Connecting the Whole Person to Whole Care

Ara is currently a senior executive at Unite US, a collaborative care coordination innovator. After founding and leading 2 successful technology companies as CEO, Ara led an international cloud business as senior vice president of Infor, the third largest B2B applications company in the world. Ara speaks 5 languages, and in his spare time serves as the entrepreneur-in-residence at New York Institute of Technology's center for entrepreneurship.
As healthcare providers work to deliver the care their patients need, many struggle with how to treat the whole person—their medical, behavioral, and social needs—and the best way to efficiently track their outcomes.
As healthcare providers work to deliver the care their patients need, many struggle with how to treat the whole person—their medical, behavioral, and social needs—and the best way to efficiently track their outcomes.
 
The Great American Body-and-Soul Imbalance
The relationship between health spending and spending on social services in the United States is very different from that observed in other developed nations. According to the Brookings Institution, “We spend almost twice as much on healthcare per capita than any other developed nation, but this spending leads to an ever-accelerating clinical revolving door.” The difference, the Brookings report goes on to explain, is how much other Organization for Economic Co-operation and Development (OECD) nations spend on social services. “On average, OECD nations spend $1.70 on social services for every $1 on health services; whereas the US spends just 56 cents.”
 
Nations in the OECD spend 70% more on social care than healthcare, while the United States spends 56% less on social care than healthcare.1 That’s a staggering difference. At some point during the development of our societies, our systems went in different directions. But now, all indicators point to an urgent need to make a U-turn and learn from OECD nations.  Health outcomes strongly suggest that it is no coincidence that the United States has this unusual combination of high spending and mediocre outcomes.
 
Ultimately, we have the wrong balance between social and medical spending.  
  • Research, at the state level, conclusively proves that a higher ratio of social to health spending leads to significantly better health outcomes in adult obesity, asthma, mental health indicators, mortality rates for lung cancer, high blood pressure, heart attack, and type 2 diabetes.2
  • According to The Commonwealth Fund, “Food-insecure individuals are 20% more likely to report that they have hypertension, and 30% more likely to report they have hyperlipidemia, than their food-secure counterparts. Poor health is closely tied to inadequate housing, food insecurity, and unemployment or underemployment.” 
  • There is concrete evidence that high utilization is typically influenced by multiple social determinants.
 
To address the whole person, it is critical to address multiple non-clinical needs simultaneously.   
 
Most healthcare professionals recognize that the lion’s share of a person’s health depends on social factors outside the clinical realm and, when unaddressed, lead to compromised health and expensive clinical revolving doors. Nevertheless, many providers still operate without effective solutions to:
  • Address the “whole person” and their multiple interconnected needs.3
  • Track patients across their total health journey.
  • Report on patient care outcomes at scale.
 
Today, most healthcare systems do a decent job leveraging technologies to track the patient journey inside their clinical setting. Electronic medical records, electronic health records, and case management systems effectively refer and track patients across multiple medical services to deliver a complete clinical solution. However, once the patient is referred out of the clinical setting, and seeks assistance with social or behavioral needs, clinical institutions go blind and powerless.
 
Social Determinants of Health Are Part of the Puzzle
Over the past few years, there has been vocal realization that social determinants of health are indeed a critical part of the total health puzzle, not only from the perspective of the patient’s health betterment, but also from the economic implications of reducing avoidable utilization. Policy makers are pushing forward with programs to address this realization:
 
  • CMS is aggressively promoting Its Accountable Health Communities Model to address a “critical gap between clinical care and community services in the current healthcare delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries though screening, referral, and community navigation services will impact healthcare costs and reduce health care utilization.”4
  • New York State is making an $8 billion investment in the Delivery System Reform Incentive Payment (DSRIP) program to promote community-level collaborations with the intent of reducing avoidable hospital readmissions. 
 
Nevertheless, most healthcare providers are hesitating on what concrete steps they should take to extend patient care coordination, improve total care, reduce avoidable utilization, and track patient care outcome visibility.
 


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