Transforming Healthcare: From Medical Fitness to Value-Based Care with Joel Hungate

This paradox , as I view it , is the trust , interaction and communication gap that exists between fitness professionals and our medical community . This podcast is all about closing off that gap by disseminating the latest , most evidence-based and most engaging information in the health sciences . And to do that , in episode 132 , we're joined by Joel Hingate .

Joel's the Executive Director of Wellbeing and Employer Services at Hancock Health , and this conversation is going to be around the infrastructure of well-being that's been created at Hancock in Hancock County , indiana , and this is not only a fascinating conversation but an inspiring conversation , and you're going to hear Joel talk about the economic value of well-being

services and medical fitness services . Joel is one of the best spokespeople in our field on wellbeing and medical fitness services and he's very passionate , he's very articulate and he's very high energy , but he buoys that with data and return on investment for healthcare systems and for employers and , for that matter , for individuals .

So many pearls to take out of this conversation with Joel . Any information we'd like to share with you from today's episode can be found on the show notes page . Let's be going to wellnessparadoxpodcom forward slash , episode 132 . Please enjoy this conversation with Joel Hungate Today . We're delighted to be joined by Joel Hungate .

Joel , thank you so much for joining us .

Many times You've helped me out by giving me a tour of your facility , once with a health care partner , and I've heard you speak many times , and I'll give a shout out to Marianne Murphy from the MFA , who is one of my continual sources for podcast guests , who insisted and recommended that I get you on to talk about this topic today .

But before we dive into this conversation , why don't you just give our audience a little bit of an idea of your background to provide some context for the conversation ?

For about 10 years did orthopedics , worked for a big international orthopedic company and , yeah , I ended up having an office in Kansas City area , down in Lenexa kind of Overland Park , that area and next to my office , one day I wandered into this thing called the Dynamic Athletic Research Institute and I said , hey , what do you guys do here ?

It was two brothers using motion capture technology and they were like oh , we're trying to predict and prevent ACL tears in NFL athletes . Oh , that's cool . Would you like to take this into healthcare and call me when you're ready to do that ?

So , 2015 , 16 , got that call , invested in this company , became a principal in this startup called DARI D-A-R-I and DARI Motion now and we were able to kind of scale that , turn it into a medical device .

Well , that got me into the world of startups and then sold it to a venture operating group in 2018 , continued to work for them in that capacity and then , right around that time , I had a chance to move back to Indiana right before my twins were born , and that's what put me on a pathway to get into the delivery of healthcare , to move out of the innovation

side and not that we ever stop innovating , right , it's just a different type of innovation and what a joy that has been . When my twin showed up in 2018 , I thought , okay , I need to stop traveling . And then my third one showed up unexpectedly in 2020 . And I thought , okay , now it's zone coverage for the wife and I . I definitely need to stop traveling .

And was able to hop on with Hancock Health , which has always had kind of a thought leadership position , thanks to the work of Dave Flinch and the leadership of Rick Edwards and Steve Long .

Rick was a CFO , steve Long is our current CEO , and this vision , this idea of integrated well-being in our community , was inspiring for me and I had a chance to hop on as the director of the wellness centers at that time , and that has since evolved into more growth and strategy focus around well-being integration , well-being service lines and how we're doing all

of that in the community and then wrapping all of that around our employers with employer strategy , and that's what got me to this position now , where I'm the executive director of Hancock Hancock Wellbeing and Employer Strategy , helping bring that to life every single day . How fun it is .

But I do really appreciate the kind of eclectic and diverse perspective you bring to this . Unlike yourself , I mean , I started working in a YMCA gym when I was 15 years old and here we are at 43 , and I'm still basically in the same industry for the most part . So I appreciate that and I really truly appreciate what you guys do at Hancock .

And I'll say this to our audience listening right now If you're ever in the Indianapolis-ish area and you could go to the Hancock centers , particularly your beautiful center in New Palestine , which I've been to many times you really get a sense of what the model is intended to look like .

