Life-changing Stories – BHS Adopts Unique Program Aimed at Underserved Populations

“I felt sorry for myself and also felt I had let myself and my family down because this was preventable,” said the president and CEO of BHS, who said the diagnosis came after he agreed to take part in the medical center’s Wellness at Work program due to a colleague’s suggestion that he become more involved. “We started the program eight years ago, and I hadn’t been as enthusiastic about it as I should have been.”

Phelps’ doctor gave him two prescriptions to treat the condition, then he and his wife headed to Cape Cod for the weekend. “I wanted to do something fun,” he said, recalling that they went to the opening of a new sports bar, but after a few bites of the cheeseburger and limitless french fries he ordered, he decided to go home, where he spent hours on the Internet researching how to live with diabetes and manage the disease.

But this was something he realized few could achieve or sustain long-term, and he doubted his own ability to maintain the dramatic lifestyle changes he had made.

So he spent some time at Canyon Ranch in Lenox, and while he was there, he learned about the Canyon Ranch Institute Life Enhancement Program and was so impressed that he returned to speak with executives, with whom BHS already had a relationship, about bringing the program to the Pittsfield medical facility.

He felt it was important because he recognized that, although he and his colleagues enjoy tremendous access to healthcare and support, others in the community do not share the same benefits.

A short time later, the BHS-CRI Life Enhancement Program was born.

It is free to all participants and strives to change the lives and health of people in underserved populations via a three-month experiential-education program that is patient-centered. It includes a comprehensive exam that assesses each participant’s physical and behavioral health, classroom sessions that focus on topics such as nutrition and stress management, exercise and meditation sessions, and a trip to a grocery store, where people learn to read labels and make healthy buying choices on a tight budget. In addition, each participant has an hour-long individual meeting with a doctor or registered nurse, an exercise physiologist, and a nutritionist, and is connected to beneficial resources.

However, the program doesn’t stop at the graduation ceremony: there are follow-up sessions for two years that include physical reassessments of each person’s health.

So far, five classes have graduated from Pittsfield, and a sixth class recently started in Great Barrington, and each has had a profound impact on staff as well as participants.

“In all my years as a doctor, I have never been part of a 12- week program where I was so heavily immersed in the lives of others, and I have never been so inspired by what is possible,” said Dr. Mark Pettus, BHS’s director of Population Health & Medical Education, who has been involved with the BHS-CRI Life Enhancement Program since its inception.

In fact, the team of 15 professionals who work in the program are all volunteers who hold executive positions at BHS and are not paid for what they do on the side.

“I didn’t expect them to continue after the first class or two,” Phelps said, adding they have all found it so meaningful, they have stayed with it. “Many of the people in our programs have complicated conditions, but the progress they make is incredibly rewarding for all of us, and their gratitude is so great that the physicians, our chief of medicine, and the other professionals involved find it very satisfying, even though it involves a major commitment of time.”

It has also required a substantial investment by BHS, because the Canyon Ranch Institute partners only with organizations willing to make a lifetime commitment to hold ongoing sessions free of charge.

The initial cost to get the program started at BHS was $500,000, but Phelps believes it’s important and says the system is also trying to find ways to provide small, local employers with the healthcare advantages his employees have access to.

“By and large, no one really invests in the population who are on Medicare and MassHealth,” he noted, adding that people in those programs make up 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the program’s participants.

They are referred by their primary-care physician or sign up through word-of-mouth advertising, which comes from co-workers, friends, relatives, or organizations such as Soldier On or the local food pantry.

For this issue, HCN looks at the BHS-CRI initiative and how it’s changing lives in many ways.

Pettus said many of the program’s participants have medical conditions, mental-health issues, or both. Some participants are single mothers struggling to make ends meet who don’t have the time or money to care for themselves, but not everyone has the same issues, and people are sometimes admitted to the group even though they have access to quality healthcare.

In fact, one participant who owned an ambulance company turned out to be so supportive of the group that he gave people free rides whenever they had transportation problems.

Indeed, Phelps said the encouragement that members of each class show each other is remarkable. “People support each other through the learning process as well as the process of change, which is part of what makes the program work so well,” he said, adding that participants are concerned if someone misses a session and often call the person.

Each class has 20 to 22 students who attend a three-hour workshop each week for three months, and Phelps told HCN the stories shared during the sessions are so compelling and inspirational that he and Pettus often attend just to hear them.

That’s essentially what those who launched this unique initiative had in mind, said Jennifer Cabe, noting that the nonprofit Canyon Ranch Institute was established by Mel and Enid Zuckerman and Jerry Cohen, who founded Canyon Ranch Spa and Resort.

“Canyon Ranch serves people of financial means who have a lot of options and are able to invest time and money to immerse themselves in activities at the properties,” said Cabe, executive director and board member of the CRI. She said the resort’s founders wanted to provide people who could not afford the facility with access to benefits culled from the best wellness practices employed there, which were combined into a week-long, 40-hour Life Enhancement Program that Canyon Ranch launched in 1989.

