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9/20/2016
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Disclosures
Lynn Steffes
• BrainyEX Founder, CEO
• Rachel Thiel– Co‐developer BrainyEX
Russ Certo
• Founder, MOG National and the MOG Model.
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Full Circle….
www.themoggroup.com
What Is Lifestyle Medicine?• “Lifestyle medicine is a scientific approach to decreasing
disease risk and illness burden by utilizing lifestyle interventions such as nutrition, physical activity, stress reduction, rest, smoking cessation, and avoidance of alcohol abuse. Lifestyle medicine is the recommended foundational approach to preventing and treating many chronic diseases.”
• American College of Preventative Medicine
• In July 2010, the Journal of the American Medical Association published results of a 2‐year project with the American College of Lifestyle Medicine and the American College of Preventive Medicine, outlining lifestyle medicine standards for primary care physicians.
• The study included 15 evidence‐based standards for smoking cessation, nutrition, exercise, and other behaviors linked to chronic conditions.
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Why the recent focus upon Lifestyle Medicine?
• “Unhealthy lifestyle behaviours are at the root of the global burden of non‐communicable diseases and account for about 63% of all deaths.
• Over the past several years, there has been an increased interest in evaluating the benefit of adhering to 'low‐risk lifestyle' behaviours and ideal 'cardiovascular health metrics'.
• Although a healthy lifestyle has repeatedly been shown to improve mortality, the population prevalence of healthy living remains low.”
» http://www.ncbi.nlm.nih.gov/pubmed/23974765
ObjectivesParticipants will:
• List 5 chronic health conditions that impact the US population and health care economy.
• Identify 3 PT based services to offer for assisting in prevention/intervention of chronic health conditions.
• Identify a model of lifestyle medicine that could be applied in their facility.
• List the top 3 chronic conditions seen in their practice and strategize interventions applicable to them.
• Identify 3 components of exercise in current PT practice that will improve the quality of life for a person with a chronic disorder.
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Top Ten Most Costly Diseases http://www.msn.com/en‐us/money/healthcare/11‐costliest‐diseases‐in‐the‐us/ss‐BBnOzYV#image=1
• #1 CV Disease
• #2 Diabetes
• #3 Dementia
• #4 Cancer
• #5 Obesity
• #6 COPD/Asthma
• #7 Arthritis
• #8 Mental Health‐ Depression
• #9 Kidney Disease
• #10 Hyperlipidemia Primary/Secondary
• 193 Billion
• 176 Billion
• 159 Billion
• 157 Billion
• 147 Billion
• 79.6 Billion
• 74.4 Billion
• 57.5 Billion
• 38.1 Billion
• 34.5 Billion
Prescribed Exercise Has Evidence in Preventing/Mitigating ALL
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Who are considered the Lifestyle Medicine Providers:
• Northwestern University Center for Lifestyle Medicine:
– Our highly skilled interdisciplinary team includes board‐certified physicians in various specialties, psychologists, nurses, dietitians, exercise specialists, and others who can help you achieve and maintain a healthier lifestyle.
• Cleveland Clinic Lifestyle Medicine:
– Cleveland Clinic Team: Team: Acupuncturists, Chiropractors, Massage Therapists, SW, Psychologists, Physicians, Nurse Practitioners
• Intermountain LiVe Well Center, Salt Lake City Utah:
– Our team of licensed and experienced healthcare professionals consist of: Physicians in Sports Medicine, Internal Medicine, Family Medicine, and Cardiology • Exercise Physiologists • Clinical Dietitian and Sports Nutritionist • Physical Therapist • Registered Nurse, Clinical Educators, Nutritionists
APTA Mission Statement
Further the professions role in the prevention, diagnosis and treatment of movement
dysfunctions and the enhancement of the physical health and functional abilities of
members of the public
The 2013 APTA House of Delegates adopted a landmark new vision of the profession of physical therapy: "Transforming society by optimizing movement to improve the human experience."
www.themoggroup.com
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PT Based Medical Fitness Difference
PT can account for disease and dysfunction when setting up an exercise program
Provide evidenced based fitness programming
Quarterly evaluations with data collection and reports to MD
Long established relationships with MD’s and Ins Co.
