On Friday, February 20th, America Walks continued the "Inspiring Stories" Webinar series with a presentation titled "Whats Happening in Health Care?" America Walks was pleased to be able to offer the opportunity to share what institutions are doing to incorporate health promotion, specifically walking and walkability, into their normal operations.

David Pauer, Director of Wellness for the Employee Health Plan of Cleveland Clinic, and Jennifer MacDougall, Senior Program Officer for Healthy Living with the Blue Cross and Blue Shield North Carolina Foundation, provided numerous examples of health care organizations initiating programs and policy campaigns aimed at increasing walking and walkability. For example, Cleveland Clinic's employee wellness program promotes "walking meetings," includes a "Walk With a Doc" component, and offers its 80,000 members insurance premium discounts, which have saved the Health Plan an estimated $80 million in unnecessary health care delivery costs over the last 4 years. Meanwhile, in North Carolina, the Blue Cross and Blue Shield Foundation worked with the state Department of Transportation to develop a statewide Pedestrian and Bicycle Plan and to include "health" in their mission statement.The knowledgeable presentations demonstrate the shift from our current sick care system to a true health care system, to quote presenter Jen MacDougall. America Walks received many questions and comments from attendees and wanted to provide an opportunity to continue the engage discussion below. Please note the certain responses were provided by a specific presenter and are denoted with [DP] for David Pauer and [JM] for Jennifer MacDougall.

Does Cleveland Clinic absorb cost of Pebble (physical activity monitoring device)? Or does the employee pay for it? The health plan pays for the first pebble but any replacement is up to the member. [DP]

Is BCBS in NC also helping to BUILD the trails, or partnering with organizations that do? We are not helping actually build the trails, as our dollars are not enough to get much trail on the ground for people across the state. We support the planning that goes into trail development such as comprehensive greenways plans or pedestrian plans, as having those can leverage significant state and federal dollars to get trails on the ground. [JM]Does the Cleveland Clinic have data that shows chronic disease reduction for participants in the walking program? We dont have final outcomes data on disease reduction by all individual diseases. However, we do show our utilization is lower (number of admissions, prescriptions, etc.) and attribute that to limiting chronic illness. We also show that people in diabetes management program are more likely to test blood for sugar and cholesterol and keep them under control (HbA1C under 7% and LDL under 100 - important for diabetes patients), and more likely to get retinopathy screenings. We hope to show outcomes in near future with less retinopathy cases and with fewer admissions/visits/prescriptions for these patients with diabetes. [DP]How do state and local professional active transportation advocates work best with healthcare professionals to collaborate on solutions? The best way is to find a healthcare professional that is already interested in the issues in which you are advocating for. You can do this by asking people in your existing circles - the cyclists, the runners, the walkers, etc. - find out who is in healthcare, build on their network on influence and friends within their profession. You have to start with those that already care. Another good way to do this is to go through the professional organizations, such as the Academy of Family Physicians or the Academy of Pediatrics. They tend to look at more "meta" issues, they know their constituents, and they can guide you and connect you to the people in their profession that will be good partners and advocates. Sometimes the professional organization itself may also be interested in having a voice - so they are a great resource and they tend to have local (state level) chapters. [JM]What strategies have been effective to increase the number of physician practices that maintain a healthy office environment (with regard to food and drinks, etc.) that is observed by patients? We have comprehensive policies on smoking (dont hire smokers, no smoking anywhere on Cleveland Clinic grounds) and food and drinks (for example, no added sugars, only diet sodas, no trans fat, only whole grains etc.). We dont allow drug rep. food and that takes care of issue, but we do have coworkers who love to bring donuts or other items in to work usually social persuasion works best when a whole group of employees who may be doing "Weight Watchers" together tells others not to bring in donut box bombs because they are working on weight loss goals. [DP]Sources of funding for program and policy implementation? Land and Water Conservation Fund, TIGER funds, Rails to Trails funds, in NC we have State Trails money through the division of Environment and Natural Resources, as well as funding through the DOT Bike Ped division. There is also the Parks and Recreation Trust Fund in NC that helps support trails programs. [JM]

Does Cleveland Clinic promote walking or biking to work?We have an extensive program of bike to work, bike parking, showers, bike events, partnerships with bike advocacy groups, etc. We do not have walk to work as a formal part of Cleveland Clinic Walks program because only a few of our facilities are conducive to this but we do encourage that in communities where employees live and work. [DP]