|  | BUSINESS PROPOSAL SUMMARY
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Over 58% of Americans are considered overweight (BMI>25) and 27% are considered obese (BMI>30). The number of overweight/obese Utah residents has more than doubled since 1989, from an estimated 388,500 persons to an estimated 801,600 persons in 2000 (Utah Dept. of Health, 2002). Obesity is associated with increased risk of morbidity associated with numerous conditions, including: type II diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, congestive heart failure, stroke, gallbladder disease, sleep apnea, and endometrial, breast, prostate and colon cancers. Recently, a two-year study of nearly 200,000 General Motors employees, retirees, and their adult dependents (conducted by the University of Michigan Health Management Research Center) noted that overweight/obese adults incur up to $1500 more annually in medical costs than other adults. The direct cost of obesity and obesity related diseases represent about 6% of national health expenditures. The sum of annual direct and indirect costs associated with obesity is approximately $120 billion, with over 70 million Americans affected and over 300,000 deaths attributable annually. A 1999 study by the Lewin Group found that 43% ($20.5 billion) of the direct costs associated with Type 2 diabetes could be attributed to obesity. For heart disease the cost relationship was 30 % ($30.6 billion) and for hypertension, 39% ($9.6 billion). (HealthLeaders, August 2003, 36-39)
On a national level very few comprehensive programs exist to coordinate/consolidate effective services for obese individuals. Many of such programs in existence are associated with major health science centers and incorporate a multidisciplinary approach, similar to that proposed for The Extraordinary Woman. The University of Utah Health Sciences Center does not have a specialized program in Bariatrics, the study of obesity. Consequently our community does not have a comprehensive program to provide necessary health care services, promote healthier behaviors, and scientifically evaluate interventions that improve the health of obese individuals. Current services for obese individuals are isolated and frequently unappealing to targeted clients.
At present, when obese individuals do lose weight, the overwhelming majority re-gain the weight lost, plus “interest”. The cycle is extremely unhealthy, let alone demoralizing. Establishing a model program to assist obese individuals reach enhanced levels of health, measured by distinct physical/psychosocial parameters could have tremendous impact upon associated morbidities. An effective treatment of obesity could come to dominate the outpatient management of many chronic diseases to which an increased body weight contributes. Any successful program must start with respecting the individual client and providing care in a sensitive, non-discriminatory manner. |
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| Objectives and Activities – |  | Creating The Extraordinary Woman, a total wellness center specifically for overweight/obese, represents the realization of a dream held by the Founder/CEO (Kathleen Stillion-Allen) for the past 25 years. Personal and professional experiences integral to the success of the business have recently culminated to support full actualization of Ms. Stillion-Allen’s plans for a wellness center that will support enhanced health status, specifically for overweight/obese working age (18 – 65 years) women. The center will provide a unique option from typical fitness centers and weight loss centers as it will offer a full range of interdisciplinary services to address the multifaceted issues that contribute to obesity in women. “The Extraordinary Woman” will offer respectful, supportive, and client–directed services within an attractive, comfortable environment offering evidence-based, high quality, professional health care. Profits from the business will be put back into the center to expand services and facilitate women without insurance coverage or private pay abilities to access care within the wellness center.
As a model* wellness center, “The Extraordinary Woman” will offer comprehensive wellness services for overweight and/or obese working age women. The goal for clients will be optimal health (inclusive of physical, psychosocial, and spiritual aspects of health) at any weight the individual is at currently. Taking the emphasis off “weight” and placing it on “health” will promote enhanced self esteem, improved body image, and more optimal health parameters [improved musculoskeletal strength, tone, and flexibility; measures of cardiovascular health (e.g. BP, resting pulse, endurance, lipid profiles); decreased insulin resistance and improved blood sugars]. |
| Deliverables and Outcomes – | | The project will provide a strong database including physiologic and psychosocial parameters for a large sample population of obese individuals. The project will strive for a 50% success rate for participants over a 3 year project period. “Success” will be defined by attaining/maintaining measurements within normal physiological parameters, accompanied with an overall perception of improved health and enhanced self concept. Although lowered BMI scores will be represented in clients achieving “success”; BMIs less than 25 - 30 may or may not be noted.