Red Flag Assessments Developing Collaborative
Partnerships
www.themoggroup.com
AMA & ACSM (2009)
Pushing their Physician
membership to promote the idea
of exercise prescriptions for their patients
Who will fill the prescription?
www.themoggroup.com
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Why Not Us???Physical Therapists are experts at exercise and itsrelationship to disease and dysfunction
Physical Therapy has a long and distinguished history as a service industry
The Physical Therapy profession should be the leaders in filling exercise prescription
www.themoggroup.com
Broaden the Base of Services
www.themoggroup.com
Traditional vs Non-Traditional Referrals
Grow 20-40%
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PTExercise
Physiologist
Nutrition
TOP 3 BCBS of WNY
1)Obesity and its related co-morbidity2)Cardiovascular Disease3)Musculoskeletal Problems
www.themoggroup.com
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HIGH RISK
MODERATE RISK
LOW RISK
Priority
Access
Cost
Assumptions
3
2
111
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Engaged
What is a Medical Fitness Center
PLACE SERVICE
• Integrated with PHYSICAL THERAPY
• Delivers evidenced based medical fitness protocols / programs for chronic disease pts
• BOUTIQUE” Fitness CLUB(85% / 15%)
• Service that solves a problem for CHRONIC DISEASE
• Referred by Family Practice
• Reduces total cost of care
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THE SOLUTION
DEVELOPEDUCATE MEASURE
DELIVER ENGAGEASSESS AND REPORT
PT driven…. Cost Effective Prevention of DISEASE
Customize plan of care based upon patient
activation and health conditions
PAM 1‐2
(LCSW & Education)
Patient Assessment (PCP/Inpatient)
PAM 3
(High touch programming)
PAM 4
(Low touch/low risk)
PAM 1-3: Re-assessment every 90 days for first year
PAM 4: Re-assessment 90 days
and 1 year for first year
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PT survey
• Questionnaire in Primary Care Office
• Above 5 87% success of completing MFS
• Above 7 92% success of completing and lowering MFS
How To Receive Reimbursements
• Develop fitness protocols and data collection systems for specific Dx
• Approach Ins. Cos • Use the Ins Co. argument that patients should
take more responsibility• P.T. is the most appropriate service, historically
we are great problem solvers• Data will demonstrate ROI with respect to
reimbursement
www.themoggroup.com
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Data Data Data(biggest differentiator)
Third Party Payers need data to demonstrate a Return On Investment (ROI) for reimbursable events.
www.themoggroup.com
Current Practice
StepDown
SchoolBased Aquatics
WorkHardening
BackSchool
TraditionalPT
www.themoggroup.com
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Integrated Health Provider
MedicCompExercEduc.
Lecture
SeniorPrograms
Aerobics
MOGA
MOGKidz
Nutrition Pers.Train
Sport Specific
YOGA
Massagetherapy
Member Services
Patient Care
Behavior Modification
Post CA Ex
Pilates
Integrated HealthPromotionServices
www.themoggroup.com
Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Improved Outcomes
PCP Specialists Data CollectionSystems
CA Support GroupsParkinson’s Assoc
PT/ “your” ClubCommunity
Local Medical Community
Your MedFit Facility
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Community Based Services
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Programs
Strategies for risk mitigation and cost containmentDementia/Mental Health
Diabetes/Chronic Disease Parkinson’s/ Movement DisordersCardiac “IV”/Vascular Cancer Obesity
COPD WOMANS Health Balance and Falls Corporate Employee Health
Diagnosis Specific Protocols
with Outcome Measures and Data
Collectionwww.themoggroup.com
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Fall Risk Program
$33,785 pp/fall with injury
Source: National Center for Patient Safety
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Cardiac Rehab“Phase IV”
70% of cardiac patients completing Phase II have another CARDIAC incident in 1yr
www.themoggroup.com
Parkinson’s Program
• Baseline evaluation
– PDQ‐39
– Mini‐best test
– Functional Gait Assessment
– TUG
– GSA
– GROC
– 4 square step test
– ROM (Cervical, shoulder, lumbar, hamstring, dorsiflexion)
www.themoggroup.com
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PARKINSONS…Fall Risk Migration
Latest research reports that exercise is the best treatment protocol for showing
improvements and maintaining independence
www.themoggroup.com
Collaboration
www.themoggroup.com
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Patient Centered Medical Homeand the M.O.G.
