Whole Person Care, Social Determinants of Health and Whole Person Service - Part 2
This blog is part 2 in a series focused on whole person care. Continue reading the series with part 1 and part 3.
There is a long history of the USA’s initiatives in the areas of health, healthcare and well-being. We tried HMOs (health maintenance organizations). Now we’re trying out MCOs (managed care organizations), experimenting with value-based payment and other models. Along with them, we learned that Whole Person Care (WPC) involving Social Determinants of Health (SDoH) is becoming increasingly important. It was an area of focus in the Healthy People 2020 report, an opinion shared by the World Health Organization as far back as 2008. (Source: Social Determinants of Health | Healthy People 2020)
Social Determinants of Health are “conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes,” according to the CDC.
When one carefully examines how WPC is implemented, it seems that the focus is on cost savings although it most certainly is not the goal. The intent of WPC and the desire of its practitioners are correct, noble. Maybe we are trying to solve the problem from the wrong angle.
A review of current research, articles and other documentation indicates that the most attention is on cost savings, with little clarity as to what constitutes the health and well-being of a person or a population. The United States spends approximately 17% of its gross domestic profit (GDP) on healthcare. (Source: Current health expenditure (% of GDP) | Data [worldbank.org]) This is the highest percentage among the industrialized countries; however, the United States does not have the equivalent national health standing. (Source: Health Care Costs by Country 2021, worldpopulationreview.com)
To be clear, Social Determinants of Health are important, and treating them is beneficial even beyond the individuals. Gainwell just believes that we can and should do a better job of addressing them.
CMS Triple Aim Quality Strategy
- Improve patient care
- Reduce healthcare costs
- Improve population health
“Triple Aim” refers to the simultaneous pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. Note that the Triple Aim is a single aim with three dimensions.
In light of increased burnout and dissatisfaction throughout the healthcare workforce today, many in the industry believe the Triple Aim should become a Quadruple Aim — adding a goal to improve the work life of health care providers, including clinicians and staff. If we do not address this situation, it will be difficult, if not impossible, to achieve the Triple Aim and patient-centered care.
The Whole Person Service difference
We introduced Gainwell’s vision of Whole Person Service — a holistic view of a person’s medical, mental, behavioral and socioeconomic well-being — in a previous blog. On the surface it may appear that Whole Person Service is not that different from other approaches, particularly Whole Person Care.
In this blog we would like to discuss how we think Whole Person Service is different, why it should be delivered differently and how it can make a difference. Again, from our previous blog, you might recall the three “Es” — experience, efficiency and effectiveness. Efficiency already may be receiving sufficient attention. So, we’ll focus our attention on experience and effectiveness in this blog.
Enhancing the user experience, inside and out
The first problem is that current health and human services programs are siloed, independent of and not coordinated with each other. This makes it challenging for individuals in need to navigate the bureaucratic web. Unfortunately, the desired coordination will take a great deal of effort at the policy, regulatory and funding levels. In the meantime, however, there are things practitioners can do to help them.
Another problem is that in the current state of the Medicaid and Health and Human Services world, individuals in need don’t know what they don’t know — for example, the availability of assistance and the process for getting that assistance among other things.
Today’s recipient and member portals do a good job of combining and presenting plenty of information. At that point it is left to the individual to try to understand the information, interpret it, absorb it, figure it out and make the necessary decisions. To say that this isn’t always an easy thing is an understatement.
We believe that if the experience is made more comprehensible, sensitive and convenient, it will help significantly. Think of how much easier it would be if a confidential conversational interaction — via chatbot or with a human — identifies a person’s needs and barriers, and then presents services that can help. This interaction can occur as “one solution” via the channel and manner that is available to and best suited to the person. Different agencies and detailed information requirements can be handled through this same single solution when and if necessary. Gainwell refers to this single solution approach as an intelligent engagement.
We need to pay attention to the employee or user experience, too, as evidenced by the emergence of the CMS “quadruple aim”. If an employee has access to and works with a whole person view — that is, complete information on a person’s eligibility and participation, with appropriate privacy control — through one solution, it will significantly improve the user experience. We call this solution integrated case management.
The reality will be that multiple agencies are involved, along with their different funding sources and data-sharing requirements and restrictions. As such, an agency’s staff will have visibility into different levels of case details — depending on which agency owns the solution, which agency the employees work for and which programs are involved.
This is not as problematic as it may seem. The important point is that integrated case management must track the complete life cycle of all the involved services at the legally allowed level.
Program effectiveness
As alluded to previously, sometimes your agency simply does not provide a service that the individual needs and you must make a referral. In this case, it’s important to have follow-through and track the progress and completion status — again, at the legally allowed level of detail. Effective integrated case management should include this information and functionality
With this integrated case information, we can better evaluate the effectiveness of various services and programs. The real power here is that this learning can be fed into the earlier step of suggesting a set of services to address the needs and barriers identified in developing the “one solution”.
These steps of monitoring, evaluating and feedback designed for improved services are part of what we call Whole Person Service Analytics. Whole Person Service Analytics helps us turn Whole Person Service into a continuously learning intelligent solution.
We established previously that a person’s well-being is not just about physical health; it also involves mental/psychological and socioeconomic health. Similarly, and along another dimension, a person’s well-being is not merely personal or only about the individual; it goes beyond them. Whole Person Service not only takes care of the whole person but also involves the individual’s family and their community.
You probably noticed that integrated case management and Whole Person Service seem to be all about data, and that is correct. We plan to return with another blog on data and Whole Person Service Analytics. Before that, though, in an upcoming blog we’ll share Gainwell’s vision for how you can design and measure the progress of Whole Person Service. We hope you’ll stay with us for future installments of this blog series.
About the Authors
Chris Van Vlack is a regional general manager at Gainwell Technologies. He has more than 25 years of commercial and public sector health and human services experience. Chris is currently leveraging his experience to help Gainwell develop new innovative strategies that will help transform the way in which recipients of the HHS programs are engaged and served through State and Local agencies. The goal of this work is to improve the overall recipient experience and contribute to improving their circumstances.
Dawn Wilder is an account general manager at Gainwell Technologies. She has more than 30 years of public sector health and human services experience. Having observed service delivery at the ground level through years of human services consulting, Dawn is passionate about the need to move to a whole person, whole family, whole community service model.