The project will demonstrate for insurance carriers the “fiscal intelligence” associated with addressing obesity as a disease entity with a reimbursable code of its own. It is hoped that through solid research, utilizing measurable parameters of health care status, insurance carriers may be convinced that health enhancement services that would cost $2300 per year per individual could offset the potential need for a surgical approach to obesity (approximately $23,000 per individual) and the potential complications of such surgical interventions (that could readily exceed $230,000 per individual). Contributing adequately to comprehensive treatment measures to address obesity may ultimately save millions in the treatment of co-morbidities (e.g. diabetes, hypertension) that often arise later. |
| Research Method – | | Individuals in the program (without outside funding assistance) will represent a “convenience” and “self selected” sample since participation will rely upon their ability to pay or have insurance reimbursement for services made available. With the addition of extramural funding , the sample could be broadened to include more socio-economic and cultural diversity. Although the research methods would be far removed from a randomized, controlled study; the descriptive information resulting from this project could represent one of the largest studies of over-weight/obese individuals ever accomplished. Data obtained could potentially challenge current dogma regarding factors influencing obesity, related morbidities and successful treatment modalities. Furthermore, the BMI-based definitions of obesity and their overall relationship to health status may be critically evaluated. |
| Communications – | | During the initial phase of the project, descriptive data will be published to give a broader view of true health status in overweight/obese clients. After the first year of operation, data related to the intervention techniques with the program will be available. Manuscripts will be prepared by the owners for potential publication within professional health care journals and presentations at conferences. The message to be conveyed to providers and insurers is that obese individuals are not readily categorized into one disorder. Addressing the multifaceted problem of obesity requires an individualized approach that is comprehensive and addresses/respects the unique qualities of every client. This audience may also learn that a surprisingly wide range of health status may be observed in obese women of the same age. An emphasis will be placed upon developing goal weights based upon genetic background, client preference, and physiological health parameters rather than arbitrary numbers taken off an archaic chart representing a narrow socioeconomic and racial sample.
Insurers also need to realize that the reluctance to cover outpatient treatment of obesity economically helps drive the further development of co-morbidities in clients. Additionally, the policy promulgates further discrimination and bias directed towards overweight/obese individuals by health care professionals.
The primary message this project will convey is “HOPE” …directed to the many obese women who have repeatedly been unsuccessful with weight loss attempts and as a result, carry a degree of that “incompetence” into other areas of their lives. For that same audience, it will reinforce camaraderie and destroy walls of isolation many individuals have constructed over the years in defense of societal discrimination towards the obese. |
| Staffing – | | Both the Founder/CEO and the Associate Owner (Valerie Flattes) are independently licensed health care providers in the state of Utah as Advanced Practice Registered Nurses (APRNs). Both are Nurse Practitioners (NPs) with diverse experience caring for a broad range of ages, as well as expertise in grant writing, research, and teaching. (Utah law allows nurse practitioners to function independently.) The individual proposed as the Chief Operations Officer is a RN with a varied background in direct care, administrative nursing, and human resources. Her expertise includes not only a full range of triaging and patient care skills, but also monitoring and management specific to CLIA and JCHAO health facility regulations. The individual identified for the Chief Financial Officer has a broad background as both a clinic administrator and a health care insurance executive.
Services within the center, provided by a multi-disciplinary team, shall include:- APRN/NP (Advanced Practice Registered Nurse/Nurse Pract.) working in conjunction with a RN –
- Perform comprehensive health histories and physical examinations
- Order and evaluate laboratory tests
- Counsel clients re: current health status
- Partner with clients to determine appropriate, attainable health goals
- Refer clients to other providers as appropriate
- Collaborate with referring primary care providers
- Serve as case managers for clients enrolled through insurance carriers
- Licensed Individual/Family Therapist-
- Provide individual and/or group psychotherapy specific to issues such as body image, compulsive eating behaviors, self esteem, self-actualization.
