Background, Contexts, and Shifting Paradigms
Shift in mindsets and understandings about health
Recent challenges from the COVID-19 pandemic exposed important and known vulnerabilities in our U.S. health system.1 In addition to traditional concerns about costs, quality, access, and experience with the system, there seems to be a growing shift in mindset about how we think about health as being more than the absence of disease. There appears to be greater recognition that our health cannot be abstracted from its ecological connections to other factors that are non-medical. These encompass an array of factors2 and may be social, behavioral, spiritual, geographical (place and location), economic, etc. in nature. Failure to include these other aspects will give us an incomplete picture and understanding of the outcomes we seek—improved health for all.
Rallying around goals that affect everyone
It may prove easier to gain traction toward changes in the system when its participants can gain broad support for shared goals that affect everyone. Good health, safe environments, and overall well-being are not hard areas to agree on and should be available to everyone, regardless of who they are and where they live. The appeal of such goals should be universal to most individuals and are not political or partisan in nature.
Why Whole Person Health? Is there Really a Need?
The concept of whole person health has grown in acceptance as an important perspective and approach for addressing the needed transformations in our health system. Even the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health has embraced and incorporated it into its strategic priorities for scientific advancement. According to NCCIH, whole person health focuses on the whole person, including the multifaceted aspects “that promote either health or disease.”3 It includes the social-ecological lens of embedded relationships of individuals to their families, communities, and the larger population, spanning interconnections of “biology, behavior, social, and environment.”3 Ultimately, “whole health focuses on efforts to restore health, promote resilience, and prevent disease across the lifespan.”3
Envisioning needs and challenges as opportunities
Persistent inequalities are rooted in social determinants which shape how they are distributed and allocated in the population.4 Health systems’ models have begun to emerge that recognize how to best meet the needs of those being served by the system. Collective integrated action is warranted where the needs (also called root causes) of the whole person are addressed.5 Instead of addressing these inequities through individual silos of excellence within the system, there is greater opportunity for collective impact if there is greater system coordinated action between area components (like primary care, public health, health plans/payors, state and local entities) to achieve shared goals for its people.6
When Strategic Initiatives Move us in the Right Direction
California’s Whole Person Care Pilot Program represented an example of one strategic initiative that helps to move us toward greater health system transformation.7,8,9,10 As part of Medi-Cal’s 2020 vision, the state hoped to move away from the traditional hospital-based, inpatient care services to more primary care and preventive care services. This focus coincides with the larger national trend in value-based care and the importance of health outcomes. At the same time, the state saw this as an opportunity to strengthen the role of public health care systems that provide mission-critical care to disadvantaged populations who are at risk for falling through the system and not having their needs addressed. An important part of this whole person approach is the intentional efforts to address health-related social needs and provide social care integration.6 To many, these leanings are very public health in orientation. Specifically, emerging system designs represent tremendous opportunities to coordinate efforts for persons, families and communities through internal organizational efforts aimed to strengthen service delivery to individuals with complex physical and social needs. Similarly, many of the same organizations that provide these programs and services must engage in multi-sectoral collaborations to deliver system-level interventions that are more responsive to those diverse population needs.
Aspirations for the Future of Health System Transformation
Given the success of this initiative, along with plans to incorporate related elements in similar reforms in other state Medicaid agencies, health plans, public health agencies, and community organizations, I fully expect these innovations to continue to push for more comprehensive transformations that incorporate the needs of the whole person. These are great strides toward fundamental changes that really benefit everyone. Such designs are hard to resist in the face of mounting evidence of their benefits and merits of whole system approaches to population health. This certainly seems to be the direction that California Medi-Cal is taking with its CalAIM strategic initiative as it clearly includes strong elements of the whole person focus among other system enhancements that address whole health.11,12
Karl J. McCleary, PhD, MPH
Dr. McCleary is the Associate Dean for Strategy, Director of the Center for Health Strategy and Innovation, and Professor of Health Policy and Leadership at Loma Linda University School of Public Health. His research interests include health policy; transformation and strategic change; innovation, systems thinking and redesign; and population health.
- DeCosta, D., Simpson, L., Luft, H.S., & Savitz, L.A. (2020, April). Health Systems Respond to COVID-19: Priorities for Rapid-Cycle Evaluations. AcademyHealth Translation and Dissemination Institute, Washington, DC. Retrieved from https://academyhealth.org/publications/2020-04/report-identifies-health-systems-priority-research-questions-covid-19.
- Advisory Board (2020, February). The Field Guide for Defining Providers’ Role in Addressing Social Determinants of Health. Washington, DC. Retrieved from https://www.advisory.com/topics/social-determinants-of-health/2020/02/field-guide-for-defining-providers-role-in-addressing-social-determinants-of-health.
- National Center for Complementary and Integrative Health. Whole Person Health: What You Need to Know. U.S. Department of Health and Human Services, National Institutes of Health, Bethesda, MD. Retrieved from https://www.nccih.nih.gov/health/whole-person-health-what-you-need-to-know.
- Marmot, M., & Bell, R. (2019). Social determinants and non-communicable diseases: time for integrated action. BMJ, 364:l251. DOI: 10.1136/bmj.l251
- Kaufman, M. (2017, July). The Whole Person Integrated Care Model: Advancing the Quadruple Aim and Community Wellness (Whitepaper). Partners Health Management, Gastonia, NC. Retrieved from https://www.partnersbhm.org/whole-person-integrated-care-model/.
- Crumley, D. (2021, September). Medicaid and Health-Related Social Needs: Four Insights over Four Years. Center for Health Care Strategies, Hamilton, NJ. Retrieved from https://www.chcs.org/medicaid-and-health-related-social-needs-four-insights-over-four-years/.
- California Department of Health Care Services. Whole Person Care Pilots. Sacramento, CA. Retrieved from https://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx.
- Chuang, E., O’Masta, B., Albertson, E.M., Haley, L.A., Lu, C., & Pourat, N. (2019, October). Whole Person Care Improves Care Coordination for Many Californians. Los Angeles: UCLA Center for Health Policy Research. Retrieved from https://healthpolicy.ucla.edu/publications/Documents/PDF/2019/wholepersoncare-policybrief-sep2019.pdf.
- Pourat, N., O’Masta, B., Haley, L.A., & Chuang, E. (2021, May). A Snapshot of California’s Whole Person Care Pilot Program: Implementation Strategies and Enrollees. Los Angeles: UCLA Center for Health Policy Research. Retrieved from https://healthpolicy.ucla.edu/publications/Documents/PDF/2021/wholepersoncare-policybrief-may2021.pdf.
- Pourat N, Chuang E, Chen X, O’Masta B, Haley LA, Lu C, Huynh MP, Albertson E, and Huerta DM. Interim Evaluation of California’s Whole Person Care (WPC) Program. Los Angeles, CA: UCLA Center for Health Policy Research, September 2019. Retrieved from https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf.
- Kim, W. (2021, July). CalAIM’s Integrated Whole-Person Approach. Loma Linda, CA: Loma Linda University Health Institute for Health Policy and Leadership. Retrieved from https://ihpl.llu.edu/sites/ihpl.llu.edu/files/docs/issue-at-a-glance/July_2021.pdf.
- Kim, W. (2021, September). AB 133: California’s Healthcare Budget Trailer Bill for FY 2021-22. Loma Linda, CA: Loma Linda University Health Institute for Health Policy and Leadership. Retrieved from https://ihpl.llu.edu/sites/ihpl.llu.edu/files/docs/presentation/AB-133-for-IHPL-website.pdf