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Running head: PRACTICUM REQUIREMENTS FOR MPH 599 Fox 1

Amanda Fox

Christian Care Ministry

P.O. Box 120099

Melbourne, FL 32912

John Reinhold: Director of Guided Care

Abstract

Practicum Requirements for MPH 599 Fox 2

Christian Care Ministry, or Medi-Share, is a medical sharing ministry providing biblical

healthcare solutions for Christians. They promote the sharing of medical bills and also living a

healthy, biblical lifestyle through different programs offered such as Restore health coaching.

Medi-Share is interested in knowing which health factors impact medical spending the most

throughout the membership, and also how the Restore program impacts medical spending.

Throughout the course of my practicum, I researched and compared the statistics on spending of

two different groups of members: those who were coached in the Restore program and those who

were not, and looked at spending done by age. Factors that needed to be taken into consideration

were pregnancy costs, greater depth and understanding on age factor, and the advantages and

disadvantages of a wellness program on medical costs. I gathered information from public

insurance websites, government websites, and Medi-Share to come up with overall costs to

compare and contrast, and allow Medi-Share a better understanding of specific factors

influencing spending, as well as the impact of wellness programs in general.

Introduction


Christian Care Ministry was founded in 1993, and is a healthcare sharing ministry in

which Christians come together and share in each other's medical costs. Medi-Share currently

has more than 106,000 members, and is continuing to grow due to the Affordable Care Act.

"According to Kaiser Family Foundation, the average family insurance policy costs $16,834 a

year. In stark contrast, the average cost for a Medi-Share family is approximately $3,600 a year,

less than a fourth of the cost of traditional health insurance" (Demoss, 2014, pg. 1). Medi-Share

works as an alternative to regular insurance for Christian families, while providing a much lower

cost as well. "Since 1993, the organization has shared more than $663 million in medical

expenses and saved an additional $281 million in medical expenses through discounting"

(Demoss, 2014, pg. 1). Restore is the health coaching program for members who come in with

disease risk factors or diagnosed disease. In addition to health care sharing and health coaching,

Medi-Share offers supplemental programs, which include PrayerStream ( a website and phone

app that allows members to post needed prayers), and TradeStream (a website that allows

members to post their careers and business).

The overall mission of Medi-Share is "to connect and equip Christians to carry each

other's every day burdens." The vision of the company is "an authentic Christian community that

reflects the love of Christ." The values of the company consist of "having compassion for one

another, encouraging, praying, and caring for each other, living with integrity, inspiring

Christians to impact the world, valuing and promoting the best in others, empowering ministry

through innovation, and sharing one another's troubles and burdens" (Christian Care Ministry,

2014). The company bases their mission and vision heavily on the book of Acts, and has a

passion for helping and caring for others.

http://kff.org/health-costs/report/2014-employer-health-benefits-survey/


A special component of Medi-Share is the Restore program. A key concept of Medi-

Share is bodily stewardship. Restore is a program that works with members when they come

into Medi-Share with an increased risk for disease, a diagnosed disease, or an illness. Restore

was created because scientific research proves that chronic diseases can be reduced or reversed

by lifestyle. Medi-Share charges members needing to participate in Restore an added $80 on

their monthly share to participate in the program, and requires them to achieve certain metrics for

body mass index (BMI), waist measurement, blood pressure (BP), cholesterol, and blood sugar.

These members are assigned to a health coach who gives them nutritional and exercise

recommendations on an individualized basis. They also offer an online platform that includes

health risk assessments, health articles, meal plans, cook books, exercise resources, etc. Once

they achieve specific numbers voted on by Medi-Share members, they graduate from the

program, and they verify these same numbers the following year. According to their website

members have a responsibility to take care of their bodies. "Your commitment to a healthy

lifestyle has lifelong impact on you, your family and the Kingdom" (Christian Care Ministry,

2014). The negative component of the Restore program is the ruling that states that the

member has to make consistent progress in health goals or they get terminated from Medi-Share

completely - for example does not lose one to two pounds a week. With the program being

mandatory, as well as the termination portion of the program, a lot of tension occurred with

getting individuals to join, as well as keeping them on with Medi-Share in general.

The project I was involved with for Medi-Share consisted of looking at the overall

spending done throughout the ministry annually as well as monthly. Also, breaking down

different factors of costs such as age, pregnancy, and the Restore program. Different factors cost

more in medical spending, for the better or worse. Medi-Share looks at spending done


specifically within the Restore program and was interested in different factors that affected the

spending and savings of the program, and the general membership overall. I researched different

statistics on medical spending done throughout the nation, and then tied this into a comparison

factor for Medi-Share. This practicum involved the concept of biostatistics, and health and

wellness prevention.

