Even with the most expensive health care system in the world, health outcomes in the United States are low across many measures. What kind of changes need to happen in our care delivery system to shift these trends? In this next installment in our policy priorities blog series, we’re looking at emerging care approaches that aim to improve health outcomes for all through Whole Person Health.
Whole Person Health is a movement toward the integration of physical and mental health services in health care, alongside the adoption of the biopsychosocial model in health care provision. As part of this, researchers have identified social and spiritual health as additional dimension of holistic wellbeing across the lifespan. Ultimately, whole person health is about centering the needs and input of patients into the care system itself, with a focus on primary care. Instead of viewing an individual patient through the lens of their discrete parts and conditions, the whole person health approach is about treating the interactions of multiple conditions and health factors which are affecting that person’s day-to-day life and functioning.
Health must be understood as a continuum from wellness to disease, where individual behaviors and social factors can influence outcomes. This approach looks at co-occurring conditions, and the factors that produce interrelated health effects, where treatments must also be assessed for secondary impacts. Supporting health means improving systems of provision themselves, so that access and funding are clear to patients. Whole Person Health includes a variety of efforts to improve comprehensive care access, including the availability of consistent, high quality oral health care, and the assurance of needed care in even the more remote, rural parts of the country.
Patient-Centered Health (Medical) Home Model
The patient-centered health (medical) home (PCMH) model is a framework for moving toward an enhanced patient experience in care provision. It centers the inclusion of patients and their families in an active partnership with primary care providers to support a person’s holistic health and wellbeing. This partnership looks to bring patient expectations and needs to inform health-related decision-making. This model is offered in health settings around the country, in particular through Federally Qualified Health Centers. Core structural principles that define a PCMH include the adoption of whole person care that is well-coordinated and fully integrated. The model is noted for helping patients to better manage their chronic conditions, for lowering care costs overall, and for the adoption of information technologies that allow for patients to access care outside of standard office hours.
Advocates have called for person-centered care practices to become core to the medical home model to ensure that the patient’s health priorities are guiding their care, centered in the context of their life. Narrative medicine and goal-oriented care are two approaches to centering patient needs in health care. These approaches move away from the disease-oriented model of care which came before, where disease eradication alone was the primary and singular focus of care providers.
Behavioral Health Integration
Part of the PCMH model is about the bi-directional integration of behavioral health with primary care and general health services. For most people, primary care providers are the first point of contact they consult about their health, including mental and behavioral health concerns. Especially if a person is struggling with substance use or a traumatic event, having a knowledgeable PCP is going to be critical for them to receive appropriate care. Research has shown that PCPs often underdiagnose mental health conditions in patients, including PTSD and anxiety disorders. People with disabilities are five times more likely to experience mental distress than nondisabled adults, so effective behavioral health integration is essential for disabled people’s access to whole person care. Further, the treatment of psychiatric conditions has been found to support overall health for patients with other conditions like diabetes and chronic pain.
In practice, behavioral health integration involves the collaboration of primary care teams with mental health clinicians. Through this approach, clinicians can offer a range of possible treatment options, including individual or group therapy, and medications. Under the Collaborative Care Model (CoCM), psychiatric consultation is offered to practitioners within the primary care setting so that they can handle medical management and psychoeducation. Alternatively, the Primary Care Behavioral Health Model (PCBH) offers a different approach where a licensed behavioral health clinician is available to support on-site as part of a primary care team. Peer support professionals, like in VA programs for veterans, can be an important part of integrated care teams that support person-centered care.
Integrated care extends beyond the effort to include behavioral health assessment more fully in primary care. AAHD is also working to support integrated program responses for people with co-occurring disabilities and chronic illnesses or behavioral health challenges, and in people with mental health disabilities along with substance use. Integrated care strategies have emphasized the importance of community-based health settings and social services, as well as patient-centered measures of success to advance effective integration of typically separated care systems. Medicaid has been a strong driver toward integrated care implementation, with innovations like Section 1115 Waiver programs which can be used to offer access to social supports like housing, lead abatement, and environmental health hazard interventions. In our coalition work, AAHD has been working to advance care integration to improve outcomes for people with disabilities nationwide. Recently, the Medicare Physician Fee adopted two important provisions related to behavioral health integration, furthering this work. These changes will allow providers to bill for integrated care services under two prominent models, and with higher payments to providers. Steady financing mechanisms like Medicare and Medicaid are essential for ensuring the success of integrated care.
Health Beyond Silos
Health programs across the country are increasingly experimenting with cross-sector interventions that impact physical, mental, social, and spiritual health. The effort to reduce silo barriers between programs is ultimately a project of improving communication, cooperation and collaboration in complex health systems. Clinical errors are known to be reduced as communication improves across departments. The expansion of data sharing through electronic health records has also improved overall health service delivery.
Researchers have reflected that the COVID-19 pandemic demonstrated the urgent need for a whole health approach where silos are dismantled between healthcare providers and social services. More effective organization, financing, and delivery of primary care and services are needed to ensure patient safety and health access during public health crises and national emergencies, including our growing climate crisis. In order to achieve whole person health, the social drivers that affect food access, housing, education, public works, and overall community development need tending to.
Important policy work to advance whole person health and care integration is happening, with a push for legislation that furthers bidirectional integrated care We’re proud to collaborate with partners like No Health Without Mental Health, the Coalition for Whole Health, the Bipartisan Policy Center, and the Mental Health Liaison Group in advancing this work. Our last post in this series focused on the unique role that NIDILRR plays in advancing disability research. Follow our Policy Updates and the Disability & Public Health Newsletter to stay on top of our current advocacy on these issues.