- Exercise and Sports Science Specialist (MS degree) working in conjunction with Certified Trainers –
- Develop individual exercise plans appropriate and safe for the individual’s current level of health and designed to move the individual towards their personal goals. Develop overall plan for physical workout classes offered on-site. Also coordinate level-appropriate day trips (e.g. snowshoeing, hiking, cross country skiing) in our adjoining mountains or 3 day trips to southern Utah for river rafting/camping/gentle biking/hiking. Many obese individuals have not “allowed themselves” the option to participate in such activities. Participating with a group of physically “like” individuals may be an opportunity to open “closed minds” about what activities obese individuals may not only do safely, but thoroughly enjoy in the process.
- Licensed/Professional Massage Therapists-
- Perform a broad range of therapeutic massage designed to promote musculoskeletal, vascular, and integumentary (skin) health; an improved sense of self; body acceptance for the client; as well as provide a safe, professional source of human touch that some clients may not otherwise have in their lives.
- Registered Dietician-
- Evaluate dietary histories for individuals and work with clients on their personal goals related to specific health problems and current health status. Individualized nutrition plans will be developed for clients. The R.D. will also provide healthful cooking demos/classes for groups.
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| Timeline – | | Successful funding of an SBA 504C loan is necessary to buy the facility/space, remodel, and provide capital equipment. A facility has been identified that is approximately midpoint north to south within the Salt Lake City Valley, within a neighborhood with higher average household incomes and higher health insurance coverage, and located close to major freeways on a 5-lane commuter road. Parking and roadside visibility are excellent. A contractor is available to start remodeling as early as Spring/Summer 2005. Grand opening for the facility is planned for Fall 2005. Further info regarding the site and the remodeling budget is available upon request. |
| Budget – | | The SBA 504C loan application outlines funding necessary to purchase the facility/land (approximately $1.2 million), remodel costs ($720,000), and provide capital equipment (approximately $60,000). An itemized budget and profit/loss projections for the first year may be requested by potential investors/angels.
Additional funding is being sought to support operational costs and up to half the individual fees for demonstration participants (1500 x $2300/2 = $1,725,000). The initial cost of the “Comprehensive Health Enhancement Package or CHEP” is $2300 annually for each client. As research evolves through the project, some aspects of the package may be revised, potentially lowering the cost per client. Insurance carriers are being approached to pay for the services as either chronic disease management or added value for current benefit packages offered to clients/employers. Large employers may also be approached directly to consider offering the CHEP as a benefit on cafeteria style plans.
Once The Extraordinary Woman is operational, additional funding will be sought through research grants specific to long-term behavioral health changes and preventive health care (available from the federal government through Health and Human Services). The CEO has previously written federal grant proposals and to date has successfully had over $1,628,000 awarded to programs from such efforts. The owners value having an interface with the University of Utah and will continue to hold adjunct faculty positions. Maintaining high quality, evidence based practice within the proposed facility is critical. Within the proposed wellness center, a broad database of measurable health parameters in overweight and obese women, will provide vast (extraordinary, if you will) opportunities for scholarly activities including publications/presentations reporting findings from analyzed data. |
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The business proposal for The Extraordinary Woman addresses characteristics displayed by consumers. Faith Popcorn, a futurist, has identified ten current societal trends that may fuel business viability (Small Business Success, Vol.13, p. 57). Seven of the ten noteworthy trends reported by Ms. Popcorn are listed below in italics. Each may be applied readily to the business proposal for The Extraordinary Woman:- 99 Lives– Today’s pace of life is contributing to societal schizophrenia and forces many of us, specifically working women to assume multiple roles. Time is money and many people value it more. This business proposal will allow women to access individual/group exercise, routine health monitoring for current or potential risk for disease, psycho-social individual/group counseling, great ideas for healthy nutrition and “fellowship” with other women in a single setting.
