The classes of 2017 and 2018 consulted in an area within the Fund’s giving priorities by developing a business plan and expansion suggestions for the Enhanced Lifestyles for Metabolic Syndrome (ELM) program. ELM is a lifestyle intervention program that aims to reverse metabolic syndrome (MetS). The class of 2017 identified the needs of grantors (such as the National Institutes of Health) and payors (such as insurance companies) to support ELM in seeking insurance coverage. The class of 2018 built on this work, developing an incremental cost effectiveness ratio analysis of patients receiving ELM treatment compared with traditional MetS treatment.
Put simply, the project aimed to build the case for third-party payors to cover ELM as a feasible treatment. ELM reverses the disease, while traditional approaches treat only symptoms. McGowan Fellows identified the cost of the ELM intervention, compared it with traditional treatments, and looked at the next stages of disease if not reversed, which include diabetes and heart disease.
Today, only patients with disposable income have access to the ELM intervention. Bringing third-party payors on will provide access and equity to all patients with insurance coverage.
By 2020, ELM had grown into a multisite clinical trial in Illinois, Missouri, Pennsylvania, Colorado, and New York, supported in part by a grant that utilized the cost effectiveness plan developed by the class of 2018. Following recommendations from the class of 2017, Rush brought in Dr. Ron Ackermann (who successfully implemented an analogous program for diabetes prevention) to advise on implementation, including an assessment of drug use and drug costs—which are of concern to payors—into the outcome assessment.