Pilot Program with BC/BS of WNY
102 “HIGH RISK” patients
Enrolled as MOG member for 1 year
Quarterly exam by MD and re‐eval at MOG
Track Data
Compare last year cost to predicted (current)
12 month total cost of care
Measurable Metrics
Physicians
A1c, Cholesterol,
PHQ9
ER/Hospitalization past 12 mos
BCBS
Predicted vs Actual
MOG
BMI, Waist Circumference, Body Composition and VO2
Functional Tests/Fall Index
VAS Pain Scale
Attendance
www.themoggroup.com
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N=102 Results at 1YR
• TotalVisits 11,960• Avg visits 2.3perweek• Weightloss 6%• BMIdecrease 7%• WaistCirc.decrease 5%• SubVO2increase 36%• MOGFitScore 23%(improved)
75%ofenrolledparticipantscompletedprogram
Cohort 1: % Decrease in Biometric Measurement 3‐6 months
www.themoggroup.com
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Cohort 1: Survey Response on Health Status
www.themoggroup.com
Harvard Pilgrim Health/InterMedChronic Disease Protocol
0%Number of Pre‐Diabetics who progressed to
Diabetics after MOG participationN=66
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www.themoggroup.com
Demonstrated ROI
The BIG Picture
• Actuaries available that calculate reductions in health care cost for decreases in specific metrics i.e. BMI, WC, functional capacity, BodyFat %
• Cost Savings through better medical management is the goal
Solutions for Family Practice and Payers
www.themoggroup.com
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Process
Corporate Employee HealthSelf‐Insured Companies are the perfect “target”
“We have squeezed all the fat from the system, all that is left is better health”
Cynthia Hammer Pres.
Premier Consulting
You can’t manage health costs if you don’t manage health.
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Self Insured Corporations
• Currently 50% of any marketplace
• Because of OBAMACARE, expected to grow to 75% of the marketplace
• Pay all employee health claims while carrying catastrophic policy
• Every dollar saved in healthcare is a dollar of profit
2 Powerful Solutions■ The employer is back in charge of the economic side of medicine with its contracted, on‐site PROVIDERS as the gatekeeper to the health care system.
■ On‐site providers can proactively attack the source of 80 percent of the nation’s high health costs, namely chronic diseases
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The Benefit
PT Business
25‐40% Growth
Cash based income
Self Insured
Decreasing health care claims
Healthier more productive employees
Benefits Providers
New product to sell
Differentiator
You’re supplying the what’s next for the corporate employer
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Proof of Concept100 employees enrolled / $400,000 to profit
Safeway SuccessReduced the number of unhealthy people in its
organization:
hypertension by 51 percent,
high glucose by 38 percent,
high cholesterol by 63 percent,
obesity by 20 percent,
tobacco users by 37 percent
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All Subscribers
If an individual passes metric tests, he or she wins a premium reduction of $1,040. For a family in compliance, it’s a $2,080 reduction. Progress toward goals also earns premium
reductions.
Diabetic incentives• Quad/Graphics gives insulin free to diabetics who have successfully managed their disease.
• Also free insulin at Briggs & Stratton, where 70 percent of its diabetics are in its management program for that condition.
• Briggs has done the hard numbers, and it shows a $3.50 return for every $1 invested in the program
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Overweight/Obesity
$500 bonus if a weight goal is met in six months and another $3,000 if the weight is kept off for
two years.
Targeted Disease processes‐Alzheimer's & Dementia
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Prevalence of Dementia
National Expenditures…
• "The projected rise in Alzheimer's incidence will become an enormous balloon payment for the nation — a payment that will exceed $1 trillion dollars by 2050," *
– Robert Egge, the Alzheimer's Association vice president for public policy.
*2012 Alzheimer's disease facts and figures. Alzheimer's and Dementia: The Journal of the Alzheimer's Association. March 2012; 8:131–168.
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The Potential Market….
Analyze Your Patient Populations:
• Aging Adults‐ BOOMERS!
– Current and past patients
– Insurers
– Health & Wellness Facilities/Patrons
– Employers
• Healthy Seniors and the facilities that serve them
– Senior Centers
– Senior Communities
– Senior Living Facilities
• Individuals diagnosed with MCI, Vascular Dementia, Alzheimer’s Disease‐ Their Families!
– Physicians
– Rehab Facilities
– Support Groups
Current and Target
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Post‐Surgical Memory Loss…
• 40% of older adults experience immediate post‐op changes in memory, ability to learn new information, ability to multi‐task
• 14% have persistent deficits for >3 months• At risk populations
– Low education– >60– Those with changes in small blood vessels & white matter with brain MRI.
