The world has experienced a pandemic before it has fully grasped the interdependent nature of mental, physical, and socio-economic health. However, although COVID-19 has exponentially increased the search trend of Google searches for terms such as “social determinants of health”, the foundation of holistic health has been hundreds of years. In the words of Osler, Moxon, and even Hippocrates, generations of aspiring clinicians have realized the importance of “understanding what kind of disease the patient has rather than knowing what kind of disease the patient has.”

This is a maxim that feels too obvious. When he or she lives in an apartment that has no air conditioning and is only a few blocks from the highway interchange, how can we expect a medicine to cure our child’s asthma? When a person with schizophrenia has no home, no car, no job, no family support, how can we expect him or her to maintain stable medication? How can we treat someone’s type 2 diabetes without addressing the possible root causes of their obesity, depression, poverty, and trauma?

The fact is that we cannot. Therefore, although the Organization for Economic Cooperation and Development spends more on health care than all other countries, the United States is the worst in providing overall health. On the surface, the U.S. healthcare system fails to provide the time, resources, and reimbursement model required to comprehensively solve mental, physical, and socioeconomic health problems. The providers in this system operate as if we see our patients trapped at the bottom of the well, and can only write down the prescription for the ladder and send it down.

This finally started to change.

North Carolina has created a network to unite a healthcare and human services organization called NCCARE360. When a doctor learns that a patient’s food is not safe during an office visit, NCCARE360 can help the patient directly establish contact with community organizations that support food. Closed-loop feedback ensures that doctors know when the patient’s support needs are met.

Available statewide since June 2020, the NCCARE360 network includes more than 2,400 community-based organizations and has recorded nearly 200,000 cases. By creating a coordinated network across healthcare and human services and feedback loops to ensure the completion of referrals, NCCARE360 promises to provide a mechanism that will ultimately revolve the system around people rather than people around the system. As other states follow suit, an integrated tool like NCCARE360 may represent the best step we can take from an era when we distribute brochures to patients, connect them to call centers, and hope for the best.

At the federal level, the leadership of the Centers for Medicare and Medicaid Services has promoted holistic health as the primary strategic focus, and is committed to exploring how Medicaid can help narrow the gap in access to behavior and social health needs. In North Carolina, the recently approved Section 1115 Medicaid exemption leverages this support and the NCCARE360 platform to authorize up to $650 million in state and federal funds to invest in pilot health opportunities within five years. These pilots can cover nearly 30 services in three regions of the state, including specialized key areas such as housing, food, transportation, and interpersonal safety.

This combination of purpose and practicality couldn’t be better. Although everyone has suffered physical, social, and mental health challenges during the pandemic, our most at-risk neighbors feel the impact of this intersection particularly strongly. Recognizing this need, North Carolina has pooled various state and federal resources to quickly initiate COVID-19 isolation support services. Statewide, existing partnerships between trusted local community organizations have allowed the program to be launched and expanded quickly. More than 170,000 support services were provided to nearly 38,000 families, and more than 70% of support services were provided to historically marginalized groups. The North Carolina plan is recognized for addressing multiple social needs in a single plan in an inclusive and fair manner.

In Wake County, we have seen similar success using long-term partnerships between cities, counties, community organizations, and WakeMed. Historically, these partnerships have focused on targeted cooperation aimed at improving the health of our most vulnerable residents. COVID-19 has greatly exacerbated the needs of our community, leading to a significant increase in patients seeking care but lacking safe housing, healthy food, primary care, and transportation. Therefore, at the beginning of the pandemic, these partnerships must also be strengthened, not only connecting hundreds of people to transitional housing in local hotels, but also connecting to local community support programs, including WakeMed’s Community Case Management (CCM) team .

For nearly ten years, WakeMed’s CCM team has spared no effort in providing holistic health services for our local communities. Team members contact some of our most at-risk and most vulnerable patients (including those placed in pandemic resettlement programs) to improve access to care and resolve barriers to improving health. In this plan, members will receive approximately 90 days of intensive case management services aimed at transitioning to a community-based long-term safety net program and primary care medical homes. In the near future, with continuous access to new and growing resources, the work of the CCM team will eventually be concentrated under one roof: a trauma-oriented community health center that aims to integrate physical, social and mental health Providers come together to provide support to assess holistic health in a payer-agnostic and fair-driven way.

Our efforts — and the efforts of other forward-thinking public and private partners across the country — emphasize both the social returns of investing in holistic health and the major changes required to bring this value to life . As a public sector, changing the resource equation needs to be more flexible, iterative and collaborative, and focus on speed and simplicity. As a private community health system, access to these new resources means that our vision extends beyond the scope of our hospitals and clinics, into physical, mental, and socioeconomic health aspects that healthcare providers have traditionally not participated in.

Time and time again, responding to the pandemic requires us to throw away the old rule book and write a new one. Not much is needed to fulfill the promise of holistic health.