Dr. Dean Ornish Spectrum Program
Policy
The Spectrum, formerly known as the Dean Ornish Advantage Prevention Program, is one of two lifestyle programs developed by Dr. Dean Ornish and offered as a covered benefit to qualified PEIA PPB members. The Dr. Dean Ornish Program for Reversing Heart Disease is an intensive and rigorous hospital based program designed to reverse heart disease or diabetes through lifestyle change.
Launched originally in 2004, “Ornish Advantage” is a six week educational program designed to educate participants about lifestyle modifications in the areas of nutrition, exercise, stress management and social support. Effective in 2010, this program has been modified as the Ornish “Spectrum” based upon Dr. Ornish’s book of that title which allows participants to individualize their lifestyle change activities based upon a spectrum of possible changes.
Therefore, PEIA has modified its approval criteria in recognition that even those with greater risk factors can benefit from the lessons learned through the Spectrum program. Current eligibility criteria are as follows (any one of the following):
- Aged 50 or older;
- Personal or family history of coronary artery disease;
- Personal or family history of hypertension;
- Personal or family history of diabetes;
- Personal or family history of cancer;
- Body Mass Index greater than 25;
- Metabolic syndrome.
Persons who previously participated in the Ornish Reversal program are not eligible to participate. There is no deductible or coinsurance, however, members are responsible for a copayment of $48 which is payable to the provider at the beginning of the first session. This service can only be provided by an authorized Spectrum provider. This is a once per lifetime benefit.
As Spectrum is preventive in nature, it is less rigorous than the Ornish Reversal Program and as such does permit fish, chicken and up to 15 percent of dietary fat.
Participants meet weekly and are provided training manuals; a full lipid profile; personal wellness profile; body fat composition; and BMI before the commencement of the training and again at 12 weeks. Copies are provided to their primary care physician.
Procedures
The Spectrum site prepares and submits a participant inquiry and eligibility form. Upon the receipt by Wells Fargo TPA, the member’s potential eligibility is scored and insurance coverage is verified to finalize the determination of participation.
Claims are sent to Wells Fargo TPA for processing with the review consisting of member identification and dates of service for attendance.