But we've talked about medical fitness on the podcast before and we'll get into some of the tactical aspects of it . But I'm really curious to hear you talk about some of the broader things that the health system is doing . You talk about the infrastructure of well-being at Hancock Health and you talk about how this is the delivery of health care , which I love .

You didn't say I'm in medical fitness , you said I'm in the delivery of health care , which I completely agree that you are . So talk about how you and then I guess , hancock Health more broadly view this infrastructure of well-being .

The healthcare landscape is more difficult than ever . You look at , kind of the post-pandemic pressures that we see in . Patient acuity is higher . They're showing up sicker , there's more comorbidities , reimbursement is lower , right , not only is it lower from a Medicare , medicaid standpoint in most regards , it's also rife with denials from commercial payers .

So the way that we used to get paid , even in commercial insurance , isn't even a guarantee anymore . I mean , certain patterns of claim denial rates right now are in upwards of 80% denials .

And operationally it's destroying healthcare systems left and right , forcing either you to shut your doors or consolidate or pick and choose service lines that are going to win and just pull them out of the healthcare system entirely .

And the irony is you know that whole equation is not going to be sustainable , especially if you want high quality access to local , focused acute care , healthcare and all the incredible amenities that that brings to a community right . So what we decided was there's no world in which this fee forservice aspect , this approach , is going to persist .

So we invested almost a decade ago in this idea of what you mentioned , this infrastructure of well-being , and I think I came up with that I don't know , somebody's probably got all rights reserved out there , so I apologize concept was the future of healthcare mandates that we get further upstream and engage with the patients in a way that prevents them from accessing

the big , scary , expensive things down the road . It's the only way we can solve the supply-demand problem . That we have in healthcare which is at the root of our economic woes with healthcare and as a health system . Many don't know this . We often get the finger pointed at us . Well , hospitals are expensive , and many don't know this .

We often get the finger pointed at as well . You know , hospitals are expensive . It's this bloated system and blah , blah , blah , blah blah .

On a good year , I mean doing backflips operationally , if you have 2% to 3% margins and we're a nonprofit , regionally relevant healthcare network and for us that's kind of it's a beautiful place to be because we're an independent health system .

We're big enough to be really interesting and have the capital to do things that are really interesting , but small enough to be responsive to the actual needs of the community .

And that's what bore this idea of the surround wellness concept that Doug Riley , for instance , has championed for many , many years and brought it to life in our community , in this infrastructure , well-being approach , to create three well-being integrated medical fitness campuses and put those strategically in our community to pull patients in , to engage with them early and

often in a way that other health systems don't even have access to . And then , secondly , we started to look at that and say , well , where are the gaps in care and how can we remove those gaps in care and to treat medical fitness as a physician extender .

That was the first aha moment right , clinical exercise , referrals , the integration of these campuses with primary care labs , imaging , diagnostics , physical therapy , specialty care that was our first kind of land . The expand version of this has turned into . Well , now I'm engaging with patients way upstream .

60% of the people that come into our medical fitness campuses don't use Hancock Health for anything . They say , hey , what do you use Hancock Health for ? They go Gesundheit . They have no idea what we're talking about . We invite them to go deeper .

And when we invite them to go deeper , we started to wrap this idea of oh what if we vertically integrated population health and community engagement in this nexus of well-being that we've created .

So we did that and we've got tobacco prevention cessation , we've got population health , well-being , integration in the community system of care congregational network and now , as of just a month ago , or actually a couple of weeks ago , really officially , we've integrated behavioral health into this ecosystem as well .

So now you have this fully integrated solution of all the proactive amenities that we bring to bear . Couple that with the full might and power of a very high quality , very price , transparent , innovative , regional health system and then we start wrapping that around employers and this direct to employer strategy .

And the beautiful part about that entire ecosystem is that health care is 100% dependent on engaging and winning hearts and minds , as I say , saying yes and saying yes to your health early and often , and then secondly , keeping them in these proactive continuums of care in this hub and spoke model , not a giant grinding bureaucracy .

