Payers, providers testing counseling for the lifestyle conundrum
The U.S. Preventive Services Task Force is now recommending coverage of behavioral counseling interventions for overweight and obese individuals with at least one other cardiovascular disease risk factor.
A corresponding “B rating” from the Task Force means the intervention will be considered a preventive service under essential health benefits covered by qualified commercial and public insurers.
After a review of 74 different trials, the PSTF concluded that behavioral counseling promoting healthy eating and activity have moderate benefits for CVD risk in overweight or obese adults — especially when it comes to diabetes.
While some studies showed minimal benefits, across the research most programs using a mix of pre-designed and individualized counseling were shown to bring modest improvements in patients’ cardiovascular health.
At 12 to 24 months after the interventions, patients on average had LDL cholesterol reduced by 3.4 mg/dL, blood pressure reduced by 2 systolic and 1.3 diastolic points, and fasting blood sugar lowered by 2 mg/dl.
The reduction in high blood sugar is notable, the PSTF said, because it came along with decreases in the incidence of a diabetes diagnosis across the research — helping eliminate a large and pernicious risk factor.
“Cardiovascular disease prevention is most effective when diet and physical activity are improved together,” said Task Force member Mark Ebell, MD, an epidemiologist at the University of Georgia. “Regardless of their risk for cardiovascular disease, everyone can experience the health benefits of improved nutrition, healthy eating behaviors, and increased physical activity.”
Testing new approaches
Two years ago the PSTF found that lifestyle intervention counseling can benefit individuals at average cardiovascular disease risk, including the nearly 70 percent of American adults who are overweight, but recommended only that health professionals use discretion in offering the service.
One feasible model the PSTF points to is the National Diabetes Prevention Program, an intervention trial across 27 research centers. Overweight adults in trial who received diet, activity and behavior coaching and tracked their wellness progress saw a 58 percent reduction in diabetes incidence, along with lower blood pressure and poor cholesterol, after three years.
Some payers and providers are moving in tandem with the PSTF or even ahead of it in testing new approaches and technologies to tackle unhealthy, often deeply ingrained and pleasurable habits at the personal and population level.
Blue Cross and Blue Shield of Georgia is recruiting members with diabetes to test the viability of an online self-management program modelled on the national program, and L.A. Care Health Plan is offering a similar online program to about 38,000 members.
L.A. Care's year-long program is aimed at gradual improvement, through lessons on nutrition, exercise and health, self-tracking of activities and diet, and counseling from health coaches who reach out weekly with support — say, for people finding it difficult to give up drinking soda and snacking on sugar-laden processed foods.
For those people, an Aetna pilot project is trying to find the best ways to make personal changes, in part by identifying those for whom junk food may indeed be addictive.
Last fall, Aetna started a pilot for 500 of its own most at-risk risk employees with metabolic syndrome. The participants are being screened for three gene variations associated with obesity, appetite and behavior, including DRD2, a gene linked to dopamine regulation and addictive behavior like overeating.
Knowing that gene is present can “help people understand it’s not their fault necessarily,” said Jeffrey Ruby, founder and CEO of Newtopia, a Toronto-based wellness startup partnering with Aetna on the pilot. Coaching styles, motivational tools or financial incentives can also be tailored based on individual genes and situation, Ruby said.