Interoperability: The Foundation of Whole Person Care

Whole person care is a set of coordinated health and human services that addresses the holistic wellbeing of an individual, including physical, mental and socioeconomic factors. Excellence in whole person care requires integration and coordination of multiple programs, such as Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), housing programs, and more. It also means addressing immediate needs for members in distress and long-term needs for members at risk. Once wellness is restored, whole person care focuses on advisory assistance to promote self-sufficiency and continued self-improvement.

Why Whole Person Care is Challenging?

Although whole person care is a promising approach, adoption to date has been slow. Research from the Commonwealth Fund found that health information technology was one of the top three barriers to advancing integrated care. Although some aspects of whole person care can be handled with manual processes or basic IT systems, more advanced activities like coordination of care across multiple health and human services is impossible without a more sophisticated infrastructure.

Based on our experience at Gainwell, we believe that three elements are critical for a successful whole person care model: 

  1. Empowering members with self-service tools. This provides seamless and streamlined member experiences. 
  2. Improving services and access to them. It’s essential to remove barriers for members, as well as providers.
  3. Providing outreach and education. Increased member engagement helps to encourage behavioral changes. 

This three-pronged approach requires both policy and technology enablement to achieve its goals. If privacy and data protection policies aren’t clearly understood and carefully implemented, for example, they may become a roadblock to effective utilization of social determinants of health and delivery of whole person care. Suitable technology solutions must enable secure, well-controlled information sharing, while guiding the journey to wellness. 

When it comes to data sharing, interoperable systems are the key. Interoperability facilitates a variety of essential aspects of whole person care including case finding, screening and referral to care; multidisciplinary care teams and ongoing care management; systemic quality improvement efforts; information tracking and exchange between providers; and linking individuals to community and social services. 

Interoperability as a Service Can Help

To conform to new federal interoperability standards for state payer use, Medicaid agencies must either update or replace their EDI platforms. If existing systems can’t meet the new requirements, CMS will pay for a new solution at a 90 percent match and allow agencies up to two years to move to another system.

Gainwell’s cloud-based Interoperability as a Service is a great option to support whole person care, while simultaneously meeting federal requirements. It provides unlimited scalability, seamless access to system improvements over time and greater ROI and adaptability than on premise solutions. During implementation, standard and custom data transformation mapping is completed, as well as trading partner setup and maintenance. 

Gainwell’s commitment to whole person care extends beyond interoperability, as well. We can provide additional critical enabling technologies and assistance with privacy and data protection laws. To learn more, feel free to contact us

The editorial staff had no role in this post's creation.