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Lifestyle Advantage was formed jointly between Pennsylvania’s Highmark (an insurance firm) and Dr. Ornish’s Preventative Medicine Research Institute. It had more than 600 participants. [5] Highmark, the first insurer to provide and pay for this program, reimbursed program providers at approximately $7,200 per patient. [6] Dr. Ornish also noted that “after eight and a half years of going back and forth with Medicare, the Medicare Demonstration Project is now paying for the first time for 1,800 patients to go through our program.” [7] Lifestyle Advantage consistently tried to balance its clinical outcomes and research objectives with consumer desires and the business opportunity. [8] Its program components included following a very low-fat eating style (all animal products are excluded), exercising 30 minutes per day, one hour of stress management daily, and regular group meetings to share feelings about life. [9]
Participants attended three 4-hour group sessions on the first and 12 th weeks of the program. After 12 weeks, an average participant had invested less than 100 hours. Based on the severity of a patient’s heart disease, some participants could meet weekly for up to an additional nine months, and often logged over 200 hours. Some hospitals were testing a less-intensive program that lasted for 12-15 hours.
The most common positive feedback was that patients could not believe the level of support they received. [10] Dr. Ornish noted, “One of the things that I learned over the years is what really motivates people to change, what works and what doesn’t, and that fear of dying is not a very good motivator.” [11]
The clinical outcomes were impressive. The 28 patients in his intensive lifestyle modification programs had 25 cardiac events versus 45 cardiac events per 20 patients in the usual care group. [12] Another study noted that while 48% of patients, at baseline, experienced chest pains, after one year, 65% of them had no angina. One insurer calculated that the program saved between $5,391 and $10,101 per patient, depending on the severity of the heart disease. [13]
Yet, Dr. Ornish noted:
My colleagues and I have demonstrated that severe heart disease often can begin to reverse when people make much bigger changes in their diet and lifestyle than most doctors had recommended. I thought after we published these findings in all the major medical journals that they would change medical practice, because the idea, which was really radical when we were doing the studies, had become mainstream. But it was kind of a surprise to find out how naïve I was, that it’s not enough to have good science. [14]
Mountain State BCBS (Blue Cross Blue Shield West Virginia, the major private health insurer in West Virginia) also approved patient reimbursement for the Lifestyle Advantage program at nine hospitals. [15] About 200 to 300 participants went through the programs. Lifestyle Advantage estimated that in excess of 75% of West Virginia’s adults had coverage for the program through Mountain State BCBS, a Medicare Demonstration Project, and the West Virginia Public Employees Insurance Agency.
West Virginia had the highest incidence of heart disease per capita in the country. One of two adults in the state were candidates. The enrollment between men and women was about equal. The company estimated that 90% of participants who started the program graduated. Program participation required approval from the patient’s primary-care physician. Candidates included men and women who were contemplating bypass surgery or angioplasty; had previously experienced heart procedures; and had been diagnosed with coronary artery disease, or significant risk factors for cardiovascular disease, such as a family history of cardiovascular disease, high cholesterol, high blood pressure, and diabetes. [16]
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