Monday, February 18, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 1

In the next few posts, I'm going to re-focus on the Patient-Centered Life-Cycle Value Chain series [click here for the first post in the series]. Specifically, I'll discuss how to bring high value to the healthcare consumer through a new type of wellness program we're developing, which offers a whole-person integrated-care solution. I welcome your questions and comments.


What is Whole-Person Integrated Care?

As the name implies, whole-person integrated-care has two related parts: Whole-Person care and Integrated care.

Whole-Person Perspective

Whole-person perspective focuses on improving a person's health and wellbeing by addressing one's physical health (body), mental/psychological health (mind), and the mind-body connection ("holistic" health). In other words, it views an individual as a whole entity, whose body and mind are interconnected.




The whole-person perspective is critical for preventing and treating health problems in a cost-effective manner because it helps lower overall healthcare expenditures, improve care outcomes, and enhance wellbeing since many physical disorders and psychological problems are related; for example:

  • Disturbances of physiology that are related in some way to situational/psychological conditions, but without actual permanent end-organ damage, such as migraines, functional bowel disease and types of chronic pain

  • Disturbances where actual physiological and psychological pathologies are evident, such as hypertension, peptic-ulcer disease, hyperthyroidism, asthma and chronic skin disorders

  • Serious physiological disorders that tend to appear or flare up with significant life changes and stress, such as disturbances in autoimmunity

  • Mental health problems caused by biomedical factors such as delirium, dementia, organic hallucinosis, and organic delusional, mood, personality and anxiety syndromes

  • Illnesses such as coronary heart disease and cancer that may be helped with adjunctive treatments which promote changes in patients' behaviors (e.g., improve eating, sleeping, and exercise habits) and psychological states (e.g., reducing resentful anger and stress-proneness)

  • Emotional difficulties often associated with medical illnesses and procedures such as AIDS, bone marrow transplants, severe burns, heart or liver transplants, end-stage kidney disease entailing dialysis, hip fracture, open-heart surgery, and plastic surgery

  • Maladaptive behaviors and attitudes that have obvious deleterious health effects on oneself and/or others, such as substance and alcohol abuse, anorexia, bulimia, obesity, smoking, unsafe sex, recklessness, suicidal tendencies, and abusive behavior toward others.

A whole-person approach is important, therefore, because:

  • Up to half of all primary care physicians' cases are either accompanied by, or constitute, psychological (emotional and behavioral) problems.[1]

  • Psychological problems cause, exacerbate, or impede healing of many physical illnesses.[2]

  • Psychological treatment (of emotional and behavioral problems) helps remedy many physical ailments and thus reduces overall medical costs.

  • People who are healthy both physically and psychologically have greater peace of mind, are more focused and energized, are more productive, make fewer mistakes, have fewer accidents, and are more satisfied with their lives and work.

See this link for more about whole-person (biopsychosocial) care.

Integrated-Care Model

Integrated care brings together well-care and sick-care:

  • Well-care focuses on preventing physical, mental and mind-body health problems from occurring or worsening—as well as achieving a sense of emotional well-being and peace-of-mind—through healthy living, wise decision-making, responsible action to deal with distressing life situations, and using effectively coping strategies.

  • Sick-care focuses on treating acute, sub-acute and chronic health problems (physical, mental and mind-body) through traditional allopathic procedures and/or complementary and alternative methods.


Thus, Instead of viewing sick-care and well-care as two separate avenues in the road to health, this integrated approach involves a new kind of coordination and collaboration between (a) medical and related sick-care practitioners focused on the diagnosis and treatment of health problems and (b) well-care practitioners focused on prevention, recovery and well-being, as well as peak performance.

By integrating sick-care & well-care in this way, overall healthcare costs would be reduced, health outcomes would be improved, and people's quality of life and productivity would be increased. These desirable results would be achieved by coordinating efforts to prevent and treat illness and dysfunction. This integrated approach is a vital to solving the current crisis and bringing greater value to the consumer.

See this link for more about well-care/sick-care integration.

All Together Now: Whole-Person Integrated Care

This whole-person integrated care strategy offers a sensible way to help people:

  • Remain healthier longer through better self-care/self-maintenance

  • Recover from illness and dysfunction more quickly and avoid complications of chronic disease through greater compliance with plans of care

  • Gain greater peace of mind by removing or coping with stress more effectively

  • Save money through reduced sick-care expenditures

  • Be more productive and focused through reduced stress and emotional distraction.

Employers also benefit when their employees are healthier, happier and more focused. These benefits include increased employee productivity and employment retention, as well as lowered healthcare expenditures, reduced sick time, and fewer workplace accidents and errors.

It is therefore a crucial component for solving the healthcare crisis by reducing overall expenditures.

Implementing this strategy requires a new kind of wellness program that:

  • Performs a comprehensive health and wellbeing assessment and generates a whole-person health profile that includes a full mind-body work-up.

  • Uses the health profile to create individualized wellness plan of care focused on improving one's health, happiness and achievement through lifestyle changes, wise decision making, and development of effective coping skills.

