An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will examine the potential for improving health outcomes through a Whole Health care model, which focuses on transformation to a whole person-centered integrative approach to health creation and well-being by incorporating patients’ goals and priorities into their health care decisions, while still providing high quality disease management. The committee will identify best practices and lessons learned from the flagship and design sites of the U.S. Department’s Veterans Affairs’ (VA) Whole Health Initiative, as well as from health systems in the private sector, and consider ways to transform health care by scaling and disseminating whole person care to the entire population. The committee will consider the foundational elements of an integrated whole health model but will not be charged with identifying specific interventions that should be included in whole health models of care, or defining specific evidentiary standards for making those decisions. The committee will identify research designs to study individual components of these delivery models, as well as implementation science strategies for integrating these components into a single system of care. The committee will review results from health services research and observational studies as well as randomized study designs. In particular, the committee will consider:
1. Where is “Whole Health” currently being implemented? (Scoping the field for examples of this approach),
• What care delivery models show promise for supporting whole health, including mental health and integrative primary care; and
• What are common core elements of current Whole Health models.
2. What does Whole Health accomplish? (Assessing what is known, and what is yet to be learned, about the effects and costs of Whole Health care)
• How can whole person care be used to more effectively address health equity and the social determinants of health, as well as inequities driven by structural racism in health care;
• What models with a focus on patient-identified goals and values (person-centered care) have produced measurable outcomes regarding both disease management and patient well-being; and
• What metrics and modeling could be used to assess and track the effectiveness of transformation to a whole person approach to care delivery.
3. How can effective Whole Health strategies spread? (Identifying barriers and facilitating conditions to scale and clinically integrate Whole Health care both within and outside the VA)
• How can the VA accelerate clinical integration with community services to expand whole person care to veterans who receive their care outside the VA through the VA MISSION Act provisions;
• How could the Veterans Equitable Resource Allocation (VERA) system facilitate the transformation to Whole Health within the VA, and also inform models in the private sector;
• What payment and financing models for use in the private sector could enable clinical integration of value-based, whole person, population health beyond the VA; and
• What strategies can be used to overcome barriers to scaling and implementing components of the Whole Health approach, such as integration of mental health, complementary and integrative health, health coaching, peer-to-peer approaches, and well-being programs.
4. What other factors affect the performance of Whole Health? (Identifying infrastructural needs and innovations to support effective Whole Health care)
• What training and structural changes, including incentives, could enable clinical care providers to embrace and adopt whole person care;
• What is the role of coaching techniques alone or in combination with care from clinically trained health care providers;
• What is the role of clinician and staff self-care and well-being in successful implementation of transformational models of care; and
• What lessons can be learned from how transformational models of care have adapted to delivering care during the COVID pandemic, and which adaptations may be useful to continue.
The committee will issue a report with findings and recommendations for future directions and priorities for the VA and other health systems in implementing a system of whole person, population health care.