Measuring Health Matters: Our Path to Partnership
What if health plans were equipped to more fully support care providers treating patients? What if health plans could help them identify patients' most significant needs with evidence-based tools — tools that help care providers make point-of-care decisions in their patients' best interest?
What if health plans and care providers viewed the individual the same way: as a person with various conditions, unique social needs, and complex circumstances? Would improving the disconnect between care providers and health plans lead to better partnerships with the possibility of treating the whole person?
The disconnect in how care providers and health plans see each person can be devastating. Disparities in health and healthcare can arise from a range of factors:
- Cultural differences
- Structural racism
- Predisposing risk factors
- Variations in quality of healthcare
- Social needs, such as lack of access to healthy foods, reliable transportation, social isolation/loneliness, caregiving burnout, and safe/stable housing
Bringing together those factors and understanding their individual contributions is essential to improve the quality of healthcare and reduce inequities. The toll of the disconnect and the resulting health inequities are reaching a tipping point — and health plans and care providers must work together to resolve them.
Working in Partnership
We know care providers do their best to treat their patients, making critical decisions and providing the best care possible. Knowing that 80% of a patient's health experience happens outside of the doctor's office,13 much remains unknown for care providers and health plans regarding social circumstances and experiences that happen outside the care provider's purview and what a health plan captures in claims and clinical data.
Together, we have an incredible opportunity to start with a common, holistic view of a person's health, utilizing that view to identify solutions that address their most pressing needs. Assembling a person's entire health journey will help care providers make evidence-based decisions. Building the journey begins with understanding our consumers deeply. Then, we can understand not only their conditions, encounters, and circumstances, but layer them together and understand how they interact to make up the person's full experience.
Understanding the full journey requires measuring whole health. We know that consumers have unique and complex sets of conditions, different access to preventive care, and diverse social needs that greatly impact their overall health. To understand what those inequities are — the intersection of how their physical, behavioral, social, and pharmacy needs weave together — we've developed a tool, the Whole Health Index (WHI). This tool quantifies an individual's relative health and reveals their most critical needs.
How the Whole Health Index Works
Adopting the framework from the National Academy of Medicine's Vital Signs, the WHI incorporates physical, behavioral, and social needs into one score, equally weighted between social needs and clinical needs.
Each consumer is scored on a scale of 1 to 100, with a score of 100 indicating the best possible health, for example, no chronic conditions, staying up to date with recommended healthcare services, and living in an area impacted by fewer health-related social needs, while a zero score indicates poor health.
The WHI has been calculated for over 40 million people14 with one of our affiliated health plans across all lines of business, including Medicare, Medicaid, Dual-Eligible, and Commercial. It is used 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. It allows us to evaluate consumers' relative health over time and measure racial and economic inequities associated with their health.
Elevance Health is committed to better synchronizing all aspects of healthcare to drive measurable improvements in costs and quality. The WHI has allowed us to effectively assemble, measure, and begin to understand whole health. Its true potential lies in being able to partner effectively with our care provider partners to co-develop solutions and enable them to make evidence-based decisions to address an individual's most critical needs.
We will continue our efforts to help improve the quality of care, reducing health inequities and advancing healthcare affordability.