What Makes for a Successful Wellness Center

Tag Words: Wellness Centers, Medical Insurance, Physical therapy, Acupuncture, Chiropractic
services, Mental Health

Authors: Jeanine Moussa and Julie M. Fagan, Ph.D.

Summary: Wellness centers, places where people may go for yoga, nutritional counseling,
physical therapy, fitness, chiropractic care, eastern medicine, etc., are more popular now than
they were a decade ago. Not all wellness centers offer the same services or accept insurance, and
many businesses close just a few years after opening. We attempted to analyze what factors play
a role in determining what makes for a successful wellness center.

The Issue: Wellness Centers – Why are Some Successful and Others Not?
Wellness Centers are popping up left and right, many disappear just as fast as they appeared.
What features does a lasting Wellness Center possess? What do you think of when you hear the
words Wellness Center? Many people imagine this beautiful place that will help guide clients to
a better lifestyle. This is not too far off. Although many people do not understand that a Wellness
Center can be many things. Each center can be drastically different with varying clientele and
services. What is the difference in success between these Wellness Centers? What characteristics
make it more likely for these centers to have a large and lasting clientele?

What makes a wellness center a wellness center?

Many people today do not understand what a Wellness Center is and what services they provide.
This lack of knowledge has prevented many from taking advantage of the countless benefits. In
fact, these days, there are many wellness centers that are simply a place to obtain information
about different treatments and alternatives. The many wellness centers do offer services also
accept insurance and provide services that are proven to help and prevent illness and simply
promote health.

Health and wellness are two words that go hand in hand. The purpose of many Wellness Centers
is to guide people into a better lifestyle. This could be anything from providing fitness programs
tailored to each individual's needs or actually providing exercise equipment. The general
characteristic that makes a Wellness Center a Wellness Center is providing information about
health and prevention of illness. This means that a center will provide people advice, data, and
knowledge about a numbers of different techniques to heal or prevent illness and injuries. Many
times there are not actual services provided to the public, but just a center where you can obtain
information.

The different types of wellness centers and their varying services

As discussed earlier, each Wellness Center is different from the one next to it. There are a few
different types that can be narrowed down. When walking into a Wellness Center, one can
expect to find anything from beauty services to physical therapy. A Wellness center can be a
place for individuals to go to simply receive information about how to stay healthy (1). The title
of a Wellness Center is extraneous to the type of service provided but rather the number of
different services the clients can choose from. They are facilities that focus on all aspects of
health; mental, physical, external, and internal.

There are centers that are mainly focused on physical fitness and weight loss. In a center like
this, one can expect to find a gym, licensed nutritionist, personal trainers, group fitness classes
and most likely, physical therapists. Although many may think this is simply a high class gym,
the added physical therapy services adds the rehabilitation aspect of a Wellness Center.
Individuals with injuries can go to physical therapy and may also join the gym in the same
facility.

Another example of a different type of Wellness Center is one that provides Eastern medicine
and healing. You’d expect to find a wide range of services that are considered unconventional;
like acupuncture, massage therapy, aromatherapy, and reiki in this sort of facility. Many times
these services can be combined with other focuses such as yoga.

There are also facilities that refer to themselves as Wellness Centers that are a chiropractic
practice that also offer other forms of therapy. In a facility like this one there is a licensed
Chiropractor who helps his/her patients achieve wellness and relief of pain through chiropractic
work, reflexology, cold laser, etc.

There are Wellness Centers that combine all Eastern and Western medicine along with beauty
services. These centers seem to have it all. They may staff chiropractors, licensed dietitians and
physical therapists, beauty specialists, life coaches, fitness trainers, yoga instructors, etc. This
diversity allows the center to accommodate many different customers seeking wellness of
whatever sort. This type of facility also provides a place where staff can operate under one roof
as opposed to having to try to survive as a lone service/business.

Every client has their individual needs and ideas about what they want to get out of a wellness
center. The freedom that a wellness center has is what makes them so special. They have the
ability to accommodate to many different consumers. This flexibility is also what makes it easy
to find a wellness center that will fit each client’s unique background.

Services Wellness Centers Provide

Physical Therapy. A physical therapist is a licensed individual with a doctoral degree in Physical
Therapy. They have an extensive background in the human anatomy, biomechanics, kinesiology,
and physiology of the human body. They use this information to help rehabilitate the body
without drugs or medication. Physical therapist can treat an abundance of injuries and disorders.
They use many different techniques such as electrical stimulation, ice/hot packs, massage,
manual therapy, weight training (2).

