What is Whole Person Care and What’s Trending Across State-based Programs and Approaches?
While whole person care isn’t a new concept, its prominence is growing as federal and state programs emphasize factors that affect health beyond medical aspects, including social determinants. Whether described by terms like integrated care, holistic care, or biopsychosocial, whole-person care is gaining traction with health plans, providers, and investors. This insight profiles whole-person care and highlights trends, successes, and key research.
What is Whole Person Care?
Many payers and providers define whole-person care as a multidimensional approach to coordinating various healthcare services, as well as other wellness, behavioral health, or other personal and social services in a patient-centered, team-based approach to achieve improved health outcomes, eliminate duplicate efforts, and deploy resources in a cost- and time-effective manner. The focus of whole-person care goes beyond medical to address physical, emotional, social, and spiritual areas that impact health.
Why are Payers and Providers Focusing More on Whole Person Care?
Chronic multimorbidity is on the rise and research indicates how environmental, economic, and psychosocial factors can negatively impact health, quality of life, as well as put an increased burden and cost on local, state, and federal funding. As programs have focused more on social determinants of health (SDoH), coupled with the widespread effects of the pandemic, payers and providers are incentivized to address new areas within whole-person care like behavioral health and housing.
People with multimorbidities, as indicated by Drs. Clarke and Clevenger, “can benefit most from whole-person care because most chronic illnesses and diseases can be traced back to—or at least effectively managed by—other non-physical aspects of a patient’s health.” A whole-person approach has been indicated as most effective for patients with chronic illnesses like arthritis, asthma, cancer, diabetes, or heart disease.
What are the Current Trends in Whole Person Care?
While financing, health information technology, and workforce challenges have been cited as three barriers to advancing integrated care, state-based Medicaid programs, Medicare Advantage, and other payer-provider-community partnerships are pushing ahead in light of federal and state programs that support wider approaches to improving health and decreasing the cost of healthcare.
Medicaid Expansion, 1115 Waivers & State-based Programs
Primarily, states have been charged with designing and implementing integrated care models mainly through Medicaid expansion under the Affordable Care Act (ACA). Outcomes have varied across states as some states expanded starting in 2014 and others just last year. Yet, research on state spending has shown that “states with higher ratios of social-to-health spending had better health outcomes one and two years later compared to states with lower ratios.” The effect of the spending ratio was most significant for 7:8 health outcomes tracked, including adult obesity, asthma, days with poor mental health, days with activity limitations, and mortality rates for lung cancer, acute myocardial infarction, and Type 2 diabetes.
California’s approach to whole-person care is well-documented. Starting in 2016, the state’s Whole Person Care (WPC) program initiated pilot programs in 25 of 26 counties with the goal of addressing “the medical and social service needs of the most vulnerable and highest-using Medicaid beneficiaries, such as those experiencing homelessness.” In January 2022, California’s WPC program will be replaced by a five-year Medicaid 1115 Waiver Demonstration program called CalAIM (California Advancing and Innovating Medi-Cal). The goal of the $3B pilot program is to extend the success of WPC where counties demonstrated how tailoring services to local needs and offering an integrated, patient-centered approach to holistic needs could create positive change.
Healthcare and behavioral health providers, social services, and community partners, such as housing support organizations, work together to identify their highest-need clients and provide them with comprehensive, coordinated care.
In CalAIM, “public and private managed health care plans will select high-need Medi-Cal enrollees to receive nontraditional services from among 14 broad categories, including housing and food benefits, addiction care and home repairs.” Participating insurers are required to assign members a personal care manager, receiving incentive payments to offer new services and enhance provider networks. Currently, 25 health plans are participating with a particular focus on behavioral health, social services, and housing. Initially, housing assistance will be available to the costliest patients where one percent of Medi-Cal enrollees account for 21 percent of spending and many are homeless. Some health plans will be offering novel nonmedical benefits like food deliveries, medical respite, peer supports, and personal assistance with cooking, laundry, and paying bills.
Recent research from Truven Analytics indicated that individuals with behavioral health conditions have two to six times higher frequency of co-occurring chronic physical conditions. Medicaid patients with a behavioral health diagnosis were 3.8X more likely to also have hypertension and 3.4X more likely to have diabetes, and 5.6X more likely to have arthritis. Commercial patients with a behavioral health diagnosis were 1.6X more likely to also have hypertension, 1.3X more likely to have diabetes, and 2.3X more likely to have arthritis.
