An update on the Ornish Program: studies provide evidence that it reverses heart disease, but are insurance companies and hospitals coming on board?

CONVENTIONAL WISDOM SAYS THAT A GOOD DIET, regular exercise, management of stress, and strong personal relationships are healthy habits. In a sense, that is all the Dean Ornish Program is about. But Dr. Ornish's innovation is the combination of these four lifestyle practices into an aggressive, highly structured program, which is validated by his own studies, as well as the research of others in the scientific and medical community. Furthermore, he's using the success of his 440-person, nationwide Multicenter Lifestyle Demonstration Project, started in 1993, to recruit hospitals to run his programs and insurers to pay for them.

Ornish's hospital-based cardiac disease prevention and reversal programs are based on his research published in Journal of the American Medical Association, The Lancet, American Journal of Cardiology, and a variety of other professional publications. Ornish's work has demonstrated that his lifestyle program reduces the amount of coronary artery blockage in patients' arteries. His patients consistently experience reductions in their blood pressure, cholesterol, and body weight after 12 weeks in his program. In addition, participants with angina and diabetes see marked improvements in their conditions after 12 weeks, often in less time.

ORNISH'S PROGRAM IS WORK FOR PARTICIPANTS

The first 12 weeks of the Ornish Program are intense. Patients visit their program site twice a week for four hours. During these sessions, participants learn about each facet of a new lifestyle. They are monitored and counseled by a team, which includes a physician, a nurse, a certified stress management specialist, a licensed behavioral health clinician, an exercise physiologist, and a registered dietitian.

Marlene Janco is a registered dietitian who oversees the Ornish Programs at medical centers in West Virginia. She is an employee of Highmark Blue Cross Blue Shield, which is both an insurance payer for Ornish as well as a program administrator. She says that the switch to a lowfat, vegetarian diet with virtually no oil is the most challenging part of the initial work. Ornish recommends no meat, fish, or fowl with one exception, fish oil. (Vegetarians entering this program may want to discuss alternatives with the program's staff.) The program provides aggressive support for dietary change.

"The nutrition component integrates hands-on experiences with grocery shopping tours, cooking demos, food label reading, recipe modification, dining out strategies, and much more to allow participants to adopt a lowfat, vegetarian eating style," Janco says. "Also, an Ornish-friendly meal is served each session, or participants will bring in their new favorite vegetarian dish for on-site potlucks."

After the first 12-week stage, patients continue onsite visits for three to nine months, depending on the improvement in their risk factors and compliance with the program. All participants are monitored for a year, regardless of how long they continue their on-site work. Janco points out that approximately 90 percent of participants complete the yearlong process.

ORNISH'S PROGRAM IS WORK FOR PROGRAM SITES

The effort for a hospital to set up an Ornish program is not trivial. Each site's caregiving team takes a week of on-site training, and they are monitored continuously through chart reviews, weekly teleconferences, and an annual site visit.

There's also separate education for dietary personnel. "Food service teams come to our Dr. Dean Ornish culinary training," says Janco. "It's a two-day intensive course with an examination and certification. We teach the chefs how to cook vegetarian, how to reduce the fat in their cooking, and how to make the food taste good and look good."

A TOUGH MARKET FOR ORNISH

Though 1,200 patients have completed the hospital-based programs since 2001, program growth has not been phenomenal. Identifying insurance payers and a critical mass of participants open to changing their lifestyles has been challenging for Ornish. A health care program that focuses on a lifestyle overhaul rather than medication and surgery is not necessarily popular with patients or the traditional medical community. (Note: Though one of Ornish's goals is to help people avoid invasive cardiac procedures and surgery, he comments that his on-site programs are only an adjunct to conventional therapy--not a substitute.)

WHERE IS THE PROGRAM OFFERED, AND WHO PAYS FOR IT?

Currently, the Ornish program is available only in Pennsylvania and West Virginia. Highmark Blue Cross Blue Shield provides insurance coverage for participants at the nine sites in Pennsylvania. Mountain State Blue Cross Blue Shield and the West Virginia Public Employees Insurance Agency cover West Virginia participants who enter one of the five sites in that state.

Program sites in Illinois and Nebraska were recently closed due to financial and reimbursement issues. However, Blue Cross Blue Shield of Minnesota has recently become an Ornish payer and is in the process of identifying hospitals for program sites.

People who are 65 years of age and older can get coverage for Ornish through a Medicare demonstration project, which runs through 2005. For patients without insurance, the cost of the year-long program is $7,200. In contrast, cardiac surgery could cost $40,000.

WHO IS ELIGIBLE FOR THE PROGRAM?

People with coronary artery disease and high risk factors for developing cardiac disease--including those who are contemplating bypass surgery or angioplasty, or those who are trying to avoid repeating a cardiac procedure--are prime candidates for the Ornish program. People with diabetes, high cholesterol, or a strong family history of heart disease are also good candidates.

CONTACT INFORMATION

Consumers interested in enrolling in the Ornish program, including those wishing to participate in the Medicare demonstration, can call [phone]. An abundance of general information about the program is also available at <my.webmd.com/content/ pages/9/3068_9408.htm>.

It is difficult for health professionals to join Ornish as individuals; they need to be part of a team at a hospital. The challenge for the program sites is finding insurers who will pay and a critical mass of patients willing to undertake major lifestyle modification.

Health care and insurance professionals interested in implementing the Ornish Program--or learning about his work and research--can contact the Preventive Medicine Research Institute (PMRI), Ornish's nonprofit research and education organization. PMRI also offers a variety of educational and training resources for both health professionals and the general public. Contact PMRI at [phone]. PMRI's website is <www.pmri.org>.

Ben A. Shaberman's articles and essays have been carried by The Washington Post, National Public Radio, American Health & Fitness, and a variety of consumer and professional publications. He also writes for a nonprofit health care firm in Baltimore, Maryland.