Whole Person Care – How We Can Revamp Healthcare

Whole Person Care is a model of healthcare that considers a person’s health in the context of their broader life circumstances. 

To illustrate the value of this model, imagine two people (A and B) with depression, diabetes, lack of stable housing, and an infected cut on their feet. 

Person A navigates a status quo healthcare system and goes to urgent care for their wound to be dressed. The urgent care provider, unaware of the patient’s background, cleans the wound and prescribes a multi-day course of antibiotics. Unable to afford transportation to the pharmacy, with no safe place to store the pills, and struggling with an acute episode of depression, person A does not pick up the prescription, their infection spreads, and they wind up admitted to the hospital at risk of losing their toe, or worse. 

Person B, who lives in a region with Whole Person Care, also goes to urgent care for their wound. They are accompanied by a community health worker who is connected to their primary care clinic. Aware that person B does not have a place to store medications, the community health worker participates in developing a treatment plan that meets person B’s preferences and life circumstances. A follow-up appointment is also scheduled at person B’s primary care clinic to ensure that their foot is healing. Person B is able to use transportation vouchers to get to and from urgent care, the clinic, pharmacy, and shelter. The community health worker also supports person B in accessing long-term housing.  

What is Whole Person Care? 

Whole Person Care Definition

Whole Person Care (WPC) is a person-centered and interprofessional healthcare model that offers comprehensive and coordinated services to address physical, behavioral, psychological, and social needs. These may include: 

  • Primary care 
  • Specialty medical care (e.g. neurology) 
  • Hospital care
  • Integrative medicine
  • Mental health (e.g. psychotherapy) 
  • Social services (e.g. case management, community health workers) 
  • Home health 
  • Pharmacy
  • Physical therapy 
  • Nutrition
  • Spiritual services

In order to function as a cohesive and integrated health experience, WPC calls for de-siloing, data sharing, and collaborative leadership across these different sectors.

WPC takes a holistic approach to each person’s health by addressing: 

  • Body: Our genetics, biology, and physical health play a part in our wellbeing. What’s more, trauma and other psychological issues can take root in the body. 
  • Community: Human relationships and connections are essential for health.
  • Environment: Social determinants of health (SDoH) include access to healthy foods, financial resources, education, a non-discriminatory environment, and a safe place to live. 
  • Mind: Mental and emotional health are integral parts of a person’s wellbeing.
  • Spirit: Whether it’s an organized religion, a reverence for science, communion with nature, or some other form of spirituality, the connection to something greater than ourselves can strengthen our health.

Dimensions of the Whole Person Care Model

The six dimensions of Whole Person Care include:

  • Selecting a target population.  
  • Providing person-centered care that incorporates physical, social, psychological, and behavioral health. 
  • Coordinating services across sectors.
  • Sharing data across sectors.
  • Having financial flexibility.
  • Developing collaborative leadership across sectors. 
The 6 dimensions of Whole Person Care

WPC as a Solution to Our Fractured Health Care System 

Mental health, substance use, primary care, specialty, and other health services are often siloed, making it challenging to provide high-quality, non-duplicative, and integrated care. Yet, experts agree that a person’s socioeconomic circumstances, psychological and emotional experiences, and physical health are all intertwined–so much so that a person’s life expectancy can be predicted by their zip code

As a model that coordinates across physical health, behavioral health, and social services, Whole Person Care is a potential solution to this problem. 

Whole Person Care Promotes the Quadruple Aim

The quadruple aim of health care is to improve population health, enhance the care experience, reduce per capita costs of healthcare, and restore the joy in practice for service providers. 

From the patient perspective, Whole Person Care alleviates the burden of having to navigate multiple separate systems which can be overwhelming and confusing. When your primary care provider is not able to communicate with your psychiatrist, the burden is on you to share relevant information so your medications line up. Or if the labor & delivery department is not in touch with your case manager, they may make an unwarranted call to Child Protective Services because they don’t have sufficient information about your background and care plan. 

For providers, when there is no opportunity to coordinate care, you’re at risk of using your limited energy to duplicate services, jeopardizing the quality of your care, and burning out.

At the system level, poor coordination can lead to wasteful use of public resources, increased healthcare costs (e.g. unnecessary and costly emergency department visits and hospital stays), and poor population health.    

How to Participate in Whole Person Care

At its core, care integration is about strengthening relationships among care providers and between care providers and patients. As a provider, this often means screening and assessing for needs outside of your direct services and partnering with local organizations to offer comprehensive referrals while sharing data to track outcomes. 

This might mean co-locating services (e.g. having social workers embedded in a primary care clinic), building capacity through case discussions or consultation, developing a network of service providers, assisting patients with care navigation, improving communication and collaboration, and data sharing to track outcomes.  

Funding for Pilot Programs

The Whole Person Care model is gaining traction. The California Department of Health Care Services (DHCS) currently has $1.5 billion in federal funds to offer 5-year Whole Person Care Pilot funding to county, city, and hospital or health authorities. The funds are to be used to integrate care for Medi-Cal beneficiaries who access multiple systems of care, yet continue to have poor health outcomes. 

California has already launched twenty-five Whole Person Care Pilot programs that provide a range of services and supports to various target populations. In 2019-20 the state invested $20 million from the Mental Health Services Fund to encourage additional counties to implement Whole Person Care pilots. In addition, the state has dedicated $100 million from the State General Fund towards active WPC pilots to provide housing support services.   

