A National Blueprint for Whole Health Transformation
Despite spending over 17% of GDP on health care, Americans live shorter and less healthy lives than their peers in other high-income countries. Rising chronic disease and mental health challenges as well as clinician burnout expose the limits of a system built to treat illness rather than create health. Addressing chronic disease while controlling healthcare costs is a bipartisan goal, the question now is how to achieve this shared goal? A policy window is opening now as Congress debates health care again – and in our view, it’s time for a “whole health” upgrade.
Whole Health is a proven, evidence-based framework that integrates medical care, behavioral health, public health, and community support so that people can live healthier, longer, and more meaningful lives. Pioneered by the Veterans Health Administration, Whole Health offers a redesign to U.S. health and social systems: it organizes how health is created and supported across sectors, shifting power and responsibility from institutions to people and communities. It begins with what matters most to people–their purpose, aspirations, and connections–and aligns prevention, clinical care, and social supports accordingly. Treating Whole Health as a shared public priority would help ensure that every community has the conditions to thrive.
Whole Health is a systems framework that aligns health care, public health, and community & social systems to create the conditions for well-being. Guided by five principles—People-Centered, Upstream-Focused, Equitable & Accountable, Comprehensive & Holistic, and Team Well-Being—the framework is put into practice through models such as the VA Whole Health System, which centers on Meaning and Purpose and operates through three core functions: Empower, Equip, and Care. (Adapted from the National Academies of Sciences, Engineering, and Medicine, Achieving Whole Health, 2023, and the Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, 2019.)
Challenge and Opportunity
The U.S. health system spends over $4 trillion annually, more per capita than any other nation, yet underperforms on life expectancy, infant mortality, and chronic disease management. The prevailing fee-for-service model fragments care across medical, behavioral, and social domains, rewarding treatment over prevention. This fragmentation drives costs upward, fuels clinician burnout, and leaves many communities without coordinated support.
At this inflection point in our declining health outcomes and growing public awareness of the failures of our health system, federal prevention and public health programs are under review, governors are seeking cost-effective chronic disease solutions, and the National Academies is advocating for new healthcare models. Additionally, public demand for evidence-based well-being is growing, with 65% of Americans prioritizing mental and social health. There is clear demand for transformation in our health care system to deliver results in a much more efficient and cost effective way.
Veterans Health Administration’s Whole Health System Debuted in 2011
Whole Health offers a system-wide redesign for the challenge at hand. As defined by the National Academies of Sciences, Engineering, and Medicine, Whole Health is a framework for organizing how health is created and supported across sectors. It integrates medical care, behavioral health, public health, and community resources. As shown in Figure 1, the framework connects five system principles—People-Centered, Upstream-Focused, Equitable & Accountable, Comprehensive & Holistic, and Team Well-Being–that guide implementation across health and social support systems. The nation’s largest health system, the Veterans Health Administration’s (VHA), has demonstrated this framework in clinical practice through their Whole Health System since 2011. The VHA’s Whole Health System operates through three core functions: Empower (helping individuals define purpose), Equip (providing community resources like peer support), and Clinical Care (delivering coordinated, team-based care). Together, these elements align with what matters most to people, shifting the locus of control from expert-driven systems to shared agency through partnerships. The Whole Health System at the VHA has reduced opioid use and improved chronic disease outcomes.
Successful State Examples
Beyond the VHA, states have also demonstrated the possibility and benefits of Whole Health models. North Carolina’s Healthy Opportunities Pilots extended Medicaid coverage to housing, food, and transportation, showing fewer emergency visits and savings of about $85 per member per month. Vermont’s Blueprint for Health links primary care practices with community health teams and social services, reducing expenditures by about $480 per person annually and boosting preventive screenings. Finally, the Program of All-Inclusive Care for the Elderly (PACE), currently being implemented in 33 states, utilizes both Medicare and Medicaid funding to coordinate medical and social care for older adults with complex medical needs. While improvements can be made to national program-wide evaluation, states like Kansas have done evaluations that have found that the PACE program is less expensive than nursing homes per beneficiary and that nursing home admissions decline by 5% to 15% for beneficiaries.
