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
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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
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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.
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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
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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.
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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
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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
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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
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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.
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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
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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
Practicum Requirements for MPH 599 Fox 12
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
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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
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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.
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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.
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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.
Practicum Requirements for MPH 599 Fox 17
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.
Practicum Requirements for MPH 599 Fox 18
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.
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Sum of expenditures in 2013 per age.