Since wellness programs are gaining momentum, fitness professionals may be able to collect insurance money for wellness services they provide. Since one does not have to be licensed to provide wellness programming, the ability to receive money must come from the following factors:

A) The ability to negotiate with insurers and achieve reimbursement will be based on provider's demonstrated ability to provide services that will have a positive outcome on the client's health or limit the future incidence of a medical condition. Fitness and health promotion programs are feeling increased pressure to be cost effective and not to repeat the same mistakes of the present health care system, such as overspecialization, overbuilding, and overspending (14). "Outcomes Management", "Managed Care", and "Lifestyle Case Management" are the buzzwords for the 1990's. Health care is now viewed as a team approach taking into account all aspects of a patient's care. Any fitness professional who truly wants to be a part of the team must understand and be able to demonstrate proper outcomes criteria to insurers, medical, and other allied health practitioners who refer to their program for continued reimbursement. A listing of health promotion-type programs is in Table I.

B) Understand what type of financial arrangement to make with insurers. Just as you set fair market rates for clients, you must be able to manage a profitable program in your facility and not overbid yourself. The insurers sole objective is to keep it's bottom line profitable, as much as possible. The ability to negotiate with insurers is essential to the growth and maturation of the entire fitness industry. For facilities and professionals who land contracts (many already have), they represent important inroads to the fitness profession becoming more legitimized as members of the health care team. They provide essential services to asymptomatic individuals for health improvement to delay the onset of disease and to diagnosed individuals for reversing or limiting the disease process, the ultimate goals being health improvement and decreased costs. This represents a tremendous challenge for the industry, which in the view of 20th century medicine has long been regarded as a health care outsider. Because of this, the industry has not asserted itself in the past and has watched many health and rehabilitation jobs fall into the hands of other allied health professionals.

Recent trends over the past few months may see a resurgence in both the market forces with fitness and health care, and government inclusion. First - A group from Arizona called Health Care Dimensions has forged into health care with a business that will link existing health care agencies with hospitals, and fitness clubs. Their goal is to expand exercise and health promotion services into the corporate and medical work environments. They are starting in the Southwest, and moving around the country. In the next couple of years it may be possible to enlist a health club or other type of exercise program (home fitness training, hospital programs, etc.) into your health insurance plan.

Secondly - The issue of government inclusion and state licensure debate may indeed be coming to a close in the next year or so. In July of 1995, the state of Louisiana passed a bill (Senate Bill No. 597) licensing clinical exercise physiologists who practice in the cardiopulmonary area of care (29). Upon obtaining the baseline criteria (Master's degree from a an accredited school, one year experience in a clinical setting, one national certification, two physician recommendations, plus a three hundred hour internship) the licensed physiologist is eligible to: formulate, develop, and implement exercise programs, administer graded exercise tests, provide patient education regarding exercise, and disseminate information to patients with deficiencies in the cardiovascular system, diabetes, lipid disorders, hypertension, cancer, COPD, arthritis, renal disease, organ transplant, peripheral vascular disease, and obesity.