it's not in their community.

We'll gradually be pushing this for our patients to help them make a healthier choice, coupled with programs and lifestyle medicine for weight loss and intensive reversal of diabetes and cardiac problems.

It's an application that leads to education and, if the physician wants to, more conversation. It's a process that asks six or fewer questions in each of the five areas. It comes with snappy educational material and order sheets that the physician can use to make recommendations. It's designed to take less than 30 seconds of physicians' time and can be done by patients with paper and pencil, Web, tablet, iPhone or Android.

FH: What's the return on investment?

MR
: There is an investment. The return on investment is not a two-year return; it's a five-year return, but then it's substantial.

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"The return on investment is not a two-year return; it's a five-year return, but then it's substantial."
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For example, for smoking cessation, you probably don't get the start of the benefit until year three. And you don't really start to see a sizable amount in smokers who don't need care as much until year five.

FH: Would you recommend that hospitals, small and large, implement wellness programs?

MR:
Yes, I recommend it.

What Dr. Toby Cosgrove believes is that if a hospital doesn't do this, it can't be a leader. We're the traditional three legged stool: patient care, research and education of academic institution, and he has made the point continually that we have to stay great at patient care in innovating.

As he says, if we don't stop the influx of chronic disease, which makes up 70 percent of medical costs and morbidity, we can't be a leader.

I believe that's true for hospitals large and small and corporations, as well.

Editor's note: This interview has been edited for length and clarity.

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