The COVID-19 pandemic has not affected all health institutions¹ equally. Some systems suffered financially when non-urgent visits and procedures were canceled or deferred. Meanwhile, advanced value-based payment models² remained financially resilient, launching innovative programs to support individuals and communities³ as the pandemic was ongoing. The renewed interest in value-based payment models as a mechanism to deliver quality at lower prices and reduce dependence on care volumes prompted interest in examining the models of care that were effective in promoting whole person health, along with the payment structures needed to support them (Morse, 2020). In the spring of 2021, the National Academy of Medicine’s (NAM’s) Leadership Consortium, in collaboration with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine, held a 3-day workshop series titled Financing That Rewards Better Health and Well-Being (NASEM, 2021a).

The workshop brought together experts and leaders from health care delivery organizations, public health, payers, health services research, patients, and families to conceptualize a path forward for delivering equitable and high-quality care oriented to whole person and whole population health and well-being. The workshop focused on the need to transform the current model of U.S. health financing from its current framework, which rewards the volume of services provided, to a model that incentivizes payment approaches that are person-centered, integrative, and holistic in advancing individual, community, and population health. The objectives included:

• Identifying examples of policies, clinical/nonclinical strategies, and payment models that are focused on patient outcomes and advancing health equity;
• Considering barriers and opportunities to scaling innovative payment models and approaches; and
• Discussing strategies for transforming health financing to improve equity and individual and population health.

A Proceedings of a Workshop—in Brief (PIB), which highlighted presentations and discussions from the workshop was published in September 2021 (NASEM, 2021a). Important themes from the workshop as well as proposed implementation actions from the PIB are briefly summarized in Appendix A (NASEM, 2021a). Following the conclusion of the workshop, the Workshop Planning Committee transitioned to a Steering Group that has met regularly to develop this Special Publication (see Box 1). The Steering Group identified approaches to elaborate on the workshop themes; and posed and identified a unified vision, measurable goals, and specific action steps that various stakeholders can use to transform health delivery and payment systems to produce more equitable health and well-being at the individual, community, and population levels. The Steering Group also established a subgroup focused specifically on supplemental financing and funding strategies (as opposed to care payment approaches) to improve whole person and whole population health. This subgroup assisted the Steering Group in developing the insights laid out in this Special Publication, adding context on ways to leverage and catalyze non-conventional sources of capital for investments in whole person and whole population health. Finally, the report engaged stakeholders such as Maggie Super Church to better understand the elements of healthy neighborhoods, such as access to food, affordable housing, available public transport, and high-quality education.

BOX 1

Steering Group Members.

This Special Publication elaborates on the themes addressed in the workshop and looks beyond whole health care models to identify society-level interventions that can be used to maintain and promote equitable health and well-being. From the vantage point of health care and public health experts, this Special Publication also explores measurable goals and identifies several levers, mechanisms, and policies that various stakeholders can take to advance individual and community health. However, these opportunities for action are not meant to be exhaustive or prescriptive; systems across states, localities, and stakeholders vary too much to provide this guidance. Additionally, the publication does not detail payment reform but rather focuses on a cultural and movement-based shift away from economism and profits and toward valuing America’s health in both numerical and cultural perspectives.

The report does not aim to present new governance, punitive, and accountability models or measures; dictate fiscal and monetary policy; discuss workforce or data issues; or suggest far-reaching changes such as a wholesale reform of public markets. Instead, the publication primarily aims to argue that, in absence of a legislative or government-based solution, health care, public health, and other stakeholders are obliged to act to the best of their ability. Therefore, the Steering Group intends this publication to be a call for a bottom-up movement to influence the nation writ large instead of a government-centric polemic.

DEFINITIONS

For the purposes of this Special Publication, the authors define whole person health as a person’s ability to thrive and attain their full, optimized potential for health and well-being. Whole person health accounts for the whole person—not just separate organs or body systems—and considers the multiple factors that promote either health or disease. As depicted in Figure 1, whole person health necessitates helping and empowering individuals, families, communities, and populations to improve their health in multiple interconnected biological, behavioral, social, and environmental arenas. Instead of limiting perspective to treatment of a specific disease, whole person health focuses on achieving, restoring, and maintaining health; promoting resilience; and preventing diseases across the life span. Whole person health defines the achievement of health and well-being by the conditions and criteria that individuals and communities identify as important.

FIGURE 1

Whole person health in the context of whole population health. SOURCE: NCCIH, 2021.

The authors refer to whole person, whole population health as the extension of the focus of whole health to a group of people rather than just one individual. This may be viewed as conceptually distinct from traditional definitions of “population health,” which are often primarily used for the purposes of attribution and geographic/demographic empanelment. For the purposes of this publication, health and well-being can be considered interchangeable with whole person, whole population health.

Whole person and whole population health care references clinical interventions that are based on the concept of whole person and whole population health and are:

1.

grounded in personal health services oriented toward health promotion and prevention, in addition to treatment;

2.

able to equitably enhance the health and well-being of an entire community or population;

3.

person-centered rather than provider-centered;

4.

relationship-based rather than transactional;

5.

holistic, integrative, and continuous rather than fragmented and episodic; and

6.

utilize measures that matter most to people, families, and populations, and support continuous learning and improvement in processes and structures that deliver better health, higher quality care, lower costs, and optimal individual and clinician experience.

For purposes of this Special Publication, the authors also wish to define and differentiate between health financing and health care payment. This Special Publication uses the term health financing to refer to the range of mechanisms through which improved health outcomes are targeted by funds that flow through various routes to support health, health care, social, environmental, and related services important to health. In health financing, money flows into the health and social services systems to fund and invest in activities and services known to improve health status, while health care payment is used to describe how service users and their fiduciary agents and insurers reimburse health providers for clinical and nonclinical interventions. For example, tax dollars and capital sources are health financing mechanisms, while mechanisms of health care payment include both fee-for-service structures (where clinicians and hospitals are paid for each service delivered) or prospective and value-based payment models.

Footnotes

1

Health institutions refer to organizations that provide health care and related services.

2

Value-based payment (VBP), or value-based care (VBC), models hold physicians, clinicians, and care facilities accountable for quality and cost through shared financial risk. They often assume a pay-for-performance fashion by tying compensation to performance measures. Advanced VBP models include bundled payments, accountable care organizations (ACOs), and global capitation.

3

Communities are places where people live, learn, work, and play. Community-driven solutions are led by community members to change local factors that can influence health and health equity, and, if successful, expand beyond a single locality. Community leaders can be regular citizens, local political leaders, or members of anchor institutions such as churches, hospitals, and schools.