Whole health for our veterans, and our nation

Every year, as Veterans Day approaches, my thoughts invariably turn toward those who have served in the United States military and have returned from wars with physical, mental, and spiritual scars.

The nation’s 23 million veterans, along with roughly 50 million family members, often suffer from a high incidence of multiple chronic conditions that require specialized intensive treatment. But their needs are often unmet.

For me, this issue is deeply personal. I am a fourth-generation veteran. My great-grandfather served with Teddy Roosevelt’s Rough Riders in the Spanish-American War and went to Cuba; my grandfather fought with Gen. George S. Patton as he swept across Europe in the World War II campaign to stop Hitler; and my father served in the Pacific during that war and then as an Army chaplain in Korea and Vietnam. The military is in my genes.

I am also a retired lieutenant colonel in the U.S. Army Medical Corps and have been treating active-duty service members and veterans as a family practitioner for 40 years, including my current practice at Fort Belvoir Community Hospital in Virginia. Working with the Veterans Administration (VA) for decades, I have seen its problems first-hand. But I have also witnessed dramatic improvements in the quality of VA care thanks to the enhancement of mental health services and adoption of an integrative, person-centered, whole health approach to patient care. Those elements of VA care should serve as cornerstone models for physicians in the private sector to adopt — not just for veterans but the nation.

Focusing on the care of veterans and the new approaches being implemented by the VA can be an important learning experience for all clinicians and their teams because the lessons of providing “warrior-centric care” and the creation of Total Force Fitness offer a roadmap for how we can improve care for all our patients and the health of our nation.

Innovations over the last decade have transformed the VA into a pioneer system for delivering top-quality whole-person care. The VA system, like all health care in the U.S., originally aimed to treat acute illnesses and injuries, not to prevent and manage chronic disease. And we all know that poor management of chronic diseases has led to a relentless rise in health care costs, declining life expectancy and quality of life, growing patient dissatisfaction, and provider burnout.

In 2018, the VA piloted an integrative health model called Whole Health for 133,476 veterans at 18 sites. Whole Health shifted from a disease-focused, transactional system to a relationship-focused, team-based treatment model that aims to address the behavioral, emotional, and social determinants that account for some 80% of health. It starts the clinical visits with questions on “meaning and purpose” of the veteran for their life and explores ways they can be involved in their own healing.

The results are remarkable: engagement with Whole Health services substantially increased patient satisfaction and dramatically lowered costs, averaging a reduction of nearly $5,000 per person or around 20% compared with those who did not use Whole Health services.

I co-authored the 2020 federal report on VA mental and Whole Health approaches for the COVER (Creating Options for Veterans’ Expedited Recovery) Commission. We found that incorporating complementary and integrative approaches and combining them with one of the most extensive and effective mental health programs in the country could produce stellar results. It is a model system for the nation.

The National Academy of Medicine recently studied Whole Health and similar models around the world and pointed to these approaches as solutions for many of our current health care challenges.

The truth is that the VA now offers better care, particularly for mental health, than much of the private sector. That’s because the system is not focused on promoting pills, procedures, and profits, but rather on the performance optimization of human beings that is crucial to the military’s mission and to every person’s life.

The VA’s continuum-of-care mental health model is a pyramid approach in which the costliest inpatient services are at the top of the pyramid, but the broadest effort is at the bottom where the focus is on effective chronic disease management and, most importantly, on prevention and social support. The importance of mental health, and the behavioral and lifestyle choices that people make in their daily lives — choices about food, movement, sleep, stress and substance use — are embedded in VA care culture.

Over the decades in my own practice, I constantly remind myself that my job is not just to treat disease but to be a healer —to help people recover and regain wholeness. To do that, I need to forge the strongest possible relationship with my patients to help me guide them on a path to good health by first seeing them as sacred, valuable beings and second by seeking to help them get engaged in preventing and healing chronic illness. The most important techniques I have learned to do this are those I have picked up in my experience with the military and the VA.

A Whole Health visit begins for each patient by developing a personal health inventory that is not limited to asking what the matter is. Instead, the inventory asks patients to write briefly about what they live for, what matters to them and why they want to be healthy. Learning to get to the root of my patients’ life goals for health and well-being makes me a better doctor.

My office visits are now built around what I call the HOPE note. As new doctors, we were trained to write a SOAP note (Subjective, Objective, Assessment and Plan) to chart the course of a patient’s medical condition and treatment. But the elements of a HOPE note (Healing-Oriented Practices and Environment) enable me to collaborate with my patient in drafting a treatment plan focused on prevention, health promotion and self-care. It brings out the patient’s own intuition about what they need most, allowing me to offer them whole-person care that combines conventional medicine with evidence-based complementary modalities, such as health coaching, group visits, nutritional counseling, acupuncture, yoga, meditation, therapeutic massage, stress reduction and other non-drug approaches.

These are proven strategies that have been shown to be effective for improving outcomes and reducing costs by lowering hospital admissions and readmissions. Veterans are accustomed to working in groups and teams, and they have been shown to greatly benefit through the VA’s use of peer-group support for combating addictions, PTSD, traumatic brain injuries, diabetes, hypertension, obesity and more.

The success of these whole-health practices has been acknowledged by insurance payors, which now have billing codes enabling practitioners to get reimbursed when they use a team-based approach that relies on group visits and health coaches, among other strategies.

More veterans are seeking care in the private sector, thanks to recent changes at the VA allowing them to receive more services closer to their homes. In some rural areas, veterans now account for about 25% of all private visits. Many practitioners may not even be aware of how many veterans they are treating because they have not ever asked about military service. For those settings, learning about and becoming Warrior Centric Healt certified is well worth it.

Whole-person care is providing veterans with better health care than ever, and my hope is that civilian practitioners will broaden their approach to whole-person care to benefit those who served our country and for all their patients.

References:

Healing Works Foundation. The HOPE note: A tool for adding integrative healthcare to a routine office visit. Available at: https://healingworksfoundation.org/resources/hope-note/. Accessed Nov. 8, 2024.
Military Health System. Total force fitness. Available at: https://www.health.mil/Military-Health-Topics/Health-Readiness/Public-Health/Total-Force-Fitness. Accessed Nov. 8, 2024.
National Academy of Sciences. Achieving whole health: A new approach for veterans and the nation. Available at: https://nap.nationalacademies.org/catalog/26854/achieving-whole-health-a-new-approach-for-veterans-and-the. Accessed Nov. 8, 2024.
U.S. Department of Veterans Affairs. Creating options for veterans’ expedited recovery — final report. Available at: https://www.va.gov/cover/. Published Jan. 24, 2020. Accessed Nov. 8, 2024.
U.S. Department of Veterans Affairs. Mental health care at the VA. Available at: https://www.mentalhealth.va.gov/about/index.asp. Accessed Nov. 8, 2024.
Warrior Centric Health. Available at: https://www.warriorcentrichealth.com/. Accessed Nov. 8, 2024.

For more information:

Wayne Jonas, MD, can be reached at Healing@HealingWorksFoundation.org or via LinkedIn.