Physical therapy has been around since the early 1900’s. It is widely used today with clinics
everywhere you turn. Medical doctors fill out prescriptions for physical therapy for many
different reasons. It can be used to prevent further damage to a joint or ligament from natural
causes or help to rehabilitate individuals following an accident or major surgery.
Acupuncture. An acupuncturist uses small needles that he/she inserts into the affected area of the
body. The study of acupuncture also goes a little beyond general anatomy where meridians of the
body are designated. These are the energy channels that are thought to run through the body. The
idea behind acupuncture is to remove blockages in these channels (3). The needles used “grasp”
onto connective tissue, causing the sensation of a deep ache, and reported to have many clinical
implications (3). Connective tissues can be found throughout the entire body, surrounding
organs, muscles, bones, blood vessels, and nerves. Therefore, it is no surprise that mechanical
changes in non-specialized connective tissue, potentially caused by acupuncture, can affect
different systems in the body by induction, “cells sense and transform these mechanical signals
into cellular responses such as the activation or deactivation of signaling molecules, translocation
of transcription factors into the nucleus, and ultimately, changes in gene expression” (3). Such
alterations in the structure of connective tissue, both macro and microscopically, are thought to
affect tissues in which it is in contact with.

Chiropractic Services. Chiropractors, what they do, who they help and why their practice works
for some, has been studied for years. While there are misconceptions about the use of sudden
movements to realign the spine, there have also been positive outcomes for most that are able to
live pain free and use a chiropractor as a refresher on occasion to realign the spine before pain
comes back. Posture is said to a contributing factor as to why back pain may begin.
Chiropractors are used by clientele usually to treat back pain but chiropractors are not limited to
only back pain. When the spine is realigned, clients have seen less pain in their necks, arms, legs
as well as their back. The treatment that chiropractors use is a spinal manipulation treatment to
give proper alignment to the spine and surrounding joints (4). The process includes a controlled
sudden movement to improve the range of motion for the client. This pain relief can change the
life of a client. Most chiropractors include nutritional counseling as well as exercise or
rehabilitation into the client treatment plan. The chiropractor and the client establish goals to
determine long term effects of the chiropractor’s treatment plan. Acute back pain is common and
generally able to be treated with the help of a chiropractor.

Mental Health. Mental health services are a large part of wellness centers. They can provide life
coaches, psychologists, counseling, and wellness coaches. Many times these services are the
largest part of a center and what they provide to their clients. A life coach for example is
someone who will work with an individual and help them bring their goals into focus. They will
work closely with a person to understand their desires, their skills, and their weakness in order to
make a plan to achieve their dreams. This strategy is helpful to regain focus and make reasonable
plans for the future. A wellness coach is similar except they provide more of awareness towards
physiological health. They help clients change eating habits, exercising plans, and balancing all
these challenges in life.

A clinical psychologist is the most common type of psychologist one might encounter at a
wellness center. Psychologists assess each individual with mental screenings, then diagnose and
treat different mental illnesses (6). They can provide screenings for mental disorders such as
depression, schizophrenia; ADD/ADHD and help patients make goals and live with their
disorders. They are not psychiatrists and do not prescribe medications, but use other forms of
therapy such as psychotherapy which may include group therapy, cognitive behavioral therapy,
art therapy, etc. (6).
Yoga and Fitness Classes. Yoga is a practice that has existed for thousands of years, with no real
evidence of a true beginning date. It is an increasingly popular form of exercise that incorporates
the mind, body and spirit, and seeks to find balance between the working body and the busy
mind. Within yoga there are three vital components that make the practice whole: breathing
exercises, body postures, and meditations, derived largely from ancient Indian philosophy (7).
There are also different forms of yoga that incorporate the components differently and are aimed
towards participants’ varying levels of physical ability.

Group fitness classes have a different dynamic than working out alone. Having an instructor or
personal trainer to guide you through a sequence, can be motivating, and challenge someone in a
way they have never done before. Group fitness classes also provide motivation by watching and
working amongst the others in the class. This generates a sense of community, feeding off each
other’s energy, and aids in accomplishing the rigors of the class.

Dietitians/Nutritionists. A dietitian or a nutritionist is someone who is helps patients eat properly

throughout the day. They can work closely with patients who are overweight, have medical
illness that prevent them from losing weight; medical conditions like diabetes, etc. (8).These
professionals have a bachelor’s degree or a master’s degree and are familiar with human
physiology and how the foods we eat react in our bodies. They can help clients make meal plans,
and change the course of their life with the foods they eat each day.