Discussion

I was blessed enough to do a practicum with my current employer. I work as a health

coach, and help people daily with nutrition and exercise goals. A few questions that have always

arisen within my department consist of: 1. whether or not the department benefits the ministry,

2. if the department costs the company extra money due to less members joining because the

program is mandatory and includes a fee, 3. how great of an impact does the department have on

decreasing medical costs, 4. and does the program actually decrease and reverse chronic

diseases? A few other questions that were worth research and discussion included the impact

pregnancy has on medical spending, and what age groups have the highest medical spending

throughout the company? A big hurdle came up right at the beginning of my internship in which

the company started making drastic changes throughout the ministry. The biggest change that

occurred was no longer making the Restore program mandatory, and moving individuals into a

self-guided, online based program. This came in due to the new laws and regulations associated

with Obamacare. The goals and objectives I was to be involved in looking at consisted of the

impact of the Restore program in spending, researching other successful wellness programs,

looking at the impact pregnancy has on medical expenditures, and "health age" of the individuals

of the general membership compared to those who have gone through the Restore program.


At the beginning of my practicum, my director had sent over numerous excel

spreadsheets on the costs and benefits of the Restore program, and overall medical spending

done ministry wide. There was also information on age of the member and how that correlates to

medical spending. A power point presentation was also sent that gave information on the

impact of the Restore program; advantages and disadvantages. My director felt, as though, there

needed to be better depth and understanding on spending in general and different components

that were impacting spending throughout the Ministry. Personally, I was interested in looking at

the impact of wellness programs in companies and the amount of money saved, as well as the

percentage of diseases that were decreased or eliminated.

My first task was to sort through the data that had been sent to me, and gain a better

understanding of what it all meant. I thoroughly went through the PowerPoint and excel

spreadsheets to look at trends and expenditures done throughout the ministry. I also looked at

the costs versus the gains of the health partnership program to see where the strengths and

weaknesses lie. I organized the data given to me in a way to gain a better understanding of

where Medi-Share was coming from in presenting the data they had collected and what it

actually meant.

Once I gathered the data, and then organized medical expenditures of Medi-Share, I

started looking up national statistics on medical expenditures. In 1970, health care spending was

at $75 billion. In 2010, health care spending had reached an all-time high of $2.6 trillion, and it

is projected to increase to $4.8 trillion by 2021 (Aetna, 2014). The breakdown of the spending

done in 2010 consisted of 30.74% of spending was done in hospitals, 20.04% on physicians

visits, 10.01% on prescription drugs, and the rest on home health care, medical equipment,

nursing/ continued care, etc (Aetna, 2014). An average of 75% of medical spending done within


the United States is due to chronic illness. The top most expensive health conditions are heart

disease, cancer, mental disorders, and pulmonary conditions. Currently, around 40% or an

average of 133 million adults within the United States has a chronic disease, and this is expected

to rise to 157 million by 2020 (National Health Council, 2014). Children are also affected by

chronic disease, affecting eight percent of children ages 5-17. Although these numbers are high,

chronic diseases are the most preventable of all disease.

Due to the rise in medical spending, insurance premiums have also increased

significantly. This year, alone, the average premium for the typical family was around

$16,000.00 (National Conference of State Legislators, 2014). These increased costs are due to

the un-insured, as well as the under-insured, the drastic rise in chronic diseases within all groups,

and is affecting employers as well as ordinary families. As previously stated, chronic diseases

are preventable. Some of the most destructive health behaviors are smoking, excessive alcohol

use, poor eating habits, and lack of physical activity. As known, these are all modifiable.

These risks are affecting major companies, large and small, in a negative way. Not only

are chronic diseases increasing medical expenditures, it diminishes an employee's performance,

safety, and morale. Currently, some companies are offering health and wellness programs to

their employers in hopes to cut medical costs, but not nearly enough. I wanted to research the

impact of these programs in hopes to prove the significance of their effectiveness, especially to

present to my company. As aforementioned, not many employers offer wellness programs like

they should mainly due to a lack of awareness for wellness programs. If companies do know

they exist, they are not convinced that the program has the potential to reduce health risk and

produce a positive financial return. Other reasons include not knowing which elements to

include in their workplace that are effective, how to implement the programs, or they feel health


and wellness is the responsibility of doctors and health care providers (Goetzel, 2008). The

Center for Disease Control (CDC), as well as a few other corporations have done studies on the

impact of wellness programming provided in the workplace. In 2007, the CDC found that well-

designed, evidence-based programs built on behavioral theory achieved long-term health and

productivity improvements in the work place (Goetzel, 2008). The most effective workplace

programs offered an individualized program for the highest risk populations within the

workplace. Harvard University also did a study on the cost-effectiveness of wellness programs,

in general, and found that medical costs fall about $3.27 for every dollar spent on wellness

programs, and absenteeism fell an average of $2.73 for every dollar spent (Baicker, Cutler, &

Song, 2010).