Success across each of these examples relies on three pillars: (1) integrating medical, behavioral, social, and public health resources; (2) sustainable financing that prioritizes prevention and coordination; and (3) rigorous evaluation of outcomes that matter to people and communities. While these programs are early signs of success of Whole Health models, without coordinated leadership, efforts will fragment into isolated pilots and it will be challenging to learn and evolve.
A policy window for rethinking the health care system is opening. At this national inflection point, the U.S. can work to build a unified Whole Health strategy that enables a more effective, affordable and resilient health system.
Plan of Action
To act on this opportunity, federal and state leaders can take the following coordinated actions to embed Whole Health as a unifying framework across health, social, and wellbeing systems.
Recommendation 1. Declare Whole Health a Federal and State Priority.
Whole Health should become a unifying value across federal and state government action on health and wellbeing, embedding prevention, connection, and integration into how health and social systems are organized, financed, and delivered. Actions include:
- Federal Executive Action. The Executive Office of the President should create a Whole Health Strategic Council that brings together Veterans Affairs (VA), Health and Human Services (e.g. Centers for Disease Control and Prevention, Centers for Medicare and Medicaid (CMS), and Health Resources and Services Administration (HRSA)), Housing and Urban Development (HUD), and the U.S. Department of Agriculture (USDA) to align strategies, budgets, and programs with Whole Health principles through cross-agency guidance and joint planning. This council should also work with Governors to establish evidence-based benchmarks for Whole Health operations and evaluation (e.g., person-centered planning, peer support, team integration) and shared outcome metrics for well-being and population health.
- U.S. Congressional Action. Authorize whole health benefits, like housing assistance, nutrition counseling, transportation to appointments, peer support programs, and well-being centers as reimbursable services under Medicare, Medicaid and the Affordable Care Act health subsidies.
- State Action. Adopt Whole Health models through Medicaid managed-care contracts and through CDC and HRSA grant implementation. States should also develop support for Whole Health services in trusted local settings such as libraries, faith-based organizations, senior centers, to reach people where they live and gather.
Recommendation 2. Realign Financing and Payment to Reward Prevention and Team-Based Care.
Federal payment modalities need to shift from a fee-for-service model toward hybrid value-based models. Models such as per-member-per-month payments with quality incentives, can sustain comprehensive, team-based care while delivering outcomes that matter, like reductions in chronic disease and overall perceived wellbeing. Actions include:
- Federal Executive Action. Expand Advanced Primary Care Management (APCM) payments to include Whole Health teams, including clinicians, peer coaches, and community health workers. Ensure that this funding supports coordination, person-centered planning, and upstream prevention, such as food as medicine programs. Further, CMS can expand reimbursements to community health workers and peer support roles and standardize their scope-of-practice rules across states.
- U.S. Congressional Action. Invest in Medicare and Medicaid innovation programs, such as the CMS Innovation Center (CMMI), that reward prevention and chronic disease reduction. Additionally, expand tools for payment flexibility, through Medicaid waivers and state innovation funds, to help states adapt Whole Health models to local needs.
- State Action. Require Medicaid managed-care contracts to reimburse Whole Health services, particularly in underserved and rural areas, and encourage payers to align benefit designs and performance measures around well-being. States should also leverage their state insurance departments to guide and incentivize private health insurers to adopt Whole Health payment models.
Recommendation 3. Strengthen and Expand the Whole Health Workforce.
Whole Health practice needs a broad team to be successful: clinicians, community health workers, peer coaches, community organizations, nutritionists, and educators. To build this workforce, governments need to modernize training, assess the workforce and workplace quality, and connect the fast-growing well-being sector with health and community systems. Actions include:
- Federal Executive Action. Through VA and HRSA establish Whole Health Workforce Centers of Excellence to develop national curricula, set standards, and disseminate evidence on effective Whole Health team-building. Further, CMS should track workforce outcomes such as retention, burnout, and team integration, and evaluate the benefits for health professionals working in Whole Health systems versus traditional health systems.
