Shifting from Disease and Sickness to Health and Wellness
Chair yoga class at the Wellness Center opened with seniors singing praises for Stephen Curry, Golden State Warrior and hometown hero. On the ground floor of LifeLong Medical Center East Oakland, people gathered in the Wellness Center to limber up, socialize and get vitals checked. The class is one of many alternative “medications” they can choose from to achieve wellness.
What if doctors wrote prescriptions for healthful food, for meditation, for congregating with others? What if patients had alternatives to a bottle or a vial, a device or procedure? Could common sense that your grandmother taught benefit your diabetes? Some grandmothers at the Wellness Center expressed thanks for being reminded of their own advice.
One woman came to class because she got the date of her medical appointment wrong and her ride had already left. “I’ve been getting things mixed up lately. May’s been like that so far. I need to relax, calm down.” She came to the right place.
Another patient was lifting and arranging chairs. He was recovering from a fall and staff gently urged him not to push it. Amid chatting and much laughter, the many canes and walkers in the room disappeared as the class moved to the soothing guidance of their instructor, Christine.
Dr. Adisa Willmer launched the Wellness Center two and half years ago with colleague Dr. Barbara Towner to practice medicine in a way that wasn’t limited to disease but to looking at health and wellness. “We were both very interested in learning and practicing integrated medicine. We were getting pretty frustrated as primary care providers having 15-minute visits and not being able to address the issues we saw patients facing.”
Whole-Person Care
The LifeLong staff noticed many complicated health issues among their elder patients, people with five to ten medical problems. “Their diabetes was still out of control, their blood pressure was out of control they were gaining weight. In order to address the whole person, Laura Miller started a group for diabetic patients, believing if it were more dynamic and focused, if we have more of a community perspective, we could have more of an impact.”
The group was so popular it outgrew its space, and when the first floor of the health center became vacant, Willmer jumped. The Wellness Center opened with group classes that treated the whole person: nutrition, smoking cessation, aging, back pain, Zumba, blood pressure control, gardening.
In Rachel Fogel’s Healthy Aging class, the group discussed the benefits of owning pets. But the discussion soon became deeply personal. Fogel had created a safe space with her group to open up any possible topic. “The patients get support from each other, this is a form of therapy.” The class also allows patients to exchange tips. “It’s empowering . We talk about healthy experiences. ‘Oh, this works, I feel less stress if I try this. Oh, I also had a stroke and this is what I do.’ “
“It’s like family,” said one of the patients after yoga. “We mess with each other, we miss each other when someone’s not here. We text each other between classes.”
Some remarked on their increased flexibility and strength, and their yoga instructor noted that she sees the difference in the patients’ mobility.
“What we’re learning,” says Willmer, “is that their well-being is community-based. There something in the literature called the loneliness factor – when people get older, their partner dies, their family moves away, they’re pretty isolated and all of a sudden they come here and are able to work on their depression and anxiety, their back pain, their diabetes. They also see that what they are saying is helping another person. They’re not just here to help themselves. They really want to support other people.” She told the story of one patient who quit smoking two years ago, but still comes to the smoking cessation class to support others.
Path to a new way of paying for care
The group setting also connects patients to needed medical care. The Wellness Center has a team to expedite referrals. After the yoga class she had taught, Willmer (a certified yoga instructor) helped one patient with a referral and another with blood pressure medicine. After the Healthy Aging class, staff connected another patient to the team to set up an appointment.
While the Wellness Center model is bearing results, it struggles to cover expenses. “We are fee-for-service. Every time I do a one-on-one interaction – I have to write a note on everybody in order to get paid (by insurance plan).” But, she argues, care would be more robust in a group setting with non-billable providers who are experts in different areas of healing. Getting reimbursement for these providers would create a sustainable model for wellness.
“That’s where the alternative payment model can help us bring in more specialists and be more creative.” The State of California is piloting alternative payment models, but the model is still far from implementation.
Despite the payment barrier, Willmer, Towner and the Wellness Center team took a leap believing it marked the path to health. A creative model that treats the whole person, the body and mind, within a community makes sense for the patients who come from the neighborhood. “When someone comes in and has had multiple traumas in their family, their son’s got shot, their grandfather died and another has cancer (I may not be able to reach them) but in a group setting, it changes,” says Willmer.
After Chair Yoga class, two of the class cut-ups introduced themselves, “I’m G.I Joan and she’s G.I. Jane.” One had attended the Women’s Health group in the morning, while the other attended Seniors and Technology with Americorps Volunteer Tristan Lee. G.I. Joan promptly dropped into an impressive downward dog. G.I. Jane told her to stop showing off, and they doubled over with laughter.