Recently Medi-Share has decided to reduce the health partnership program, and diminish

the health coaches. Looking at some details of the company, Medi-Share offers a significantly

reduced price for bill sharing in health care costs, which has gained a lot of attention with the rise

in premiums throughout regular insurance companies. One component Medi-Share is very

passionate about is health and wellness, which is why the Restore program was a mandatory

program at the company’s inception. They knew if people were required to make lifestyle

changes in their health, medical spending would be down. Regardless of the facts that the

research at Harvard has come up with, Medi-Share is in the process of decreasing this program

so that it will not be a friction point to joining. Other components adding to this are the new

laws and regulations given in Obamacare, and more money was spent on the program than was

necessary so cuts needed to be made.

The first part of the project looked at what Medi-Share had come up with for costs versus

benefits of the Restore program. Some of the costs of the Restore program included department


expenses, telephonic coaching costs, health partnership additional costs in the application

process, health partnership maintenance on bill costs, health partnership fail missing

costs/missing engagements, health partnership termination costs/engagements, health partnership

fails due to lost administration fees, health partnership fee fails, health partnership lost

administration and fee, and applicants lost due to having to participate in health partnership. The

total amount of costs for the program for 2014 was $773,540.00. The benefits of the program

consist of the active health partnership monthly fee and reduced medical expenditures ministry

wide once an individual graduates from the program. The total benefits for 2014 from the

program were $424,320.00. Looking at the cost and benefits, the net cost per year equaled out to

an average $349,000.00 per year. Because of this excess in costs, Medi-Share started

questioning the actual impact and benefit of the Restore program for the company.

One of the goals I had with the practicum was to look at the effectiveness of the program

with numbers. With the data I was given, I looked at the age groups of members who were in the

restore program for a year. The ages ranged from 12-65. I then looked at monthly expenditures

for the year of 2013 for each age group. I was able to get the sum of the age groups between 12

and 65 which equaled an average of $136,955,002.90 million spent in medical costs for the given

year. I then looked at the net cost of the Restore program, which was $349,000.00 and wanted to

know the savings this had on the company as a whole. When looking at the Harvard study and

saving $3.27 per dollar spent on wellness programs, I implemented this logic with the Restore

program and this brought the total savings for Med-Share to $1,141,230.00 for the 2014 data

given. Looking at the net costs of Medi-Share as a whole, although it seems small, there are still

savings to be made annually with the program.


Another goal I had in sorting through data and researching was to look at "health age."

Studies show that from birth to the age of one medical costs are high, then drop going into

toddler years, childhood, and teenage years. These costs start rising again in the late 40's and

grow substantially once an individual hits 60. As seen in the data collected and analyzed,

medical costs of infants until their first year in Medi-Share in 2013 had expenditures of

$10,586,072.47. I then averaged the sum of expenditures for every ten years for 2013. In years

one to ten the average medical expenditure was $1,022,686.34, 11-20 the expenditure was

$1,054,172.05, 21-30 the expenditure was $2,625,867.85, 31-40 the expenditure was

$2,485,659.50, 41-50 the expenditure was $2,427,246.94, 51-60 the expenditure was

$3,912,798.68, and 61-65 the expenditure was $4,777,254.65. There was an increase in the 21-

30 age group, and research shows this is mainly due to pregnancy that occurs during this time

frame. As seen from data, medical costs definitely follow the flow of increasing over time. An

interesting component to look at, though, is when an individual goes through the Restore

program and graduates, medical costs of these individuals decrease, where-as the general

population who did not participate in the program will show an increase. Data analyzed looked

at a study done for three years during and after an individual participated in the program. Pre 36

month the average cost per month of a member in the Restore program was $301.00, where as

the general membership individual was at $210.00. After 36 months, the graduate from the

Restore program averaged $282.00, where as the general membership individual averaged

$647.00. The general population, and general membership not going through a wellness

program are gradually increasing in medical expenditures over time. On the other hand, there is

a drastic long-term reduction in medical costs in an individual who has gone through the health

and wellness program. These individuals in older age have a better "health age" going through a


health prevention program, proving the impact and positive effects of these types of programs in

reducing chronic illness.

