It wasn’t long after New York City became a covid-19 hot spot that Lisa David knew the subways were going to be a problem. As president and CEO of Public Health Solutions (PHS)—the city’s largest public health nonprofit—David oversees an organization dedicated to improving health outcomes for low-income individuals. Clients came to PHS locations around the city for a range of services, from pre-natal care to assistance with health insurance enrollment. And almost all of them rely on public transit. Amid a pandemic, however, subways and buses could be petri dishes for the virus. David knew she needed to support her clients, while not putting them at greater risk of infection simply because they couldn’t afford a taxi.
The staff of PHS responded quickly. By May, the organization delivered roughly 90 percent of services to patients in their homes through telehealth visits and digital enrollment services. “We always talk about patient-centered care and meeting people where they are, and now it’s actually happening,” said David.
The effort by PHS was not unique. The health services company Optum, for example, which has long been a leader in telehealth, reported helping nearly 5,000 care providers add video capabilities, resulting in 68,000 virtual visits in the first month of the pandemic. It’s part of a transformation that extends beyond just telehealth—and began well before the pandemic. For years, healthcare providers, public health agencies, tech companies and other organizations have been developing innovative interventions that are geared towards addressing the full range of patient needs. Known as whole-person care, this approach is built on a simple, but long overlooked premise: Optimal health comes from more than just medical care. Factors such as geography, financial circumstances and family health history actually influence health outcomes.
PHS efforts to tailor services to the unique needs of their low-income clients during the pandemic is just one example of how the system is adapting to this reality. All across the country, providers are reimagining the full spectrum of care with an eye towards determinants of health, developing patient-centric interventions to improve outcomes for everyone.
“As a health care system, and as a society, we need to broaden our view to include all of the factors affecting a person’s health,” said Wyatt Decker, MD, CEO of OptumHealth, “to consider and support them as a whole person.”
Confronting the range of factors that determine our health
Although the concept of determinants of health isn’t new, its significance has been reinforced amid the global pandemic, says Rishi Manchanda, MD, MPH, CEO of the nonprofit HealthBegins. He notes that certain communities, including low-income groups and immigrants, have been particularly vulnerable, citing a widespread testing effort in San Francisco’s Mission District in late April 2020 to illustrate his point.
The results show that whether someone gets sick with covid-19 hinges tightly on income, job description, living situation and whether they can follow stay-at-home and social distancing recommendations. In this study, nearly all of those with active infection earned less than $50,000, lived in households of more than 3 people and could not work from home. Other research suggests that behavioral factors like smoking and inherited conditions also contribute to an individual’s risk of catching the virus and dying from it.
These determinants of health are equally as consequential for almost any health condition, especially chronic ailments. Low-income Americans, for example, have higher rates of heart disease, diabetes and stroke as compared to wealthier Americans. Rural Americans are more likely to suffer from high blood pressure and obesity than urban counterparts. Part of the issue is that these myriad factors can influence a patient’s capacity to adhere to recommended treatment, says Optum’s Decker.
“If you have a chronic condition like diabetes, but don’t have regular access to healthy food, it becomes harder to manage,” he said. “If you need regular monitoring for a heart condition, but don’t have access to reliable transportation or don’t have an internet connection for remote monitoring, you’re not going to be able to manage your condition as well someone who has those things.”
This recognition demands a more expansive and thoughtful approach to patient care—one that is slowly taking root among system stakeholders across the country.
How whole-person care can improve outcomes
Decker notes that for years some of the best healthcare providers have taken social, behavioral and environmental determinants of health into account when developing programs and initiatives. “Patients are more than a machine that has a malfunctioning part, they are a whole person,” he said “Each of us is an individual with our own goals, our own preferences for seeking care. When we take all that into account, we can deliver on the promise of whole-person care.”
This approach has seeded the ground for important interventions during the pandemic. Optum, for example, is leveraging analytics to try to track covid-19’s spread. As part of a broader academic collaboration, the company adapted an artificial intelligence platform built for predicting flu outbreaks to create a covid-19 dashboard. The machine-learning tool uses de-identified data from electronic health records and pharmacy and medical claims to detect patterns that can signal which communities may experience an impending outbreak.
Of course, these unified solutions extend beyond just covid-19 care. One example is the increasing prominence of case managers and community health workers. These individuals improve the experiences and outcomes of the patients they work with by helping to connect the dots among system stakeholders, such as providers, insurers and medical innovators. In an Optum survey of patients who use this type of service, 86 percent of respondents reported that it helped them have a better, more positive health care experience. The intervention also helps bring costs down. The company’s telephonic case management program, for instance, provided savings of more than $3 per-member, per-month over a three-year period.
For David at PHS, the covid-19 pandemic offers an opportunity for these types of interventions to become even more widely adopted and lead to true system transformation. “I hope and pray that this crisis generates significant change” in access to more comprehensive healthcare, she said.
Decker is optimistic. With a focus on whole-person care, health care providers can deliver on their mission to provide better treatment to all Americans. “When we get this right, you have better health outcomes for people,” he said. “We’re making the system work for people, not the other way around.”
Read more from Optum:
Centers for Disease Control and Prevention
UC San Francisco
World Health Organization