That is the carousel of health care . Right Home base for health is proactive , it's well-being centric , it's lifestyle medicine focused in these medical , medical , fitness integrated campuses . Connecting these dots appropriately . We're being better stewards of medical utilization .

We're getting the insurance company and the denial and the reimbursement out of that equation in terms of being an antagonistic force against being paid for the wonderful outcomes that we drive and the wonderful services we provide .

We directly contract with the end-stage user of healthcare and it's creating this incredible parallel service line that will , for us , we think , be one of , if not the most strategically important things that we're doing in the next 10 to 15 years . It is literally 50% of our strategic plan doing in the next 10 to 15 years .

It is literally 50% of our strategic plan and it's this idea that when you lead with lifestyle and lead with well-being , lead with medical fitness , the differentiation you bring in these direct-to-employer contracts , direct-to-employer primary care clinics , direct-to-consumer care offerings it's unmatched and you're pulling levers on risk that other healthcare systems in mass across

the country , across the world , have not found a way to put their finger on the pulse . And when you can do that now , you're interesting .

You're interesting to benefit advisors , you're interesting to the employer , centered around this , because you're affecting risk in ways that you know and I know and folks that are in the well-being and medical fitness exercise physiology space . We know we have an outsized effect on the levers of risk .

But the hardest part has been bringing all this together , integrating it into what , even getting away from the idea of direct contracting we call a capitated bundling right now , and that's kind of bridging the gap between the speak of us in the clinical space and what they think about in benefit advisory and actuarial science .

We're starting to see those stakeholders come together . So it's a really exciting time and for us medical fitness and the integration of well-being that was the aha moment for the differentiator in health care that we're living every day now .

As many of you know , the wellness paradox is all about closing off the trust , interaction and communication gap between fitness professionals and the medical community , and no organization does that better than the Medical Fitness Association . They are the professional member association for the medical fitness industry .

This is the industry that integrates directly with healthcare in many facilities throughout the entire country . The MFA is your go-to source for all things medical fitness . They provide newsletters , webinars . They even have standards and guidelines for medical fitness facilities .

They do events around the entire country and , most importantly , they are one of the more engaging networks in the entire fitness industry . I personally have benefited from the network that I've developed through the Medical Fitness Association , and I highly recommend that all of you that are interested in solving the wellness paradox engage with the MFA .

To find out more about the Medical Fitness Association , you can go to their website , medicalfitnessorg . That's medicalfitnessorg . Now back to today's episode , that's . I hope that everyone that listens to this just plays that piece over and over and over again .

If you're a health system executive , you really need to replay that a couple of times to capture everything you said . So I'm going to summarize a couple of really important points and then kind of move on to a question .

One of the things you said early on and I'll quote our good friend and mentor to both of us , doug Riley , is that healthcare is currently an unsustainable economic equation . Costs are up , patient volumes are up , reimbursements are going down . Health systems are running off . If they're lucky , a 2% profit margin .

If I ran my business off a 2% profit margin , I would just close up shop , as would most other businesses . But that's a good healthcare system . I mean a lot of healthcare systems are sitting around zero . Sometimes they're on the bad side of zero . So the current equation is unsustainable .

You basically talked about moving to a value-based care model where you're not paid for all of the things you do the volume-based fee-for-service model we have right now . You're paid for the value that you provide to patients and a lot of that value is preventing illness before it occurs .

Or when it does occur , it doesn't occur as severely because people are healthier going in . So here's the question I think everyone universally who is listening to this would agree that that's the way health care should be practiced . I don't think anyone , even the people that make their living off fee-for-service , thinks what you said is wrong .

What is it that's so unique about Hancock that has you guys being able to do this , where I mean 98% of the health systems in the country just scratch their head and almost don't even know where to begin .

In healthcare all the time it's reactive . We take a management of your condition mindset . We don't think control , prevention , reversal . And when you realize that and this was the aha moment for us from the business of healthcare and I'm an engineer , I can't help it the numbers guy .

