Screen test

Eric Greenberg and Dave Campbell tell Martin Ashcroft how Life Line Screening brings reassurance to millions by providing an early warning of the risk of stroke and other vascular disease. ÔÇ£ItÔÇÖs important to realize that the medical system we have today is not about prevention,ÔÇØ says Eric Greenberg, vice president of marketing for Life Line Screening. ÔÇ£I get sick, I have symptoms, I go to my doctor and he fixes me.ÔÇØ ThatÔÇÖs all fine and dandy, but what if you donÔÇÖt feel sick and donÔÇÖt have symptoms? YouÔÇÖre not ill, right? Not necessarily. More than half of people who suffer a stroke have no symptoms, and for aortic aneurysms, the number is 70 to 80 percent.Even without symptoms, however, there are ways of finding out whether you are likely to be hit by a disease that could otherwise creep up on you unaware. Life Line Screening conducts four painless non-invasive ultrasound screenings that test for plaque build-up in the body to detect a number of conditions. ÔÇ£We basically screen for the risk of stroke and other complications of vascular disease,ÔÇØ says Greenberg. ÔÇ£If you have a plaque build-up in the carotid artery of your neck, thatÔÇÖs what causes most strokes. Plaque build-up in the abdominal aortic artery weakens the wall of the artery and can cause an abdominal aortic aneurysm. If you have plaque build-up in the extremities, thatÔÇÖs peripheral arterial disease and that means youÔÇÖve got about four to five times the risk of dying of heart disease. And then we have an ultrasound screening for osteoporosis, which is not a vascular screening, but it also uses ultrasound.ÔÇØ It all began in 1993 in Florida, when two healthcare professionals (a doctor and an ultrasound technologist) watched a family member go through the after effects of a sudden, unexpected stroke. Wondering why someone could be strong and vibrant one day, then at deathÔÇÖs door the next, they started to do some research into the subject. Finding some published studies that showed that the majority of all strokes are the result of carotid stenosis (the build up of plaque in the carotid arteries), they decided to start screening people in their community to help them avoid stroke. Within a few weeks they turned it into a start up business. The founders were content to screen seniors in Florida, but fate stepped in, in the shape of an investment banker from Cleveland who had a home in Florida. He went to a presentation in a church one Sunday about the risk of stroke and the importance of getting screened and was amazed to see a couple of hundred people sign up after the service. He knew it was a good idea so he called up two of his family members (Colin Scully and Tim Phillips) and suggested they get involved in the business. In 1996 they purchased the first franchise, with rights to northern Ohio, and set themselves up in Cleveland. Mr. Scully is currently the companyÔÇÖs chairman and CEO while Mr. Phillips is the executive vice president of sales and marketing.Company president, Dave Campbell, takes up the story. ÔÇ£Over the next few years they learned how to market the business to consumers. Florida is unique as thereÔÇÖs such a high density of seniors that itÔÇÖs straightforward to market,ÔÇØ he says. ÔÇ£In almost all other parts of the country, people over age 50 are interspersed throughout the community. They had to figure out how to market the business. In the meantime they bought the rights to other markets. In 1999 the opportunity presented itself to buy the parent company, which they did.ÔÇØ From 1999 until 2003, he says, there was a concerted effort to get the company national. ÔÇ£In 2003 we completed that effort, with representation or coverage in all 48 continental states. Since then weÔÇÖve continued to expand the business and today we have 87 teams in different markets around the United States and we continue to expand.ÔÇØOne of the beauties of the Life Line Screening business model is that it is mobile. ÔÇ£All of our screenings are done in community locations around the country,ÔÇØ says Greenberg. ÔÇ£This year weÔÇÖll be in over 20,000 different locations around the country. We try to make it convenient for the public at large to get screened.ÔÇØ Marketing is mainly direct to consumers, who are asked to call in advance and make an appointment. ÔÇ£When we go to the church on Main St. weÔÇÖll be there for the day,ÔÇØ says Greenberg. ÔÇ£The team will unload the equipment from the van and set it up in the church, and theyÔÇÖll screen upwards of 90 people in that facility in a day.