Achieving the Quadruple Aim with Holistic Care


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The devastation of Covid-19 – even beyond the deaths of more than a million Americans – has been its revelation of the shocking extent of the underlying preconditions plaguing our population and our sad inability to address them. treat. Six out of 10 people in the United States suffer from chronic diseases. About 40 million Americans have five or more chronic diseases, which account for 41% of all spending in the most expensive healthcare system the world has ever seen. Nevertheless, despite all this expense, 66% of us rate our medical care as weak or poor.

Our country is one of the most advanced in the treatment of acute diseases by delivering pills and procedures. But the truth is, our system just isn’t designed to keep us healthy. Many studies show that medical treatment itself is only about 20% of health. Nearly 80% comes from other factors rarely taken into account by our system. These are emotional and mental health, behavioral and lifestyle factors, and the social and economic environment in which a person lives.

The good news is that we already have a better path to lifelong health and well-being. In our new report, The case for providing comprehensive care, the Family Medicine Education Consortium and the Samueli Foundation have funded the study of many concrete examples of health systems, hospitals and clinics that are currently practicing “integral” care. This approach allows these facilities to achieve the elusive “quadruple aim” of reducing costs while improving population health, patient experience, and even clinician well-being.

These are not pie-in-the-sky concepts. For example, the Veterans Administration has documented the remarkable success of a new model of care that shifts from a traditional illness-based transactional system to a person-centered, team-based care model that addresses wellness. physical, emotional and social of patients. In their four-year pilot program with 130,000 veterans at 18 sites, the VA not only reported improved outcomes and patient experience ratings, but also significant savings of 20%, or more than $4,500. per year and per veteran.

Whole person care combines conventional medicine, non-drug treatments, and evidence-based complementary modalities to promote self-care. He uses approaches such as health coaching, group visits, nutritional counseling, acupuncture, yoga, meditation, therapeutic massage, stress reduction, and other non-drug approaches to healing. It explores the social and economic circumstances of the patient and helps them help them. It starts with finding out what matters to the person and then exploring the determinants of health and healing that are most relevant to them. Thus, the approach goes to the root causes of their ailments and seeks to support them with long-term solutions.

The VA’s “Whole Health” model resulted in a 23% to 38% reduction in opioid use, compared to 11% with conventional care alone. Overall health patients also reported greater improvement in perception of care, engagement in care and self-care, meaning and purpose in life, pain, and perceived stress. Additionally, VA’s own employees reported higher engagement, job satisfaction, and intrinsic motivation, leading to reduced turnover and burnout.

The whole-person approach to care has great advantages:

  • A large Pennsylvania healthcare system provided free healthy food and nutrition education, resulting in tangible decreases in patients’ weight, HA1C, blood pressure, and triglycerides.
  • A clinic in Arizona practicing integrative health reported increased confidence and satisfaction in 90% of patients.
  • A multi-center integrative care clinic in Chicago reported significant declines in hospital admissions, surgeries, and drug costs.
  • And in New York, at a major safety net facility, patients with long-term Covid-19 reported greater relief when their medical care was supplemented with dietary plans, physical and breathing exercises, meditation , group and individual mental health counselling.

The heart of these successes is that holistic health care enables patients to develop and better utilize their own personal healing capacity. We are all familiar with the “social determinants of health” in which social and economic environments determine health outcomes for an entire zip code. Whole person care taps into these solutions with the goal of finding the “personal determinants of health” – those determinants that promote individual healing in any environment.

A practical approach to implementing this type of care is to have practitioners ask the patient to rate their physical, emotional, and spiritual well-being through a Personal Health Inventory (ISP). PHI asks the provocative question: what matters to you in life and what brings you joy? It then goes on to assess how willing you are to make changes in various aspects of your life to achieve that life goal and enjoy good health. After the IHP, an “Integrative Health Visit” identifies the patient’s values ​​and healing goals. I call it the HOPE Note (Healing-Oriented Practices and Environment) Toolkit.

The HOPE rating is based on the SOAP (subjective, objective, assessment and plan) rating that every medical student learns to apply in daily practice. SOAP asks “what is the problem” and deals with the medical diagnosis or immediate symptoms. HOPE reaches patients on a deeper level by not just asking “What’s the problem?” » Instead, we ask “What is really matters to you? He then focuses on addressing the root causes of the disease.

This process builds a stronger relationship with the provider, whose role is to truly understand the patient’s healing goals and then provide the evidence and support to help them. It’s not just a feel-good process. Our research has shown that whole person care yields tangible results supporting the Quadruple Aim, such as:

  • Better patient outcomes: increased ability to manage chronic pain, decreased opioid addiction, lower HbA1c with diabetes, improved medication adherence, reduced severity of heart disease, and even reduced loneliness in the elderly .
  • Improved patient experience: Improved retention and satisfaction with providers and care in general, as well as higher quality of care ratings.
  • Reduced healthcare costs: reduction in total cost, reduction in drug expenditure, as well as reductions in hospital admissions, length of hospital stays and emergency room visits.
  • Improved clinician experience: reduction of professional exhaustion of service providers and reduction of turnover of both service providers and employees.

In 2021, a study by the National Academy of Sciences, Engineering, and Medicine recognized high-quality care for the whole person as the foundation of primary care for a strong American healthcare system. It recommended the system-wide implementation of “integrated, accessible and equitable health care for the whole person by interprofessional teams responsible for meeting the majority of an individual’s health and well-being needs in all settings and through lasting relationships with patients, families and communities. .”

We know this approach works. All we need now is to focus on overhauling our health care system to provide this kind of care and find the courage to do so.

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