I live and die by the analytics and the healthcare economics for what we are doing in well-being integrated service lines . They're staggering . It's this idea that when we look back at this a great example with Hancock Health that 60% that I told you that wander into a medical fitness facility that we operate that don't use Hancock Health at all for anything .

The economics of healthcare . I'm engaging with those patients now when I resurvey them . In six to eight months it goes from a 60-40 split to a 40-60 split . That 20% of found unique patient volume has amounted since we started this effort of quantifying that .

And again , the other secret sauce is we've invested a lot of time and effort and people power into quantifying the impact of what we're doing in medical fitness and in this well-being integration service line .

It has amounted over $50 million in found patient revenue downstream , broad-based , unique established patient across every service line that we possibly offer in the health system since I've been doing this and then we're going on five years now of capturing that data and showing the pull-through is real .

And not only is it real , it is also viable as a standalone business . When you run this , it generates an incredible amount of cash flow for the health system . So for us , we started to say number one we challenged the notion that the wellness centers , or well-being or wellness efforts are a loss leader .

Well , it's a thing we got to do for the community , and Doug Riley was . I mean , he is the catalyst for that mentality , right ? This ? idea that no , these are , when well run , incredibly viable standalone services . So that's number one .

Number two you have to be able to tell the value proposition story about how you affect the bottom line , and that's because you could have a hospital administration shift from an executive leadership standpoint .

And if it is not self-evident that these are driving value , or you haven't quantified not only what you do operationally and the pull-through value , the strategic value of what you're doing , say sayonara right , that business is not going to be supported .

And then , third , challenging the notion that healthcare systems that this is outside of the scope of what they should be doing . Because when you're a hammer , everything's a nail .

And what healthcare doesn't realize is that we're not a hammer , we're a multi-tool , we're like a toolbox , we're this incredibly diverse entity that can affect change in so many more powerful ways than we even knew that we could .

And when you start to embody that from a culture standpoint , when you start to embody that at the provider and practitioner level , that when they think about exercise and nutrition and healthcare education , not just as the end goals but as a means to something else and I say this all the time health is a terrible end but it's a wonderful means we all know we

should be healthier . And the amount of time I've referenced your just legendary phrase , you know the ability to take somebody from couch potato to potato . Oh , the light bulb moments that people have when they see that . And then they look at the lower-doll-cause mortality and the data that supports this in large powered studies across multiple different verticals .

When you look at just pure play , medical fitness , look at just physical activity and the low bars what we're talking about from active I mean very low bar .

So there's this aha moment that happens as a health system where you realize , huh , I could be affecting that change , both from a mission standpoint for my community and from a margin standpoint , and I can monetize these service lines and do so with margins in a way that a lot of the independent operators in that space won't be able to touch , because you have

this much longer runway to create value for your organization than if I'm a pure play standalone facility . To your point , you have to have margin to survive . You can't go pay period to pay period wondering if you're going to make payroll . You have to have margin to survive .

You can't go pay period to pay period wondering if you're going to make payroll , you have to shutter that business . As a health system , I have this longer ramp , this more forgiving runway to create value and you can start to do so by integrating with these partners or vertically integrating that and offering that service yourself .

And then you're realizing that you are so far upstream . You're actually where the stakeholders , the consumers , want to be , and then the alignment of the incentive finally comes into play , as opposed for us being this black box , antagonistic thing that everybody just spends money on and then gets a horrible balance bill and this miserable experience .

The health care is hard to navigate , blah , blah , blah , blah .

When you realize you don't have to be that antagonistic entity , that's when our thought leadership in the space started to materialize on behalf of health systems and then we started to show that it was possible to do all of that and that it was translating into real economic value , and then finally that's starting to get the attention of policymakers .

So not only are we talking about this from just a blocking and tackling community health , population , health , healthcare , economics this is a great model for your health system and your community in mass , no matter where you are , no matter what you're doing . Some version of what we're talking about matters and it can be deployed and it can be done effectively .