Another area of concern my director had was on the cost of pregnancy. He wanted me to

examine an average cost of pregnancy and the impact on total expenditures done throughout the

company. Pregnancy and maternity costs are extremely high in the United States. With an

annual average of four million births, the cumulative costs are $50 billion (Rosenthal, 2013). In

1942, the average cost for a maternity room in a hospital was $7.00 per day. If you add inflation

to this number, in 2011 that would have cost around $97.29, but instead cost is an astounding

$1,360.00 per day (Agresti, 2012). On average, women with insurance pay an out of pocket

expense of $3,400.00. Two decades ago, women paid nothing other than a small fee (Rosenthal,

2013). According to a recent study, "the average total price charged for pregnancy and newborn

care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial

insurers paying out an average of $18,329 and $27,866" (Rosenthal, 2013, pg. 1). On the other

hand, if someone is on Medicaid, prenatal care is nothing and they pay minimal delivery and

hospital charges. Looking at these specific statistics, there are known high costs going to

insurance and health sharing companies with pregnancy and childbirth. I gathered the amounts

spent in the zero age group, and the ages of 20-40. Although the adult population consists of

more than maternal care, there is a rise in costs throughout this time, mainly due to pregnancy.

The average spending done throughout these groups in Medi-Share in 2013 was $11,677,212.49.

This has put a pretty big dent in the medical spending done throughout this age group for the

company.

Overall, the objectives and goals were attained through analysis and research of the

particular topics. If there was more time, and more numbers given from the company, more

http://health.nytimes.com/health/guides/surgery/c-section/overview.html?inline=nyt-classifier


depth could be added to what is stated above. Although these were attained, there were a few

challenges and barriers getting to the conclusions of the goals. A major barrier to the entire

practicum was the entire change of my department at the beginning of the project. I had set up

this project with my director at the time, and due to the changes that were about to be made and

the eliminations/downsizing of the health coaches, he walked out the day my practicum started

with no warning. Thankfully, my current director was able to gather together components that

would help the ministry in understanding medical expenditures. I learned through this, that

communication is vital to all departments, and there is a need for flexibility wherever we are at.

Another barrier was trying to understand exactly what my director was needing from me ( just

being on the same page as my director). Because of all the change, he was hard to connect with,

but we did the best we could and what we could with the given circumstances.

Personal Assessment

This practicum gave me great experience in the public health realm. Knowing I had to do

a practicum, I had no idea I would be doing statistics and research, but I am glad I went outside

of my comfort zone and was able to do something a little different. The main part of public

health that I am very familiar with is health prevention. That is what I currently do for work, so I

am very knowledgeable on the significance and importance of that one area. After going through

this practicum, I found out there was a lot I needed to learn about health care companies, and the

entire scope of how they are run and what impacts the decisions that are made daily. The one

area that I really was able to research and dissect was the medical spending, and the impact our

department in particular had on company spending, as well as the impact on the members lives.

I was not very aware of the impact of medical expenditures on companies, and even individuals

in general. As stated before, I am knowledgeable in knowing that chronic diseases will impact


medical expenditures, but did not dissect it into age groups. I also did not realize the high cost of

pregnancy, and all the billing pregnancy entails.

This practicum allowed me to work with Excel and try to come up with trends and

impacts on money spent throughout the membership of the company. I looked at net costs, and

the sum of costs across different age groups to see the differences in spending. I also was able to

look at the impact of the Restore program, and research other wellness programs and the benefits

those have on reducing medical costs. I also saw the significant impact of pregnancy, and was

able to research costs associated with pregnancy and birth, in which was an entirely new realm

for me.

There were a few public health competencies that were applied throughout the time of the

practicum. The main one being analytical/assessment skills. The entire project entailed analysis

of numbers, and assessing the impact of specific factors on spending and a wellness program.

Analytical/assessment skills involved were looking at factors that affected medical spending, and

also the impact of a health prevention program on medical spending. I then broke down the data

quantitatively to look for trends, and then analyzed the data given, as well as research done on

each topic, and found comparable data to gain conclusions. Communication skills were also

implemented throughout the practicum. Communication was involved between my boss and I,

as well as fellow coworkers to give any additional materials they could in helping with the

understanding of the material. The final skills used minimally within the practicum were

financial planning and management skills. The entire practicum looked at expenses and the

impact of different components on expenses; positive or negative.