» Jill Pease Memory Loss & Thinking problems after surgery» PHHP News Spring 2013
Post Concussive Syndrome
• Animal studies suggest that exercise increases brain chemicals that promote neuroplasticity and neurogenesis; decreases oxidative stress, which can impair brain cell function and lead to cell death; and reduces neuroinflammation and cognitive dysfunction (Carro et al. 2001; Cotman and Berchtold, 2002; Ding et al., 2004, 2006; Griesbach et al., 2004;Neeper et al., 1995; Piaoet al., 2013).
• Preliminary studies of the use of exercise to help reduce persistent symptoms following a concussion show there may be a positive effect (Gagnon et al., 2009; Leddy et al., 2010, 2013; Schneider et al., 2013).
• http://www.ncbi.nlm.nih.gov/books/NBK185342/
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Target Populations: Cognitive Enhancement
Pre‐ and Post‐concussive Syndrome
Athletes in Contact Sports and Elite Athletic Programs/Clubs
– High School/College Programs
– Professional Athletes
– Coaches
– Sports Medicine Providers
Cognitive Performance Enhancement
High Power Executives/Students
• C –suites– CEO, CFO, COO
– LSAT and GRE prep
– Lifestyle Modifications:
• DSR: Dietary & Supplement Recommendations
• SSM: Sleep & Stress Management Strategies
Concussion studies point to prescribed & monitored exercise!
• American Medical Society for Sports Medicine Position Statement on Concussion in Sport
• Management of a post‐concussion syndrome is ideally done by a team of providers who work with concussion on a regular basis (level of evidence C).
– “Cognitive therapy,[188] integrated neurorehabilitation programmes[187] and supervised progressive exercise programmesmay improve recovery[189] (level of evidence B). Progressive exercise programmes involve exercising to the onset of symptoms, then every other day exercise at 80% of the symptom threshold, with retesting and progression of activity as tolerated. The general return‐to‐exercise recommendation is to advance slowly as symptoms permit. ”
– Kimberly G Harmon; Jonathan A Drezner; Matthew Gammons; Kevin M Guskiewicz; Mark Halstead; Stanley A Herring; Jeffrey S Kutcher; Andrea Pana; Margot Putukian; William O Roberts DisclosuresBr J Sports Med. 2013;47(1):15‐26.
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Brain Fitness Audit
• Adapted from David Perlmutter’s Book: The Better Brain Book 2004
• Give clients a self‐awareness of daily cognitive function
• Brain Fitness is more than memory!
• Memory is often the primary focus of Executive Function!
• There is More to cognition than Memory!
• Cognitive (Executive) Function includes:
– Working Memory / Learning
– Attention/Concentration
– Speed of Processing Information
– Adaptability / Flexibility
– Problem Solving
Target Populations: Health Conditions
– Baby Boomers
– Post‐Concussion Syndrome‐ Athletes
– Post‐ Operative Syndrome‐ Post‐Op Orthopedics
– Post‐ Traumatic Stress Disorder‐ Vets
– Post Chemo Syndrome‐ Cancer Survivors‐Women’s Health
– Parkinson’s Disease, CVA, MS/ALS
– Neuro Rehab Pts
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Opportunity!
• Brain Fitness provides Private Practices & Facilities with an Opportunity to Bond with Baby Boomers!:
– Add Value for current patients
– Add Services that meet the growing needs of the young Baby Boomers 50‐65+
– Attracting additional clientele in new categories
– Add Innovation to the conversations you are having with physicians & your communities
AARP:
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BRAIN FITNESS/BRAIN HEALTHIS LIFESTYLE MEDICINE!
What is Brain Fitness?
• Brain Fitness is a Wellness program designed to bring brain health based on prescribed aerobic exercise paired with cognitive exercise and topped off with wellness education into the PT & Fitness Market Space!
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Brain Fitness is:• Based on the latest Evidence in Brain Fitness
• Designed to meet the growing needs of PREVENTATIVE BRAIN FITNESS!
• Comprehensive in both Body & Brain Fitness
• Designed to deliver assessments, physical & cognitive fitness paired with wellness education!
Brain Fitness Cognitive Testing– Cognitive Enhancement:
• Executives
– Cognitive Preservation:
• Individuals with desire to stay on top of their game as they age!