You just need to challenge your notion that it's not a space that you should be playing in . Now we're starting to see this at systematic levels , like a systemic approach , from a policy standpoint . Could these ideas fundamentally change healthcare ? And oh yeah , it can , and people are starting to see that the numbers are adding up .

So , whether it's governors , our local , state , federal legislators , we're starting to have these policy conversations now and I know you've been at the forefront of a lot of that too is where are we going in terms of an industry , in representation , in reimbursement , in our place as physician extenders and force multipliers in health care ? My , oh my .

That wave is starting to rise and people are starting to take notice . So what an exciting time .

Basically , we get people in a very non-intimate way to a certain extent . I mean , there's a big difference walking on a treadmill in one of your centers versus going to a physician , but they start to become acclimated with your system . Then , as you said , what was the number ? Was it $50 million ? Was that the number you gave ?

And when they choose to do that , when I quantify that over the going on five years that we've started to capture those financial metrics , it is an incredible amount of dollars that have found us . And it's because we built that trust and because we're aligned around driving the outcomes that matter , which are really what we do every day in medical fitness .

It's that return to dynamic movement , that return to quality of life , that keeping the wolves at bay when you talk about frailty and resilience and resistance training .

And now that's only going to become more and more apropos when we get into the new therapies that are out there on the market that are going to have unforeseen effects on this and anti-obesity , anti-diabetes medications .

So you're finding these overlapping interfaces of value that , when you're buttoned up and telling the economic story , there are these incredibly easy , beautiful add-ons where patients say , yeah , my gosh , I go to Mike's facility and they know me , they know what healthy looks like . They're invested in me and my family .

I'm going to choose to go deeper with them and their partners because they know what healthy looks like . I'm not just some person rumbling in off the street .

There's the community , the accountability , and that's really what we offer at the end of the day , and we're just turning that into outcomes because , you'll see this , for anybody that gets in the direct consumer , direct employer space you live or die by engagement and healthcare .

The future of healthcare is going to live or die by engagement in terms of consumer driven outcomes , and we have that down to a science in medical fitness and bringing that to bear on behalf of a healthcare system . What an incredible value .

Look out five to 10 years from now , with what you guys are doing at Hancock , what's on the horizon that excites you the most over the next five to ten years ?

point where this becomes a lever that allows us to create the insurance products of the future , and what I mean by that .

I think in five to 10 years in my community we will have a community health plan we're already working on it that will fully integrate access to our direct primary care clinic , ecosystem , lifestyle medicine , access to our wellness centers and all of the programming and we will , at some level , be sponsoring that in two-sided risk , when we're already doing this in

the accountable care organization world as health systems , but getting into and some are doing it in the insurance space .

But imagine the outcomes we can drive when all these stakeholders are aligned that healthier is better , everyone wins financially and I see us being the primary destination for the community health plan in our community and in East Central Indiana where folks can access those amenities as a part of that solution .

Imagine insurance where all of that is pre-baked and your engagement with it , the incentives that could be built around , premiums and deductibles and steerage to our health system with zero copay and zero coinsurance .

That's what the future is going to look like and my goal winning or losing in five to 10 years is that just by living in Hancock County , you will have made the choice to be healthier .

That we will have integrated so robustly into the community with partners everything from restaurants to our health system , to employers , to the indigent populations and to the entities that serve a variety of socioeconomic and social demographic needs that just by being here , we have integrated well-being so effectively that that infrastructure is embodied in not only our

county health rankings . But just by being here you are choosing . You and your family will be healthier . You are taking this almost silent pledge , just by living in Hancock County , that your family will have a happier , healthier life .

And if I can say that and then we can point back to that in our county health rankings and our health grades and our outcomes data and be able to look at this inflection point that we're building right now and say that commitment to the infrastructure of wellbeing created a model that could make communities healthier .

That's not just a healthcare question , right , that's an economic development question . It's opportunity , it's the rising of the tide for the economic prospects , the employer prospects , the development prospects , the quality of life prospects for our community in perpetuity .

