Prescription for senior health: recreation: a managed health care company offers parks and recreation opportunities as part of its benefits package.

Most seniors looking for health insurance search for the richest benefits package: good prescription plan, low-cost hospitalization, reasonable co-pays or the option to stay with their current provider. For the seniors enrolled in Senior Dimensions, a Medicare + Choice plan of the Health Plan of Nevada, the richness of the benefit might be attributed to keeping an eye on preventative health. The Fit for Life Club benefit provides members with free fitness opportunities at more than 30 parks and recreation facilities throughout southern Nevada.

Fitness benefits come in different forms for health plans. The most common fitness benefit, in many cases a "value-added" benefit (in managed health care terms), is a discount at local fitness centers. For many seniors on a fixed income, even a low-cost monthly fee is prohibitive, so health plans have thought creatively to include fitness in the actual plan profile. The Fit for Life Club fitness benefit is part of what plan administrators sent to Medicare that details what Senior Dimensions promised to deliver to members--that is, that fitness is part of the benefits package, not a bonus.

Many health plans will contract with a vendor to connect seniors with exercise, but this design proved to have limitations when Senior Dimensions road-tested that option in 2001. The health plan contracted with a respected out-of-state vendor for a per-member, per-month fee. Although the program was well-developed and provided high-quality, trained instructors at six locations in the Las Vegas Valley, the fitness benefit was under-utilized by members, with less than 2 percent of members were exercising regularly at the end of 2001. Senior Dimensions knew it had the right idea--promoting activity to enhance quality of life and health for members--but not necessarily the best source.

Networking Through Recreational Tennis League

In 1997, two lifelong athletes met at a United States Tennis Association adult league. Between matches, Joanne Lorrey, senior recreation program administrator for Clark County Parks and Community Services, and Jennifer Martinsen, director of health education and wellness at Health Plan of Nevada, agreed that their two focus areas, health promotion and recreation, had potential for partnership to serve the community.

Years later, that idea of linking health education and wellness to parks and recreation in southern Nevada came to fruition through Senior Dimensions' search for a suitable fitness benefit. Lorrey and Martinsen opened discussions again in 2001 and, within weeks, had hammered out the details to launch a fitness benefit for Senior Dimensions members at Clark County Parks and Recreation. Dave Allazetta, sales manager for Senior Dimensions, concurrently contacted other recreation entities in southern Nevada, and terminated his contract with the vendor that had provided the fitness benefit for Senior Dimensions for only seven months. He knew his health plan could do better with a homegrown, regional program, and he had found the best source for senior activities already flourishing in the community.

"It was apparent that a commercial gym wasn't the most senior-friendly environment," says Allazetta. Within months, Allazetta, Martinsen and their respective departments contacted four other municipal recreation organizations--those in Henderson, Las Vegas, North Las Vegas and Boulder City--to arrange for senior usage of their facilities for a monthly fee. (YMCA of Southern Nevada was added the following year.) The Senior Dimensions Fit for Life Club became the first health plan in the country to partner this fully in a comprehensive delivery of fitness and health education through community centers, senior centers, recreational parks and pools.

Betting on Serving Seniors

"As public employees, we have an obligation to find ways to provide services without further burdening shrinking general fund dollars," affirms Pat Marchese, director of Clark County Parks and Community Services, which encompasses Las Vegas, Henderson and Boulder City. "Given the right circumstances, partnerships are a way to accomplish that."

Las Vegas is a Southwestern boomtown with a twist. Not only is it considered the country's fastest growing region, it's the country's gaming industry leader. This blend of burgeoning population, shifting demographics and the 24-hour gaming industry makes for a unique set of challenges to the recreation programmer.

"Clark County Parks and Community Services is dedicated to building a sense of community in a place that is known for its glitz and glamour, but not necessarily home-town friendliness," states Marchese. "Seniors are moving to Las Vegas at a pace unequaled to anywhere else in the country, and we feel it is important to connect with them as soon as possible to help them with the transition. This partnership provides our seniors with the opportunity to connect, make friends and stay active in a comfortable setting."

Southern Nevada is favorable to the senior population: reasonable real estate, sunny and dry climate, plenty of recreational opportunities and affordable health care. Often the first challenge new residents face is finding health care insurance. Through Senior Dimensions Fit for Life Club, seniors get a zero-premium plan (no monthly fees) as well as recreational, fitness and social opportunities. The blending of health care and recreation provides an instant link for an entire lifestyle support system: physician, clinic, exercise, social services and card club all in one.