– Cognitive Recovery
• Individuals with post‐concussion syndrome
• Individuals with memory issues related to depression
• Middle‐Aged men & women with memory issues related to menopause
• Post‐ Chemotherapy/Post‐operative Brain Fog
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Brain ‐ Risk Assessments
• Brain Fitness Lifestyle Assessment:
– Brain Fitness Audit
– Basic Genetic Risk Assessment
– Self ‐ Screening
• Cognitive (Executive) Function
– Attention / Concentration
– Speed of Processing Information
– Working Memory / Learning
– Adaptability / Flexibility
– Problem Solving
Brain Fitness Physical Testing
• Brain Fitness offers VO2 Max Tests to measure, prescribe & monitor aerobic exercise as it applies to Brain/Body Fitness
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BRAIN HEALTH IS A LIFESTYLE CHOICE…
Brain Fitness can Provide the Solution!
On Memory
• Memory is imperfect in us all at some point.• Some people have naturally better memories than others.
• Memories are stored in multiple locations in the brain: Hippocampus, Amygdala, Cerebral Cortex, Frontal Lobes.
• Not all types of Memory are enduring!– Short Term Memory‐ what you need to retain for seconds or a minute‐ Not needed or practical to store. Easily lost with distraction, interruption.
– Long Term Memory • Explicit• Implicit
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Long Term Memory: Explicit
• Semantic:
– Factual Info: learned & often revisited over time
• Names of known places
• Color of common objects
• School‐based knowledge
– General Knowledge: Endures aging
• Skills & Procedures
• How to do every day activities
• Episodic
– Images & details of life experiences thought of occasionally
• Personal memories tied to times/places
• More fragile than Semantic Memories
• May require certain cues to recall (places, people, events, etc)
Long Term Memory: Implicit
• Relies of information from your sub‐conscious
– Procedural: Automatic memory of routine activities (How to ride a bike)
• Long Term Memory has a “use it or lose it” quality also known as “transience” which is actually helpful as it makes room for new information!
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Aging & Memory
• Memory often shows changes after age 50
• Memory is also impacted by stress, fatigue, multi‐tasking, depression, medications, unhealthy habits….
Brain Fitness Program• Initial Assessment & Testing• Build a Better Body
– Session #1: Introduce Exercise Prescription– Session #2: Introduce Brainy Dietary Choices– Session #3: Introduce Brainy Supplements
• Build a Better Brain– Session #4: Introduce Lumosity– Session #5: Introduce Sleep Management– Session #6: Introduce Stress Management– Session #7: Integrate Brain Fitness Lifestyle Choices– Week 8: Reassessment & Build Long Term Plan– Week 12: Reassessment & Follow Up
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Brain Fitness Experience
• Motivational Coaching
• Aerobic Ex
– RPE
– Exercise Prescription
• Cognitive Ex
• Wellness Education
• Motivational Coaching
ReferencesColcombe S & Kramer AF. “Fitness effects on the cognitive function of older adults:
a meta‐analytic study.” Psych Sci 2003; 14(2):125‐30. Dresler M et al. “Non‐Pharmacological Cognitive Enhancement.”
Neuropharmacology 2013; 64:529‐43. Fortanasce, Vincent. The Anti‐Alzheimer's Prescription: The Science‐proven
Prevention Plan to Start at Any Age. New York: Gotham, 2009.Gomez‐Pinilla. “Brain foods: the effects of nutrients on brain function.” Nat Rev
Neurosci. 2008 July; 9(7): 568‐578. Patoine, Brenda. "Your Brain at Work." Dana Alliance and Brain Initiative. The
Conference Board, 2008.Perlmutter, David. The Better Brain Book. New York: Penguin Group, 2004. “Physical Activity and Sleep in Adults with Chronic Pain.” Physical Therapy Vol. 94,
Number 4, April 2014. "Sleep and Disease Risk." Healthy Sleep. Division of Sleep Medicine at Harvard
Medical School, 18 Dec. 2007. Web. 28 July 2014.Sorgen, Carol. "Best Brain Foods for Brain Function, Health, and
Memory."WebMD. WebMD, 18 Dec. 2008. Web. 27 July 2014.Uscher, Jen, and Jennifer Carr. "BrainFacts.org." Physical Exercise Beefs Up the
Brain. BrainFacts.org, 28 Aug. 2013. Web. 28 July 2014.
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Questions?
• Lynn Steffes
• www.brainyex.com
Follow BrainyEX on Facebook
• Russ Certo
