The shift from transactional to whole person care (WPC)

Picture a typical scenario where a person with diabetes is treated by their primary care physician (PCP) as well as an optometrist and podiatrist. The PCP may perform blood tests and otherwise monitor their diabetes at their regular checkups. But are those results shared with the other doctors? And is the PCP thinking about broader issues, such as diet and mental health?

Now imagine a different scenario for that same patient. Patient care is provided holistically, featuring regular coordination between all medical offices, as well as behavioral health and social services. It’s called Whole Person Care (WPC) and it’s the future of patient care.

Vital signs for success

To understand the importance of this significant shift from a more transactional patient-provider experience to one that takes a much more holistic approach, and how WPC can help improve the overall quality of life for individuals with chronic medical conditions, there’s a simple yet effective way to illustrate this. Let’s say there are two patients, both of whom have a toothache. One has a history of heart disease and the other is relatively healthy with no chronic conditions. For the healthy person, a trip to the dentist is the first and last stop, whereas for the person with heart disease, a toothache may point to underlying symptoms. Through WPC, the dentist can address and flag any problematic issues with that person’s PCP or other providers before symptoms worsen.

Why does this matter? For someone with a chronic condition like diabetes or heart disease, they often go to doctor after doctor, and from appointment to appointment. WPC tasks these multiple entities with coordinating together to deliver seamless care that addresses the physical, mental, and social needs of such an individual. The goal of WPC is to achieve better and more sustainable health outcomes for those with chronic and/or high-risk conditions by eliminating the idea that each visit to a health professional is an isolated incident. In turn, this streamlines what is a much more effective care and treatment plan that can have a significant impact on the well-being of a patient suffering from long-term health issues.

Moving from a transactional healthcare model to one that is value-based with a single view of the patient is crucial to addressing and treating the long-term physical and mental health of the population in a much more holistic way. But the challenge is getting there. So how can health insurers and providers collectively achieve it?

6 key steps to a successful Whole Person Care program:

1. Goal alignment: To move towards a goal of value-based treatment, the first and most important step is for all of the entities involved in a patient’s ecosystem to align on the common goal of coordinated care across the value chain. The end result should be a shared vision and purpose for all the entities involved with a complete understanding of the challenges unique to each party.

2. A successful and proven program design: The foundation of a solid WPC system is a proven program design. Best practices include the creation of an infrastructure that allows for long-term collaboration among all entities in the patient ecosystem. Once the goal is understood from Step 1, each of the entities should have input into the design of the program and how the goals will be implemented.

3. Data sharing: For health insurers and providers to succeed under WPC, they need each other’s data and cooperation. Health information exchange can play a large role in strengthening population health management and improving the quality of care. ICF Next found through our work on a recent utilization management design project for a large health insurer how important data integration is within a care management platform (practice management system that enhances patient care and simplifies the patient care workflows). The project provided care managers a complete view of the patient’s health data, which resulted in patients having improved health over time resulting from the timely and accurate data received.

4. Program governance: ICF Next’s Program/Project Management Office (PMO) experience has illustrated to stakeholders that for a WPC program to be most beneficial, it needs to have a director who has a direct line to the C-level executives with all key players (the project executive, clinical department head, IT department lead, etc.) having a role on a steering committee. ICF Next partnered with a Fortune 100 health insurer to institute program governance through implementing a robust digital platform offering incentives for employees through wellness initiatives. This required coordination across multiple business and IT stakeholders internally and externally, and led to a utilization of a standard set of processes to prioritize and triage high impact issues. The result? Consistent communication and improved issue resolution turnaround time.

5. Review cadence: It’s important to hold regular meetings that are biweekly or monthly, to monitor and flag any key issues, deliverables, milestones, dates, budgets, vendor issues, and change requests that may arise. This ensures that WPC projects are progressing on time and on budget, and that all pressing issues get adequate attention.

6. Project delivery: Proper delivery will include utilization of well-organized procedures and protocols for initiating, planning, controlling, and monitoring of the WPC project. Strategic decisions will need to be made for managing time, cost, and quality and to establish key performance indicators for performance evaluation and analysis.

Symptoms of concern

While success is possible, as we’ve outlined above, the industry’s transition from fee-based to holistic care yet faces headwinds. Resistance to data sharing is one of the biggest barriers to WPC programs. Providers and health insurers do see the logic in sharing data, but there remains a stubborn reluctance as the industry continues in its transition on the issue of reimbursement. In fact, most coverage plans still pit health insurers and providers as adversaries in settling claims.

Effective provider-health insurer collaborations are crucial for WPC, so it’s important to move them from an adversarial to a teamwork mindset. Ensuring that privacy is strongly supported can help achieve that goal; putting a system in place to confirm that firewalls are working and there are no breaches or holes in data transfer protocols is one such example.

When looking at successful data sharing, consider the following fundamental components: 1) Securing the patient data, as mentioned above; 2) Reducing the complexity of data transfer and exchange – data transfers can consist of a multitude of files which requires proper reporting and tracking to ensure that data is copied completely and accurately; and 3) Performance – data transfers can be comprised of very large files that can take a long time to process. Keeping an open process that’s in line with existing regulations ultimately is vital in bringing partners to the table and giving both sides peace of mind.

A healthy business model

As healthcare systems move away from fee-for-service arrangements, health insurers are working with providers to look at where is care being most used. The goal is not reducing patient care, but rather treating the whole patient in order to ultimately prevent further health issues. ICF Next has seen firsthand how important the prevention goal is through our work with the CDC and changing behavior around some of the world’s most pressing public health issues, including prescription drug overdose, tobacco use among youth, and diabetes in high-risk populations. Efforts centered around marketing innovation with the latest tools, tactics, and technologies to ensure that CDC’s campaigns reached the right audience, with the right message, through the right channel.

Why is this important? A healthy population can chip away at rising medical costs by driving down costs within the entire health ecosystem. Downstream costs are reduced when there are fewer unnecessary doctor visits, including emergency services.

We’ve seen that components of strong programs include advanced medical home care, a community resource database, care management tracking, and reporting portals. Signs of success are patients being compliant with their medications and seeing their PCPs regularly.

A positive prognosis

WPC initiatives are gaining traction. In California, for example, the Department of Health Care Services has launched a total of 25 pilot WPC programs. These five-year pilots include coordination of non-Medicaid services, housing, and supportive services for Medicaid beneficiaries. Also key to the initiative is that the pilots rely on data sharing to identify the targeted populations, link them to services, and track the intervention impact on outcomes. Some of the major keys to success utilized in these pilots include program governance and data sharing, which we have seen can be major lynchpins to success through our work with health insurers.

Future trends for WPC include expanding services beyond what’s been considered a typical health service. For example, the diabetes patient we mentioned earlier may be suffering from nerve damage that impacts their mobility, which can make them more likely to miss a doctor’s appointment. But what if their network of services included a partnership with a ride share service? Without the patient needing an app or a smartphone, a WPC program can arrange for a reliable ride to and from health services or support groups. Or, what about healthy food delivery service? By ensuring the patient has healthy food options, prevention of illness as well as recovery of illness can be greatly impacted. This type of innovative thinking promotes positive patient outcomes—a crucial model for treating the whole person and not just the disease. And when you address the disease, you in turn address the larger community and the long-term health of a population, which leads to happier and healthier outcomes.