Committing to Whole Health

Elevance Health's Shantanu Agrawal, MD, Chief Health Officer, and Felicia Norwood, EVP and President of Government Business Division, discuss how we're partnering with care providers to advance whole health.

Felicia Norwood: So, you know, despite decades of attempts to improve healthcare quality and lower costs, the healthcare system just hasn't seen enough progress.

Dr. Shantanu Agrawal: You are totally right about that, and I think there's a really complicated answer as to the why. The U.S. healthcare system is one of the most sophisticated in the world. But it's also, unfortunately, one of the most costly and delivers uneven outcomes. Healthcare is more fragmented than ever due to the specialized nature of the delivery system. Despite decades of focus as a country, we haven't significantly improved outcomes or costs.

A significant factor is that as much as 80% of health is driven by factors outside the traditional healthcare system. We've known this for some time, and yet the focus has remained on what we do inside the healthcare delivery system. But today, with greater perspective, we see this as an opportunity to improve health.

Felicia Norwood: So, let's talk about that opportunity and how we are achieving this broader view of health and facilitating that change.

Shantanu Agrawal: What we're really talking about is whole health, inside and outside of the healthcare system. We know that understanding health in a more personalized and holistic way is critical to improving outcomes. It's why measuring health through rigorous research matters so much. But the system today isn't set up in a way that makes it easy to see a person's whole health.

Whole health means looking at the most powerful factors that drive health for each person. This requires a broader and more personal view of health and the resulting support. Together, with our care providers, we can work differently, in tighter partnership, from each of our points of strength.

Felicia Norwood: You know, an integrated view of health is critical for all of us. The key is to take a personalized and holistic approach. In the government business, our consumers rely more heavily on the healthcare system due to their age, their income, their disabilities. So, we have a responsibility to do more to level the playing field for these consumers.

Looking at care providers, many seem to be embracing the move from a fee-for-service model to value-based care. This is good news in terms of health outcomes and healthcare affordability. Our peers are making investments in the traditional model, but at Elevance Health, our approach is different. We continue to build our strategy through partnerships, building a more holistic view and system of broader support.

We are focused on improving health where we see the greatest potential, building a more complete view, and better leveraging the factors that we know drive improved health. We believe it is the best path to improving quality, value, and healthcare affordability.

Shantanu Agrawal: While the shift in our approach will take time, it's worth it, and it's working.

Felicia Norwood: I know we still have a lot of work to do, but we're making meaningful progress.

Why Should We All Commit to Whole Health?

Contributing expert: Shantanu Agrawal, MD

The way Elevance Health defines health is evolving. With 80% of a person's health driven by what happens outside the doctor's office,^* health is no longer just about receiving treatments and tests; we believe it's about caring for the whole person.

Our broader, whole-health view — created and driven by medical, pharmacy, social, and behavioral factors that influence health — helps achieve better outcomes. The case for a broader definition is well-documented, but the overall healthcare system remains organized around a narrower definition of health.

That's why we are working to create a better system — one that supports the whole health of the people we serve. Such a focus is critical to improve access to care, raise value, raise quality, coordinate care, and address affordability. It is what differentiates us — and our care provider partners.

We focus on the most pressing opportunities by recognizing inequities and understanding our consumers' clinical and social needs relative to a broader population. Our Whole Health Index enables us to take action, including deploying strategies, programs, and interventions aimed at the right consumers; identifying evidence-based solutions; improving decision-making; and driving quality improvement, step by step, hand in hand, with our care provider partners.

80%

of a person's health is driven by what happens outside the doctor's office

Advancing Whole Health

By integrating the drivers of a person's health, we see a bigger picture. When we share that knowledge and data beyond doctors and hospitals to include all care providers, they can address needs more holistically and see a person's whole health.

The traditional healthcare system fragments care by focusing on a particular disease, diagnosis, or condition. We purposefully swim against that approach, proactively integrating our capabilities to create a holistic view. This enables care providers to determine how to help an individual most effectively. That may mean leveraging not only traditional healthcare and medications but community and home-based services based on an understanding of a person's specific needs.

When we consider each person's full experience, we go beyond treating a disease, diagnosis, or condition to help them achieve optimal health.

Drivers of Whole Health

It's important to keep in mind that these social, physical, and behavioral drivers can overlap and impact each other. To achieve optimal health, we must address what drives health:

Physical drivers

Functional status
Physical well-being
Body systems

Social drivers

Housing and transportation
Food and nutrition
Income
Health literacy and accessible care (affordable, free from bias)
Loneliness and isolation

Behavioral drivers

Psychological factors, such as mental health and substance use disorders
Reactions to external factors

The Need for Health Equity

Our work to improve whole health is anchored in the need to advance health equity — when everyone has a fair and just opportunity to be as healthy as possible. Health equity is not a product or vertical line of service. We believe we must proactively design for the outcome we want to achieve — health equity — and, as such, it must be embedded and reflected in all that we do across all of our lines of business, including our processes, practices, programs, and products.

More specifically, our strategic approach, termed "health equity by design," is a personalized and intentional approach to ensure that all people, regardless of race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access, can receive individualized care. It's about optimizing health at the individual level for all.

We know that our customers — the businesses, states, and individuals we serve — are invested in advancing health equity as well.

Measuring Whole Health

Data and technology allow us to understand whole health, personalize healthcare, and empower people — all of which help improve individual health and advance equity. In fact, we developed the Whole Health Index (WHI) to understand individual needs better to best support and improve an individual's health.

This index takes an integrated approach that considers the physical, behavioral, and social drivers of care to assess an individual's overall health, identify opportunities to address different health status drivers, and advance efforts within the care delivery ecosystem to improve the whole health of our consumers and communities.

Forward Together

Achieving real whole health — at the individual and societal level — requires immense commitment and sustained collaboration between care providers, employers, government leaders, and payers alike.

At Elevance Health, partnering with care providers to address whole health and its drivers is the hallmark of our business strategy. To get there, we are:

Contracting for outcomes.
Collaborating for success.
Connecting for health.

Advancing health is only possible by working together.

^*U.S. Department of Health and Human Services. Community Health and Economic Prosperity: The Problem, the Causes, the Opportunities, and the Solutions—At a Glance (January 2021): hhs.gov/sites/default/files/chep-sgr-at-a-glance.pdf.

The Case for Change

Understand how trends emphasize needed change