THE VILLAGES — One blazing late morning at Florida's Friendliest Hometown, some 80 people line up for water volleyball, having zipped to the pool in customized golf carts that blow bubbles out the back. Women in swinging skirts dance the hula. A graying man in a skin-tight bicycle jersey heaves chest presses into the air.
This is the Villages, Florida's enormous retirement mecca, which radiates health, happiness and insularity that is almost surreal. It has 90-plus restaurants, 17 pharmacies, seven churches, a newspaper and radio station, happy hour all day and live music every night. It has a charter school for children of workers. It has hospitals.
And yet, a few years ago, the Villages still lacked for something: health care services as convenient and orderly as the rest of its meticulous offerings.
Thirty percent of residents were going outside the community for care, more visiting the speciality storefronts in the 11 medical plazas scattered in town, audiology, cardiology, imaging, infectious disease, veins, you name it.
A place that seemed to need nothing still had a need, and doctors at the University of South Florida took note. Maybe the mega-suburb dreamed up by a wealthy developer was an academic researcher's dream — or more, a launch pad for returning American health care to a welcoming, one-stop shop.
Could the Villages, known as so many things, become America's Healthiest Hometown?
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"A retirement community? Steve, have you lost your mojo?"
Dr. Elliot Sussman couldn't understand why the dean of USF's medical school was asking him for help forming a relationship with the Villages. Dr. Stephen Klasko was a mover and shaker who had worked feverishly to rebrand USF as a medical school with state and national reach. For one, he'd formed a partnership with Pennsylvania's Lehigh Valley Health Network, where Sussman was president and CEO.
But the Villages was not a sleepy 55-and-up hive.
"I was blown away by what I saw," Sussman said.
The Villages is a series of special taxing districts just south of Ocala developed by politically connected H. Gary Morse. The community of nearly 100,000 usually makes headlines as a campaign stop for political candidates.
Here, USF researchers saw tens of thousands of residents so bonded, they often checked the mail together. While some were leery of technology, they desired modern medicine. They yearned for the era of Marcus Welby, the classic television doctor known for his house calls and warm bedside manner.
"It was based on relationships," said Sussman, now chairman of the Villages Health System and a professor at USF. "You had a doctor who really knew you, and that was Marcus. He knew you, and he knew your family. He had the context for your life, your health and your disease, so that idea of understanding, that relationships matter whenever people make big decisions, they need trusted guides and trusted advisers, that's what physicians were."
Klasko was passionate about making physicians move away from what he called a "cult" centered on four biases — competitive, autonomous, hierarchical and noncreative, as he wrote in a 2011 article. That year, USF formed a partnership with the Villages and deployed doctors and researchers.
Marcus Welby became part of the pitch, a careful approach that required USF gaining the trust of the Villagers, as they are known. USF opened a storefront with white rocking chairs where Villagers could get body mass index and memory screenings, or learn how a Big Mac stacks up to yogurt and grapes. Researchers held focus groups and interviewed residents to compose a huge survey that would provide a treasure trove of knowledge about the health of this large senior population.
The Villagers were clear about what they wanted. The survey font had to be big enough to read, but not so big as to be insulting. If the survey was longer than 20 minutes, they wouldn't bother. They didn't want the survey online. And they laughed when the researchers suggested the "standard" pour of wine was 4 ounces.
"The level of cohesion in this community is through the roof," said Dr. Donna Petersen, dean of USF's College of Public Health, now serving as an interim leader of USF Health as Klasko leaves for a new post.
USF doctors met with retired nurses, men's groups, women's groups. They met with the Airheads, a group of Villagers with chronic obstructive pulmonary disease eager to talk about the stigma they faced. They met Nick Jones, Airheads president, who quit smoking in 1985 after his then-doctor pulled out a pack of Camels during an exam. He has been through heart attacks, guided people out of panic attacks when they couldn't breathe, delivered 15 eulogies.
"When we grew up, it was cool to have a pack of Lucky Strikes wrapped up in your T-shirt, and having your slicked back hair," said Jones, 77. "These doctors were wonderful. They were listening to everything I was saying. I was so excited about that fact."
What evolved from the conversations was a full-fledged primary care network with insurer United Healthcare as a partner, with electronic medical records and ongoing construction of primary care clinics staffed by Villages doctors with lighter patient loads. Seats are soft, scales are hidden in the carpet. There is no waiting room — there is a "living room." There is a "knowledge pharmacy" where patients can use a computer to learn about their illness and care.
Plants are printed on almost every surface, on sofas and wall art and placards, meant to symbolize life.
Also under construction: a large specialty care center where USF physicians will perform everything from cardiology to orthopedics to neurology to urology procedures to plastic and thoracic surgery.
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The Villagers are healthy.
The almost 34,000 responders to USF's survey felt good. They were educated. Married. Spiritual. They had lots of health insurance. Their biggest problems were cholesterol, vision, hypertension. They rarely felt down in the dumps. They believed their neighbors would grocery shop for them if they were sick. A fairly modest percentage reported being dissatisfied with sleep or sex lives.
They said their lives were meaningful. They didn't like to talk about dying. A USF session about advanced planning had the lowest attendance of all talks.
Why, then, if the Villagers were so healthy, would USF commit resources there? Why not go somewhere with more pressing needs?
To impart change, Klasko said, you don't start in extreme poverty or wealth.
"We took what is a microcosm of America," he said. "If you want to prove that you can transform medicine from the ground up, you would start in the middle."
Despite the fact that the Villages is very white — 98 percent, according to census data — the researchers contend it is more diverse than people think. While its developer is wealthy beyond imagination, researchers describe the residents as a mix of everything from former CEOs to teachers and firefighters.
"People come from all over the world, different socioeconomic backgrounds, work backgrounds," said Petersen. "It's a very diverse population so it is worthy of study."
The USF Physician's Group has put $4 million toward the project. The Villages leadership has put forth a "considerable" amount, said Dr. Jeffrey Lowenkron, CEO of the USF Physicians Group, but he declined to give specifics. USF is seeking a grant from the Centers for Medicare & Medicaid Services — the federal agency that runs Medicare — to help researchers study how the model can work for other populations, perhaps places without a wealthy backer.
"I think it can clearly translate to other groups," said Sussman. "We're doing this in partnership with the largest insurance partner in the nation, who insures more people with both Medicare Advantage and Medicare supplement than anybody in the country. It's not that we're talking about concierge programs and charging people thousands of dollars extra for this."
No matter the population, experts say hospital readmittance rates are lower for people with primary care networks versus those who shop for doctors.
"That doesn't mean they don't get sick," said Joanne Conroy, chief health care officer at the Association of American Medical Colleges. "But they use the appropriate level of service. They go to urgent care; they don't go to the ER. It's access and availability. It's all about caring for a population and understanding how to keep them healthy and appropriately using resources."
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Cathy Kazee and her husband needed something new. They were getting the winter blues at home in Ashland, Ky. They Googled "active adult community." The Villages' results:
"Right on the top," said Kazee, 62.
They moved here more than two years ago. Kazee played pickleball. She golfed. She learned to play a dulcimer. But she was still in the market for a new doctor.
She attended a presentation from USF and lit up when she heard about the old, friendly physician, Marcus Welby. She volunteered to help pass out literature, to take the BMI test, to participate in community scavenger hunts that encouraged walking.
She's going home to Kentucky for a visit soon, she said while standing at the white fence surrounding USF Health's storefront in a strip of shops. She plans to visit her old doctor, and try to get him to think about coming to the Villages.
Times researcher Carolyn Edds contributed to this report. Stephanie Hayes can be reached at firstname.lastname@example.org or (813) 226-3394.