President and CEO, National Alliance of Healthcare Purchaser Coalitions
Employer strategies continue to evolve and improve to support the health and well-being of their employees. Organizations were initially focused on population health with a continuum of programmatic support, including myriad programs for wellness, disease management, and care management support reflecting the diversity of people covered in their population. Their focus then took a more expansive approach, taking into account the role of culture (e.g., culture of health) to develop sustainable changes and organizational support of health and well-being.
The next generation of strategies builds on our past successes, not by going broader but rather by taking a more individualized and comprehensive approach to meet the personalized needs of employees and their families — total person health.
Total person health focuses on the interplay of multiple bio-psycho-social dimensions of individuals across the spectrum of health status, and interventions to meet people where they are on a more personalized basis. Each person is a universe of one and support of that individual is optimized when we consider the multi-dimensional factors that contribute to the management of their health. Dimensions that contribute to that evaluation include: the impact of the growing number of people that have multiple medical conditions at the same time, the need to integrate mental health with physical health, and the social risk factors that influence how people manage their lives and their health.
Traditional one-dimensional interventions do not recognize the complexity of the health burden of the typical individual, especially when you consider that 90 percent of U.S. healthcare expenses come from people with at least one chronic condition. However, among those people, almost half have three or more chronic conditions and represent almost two-thirds of the nation’s $3.8 trillion spent on healthcare. As the root causes and impacts are often interrelated, we need to migrate from approaches that focus on managing a single disease to one that supports people living with multiple diseases holistically.
Synergizing mental and physical health
Nothing has traditionally been more siloed than the management of mental health from physical health. Yet we know that the management of health behaviors required to mitigate disease and improve outcomes is almost always intertwined with the underlying emotional state of the individual. Recognizing and supporting an individual’s mental health can improve self-efficacy for both personal behaviors and treatment adherence. Ignoring those issues can be a recipe for futility, continued deterioration in health, and greater costs over time.
Finally, the social factors that contribute to health are estimated to impact 20 percent of health outcomes and are an even greater contributor to health disparities and inequities. These factors can range from socioeconomic and cultural influences, healthcare access, basic transportation, and life pressures. Efforts focused solely on educating employees and their families to modify behaviors without considering the context of their personal physical and social environments will fall short, particularly in diverse communities. We need to better understand the impact of these differences, connect people with appropriate resources, and, where warranted, invest in helping to close gaps in those environments.
The opportunities to address total person health span across the spectrum, from wellness and prevention, chronic disease management, to primary- and specialty-care delivery. Population health is optimized when we build systems of support that recognize the complexities of our people and are committed to reducing the variation in the impact of our interventions. By delivering multi-dimensional person-centric systems of support, we outperform (clinically and financially) efforts that are more one-dimensional.