Reimagining Health Care ROI: A Whole-Person Approach to Health
Reimagining Health Care ROI: A Whole-Person Approach to Health
As part of the Doris Duke Foundation’s Collective to Strengthen Pathways for Health Research, the University of Utah convened Extending Return on Investment: A Multi-Sector Approach to Whole-Person Health in 2025—bringing together clinicians, researchers, payers, policymakers, community leaders, and funders around a fundamental question: How can the U.S. health care system redefine success beyond short-term financial returns to reflect the long-term well-being of people and communities?
Central to the conversation was the need to shift how value is defined and measured in health care. Amy Locke, MD, Chief Wellness Officer at the University of Utah, emphasized that sustainable change requires an intentional focus on whole-person health—one that recognizes prevention, access, and population well-being as essential outcomes, not peripheral considerations.
“If we want a healthier future, we must broaden how we define value in health care to include prevention, access, and long-term population well-being,” Locke said. “Advancing whole-person health means investing not only in clinical outcomes but also in the social, economic, and community conditions that allow people to thrive across the lifespan. This work underscores the importance of aligning care delivery, research, policy, and community partnership to achieve lasting, evidence-based impact.”
The University of Utah’s efforts are part of a growing national movement supported by major philanthropic partners, including the American Cancer Society, American Heart Association, Burroughs Wellcome Fund, Robertson Foundation, and Dana Foundation. Across the country, 18 institutions are hosting parallel conversations—ranging from Arizona State University’s digital health initiatives and Virginia Tech’s focus on rural health to Morehouse School of Medicine’s community-driven research and Harvard Pilgrim’s maternal health work. Together, these efforts are contributing to a shared, evidence-informed blueprint for transforming how the nation prevents disease and delivers care.
The Crisis We Face
The United States spends more per capita on health care than any other nation yet consistently lags behind in key health outcomes. Our current system excels at treating disease but fails to address the upstream factors—including health behaviors, housing instability, food insecurity, and social isolation—that make people sick in the first place. These social determinants of health drive persistent disparities across geographic, racial, and income groups, yet they remain largely invisible to traditional health care metrics.
This disconnect points to a critical need: shifting from fragmented, reactive care to coordinated, upstream solutions that improve population health while yielding collective return on investment. Whole-person health (WPH) offers a pathway forward: an interprofessional, team-based approach anchored in trusted longitudinal relationships to promote resilience, prevent disease, and restore health by taking a comprehensive, holistic, upstream focus on health.
Why Long-Term Thinking Matters
Demonstrating WPH's value requires patience. Patricia Herman, a senior behavioral scientist at RAND Corporation, modeled a hypothetical patient over 40 years and found that, although whole-person care incurred slightly higher costs initially, it substantially reduced long-term expenditures by reducing hospitalizations, medication use, and specialist visits.
“Whole-person health doesn't replace conventional care—it optimizes it,” Herman explained. But those savings take years to materialize—a timeline that clashes with quarterly earnings reports and two-year election cycles.
Jennifer Dailey-Provost, PhD, MBA, who serves in the Utah House of Representatives while teaching public health, emphasized this challenge: “There is no policy that is not a public health policy.” Yet legislators face constant pressure to produce immediate, measurable results, making it politically difficult to invest in upstream interventions like stable housing or nutrition programs, even when the long-term case is compelling.
A Fundamental Power Shift
Whole-person health represents what Herman described as “a fundamental shift in the balance of power in the health care system. It puts the power in the hands of the patient and moves the patient from being a passive recipient to an active participant. The health care system is a guide and partner.”
Instead of waiting for people to become ill and then treating symptoms, this approach engages individuals in understanding their health goals, addresses barriers to wellness, and coordinates care across medical, social, and community services. The model is built on five foundations: being people-centered, holistic and comprehensive, upstream-focused, equitable and accountable, and supportive of team well-being.
A Blueprint for Change
Rather than proposing wholesale revolution, health leaders are embracing “strategic incrementalism” to test interventions, scale what works, and build resilient systems that can withstand political and institutional turnover.
The plan unfolds in three phases:
- Short-term (1-3 years): Build multi-sector partnerships between health systems, community health centers, public health departments, and community organizations. Implement community health worker training programs. Initiate pilot wellness visits to address social determinants of health. Most critically, develop a shared definition of “collective ROI” that accounts for long-term societal benefits and community-defined outcomes.
- Intermediate-term (3-5 years): Expand Medicaid reimbursement for non-traditional providers like health coaches. Create integrated data platforms linking social and clinical services. Launch multi-site demonstration projects testing these models in urban and rural settings. Make behavioral health integration standard practice in primary care.
- Long-term (5-10+ years): Institutionalize community health partnerships as core components of care teams. Transition from fee-for-service to value-based payment models with community-defined success metrics. Normalize upstream, team-based, whole-person care as the default across all payers.
Through this work, the University of Utah is contributing essential insights to the national blueprint. Utah's Osher Center for Integrative Health, Prevention Research Center, and Center for Metabolic Health combine their efforts into the Driving Out Diabetes Initiative, demonstrating evidence-based frameworks for measuring collective ROI, models for integrating oral health and behavioral health into primary care, and strategies for scaling interventions across urban and rural settings.
Breaking Down the Barriers
Achieving this vision requires confronting stubborn obstacles. Fee-for-service payment models incentivize treating illness rather than preventing it. Data silos hinder coordination between health care, housing, education, and social services. Traditional ROI metrics fail to capture improvements in emotional well-being, community participation, or health equity.
Nathorn Chaiyakunapruk, PharmD, PhD, health economist at the University of Utah, encouraged community engagement: “We need new measurement tools but also partners in the community or in health care settings to weigh in.” Developing collective ROI frameworks requires genuine community involvement in defining what outcomes matter most.
Ann Greiner, President and CEO of the Primary Care Collaborative, highlighted the connection between delivery and payment: “We need to marry the delivery system ideas with the right payment models to really implement them.” Without aligned incentives, even the most promising interventions struggle to scale.
The Stakes
The momentum behind whole-person health is building. The question is no longer whether change is needed but whether we have the collective will to prioritize long-term well-being over short-term profits, prevention over intervention, and equity over efficiency.
A health care system that truly embraces whole-person health won't just save money—though Herman's research suggests it will. More importantly, it will support human dignity, reduce health disparities, and create sustainable communities where people can thrive.
The blueprint exists. The evidence is mounting. Now comes the hard work of implementation—and the even harder work of sustaining that change until the benefits, years down the line, prove undeniable. The University of Utah is committed to helping lead that transformation.