ÔÇØ Another beauty is that Life Line offers all four screenings for $129. ÔÇ£ItÔÇÖs very affordable,ÔÇØ says Greenberg. ÔÇ£We have a very ubiquitous customer base with an average household income of about $60,000, so it really reflects the middle-American consumer, primarily baby-boomers that are age 50 and over.ÔÇØ Dave Campbell stresses that all of the companyÔÇÖs mobile teams are employees of the company. ÔÇ£WeÔÇÖre the largest employer of ultrasound techs in the country that we know of,ÔÇØ he says. ÔÇ£WeÔÇÖve got over 500 techs around the country. Many of them have come from laboratory or clinical settings, and we use the same equipment, except that ours has wheels on it, and we use the same protocols and procedures that they use. WhatÔÇÖs different is that we bring it to you. This year weÔÇÖll screen over one million people, so we can afford to do it at a much cheaper rate than others can.ÔÇØDespite this obvious competitive advantage, Life Line Screening does not see itself as being in competition with traditional health care providers, for whom screening is not a business in itself, but a process within a broader portfolio of health services. ÔÇ£Typically, they are not interested in doing a $35 carotid artery screening,ÔÇØ says Campbell. ÔÇ£Over 350 hospitals around the country partner with us today, because they realize that we are helping them to uncover previously undiscovered disease in their service area. When we find an abnormal condition we give the patient their results so that they can share it with their personal physician. Some of them are going to need surgery. Some of them are going to need medical management. Some of them will need help with lifestyle changes. The hospital and its physician network benefits from the follow up care. In the end, the hospital doesnÔÇÖt want to do a $35 test, they want to provide the follow on testing and treatment which can cost thousands of dollars.ÔÇØ Yet another beauty of the business is the accuracy of the tests, in sensitivity and specificity. ÔÇ£If we say you donÔÇÖt have disease, weÔÇÖre right 100 percent of the time,ÔÇØ says Greenberg. ÔÇ£If you do have significant disease, weÔÇÖre right 95 percent of the time, and the other five percent is because we define significant disease as greater than 60 percent blockage, and someone else might define it as a slightly higher or lower percentage. It doesnÔÇÖt mean you donÔÇÖt have disease, itÔÇÖs to do with the technical definition of what we call significant. To give you something to compare to,ÔÇØ he continues, ÔÇ£vascular screenings are significantly more accurate than mammograms. ThereÔÇÖs a much higher rate of false positives with mammograms.ÔÇØ ItÔÇÖs a good thing that Life Line Screening is affordable, because these screenings are typically not yet covered by insurance. Greenberg points out that the incidence of positive findings in mammograms is about one percent, some of which will be false positives, but of the five million people so far tested by Life Line Screening, people with no symptoms, about eight percent have been found to have significant vascular disease. ÔÇ£And yet mammograms are routinely covered by insurance companies and by Medicare, and vascular screenings are not. And cardiovascular disease kills 20 times more people than breast cancer. People donÔÇÖt get it yet.ÔÇØ Life Line Screening has grown phenomenally since its inception in 1993, and intends to continue doing so, with a multi-faceted growth strategy. ÔÇ£We are making plans to take the business overseas,ÔÇØ says Campbell. ÔÇ£We hope to be in another country this year with plans to go into other markets in ensuing years. Vascular disease is not a condition unique to Americans in the United States.ÔÇØNew tests are another opportunity. Life Line Screening introduced finger stick blood tests last spring, for glucose, lipids and C-reactive protein, a marker for heart disease. ÔÇ£WeÔÇÖre rolling that out across the United States,ÔÇØ he says, ÔÇ£and weÔÇÖll complete that implementation later this year; there are other tests on the horizon that we continue to research and to pilot to gauge the publicÔÇÖs interest.ÔÇØBut new tests have to be carefully thought out and planned, to ensure they are medically necessary, suitable for a mass market and can be carried out to the high standards required. There also has to be a treatment option for the consumer. ÔÇ£You donÔÇÖt want to tell somebody they are at risk for a life threatening disease if thereÔÇÖs nothing you can do about it,ÔÇØ says Campbell. ÔÇ£WeÔÇÖre not going to go out and screen for terminal cancer.ÔÇØ