Insurance Coverage
There are pros and cons with regards to whether Wellness Centers would wish to accept
insurance. By accepting insurance, the wellness center will get customers that they otherwise
wouldn’t bring in. For many clients, insurance coverage is the main reason they find themselves
at a Wellness Center. A doctor may give the patient a referral for physical therapy, for example
and refer them to a physical therapist that works at a Wellness center. This may be the client’s
first visit to a Wellness center. Once there, clients will be introduced to the other services the
wellness center offers and potentially participate in those as well creating a steady stream of
income.

The negative side of the Wellness Center accepting insurance is that 1) there is considerable
paperwork to process which requires skilled administrative staff, 2) requires licensed personnel
to perform the services and 3) that the insurance company dictates how much they’ll pay out for
specific services. So their profit margins are severely limited as the Wellness Center needs to
pay a decent wage to the people certified to provide these services; otherwise they’ll jump ship
and start their own business. One would imagine that some wellness enters may struggle to keep
qualified and certified staff on board, especially those that develop a following and begin to work
full time.

What do major insurance companies cover?

There are many different medical insurance plans, coverage policies, levels of coverage, etc. In
general, many marketplace health insurance plans (private health plans) will cover rehabilitative
services (services to help people with injuries, disabilities, or chronic conditions gain or recover
mental and physical skills) and some preventive and wellness services (9). Rehabilitative
services such as physical therapy and chiropractic care may be covered if a doctor prescribes it
and the insurance company approves it. Weight loss and nutritional counseling may be covered
under insurance if these services are considered medical necessity. In most all cases,
authorization by the insurance company is required for coverage of these services and may be
limited in the number of visits which is dictated by the insurance company depending on patient
need as determined by the physician.

What insurance companies do not cover

There are many services offered by wellness centers that are not covered by insurance plans.
These services can include things such as fitness class, holistic eastern medicine, and beauty
services. Although holistic and eastern medicine is growing in popularity, the insurance
companies generally do not cover these services. Insurance companies claim that there is not
enough scientific research to supporting its benefits. Insurance companies’ base their coverage
on what is necessary to health and what has been shown to provide significant benefit. While
these services may help make a patient feel better, insurance companies do not deem them
medically necessary. There are exceptions and there are a growing number of alternative
medicine services that are getting covered.

Community Action: Identifying the differences between successful and unsuccessful

Wellness Centers
Local wellness centers were examined in order to understand the commonalities amongst the
more profitable (> $500,000 gross annual revenue) vs less profitable (< $500,000 gross annual
revenue) wellness centers. Twenty seven wellness centers in New Jersey were examined; 16
were open and running while the remaining 10 are now closed. It would be expected that he
wellness centers that are now not operating likely closed because they could no longer stay in
business financially. Little information was found on these former centers as most of their
websites are no longer in service.

The 16 open wellness centers were surveyed over the phone and asked about the number of
services they offer, what their most popular services were, what certifications they require of
individuals that perform services (and which services, what certifications), what their most
successful service was, which services are covered by insurance, and how they acquire clientele
(physician referral?), and how many clients on average visit each week.

Wellness center information on the annual revenue (below), year established, and the number of
employees was obtained from the website manta.com.
Characteristics of the most Successful Wellness Centers Studied
The three most successful wellness centers, based on annual revenue, were NJ3, NJ5 and NJ10.

NJ3 has been open for 9 years and was established in 2006. Their revenue is approximately
$500,000 to $1,000,000. They have a staff of about 19 (many of these are part-time) and they
only offer 3 services (beauty services, acupuncture, nutritional counseling). Their most popular
service is nutritional consulting. Many of their clients are referred by area physicians. The
wellness center typically services ~150 clients a week. They do accept insurance for
acupuncture.

NJ5 has been open for 6 years and was established in 2009. This center employs about 7 and
offers 10 services (fitness services, group fitness classes, physical therapy, massage therapy,
chiropractic care, medical herbal therapy, medical herbal therapy, nutritional counseling, and
personal training) and their revenue is about $1,000,000 to 2.5 million. They accept insurance for
services that are referred to by their physicians. These services are physical therapy, massage
therapy, chiropractic care, and nutritional counseling. They offer group fitness classes along with
physical therapy, massage therapy, aesthetic services, and many more. Their most popular
services are ones that are not covered by insurance: facials/massages and fitness training. They
see a total of about 350-400 clients a week.

NJ10 has only been open for about 3 years now, employs 6 people who are certified in their field
and offer 5 services (Chiropractic care, Electro-Acuscope and Myopulse, Jin SHin Jyutsu, Neuro
Emotional Technique) Their revenue is between $500,000- 1 million. They accept insurance for
services that are referred to by their physicians. The service that are accepted by insurance are
chiropractic care. Their most popular services are chiropractic care and nutritional counseling.
They see about 400 clients a week.

