Efforts Paying Off

The health and fitness industry has experienced a multitude of changes in the last 25 years, but nothing as profound as the hospital-based fitness center concept. Health care systems have traditionally focused on the detection and treatment of disease, injury, and illness. Today they have evolved into systems focusing on prevention and early detection. These trailblazers have proven they can provide a continuum of care, draw new patients to the health care system, and expand a hospital’s mission—all while operating as a viable profit center. Perhaps most importantly, these centers have improved the health status of their community, incorporating a positive step toward reducing health care costs.

TriHealth Fitness and Health Pavilion is a state-of-the-art, 110,000-square-foot fitness and wellness center located in Cincinnati, Ohio. The center provides members with rehabilitation and prevention services and health and fitness programs in one building. By integrating member-based community fitness centers with clinical rehabilitation services, there is the continuum of care that flows from inpatient, outpatient, and post-rehabilitation to fitness and wellness.

The hospital-based fitness center concept was based on attracting unfit-at-risk participants for safe exercise. TriHealth was very good at providing this service at our established corporate fitness centers. Therefore, we proposed to our board of trustees and the medical staff that we expand this concept to the public at large. TriHealth’s strategy was based on a full spectrum of rehabilitation that provided six service goals:

1. To fill an unmet need of the community by providing programs targeting medically unfit-at-risk individuals. Many people in the community who do not belong to a fitness center are very uncomfortable beginning a fitness program without professional guidance. Our goal was to reach out to these individuals with a non-threatening, medically supervised environment.

2. To transition rehabilitation patients while adapting to payment systems which promote optimizing health status rather than fee-for-service arrangements.

3. To make a significant impact on the northeast community of Cincinnati with outpatient and physical therapy services while improving the opportunity for cost reduction and revenue enhancement.

4. To attract the unfit-at-risk population.

5. To provide a system to transition rehabilitation patients to a lifestyle of maintaining health and fitness.

6. To enhance the hospital’s image and leadership in health in the community, fulfilling the mission of improving the health status of the people we serve.

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Our immediate goal was to emphasize the continuum of care of inpatient, outpatient, post-rehabilitation; providing general fitness programs came next. There are several different ways to integrate or offer a transition process within a system:

• A low level of integration, which utilizes facility design and incorporates all departments within one building with minimal cooperation of departments.

• A medium level of integration, in which you share working space and start to combine services.

• A high level of integration, which provides one management team, shared staff within departments, and the utilization of outcome measures for complete health management, serving the whole individual.

The entire project of TriHealth Fitness and Health Pavilion cost $16 million. In order to fund the project we needed a great deal of research to support the concept. Physicians, consumers, corporations, and the competitive market were targeted to analyze the potential of this concept. The physician study was very important, because we wanted to know if physicians saw a need for this type of concept and if they would support it and contribute as medical directors and medical speakers. We also studied the consumer population in the Northeast corridor of
Cincinnati.

Site visits nationally to other fitness centers allowed us to explore the hospital-based trend occurring nationwide. Corporation studies were done to see if they would subsidize memberships for their employees to participate in long-term wellness. Competitive analysis of other fitness centers in the area allowed for additional insight to our vision. Could we attract the unfit-at-risk population and safely provide professional care with the hospital name? Following in-depth research, we discovered the need was present and the community was ready. We presented the concept to the board of directors for approval.

Our mission statement reads: "The TriHealth Fitness and Health Pavilion exists to improve the health status of the community through prevention, exercise, rehabilitation and health education. As a hospital-based center, we provide a variety of opportunities for physical, mental and emotional well being, delivered by caring professionals in a clean, service-oriented environment." A development team of professionals, hospital board members, physicians, nurses, therapists, financial advisors, and marketing specialists played an important role in the design and layout of the building. The Pavilion was opened in January, 1997 and includes:

• Fifty-foot translucent atrium with sheltering live trees, fountain, pool overlook, Atrium Café, Pro Shop and Pavilion Day Spa.

• Two aerobic performance studios totaling 5,000 square feet with resilient wood floor, wall-to-wall mirrors, glass walls for maximum light, ceiling fans.

• Spacious 9,000-square foot exercise floor filled with more than 100 pieces of cardiovascular and resistance training equipment, extensive free weight area, televisions, computer log-in station, indoor lounge and outdoor decks.

