NAM Pitches HHS, VA Collaboration for Whole Health, Patient-Centered Care

Should the Department of Health and Human Services (HHS) collaborate with the Department of Veterans Affairs on a nationwide effort to promote patient-centered care? That’s the conclusion of a new report from the National Academies of Science, Engineering, and Medicine that calls for a national structure for whole health care.

Whole health care uses team-based care to support a better patient experience, stronger patient-reported outcomes, and improved patient access to care. The model can also help support better clinical quality measures like emergency department utilization and hospitalizations.

Those kinds of improvements are necessary for the US, a nation that, per Commonwealth Fund figures, outspends but underperforms the rest of its developed peers.

“Whole health is an approach that holds great potential for addressing major challenges in health care workforce well-being that have only intensified in recent years,” Victor J. Dzau, president of the National Academy of Medicine, said in a press release.

“As the report says, shifting to a whole health approach would put a renewed focus on professionally diverse teams that work together to provide integrated care — improving efficiency, mitigating burnout, and reducing strain on our health care workers,” Dzau added.

Whole health focuses on social determinants of health, institutional barriers, and other roadblocks to achieving well-being, the National Academies explained. Through that lens, whole health can achieve more preventive care and support for public health, potentially helping to dodge the chronic illnesses that beleaguer this country and jack up healthcare spending.

“If the measure of an effective health care system is whether everyone has the opportunity to be as healthy as possible, then the U.S. is failing,” committee co-chair Alex Krist, professor of family medicine and population health at Virginia Commonwealth University, stated publicly.

The researchers particularly reference the Department of Veterans Affairs’ Whole Health System (WHS), which it implemented in 2018 at 18 care sites to support veterans with chronic pain, mental health needs, and disabilities.

The WHS integrates unique patient care goals into clinical care plans, the report authors explained. It also blends traditional clinical care with models of peer support, health coaching, and well-being courses.

The model has been successful, the report authors noted, resulting in higher patient satisfaction scores and lower dependency on opioid painkillers for chronic pain patients.

“The VA’s Whole Health System shows the promise of whole health care for veterans across the nation, and we believe it is possible for whole health approaches to be expanded to the rest of the U.S. health care system, with enormous potential benefits for all,” Krist explained.

Any effort to scale this program needs to be helmed by federal policymakers, the researchers argued. Considering the enormity of the undertaking, federal policymakers at HHS are the only body with enough resources and decision-making power to facilitate these changes.

“We recognize that the path to whole health requires a fundamental shift in the health care system’s priorities,” Jeanette South-Paul, senior vice president and chief academic officer, Meharry Medical College, and committee co-chair, said in the press release.

“Federal leadership of a transition to whole health is critical if we want to see a future where the health care system in this country is proactive and helps people be as healthy as possible before problems arise, addresses what matters most to people, and supports the well-being of the health care workforce.”  

HHS can tap numerous of its sister agencies, like the Healthcare Resources and Services Administration (HRSA) and its fleet of community health centers that are already performing some of this WHS work.

The report said a partnership with VA, after which a potential nationwide model for WHS would be tailored, will be essential. Particularly, HHS and VA should partner to create something akin to the CMS Innovation Center or the federal Cancer Moonshot initiative. A proposed Center for Whole Health Innovation would need the capital that CMMI and the Cancer Moonshot have received, meaning it would likely need Congressional support, the authors acknowledged.

Still, a possible Center for Whole Health Innovation would be instrumental in boosting patient-centered care and well-being. The center would be charged with advancing the vision of whole health for the nation, equitably allocating resources, and pushing for value-based care models. Moreover, the Center would help develop clinical quality measures and define accountability, as well as monitor structures, processes, and infrastructure to support whole health.

A nationwide model for whole health doesn’t exist yet, the researchers pointed out, but the WHS at the VA does. The researchers recommended VA expand WHS to all veterans, as well as embed the principles in the Veterans Benefits Administration and Veterans Health Administration.