For the emergency room, it was a typical day. For Dr. Frank Lord, MD, it was a final straw.

Roughly two years ago, he recalls, a patient came to Silverton Hospital complaining of chest pain. After triage, he notified the cardiologist on call.

It was likely time for a stent: an angioplasty operation in which a small ring is inserted through a blood vessel in the groin and routed through the aorta to reinforce the walls of a congested coronary artery. The evaluation came with a sickening sense of déjà vu, and with good reason.

It would be the patient’s eighth such procedure.

“I remember thinking at the time, ‘This is crazy,’” said Lord, Medical Director for the Silverton Hospital Network and an emergency medicine specialist with 35 years of experience in Oregon. “There’s got to be some better way to deal with this than just these surgical interventions.”

With WellspringHeart, Lord believes he has found a better way.

In November 2007, the Wellspring Medical Center in Woodburn launched WellspringHeart, an intensive instructional program that focuses on lifestyle changes such as diet, exercise and stress management to reduce the risk for cardiovascular disease.

Far more than just rehabilitation for heart attack patients, the program focuses on preventative health care to reduce the risk of cardiac failure.

It’s the only program of its kind in Oregon. Participants in the program receive a CT angiogram in which they can see possible early warning signs of coronary artery disease. For 12 weeks, two times a week, they also receive a personalized physical exercise regimen, nurse consultation, and coaching on nutrition, stress management, and overall heart health.

They can track their nutrition and exercise through a PDA. They monitor their cardiovascular health through frequent blood work. They even get cooking lessons, and go on hikes and wine tasting tours.

Prospects for the program are screened for warning signs of heart disease, such as family history, past cardiac events, obesity, age or high blood pressure. In its two years, roughly 200 have graduated from the program.

For Lord, who also serves as the program’s medical director, what makes it so effective is the emphasis on group support. Participants in WellspringHeart learn with cohorts, united by their risk, and continue meeting and sharing their lessons with each other and Dr. Lord’s staff for a year after their 12 weeks are over.

"Their group supports them,” Lord said, “and encourages them to adopt this as a lifelong [change] instead of a flash in the pan.

"They become really close folks, really interested not just in how each other’s diet is going but how their kids are doing or what their jobs are like, and all those other things that happen when you’re friends with people and have a close connection.”

The program has made a change in its two years: A one-week live-in “immersion” alternative has been set up with the Oregon Garden Resort in Silverton. The offering is the same, but participants do not have to trek down to Woodburn twice a week for three months. This change expands the program to people outside the mid-Willamette Valley area. People from as far away as Florida have signed up, Lord said.

There is one challenge to joining the program, however, and it puts WellspringHeart at the heart of the national health care debate. The cost of the program is $6,000; no insurance company currently foots any part of that bill. There are payment plans, and a “scholarship” fund has been put in place to subsidize half the cost for some applicants, but ultimately the bill goes right to the patient.

The reason? Choice in policies does not translate into choice when it comes to preventative care.

In Oregon, insurance policy holders are divided among so many companies that the average policy holder remains with his or her insurance for only about 18 months. Programs like Lord’s would save providers money by reducing the need for surgeries or chronic care, but they’re long-term investments that would likely pay off for another insurance provider. Despite repeated calls and negotiations to insurance companies, Lord has been unable to make progress in getting coverage for WellspringHeart.

“It’s [insane] for me because if all of them, if every insurance company in Oregon would cover this, every insurance company would make money,” he said. “Their insureds would have less in the way of procedures down the line. They would have fewer hospitalizations, they would use fewer medications, all of which insurance companies pay for.

"There’s a lot of data that we have already that says that it will save money."

This stalemate reveals a larger fundamental problem with U.S. health care today, not just its lack of coverage for all citizens, but its focus on operations and medications, which restricts what doctors can do for their patients, Lord said. Merely mandating insurance coverage would not help, Lord said.

“It will be financially disastrous to incorporate everybody into the system we already have because the system we already have is so reactive and non-proactive,” he said.

Strict timetables make insightful discussions about healthy living impossible.

“The system now says that you get to spend ten minutes with your doctor or less," he said.

Having worked in ERs for decades, Lord knows doctors aren’t able to really reach out to patients and make a difference in their lives, once their ailments bring them to the hospital.

“If [doctors] are seeing 30 patients a day and making rounds in the hospital and doing all the other responsibilities docs have, they just can’t do this,” Lord said.

Advocates for health promotion are actively lobbying Congress to ensure preventative health care is made part of a final health reform bill. Dr. Dean Ornish, M.D., on whose writings and research WellspringHeart is largely based, has been meeting with leaders in Congress and has testified to the Senate Committee on Health, Education, Labor and Pensions on the value of prevention.

Ultimately, Lord said, health care should be about more choice.

“One thing that people often say to me is ‘Oh, everybody just wants a quick fix, so they want a stent put in instead of [being put on] a low-fat diet.’ But the fact is that people don’t get a choice.”

At WellspringHeart, a 64-slice CT angiogram is able to show the actual plaque build-up in the walls of a clogging artery; not a drawing or guess, but the actual disease taking root inside the body. In Lord’s experience, it’s seeing that plaque, poised to kill, that often makes that choice much easier.