All municipal partners of the Fit for Life Club provide services for a monthly fee paid by Senior Dimensions. Terms vary by partner, but they're paid either by a capitated fee, or a by per-member participation. Members who access the community partner facilities also are exposed to the variety of other classes and services the center provides. "Having someone seek fitness in our center introduces them to the availability of our other services," says Beth Busseau, recreation programmer for North Las Vegas Senior Center.

Members of the Fit for Life Club enjoy:

* Unlimited access to identified indoor and outdoor pools for open/lap swim.

* Unlimited use of fitness rooms.

* One free senior/low-impact exercise or water exercise class every six weeks, or ongoing for those that are offered on a continual basis.

The expected daily-use fees for pools and fitness rooms, as well as access to certain fitness classes suited for seniors, is figured into the monthly payment rate. Because Senior Dimensions is a federally funded Medicare + Choice program, funding is limited to fitness opportunities. However, if a fitness class brings someone in the door, there's a chance they may also sign up for ceramics or a computer class at their expense.

"Once we get folks in the door and they see what the recreation department has to offer, the rest is easy," suggests Joanne Lorrey of Clark County Parks and Community Services. She adds, "It's true some people come only for the fitness classes, but in many cases, Fit for Life Club members are involved in other activities as well."

Bridging the Knowledge Gap

There's a broad range of class offerings to seniors in the Las Vegas Valley, from tai chi and yoga to traditional chair or low-impact aerobics. It's the diversity of the programming that has brought so many Fit for Life Club members to the partners' parks and recreation facilities. There's also a broad range of teaching styles and educational backgrounds among the instructors. Some are seasoned group exercise instructors with master's degrees in exercise physiology; some are volunteer seniors who have exercise background as a participant, but not as a leader.

In partner meetings held periodically at the corporate campus of Sierra Health Services, recreation administrators had related a need to hold instructor-training workshops to ensure the quality of their classes. Senior Dimensions responded by contracting with Exercise Etc., an exercise-instructor training vendor from Florida, to provide a 14-hour, seven-session "Older Adult Fitness Instructor Workshop." Senior Dimensions subsidized the cost of the workshop for one instructor at each partner facility, as it was an investment in the programs it regularly refers members to.

"The workshop definitely offered ideas I can use when I train the seniors at my facility," says Amanita Faust, a personal trainer who's also working on her degree in leisure services management and gerontology. During the workshop, the goal was to underscore the importance of safety for special populations, the dos and don'ts of instructing seniors, and provide ideas for stretching, strengthening and cardiovascular training for classes and one-on-one sessions. Participants received continuing education credits/units if they were previously certified, and were also offered the option to test for a specialty certification upon completion of the course.

Faust works at the Henderson Multigenerational Center, an 84,000-square-foot facility that opened in January The center is the first to take advantage of the option to offer health education classes by Health Plan of Nevada for their community. The center has been the most proactive in getting Health Plan of Nevada/Senior Dimensions programs infused into its programming. "Health Plan of Nevada helps to market these programs to patrons that might not regularly visit our facility," says Annette Mullins, recreation supervisor for Henderson. "They also help us facilitate programs that may be harder to staff."

The center will not only be offering use of its extensive fitness room, personal training, indoor walking track, heated indoor pool, exercise classes and health education classes through Health Plan of Nevada. It will also use its community services area to offer provider-referred one-on-one health education consultations. "It has grown into a relationship that educates and provides programs for not only their members, but to all citizens in the community," stresses Mullins. "I see the partnership continuing to grow into areas that we never anticipated it to in the beginning."

Aquatics, a Favorite Joint

The aging population often finds that their joints aren't as willing to exercise as the rest of their body. Osteoarthritis prevents many people from seeking exercise opportunities because it can cause discomfort or pain. Aquatic exercise classes, lap swimming and recreational swimming is kinder on the joints, and is a major attraction for Senior Dimensions members.

The Municipal Pool in Las Vegas, the Desert Breeze Aquatic Center in Clark County and the Whitney Ranch Indoor Pool in Henderson get large numbers of Fit for Life Club members using their facility. At the "Golden Oldies" aerobics class at Desert Breeze Pool, the exercise area is filled to capacity as they rock to Elvis. (This is Las Vegas, after all.) At the Whitney Ranch pool, the "SMILE" class is designed specifically to help those with joint pain to exercise safely. The Las Vegas pool is filled with lap swimmers as well as participants in a group exercise class created by The Arthritis Foundation, which frequently conducts train-the-trainer sessions at the location.

Aquatics added an important component to the Fit for Life Club, as the previous vendor that provided the fitness benefit had only one pool for member access. Recreational outdoor pools provide a unique component to Senior Dimensions members--a chance to play with their grandchildren at no cost to them. A trip to Grandma's might just mean a trip to the local Clark County safe, guarded, zero-entry pool for family swim. That kind of health plan fitness benefit is unique.

