By then, more than forty insurance companies besides Mutual of Omaha were covering our program, on either a defined-benefit or case-by-case basis. One of these was Highmark Blue Cross Blue Shield, which had such great results that it decided to provide the program in three sites as well as to reimburse it.
Highmark Blue Cross Blue Shield conducted its own demonstration project. As in the Mutual of Omaha demonstration project, it compared people who went through our program with similar patients who did not (called a "matched control group study").
Highmark found that its overall health care costs were reduced by 50 percent in the first year and by an additional 20 to 30 percent in subsequent years. At a time when health care costs (really, disease care costs) are reaching a tipping point, these findings are even more important today.
After the success of these two demonstration projects plus the earlier randomized controlled trials, we approached Medicare to see if it would provide coverage. It initially said no.
In 1995, Chip Kahn (who was then the staff director of the House Ways and Means Health Subcommittee) introduced me to Bruce Vladeck, Ph.D., who was the administrator (Director) of Medicare at the time. In that meeting, Dr. Vladeck said, "Dean, before I'll consider doing a Medicare demonstration project, you first need to get a letter from the director of the National Heart, Lung, and Blood Institute of the National Institutes of Health stating that your program is safe."
"You mean that it's safe as an alternative to bypass surgery or angioplasty?"
"No, just that it's safe."
I was incredulous. "You want me to get a letter saying that it's safe for older Americans to walk, meditate, quit smoking, and eat fruits and vegetables?"
So I met with Dr. Claude Lenfant, who was Director of the National Heart, Lung, and Blood Institute at the time, and his colleagues, and we reviewed the medical literature. Not surprisingly, we found that these are not high-risk activities--especially when compared with having your chest sawed open for a bypass operation. In our earlier research, we had found that older patients improved as much as younger ones, whereas the risks of bypass surgery and angioplasty increased in older patients. So these lifestyle changes are especially beneficial for older patients in the Medicare population.
Dr. Lenfant then sent a letter to Dr. Vladeck saying that the nutritional program I recommend is safe, whatever the age of the patients following it.
A month went by. Dr. Vladeck then wrote a letter back to Dr. Lenfant saying that although he had said that the nutritional program is safe, is it okay for people over sixty-five to do moderate exercise and stress-management techniques?
Not surprisingly, Dr. Lenfant replied that these were of "minimal risk" provided that patients are offered all proven treatments.
Four years later, in 1999, with strong bipartisan support from then President Clinton, then Speaker of the House Newt Gingrich, Representatives Nancy Pelosi, Charles Rangel, Alcee Hastings, Lynn Woolsey, and Dan Burton, Senators Barbara Boxer, Arlen Specter, Dianne Feinstein, Ted Stevens, Hillary Clinton, Bill Frist, Maria Cantwell, Chuck Robb, Jay Rockefeller, and Barbara Mikulski, and others across the political spectrum, Medicare agreed to conduct a demonstration project.