In the last few years, many payors have worked hard to implement a whole-person care approach or whole-person integrated care model.
But what does that even mean? What is the definition of whole-person care? How is whole-person care delivered today? And what are the challenges in whole-person care today?
Below we dive into all three for a quick understanding of modern-day whole-person care.
What is Whole-Person Care?
Whole-person care is a framework for care delivery. It involves an approach where healthcare payors and practitioners consider the well-being of a person collectively. This means a care model that focuses on optimal physical, behavioral, emotional, and social wellness and outcomes.
In whole-person care models, trust-based relationships power a proactive and preventive approach that prioritizes health, well-being, and disease prevention. Care plans and goals are developed to align with a person’s life, mission, and optimal long-term health and routinely evolve as a person’s health needs and status change over time.
Care is also delivered in a personalized way, meeting member (patient) needs and desires to best empower them to make better health decisions.
Whole-person care also involves more than just the individual. It means considering their family and community, and how multiple interconnected biological, behavioral, social, and environmental areas can be improved to empower sustainable health across a person’s lifespan.
SDOH is a Critical Part of Whole-Person Care
Social determinants of health (SDOH) have gained increased focus in the last few years alone under this approach, as data revealed the profound impact of SDOH on health. SDOH impacts a whopping 80 percent of health outcomes from acute to chronic disorders. (We talk more about addressing SDOH and strategies for different generational groups here.)
Integrated Whole-Person Care Model Challenges
The biggest challenges to an integrated whole-person care model right now are payor-provider communication, seamless collaboration, and addressing social determinants.
The first two challenges are heavily a result of the myriad of disparate technology systems across the healthcare industry. Different healthcare providers and settings use different portals or management systems, and they don’t communicate with each other. This means nobody shares a singular clear view in real-time of the member. Why is this happening? A lack of interoperability. It’s exactly why the Centers for Medicare and Medicaid Services (CMS) pushed new FHIR® APIs forward as part of its recent ruling on prior authorization and interoperability, and why the strategies to solve interoperability mentioned here are so key.
- SOLUTION: When payors are struggling with payor-provider or provider-provider communications, solving for interoperability needs to become a core goal. The HL7® FHIR® standard specifically makes it easier to share data and support patient-centric and coordinated care.
As for addressing social determinants, this is where built-in assessments can help flag SDOH risk factors, and routine outreach via telehealth can support more open communication with health plan members for better awareness of issues. To solve it? That’s why HELIOS specifically operates as a closed-loop ecosystem for optimized care coordination, working with a network of leading industry and technology partners to offer integrations for identifying and addressing social determinants of health, predictive analytics for population health needs, automating prior authorizations, and comprehensive quality reporting capabilities for auditing and compliance.
Some of our partners include findhelp, Unite Us, Continual Care Solutions, Healthwise, Krames, WebMD, Prealize, Edifecs, Itiliti Health, Inovaare, MCG, Change Healthcare, and Kangaroo Health, among others.
How to Deliver Whole-Person Care Effectively
Delivering whole-person care effectively can be challenging depending on the population size or health of a member base a healthcare payor has. Medicaid populations specifically can be more challenging due to a higher percentage of individuals with complex and chronic conditions like diabetes, or who may be facing health-related social issues such as poverty, food inadequacy, or geographical limitations. Many also need long-term supports and services (LTSS) and behavioral health care.
But to deliver whole-person care effectively, a healthcare payor needs to:
- Understand the complete member picture (360 degrees)
- Build a relationship with each member that encourages them to open up about both health and social issues they’re facing. (We cover how to do that better here.)
- Support the member with services that address physical and mental health, as well as social determinants
- Enable seamless collaboration and communication between each care specialist that’s included on a member’s transdisciplinary team. (Learn more about how HELIOS can support whole-person coordinated care here.)
The Components of a Whole-Person Care Approach
The critical components of a whole-person care approach include:
- An individual is an involved part of their health and directly influences care plan goals, adjustments, and delivery methods.
- Care is delivered with a member-centric (patient-centric) lens as an interprofessional team (i.e., collaborative care).