The 3 least successful wellness centers based on annual revenue of less than $100,000 were NJ6,
NJ7, NJ16. Their net income may actually be negative (they run on a deficit). The annual
income reported does not take into account the rental of the property, heating/ cooling/ electric/
water and sewer costs, or payments to the people providing administrative or wellness services.
If they don’t rev up their revenue, that will likely close.

NJ6 was established in 2012 with revenue estimated to be about $84,000/year. They have 3
employees and offer 2 services; aesthetic services and cosmetic acupuncture. They have certified
individuals in both the aesthetic services and acupuncture. - They do accept insurance for
acupuncture (for those plans that cover acupuncture) and their most popular service is
acupuncture. They see about 35 clients a week.

NJ7 has been open for 32 years and has a staff of 9 who are all certified in their field. Their
revenue is about $100,000 annually. They do accept insurance. They have 9 services which
include, chiropractic care, physical therapy, massage therapy, acupuncture, weight loss services,
micronutrient testing, vitamin supplements, DOT exams, subluxation station, corrective
exercises, lifestyle advice, nutritional counseling, spinal and postural screenings. Their most
popular services are chiropractic care and physical therapy. They see about 75-100 clients a
week.

NJ16 has been open since 2010, has 1 staff member with an annual revenue of about $58,000.
This business accepts insurance and has 4 services: beauty services, massage therapy (most
popular), physical therapy, and chiropractic care.

Table 1. Services Offered by Wellness Centers

Revenue Greater than $500K Revenue less than $500K

NJ3 NJ5 NJ10 NJ6 NJ7 NJ16

Services offered (*
accepts insurance,
#physician
referrals)

Physical Therapy N Y*# N N Y* Y*

Chiropractic Care N Y*# Y*# N Y* Y*

Nutritional Y Y* Y N Y N
Counseling

Exercise Classes N Y N N N N
 NJ3 NJ5 NJ10 NJ6 NJ7 NJ16

Acupuncture Y*# N N Y* Y* N

Beauty Services Y Y N Y N Y

Wellness Centers No Longer In Business

NJ18 opened in 2005 and had about 5 employees. They offered 3 services, facials, massage, and
workout classes such as kickboxing and yoga. Their annual revenue was about $200,000. They
did not accept insurance because they did offer services that accepted insurance. Reason for
closing is unknown.

NJ19 opened in 2007 and had 2 employees. They offered 2 services; physical therapy and
massage. They accepted insurance and their annual revenue was about $500,000. They closed,
but then opened up a new facility in 2010 which is under a different name (the NJ2). They now
offer more services.

NJ20 opened in 2012 and had about 3 employees. Number of services unknown, their annual
revenue was about $500,000. The owner was called but refused to answer any questions. NJ21
opened in 2010 and had 5 employees, revenue was under $500,000. The owner was not
interested in answering questions. Not much information was collected for these two companies.

NJ22 and NJ23 both opened in 2012 with reason for closing unknown. NJ24 was opened in 2011
and had 4 employees with reason for closing unknown. NJ25 was opened in 2000 and had 8
employees with reason for closing unknown. NJ26 opened in 2009 and had 2 employees. Reason
for closing is unknown.

NJ27 opened in 2001 and had about 9 employees. Their annual revenue was about 1 million to 2
million. They offered many services, yoga, kickboxing, chiropractic care, fitness coaching, they
had a pool and sauna. Insurance was accepted. They closed down because the owner moved to
Australia and opened up a new practice there.

The Difference Between A Successful and Unsuccessful Wellness Center

We defined a successful wellness center as one that is operating with gross annual revenue of
over $500,000. We found that the more successful centers had a full working website. They
presented their staff and the services they provided with detail. The services that were provided
by the successful wellness centers included physical therapy, chiropractic care, and nutritional
counseling. These services were covered by some insurance plans with clients getting physician
referrals for these services. The wellness centers that had gross annual revenues of less than
$500,000 had websites that were not very informative. Their services were either not explained
thoroughly on their website or they did not have an active website.

What people want out of a wellness center - Informal Poll

There are many wellness centers with different services and different objectives. The centers that
seem to last and have a lasting clientele are the ones that offer numerous services. Whether these
services are covered by insurance does have an impact on success but, based on a very informal
poll, insurance coverage may not be the only contributor. However, many people do not always
find the need for a wellness center unless a doctor suggests it. With that being said, offering
services that do accept insurance are more likely to be utilized. Although it is not to say that a
wellness center cannot be successful without insurance coverage.

