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How to Save Lives: McGowan Fellows Work on Getting Insurers to Cover a Preventive Health Program

When the William G. McGowan Charitable Fund proposed that its 2017 class of Fellows figure out how to get health insurance companies to cover the McGowan-supported initiative Eat Well, Love Better, Move More (ELM), the Fellows rose to the task with creative energy and passion.

At the heart of the challenge was a life-threatening problem: metabolic syndrome, a cluster of conditions including high blood pressure, low HDL cholesterol, high triglyceride level, and abdominal obesity that, in combination, can multiply a person’s risk of heart disease and diabetes.

The associated risks are serious: people with metabolic syndrome are five times as likely to develop diabetes and twice as likely to develop heart disease leading to heart attack and stroke. The size of the problem is serious, too: 35 percent of the U.S. population has metabolic syndrome.

ELM is an intensive, six-month group lifestyle intervention developed at Rush University Medical Center in Chicago by a preventive medicine specialist and a multidisciplinary team drawing from expertise in cardiology, psychology, and nutrition. The program consists of weekly physical activity, detailed demonstrations on cooking meals and how to read food labels, and behavioral modifications that help guide people to eat well and exercise more.

McGowan supported ELM early on by giving Rush University the critical seed funding it needed in 2010 to prove the efficacy of the model, and the results were staggering: Rush found that ELM reversed metabolic syndrome in over 50 percent of program participants.

“ELM has the potential to reverse metabolic syndrome and save lives,” said Diana Spencer, McGowan Fund Executive Director. “The hope is that ELM can be an optional treatment for people with metabolic syndrome, that clinicians will offer it as a viable treatment that works, and when people take that treatment, it will be covered by health insurance.”

Because ELM can ultimately save lives, “It made perfect sense to propose this as a social impact project to our 2017 McGowan Fellows class,” said Spencer.

Practically none of the Fellows had experience in healthcare, but that was not a hindrance. “It was a space so relevant and important to everyone,” said H. Kay Howard, the 2017 McGowan Fellow studying at Northwestern University’s Kellogg School of Management.

So how did they get down to brass tacks?

“We divided and conquered,” said Howard. The Fellows class broke up into pairs and groups to analyze various aspects of the issue and to consider best ways forward to get ELM covered.

Howard partnered with Fellows classmate Jonathan Fung, a student at the University of Chicago’s Booth School of Business. While Howard comes from a nonprofit background, Fung has an accounting background. But bringing these different perspectives to the table together, “strengthened our part of the Fellows project,” said Howard.

In order to better understand how a program like ELM could be covered by insurance providers, Howard and Fung took an in-depth look at the Diabetes Prevention Program, the first preventive health program to receive nationwide coverage. They spoke with three different experts who worked on getting diabetes prevention covered by insurance across a 20-year period.

“Being able to walk through every part of that timeline gave us a much deeper understanding of this process,” said Howard.

They also had some fun along the way. Coming from two rival top business schools in Chicago, Kellogg and Booth, the pair would joke about needing to meet “on neutral territory.”

Ultimately, the 2017 Fellows came up with a strong set of recommendations and next steps for Rush University to consider.

And for the whole Fellows class, the project was a natural platform for thinking about ethics in leadership and business. “I think it’s really easy to look at this issue from a business angle, profitability, how to get something as cheaply as possible to the purchaser,” said Howard. “Our goal was, ‘How do we get this to as many people as possible, and as quickly as possible?’ In the same thinking, Rush University wants ELM to be covered to reach as many people as possible so they can have a greater impact on people with metabolic syndrome.”

The McGowan Fellows Program is a unique scholarship program of the William G. McGowan Charitable Fund for top business school students committed to ethical business practices. The program provides full tuition for a student’s second year of business school, mentoring, and yearlong discourse, as well as the development of lifelong relationships with Fellows alumni that last into and beyond their careers.