  • Provides ongoing guidance and support from networks of wellness coaches/counselors who use the health profiles and collaborative communication tools to increase the person's knowledge, understanding and motivation.

  • Supplies essential information that enables sick-care practitioners to understand more fully:

    • How to handle the interplay between a person's physical problems, mind-body health needs, emotional drivers & obstacles, and psychological boosts & blocks
    • Complementary & alternative intervention options to traditional medical treatments.

What is the Goal of Whole-Person Integrated Care?

The goal of such a program is to improve people's health and wellbeing by helping them reduce their stress & distress levels (i.e., increasing peace of mind) and change their maladaptive behaviors (i.e., making lifestyle/ compliance changes) via a counseling & education process that deals with the interactions between one's:

  • Cognitions (beliefs, attitudes, perceptions, thoughts)
  • Emotions
  • Behaviors
  • Level of Knowledge & Understanding
  • Coping strategies.

How is it Done?

The Whole-Person Integrated Care process is also personalized; it is tailored to the needs of different types of individuals with drastically different characteristics:

  • Activists are motivated to deal with health & wellbeing issues actively

  • Wannabes talk about improving their health & wellbeing, but never seem to act on it, or do so half-heartedly

  • Inactives think about their health on occasion, but do not believe they should or can do anything to improve their health & wellbeing

  • Ignorers/Deniers are not health conscious because they don't accept that they have health problems or risk factors, or they just don't care.

In the next post in this series [at this link], I examine the character qualities of these four groups, i.e., the cognitions, emotions, behaviors, knowledge & understanding, and coping strategies that promote or impede one's willingness and ability to adhere to healthy living strategies.

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[1] Research shows that a significant percentage of all primary care billing is for stress-induced or behaviorally-related disorders, with a minimum of about 20 percent of patients in a primary-care practice suffer specifically from anxiety or depression. And if one assumes undiagnosed complaints are related to underlying anxiety disorders or depression, the proportion of patients seeking treatment for psychological reasons jumps to 40 to 50 percent. Depression alone, which is the fourth most disabling illness worldwide, has been estimated to cost the United States $83 billion in 2000. Of this amount, $57 billion is attributed to such things as depression-related absenteeism, reduced productivity at work, and the value of lifetime earnings lost due to suicide-related deaths, leaving $26 billion in direct out-of-pocket expenses for healthcare treatment costs.

References:
Goleman, D. (December 14, 1994). Push is on for Family Doctors to Spot Psychiatric Problems. New York Times. Available here
AAFP white paper on the provision of mental health care services by family physicians - American Academy of Family Physicians Commission on Health Care Services. American Family Physician. (May 1, 1995). Available at http://www.findarticles.com/p/articles/mi_m3225/is_n6_v51/ai_16874729
NIMH
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study at http://www.nimh.nih.gov/healthinformation/stard_qa_general.cfm

[2] A growing body of research in mind-body medicine not only demonstrates an undeniable interplay between biomedical, psychological, and social factors, but points specifically to a causal link between mental/emotional problems and many physical illnesses. The field of psychoneuroimmunology is demonstrating that stressful life events can adversely affect the immune system. Other researchers are identifying “coronary-prone behaviors” such as feelings of insecurity and a perceived lack of self-efficacy. Still others are finding a connection between optimism, coping skills, and physical health. Potentially high-cost, medically dangerous behaviors — such as excessive consumption of alcohol, use of illicit drugs, violence, and unsafe sex — also find their roots in behavioral disorders. For example, researchers found that depression is a precursor to heart disease, with certain depressed patients being 50 percent more likely to develop or die from heart disease than those without such symptoms, even though they had no prior history of heart disease. Depression, therefore, likely affects not only the mind but also physical health by being linked to increased blood pressure and abnormal heart rhythms, as well as chronically elevated stress hormone levels, which can increase the heart's workload.

References:
Borysenko, J. (1988). Minding the Body, Mending the Mind. New York: Bantam
Cousins, N. (1990). Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York: Viking Penguin
Dienstfrey, H. (1991). Where the Mind Meets the Body. New York: Harper Collins
Gordon, J. S. & Bresler, D. (Eds.). (1984). Mind, Body and Health: Toward an Integral Medicine. New York: Human Sciences Press
Gordon, J. S. (1990). Stress Management. New York: Chelsa House
Ornstein, R., & Sobel, D. (1988). The Healing Brain. New York: Simon & Schuster
Ornstein, R., & Sobel, D. (1990). Healthy Pleasures. Reading, Mass: Addison-Wesley
Kroenke, K. (2002). Psychological medicine: Integrating psychological care into general medical practice. BMJ;324:1536-1537. Available at http://bmj.bmjjournals.com/cgi/content/full/324/7353/1536
Huggins, C.E. (March 1, 2006). Depression, heart disease often go hand in hand. Reuters Health. Available at http://go.reuters.com/newsArticle.jhtml?type=healthNews&storyID=11380752&src=rss/healthNews

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