WASHINGTON — As U.S. life expectancy falls and the nation struggles to achieve health outcomes on par with other high-income countries, the U.S. Department of Veterans Affairs and U.S. Department of Health and Human Services should collaborate to create a national Center for Whole Health Innovation, recommends a new National Academies of Sciences, Engineering, and Medicine report. This center should be charged with supporting, scaling, and spreading whole health care nationally across health systems — as well as with developing policies, practices, and tools to support the adoption and implementation of whole health. 

Whole health care is a care model that addresses the social and structural determinants at the root of poor health, focusing on the priorities and goals of people, families, and communities. Whole health care centers on promoting resilience, preventing disease, and restoring health. The report says this model holds promise for improving not only patients’ health but also the well-being of health care workers and public health overall. Medical care in the U.S. currently concentrates on disease treatment and uses fee-for-service payment models, and is not designed to promote overall well-being or prevent disease. Whole health care uses an interprofessional team-based approach to health care, anchored in trusted relationships. Benefits include improved patient experience and patient-reported outcomes, increased access to care, reduced emergency room use and hospitalizations, improved clinical quality metrics, and more.   

The committee that wrote the report examined the VA’s Whole Health System (WHS) and other whole health systems and concluded the WHS has demonstrated positive outcomes for veterans’ health, and is one model for whole health delivery that could benefit all people across the country. Starting in 2018, the WHS was implemented in 18 VA sites, focusing on veterans with chronic pain, mental health needs, and disabilities. The report says the WHS uniquely incorporates individuals’ goals and priorities into health care decisions — integrating conventional medical care with peer support, coaching, well-being courses, and more. Studies show the program has demonstrated positive outcomes for veterans’ pain management and opioid use, with high patient satisfaction. The VA has since expanded the program and the conditions it addresses, and has plans to implement it across the entire VA system by 2027.  

“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,” said committee co-chair Alex Krist, professor of family medicine and population health at Virginia Commonwealth University. “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.” 

“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,” added Victor J. Dzau, president of the National Academy of Medicine. “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.” 

Federal Leadership of the Whole Health Transformation 

Given the magnitude of change needed to scale and spread whole health nationwide, and the complexity of needs across different populations, the report says only the federal government has the authority and resources to oversee the changes required across sectors. Building on its existing health center program, the Health Resources and Services Administration is well positioned to lead implementation at the community level. Health care systems, community programs, social services, and public health organizations should model their whole health approach after the VA’s and those of other early adopters that have shown initial successes, says the report.  

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

The VA and HHS should lead the creation and design of a new Center for Whole Health Innovation, modeled after efforts such as the Centers for Medicare and Medicaid Services’ Innovation Center or the federal Cancer Moonshot initiative. The new center will likely require congressional support, needing investments in the range of these exemplars.  

The report says the new Center for Whole Health Innovation will need to: 

• Disseminate and advance the vision of whole health for the nation. The center can aggregate and share lessons learned and best practices.  
• Consider equitable allocation of resources. Because much of whole health occurs outside of conventional medical care delivery, there is a need to invest in social services, especially in historically under-resourced settings.  
• Adapt value-based payment models. Payment models will need to be inclusive of interprofessional teams and the full scope of whole health care services.  
• Define how to measure and hold systems accountable for success. Measurements should help determine whether systems are delivering on the foundational elements of whole health care, such as by assessing health outcomes or the process and delivery of care.  
• Ensure structures, processes, and infrastructure exist to support whole health. The transition to whole health care will require experimentation with new processes and organizational structures. Infrastructure needs include health information technology and workforce training, for example.  

• Disseminate and advance the vision of whole health for the nation. The center can aggregate and share lessons learned and best practices.  
• Consider equitable allocation of resources. Because much of whole health occurs outside of conventional medical care delivery, there is a need to invest in social services, especially in historically under-resourced settings.  
• Adapt value-based payment models. Payment models will need to be inclusive of interprofessional teams and the full scope of whole health care services.  
• Define how to measure and hold systems accountable for success. Measurements should help determine whether systems are delivering on the foundational elements of whole health care, such as by assessing health outcomes or the process and delivery of care.  
• Ensure structures, processes, and infrastructure exist to support whole health. The transition to whole health care will require experimentation with new processes and organizational structures. Infrastructure needs include health information technology and workforce training, for example.  

The report also makes recommendations for future research and evaluation of whole health — including that the Agency for Healthcare Research and Quality lead this research and disseminate evidence regarding whole health practices.  

Whole Health at the VA 

The report recommends leadership at the VA ensure all of its sites are ready to offer the WHS to veterans. Each site should understand and adopt the whole health mission and vision, and have the resources needed to change its approach to health care delivery.  

The VA should also integrate the delivery of whole health services between the Veterans Benefits Administration and the Veterans Health Administration. While they currently have separate leadership, budgets, and reporting structures, integrating the two administrations has the potential to maximize the VA’s whole health efforts, says the report. 

The study — undertaken by the Committee on Transforming Health Care to Create Whole Health: 

Strategies to Assess, Scale, and Spread the Whole Person Approach to Health — was sponsored by U.S. Department of Veterans Affairs, Samueli Foundation, and Whole Health Institute. 

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. 

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