Several years ago, the St. Luke’s University Health Network, which serves Bethlehem, Allentown and other parts of eastern Pennsylvania, surveyed residents on their health as required for its tax exemption under the Affordable Care Act.
Officials were alarmed by the findings. The survey found that 14 percent of residents had diabetes and an additional 3 percent said they had suffered from diabetes in the past. By comparison, the national average of those with diabetes is 9 percent.
Also, more than a third of respondents reported getting no exercise during the week, while Hispanic residents were more likely than others to be overweight or obese and less likely to consume three servings of fruits and vegetables on an average day.
In looking for ways to address the situation, St. Luke’s found a partner in the Delaware and Lehigh National Heritage Corridor, an organization tasked with promoting and maintaining the Delaware and Lehigh Trail, which stretches 165 miles between Wilkes-Barre and Philadelphia.
Together, they created Get Your Tail on the Trail, a program designed to encourage physical activity and usage of the historic pathway. Now in its fourth year, more than 5,900 Get Your Tail participants have logged more than 1.8 million miles walking, running or biking along the corridor.
This program came together in part because of Obamacare. Under ACA guidelines, nonprofit hospitals such as St. Luke’s are required every three years to conduct a community health needs assessment and to draft an implementation plan for addressing the findings.
Partnerships such as that of St. Luke’s and the D&L corridor group are also part of a shift by hospitals away from just treating people who are ill in a fee-for-service manner and toward what is known as population health, or “the move from volume to value,” said Bonnie Coyle, St. Luke’s director of community health.
“At the federal level, they’re saying, ‘We’re not just going to pay you because you delivered the services. We’re going to pay you if you made the patient healthier in the process of providing them that care,’ ” Coyle said.
Michael Consuelos, a physician and senior vice president of the Health & Healthsystem Association of Pennsylvania, a trade group, said St. Luke’s is a model for other nonprofit hospitals looking to address the health needs of their service area.
“Hospitals are assessing the needs of their community, moving from just taking care of sick patients and moving toward taking care of the population as a whole. That work needs to be done,” Consuelos said.
With the program well underway, officials are involved in early stages of licensing the Get Your Tail model to other hospitals and for those wanting a scalable wellness program.
Founded in 1872, St. Luke’s has a long history of wellness activities, such as running an organic farm and operating a fleet of vans to reach underserved populations.
“It’s part of our corporate culture to try to get out and be active,” said Kenneth Szydlow, St. Luke’s vice president for marketing and public relations.
At the same time the hospital network was reacting to the “volume to value” mandate, officials at the D&L Trail were looking to create programming and sponsors to boost the trail’s usage. Trail corridor executive director Elissa Garofalo reached out to St. Luke’s officials to propose several ideas, one of which became Get Your Tail on the Trail.
As part of the effort, participants register at tailonthetrail.org and report miles that they spend walking, running or biking on the trail. They’re encouraged to meet goals such as the 165-mile challenge that began May 1 and concludes Nov. 1.
Garofalo said everyone has been surprised at the high level of participation. She expected that a couple hundred would sign up. After the end of the first season, close to 2,500 people logged more than 255,000 miles biking, running and walking.
Susan Deibert, 45, from Hellertown, has lived in the Lehigh Valley her entire life but hadn’t used the D&L Trail for any type of exercise. Signing up for Get Your Tail gave her and her friends the opportunity to socialize while exercising.
“So I went out more and more, and I thought, ‘Let’s take a look around here.’ And I found myself as I went on getting into biking, going to different parts of the trail, taking on different challenges I would have never thought I would have done,” she said.
Deibert said she lost weight and became more physically active, taking to biking the trail to meet the 165-mile challenge. “It spurred me to become more active, which in turn makes you more healthy and want to do more. I’ve been participating ever since [the start of Get Your Tail],” Deibert said.
Both Coyle and Consuelos say the ACA has become a powerful motivator in advancing population health. That’s a concept defined by researchers David Kindig and Greg Stoddart as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” This means hospitals take part in addressing larger community health issues to improve health care while lowering costs.
Consuelos notes that this undertaking is a challenge because “hospitals are medical facilities and treat medical problems.
“Hospitals will only affect 10 percent of health-care outcomes. The rest of social determinants they are bumping up against: education, crime, transportation, housing,” Consuelos said. “This is a journey that our hospitals are on, to explore new and innovative ways to work with their community to improve the health of the community.”
To that end, the challenges allow for creative partnerships with existing infrastructure such as multi-use and rail trails. While used for recreational purposes, communities are taking advantage of trails to also promote wellness.
Szydlow said they were cautiously optimistic at the beginning that the program would work because of the immensity of the wellness challenges in the Lehigh Valley — a population of more than 820,000, of whom an estimated 13 percent lack health insurance — as well as the general lack of awareness and usage of the D&L Trail.
He has been pleased with the results.
“It surprised us in a positive way. We thought it would be more of struggle to get people to get out and about and interested. But there’s something about this program that resonated with the population we were aiming at — which, quite frankly, is calling them couch potatoes,” Szydlow said.
St. Luke’s and trail officials say the partnership is mutually beneficial: St. Luke’s gets more people active and the D&L gets more awareness of the trail system.
“We crossed paths at the right time to say, ‘Here’s a great partnership to accomplish multiple goals,’ ” Coyle said. “Hospitals should think about partnering with trails and trails with hospitals. They may not a natural partnership, but in the world of wellness, it’s a perfect partnership.”