And imagine we start to have that conversation across the country , that if we could be even a small catalyst , along with the voices like yourself and the people in our industry that are spreading the good news from the mountaintop right now to see that change start to catch fire , I think we're going to have policies that make it where you'd be crazy not to , as

a county , have these sorts of things by that time . So it's moving so fast . I don't think it's too bold to put those type of goals on the big board , you know , and to say that that's what winning and losing looks like . It's hearts and minds . And it's funny . You know the economic problems plaguing healthcare right now . They solve themselves .

If we do that , you know it's beyond the sale . So that's what I would say you know , just by being here , you're healthier in five to ten years and we've got this wave of communities living out that model .

So before I bring it to a close and ask the final question , where can people go if they want to find out either more about you individually or all the great work that you're doing at Hancock ?

So I have my own website , joelhungatecom , where we take that connection of health , well-being , adventure readiness , leadership and talk about what that means for a more ready , capable , resilient citizenry .

You know how can we make choices to say yes and stay yes to adventure and what does that mean for health and well-being and how does that impact the things that we're talking about today ?

So you can find a lot of that there , in addition to information for the speaking engagements and events and things that I do on that front , and then , specifically , the blocking and tackling for what we're doing at Hancock Wellbeing . There's hancockwellbeingorg and hancockwellbeingatworkorg where those are the specific programs .

But Hancock Health if you just Google us hancockhealthorg , you can see a health system with the leadership of our board of trustees and Steve Long , who is just a visionary in the space , a health system committed to these ideas . So check it out . And then you can check me out on social .

It's usually at Joel Hungate no spaces for TikTok , instagram , facebook or at this underscore is underscore Hungate on X and then LinkedIn it's Hungate Ventures . You can find me . Give me a follow . I'll follow back . Love the conversations and any thought leaders , anybody that has questions .

We are never too busy to take the time out to share how to make this model come to life in your neck of the woods . So don't be shy .

So I consider the wellness paradox to be the trust , interaction and communication gap that exists between fitness professionals and the medical community . Based on your observations of literally solving that gap at Hancock , what's one piece of advice you can give to the fitness professionals listening right now to solve that gap in their communities ?

You can do it today and that could be the step just having these sorts of conversations with the people in your community that you can connect with and start to tell this story . Take every single talking point , parrot it , make it your own , write it verbatim . I don't need any credit for that . I know Mike doesn't care if he does .

If you are able to take this idea that we're all better at the end of the day when we bring this into alignment and healthier earlier and often , and removing barriers to saying yes and staying yes to that , we're all winning . And you can do that right now by figuring out what assets do you have in your community .

Don't solve a problem from a problem-based , centric approach . Look at the assets you have available , put all of those on the menu and think about how you can connect the dots . And that's exactly what we did . We had leadership that invested in some of this infrastructure assets . We said , well , how can we connect these to the people that need them ?

And connecting those dots intentionally and communicating and having the good faith to say we're all moving towards that vision of a healthier , more productive society , amazing things start to happen and you find people that want to do that too , and the economics they make sense and they can , and we can help with that .

If you need help quantifying that , give us a call , cause we'll give you what we do on that front so you can go do it . But don't , don't wait . Don't wait , boy . If I wish I just had this facility , or oh , I wish I just had this facility , or oh , I wish I just had this .

You can do this programmatically with the assets you have right now and it'll change lives and if you change one , it's worth it . I mean seriously , the amount of change that happens when we do what we do every day and bring these things to bear aligned , integrated . Look out . So don't wait , you can do it .

Ask the next best question challenge those notions and get outside of your lane , because really , where all the magic happens is you connect dots outside of your domain , you connect dots outside of your industry and outside of the things that you didn't think would correlate to what you're doing , and all of a sudden you've created something new .

And we just did that incrementally until we look back and we're like , oh my gosh , we've created a systematic kind of approach to do this . It can happen in your community at whatever scale and size makes sense . Don't wait .

Forward slash episode 132 . Please be on the lookout for our next episode when it drops in two weeks , and don't forget to subscribe through your favorite podcast platform . Until we chat again next , please be well .