The Well-Being Journal

The Future of Healthcare: Lifestyle Medicine and Heart Disease

Adam Farina

The cost of healthcare has long been at the forefront of our nation’s fiscal challenges, impeding our competitiveness in the global economy and generating financial hardship for our citizens and institutions. Healthcare expenditures in the U.S., for example, consume a larger percentage of our GDP – 17% - than they do in any other country in the world. And despite our exorbitant spending, our return on that investment - as measured by the health status of our citizens - is alarmingly low.

The potentially ill-fated Affordable Care Act was implemented, in part, to address this very issue by paying providers based on results rather than on number of procedures performed. Though the act represents a step in the right direction, it is not enough – further work must be done if America is to have a healthcare system that is sustainable, affordable, and equitable for all of its citizens.

One way for us to take the next step towards a healthier and more cost-effective future is by focusing on behavioral waste – costs resulting from lifestyle choices such as bad eating habits, smoking, poor adherence to health plans, substance abuse, and limited stress management. These habits are not only costly (between $303 and $493 billion per year), they’re deadly; heart disease, obesity, diabetes, and certain types of cancer have all been traced back to the choices we make in our everyday lives. Although that may sound discouraging, it ought to be empowering. Everyday habits can be reversed, and with them, so can the costs and diseases they create. That is the aim of lifestyle medicine, the competency that will help determine the future of healthcare in America.

Whereas drugs and surgery tend to focus on treating the symptoms of chronic diseases, lifestyle medicine targets the behaviors that are root causes of them – thus creating a feedback loop of sustainable health-care rather than revolving door sick-care. Led by pioneers such as Dr. Dean Ornish, President and Founder of the nonprofit Preventive Medicine Research Institute, a growing body of evidence demonstrates the clinical and financial effectiveness of lifestyle medicine. Specifically, Dr. Ornish has proven in over 25 peer-reviewed studies that lifestyle medicine:

  • Reverses the progression of even severe coronary heart disease, generates more reversal after five years than after one year, and leads to 2.5 times fewer cardiac events.
  • Reverses the progression of type 2 diabetes, high cholesterol levels, hypertension, and obesity;
  • Slows, stops, or reverses the progression of early-stage prostate cancer;
  • Beneficially changes the expression of your genes in over 500 genes in three months;
  • Lengthens telomeres, thereby beginning to reverse the cellular aging process.

These unprecedented clinical effects are grounded in similarly transformational financial ones. To illustrate these impacts, let us examine lifestyle medicine’s impact on heart disease in America.

Heart disease is currently the leading cause of death in the United States, and 90% of it is attributable to lifestyle-related activity. Furthermore, it accounts for 17% of all health expenditures in the United States and its costs are expected to triple to $818 billion by 2030. Simply put, there is no aspect of the healthcare industry that needs lifestyle medicine more than heart disease does – and in 2011, Medicare recognized that need. It did so by deciding to reimburse for 72 hours of a new benefit category, Intensive Cardiac Rehabilitation (ICR), which covered – for the first time – lifestyle medicine programs such as Dr. Ornish’s program, Ornish Lifestyle Medicine™. Since that time, other commercial payers have followed Medicare’s lead and decided to cover the program, thus establishing lifestyle medicine as a viable clinical treatment alternative for cardiac disease.

These votes of confidence from Medicare and other commercial payers have not gone unfulfilled by Ornish Lifestyle Medicine – far from it. By the second quarter of 2016, the program had over 1500 participants nationwide, and their results actually exceeded those predicted by clinical trials. Over the course of the nine-week program, the average participant’s weight decreased by 5.9%, cholesterol decreased by 20.5%, triglycerides decreased by 12.1%, blood pressure decreased by 6.15%, and depression score decreased by 53.5%.

Along with these superior clinical outcomes, Ornish Lifestyle Medicine has reduced long-term costs for providers – thus making the program extremely valuable as the industry seeks to reduce behavioral waste and transition to a fee-for-value payment model. A study conducted at a large commercial health plan, for example, determined that offering Ornish Lifestyle Medicine resulted in an average savings-per-participant of $17,687 over a three-year period (based on the value of the dollar in 2000). Providers and patients also benefit from the program’s attendance rate, 93.5%, which clearly outstrips that of other, more-traditional methods for combatting heart disease. For providers, this rate means more reimbursable hours, and therefore, more revenue; for patients, this rate means life-changing clinical outcomes, reduced readmissions, and lower long-term costs.