Conclusions and Recommendations


The main concept I took away from this practicum was the significant impact of health

and wellness programming. Seeing, as though, the implementation of an individualized program

decreases costs $3.27 for every dollar spent was an eye opener to me. Many companies do not

implement these types of programs due to a lack of understanding of how to utilize these

programs, or they just do not feel, as though, they would make a significant impact on costs

within the company. If more companies were aware of these programs, and there was an easy

process to get it started, chronic disease costs would drop significantly. One example is that

increasing the amount of cruciferous vegetables daily by 20% decreases the chances of getting

cancer by 40%. That is an easy lifestyle change with huge impact on cutting costs from a

chronic disease such as cancer. Another example is monitoring sodium intake to a limit of 1000

mg per day to keep blood pressure and inflammation in check, which significantly reduced the

chance of heart disease and stroke. This is all impacted through educational efforts by health

coaches and wellness programs. The lifestyle changes made from an increase in exercise impacts

all of the chronic diseases. More needs to be done in the public health realm to share the

significance of these programs, and the importance of getting individuals more involved with

their health risks due to lifestyle. The ability to make changes while people are young have the

most impact on quality of life and money spent on long term healthcare .

Another concept to take a look at is the spending done for pregnancy. The United States

has one of the highest costs for pregnancy. Public health officials needs to come together to find

a way to decrease and eliminate some costs of pregnancy. These costs are a major concern for

the increase in medical expenses for insurance companies, and just the country in general. There

is also a major gap in women who have private insurance and what they are paying out of pocket

versus those on Medicaid. This is an area that needs further investigation to reduce costs.


Medi-Share has also proven the effectiveness of wellness programming due to the

decreased amount in medical expenditures over time in unhealthy people who worked with a

health coach, versus those who may have come into the company healthy but had their health

decline as they aged due to poor health and lifestyle habits. This is typically the opposite

throughout the general population. This also needs to be taken into consideration due to the

decreased amount of medical costs this group of individuals has due to participating in a health

and wellness program.

It is my strong belief that all persons can benefit from being educated in proper health

and wellness habits, which leads to a higher quality of life for longer years, and decreases the

amount spent on their health care costs as well. Therefore, it is in the best interest of insurance

companies and sharing ministries to offer this to all people who join, and also to give them a

reduction on their rates if they continue to keep their numbers within range on a yearly basis

as incentive. Research has proven that future medical costs will be decreased even

though the costs upfront to educate appear cost prohibitive at the time.


References

Aetna. (2014). The facts about rising health care costs. Retrieved on December 1, 2014, from

http://www.aetna.com/health-reform-connection/aetnas-vision/facts-about-costs.html.

Agresti, J. (2012). Healthcare. Retrieved on December 4, 2014, from

http://www.justfacts.com/healthcare.asp.

Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings.

Retrieved on December 1, 2014, from

http://www.workplacewellness.com/images/Workplace_Wellness_Programs_can_generat

e_savings.pdf.

Christian Care Ministry. (2014). Health matters. Retrieved on November 30, 2014, from

https://mychristiancare.org/restore/.

Demoss. (2014). More americans mix healthcare with religion. Retrieved on November 30,

2014, from http://demoss.com/newsrooms/medishare/news/more-americans-mix-

healthcare-with-religion.

Goetzel, R. (2008). Workplace health promotion: policy recommendations that encourage

employers to support health improvement programs for their workers. Retrieved on

November 9, 2014, from

https://www.prevent.org/data/files/initiatives/workplacehealtpromotion-

policyrecommendations.pdf.

National Conference of State Legislators. (2014). Health insurance: premiums and increases.

Retrieved on November 8, 2014, from http://www.ncsl.org/research/health/health-

insurance-premiums.aspx.


National Health Council. (2014). About chronic disease. Retrieved on December 3, 2014, from

http://www.nationalhealthcouncil.org/NHC_Files/Pdf_Files/AboutChronicDisease.pdf.

Rosenthall, E. (2013). American way of birth, costliest in the world. Retrieved on December 4,

2014, from http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-

in-the-world.html?pagewanted=all&_r=0.

Yamamoto, D. (2013). Health care costs-from birth to death. Retrieved on December 6, 2014,

from http://www.healthcostinstitute.org/files/Age-Curve-Study_0.pdf.


Appendices

"Health age" of Medi-Share members of Restore participants vs. non Restore participants.

Medical costs of aging male and females of regular insurance vs. Medicare participants.

Births per women per age group.


Sum of expenditures in 2013 per age.

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