Medicare Part C Can and Should Be Refocused for Zing, Zest and Zizzle: A New Role For Primary Care


This article outlines a wellness initiative for health insurance companies offering Part C Medical Advantage programs under Medicare. While there are (as of 2014) 66,800,000 plus Americans on Medicare (53.8 million of whom are aged – the rest qualify as disabled), only 16.2 million participants have Medicare Advantage programs. So, this segment represents an attractive test population for an initiative that could in time be available for all Medicare recipients and, eventually, all Americans.

The proposed initiative begins with expanding the kind of data that will be collected and digitized for Advantage Plan members. The expanded data will be of exercise and other wellness-related activity. This initiative will expand and improve prevention-focused offerings now in use under the Advantage primary care programs. Existing efforts are almost entirely illness-focused, non-positive, not much fun and ask little to nothing of patients concerning steps to take to promote their own well being. The primary care is passive, not active with an emphasis on risk reduction. Currently, primary care visits are consumed by sickness/worseness measuring efforts, supplemented at times with traditional health education brochures and the like.

In short, Advantage programs have little or no ZZZ – zing, zest and “zizzle.” (“Zizzle” – my neologism for enhanced “sizzle,” but with the letter “z” added to enable the cool acronym)!

ZZZ will be under the control of plan doctors, despite the fact that, at present, doctors have limited time for, knowledge of or, in many cases, commitment to exercise and fitness – their own or their patients. However, they will embrace ZZZ because it will make them better doctors, improve patient health status and render coming to work more interesting. Furthermore, patients once aware of and engaged in ZZZ endeavors will be happier, as well as healthier.

The ZZZ model will get patients on board with active participation, praise and a positive focus. It will provide all patients with the realistic hope for a better, more effective way to live. It will feature a transfer of responsibility for life quality from the medical system or the doctor to every patient. This shift is desperately needed. Believe it or not, some health insurance wellness program descriptions still use the ghastly phrase, “preventive health.” For the record, no one, particularly a health care provider, should seek to prevent health! The use of this ill-considered phrase reveals the absence of thinking in terms of health and life enrichment, and its use should be considered a felonious offense, followed by a moment of shaming and then, rehabilitation of the offending medical miscreant. Without exposure to the ZZZ program, this excrescent term will never be heard again.

Elements Of The ZZZ Wellness Program

ZZZ initiatives will be expressed in upbeat, positive tones that emphasize the benefits and advantages of the program for doctors and patients. In making the case for ZZZ, it will be wise to minimize criticism of the poor record of the health care and fitness industry historically. This despite the fact that the medical system has ignored the myriad elements of genuine physical and mental well being, cultural support and meaning and purpose. This will change under ZZZ programming.

Instead of measuring and monitoring risk, ZZZ elements will feature the assessment of achievable benefit levels. Computerized data gathering for all patients will give medical providers a full picture of patient exercise habits. Doctors will, after conferring with patients, encourage specific exercise and overall well being targets/objectives for 3 month, six month and one year periods. Monitoring, evaluation and, when appropriate, celebration rituals will be conducted at each stage.

Initial Steps for Implementing ZZZ

* Enlist the participation of the medical community. Note areas of opportunity, intervention and programming at the three ZZZ stages.

* Involve specialists to work with the patient and primary care doctors. The ZZZ program is managed and conducted not only by primary care physicians but also available wellness practitioners (nurses, etc.) and fitness specialists.

* Rather than prescriptions, medical personnel will insist that short and long terms objectives be part of individual ZZZ wellness plans. These should be drawn by individual patients in collaboration with wellness center resource personnel.

* Aerobic fitness tests will be used to evaluate strength and flexibility, alignment and balance. No longer will standard medical exams and routine office visits overlook total-body health, fitness and wellbeing.

* Emphasize the integration of wellness elements with smart technology. The ZZZ model enlists tech devices (such as exercise apps, smart watches, iPhones, Bluetooth and cloud storage) to collect and transmit computer data to medical managers. These data are integrated with traditional medical apparatus (blood pressure machines, digital scales, blood glucose monitors and so on) to create comprehensive pictures of patient health status at varied points along the way.

* A wellness-focused website will be set up and promoted for continuing education. The sites will be used by personnel as resources for patients (e.g., it will contain articles on REAL wellness skill areas as well as the usual prevention topics). The site will be update with fresh information on a daily basis, in part in response to interests shown by Advantage primary care ZZZ participants.

Doctors will utilize these tools in initial and all subsequent encounters with patients, many if not most of whom will be initially be overweight, discouraged, stressed and without non-pharmacological coping skills.


With Medicare doctors linked to individual exercise history, patient/provider interactions will become more attuned to the importance of lifestyle, which is not the case at present. ZZZ will represent an historical advance, and boost the likelihood that care givers will attend to signs and symptoms of fitness, good diet and personal development and become more circumspect about destructive norms, lack of meaning in life and the value of finding added meaning from work.

With this linkage, symptoms such as metabolic dysfunction will not be signals for automatically prescribing drugs to lower high blood pressure or cholesterol, but rather as indicators for specific lifestyle initiatives. The doctors will confer with other office team members (nurses and varied specialists in lifestyle interventions) for exercise and meaning-related “prescriptions.”

With the ZZZ program, all health practitioners will have the tools, procedures and information they need to measure and monitor lifestyle patterns, and the training, intelligence and wisdom to use non-drug approaches to ameliorating problems. Most important, the focus will be upon turning patients away from the mediocrity of dwelling on ills and troubles. The ZZZ shift will instead channel their energies toward health and life enrichment.

The ZZZ Program will give new meaning to the term “prescription.” Instead of a permission slip for gaining a drug from a pharmacy, the patient/doctor follow-through memo will be a pathway for more zing, zest and zizzle from life. The affirmative goal will be to create and carry out a simple wellness plan. This will be patient-authored, with assistance from the ZZZ doctor group. It will culminate with improved exercise patterns and fitness results, and new initiatives in diet adjustments and attention to personal development. All this will be reviewed by the health insurance provider and the patient on a yearly basis.

The World Healthy Organization has shown that human lifespans more than doubled over the course of the 20th century, mainly because of the triumph of science over disease, particularly diphtheria, measles, whooping cough, polio, tetanus, typhoid and smallpox, among others. Perhaps a similar gain might be achieved in the course of the 21st century. This, too, will be enabled by science but focused not only on eradication and control of infectious diseases, but on enhanced life quality and longevity. Such would come about by a dramatic reduction in the incidence of diseases of choice, that is, lifestyle and environmental “contagions” passed along by cultures that make uninformed, destructive behaviors seem normal and convenient. Warnings against such patterns of self-abuse will never be as effective as opportunities to experience the liberating power of personal advances. Improved energy levels, better appearance and greater feelings of well being, all and more occasioned by exercise, good diet, effective management of stress and other skills taught in ZZZ-like endeavors will follow primary care that focuses upon exercise, responsibility, exuberance and the joys of self-empowerment.

Such a shift will be the ultimate form of an Advantage-based health insurance programs, initially for a relatively small group of Medicare enrollees and, perhaps, eventually for all the American people.

Be well, look on the bright side and always insist of a good measure of wellness-related conversation with your friendly neighborhood primary medical doctor.