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1 Introduction
Pages 17-32

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From page 17...
... In 2009 the IOM summary of the Summit on Integrative Medicine and the Health of the Public noted the importance of integrating the best conventional care, fully engaging informed people so they achieve better health, and including the full range of approaches to enhancing health and wellness as well as to preventing and addressing chronic disease (IOM, 2009)
From page 18...
... Its people-centered, integrative, and transformative approach to health care is intended to create and enable health and well-being by incorporating individuals' goals and priorities into their health care decisions. The VA WHS care model includes peer-led support, personalized health planning, coaching, wellbeing courses, and integrated evidence-based conventional, complementary, behavioral, and integrative practices with the goal of addressing the social determinants of health.
From page 19...
... Within this context, the VA has made various efforts to advance the concept of people-centered care and whole-person health care by adding features to standard medical care, such as comprehensive mental health care integrated into primary care, patientcentered primary care homes, complementary and integrative health,1 and efforts to address social determinants of health. VA WHS, which the VA first implemented in 2018 at 18 pilot sites and is now promoting at all 171 of its medical centers, is perhaps the most advanced example of an effort to implement a new paradigm of care based on the premise of system transformation to support veterans' health, recovery, and well-being.
From page 20...
... The same analysis showed differences of up to 18 years in life expectancy at birth among groups of different races and ethnicities. Most of the widening gap in life expectancy between the United States and other countries is due to an increase in mid-life mortality caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases (Woolf and Schoomaker, 2019)
From page 21...
... . STUDY APPROACH The Committee on Transforming Health Care to Create Whole Health: Strategies to Assess, Scale, and Spread the Whole Person Approach to Health comprised 18 members with a broad range of expertise, including people-centered clinical care, nursing, primary care, health care systems in general, the VA health care system in particular, health care disparities, health care policy, health services research, integrative medicine, behavioral health, social work, community wellness, psychiatry, pharmacy, and the social determinants of health.
From page 22...
... The committee will consider the foundational elements of an integrated whole health model but will not be charged with identifying specific interventions that should be included in whole health models of care or defining specific  evidentiary standards for making those decisions. The committee will identify research designs to study individual components of these delivery models as well as implementation science strategies for integrating these components into a single system of care.
From page 23...
... (Identifying barriers and facilitating conditions to scale and clinically integrate whole health care both within and outside the VA) • How can the VA accelerate clinical integration with commu nity services to expand whole person care to veterans who receive their care outside the VA through the VA MISSION Act provisions; • How could the Veterans Equitable Resource Allocation system facilitate the transformation to whole health within the VA and also inform models in the private sector; • What payment and financing models for use in the private sector could enable clinical integration of value-based, whole person, population health beyond the VA; and • What strategies can be used to overcome barriers to scaling and implementing components of the whole health approach, such as integration of mental health, complementary and inte grative health, health coaching, peer-to-peer approaches, and well-being programs?
From page 24...
... The speakers provided valuable input on a broad range of topics, including integrative approaches for women veterans, spiritual care, health coaching, people-centered system design, the COVER report, the VA Whole Health Initiative, and the work of the Whole Health Institute. To further inform its work, the committee commissioned three papers on the following topics: evidence on patient-centeredness, patient-centered systems, and implementation and scaling of whole person health; whole health in VA health care, including insights on implementation, research, and future evaluations; and lessons for whole health from other health systems.3 With the help of National Academies staff, the committee also completed an extensive search of the peer-reviewed literature, ultimately considering more than 5,000 articles and targeting English-language articles published since 2001 on topics including where whole health is currently being implemented; what whole health accomplishes; what factors affect the performance of whole health; the VA Whole Health Initiative; and health system transformation.
From page 25...
... While high-quality primary care plays a critical role in achieving this, adequately building new systems around a whole health approach will require redefining the very notion of health from a reactive, treatment-based approach, which is the norm today, to one that is more proactive and focused on the five foundational elements of whole-person health systems. About the VA The VA comprises three organizations: the Veterans Health Administration (VHA)
From page 26...
... VA Health Care Through VHA, the VA health care system is the largest integrated health care system in the United States, providing care for veterans of the U.S. armed forces discharged under other than dishonorable conditions through 18 veterans integrated service networks, which are regional systems of care working together to better meet local health care needs and provide greater access to care (VA News, 2022)
From page 27...
... New programs provide treatment for traumatic brain injuries, post-traumatic stress disorder, suicide prevention, issues unique to women veterans, and more. While historically the quality of VA-delivered health care has been variable, VA enacted a series of reforms starting in 1995 which have significantly improved care delivery, quality of care, and outcomes (Kizer, 1995)
From page 28...
... According to the study investigators, who are conducting a multiyear study of the WHS transformation, efforts to support veterans and employees included patient wellness calls and promoting complementary and integrative health therapies, self-care, and whole health concepts to combat stress and support well-being (Dryden et al., 2021)
From page 29...
... health care because few existing systems have grappled with the realization that individuals, families, and communities cannot achieve and maintain health without a realignment of forces to assess and address upstream factors of health, including social determinants, as an integral feature of all health care. Similarly, fragmented payment systems, health information technology systems, workforce shortages, and unequal access to services further complicate the scale and spread of a national whole health system.
From page 30...
... The remainder of this report lays out the committee's analysis of VA's WHS as well as of similar efforts conducted by other health systems in the United States and internationally. Chapter 2 provides the committee's definition of a whole health approach, one that starts with VA's definition and describes in detail the five foundational elements that are essential to any whole health system.
From page 31...
... 2021. 2021 Military Family Support Programming Survey.
From page 32...
... 2018. How evolving United States payment models influence primary care and its impact on the quadruple aim.


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