Hospitals, HMOs embracing preventive medicine.

It's health care's hottest trend: wellness, or the idea of keeping people healthy so they won't have to spend so much time in the hospital with acute illnesses.

Examples of the wellness movement pop up throughout Southern California:

* Hospitals are upgrading their facilities with fewer inpatient beds and more outpatient clinics, fitness and nutrition centers and wellness programs.

* Health plans are promoting screening and self-treatment programs and have even beg tin to endorse alternative medicine treatments.

* Employers are setting up screening programs, while individuals, becoming more proactive in their own health care, have been using the Internet to keep up to date on the latest medical research.

"Health promotion and disease prevention are more important than ever," said Cindy Keitel, director of wellness for Woodland Hills-based Health Net. "It's all part of a growing coordination of care between health plans, patients, hospitals and primary care physicians that is focusing on the patient as a whole person and not just an illness statistic."

In fact, Health Net and Blue Shield of California both announced this month that they would cover some forms of alternative medicine.

Wellness is not exactly a new idea. The term was first coined in the 1970s, but the concept is nearly as old as medicine itself and is embodied in the old adage: "An ounce of prevention is worth a pound of cure."

Until the last few decades, though, preventative medicine techniques were relatively crude, focusing on diet and herbal remedies. With improvements in screening and immunization came the awareness that many diseases could be detected early or even prevented. Some forward-looking companies and health care providers began to screen employees in the hopes of saving on rapidly escalating health care costs.

At the same time, baby boomers began experimenting with alternative forms of medical treatment, such as acupuncture and massage therapy. Also, they took to gyms and jogging paths as part of the fitness craze.

However, the mainstream health care establishment, including doctors, insurers and hospitals, were slow to change. Locked into the "fee-for-service" delivery system, most health care providers had focused on hospitalization and treatment for acute or chronic conditions.

"The engine driver had been acute care," said Mike Dwyer, an analyst in the health care advisory services division of the accounting firm BDO Seidman. "Only in the last few years has that begun to change and allow wellness to come to the fore."

Several factors have converged to bring the mainstream health care community on board:

* The development of managed care and the focus on reducing long-term hospital stays, the most expensive portion of health care costs.

* An aging baby boomer population demanding more input in their health care treatment.

* Major studies over the last decade showing cost savings in preventative care. One such study last year from Duke University found that preventative care saved an average $5,000 per individual per year.

* Advances in technology, which has enabled procedures that used to require major invasive surgery and lengthy hospital stays to be done on an outpatient basis.

* An overabundance of hospital beds, especially in Southern California, which has forced hospitals to rethink how to deliver health care. That reevaluation has been further forced by the Northridge earthquake and subsequent legislation requiring all hospitals to retrofit their structures.

* Employers who want lower health care costs and healthier employees who take fewer sick days.

While these trends have swept the industry, it is at hospitals where they are most evident. Not so long ago, hospitals were room after room of patient beds, test equipment and emergency centers. Today, they have fitness centers, nutrition programs and outreach centers for the elderly.

St. John's Hospital and Health Center in Santa Monica, for example, is undergoing a $285 million facelift that will include a $15 million to $25 million lifestyle center.

The St. John's center will focus on providing fitness, nutrition and other wellness programs for the 40-plus population.

"There is a tremendous demand out there for fitness programs for this age group," said Sister Marie Madeleine Shonka, president and chief executive of St. John's. "They don't feel comfortable exercising with the young and fit at a for-profit health club."

St. John's is also changing its mix of inpatient and outpatient services. Fifteen years ago, only 12 percent of the hospital's resources went towards outpatient services; with the new campus, that will increase to 60 percent.

"In the next 10 years or so, some 85 percent to 90 percent of all surgical procedures will be done on an outpatient basis, so we want the flexibility to allow for fewer permanent beds," Sister Shonka said.

The new inpatient building will have 150 beds, each in a private room, instead of the 225 beds that exist today.

As part of the redesigns, hospitals are incorporating private rooms, gardens and areas for family members to gather, according to Michael Ross, an architect with the Los Angeles office of Stone Marraccini Patterson.

"The focus is a sense of wellness, of oneness with nature and one's surroundings," Ross said. "If you feel better mentally, then you will feel better physically."

Both hospitals and health plans have increased their phone advice lines and distribution of informational pamphlets to tap into the growing consumer demand for information.

Kaiser Permanente, which as the nation's oldest health maintenance organization long has focused on preventative care, sends subscribers a handbook that offers first aid and self-care tips.

"In terms of providing the best care, determining when the best time is to come into the hospital is crucial. If you wait too long, the consequences could be disastrous. But if you come in too soon, it could turn out to be just a wasted trip," said Ron Nakamura, regional health education director for Kaiser.

Companies, too, are joining the wellness bandwagon as they have felt the pressure to reduce health care costs.

"Many of our companies are coming to us for advice on how to set up wellness programs," said Health Net's Cindy Keitel. "They know that things like prostate cancer screening, flu shots can save them a lot of sick days."

At Boeing Co.'s Palmdale plant, a just-completed five-year study of wellness programs found that sick days has fallen to an average 1 day per year per employee, from 1.8 days in 1992, according to fitness program manager Barbara Green. That translates to annual savings of $93,000 for the plant's 480 employees.

Also, the number of visits to the doctor fell from 2.8 visits per year per employee to one visit per employee per year.

Green said that because studies like this are expensive for companies to conduct, many finns are relying on other companies to give them the data they need to justify the cost of setting up wellness programs.

"These companies realize intuitively that wellness programs save money, so they are willing to take this leap of faith and set them up," Green said.