Blue Zones has been around for a couple of decades. Can you describe some of the work you’ve been doing to address health outside of the four walls of the hospital?
Ben Leedle: Blue Zones is a company that works on transformations for whole communities and for organizations by helping to bring in nine secrets of longevity and happiness that were discovered by its founder and National Geographic Fellow, Dan Buettner. He was supported by a science team from the National Institute on Aging and sent around the world to find the non-genetic related places where people live the longest, the best. And from that work, he wrote several best-selling books. The contents of that evidence base have been used to create a reverse engineering for our American communities to try to increase what has been a trending effect on both the growth in disease and the shortening of our lives here.
In April 2020, Adventist Health acquired Blue Zones. How and why does that kind of union come together?
Leedle: It’s really interesting what’s taken place, particularly over the last 10 or 12 years. Not-for-profit health systems are required under their tax status to contribute back to the communities that they’re serving beyond the traditional acute-care scope of work, which means trying to find the right way to invest those dollars in a meaningful way to lift up the health and well-being of everyone in their markets. And there’s been a lot of formal work done and advancement around community health needs assessment, which is getting better at pointing out the problems we face. But there was difficulty because, traditionally, hospitals and clinics were not set up with mechanisms or infrastructure to pursue creating this type of change.
What are some of the opportunities and challenges you’ve faced integrating Blue Zones into Adventist?
Leedle: Adventist has made a bold commitment to its communities, expecting to invest $1 billion over the next 10 years through community benefit, gifts, grants and partnerships. Even though that resourcing is there, the real hard lift is working with the existing business and infrastructure of hospitals and clinics to collaborate and build coalitions, because this is not work you do to a community. It’s a body of work that you empower a community to do for itself.
We bring experts. We bring tools. We bring process. We bring funding and resources. But the biggest challenge is that it’s awkward, at best, for most providers to step out into the community and do this work. We’re in the phase of rolling out six communities concurrently across a footprint. That’ll grow to 25 over the next three years. The early work is putting in the relationship and governance structure with a community, and then allowing this to be a primary part of the work that the hospitals and clinics will do in concert with Blue Zones.
Culturally, it’s a big shift. And experience-wise, we’re exercising new muscles as a health system to get outside the four walls and at a grassroots level begin to create the change that these communities need.
How do you sell it at the local level? What resonates with those leaders and communities?
Leedle: There’s a mission conversation and Adventist Health is living God’s love by inspiring health, wholeness and hope. That is well-being. And, yes, you can do that through medical care provision, but the companion to that, all that love poured into the patient, gets diluted if they’re going back into a life setting that is working against all of those measures of effort. So part of this is that it’s our mission. It’s not just our purpose, we have an obligation, and that always resonates.
The business case moves from a qualitative construct to a quantitative one. For each of these communities, we do quite a bit of analysis using simulation models to take in all of the forces that create value, those that could destroy value and then share what we think that looks like as an impact from the program.
We’re spending anywhere from three, six, nine months building out those cases on a market-specific basis, and then going to the broader community with the community case. Oftentimes it’s needing to be able to be understood across the public sector and the private sector. These are fairly sophisticated developments and they take some ground time to get installed.
How do you identify the communities that are well suited to start this kind of work?
Leedle: We have, over the last 12 years, built an underwriting process, (not) in an actuarial sense, but in a sense of what’s the likelihood that if the resources were brought (in), that there would be leadership across a community—the public sector, the private sector, not only the healthcare industry leaders, but business in general and the not-for-profit organizations in a community—and a willingness to stack hands around a common approach. And then, we ask the scientists to do quite a bit of work using the Gallup database on well-being, where we’re actually looking historically and current state. And then, asking the scientists to project, if nothing different is done, what does that cost of doing nothing mean for this community in terms of medical costs, lost productivity, economic vitality, jobs, real estate value? Then we forecast what we would expect a Blue Zone project to create as a positive impact on that forecast.
How long does it take for you to start to see some measurable results?
Leedle: You see some process measures fairly early, particularly around a groundswell of citizen or consumer awareness and engagement. With the engagement, we have the chance to be able to parallel and put in implementations across policy and a lot of place-based work. And what that yields is the beginning of people being exposed to things that will create healthy choices being the easiest choice, if not the absolute default, in most of the places and spaces where they’re spending their time. For adults, maybe the workplace. For kids, schools. But also, restaurants, grocery stores, faith-based organizations. And even encouraging citizens to take pledges to do things in their own home that align to Blue Zones and the Power 9 principles.
By year two of these projects, we begin to see risk reduction of a dozen really key risks that we know feed into the development of chronic disease. And by years three, four and five, we began to see the ability of that risk reduction translating into medical costs, workforce productivity, and even begin to look at the early measures around broad-based community metrics that have been important measures for the community long term.
By the time you’re three to five years out, you begin to bring the results back against the investment. Typically, these projects will hit a run rate break-even by two years and, cumulatively, pay back the investment three years into the work. And by five years, you’re seeing solid 2-, 3-, 4-to-1 (return on investment).