“There was no curriculum, but health professionals steeped in integrative health were brought in to teach classes in their area of expertise, and the institute was formed three years later in Tucson, Arizona, to serve people at the other end of the spectrum,” Cabe explained.

“Most participants have a little more or a little less than a high-school education, and we bring an integrated model into their community,” she continued, adding that, in 2002, Dr. Richard Carmona was appointed as surgeon general, became president of the institute’s board of directors in 2007, and hired her shortly after.

The curriculum was developed that year, and the institute’s program was launched for the first time in the South Bronx area of New York City.

Today, CRI operates in 20 locations; 18 are in the U.S., and the others are in Lima, Peru and Nogales, Mexico. In addition, it has become a government program in Singapore.

“The vision of the founders was to create partnerships that would address disparities that lead to poor health,” Cabe said, citing research showing that the lower a person’s income, the more likely they are to have poor health and experience high levels of stress. “And stress can damage health and put people at higher risk for chronic diseases like asthma, type 2 diabetes, and heart disease; if someone is working three jobs, they don’t have the time to exercise or eat healthy.”

The BHS-CRI program begins with a baseline assessment of each participant’s health that includes a comprehensive physical exam. “Individuals spend two hours in the assessment before they begin the program. We look at their personal goals, the medications they are taking, and do a full laboratory panel of blood tests,” Pettus said.

Their functional, or physical, capacity and performance is also measured. “They are put on a very slow treadmill, and we see how long it takes them to get winded,” he explained. “It serves as a benchmark, and we do our best to get all of the information we can from their primary-care providers, with their permission.”

He added that he goes over each person’s bloodwork and reviews what is most important to them.

“The majority want to focus on changing their lifestyle,” he explained. “We are not prescribing new medications for them; we are educating them and doing things that can complement or be integrated with the healthcare they have.”

In some cases, by the end of the program, participants have been able to stop taking prescription drugs as a result of improvements in their health.

The information gathered during the assessment is shared with each member of the team, who makes it a point to help each individual progress along a continuum.

“We meet frequently as a team and go over our observations together so the approach to our interactions with each participant is team-based,” Pettus noted.

Cabe explained that the goal is to help people become more health-literate, then start to use what they are taught.

“It’s one thing to know it’s a good idea to eat fruits and vegetables, but many people know it and don’t do it,” she said. “So we want them to really understand that their choices can change their life and health.”

When the program begins, each participant receives a comprehensive workbook, with a detailed description of each workshop. “The educational model revolves around nutrition, stress management, movement, and meaning and purpose, as the mind and body both play a part in health,” Phelps said.

There are a number of hands-on classes; for example, people are not only presented with healthy recipes, they learn how to make the foods. And although BHS works with local health clubs to get participants reduced rates, they are shown how to do calisthenics and use stretch bands, because many find it difficult to go to a gym.

“We also teach them how to breathe and use guided imagery in meditation,” said Pettus. “We meet people where they are, as our goal is to shape understanding and behaviors in a way that is sustainable.”

Although each person has individual goals, the emphasis is on taking small steps, such as losing one pound at a time or cutting out one meal a day that contains fried food. “It’s not effective or successful to expect people to change their lives all at once, and this program is really about taking small steps to become healthier, happier, and have better relationships,” Cabe said.

Pettus agreed, noting that the program is thoughtfully crafted.

“All the materials we teach and the slides we project are understandable. It’s important because even people who have really good healthcare don’t always understand what their doctor says, and everything starts with literacy,” he said, adding that the social component is also critical, as clinical research shows that inspiring change is more effective in a group setting.

The graduation ceremony is always emotional, and reunions, staged monthly, include additional physical evaluations.

“Baseline follow-up exams are done at three, six, 12, and 24 months, and the outcomes we have seen are significant. They range from improving depression to becoming more active, drinking more water, eating more vegetables, and improving things like body-mass index and cholesterol levels,” Cabe noted. “We measure all of this and have found the program results in sustained change.”

Pettus says the results at BHS have been stunning. “People have stayed in touch with us, and because we’ve been running the programs for a year and a half, we’ve seen that they are able to sustain the changes they have made. Sustainability is really the secret sauce.”

Pettus admires Phelps for making the BHS program possible.

“It’s very unique. There aren’t many health systems that would see the value in this and make the investment,” he said. “But it brings tears to your eyes when you realize how much of a difference compassionate healthcare can make. It’s very powerful and is a transformative experience for the participants and the staff.”

Cabe agrees. “Our partnership with BHS is very robust,” she said, adding that she finds it laudatory that the system adopted the program and made the commitment to continue it forever.

Phelps told HCN it has become a permanent part of the professional lives of everyone involved. He gets emotional at each graduation ceremony and says the participants’ gratitude is priceless.

“I hoped something good could come out of this, and we all stay involved in every aspect of the program,” he said. “We’re moving into an era where we need to accept more responsibility for the health of the community.”

Which is something that Phelps, the BHS board of directors, and the staff is fully committed to as they continue to change lives, one person at a time.