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How mind-body program reduces stress, healthcare costs


Insurers can save money if their members participate in a mind-body stress reduction program. At least that's the preliminary conclusion from a recent study conducted by Aetna in which participants received complementary therapies focused on mindfulness meditation and yoga.

The mindfulness meditation-based program taught participants stress reduction techniques, effective management of work load and ways to prioritize tasks to increase efficiency and effectiveness. Participants in the therapeutic yoga-based program learned yoga postures, breathing techniques, guided relaxation and mental skills. The classes also provided coping strategies for dealing with stressful events and promoted use of home and office strategies for reducing stress through yoga. A control group of participants received no stress reduction assistance.

Aetna's review of medical claims showed a positive correlation between costs and study participants' stress levels. Among the study volunteers, those reporting the highest level of stress had higher medical costs, nearly $2,000 more annually, than those reporting the lowest level of stress.

To learn more about the implications of the mind-body connection in reducing stress and healthcare costs, FierceHealthPayer checked in with Kyra Bobinet, MD, MPH, Medical Director of Health and Wellness Innovation at Aetna (pictured) and clinical director of the study.

FHP: What were some of the medical costs incurred by the control group? Could they be associated with stress?

Bobinet: The control group vs. the treatment group costs were not analyzed as part of this study. The cost correlation that is referenced in the press release refers to the PSS score of ALL applicants to the study and their medical costs BEFORE they were randomized to control vs. treatment arms. The study control group received no treatment intervention during the study period.

FHP: Can you explain the type of "self care" that was taught through the program as well as provide examples of "stress reduction techniques" that were offered?

Bobinet: In the mindfulness meditation program, participants learn:

  • self-care with the objective of improving overall health and energy levels,
  • stress reduction and associated reduction in lost productivity and improved wellness,
  • more effective management of work load,
  • improving attention, resulting in better prioritization of tasks, efficiency and effectiveness, and
  • leveraging mindfulness to respond to overwhelming situations with greater clarity and insight (instead of reacting).

In the Viniyoga stress reduction, the program aims to help participants:

  • relieve musculoskeletal tension in back, neck and shoulders,
  • relieve headaches caused by musculoskeletal tension,
  • improve sleep,
  • increase feelings of well-being,
  • improve coping strategies for dealing with stressful events and the subsequent negative symptoms of stress, and
  • promote adoption of home and office strategies for reducing stress through yoga.

FHP: As Aetna expands the study, will it include other types of mind-body stress reduction techniques?

Bobinet: For 2011, we are expanding the study to include more Aetna employees as well as a few "early adopter" employers. The expansion will continue to include the mind-body approaches (mindfulness meditation and therapeutic yoga) that were initially tested.

FHP: What preliminary conclusions is Aetna drawing thus far from the study?

Bobinet: Early results show:

  • significant reductions in stress, blood pressure, pain, cardiac health;
  • positive correlation between medical costs and participants' stress levels;
  • treatment group participants were five times more likely to lower their stress compared to the control group;
  • directionally favorable metrics demonstrated in productivity, insomnia, depression, long-term/worst pain scales; and
  • online classes and in-person delivery showed equivalent results and both had high participant engagement rates.

FHP: How does Aetna hope to integrate mind-body connections into its health plans?

Bobinet: Our market insights indicate that yoga/meditation activities are on the rise. Approximately 7 to 8 percent of Americans have used meditation or yoga to help manage stress. Over the past year, 13 percent of employees have increased their reflective/meditative activities (i.e., yoga, meditation). Stress is a major underlying cause of most modifiable diseases, including cardiac, obesity and diabetes. Eighty-seven percent of physicians report increase in patients with stress symptoms in the past year. These market insights are difficult for any health plan to ignore. Addressing the linkage between stress, health and medical cost may help employers to target the root cause of health behaviors they are addressing separately today.

FHP: Do you think $2,000 is a substantial enough savings that it could compel other health plans to implement stress-reduction programs?

Bobinet: All employees who applied for the study were asked to complete the Perceived Stress Scale questionnaire. The Perceived Stress Scale (PSS) is a 10-question survey commonly used in the psychiatry and psychology fields to measure the perception of stress in a person's life. Those reporting the highest level of stress correlated to higher medical costs, each nearly $2,000 more annually, than those reporting the lowest levels of stress. This is significant considering that according to the 2010 Milliman Medical Index, the total medical cost for a typical American family of four averaged $18,074.

FHP: Is integrative medicine the inevitable future of U.S. healthcare? If not, should it be?

Bobinet: The favorable results seen in Aetna's study demonstrate that evidence-based mind-body approaches to health improvement are an effective and targeted solution for employers who want to lower the costs associated with stress and help their employees achieve better overall health. Aetna will continue to lead efforts to better understand--and demonstrate--whether integrative medicine can offer our members options that both better suite their lifestyles and can be proven to improve their health.