Push for prevention: Doctors and insurance companies work to build momentum behind the adage ‘an ounce of prevention is worth a pound of cure’

By Joy White

Dr. Hieu Campus

The number of hospital beds on island has been at the forefront of discussion regarding Guam’s health care needs, along with the need for specialty care and specialists. A major goal of the new Guam Regional Medical Center has been to provide resources that allow residents to stay on island for specialty care. The island has also seen a wave of specialty clinics and specialty doctors, such as the GRMC Specialty Care Clinic, open temporarily until the hospital is complete, and the second branch of the American Medical Center, due to open in Mangilao.

However, the opening of the new American Medical Center branch not only speaks to the island’s need for health care in general, but to the need to focus on preventing residents from needing to visit the hospital or see a specialist in the first place.

Primary care physicians provide patients with referrals to see specialty care doctors. The increase in the availability of specialty care has not necessarily translated into an increase of primary care physicians to refer patients, says Dr. Hieu Campus, primary care physician and partner at the American Medical Center.

Something that goes hand-in-hand with preventing health issues is maintaining a healthy lifestyle, which is often promoted by insurance companies in the form of wellness programs. According to Campus, if people eat healthy, exercise and maintain a healthy lifestyle, they have done all they can to prevent disease not caused by genetics.

Campus says he sees patients for urgent care and acute issues. These patients are either sick or injured. “But our real goal is to keep people out of the hospital, maybe so they don’t need a specialist. Once you’re sick, once you need a specialist, then the preventative option is gone at that point. So you’ve heard prevention is the best medicine — that’s pretty much what we’re trying to achieve,” Campus says.

In general, Guam has been mirroring trends in the United States to promote preventive care, wellness, fitness programs and healthy lifestyles. Guam is slowly moving toward being more proactive instead of reactive when it comes to health care.

Having been away from Guam for about 20 years, Campus says he observed a better awareness for the need for prevention among the local population, but there may still be pockets where the awareness is not consistent.

“Guam has a big spectrum of rich and poor — educated and poorly educated. We see the whole spectrum. In general, I think people are becoming more aware of the importance of health. […] I think simple principles are starting to shine through: There’s a running event every other weekend it seems, and over the 20 years I’ve been gone, comparatively, the population’s not much larger, but we’re seeing that trend where people are more physically active and health-conscious. Education is getting out there, especially [among the] local people — when speaking to a particular spectrum of people, economical and social, there’s different populations that are here that weren’t here before. But for the local population, there is more awareness, and they are very open when I sit down and recommend taking preventive care measures,” Campus says.

Insurance providers have seen the need and are offering their members more comprehensive plans that not only offer full coverage on preventive procedures, but also wellness programs and incentive programs to promote exercise and healthy eating.

Most, if not all, insurance companies offer a selection of wellness programs. TakeCare offers programs for diabetes management; cardiac risk management; congestive heart failure; wellness; children’s health improvement; Well Mommy, Well Baby; smoking cessation; nutrition counseling and case management; worksite wellness and group fitness classes. Calvo’s SelectCare offers a weight management and control program; nutritional classes; and hypertension, diabetes and gestational diabetes management classes.

Each insurance provider is also looking for creative ways to assist the healthier lifestyles they are promoting. This has resulted in online resources and health assessments, fitness classes, discounts on gym memberships and newsletters.

Preventive screenings and procedures have been increasing in number as the need for preventive care is communicated.

“We are seeing an increase in preventive care services, such as the mammogram, colonoscopy and annual health screenings as our top three preventive care procedures being utilized more than others,” says Jerry Crisostomo, plan administrator of NetCare.

“Guam has the resources to offer quality preventive care and wellness programs. All health plans offered by TakeCare Insurance cover a set of preventive care benefits including immunization vaccines and different health screenings,” says Jeffrey P. Larsen, chief operating officer of TakeCare.

However, there seems to be a lack of confidence among the population in Guam’s ability to offer primary care. Many residents travel off-island for primary care that is vastly cheaper than on-island.

“In general, you don’t need to leave island for very thorough and comprehensive health maintenance or preventative exams. We have more than enough of what is required for all
medical association recommendations or guidelines,” Campus says.

Crisostomo says there is potential, but the drawback is the lack of readily available primary care physicians.

“While a few medical facilities on Guam, such as the [Seventh-Day Adventist] Clinic, already provide preventive care programs including wellness programs, I believe we need more medical facilities to jump on the wellness bandwagon and offer programs that focus on wellness and preventive care service rather than just [on a] treating-a-condition basis. We see more preventive care services going to the Philippines, for example, since the medical facilities, such as St. Luke’s [Medical Center] and Medical City, provide a very comprehensive annual physical examination and others,” Crisostomo says.

According to Campus, guidelines dictate that health maintenance organization physicians in the United States attend to a couple thousand active patients on their panels, with 2,000 patients being the maximum. Campus says that American Medical Center serves between 20,000 and 40,000 active patients between five primary care physicians.

“We do great capturing those who come in and encouraging them [to see a primary care physician], but if we start becoming more aggressive about spreading the word to everyone that they should be coming in here for annual physicals, we would not be able to handle that capacity,” he says.

Another obstacle is that many health insurance carriers do not take full advantage of their health insurance benefits, suggesting that education may not be the issue, but rather an unwillingness to take a proactive approach by seeing a primary physician and living a healthier lifestyle.

