Could the US, World Benefit From "Whole Person Care" Program?

With efforts to help those in need of overall good health, California became home to 25 pilot "Whole Person Care" (WPC) programs in 26 of the state's counties, early this year.

According to a recent report published in Health Affairs, the WPC pilot programs were implemented to address the medical and social service needs of the most vulnerable and highest-using Medicaid beneficiaries, such as those experiencing homelessness.

Since mid-March, the WPC programs have become more essential to those 26 counties and the state because of the international coronavirus (COVID-19) pandemic.

The state of California now has seen 54,937 total cases, 2,254 total deaths and has tested 715,751 total residents as of May 4.

Like many other states affected by COVID-19, California county health and public health departments have refocused their efforts on response to the pandemic and their resources are stretched very thin. The challenges to such emergency responses are well-documented and include the need for centralized leadership and rapid and effective information sharing; this is necessary to raise awareness of priorities and implement a coordinated response across all sectors that provide essential health and human services, according to the report.

Related: Free Recruitment Services to US Hospitals to Aid in COVID-19 Relief

WPC pilots can address these challenges, as they are typically led by county health or public health agencies and include an explicit focus on development of cross sector partnerships, forming multidisciplinary care teams, and building data sharing infrastructure to support care for vulnerable residents, the report says.

In April, Health Affair asked the pilots to describe whether and how they used WPC partnerships and infrastructure to respond to COVID-19 and whether the COVID-19 pandemic affected WPC implementation. A rating of 1 meant that a pilot did not rely at all on a WPC resource in their COVID-19 response; 5 meant that they relied on that resource to a great extent. Twenty-one of the 26 WPC counties, representing 20 WPC Pilots, responded to the questionnaire between April 7 and April 20, prior to the report being published in late April. 

Pilots reported relying extensively on nearly all WPC resources to coordinate their counties’ COVID-19 response. Pilots said they relied most extensively on the expertise of the multidisciplinary leaders and staff-with a median rating of 5-which were used to develop plans and implement them across agencies and service providers.

Pilots gave nearly as high ratings to interagency and other partner relationships developed as a result of WPC, and to WPC pilot program services. Both of these resources received a median rating of 4.

Finally, pilots said WPC data sharing infrastructure also had an impact on the COVID-19 response, but to a lesser degree (median rating of 3) than other WPC resources. This was likely due to significant variation in functionality of such infrastructure. Pilots with higher functionality were better able to facilitate remote work and disseminate data county-wide.

In addition to rating how extensively they relied on different WPC resources in their COVID-19 response, pilots also described how they used those resources:

• Multidisciplinary Leaders And Staff: Agency leaders and staff used skills developed as a result of WPC (e.g., system integration, partner relationships, effective referrals and linkages) to organize a coordinated COVID-19 response.

• Interagency And Other Partnerships: WPC partner relationships facilitated rapid and timely COVID-19 communication and cross-agency collaboration to assess need and develop plans such as assess partners’ needs for personal protective equipment; develop hospital surge plans and ED protocols.

• WPC Pilot Program Services: Pilots redirected resources in mental health transitional care, recuperative care, and sobering centers; they used these resources to expand hospital capacity for COVID-19 patients and as temporary housing for recently incarcerated and homeless individuals.

• Data Sharing Infrastructure: WPC inter-agency data sharing agreements, data sharing platforms, patient emergency plans, and data on patient location, medical, and social needs were used to facilitate remote work and telehealth, plan COVID-19 response, and identify patients at high-risk for COVID-19.

According to the report, the most commonly reported impact of COVID-19 was changes in process of identifying and enrolling eligible beneficiaries, as well as engaging them and providing care coordination and other WPC services. Many pilots reported a shift from in-person engagement to telephonic or other remote approaches and this shift was considered a set-back. Pilots’ experiences reported elsewhere had indicated that many beneficiaries eligible for WPC lacked mobile phones or landlines, and that intensive in-person contacts and outreach was important for developing trust needed to engage in services.

The second most commonly reported impact was changes in staffing procedures. Multiple pilots reported reassignment of WPC staff to COVID-19 response activities, such as COVID-19 testing sites and command centers. Several pilots also noted that cross-sector care coordination was more challenging.

The experience of California counties with WPC pilots illustrates the unanticipated value of investments in system-wide integration in responding to emergencies such as COVID-19. Furthermore, the benefits of WPC often reached beyond those enrolled in the program to the entire county population, the report says.

Key elements of WPC-such as public-private partnerships that allow effective collaboration, availability of patient health and social needs data to all providers, and staff that can coordinate care across sectors-can be implemented in other counties around the country; addressing all socioeconomic disparities. Federal seed-funds could help jumpstart integration efforts and local funds could be used to sustain them over time, the report says.