It’s taken a pandemic for the world to fully grasp the interdependent nature of mental, physical and socioeconomic health. Yet, while COVID-19 has exponentially increased Google search trends for terms like “social determinants of health,” the foundations of whole person health run centuries deep. In words variably attributed to Osler, Moxon and even Hippocrates, generations of aspiring clinicians have learned the primacy of “knowing what sort of a patient has the disease than what sort of disease the patient has.”
It’s a maxim that feels all too obvious. How can we expect a drug to cure a child’s asthma when he or she lives in a mold-infested apartment without air conditioning and just blocks from a freeway exchange? How can we expect a person with schizophrenia to maintain a stable medication regimen when he or she has no home, no car, no job and no family support? How can we treat someone’s Type 2 diabetes without solving for its possible roots in his or her obesity, depression, poverty and trauma?
The truth is we can’t. As a result, despite spending more on healthcare than all other nations in the Organisation for Economic Co-operation and Development, the U.S. is among the worst in delivering whole person health. Seemingly by design, America’s healthcare system has failed to provide the time, resources and reimbursement models needed to comprehensively address mental, physical and socioeconomic health. Providers within this system operate as if we’ve seen our patients stranded at the bottom of a well, able only to scribble prescriptions for ladders and send them down.
That’s finally starting to change.
North Carolina created a network to unite healthcare and human services organizations called NCCARE360. When a doctor learns a patient is food insecure during an office visit, NCCARE360 helps connect that patient directly to food-supporting community-based organizations. Closed-loop feedback then ensures the doctor knows when that patient’s support need is fulfilled.
Available statewide since June 2020, the NCCARE360 Network includes over 2,400 community-based organizations and has already logged nearly 200,000 cases. By creating a coordinated network across healthcare and human services and feedback loops to ensure referrals are fulfilled, NCCARE360 promises a mechanism to finally wrap systems around people instead of people around systems. As other states follow suit, integrated tools like NCCARE360 may represent our best leap forward from the days of handing patients pamphlets, connecting them with call centers and hoping for the best.
At the federal level, leadership at the Centers for Medicare and Medicaid Service has lifted whole person health to a top strategic priority, committing to explore how Medicaid can contribute to closing gaps in access to behavioral and social heath needs. In North Carolina, a recently approved Section 1115 Medicaid waiver leverages this support and the NCCARE360 platform, authorizing up to $650 million in state and federal funding over five years to invest in Healthy Opportunities Pilots. Nearly 30 types of services can be covered by these pilots in three regions in the state, including dedicated focus areas in housing, food, transportation and interpersonal safety.
This alignment of purpose and practicality couldn’t have come at a better time. While all have suffered physical, social and mental health challenges during the pandemic, the impact of this intersection has been felt particularly strongly by our highest-risk neighbors. Recognizing this need, North Carolina braided together various state and federal resources to rapidly launch a COVID-19 Isolation Support Service. Across the state, existing partnerships among trusted local community organizations enabled the program to launch and scale quickly. More than 170,000 support services were delivered to nearly 38,000 households, with over 70% of support services going to historically marginalized populations. North Carolina’s program has been recognized for addressing multiple social needs in a single program in an inclusive and equitable way.
In Wake County, we’ve seen similar success leveraging long-standing partnerships among the city, county, community-based organizations and WakeMed. Historically these partnerships focused on targeted collaborations aimed at improving health outcomes of our most vulnerable residents. COVID-19 dramatically intensified our community’s need, bringing substantial increases in patients seeking care who lacked access to secure housing, healthy food, primary care and transportation. As a result, at the onset of the pandemic these partnerships had to intensify as well, connecting hundreds of people not just to transitional housing in local hotels but with simultaneous connections to local community support programs including WakeMed’s Community Case Management (CCM) team.
For nearly a decade, WakeMed’s CCM team has left no stone unturned in serving whole person health across our local community. Team members connect with some of our highest-risk, most vulnerable patients—including those housed in the pandemic placement program—to both improve access to care and address barriers to better health. In the program, members receive intensive case management services for approximately 90 days with an aim toward transitioning into long-term, community-based safety-net programs and a primary care medical home. In the very near future, with emerging access to new and growing resources, the CCM team’s work will finally come together under one roof: a trauma-informed Center for Community Health intentionally designed to co-locate physical, social and mental health providers in support of whole person health in a payer-agnostic and equity-driven manner.
Our efforts—and those from other forward-thinking public and private partners around the nation—highlight both the societal return to investing in whole person health and the substantial changes needed to bring that value to life. As a public department, changing the resource equation has required getting more nimble, iterative and collaborative with a focus on speed and simplicity. As a private community health system, accessing these new resources has meant widening our aperture to reach beyond our hospital and clinic walls into aspects of physical, mental and socioeconomic health that healthcare providers haven’t traditionally engaged.
Time and again, responding to the pandemic has required us to throw away old rulebooks and write completely new ones. Reaching the promise of whole person health will require nothing less.