“Guam has reasonable fitness facilities and quality clinical preventive wellness programs. The resources are available, but utilization still needs to improve,” says Frank J. Campillo, plan administrator for Calvo’s Insurance Underwriters.

The same is seen across the board with other health insurance providers.

“While all health insurance plans on Guam provide 100% coverage for preventive care and health screening services, a significant number of members still do not take advantage of these free services and programs available to them. Perhaps, they are unaware of the free services or they prefer not to know what may be wrong with them,” Crisostomo says.

Health insurance companies and employers often take on the responsibility of promoting preventive care and wellness in order to provide for a healthy community and to save all involved some money.

“All NetCare benefit plans provide 100% coverage for all preventive care services including health screening procedures. This should be an incentive and a financial motivation for members to seek an annual physical examination and health screening programs to improve their health status and outcome. It is NetCare’s position that the choice regarding our health is simple: We either invest a relatively small amount of money on preventive care programs in order to stay in good health or pay a huge amount of money later to treat the illness or disease that is bound to eventually have a negative financial impact on us,” Crisostomo says.

Wellness programs incorporate this thinking to keep insurance clients healthy and away from the hospital or clinic, which results in savings for the insurance provider as well as the insurance holder. Employers often include wellness programs in employees’ health coverage.

“A well-designed wellness program helps low-health risk members maintain their health and contain health care costs, while at the same time helping high-risk members to make lifestyle changes, improve their quality of life and eventually lower their health risk along with their health care costs. Our wellness programs are a convenient and proactive approach for members to take advantage, and these programs can make a dramatic impact in the containment of overall health care expenditures,” Campillo says.

Insurance providers also partner up with community members. For example, SelectCare works with a variety of wellness partners, including SDA Wellness Clinic, Dr. Hourinochi’s Wellness Clinic, Paradise Fitness Center and Synergy.

Companies like BankPacific and IT&E encourage employee participation in wellness programs and offer employees comprehensive health care.

BankPacific has become very active in the Guam Hotel & Restaurant Association’s sports program and has registered teams for softball, basketball and volleyball. The BankPacific Employee Club’s most recent weight-loss competition ended in September with the winner receiving $450 for losing 14 pounds.

“I believe that it is important to offer wellness programs because healthy employees are happy employees. Eating right and exercising regularly reduces anxiety and depression in an individual, therefore making them more alert and productive in their daily activities and not focused on what ‘coulda, woulda, shoulda.’ Exercising can also help employees relieve stress,” says Philip J. Flores, president of BankPacific.

Flores estimates that less than 10% of BankPacific employees who are eligible are taking advantage of the bank’s wellness program.

IT&E has uniquely built gyms and showers at its Northern Mariana Islands and Guam locations so employees can exercise during their lunch breaks or before or after work. The company also has health fairs with insurance carriers offering screenings, and it hosts its own weight loss competitions and participates in various races and sports activities.

Jennifer Joy S. Santos, general manager of IT&E’s Guam branch, reports there is usually a large turnout to health fairs, due to promotion in-house.

“I am also proud to say that we are a 100% smoke-free company. Before we were able to achieve this, we held several smoking cessation programs to help employees transition from smoking,” Santos says.

“In general, we believe that wellness isn’t just beneficial to the company in terms of fewer sick days. It is also important for the overall well-being of our employees, which, in turn, results in better engagement and productivity of the employees,” she says.

Larsen sees that companies overall are showing more concern for employee health.

“We see Worksite Wellness Programs being instituted in private companies not just government agencies. We see companies wanting to schedule Worksite Wellness classes with various topics on preventative care, better nutrition, weight management and improving fitness,” Larsen says.

Campillo says a Gallup Report reported that 51.6% of adults in the United States exercise frequently.

“The numbers on Guam are still small compared with some of the fittest states, as noted in the Gallup Report. The most preventive and embraced change is fitness and mobility, which is a huge and positive change in people’s lives,” he says.

Paradise Fitness and Synergy have reported increased participation in the different activities offered by their facilities, according to Campillo.

“We have seen the rise in research showing that exercise is a key ally in the battle against specific diseases, such as cancer and diabetes. Healthy lifestyle habits have proven to be effective in preventing or managing chronic conditions. We are seeing the increasing calls for physicians to prescribe exercise and proper nutrition to their patients on a regular basis,” Crisostomo says.

In keeping up with the trend, NetCare will be launching an enhanced fitness program and a rewards program. GlobalFit will pay up to a specific dollar amount for a member’s gym or fitness membership and in addition, will reward the member up to a certain dollar amount per year if they attend the gym or fitness facility a minimum of eight times per month, regardless of whether the facility is a participating NetCare fitness partner.

“In addition, we are finalizing an arrangement with a fitness partner in the Philippines as well as in Hawaii and Los Angeles that will allow NetCare members to visit these fitness facilities [when they are off-island] at a preferred rate and seek full reimbursement from NetCare for their visit,” Crisostomo says.

NetCare’s HealthPlus Rewards Program will provide its members with various discounts and rewards from more than 40 rewards partners focused on health, fitness, wellness, safety, therapy and holistics.

“Our members have more energy, feel healthier and actually want to continue living healthy lifestyles because of the results they’ve seen. Participation in our group fitness classes and attendance with our gym partners has increased due to the fitness movement and our wellness incentives. The Guam population is becoming more aware of these programs as our community is moving toward a healthier lifestyle and disease prevention,” Larsen says. n