As an example, San Francisco has a pilot program focused on better serving adults experiencing homelessness and who frequently access emergency and urgent care services. Partnering across multiple San Francisco agencies, the goal of this pilot is “to establish a comprehensive, seamless and human-centric system of care that improves beneficiaries’ health outcomes and supports the goal of making homelessness rare, brief, and one-time.”

With Whole Person Care, Everyone Wins 

Think back to the examples of Person A and Person B. Person A suffered poor health outcomes, utilized expensive emergency services, and was left to their own devices to navigate their fragmented care. 

Person B, on the other hand, was able to experience better health outcomes and address the issues in their life that impacted their health. Person B’s care providers were also able to be more efficacious in their roles, and social resources were used in a coordinated and thoughtful manner.    

The purpose of a healthcare system is to enhance the quality of life of a population by promoting health and wellbeing. Offering comprehensive and coordinated services in a Whole Person Care model is one potential route towards achieving that aim. 

*Kate Dubé is a Licensed Clinical Social Worker (LCSW) and health & wellness writer in Berkeley, California. You can find her at https://www.linkedin.com/in/kate-dube.


Article

How does the VA support the nearly half of veterans who are 65 and older?

Written by: Paxtyn Merten

Despite a decrease in the number of veterans, the Department of Veterans Affairs spends three times more today than it did 20 years ago, according to expenditure reports from the organization.

In addition to the VA substantially expanding its benefits, veterans are trending older as the overall number of veterans declines. VA data suggests that while the number of veterans will drop about 34% between 2023 and 2048, the number of veterans older than 85 will grow by 31% between 2021 and 2024. In addition, more veterans are claiming compensation benefits and using VA medical care than ever before. The VA has also expanded its benefits substantially.

Most recently, the 2022 Promise to Address Comprehensive Toxics Act broadened health care and benefit eligibility for those exposed to toxins and hazards during military service. This move was accompanied by a major outreach campaign that increased claims. As a result, the VA paid out a record $150 billion in compensation and pension benefits last year and provided veterans with a record 116 million medical appointments. Even before the most recent surge, the number of veterans enrolled in the VA’s health care system grew by more than 1 million between 2006 and 2022.

Like all senior Americans, older veterans have higher rates of disabilities and health conditions than other adults—but for vets, these trends are even more distinct. Most older veterans served in or at the time of the Vietnam War, which exposed them to Agent Orange and other herbicides, which have since been linked to many severe health conditions. As these veterans have aged, the VA’s medical bills have climbed in step.

Foothold Technology utilized data from the Census Bureau and Department of Veterans Affairs to analyze tax-funded VA spending and examine how it has added benefits while accommodating the growing share of older veterans. The most recent VA data covers fiscal year 2022, which runs through September of that year, and doesn’t portray the major investments made last year.

VA expenses are up—and expected to keep growing

After steady growth over the past 20 years, VA expenditures surpassed $266.7 billion in 2022. The agency received a budget of $303.2 billion in 2023, including record-high discretionary funds.

The largest expense category is compensation and pensions, which largely represent monthly payments to retired service members and their families. The share of veterans receiving disability compensation, in particular, has nearly tripled over the past two decades, as has the average annual benefit paid out to those veterans, according to a Standford Institute for Economic Policy Research analysis.

Disability compensation is paid to veterans with disabilities and medical conditions that were caused or worsened during their service, and new research has broadened eligibility criteria. For instance, veterans with diabetes who were exposed to Agent Orange are now eligible for disability compensation, as researchers identified the herbicide as a risk factor for the disease.

Medical care is the other dominant VA expense. About 38% of veterans are enrolled in VA health care—with slightly higher rates among those over age 65. Health benefits through the VA are typically more affordable for veterans. They have diversified in recent years, particularly in maternal and reproductive health care. The VA has also grown mental health services, including emergency medical care for veterans in suicidal crises.

These health care expansions have been vital, as the VA reports that veterans enrolled with the VA have better health outcomes than those who are not.

An aging population requires additional medical care

Nearly half of U.S. veterans were 65 years or older in 2021, compared to about 17% of the general population, Census Bureau data shows. This age group accounts for 36% of U.S. health spending as older adults tend to develop health conditions and disabilities that require costlier care. For veterans, those trends are even more pronounced. For instance, about a third of the general 65-plus population is disabled, while about 42% of veterans in that age bracket are disabled.

More than 100 VA medical centers have committed to providing holistic care for aging veterans by participating in the official Age-Friendly Health Systems movement. This movement centers around older patients’ care preferences, including end-of-life care, using medications that don’t interfere with elders’ priorities, retaining mobility, and preventing or managing common mental health conditions that come with age, like depression and dementia.

Participation in the VA’s medical program has grown along with the rising number of older veterans. Paired with rising health care costs more generally—the cost of medical care in the U.S. doubled from 2002 to 2022—VA expenses ballooned as the organization provided veterans with the health care necessary to maintain or improve their quality of life.

Despite the rise in expenditures, costs will ebb as the number of living veterans from major military campaigns—including World War II, Korea, and Vietnam—decreases overall. Today, the U.S. military has about 1.3 million active-duty troops—down from about 3.5 million in 1968. Over time, this decline should temper VA spending, even while retaining or improving the quality of care and benefits for surviving veterans.

Story editing by Nicole Caldwell. Copy editing by Kristen Wegrzyn.