Whole Health

VA’s Whole Health approach lets Veterans make use of clinical and complementary care to help them live healthier lives.

A new progress report shows improvement in the lives of Veterans who use Whole Health services.

The report gives updates from a three-year pilot study monitoring the effects of adding a Whole Health approach at 18 VA flagship sites. Whole Health is an approach to care where clinical care (such as medicines or counseling) and complementary care (such as acupuncture or yoga) work together as part of an overall treatment plan. A Whole Health approach lets Veterans make use of all appropriate therapies to help them explore what matters most in their health and well-being and live healthier lives.

The progress report—VA Center for the Evaluation of Patient Centered Care (EPCC): Whole Health Flagship Site Evaluation—now offers a glimpse into the success of the study after two years. Early results show higher employee engagement and early signs of potential cost savings in pharmacy and outpatient care.

But perhaps most importantly, the study reveals positive impacts of Whole Health on Veterans.

Veterans with chronic pain who used Whole Health services had a threefold reduction in opioid use compared to those who did not. Opioid use among Whole Health users decreased 38% compared with only an 11% decrease among those with no Whole Health use. Veterans who used Whole Health services also reported being able to manage stress better and noted the care they received as being more patient centered. These results indicate improvements in Veterans’ overall well-being.

The demand for Whole Health services remains high. Over 97% of Veterans responded they were either somewhat interested, very interested or already using at least one Whole Health service. During interviews for the report, Whole Health leads shared several stories of the impact of Whole Health approaches on Veterans, including reductions in the use of opioids and other pain medications, weight loss, smoking cessation, and improvements in mental health.

Whole Health leaders attributed these changes, in part, to a radical shift in approach to health care, from one that fosters dependence on medical professionals to one that empowers Veterans and promotes their active partnership with a medical team as they figure out what health and well-being looks like for them.

Equally noted was the effect Whole Health had on VA employees, many of whom are Veterans themselves. Employees involved with Whole Health at the flagship sites reported lower burnout, lower voluntary turnover, greater motivation, and were more likely to rate their facility as a ‘best place to work.’

Initial findings also suggest that using Whole Health services may reduce pharmacy costs. Whole Health service use among Veterans with mental health conditions (such as PTSD, anxiety and depression) was associated with smaller increases in outpatient pharmacy costs (3.5% annual increase) compared to similar Veterans who did not use Whole Health services (12.5% annual increase). Additionally, Whole Health service use among Veterans with chronic conditions was associated with smaller increases in outpatient pharmacy costs (4.3% annual increase) compared to similar Veterans who did not use Whole Health services (15.8% annual increase).

“These are early findings, but even so the opioid outcomes are striking, and we’re seeing this is good for employees and the system,” said Barbara Bokhour, Ph.D., the Principal Investigator for the study, and the Director of VA’s Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research at the Bedford and Boston VAMCs. “This may take as many as 7-10 years to adopt a Whole Health approach across VA, and we have to ask, is this the way VA should go? Early findings are saying yes.”

Improving Veterans’ experiences with care may in turn improve Veteran engagement and foster better self-management of chronic illnesses. And self-management is critical to better health and well-being over time. Implementation of a Whole Health approach is complex and takes time. Yet, early findings demonstrate that when Veterans engage in Whole Health services, improvements in perceptions of care, engagement in care, and well-being are possible.

Additional resources regarding this report can be found below:

• VA Center for the Evaluation of Patient Centered Care (EPCC): Whole Health Flagship Site Evaluation report
• Infographic on Whole Health Evaluation Report

Funding for this report was provided by VA’s Quality Enhancement Research Initiative (QUERI) and the Office of Patient-Centered Care and Cultural Transformation.