Health assessment provides comprehensive overview for 49ers

by Katie Sanders  An 8 a.m. health assessment is just the thing to jump-start your day, I think with some annoyance, as I maneuver the car through the snow. I’m dressed in gym clothes and have a snack tucked in my bag to eat after the fasting blood draw. I’ve signed on for this activity to better understand the model and process of preventative health care used by the Operating Engineers Local 49.

I’m early. I climb out of the car and make a dash for the office door. The snow is wet and heavy. I’d rather be at home with a cup of tea.

Shortly after I settle on a place to sit, I’m called by a woman who introduces herself as Sandi. It turns out there is a tag-team approach to the screening. I will be switched back and forth between Sandi for some tests, and Jeremy, another physical therapist, for others.

The first order of business is vital signs and the blood draw. Both Sandi and Jeremy realize I’m participating in the screening in order to write an article or two. They take my blood pressure, then I obligingly fill (though not very quickly) the two vials of blood that will be used for nearly 20 different profiles.

Next is testing for flexibility and range of motion. Most 49ers operate heavy machinery. All that climbing around, vibration and physical wear and tear take a toll on little things: how far can you flex your neck from side to side? Up and down? How about your legs and ankles? How far do they bend?

It turns out, though I’m not operating heavy machinery, I’m not very bendy. I explain that my grandmother had what I call Greta Garbo slippers (heels with fuzzy toes) because she couldn’t stand flat-footed. Which brings up an important point for later in my final analysis results: heredity. But then I’m off for urinalysis and to Jeremy for body fat analysis, EKG and spirometry.

First, I lie face-up on a table while leads are stuck on my right and left sides for the EKG. In short order, I’m disconnected and holding on to two rods, one in each hand. They emit a very low-level electrical charge that indicates your percentage of body fat, as the electricity travels differently in tissue, bone and fat.

Spirometry, the test where you huff into a tube until your lungs are empty, has changed in the years since I last took one for asthma. Jeremy helpfully provides an automated picture of my breath blowing out the flames of a cartoon house to gauge my progress. It beats the well-meaning encouragement of the nurse who kept suggesting that I “Keep going! Keep going,” years ago.

I reassemble myself and report back to Sandi for the treadmill test. She sets the treadmill at 4.8 mph and I walk grades of 3%, 6% and 9%. Sandi checks my pulse at the beginning and end of each grade change for a total of four readings.

Finally, I’m transferred over to Jeremy for one last test: strength. Essentially, I do a series of leg presses on a machine and a series of arm presses. They look for 60% of body weight on arms and 110% of body weight on legs. When the results come back I find that I am at 230% of expectation on my legs and barely 60% on my arms. Weightlifting will be recommended.

Finally, I meet with the on-site physician who gives me a cursory physical and looks over the results that are available from the day’s activities. As far as the appointment goes, this is the only part that I am treated differently than a regular patient. This is because my primary care physician is outside the Health Dynamics System, and I am not having some of the screenings that I would as a 49er.

And then I’m done.

Two weeks later, I’m back for another early morning appointment to discuss the results. I meet with Sandi again. In addition to telling me about my labs and the appointment, I receive a booklet with the identical information inside to what Sandi has in front of her. The booklet is mine to keep. This is an important point of the program. I can walk into the office of any provider I choose in any place and lay before them the results of that March appointment. No medical release forms to sign, ship and await return.

The spirometry and EKG are there too. The blood profiles are particularly impressive. Even as someone who doesn’t know bilirubin from bacteria, I can appreciate the “In Range” or “Out of Range” designation given for each test. I am happy to report that I was within range not only on my blood-work, but also on my other tests.

This follow-up appointment is where the rubber hits the road for many 49ers. There are dozens of stories where the tiniest elevation has tipped off Sandi or one of her counterparts. In some cases, zero-level cancers have been diagnosed years in advance of actually manifesting because of this extensive blood profile, which tests for items normally not measured in most standard annual physicals. I ask Sandi how all of this goes over with her clients from the 49ers.

“I tell everyone that people need to hear something three times before they make a change. If we can get people to come back for this screening three years in a row, they make changes in their lives,” she said.

We continue to go over both my test results and the self-assessments I filled out: One on stress and the other on eating/drinking habits. In short, lifestyle choices. My “Risk Level summary” finds I’m moderately stressed these days, but my physical fitness and blood profile come back in the excellent range (The categories are: Poor, Acceptable, Normal, Good, and Excellent). And don’t forget heredity. You get points for family history of illness. In short, the lower the number of points, the healthier you are.

The risk levels are: High risk: over 25 points; High-moderate risk: 20-24 points; Moderate risk: 16-19 points; Low-moderate risk: 12-15 points; Low risk: 0-11 points. I squeak into the low risk category despite my non-flexible body and family history of heart disease. I am a low risk of either a cardiovascular event or stroke within the next 10 years.

Obviously, I can’t change my family history, age or gender. But looking at these numbers is still sobering. I could eat better – much better, it turns out. I could also manage stress better, too. Modifiable behaviors that aren’t necessarily easy, but worthwhile to get those risk numbers to go lower. Sandi says this is generally where the reality sets in for people making less healthy choices.

“The smoker whose Dad just had a heart attack sees the number for how smoking increases his own risk for heart attack and he starts to think,” she said. She also notes that she has seen groups of clients out on a run instead of heading to the bar. “That is more about changing the culture, not just the lifestyle,” she notes.

While not every member takes advantage of these comprehensive screenings, Local 49 has seen a steady rise in participation, accompanied by improving health results and lower costs. Every person who goes through the screening is better educated – and an educated patient is a consumer who can make better choices.

Read more about how Health Systems Management and IUOE Local 49 team up to build the best health care system in the country, including stories from participants in the program.

Watch "A Model for Health Insurance" on the Mary Hanson Show, featuring Jim Hansen and Martha LeFave.