No one has been a greater force than Dr. Dean Ornish in proving the efficacy and cost-effectiveness of ‘lifestyle over procedures’ for chronic disease. His seminal work, designing whole systems research models and documenting remarkable outcomes—for reversing heart disease and early stage prostate cancer—has been extraordinary.
Most impressive has been Ornish’s unwavering determination and skill over three decades to effectively translate scientific findings to practical clinical program models; thereby disrupting the healthcare status quo.
Tipping Point Reached—Finally
Since late 2013, when Ornish’s Preventive Medicine Research Institute entered into an agreement with Healthways to roll out the program, 17 hospitals and health systems added it.
In addition to CMS, commercial payers in 17 states now reimburse for the Ornish Reversal Program (ORP).
And why shouldn’t they?
Featuring a plant-based diet, physical activity, yoga-based mindfulness training and group support, the relatively low program cost and proven effectiveness of this intensive cardiac rehabilitation program is dramatic. Eighty percent of those who effectively changed their lifestyles avoided heart surgery or angioplasty—saving almost $30,000 per patient in the first year.
The adoption of ORP represents a major disruption in the status quo of procedures over prevention, moving us toward the future of health creation over disease care, and is the epitome of patient-centered, value-based care.
Reimbursement Advantage of ORP over Integrative and Functional Medicine
I posit that lifestyle medicine is the most accessible tent in the larger camp of integrative health and wellness. Here’s why:
A couple of months ago I spoke with a client—a clinician/scientist at a major academic center—about his vision to expand his successful integrative medicine program into their NCI-designated comprehensive cancer center and new cardiac center.
We discussed viable clinical models, group clinic visits, and the research process needed to determine CMS and commercial payer reimbursements.
At high level meetings with top administrators and physician leaders within the institution everyone agreed to pursue the expansion of the integrative medicine program specific to cardiac care. That is, until the ORP was presented to the cardiac center.
They bought into the ORP in lieu of an integrative medicine program because of its profound advantages:
- solid peer reviewed science;
- proven quality outcomes;
- proven cost-effectiveness;
- coverage by CMS;
- coverage by a growing number of commercial payers including Aetna, Highmark Blue Cross Blue Shield, Wellpoint—under its subsidiaries including Anthem Blue Cross Blue Shield, and Anthem Blue Cross.
The aforementioned sharply illustrates why lifestyle medicine, specifically ORP, is more adoptable by health administrators than integrative and functional medicine approaches that are often money-losing service lines due to the still-paltry reimbursements. The unique proposition of ORP is the coverage by CMS and a growing group of participating insurers across the country.
The Art Of Obtaining Buy In
Lifestyle medicine is simply more accessible for rational-minded clinicians and health system administrators. After all, the core tenets of lifestyle medicine focus on nutrition, physical activity, and stress reduction—exactly where a growing body of irrefutable medical literature lives.
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In the face of economic conflict of ‘prevention over procedures’ in the dawn of ACOs, value-based reimbursements, and the Triple Aim, there has never been a better opportunity for lifestyle medicine to take center stage.
Take A Bow: Homage to Ornish
Ornish, arguably the Father of Lifestyle Medicine and pioneering medical status quo disrupter, brilliantly told a compelling story, proving his hypothesis and, with invaluable support from Healthways, sold it to CMS and commercial payers across the country. For this Ornish should be celebrated the world over by champions of true prevention, health creation, and by the financial stewards of modern healthcare delivery.
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