The Big Picture

"It is very cutting edge for a health plan to recognize, promote and pay for their members to actively be involved," says Sharon Lopez, recreation program supervisor for Clark County Parks and Community Services. "The recreation centers, whose mission is usually to serve people and enhance quality of life, are filled with happy people that are eager to participate in physical activities paid for by the Senior Dimensions plan," adds Lopez. "These members are also introduced to other activities once they walk in the door."

Public and private partnerships for community health initiatives are reasonably common. Regional medical centers and large clinical physicians' groups often provide workshops or refer clients to parks and recreation. These facilities are ideal venues for community health projects including those, for example, tied into regional health districts that have received tobacco settlement dollars to provide smoking-cessation programs in the community.

The Senior Dimensions Fit for Life Club program is a more cooperative, shared-belief program under the direction of a managed health care company's medical director, and several community partners that are realizing the value of enhancing both their monthly revenue and the caliber of their workshops and fitness classes. The extensive nature of this program--it currently partners with so recreation facilities and several outdoor seasonal pools--makes it a first of its kind. "Fit for Life Club is a spoke on the wheel of the health education and wellness continuum of care," says Allan Ebbin, M.D., M.P.H., vice president of healthcare quality and education for Sierra Health Services, the parent company of Health Plan of Nevada and Senior Dimensions. "It strengthens the services they already provide."

"We wanted this program grounded by a medical director and health education staff so the integrity and the mission of the program would be taken seriously," underscores Jennifer Martinsen. Although housed in a for-profit managed health care company; the Health Education and Wellness Department is a non-revenue-generating department that offers exactly what its title suggests. This provides a more natural link to nonprofits and government agencies. "The parks and recreation partners in this area are fabulous places that meet the needs of all generations at all income levels," says Martinsen. "Its major expertise is a delivery system that involves the entire community."

"For years we have worked to show a link between recreation and improved health," says Pat Marchese, director of Clark County Parks and Community Services. "This partnership is another very effective way for us to get that word out."

Can it Work for You?

One of the factors that makes the Fit for Life Club partnership a manageable project is the fact that Senior Dimensions is a health plan for Nevadans, so localizing efforts for fitness and member health is possible. However, many multistate regional offices of larger health plans would be able to implement this arrangement as well, A limited service area makes the home-grown nature of the program possible.

If your organization is interested in expanding senior services as baby boomers age, or perhaps reaching out to health plan resources for all populations, the most important steps are:

* Contact your local health plan and ask questions: Do they have a Medicare + Choice plan? Do they have a health education or wellness division? Do they currently have a vendor providing fitness benefits, and are they satisfied with the participation? What is their service area? The sales department would be able to answer these questions, but find contact people within the organization--their internal communication link is critical. To find health plans in your area, go to the American Association of Health Plan's Web site at www.aahp.org.

* Find out where the health education and wellness division is housed and what programs it offers, and if it's linked to a disease-management task force. Does it need more venues to offer classes to the community? Is it involved in a grant that requires a certain amount of workshops on its schedule?

* Discuss partner options with your recreation administrative team. What kind of revenue would you need to generate? Who will coordinate the effort from the recreation side?

There are many more steps to follow, and as with any new program, it will develop its own character based on the team that plans it. The most important factor is to continue along with your respective missions, and see if partnering aligns with them and enhances the possibilities.

One-Stop Health Shopping

One of the challenges parks and recreation facilities face is the limitation of tight budgets, which often make it difficult to offer high-quality specialty classes. With the Fit for Life Club partnership, the door has been opened to 17 health education curriculum programs that are currently offered through Health Plan of Nevada's Health Education and Wellness Department. The most popular include diabetes management, cholesterol reduction, weight management, mature women's issues and smoking cessation. Providers rarely have the time to educate a newly diagnosed patient, but they actively refer to those who can fill the knowledge gap: health educators.

Classes at Las Vegas-area clinics are provided through Health Plan of Nevada for a low cost. The Fit for Life Club partnership is at the beginning stages of bringing the same disease-management classes to partner recreation facilities. This is a boon for seniors who are comfortable going to their community center for walking group, but not too thrilled with medical centers.

"We hope to bring wellness, disease management and fitness programs to the centers to enhance their current offerings to help our growing senior population stay healthy," says Jennifer Martinsen, director of health education and wellness at Health Plan of Nevada.

Janit Stahl is the project manager of the Fit for Life Club. Her family utilizes area parks and recreation facilities on a regular basis, from tiny tot sport classes to swim lessons. She can be reached at jstahl@ sierrahealth.com.