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Good to Know: Minn. program boosts seniors' fitness class participation

Gail Johnson, center, the health and wellness manager

Gail Johnson, center, the health and wellness manager for CommonBond Communities, leads a tae ji kwon class adapted for residents at the Kingsley Commons building in Minneapolis, Minnesota. Credit: Minneapolis Star Tribune (TNS)/Anthony Souffle

As she approaches her 80th birthday, Ardella Cherry knows she needs to keep her body moving and her spirits up, if she has any hope of remaining independent. Halfway through an eight-week class to improve balance and fitness, she already feels more confident.

“Getting older can be a process where you feel like you’re a hindrance,” Cherry said during her class, A Matter of Balance, held at her senior-housing complex in north Minneapolis, Minnesota. “I look at things as an adventure. Try to have fun.”

Minnesota’s aging agencies have spent the past decade trying to get more people to attend healthy-aging classes, which research shows can be a low-cost, effective way to teach those with chronic diseases or at risk of falls how to improve their health. But the process has been fraught with poor participation and canceled classes.

In the face of a rapidly aging population, a new statewide initiative known as Juniper aims to exponentially boost participation in the classes by taking an obvious but unusual tack: getting doctors and insurance companies involved.

“Part of the problem with our health care system is that for so long patients have treated their doctor as all-knowing,” said Dr. Sara Lindquist, a board-certified internist and geriatrician and Juniper’s director of health care integration. “If we can help patients be more proactive in caring for themselves instead of putting all their care in the hands of physicians who they see only once a year or every six months, it can potentially be a transformative cultural shift.”

Juniper relies on the state’s seven Area Agencies on Aging plus the Minnesota Chippewa Tribe, aiming to unify their efforts and build upon their established relationships with nonprofits and community-service organizations.

A $3 million grant from the Margaret A. Cargill Philanthropies helped build a website, yourjuniper.org, to facilitate class registration and health-care provider referrals. It also allows Juniper to accept contracts from health insurers or employers.

The idea behind Juniper is to organize and standardize what now is an informal and haphazard smattering of wellness classes.

“These programs have been around for decades,” said Georgia Lane, the senior planner and developer at the Arrowhead Area Agency on Aging based in Duluth. “What hasn’t been around is a way to link them. They pop up at community centers or different faith communities . . . Juniper allows for a sustained delivery network and improves medical outcomes.”

From the start, participation in Juniper’s evidence-based programs exceeded expectations. The original goal was to have 2,000 people enrolled over the first three years. More than 1,700 Minnesotans completed a class in 2015, the inaugural year, according to the Metropolitan Area Association on Aging, which is leading the project.

Since then more than 6,500 people have attended programs that run for six to 12 weeks and often include a mixture of discussion and strength-building exercises.

This year, 580 classes will be offered under the Juniper umbrella, serving 5,200 people.

“We’re just starting to scratch the surface,” said David Fink, program developer for the Metropolitan Area Agency on Aging. “To really impact the overall culture of wellness of our state, we have to make it a lot easier for a lot more people to find classes, get to classes and understand why they’re useful.”

Public health officials have long known that social, economic and behavioral factors are tied to poor health. But with a shortage of geriatricians and financial pressure to avoid preventable hospital readmissions, the medical community is eager find ways to lower costs and improve health.

A fall that causes a significant fracture can cost $34,000 and often precipitates a downward spiral. About a quarter of patients will stay in a nursing home for at least a year after the fall, and one in four people who fracture a hip will die within a year.

“The challenge we have as a community and an aging population is that the intervention for remaining independent is based on such things as preventing injuries, preventing falls — interventions that are not classic medical acute care,” said Dr. Thomas von Sternberg, associate medical director of geriatrics, home care and hospice at HealthPartners, which has joined Juniper.

With research showing that patients are 18 percent more likely to attend classes if a physician recommends it, von Sternberg said it makes good medical sense and business sense to make Juniper’s resources a part of every primary-care visit.

“The secret sauce is, can you get people to keep doing the program, to keep showing up, doing it at home, and normalizing exercise and balance — like brushing your teeth,” he said.

HealthPartners has set up a billing and claims system to reimburse Juniper like any other provider.

“What’s nice about Juniper is it’s the main connector of all partner programs,” said Nancy Hoyt Taff, HealthPartners’ public health program manager for government programs. “You can find them yourself or our member services coordinator can help. It’s an easier shopping experience if you will.”

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