- Being Alive - Many individuals recognize the relationship between good health and longevity or good health and happiness. Health promotion services are continuing to grow. The weight-loss industry, despite poor results, has profits in the multi-billion dollar range. Overweight/obese individuals evidently want help in becoming healthier and are willing to pay for it..
- Clanning- People seek to validate their belief systems by identifying with a group that shares some of their perspectives. Clients at “The Extraordinary Woman” will share many common experiences just as working women who are juggling multiple roles; as well as those that are specifically based from being overweight in a culture that is obsessed with thinness and that automatically assumes a thin individual is “healthier” than a larger person.
- Egonomics - To offset a depersonalized society, today’s consumers crave recognition of their individuality. Overweight/obese individuals are typically addressed by providers in a very generic manner…” just eat less and exercise more”. Many find that LESS than suboptimal. The key feature of the proposed wellness center is to identify the unique needs/health concerns of individual clients and develop individualized plans to achieve personally appropriate goals for enhanced health.
- Cocooning- This represents a trend by many to seek protection from the harsh realities of the outside world. Health spas and gyms already exist that are exlusively for women only, beginning to address the market need of women who prefer not to exercise in the company of men or in settings that cater to the “young, toned, and single” crowd. However, many overweight/obese women still feel “out of place” or ridiculed when exercises with “normal” size women. Additionally many women in our target population perceive a lack of respect, “being heard”, or taken seriously by their health care providers. As a result, some have experienced serious consequences, such as misdiagnosis or mismanagement of health problems. “The Extraordinary Woman” will deliver services to its target clients in a respectful, supportive environment offering evidence-based, high quality, professional services.
- Eveolution- Women are driving a marketing shift away from a hierarchical model toward a relational one. This business proposal was conceived by women and intended to target women consumers. It has pulled together expertise from a wide range of professional experiences, scholarly endeavors, and personal experiences of many overweight or obese women living in our “thin obsessed” society. Employees within the center may be either men or women. The key characteristics all employees must have are adequate knowledge/skills for specific roles and, CRITICALLY, the ability to demonstrate a sincere desire to serve the target population in a respectful, professional and caring/supportive manner.
- Small Indulgences- Stressed out consumers crave affordable luxuries and ways to reward themselves. Proposed plans for “The Extraordinary Woman” include a great deal of creative collaboration with other small businesses in the local community. Through these relationships, we will offer our clients numerous and varied perks and rewards. (e.g. We will acknowledge a client who has met a certain health goal such as exercising 4 x /wk for a month and present her with a certificate for a free manicure/pedicure. We buy the certificates in bulk at a greatly discounted fee as we will directly route new clients to that business. In turn, that nail business is likely to recommend back to us potential customers for our services from their client pool with a introductory offer.
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The largest challenge this demonstration project plans to overcome is the reluctance of insurance carriers to pay for preventive care and health promotion services. This obstacle is evident throughout healthcare issues in the United States.
Another challenge to be addressed is the seemingly “acceptable” discrimination of overweight and obese (women in particular) in this country. Ignorance, regarding the complex multi-factorial issues related to obesity and newer scientific literature noting established obesity as a multi-organ endocrinopathy of body weight regulation; plays a distinctive role in promoting/sustaining such biases. Communications resulting from this project will specifically target health care providers and health insurers for developing a more informed, compassionate, supportive and respectful approach to obese clients. |
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- Biosketches and Personal Letters of Support for CEO/Founder and Associate Owner
- Comprehensive Health Enhancement Package - CHEP
- Detailed Budget and Profit/Loss Summary for Year One - must contact CEO to obtain this information - available to serious potential investors only
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* model – exemplary program structure for clinical effectiveness; prime teaching site for health professions students | |
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