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The devastation of Covid-19—even surpassing the deaths of more than a million Americans—is that it has exposed the alarming extent of the underlying preconditions affecting our population, and our tragic failure to treat them. In the United States, 6 out of 10 people have a chronic disease.About 40 million Americans own five or more Chronic diseases – account for 41% of all spending in the world’s most expensive health system. Still, despite all this spending, 66% of us believe our healthcare is of low or poor quality.
Our country is one of the most advanced when it comes to treating acute illnesses through the delivery of pills and procedures. But the truth is, our systems are simply not designed to keep us healthy. Numerous studies have shown that medicine itself only accounts for about 20% of health. Nearly 80% comes from other factors that our system rarely addresses. These are emotional and mental health, behavioral and lifestyle factors, and the social and economic environment in which a person lives.
The good news is that we are already on the path to better lifelong health and well-being. In our new report, cases of providing holistic care, The Alliance for Family Medicine Education and the Samueli Foundation funded research on numerous real-world case studies of health systems, hospitals and clinics currently implementing “whole person” care. This approach enables these institutions to achieve the elusive “quadruple goal” of reducing costs while improving population health, patient experience, and even clinician well-being.
These are not pie-in-the-sky concepts. For example, the Veterans Administration has documented the remarkable success of a new model of care that shifts from a traditional disease-based transactional system to a team-based, person-centred model of care that addresses the physical, emotional, and social well-being of patients. In their four-year pilot program with 130,000 veterans at 18 locations, the VA not only reported improved outcomes and patient experience ratings, but also significant savings of 20%, or more than $4,500 per veteran per year .
Whole-person care combines traditional medicine, non-pharmacological treatments, and evidence-based complementary approaches to promote self-care. It uses methods such as wellness coaching, group visits, nutritional counseling, acupuncture, yoga, meditation, therapeutic massage, stress reduction and other non-pharmacological treatments. It explores the social and economic situation of patients and helps them address them. Start by identifying what matters to a person, then explore the determinants of health and recovery that are most relevant to them. Therefore, the approach targets the underlying causes of their disease and seeks to help them provide long-term solutions.
The VA’s “whole health” model reduced opioid use by 23% to 38%, compared with an 11% reduction in traditional care alone. Overall health patients also reported greater improvements in their perceptions of care, participation in care and self-care, meaning and purpose in life, pain and perceived stress. Additionally, VA’s own employees report higher levels of engagement, job satisfaction, and intrinsic motivation, resulting in reduced turnover and burnout.
A holistic approach to care has many benefits:
- A large Pennsylvania health system that provided free healthy food as well as nutrition education resulted in significant reductions in patients’ weight, HA1C, blood pressure, and triglycerides.
- An Arizona clinic that practices integrative health reported an increase in 90 percent of patients’ trust and satisfaction.
- A Chicago multicenter general care clinic reported a significant drop in hospitalization, surgery and drug costs.
- At a major safety net facility in New York City, long-term Covid-19 patients reported that their condition improved when their health care was supplemented by meal plans, physical and breathing exercises, meditation, group and individual mental health counseling greater relief.
At the heart of these successes is whole-person healthcare Allows patients to build and better utilize their own personal recovery capabilities. We are all familiar with “social determinants of health,” in which social and economic circumstances determine health outcomes across zip codes. Whole-person care aims to address these questions in order to find “personal determinants of health”—those that contribute to an individual’s recovery in any setting.
A practical way to implement this type of care is for practitioners to ask patients to assess their physical, emotional and mental health by Personal Health Checklist (PHI). PHI poses a provocative question: What is important to you in life and what brings you joy? It then goes on to assess your willingness to make changes in all areas of your life to achieve this life goal and enjoy your health. After PHI, the “Integrated Health Visit” identifies the patient’s values and recovery goals. I call it the HOPE Note (Healing Oriented Practice and Environment) Toolkit.
The HOPE Note builds on the SOAP Note (Subjective, Objective, Evaluation and Planning) that every medical student learns to apply in their daily practice. SOAP asks “what’s going on” and handles immediate medical diagnoses or symptoms. HOPE doesn’t just ask “what’s wrong?” to reach patients more deeply.Instead, we’re asking “what real Is it important to you? “It then focuses on addressing the underlying causes of the disease.
This process builds a stronger relationship with the provider whose role is to really understand the patient’s recovery goals and then provide evidence and support to help them. It’s not just a feel-good process. Our research shows that whole-person care produces tangible outcomes that support the quadruple goals, such as:
- better patient outcomes: Improves ability to manage chronic pain, reduces opioid dependence, lowers HbA1c in diabetics, improves medication adherence, reduces heart disease severity, and even reduces loneliness in older adults.
- Improve patient experience: Improved retention and satisfaction with providers and overall care, and higher ratings of quality of care.
- Reduce health care costs: Lower overall costs and lower drug spending while reducing hospital admissions, length of stay, and emergency department visits.
- Improve the clinician experience: Reduce provider burnout and reduce provider and employee turnover.
A 2021 study by the National Academies of Sciences, Engineering, and Medicine identifies high-quality holistic care as the foundation of primary care for a strong U.S. healthcare system. It recommends a system-wide implementation of “whole-person, integrated, accessible and equitable health care, led by interprofessional teams that address most of the health and wellness needs of individuals through ongoing relationships with patients, families and communities.”
We know this method works. All we need now is to focus on redesigning our healthcare system to deliver this type of care — and get the courage to do it.