- U.S. Congressional Action. Expand CMS Graduate Medical Education Funds and HRSA workforce programs to support Whole Health training, certifications, and placements across clinical and community settings.
- State Action. As a part of initiatives to grow the health workforce, state governments should expand the definition of a “health professional” to include Whole Health practitioners. Further, states can leverage their role as a licensure for professionals by creating a “whole health” licensing process that recognizes professionals that meet evidence-based standards for Whole Health.
Recommendation 4. Build a National Learning and Research Infrastructure.
Whole Health programs across the country are proving effective, but lessons remain siloed. A coordinated national system should link evidence, evaluation, and implementation so that successful models can scale quickly and sustainably.
- Federal Executive Action. Direct the Agency for Healthcare Research and Quality, National Institutes of Health, and partner agencies (VA, HUD, USDA) to run pragmatic trials and cost-effectiveness studies of Whole Health interventions that measure well-being across clinical, biomedical, behavioral, and social domains. The federal government should also embed Whole Health frameworks into government-wide research agendas to sustain a culture of evidence-based improvement.
- U.S. Congressional Action. Charter a quasi-governmental entity, modeled on Patient-Centered Outcomes Research Institute (PCORI), to coordinate Whole Health demonstration sites and research. This new entity should partner with CMMI, HRSA and VA to test Whole Health payment and delivery models under real-world conditions. This entity should also establish an interagency team as well as state network to address payment, regulatory, and privacy barriers identified by sites and pilots.
- State Action. Partner with federal agencies through innovation waivers (e.g. 1115 waivers and 1332 waivers) and learning collaboratives to test Whole Health models and share data across state systems and with the federal government.
Conclusion
The United States spends more on health care than any other nation yet delivers poorer outcomes. Whole Health offers a proven path to reverse this trend, reframing care around prevention, purpose, and integration across health and social systems. Embedding Whole Health as the operating system for America’s health requires three shifts: (1) redefining the purpose from treating disease to optimizing health and well-being; (2) restructuring care to empower, equip, and treat through team-based and community-linked approaches; and (3) rebalancing control from expert-driven systems to partnerships guided by what matters most to people and communities. Federal and state leaders have the opportunity to turn scattered Whole Health pilots to a coordinated national strategy. The cost of inaction is continued fragmentation; the reward of action is a healthier and more resilient nation.
This memo produced as part of Strengthening Pathways to Disease Prevention and Improved Health Outcomes.
Both approaches emphasize caring for people as integrated beings rather than as a collection of diseases, but they differ in scope and application. Whole Person Health, as used by NIH, focuses on the biological, psychological, and behavioral systems within an individual—it is primarily a research framework for understanding health across body systems. Whole Health is a systems framework that extends beyond the individual to include families, communities, and environments. It integrates medical care, behavioral health, public health, and social support around what matters most to each person. In short, Whole Person Health is about how the body and mind work together; Whole Health is about how health, social, and community systems work together to create the conditions for well-being. Policymakers can use Whole Health to guide financing, workforce, and infrastructure reforms that translate Whole Person Health science into everyday practice.
Integrative Health combines evidence-based conventional and complementary approaches such as mindfulness, acupuncture, yoga, and nutrition to support healing of the whole person. Whole Health extends further. It includes prevention, self-care, and personal agency, and moves beyond the clinic to connect medical care with social, behavioral, and community dimensions of health. Whole Health uses integrative approaches when evidence supports them, but it is ultimately a systems model that aligns health, social, and community supports around what matters most to people. For policymakers, it provides a structure for integrating clinical and community services within financing and workforce strategies.
They share a common foundation but differ in scope and audience. The VA Whole Health System, developed by the Department of Veterans Affairs, is an operational model, a way of delivering care that helps veterans identify what matters most, supports self-care and skill building, and provides team-based clinical treatment. The National Academies’ Whole Health framework builds on the VA’s experience and expands it to the national level. It is a policy and systems framework that applies Whole Health principles across all populations and connects health care with public health, behavioral health, and community systems. In short, the VA model shows how Whole Health works in practice, while the National Academies framework shows how it can guide national policy and system alignment.
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