Alternative therapy bolsters heart health

Program saves about $16K per participant

If everything truly does start in California, a revolution may have begun in the way health care professionals help employees to manage — and reverse — their heart disease. And that revolution has already spread east in a big way, thanks to a pioneering effort by Highmark Blue Cross/Blue Shield, based in Pittsburgh and Camp Hill, PA.

In November 1997, Highmark implemented an innovative program developed by Dean Ornish, MD. The Ornish program incorporates a vegetarian diet, exercise, yoga, support groups, and meditation. Highmark is the first U.S. health insurer to provide and pay for Ornish’s program.

The results? Highmark estimates it has saved approximately $16,000 per person through the program. While up to 80% of the participants would have required heart surgery in the next five years if they had not joined the program, none of them has suffered a heart attack since the program began; there have been no deaths; no one has required bypass surgery; there have been no strokes or transplants; and there has been only one angioplasty. (A complete reporting of outcomes is provided in the chart on p. 32.)

Becoming a believer

"I saw Dr. Ornish speak at a conference in 1996, and became convinced that confronting heart disease in this way was the right thing to do," recalls Anna L. Silberman, MPH, vice president of HealthPLACE, a division of Highmark that offers a broad spectrum of health promotion programs.

"What attracted me was the combination of four interventions for which there is a scientific basis; we know what works," she continues. But Silberman rejects the label of "complementary medicine" when discussing the program; she also bristles at the term "disease management," preferring instead to call the process "health management."

"We’re talking about nutrition, exercise, stress management, and group support," she explains. "Each one is very effective in itself. Together, the synergy is very powerful."

Silberman notes that the basic philosophy of the Ornish program is a departure from traditional health promotion.

"In health promotion, we learn that people become successful in small steps," she explains. "This is different; you change all at once. You’re no longer eating meat, you’re exercising, Type A’ executives are meditating right away. Your life changes right away. It’s the combination of these big changes that produce the big results. By the third day, many people have lower blood pressure because of the stress management sessions; chest pain is relieved because more blood is flowing to the heart; and they see a number of risk factors dramatically reducing."

Getting it started

Highmark drew its initial participants from among its 2.5 million members in Western Pennsylvania. (It has 18 million members nationwide.) "Most were employees at local companies," notes Silberman. "Heinz sent a number of people, because they have a culture that is very supportive of wellness. If employees need to leave work early two days a week to participate in the program, it’s fine with them. We also have our own employees and dependents in the program."

In addition, the program was opened up to some local Medicare patients and unemployed individuals through scholarships.

Strong adherence to program

The program was jump-started with "a huge article" in the local newspaper," Silberman recalls. "The newspaper got wind of it, and people started to call," she says.

Many individuals who read the article went to their cardiologist for referrals, says Silberman. "The participants were people with documented cardiovascular disease," she explains. "One had had a heart attack; others had bypass surgery or angioplasty, or they had a combination of risk factors and knew they were on the pathway to the hospital. We welcomed them with open arms."

They did not accept smokers. "That would have been too much at once, so we put them in our smoking cessation program. We also offered a nutrition program for individuals with serious food problems," she explains.

Of the 300 people who signed up for the program, only three dropped out, says Silberman. "You have the opportunity to really connect with people," she notes. "The participants develop strong relationships with one another, as well as with the staff." The staff include exercise physiologists, nurse case managers, registered dietitians, a medical director/cardiologist, a behavioral health clinician, and stress management and yoga instructors.

"For years, we’ve been delivering sick care; this is really health care," Silberman asserts. "By its nature, cardiovascular disease is very progressive, but when adhered to, this program reverses it. Weight drops, anxiety scores, depression scores all go down. The results we’ve achieved have been accomplished amongst this very high-risk population."

Highmark’s actuary department estimates the insurance carrier is saving about $16,000 per person by avoiding the costs of complications.

"When I saw this [program] in California, I thought that maybe it would only work there," she continues. "But our program has renewed my faith in people’s ability to learn a new lifestyle, to integrate it, and to promote it to others. I really respect their accomplishments. They’re with us only 10 hours a week, but obviously they’re adhering to the program when they’re away from us because the results are holding."

Some of those results have been truly impressive. One of the participants, John C. Court, DC, wrote Silberman the following: "I had fantastic lab results yesterday. My cholesterol dropped from 258 to 172, my triglycerides dropped from 693 to 259, and my stress test improved 14.3% These data show tangible proof that 12 weeks of following the Ornish guidelines work. Your staff did an outstanding job leading me through the program. The numbers do not adequately show how great I feel, having made this lifestyle change. I am 18 pounds lighter, and have the energy and zest of an 18-year-old."

For those health promotion professionals interested in the program, Highmark "would be most willing to go into any large employer who would have 15 or more people eligible to participate," says Silberman. She notes that Highmark is "close to having exclusive rights to the program all over the country."

Referrals to Highmark should come from the wellness coordinator, Silberman adds.

[For more information, contact: Anna L. Silberman, Highmark Blue Cross/Blue Shield, 120 Fifth Ave., Suite 1721, Pittsburgh, PA 15222. Telephone: (412) 544-4182. E-mail:]