Managing Care From a Whole-Person Perspective
In order to reduce hospital admissions and readmissions, it’s important to address a client as a whole person and not a collection of chronic conditions. When multiple factors are a part of assessment and care planning, services go beyond just treating a patient’s symptoms or underlying illness.
An integrated whole-person approach recognizes many moving parts in a client’s life are fundamental to closing the gap between sickness and health. An evidence-based report in the U.K. commissioned by the King’s Fund and Nuffield Trust found “integration without care coordination cannot lead to integrated care.” In other words, effective care management is achieved only by taking into account the holistic needs of the client.
Continuing to use a disease-based approach leads to greater healthcare fragmentation and higher costs, while adopting an integrated model uses services more effectively and cost-efficiently. Evaluating a client from a whole-person perspective is not about structures or pathways, but rather an aim at better outcomes for clients and communities.
Case Management Drives Integrated Care
A fragmented approach to healthcare is focused on expenditures within a hospital or specialist office system and may lie at the root of poor health outcomes for large vulnerable populations. Higher costs and poor client experiences create a vicious cycle, in which the client loses.
Case managers help connect clients and providers and expand the focus beyond traditional services in order to address circumstances that impact population health such as housing, transportation and food. Each of these unique needs must be addressed in order to support the healthcare plan initiated within the system.
Challenges case managers face include the need to reduce the siloed approach to service delivery in order to broaden the view to what influences their client’s health. One of the benefits of effective case management is the potential to integrate services across a comprehensive base, impacting the individual clients’ overall needs.
Unfortunately, traditionally managed plans often miss this opportunity, increasing the risk for readmission when the client is unable to follow a care plan because of life circumstances. Using a whole-person approach also incentivizes the client, as collaboration is often required to achieve the goals, thus including the client in their own plan of care.
Clients with complex needs are at a higher risk of depersonalized and over medicalized care that addresses only their latest health crisis. A whole-person model of care has demonstrated positive data results in research with participants who suffered significant chronic illness.
Whole-Person Approach Cuts Obstacles to Quality Care
Case management using a whole-person approach also cuts waste by removing obstacles to quality client care and improves the client care experience, directly impacting service providers’ relationship with third-party payers. Conversely, when behavioral health conditions, lack of housing, or food instability are not addressed, health problems escalate and costs rise.
For example, at least 40 percent of clients who have had a heart attack will go on to experience depression. When depression is left untreated there is a three to four fold greater chance of death in the six months following the initial heart attack. Untreated depression also has a negative impact on a clients’ ability to properly manage other chronic conditions, such as diabetes, arthritis and heart disease.
Trapped in a fragmented healthcare system with undiagnosed or untreated behavioral health problems may occur when there is a lack of coordination between primary care and behavioral healthcare. While mental health concerns constitute a significant challenge to whole-person care, the case manager also must integrate a client’s housing, transportation and food resources in order to integrate a plan that legitimately and logistically work within a client’s current circumstances. Without this integration, the healthcare system increases the likelihood of poor outcomes for the client and increasing costs for the system.
Care Plans That Stretch Further
A key part of a case manager’s ability to be successful is connecting with the client and the healthcare system on a personal level. Case managers must understand a client’s values, cultural influences, and life circumstances in order to develop a successful plan of care that will optimize patient outcomes.
Through strong relationships with clients and providers, a care manager can positively influence a clients’ use of community resources and a providers’ perspective on the total needs of the client. By working across disciplines, organizations, and social service agencies, the goal of whole-person care can be met.
SOURCES
The King’s Fund and the Nuffield Trust
The Evidence Base for Integrated Care https://www.kingsfund.org.uk/sites/default/files/Evidence-base-integrated-care2.pdf
The American Journal of Hospice and Palliative Care, 2018;35(1):104 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704566/
Mental Health America, Co-Occurring Disorders and Depression, http://www.mentalhealthamerica.net/conditions/co-occurring-disorders-and-depression