• Kids’ Life Center with skylighted gymnasium, dasherboard for in-line skating, basketball, indoor soccer, floor hockey, aerobics, martial arts, outdoor playground, nursery, computers for homework or play.

• Pavilion Day Spa with six salons for massages, facials, manicures, pedicures, body wraps, mud treatments.

• Indoor 25-meter pool with six lanes for water aerobics, lap swimming, and lessons.

• Outdoor leisure pool, zero depth to five feet, with lounge deck, snack bar, and changing rooms.

• 10,000-square-foot physician office space.

• 100-seat multimedia conference center and patio with catering facilities.

• Seminars including wellness classes and cooking/nutrition classes in demonstration kitchen.

• Indoor, warm-water therapy pool with hydraulic lifts and underwater workout equipment for arthritis and other disabling conditions.

• Skylighted sports arena large enough for two simultaneous basketball games or three volleyball matches.

• Indoor 1/8-mile, three-lane jogging track, outdoor tree-lined asphalt ½-mile jogging track, and indoor walking path with telemetry units.

• Outdoor sand volleyball adjacent to leisure pool.

• Outdoor basketball court.

• Cardiac, physical, hand, and speech rehabilitation staffed by physiatrists, nurses, therapists, dieticians, and exercise physiologists.

• Men’s and women’s locker rooms with sauna, Jacuzzi, steam rooms, lounges, and amenities.

• Health assessment, computerized workout log-in stations.

• Five family changing rooms.

• Exposed location off highway I-71.

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The post-rehab program is the transitional phase of the continuum of care concept. This phase focuses on providing a system to transition unfit-at-risk therapy patients into safe, effective, independent fitness programs. The post-rehabilitation membership is a three-month membership offering a waived enrollment fee on general membership if they choose to join long-term. To flow with the continuum of care concept, members are required to have completed therapy within the last 60 days and to obtain information from their physician and nurse or therapist regarding their medical status.

Patients that can benefit from the post-rehab program range from newly injured workers to those with multiple injuries and a high risk for recidivism to those who have completed cardiac rehab or have undergone surgery or joint replacement. Some workers’ compensation carriers and boards will pay for such programs, particularly if the worker’s continued employability will be improved and when the programs are medically based, providing the worker with professional guidance.

After a patient has been referred into the program, a certified athletic trainer will initiate an appointment with the "member" to begin the transition process. An assessment appointment will include medical history, current status of injury, current exercise status, setting short- and long-term goals, screening for aerobic conditioning, flexibility, strength, functional capacity, participation in wellness activities, and educational programs. Weekly appointments provide the basis for implementing a full body fitness program consisting of aerobic, flexibility, and strength components. The program also introduces injury-specific transitioning and progression of therapy exercises, developing functional activities, and teaching long-term management.

Targeting the unfit-at-risk population requires slow introduction of exercises and gentle progressions. Monitoring and charting progress can be very supportive in the motivation of continued exercise. A goal of the post-rehabilitation program is to assist the unfit-at-risk member to feel comfortable integrating with a healthy member.

A 90 day reassessment will include an evaluation of short-and long-term goals, advancement of fitness components, and discussion of general membership. The goal is to encourage continued participation to complete the continuum of care.

Optimal outcomes develop positive relationships within the medical community, in turn producing more referrals. Since the TriHealth Fitness and Health Pavilion opened, 256 physicians have referred patients to our post-rehabilitation program. During this time, 120 therapists or nurses have referred patients, reflecting the positive, professional impact we have had in our community. A total of 586 members have come through the post-rehabilitation program, including injured workers, cardiac rehab and post-surgical patients and individuals with chronic conditions such as arthritis, diabetes or fibromyalgia. The post-rehab program also has a high conversion rate with 72% of the participants joining the Pavilion as long-term members. This affirms that the unfit-at-risk individuals, our target market, are having success and continuing with independent fitness programs.

Hospital-based fitness centers have impacted the health and fitness industry by successfully combining a full spectrum of healthcare services. By providing a continuum of care and focusing on individual member’s needs, these centers have improved their communities’ health status. At the same time, they have taken a major positive step toward reducing healthcare costs by focusing on prevention and wellness. More and more hospitals are expanding their continuum of services to include prevention and promotion of healthy lifestyles. As this trend continues, the hospital-based fitness center concept will become more prevalent, offering health systems and the health consumer more options that create a healthier, more productive workforce and community. 

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