That same research revealed six actions that, in their assessment, could use whole-person care to save $185B. Increased reimbursement for behavioral health outpatient services with additional primary care visits for timely intervention could save $60B. Reducing preventable inpatient, emergency, and residential care through integrated behavioral-physical health and improved crisis intervention could save $35B. Lastly, reduced inefficiency in healthcare systems and services, coupled with intervening via care navigation and wraparound services could save $210B.
Behavioral health start-ups are increasing in number and investment over the past five years. As of June 2020, there were 129 new companies and more than $4.3B invested. These solutions ranged from digital platforms to provide care, digital therapeutics, patient self-help, data and analytics, care delivery model innovations, and EMR and workflow tools.
And, according to Rock Health, “generalist and specialist behavioral health companies serve distinct needs in different patient populations.” They point to generalist companies that tackle mild-to-moderate, lower-severity behavioral health conditions, like anxiety in a diabetes patient. They note, “Specialist companies that exclusively focus on behavioral health conditions (and sometimes among specific populations) can focus on creating tailored solutions for unique needs (e.g., pediatrics) and serve higher-severity conditions (e.g., schizophrenia).”
In relation to whole-person care, individual states and health plans are launching a variety of initiatives. For example, CMS approved Connecticut’s Medicaid state plan amendment that combines Medicaid health coverage with housing services for adults with homelessness and chronic health diseases. Florida will continue their Medicaid housing pilot in six counties as part of its 1115 demonstration waiver. Pennsylvania awarded $43M to 37 multifamily housing developments that will create or update nearly 2,000 affordable rental units.
Humana, as a health plan example, announced a $25M investment into affordable housing in eight states. Medical Home Network, an ACO serving Medicaid beneficiaries in Chicago, announced their investment into a housing first program.
Whole Person Care Evolves PHM
Some may ask, “Isn’t whole-person care just disease management or another flavor of population health management?” However, the programs and investments being made would indicate that whole-person care is an evolution of PHM concepts and goals but using a wider scope of how to accomplish health. As research provides the need to address social determinants as part of improvements in health, it makes sense that the most impactful issues would be a focus. Whole person care has the potential to address broader PHM goals by “addressing individual and local needs and looking at individuals as representation of a larger population or community,” shared Caraline Coats, vice president of Bold Goal at Humana.
Or, as healthcare executive, Trisha Swift, DNP, RN, shared in a recent blog, “Caring for the whole person means leveraging prevention by addressing the factors that contribute to illness and disease upfront. By shifting our focus from “sick” care to a true model of “health” care, measuring wellness, social determinants, mental health, engagement, nutrition, spiritual health, etc., we create the foundation of an effective care management program. When we apply this holistic approach to a group of people with similar health needs — a population — we start to create a whole-person care delivery system.” Whole person care model, it is believed, will lead to healthier communities and improved population health.
What are the Key Components of Whole Person Care Programs?
While success factors for whole-person care have a great deal of overlap with PHM and care management programs, the key components are more critical because the programs may require more diverse data, expertise, systems, and technologies while at the same time needing more integration of knowledge, approach, and personalization.
Key elements of a whole person care program include:
- Public-private partnerships that can collaborate effectively around shared goals
- Stakeholder and patient involvement in program goals and design
- Adequate population and individual knowledge to ensure trust and engagement
- Health and social needs assessment data available to the entire care team
- Providers and staff that are equipped and trained to coordinate care across points of access
- Addressing socioeconomic disparities
- Adequate federal, state, or organization resources and investment
- Data sharing & interoperability capabilities
- Digital tools and technologies to implement program initiatives, outreach, and communication
- Operational plans, processes, structures, and management
- Performance measurement, reporting, and improvement efforts
- Adequate governance
Interoperability: The Foundation of Whole Person Care
A recent article highlighted the foundational value of interoperability to realizing the goals of whole-person care. “Data infrastructure that allows for clinical, behavioral health, and social services information exchange is an important yet underdeveloped building block of whole-person care.” “At a minimum, data sharing can produce a more effective and less redundant care management process. At best, data sharing can transform operations and financial return for the organization while also improving the quality of life for the consumer.”
Without access to, analyses, and proper usage of data housed in diverse systems, organizations, and structures, whole-person care programs will remain disease management, transactional approaches. Achieving the secure flow of needed data, whole-person care can become seamless, systematic, and automated to the point that people can focus on the current and future needs of our most vulnerable patients and populations.
Building a Successful Whole Person Care Program
Collaboration is key to successful whole-person care, and it’s the center of what we can achieve through our seasoned and experienced team of healthcare, design, operations, technology, automation, and interoperability service professionals and solutions. That collaboration extends to the larger healthcare family we are a part of in CitiusTech.