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Addressing Loneliness And Social Isolation In The Medicare Population

Apr 14, 2020

By: Anne Davis, Director of Quality Programs and Medicare Strategy at HMS

In recent years, the healthcare industry’s understanding of social determinants of health (SDoH) and their impact on patient outcomes has grown dramatically. Researchers and practitioners now recognize that social isolation and loneliness fall under the SDOH umbrella. In response, many payers and providers are exploring initiatives to address social isolation among members and patients.

The health effects of social isolation and loneliness are costly and harmful. According to Health Affairs, social isolation results in $6.7 billion of additional healthcare costs each year among Medicare beneficiaries. This increased spending is driven by higher levels of hospitalization, emergency department visits, and nursing home placements.

Further, researchers have found that socially isolated seniors face higher mortality rates. Loneliness and social isolation are associated with a 64% increase in the risk of dementia, a 32% increase in the risk of stroke, and a 29% increase in the risk of coronary artery disease.

In response, both payers and providers are investing in programs to address issues related to social determinants of health. Most high-profile commercial payers have already launched programs to improve SDoH, while hospitals spent approximately $2.5 billion on SDoH programs between 2017 and 2019, Healthcare Dive reported.

These programs include initiatives designed to reduce loneliness and social isolation. The investment from both payers and providers is encouraging since neither stakeholder group can combat the negative effects of loneliness and social isolation on its own.

Understanding the problems of social isolation and loneliness
While sometimes used interchangeably, the terms “loneliness” and “social isolation” actually refer to different concepts. Social isolation is an objective measure describing a lack of social connections. Loneliness, on the other hand, is a subjective feeling. One out of every three adults over 45 years old in the U.S. reports feeling lonely, according to the AARP.

People who have poor social connections are more likely to experience loneliness. It’s important to realize, however, that some people may feel lonely even if they are surrounded by others. For instance, one survey found that 34% of respondents who lived with two or more other adults reported that they still felt lonely, according to Health Affairs.

Loneliness is a complex emotional state. Researchers have found that efforts to alleviate loneliness often fail if they only focus on increasing social connections. Instead, loneliness-reduction programs that correct “maladaptive thinking” — such as teaching ways to reframe one’s thinking about social interactions, promoting positive coping, and managing social anxiety — yield greater success, according to Health Affairs.

Three ways payers can make a difference

For years, providers have been referring patients to community-benefit organizations (CBOs). Meanwhile, as the term SDoH has become more commonplace in the healthcare sector, many payers have started gathering social determinants data. Both of these avenues are certainly worth pursuing.

More recently, however, SDoH efforts have grown in sophistication to include more robust programs and interventions that prioritize not only social support and connections but also housing and food security, as well as access to transportation and quality healthcare.

Health insurers now find that they are uniquely positioned to help members address social isolation and loneliness. One reason is the surging popularity of Medicare Advantage (MA) plans and the expanded benefits these plans can offer.

Here are three ways that payers can move the needle on these important social determinants of health:

1. Use analytics to predict loneliness and social isolation risk

Data is an essential first step in supporting a health plan’s membership. With the wealth of member data and diverse information sources that are now available, insurers can build predictive models that quantify present and future risk of loneliness and social isolation. For example, Humana and Aetna have both recently discussed development of loneliness predictive models that highlight at-risk members. While payers have traditionally focused on data related to demographics and eligibility, member-reported data on feelings of loneliness could be an important input to future predictive models.

2. Partner with community organizations

CBOs are an essential component of the healthcare system, acting as the “boots-on-the-ground” for health plans’ most vulnerable members. CBOs interact with and counsel community members who are dealing with a variety of issues. They play an invaluable role in alleviating loneliness and social isolation. However, many of these organizations are struggling to stay afloat. In 2017, approximately one out of every eight human services CBOs were financially insolvent, according to the Alliance for Strong Families and Communities. This is a statistic that one insurance executive described as “insightful and terrifying.

The good news is that payers can help. They have far more staff, funding, and resources than most CBOs. Many payers have already established partnerships with CBOs to provide operating support for programs that assist community members with SDoH. This support may take various forms, such as funding for technology or assistance in building and maintaining programs. In March, Humana began paying social service agencies for some services related to SDoH.

3. Provide supplemental benefits that target SDoH

In 2018, the U.S. Centers for Medicare & Medicaid Services (CMS) passed a rule that gives MA plans greater freedom to establish a variety of flexible and creative supplemental benefits. MA insurers have quickly seized on this opportunity. Many now offer an array of benefits that can reduce social isolation, such as home delivery of meals and ride-sharing services from Uber and Lyft.

Some MA plans also cover visits from employees of tech startup Papa, which bills itself as offering “grandkids-on-demand.” In addition to providing companionship, some “Papa Pals” take seniors to the grocery store or doctor’s appointments, help with chores and teach them how to set up a new smartphone.

Medicare Advantage plans are proactively addressing social isolation among seniors. In the future, traditional insurers for the under-65 crowd may push for the right to offer similar member benefits. This could address the subjective feelings of loneliness that affect one-third of adults over 45. 

In spite of our highly interconnected world, too many Americans suffer silently from social isolation and loneliness. Fortunately, healthcare organizations are embracing innovative new approaches that could systematically combat these issues like never before. By leveraging analytics to predict the risk of social isolation and loneliness, partnering with CBOs and offering creative benefits, payers can reduce the impact that these social determinants of health have on their members’ wellbeing.

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