The Whole Health in the States (WHITS) Initiative is a coalition of state-level collaboratives that use a multi-stakeholder approach to solve a range of problems that states face in providing whole person care to medically underserved patients. High-quality, whole person care is largely inaccessible in most states, especially in rural areas. There are many evidenced-based treatments that are not covered well or at all by public and private insurers and, if they are, utilization is not optimized, and many barriers persist. Currently the WHITS Initiative is supporting efforts in six pilot states and Washington, DC to: 1) increase access to evidence-based non-pharmacological treatments, and 2) drive utilization of high quality, comprehensive pain care for medically underserved populations. These efforts, tailored to the unique characteristics and opportunities of each state, are addressing how non-pharmacological therapies for pain are integrated with traditional pain care.
Samantha Simmons, President of the Oregon Collaborative for Integrative Medicine and Director of WHITS, explains how the initiative will help medically underserved populations—those who are disadvantaged because of ability to pay, ability to access comprehensive healthcare, or other disparities for reasons of race, religion, language group or social status. “We have found that it is critical to take a state-based and local approach that brings all stakeholders to the drawing table. Because of multiple systemic issues in the U.S., the whole person care that we want to see for under-resourced patients can be brought more quickly, efficiently, and effectively by addressing these barriers at the state level. States have many differences in how they approach providing health care to their citizens, especially those on Medicaid. If we want to make tangible change, and change that doesn’t take several years, a state-based, collaborative approach is essential. Proven successful system change will bubble up to the national level.”
As an example of the work of the initiative, Vermont, one of the pilot states, has a successful whole health pain program at the University of Vermont that has demonstrated promising health and cost-effectiveness outcomes for privately insured Blue Cross Blue Shield (BCBSVT) participants. With support from the WHITS Initiative, stakeholders in Vermont are working to bring this innovative pain program to underserved patients by establishing pilot eligibility for Medicaid patients and working towards expanding the program around the state, including to more rural areas.
Cara Feldman-Hunt, Program Manager of the University of Vermont (UVM) Comprehensive Pain Program, describes the integrative pain program they developed with Blue Cross Blue Shield. “Through an innovative bundled payment model, participants come to our clinic over several weeks for group medical visits and acceptance and commitment therapy. They receive acupuncture, yoga, reiki, massage, culinary medicine, hypnosis, EMDR (Eye Movement Desensitization and Reprocessing) occupational therapy, and physical therapy. We are able to put this all together and get reimbursed one rate per patient.” Because the UVM Medical Center program teaches skills that people can take home with them, UVM has noted a substantial decrease in Emergency Department visits and costs for program participants. Cara says, “We’re finally holding space for these people who have bounced around our system for decades. They are being heard and getting into therapies they never would have had access to before. It results in cost savings for our hospital, and most importantly, it keeps people healthy and happy. If Medicaid covers integrative pain care, other insurers will follow their lead.”
Cara says of participating in WHITS: “WHITS has been an incredible gift. We struck gold by being part of this because we get to look at ourselves. It accelerated our work in such a way that’s just incredible. It’s opened up door after door after door of conversations that would not have happened without this grant, or it would have happened but it would have taken three more years.
“As one example, we want to reach the Medicaid population. We hadn’t been successful at Vermont Medicaid yet. We were almost there and then the pandemic hit and it set us a few steps back as far as Medicaid covering the episode of care like BCBSVT does. Then we were reminded that there are Medicaid waivers that could potentially cover this care. That was from the WHITS interviews with the stakeholders. It was like fireworks went off–there were all these things we could be doing together to serve our patients in the state of Vermont, and we could measure them and evaluate them. That is invaluable.”
The WHITS Initiative is helping state leaders and other key stakeholders bring comprehensive pain care to underserved patients in pilot states through building consensus, developing actionable plans, and identifying resources to support their collaborative efforts. WHITS develops blueprints for how states are achieving expanded coverage for evidence-based pain care for other states to use and is developing tools to drive utilization. By working with private insurance companies too, WHITS’ goal is to leverage whole person care to be accessible to medically underserved patients. Samantha points out that there are many health conditions that benefit from a whole person, multi-disciplinary approach. Pain is one of these, especially because of the opioid epidemic. “People are suffering from pain and evidence-based treatment options are inaccessible because of a lack of insurance coverage and other access barriers, including uncoordinated care and provider unavailability in less densely populated areas. They are not getting adequate help with their pain most of the time. Many people are prescribed opioids. For some people it is really needed for a time—opioids are part of a whole comprehensive pain program. But without access to any non-pharmacological treatments, we too often set people up to become addicted to opioids and contribute to burn out in primary care providers. With an evidence-based comprehensive pain care approach, we can help patients suffering from acute pain and chronic pain and we can make it easier for health care providers to collaborate in caring for their patients.”