In short, this program has created a new paradigm for how we treat heart disease in America; it brings about a synergy between the interests of providers and consumers in an often zero-sum healthcare industry, and it does so by targeting the very same behavior patterns that generate the majority of our country’s behavioral waste: nutrition, stress, exercise, group support, and smoking. This approach extends beyond heart disease as well; as Dr. Ornish’s research demonstrates, lifestyle changes bring about similar results for patients with prostate cancer, obesity, diabetes, and other chronic diseases as they do for patients with heart disease.

The use of lifestyle medicine to treat heart disease starkly contrasts the methodology of the rest of our healthcare system. A cartoon that Dr. Ornish likes to show during his presentations illustrates this very point; in the cartoon, a janitor is trying to mop up water on the floor of a bathroom, but the faucet is still running and the sink is still overflowing while he does so. “Wouldn’t it make more sense,” Dr. Ornish asks, “if we just turned off the faucet?” That’s the difference between our current healthcare system and lifestyle medicine; lifestyle medicine turns off the faucet - it corrects the behaviors that cause chronic diseases and behavioral waste - whereas our current healthcare system simply keeps trying to mop up the floor.

We must, therefore, follow the heart disease industry’s lead and expand the use of lifestyle medicine. Doing so would directly limit chronic disease and behavioral waste in America, and bring us one step closer to a healthcare system that makes sense for patients, providers, and the country alike.

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Topics: Lifestyle Change ACA Ornish Lifestyle Medicine lifestyle medicine Dr. Ornish Intensive Cardiac Rehab Heart Disease Dean Ornish

The State of Health Care – President Obama’s Recent JAMA Article

Cameron Bowman

Six years after the adoption of the Affordable Care Act (ACA), and with President Obama’s second term in office coming to a close, a great deal of scrutiny has been placed on health care trends in the United States under the new law.

To address this topic, President Obama recently released a scholarly article in JAMA (Journal of the American Medical Association), notable as the first time a president has published a scholarly work while in office. Reading as part retrospective, part analysis and part call-to-action, the article entitled “United States Health Care Reform: Progress to Date and Next Steps,” details the impact of the ACA.

Findings and data from the Gallup-Healthways Well-Being Index are cited prominently in the article, illustrating the impact that expanded Medicaid coverage and state-based marketplace exchanges have had on lowering uninsured rates.

The results are telling – there is a near doubling in the reduction of uninsured rates in states who had adopted both provisions.

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Since 2008, Gallup and Healthways have tracked uninsured rates across the U.S. and the Well-Being Index is considered one of the most authoritative measures on this topic. Our research shows that the adoption of the ACA has had a profound effect on reducing uninsured rates, which have declined 6.1 percentage points since the fourth quarter of 2013, right before the key provision of the Affordable Care Act took effect. As of the 2Q 2015, uninsured rates are at historical lows.

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“The substantive analysis presented by President Obama on the impact of the ACA underscores the importance of tracking health and well-being of our citizens on an ongoing basis,” said Mr. Witters. “It is an honor to be cited by the President, and we hope our ongoing well-being research continues to be  leveraged to highlight opportunities for improving population health and our health care system nationwide.”

For additional commentary on the JAMA article, click here.

Learn more about our Gallup-Healthways Well-Being Index findings.

Topics: ACA Uninsured Rate

Infographic: More Americans Now Have Health Insurance, New Gallup Data Shows

Madison Agee

New data from the Gallup-Healthways Well-Being Index® demonstrates that, despite the many hiccups associated with rolling out provisions of the Patient Protection and Affordable Care Act (ACA), the healthcare law has led to a tremendous shift in health insurance coverage. In the third quarter of 2013, 18 percent of Americans were without health insurance; by the first quarter of 2014, that number was down to 13.5 percent, its lowest point in years.

Check out our newest infographic, which reveals some fascinating insights from Gallup-Healthways research, including which states are seeing the greatest percentage of their residents without insurance as well as how health insurance coverage affects well-being.

For a deep dive into the data, Dan Witters, research director at Gallup, extensively discussed trends associated with health insurance data in a Healthways-sponsored webinar last month.

To learn more about the Well-Being Index, visit http://info.healthways.com/wbi2013.

The ACA's Impact on Health Insurance Coverage Nationally, Regionally and Individually

 

Topics: In the News Healthcare Gallup ACA