This document discusses wellness and primary prevention as the keystone to transforming healthcare. It outlines that the current healthcare system focuses more on sickness and disease management rather than prevention. A shift needs to occur towards prioritizing health promotion and preventing disease to lower costs. A five step strategic approach is proposed: 1) Organize the population by risk level, 2) Conduct a corporate health audit, 3) Adjust corporate culture, 4) Implement programs to keep low risk low and move high risk lower, 5) Evaluate, update and maintain programs. The document argues that wellness is not just an individual responsibility but a shared social contract between society and individuals with both rewards and penalties.

1. Wellness & Primary Prevention
The Keystone to Healthcare Transformation
Michael H. Samuelson
President & CEO, The Health & Wellness Institute
Adjunct Professor, Health Services Administration
The University of Rhode Island

2. Outline
! Radar: Pay Attention
! Context & Texture
! What is Wellness?
! Fundamental Understandings
! Healthcare vs. Sickcare: Time to Level Set
! Framing the Challenge: The 5 Ws
! What’s Happening? – Current Conditions
! So What? – Trends and Consequences (DNA)
! What Now? – Triage and First Things First
! What’s Next? – Strategic Intent and Plan
! What Difference Will/Did it Make? – ROI
! The Health Care Social Contract
! The 5 Critical Components of a Prevention Strategy
! Q&A

3. then and now:
A 30+ Year Journey
1978" 2010"

4. then and now:
A 40+ Year Journey
1978 1968 2010

5. radar & mountains
Indian Mountain AFS, AK, 1968

6. Context & Texture

7. Tao Te Ching
- Lao Tzu, 6th century BC
Thirty spokes share the wheel’s hub;
It is the center hole that makes it useful.
Shape clay into a vessel;
It is the space within that makes it useful.
Cut doors and windows for a room;
It is the holes which make it useful.
Therefore profit comes from what is there;
Usefulness from what is not there.

8. healthcare 2010:
Critical Areas of Concern
Genomics Indigent Population
Aging Population Medical Tourism
Access Convenient Care
Affordability Technology
Uninsured Malpractice
Economic and Health Impact of Behavior Paternalism/Entitlement
Universal Healthcare Mandated Benefits
Single Payer Defensive Medicine
Growth of Chronic Care Immigrant Healthcare
Shared Responsibility Health Literacy
Personal Accountability Health Education
Specialty Pharmacy Never Events
End of Life Issues Rx Drug Reform
Legislative Streamlining and Reform Electronic Medical Records
Culture/Language Barriers Emergency Medicine (disaster/pandemic)
Transparency Pay for Performance
Medical Report Cards Tele-Medicine
Economics & Enforcement of HIPPA Shift to the Prevention Side of the Care Continuum
Orphaned Diseases Medical Divide (regional, global, cultural, ethnic disparity)
On-Line Rx E-Health Information & Misinformation (WEB)
Media Influence (TV/Movies) Tort Reform

9. What is Wellness?

10. definition of wellness"
WELLNESS is an umbrella descriptor for
programs, policies and initiatives that promote
health, prevent certain diseases and compress
morbidity (shorten length of illness). Wellness
is also an objective and subjective incremental
state of well-being with infinite variations.
- The Health & Wellness Institute
!"

11. Ten Fundamental Understandings
1. Change is a linear and sequential process.
intellectual
emotional
visceral
cellular

12. Ten Fundamental Understandings
1. Change is a linear and sequential process.
2. The incumbent has the power.
3. People run from pain faster than they run toward
pleasure.
4. There is no power stronger than self-fulfilling
prophesy.
5. What you learned in Kindergarten is not enough.

13. Ten Fundamental Understandings
6. Beware, the law of assimilation.
7. What you don’t know can hurt you!
8. It is critical that you secure your own mask before
assisting others.
9. Without innovation, you are simply living a memory.
10. “He not busy being born is busy dying.” - Bob Dylan

14. Healthcare vs. Sickcare

15. Healthcare vs. Sickcare: Time to Level Set
1. Nothing and Nobody will Lower your Healthcare Costs.
2. Death is not a Curable Disease.
3. “Wellness” is an amorphous, dangerous & distracting term.
4. The issues of concern are health promotion, disease PREVENTION,
compressed morbidity, increased productivity and medical cost
control.
5. Ultimately, organization measure success by mission and margin.
Individuals (employees) measure success in terms of subjective
well-being.

16. Healthcare vs. Sickcare: Time to Level Set
6. There is no political will to change healthcare: The question is not
HOW do we improve health? The question is WHY don’t we care?
One answer is science, the other is art.
7. If “greed” is good…”sickness” is better.
8. Pogo was right…
9. Healthcare spend & focus needs to shift from disease management
(survival) to primary prevention (thrival).
10. It is arrogant and presumptuous to suggest that a list has
independent value.

17. Context & Texture Clarity & Meaning
Derek

18. The Five Ws: Wellness in Context

19. the five Ws: wellness in context"
framing the challenge: the 5 Ws:
• what’s Happening? – current Conditions
• so what? – trends and consequences (DNA)
• what now? – triage and first things first
• what’s next? – strategic intent and plan
• what difference will/did it make? – ROI

20. #$%&'()#" *$++#"
,$%-)"
The Healthcare Social Contract "
&$.##)'."" /)0)&#$1"

21. The Health Care Social Contract"
2)',(*"3'&)"4$%5',"3$1(&'%("
The Health Care Social Contract

22. the health care social contract
Health Care Social Contract"
responsibilities
Society
(Government, Medical Providers/Employers) Individual
• Awareness • Healthy Choices
• Education • Self-Observation/Care
• Access • Evidenced-Based Screenings
• Supportive Infrastructure (Age/Gender)
• Evidence-Based Medicine & • Timely & Appropriate
Prevention Support Attention
• Medical Compliance

23. the health2)',(*"3'&)"4$%5',"3$1(&'%(" contract
care social
penalties
Society
(Government, Medical Providers/Employers) Individual
• Removal from Public Office • Increased Financial Obligation
(Government) • Compressed Quality of Life/
• Fines (Employer) Expanded Morbidity
• Reduced Reimbursements • Potential Criminal Charges
(Medical Providers) (Re: Care of Minors)

24. the health2)',(*"3'&)"4$%5',"3$1(&'%(" contract
care social
rewards
Society
(Government, Medical Providers/Employers) Individual
• Re-Election (Government) • Favorable Insurance and Co-
• Tax Credits and Favorable Pay Rates
Insurance Rates (Employer) • Expanded Quality of Life &
• Higher Reimbursements Compressed Morbidity
(Medical Providers) • Happier & Healthier
Dependants

25. A Five Step Strategic Approach"
1. Organize population by risk level
2. Conduct corporate health audit
• Senior management & employee attitudes
• Policies and benefits
• Communications systems
• Environment
3. Adjust corporate culture
4. Implement program of awareness, education, and intervention to keep
low-risk low and move high-risk to low-risk
5. Evaluate, update, and maintain

26. thank you!
1978 1968 2010

27. Wellness & Primary Prevention
The Keystone to Healthcare Transformation
Michael H. Samuelson
President & CEO, The Health & Wellness Institute
Adjunct Professor, Health Services Administration
The University of Rhode Island