A New Standard for Human-Centered Healthcare

In today’s healthcare landscape, diagnoses rule. A patient diagnosed with diabetes is prescribed a regimented program aimed at improving diet and exercise and monitoring blood glucose levels. A physician treating a Medicare patient is paid based on the patient’s Diagnosis Related Group (DRG).

While diagnoses help us quantify and understand diseases, they can also draw focus away from the individual being treated. In her blog post in the New York Times, Pauline W. Chen, M.D. notes, “When we know what is wrong, we sometimes stop paying such close attention to those patient experiences that seem to have little relevance to the diagnosis at hand”.

Oftentimes, these patient experiences and life factors turn out to be the true underlying issue. For example, a physician might tell a diabetic with uncontrolled glucose to eat healthier and exercise more. But perhaps that patient recently lost a loved one, or has been struggling with depression, or perhaps it’s difficult for them to find time to shop for fresh fruits and vegetables. Without addressing these life factors, the diet and exercise are unlikely to change.

Historically, mental health, social work, and other specialty services have been separate from the primary care setting. However, recent literature has challenged this model by showing that untreated mental illnesses can exacerbate the risk for developing chronic conditions. For example, researchers found that people with a mental illness are at a higher risk of developing heart disease, and vice versa. It highlights a key issue: there is a deeply interwoven relationship between components of our overall health that include our physical, mental, and social health.

In recent years, the healthcare industry has begun to shift away from the traditional silos towards a more integrated model. Quality initiatives like HEDIS and DSRIP have incentivized organizations to implement integrated care in the primary care setting (i.e. providing mental health evaluations to patients coming in for a PCP visit). Integration is also becoming more prevalent in the treatment of a spectrum of different health conditions:

• Diabetes and Depression – current gold standard of care that utilizes a physician for the medical intervention and an interventionist to address a patient’s financial, social, and emotional needs.
• Medication-Assisted Treatment – the most effective care for patients abusing opioids. This treatment aims to prevent relapse by providing behavioral therapy in addition to medication, and does so using a team of physicians, therapists, case managers, and/or social workers.
• Collaborative Care for Dementia – the leading type of care for patients with dementia. This addresses mental and social health by utilizing a care team composed of a physician, nurse, social worker, and occupational therapist.

Each of these integrated models of care have emerged as the gold standard of treatment. The common thread across each of these care models is a team of interdisciplinary professionals who collaborate to address factors beyond the walls of the clinic.

Patients are more than a diagnosis – patients are people, and it is vital to treat them as such. Each individual has a different set of physical, mental, and social situations in their lives, and the way one component influences another may differ drastically from person to person. Using an integrated team allows for specialized care at each component while aligning around the overarching goal of providing human-centered health care.