Updates from EIM

A Health Insurer’s Perspective: Challenges of Lifestyle Medicine Implementation

August 24, 2022 by Amy Starr

Lifestyle impacts health. Such a simple concept, but one that is so easy to forget while we’re busy living our lives full of highs and lows – taking on new projects at work, falling in love and building families, taking care of responsibilities to our loved ones, all the while handling social, emotional and financial stresses. Daily walks or runs happen less and less frequently. Home cooked meals get replaced with take-out or easy prepackaged meals to save time and energy and over the course of months or years, we see the impact on our bodies. The number on the scale goes up, our blood pressure rises, we may even develop pre-diabetes and get prescribed medication to control these conditions. We understand on a basic level that our everyday habits influence our health, but it may not be until a diagnosis of prediabetes or hypertension that we realize the true impact of lifestyle. 

Lifestyle medicine uses changes in habits to prevent, treat and reverse chronic diseases that are directly related to our everyday choices and behaviors. Different lifestyle elements are used for treatment: exercise, nutrition (whole food, plant-based meals), stress management, positive social connections & relationships, sleep, avoidance of risky substances, and healthy environments. It is all a balance, and some of us are better at some of these than others. Personally, I struggle with stress management. Although all these elements impact health outcomes, nutrition and exercise are often the initial focus when looking to reverse chronic conditions. 

These statistics fuel my drive to advocate and push for more adoption of lifestyle treatment: 

  • 6 in 10 adults in the US have a chronic disease 
  • Almost 30 million children and adults in the US have diabetes 
  • 1.4 million Americans are diagnosed with diabetes every year 

Working at a health insurance company, it’s common for people to ask me why we would care about offering lifestyle medicine programs. Insurance companies protect members from unexpected high medical costs. We automatically think about medical emergencies, something involving a rush to the ER and unexpected tests and treatments. But the role of health insurance is to consider members’ health not just in times of emergency, but throughout the lifespan. There are many initiatives focused on prevention to encourage members to see their doctor annually and complete critical preventative screenings that can detect cancer and other health conditions early. Health plans want their members to have the appropriate care and improve health conditions. If members are healthier, for example taking fewer medications, and feel better, then healthcare costs are reduced. With the statistics mentioned above, it behooves all health systems to promote lifestyle medicine to prevent and treat chronic conditions.  

Wellvolution is Blue Shield of California’s lifestyle medicine digital health platform. All fully insured members can enroll in a program at no cost to the member. It is claims-based (paid by the health plan) and set up as a “pay for performance” payment model. This means, the vendors offering the programs work hard to keep members engaged because the more engaged the member, the more likely the member will meet clinical outcomes. Clinical outcomes tracked include weight loss, A1c reduction and medication reduction. The Diabetes Prevention Program research group found that if a person lost 5%-7% of their body weight, there is a 58% reduced likelihood to develop diabetes type 2. When an engaged member hits milestone 2, they are given a Fitbit device to help track their exercise activities. The Wellvolution platform launched in June 2019. Other lifestyle medicines programs, such as the Dean Ornish Undo-It program and a diabetes prevention program launched in 2015 and 2016, respectively.  

Wellvolution has been available for three years and has helped over 98K members improve their health. One recent example is a member who started a Type 2 Diabetes reversal treatment through Wellvolution including diet, exercise and stress management. In just 48 days, he lost 35 pounds, lowered his A1C (a type of hemoglobin A that is associated with diabetes) by one point, and has been taken off one of his medications. The success of Wellvolution stems from the effort and passion of our team and ongoing collaboration with internal stakeholders and innovative vendors. We’ve gotten creative starting with piloting programs with our employees. We rely on data, digging into clinical trials, leveraging national recommendations and guidelines, and analyzing clinical outcomes and the impact on the cost of healthcare. From this enthusiasm and dedication, the interest in partnership has only increased. 

Our member testimonials speak volumes about the impact that lifestyle medicine can have on individuals and their families and continue to inspire me. I encourage you to join me in evangelizing the benefits of lifestyle intervention.  

Amy Starr is the Sr. Manager, Lifestyle Medicine Operations at Blue Shield of California. In her role, she manages the lifestyle medicine digital health programs for commercial and Medicare populations.  

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