Informal Poll
Do you go to a Wellness Center?
What do you want to see in a wellness center? Services?
Rate the importance of each contributing factor from 1-5, with 5 being the most important.

Convenience (Hours Available)

Location
Price
Acceptance of insurance
Services offered
Customer Service
Expertise of care providers

Twenty five people were asked to rate the significance of the above contributing factors from 1-
5; with 5 being the most significant/very important to the individual. the above questions. These
people were acquaintances of JM ranging in age from 23-65 with approximately 20% of the
people in each of the five age groups: 23-30, 31-40, 41-50, 51-60, 61-65. This informal poll did
not take account socioeconomic factors and only provided a snapshot of a small population.
However, many of JM’s acquaintances had not been to a wellness center and because these
individuals were not separated out, the numbers below provide little or no information.

“What People Want Out of a Wellness Center”

1 2 3 4 5
Convenience: 2 3 3 4 13
hours available
Location 1 3 4 15 2
Price 2 6 6 11
Acceptance of 20 2 3 1
Insurance
Services offered 1 7 17
Customer Service 3 7 15
Expertise of care 1 2 22
providers

The ratings the acquaintances gave suggested that the deciding factors of attending a wellness
center were mostly based on the quality of care. Many said they would pay out of pocket if they
felt like they were receiving proper care by individuals who cared and were knowledgeable in
their field. Convenience and location were also quite important to many people; that it would be
a determining factor of whether or not they would attend a wellness center.

Demographics are likely to impact wellness center participation. One would expect that a
younger demographic would consider paying a little extra out of pocket in order to receive the
services and quality of care they desire. As the patients and customers get older, it would be
expected that insurance coverage would be a huge factor in determining whether or not they
would attend a wellness center. There was not a representative sampling of this population to
determine whether or not insurance would be the deciding factor on whether they would go to a
wellness center. It would also be expected that millennials might rate “acceptance of insurance”
low when compared to services offered, convenience and expertise of care providers. Pricing of
the service was not rated as that important on the client's decision to attend a wellness center,
although the largest number of people did rate it with a four. It is not enough to say that clients
will not pay if the service is expensive. When the participants were asked to reflect on their
ratings, many responded the same way; “I will pay out of pocket, or a more expensive rate if I
am getting quality care and what I want.” This shows that people are willing to go to wellness
centers that they feel offer them proper care. Every individual has different needs and requires
different services.

References
1.Shepley, Phil., Haris, Bronwyn. (July 2015). What is a wellness center? Retrieved from
http://www.wisegeekhealth.com/what-is-a-wellness-center.htm
2.Winstein, C., & Requejo, P. (2015). Innovative Technologies for Rehabilitation and Health
Promotion: What Is the Evidence?. Physical Therapy, 95(3), 294-298.
doi:0.2522/ptj.2015.95.2.294
3.Langevin, M. Helene. “The study of connective tissue is shedding light on pain and providing
new explanations for alternative medicine.” The Scientific Magazine. 1 May. 2013.
4.Robinson, Jennifer (January 2015) “Chiropractice Care”Retrieved from
http://www.webmd.com/pain-management/guide/chiropractic-pain-relief
5.Goldberg, Joseph.”Life and wellness coaches”(September 2014)
http://www.webmd.com/balance/guide/life-and-wellness-coaches
6.Cherry, Kendra “Types of Psychology” Retrieved from
http://psychology.about.com/od/psychologycareerfaq/a/types-of-psychologists.htm
7.Cramer, H., Lauche, R., Haller, H., Langhorst, J., Dobos, G., & Berger, B. (2013). 'I'm More in
Balance': A Qualitative Study of Yoga for Patients with Chronic Neck Pain. Journal Of
Alternative & Complementary Medicine, 19(6), 536-542. doi:10.1089/acm.2011.0885
8.Santiago, Andrea “Nutritionist-What is a Nutritionist” Retrieved from
http://healthcareers.about.com/od/n/g/Nutritionist.htm
9.http://www.medicare.gov/coverage/your-medicare-
coverage.html?q=chiropractic%20services%20medicare%20coverage

Letter to the Editor

submission@wellness.brawopress.com
Dear Editor,

Please consider publishing my letter to the editor.

I am writing about Wellness Centers, an issue that is important to me. I am interested in the
success of Wellness Centers, and what they provide to the public. I believe that many people
don’t know about the services offered by Wellness centers and this lack of understanding has
caused many wellness centers to go un-noticed by the public leading to their closure.

Thank you for your consideration,

Jeanine Moussa