Measuring Health Matters

Contributing experts: Marcus Wilson, PharmD, Qi Zhou, MD, and Kevin Bowman, MD

As healthcare stakeholders, we all share a universal purpose: to improve the health of the people we serve. We believe working with our care provider partners is key; at the same time, we must identify the factors that contribute to whole health and transform them into quantifiable measures — then make them actionable.

Quantifying Whole Health

Physical, behavioral, and social needs all contribute to a person's whole health. To understand how those factors influence the health of the consumers we serve, we developed the Whole Health Index. The externally validated tool quantifies each consumer's relative health and reveals their most critical needs, giving us information to help improve their health — and health equity.

The Whole Health Index uses consumer- and area-level data from 93 measures representing physical, behavioral, and social factors. That information comes together to create a single score to quantify each consumer's whole health.

Whole Health Index (WHI)

Whole Health Index breakdown:
Social Drivers Domain (50% of WHI): Financial strain (36.67%); housing instability (22%); affordability (18.33%); food insecurity (16%); transportation barriers (6%); neighborhood composition (1%).

Clinical Quality Domain (20% of WHI): Cardiovascular care, diabetes care, oncology, respiratory care (40%); overuse/appropriateness, patient safety (20%); access to care, prevention, screening (10%); acute care utilization, care coordination (10%); behavioral health (10%); women's health (10%).

Global Health Domain (30% of WHI): Presence of both acute and chronic conditions (100%).

Social Drivers Domain
(50% of WHI)

  • Financial strain (36.67%)
  • Housing instability (22%)
  • Affordability (18.33%)
  • Food insecurity (16%)
  • Transportation barriers (6%)
  • Neighborhood composition (1%)

Clinical Quality Domain
(20% of WHI)

  • Cardiovascular care, diabetes care, oncology, respiratory care (40%)
  • Overuse/appropriateness, patient safety (20%)
  • Access to care, prevention, screening (10%)
  • Acute care utilization, care coordination (10%)
  • Behavioral health (10%)
  • Women's health (10%)

Global Health Domain
(30% of WHI)

  • Presence of both acute and chronic conditions (100%)

When compared to other population health management tools, the Whole Health Index is different. No other index we're aware of draws from such a comprehensive set of area- and consumer-level social and clinical risk factors to inform health.1

External Validation of Our Methodology

We believe our Whole Health Index has the potential to become a universal measure for the greater healthcare industry, which is why we've been transparent about our methodology. By sharing it, we hope to encourage wider adoption of the index among industry stakeholders.

To prove the Whole Health Index's effectiveness and practicality, we enlisted the help of the research and data analytics consultancy firm Mathematica. An assessment in partnership with their policy research team demonstrated that the index is a valid measure of whole health for individuals and geographic populations.

Those findings were reported in NEJM Catalyst, a peer-reviewed journal featuring innovations in improving the healthcare delivery system.1 The 2023 article — The Whole Health Index: A Practical, Valid, and Reliable Tool to Measure Whole-Person Health and Manage Population Health — highlighted our methodology, as well as the results we've seen across the 45 million people for whom we've calculated Whole Health Index scores.1

Comparing Our Metrics to the Industry

We've also studied the relationship between industry benchmarks and Whole Health Index scores. We've seen evidence that Whole Health Index scores generally trend higher for patients of care providers performing especially well in external quality and efficiency metrics, like preventive care and healthcare services for chronic conditions. Those patient populations have Whole Health Index scores approximately 4% higher than lower-performing care providers' patient populations.2

This tells us that clinical quality performance measured by external industry benchmarks translates to real impacts on individual patients' well-being. Our findings also underscore how important it is to expand access to care providers with a record of delivering high-quality, efficient care, while supporting every care provider's efforts to improve.

Additionally, we've looked at the relationship between value-based care and health equity. Medicare consumers with social risk factors (eligibility for low-income subsidy, dual Medicare-Medicaid coverage, or disability benefits) who see care providers participating in value-based care arrangements have better outcomes in external quality metrics compared to nonparticipating care providers.2

Trends Among Our Consumers

Our Whole Health Index scale ranges from 0 (worst health) to 100 (best health). Scores for the consumers we serve range from 9.17 to 90.75, with average and median scores coming in at just over 53.1

This figure represents the Whole Health Index assessment of the consumers Elevance Health serves, based on a sample size of 45 million people over a 12-month period (July 1, 2021 to June 30, 2022).

Generally, Whole Health Index scores trend lower for historically socially vulnerable population subgroups, such as:1

  • Rural residents.
  • Women.
  • Older adults.
  • People dually eligible for Medicare and Medicaid.
  • Black, Hispanic, and Native American people.

We've also observed lower assessment in the southeastern United States, when compared to states in the Northeast.

Improving Outcomes with the Whole Health Index

Identifying whole-health drivers is the first step to improving them, especially for populations with poor whole health. Our findings allow us to personalize interventions and connect people with the right solutions to meet their needs, whether they are delivered by our care providers or community organizations focused on social drivers of health.

That's the focus of our Whole Health Improvement Now (WIN) program. It makes the Whole Health Index actionable. By using Whole Health Index data, we identify consumers and their families with the poorest health and greatest social needs. Then, we connect each person to our social care solutions partner to offer support for addressing social drivers of whole health.

Here's an example of how we're making a difference with the Whole Health Index: We targeted people with Whole Health Index scores in the bottom 25th percentile in hopes of increasing their flu vaccination rates.3 As a result, the group was vaccinated at a rate of up to 18% higher than others with higher Whole Health Index scores.3

1 Winnie C. Chi, PhD, MS, J. Marc Overhage, MD, PhD, Todd Sponholtz, PhD, MPH, Binh T. Nguyen, PhD, Peter Brady, MBA, April Falconi, PhD, MPH, MA, Martha Johnson, PhD, et al.: The Whole Health Index: A Practical, Valid, and Reliable Tool to Measure Whole-Person Health and Manage Population Health. New England Journal of Medicine Catalyst (May 2023): https://catalyst.nejm.org/doi/full/10.1056/CAT.23.0015. 2 Elevance Health, internal analysis (2023). 3 Elevance Health, internal data, flu season 2022 (July 2022 to June 2023).