Open Source Wellness

Nature of the Problem

Our national healthcare system has been wildly ineffective in addressing chronic, progressive, preventable conditions (e.g., depression, diabetes, cardiac disease, hypertension, social isolation) that drive over 85% of healthcare spending and immeasurable human suffering. Whether the manifesting disorder is physical, psychological, substance-related, or (commonly) a co-morbid expression of the above, the drivers of these chronic diseases are behavioral and trans-diagnostic. Unfortunately, unlike our excellent infrastructure for distributing medication (pharmacies), our nation has no democratized delivery system for the basic, universal practices that potentiate human health and wellbeing. Across specialties and diagnoses, clinicians give “behavioral prescriptions:” “Eat better! Exercise more! Reduce your stress! Get some social support!” with an impotent “Good luck with that – I’ll see you next time!” For those who lack access to the boutique wellness industry, these behavioral instructions are essentially a prescription to nowhere, and our patients, practitioners, and communities suffer for it. Just as Thomas Scattergood believed in the moral treatment of those with mental illness, Open Source Wellness believes in democratized access to the basic practices that underlie wellbeing. The time for clinic-community integrated systems that provide affordable, accessible, culturally relevant support for the behaviors and contexts that drive behavioral and physical health is now!

Program Description

Open Source Wellness operates as a Behavioral Pharmacy, a democratized delivery system for the fundamental behavioral drivers of human health and wellbeing. We leverage the power of community in clinical, housing, community, and corporate contexts to animate a very simple platform: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). Participants join 4-month cohorts, experientially practicing each of these interventions in weekly groups, guided by health coaches and their peers. To “Food is Medicine,” Open Source Wellness adds “Community is Medicine,” and potentiates interpersonal connection, support, and accountability towards whole-person health and wellbeing. We train health coaches and peers to deliver a core model that is affordable, accessible, and flexible for cultural- and contextual-adaptation. In the clinical setting, Group Medical Visits are utilized to make our trans-diagnostic, physical/psychological intervention billable, EMR-integrated, and workflow-integrated in both fee-for-service and value-based payment settings. Our community-based programs take “prescriptions” from multiple healthcare providers and insurers, and transition patients from medical settings to community health settings. Our housing-based and corporate programs engage participants in their natural community contexts. Our goal is to refine, spread and radically open-source a fundamental human technology for animating clinic and community as a platform for health.

Disruption

The Open Source Wellness model is pioneering in that it is: 1. Experiential: We don’t just TALK about health behaviors, we DO them, in community, in a way that is joyful, socially rewarding, and (therefore) sustainable. 2. Transdiagnostic: We don’t segregate by diagnosis or demographics; the fundamental behavioral prescription of MOVE NOURISH CONNECT BE is universal and holistically addresses the roots of behavioral, physical, and substance-related challenges. 3. Democratized: By utilizing para-professionals (as opposed to specialists), uplifting peer leadership, and leveraging economies of scale, the model is both affordable and accessible. 4. Culturally-Flexible: While the fundamental platform is consistent, every aspect of the implementation (music, food, language, group norms) can be customized to the population. 5. Place-Based: Open Source Wellness meets real physical needs where they exist, while weaving powerful, enduring, in-person community connection.

Leadership

Open Source Wellness is providing leadership to the broader health community, which is increasingly looking to behavioral health for answers to its most vexing and costly problems. Here’s why and how: 1. Comorbidity between physical, behavioral, and substance-related conditions is the rule rather than the exception. 2. Health behavior change initiatives are ineffective when they fail to address the emotional pain that drives maladaptive behaviors. 3. Social/emotional states and experiences are not “complementary” to healthcare, but integral; it is time that we treat them as such. For example, social isolation is as predictive of poor health outcomes as smoking (Holt-Lunstad, 2010). Lastly, OSW offers leadership to our nation’s moral commitment to health equity, via scalable clinic-community integrated structures that provide democratized support for behavioral and physical health. Open Source Wellness is poised to provide leadership at the levels of pragmatic intervention, strategy, and thought leadership into the coming decade.

Scalability

The OSW model has been piloted in an FQHC (Alameda Health System), a community site (Prevention Institute), and a low-income housing site (Alameda Point Collaborative) with striking outcomes. We are entertaining partnerships with an Emergency Department, a VA Medical Center, and a rural health clinic. In a fee-for-service clinical environment, the key to scalability is Group Medical Visits (GMV’s). The OSW program is scheduled, charted, and billed as a GMV, allowing a single provider to bill for 24+ patients instead of 8-10 they would see individually, supporting the OSW program and radically amplifying the reach and effectiveness of providers. In a value-based payment environment – (including providers on capitated payment, insurers, and integrated delivery systems), the outcomes reliably generated via the OSW model predict long-term savings, and local insurers (Alameda Alliance for Health) are embarking on pilots to test this.

Results/Outcomes

We are a data-driven organization, and use gold-standard measures to track a range of mental and physical health outcomes. Our participants experience a predictable sequence of improvements: First, they qualitatively describe a sense of connectedness, vitality, and activation. Second, their behavioral and mental health measures show improvement: in our clinical population, patients showed 32% drops in depression scores (PHQ-9, 14.4 to 9.8, p < .01) and increases in weekly exercise from 82 to 123 minutes (p < .01) and daily fruit and vegetable consumption from 5.0 to 5.9 servings (p = .01). Finally, biomarkers improve: our hypertensive subset saw a nearly twenty-point drops in blood pressure (150/82 to 131/77, p < .01). Ultimately, we aspire to show results at organizational and national levels over the course of our growth, and are working with providers, insurers, and integrated delivery systems to build the clinical and financial case for its widespread adoption.