Patient Engagement, Payers

How CareMore is tackling loneliness as a clinical issue

At the MedCity ENGAGE conference in San Diego CareMore Health's Robin Caruso will how the organization has tackled the issue of social isolation head-on, improving the social and physical well-being of their Medicare population in the process.

Researchers have known for decades that social determinants have a huge impact on people’s overall health and well-being, but only recently have they started to quantify that impact.

While it’s easy to draw a direct line to health outcomes for economic factors like housing, access to healthy food and transportation, increasingly there’s been an understanding that social factors play a big role in health as well.

For example, one oft-cited study found that loneliness and social isolation’s  impact on mortality can be equivalent to smoking 15 cigarettes a day.

Robin Caruso has been a social worker for nearly three decades and has seen these issues and their negative affect on health first-hand. When working with patients who had undergone heart health issues she found that one major factor in the prevention of readmission was having a strong social support system.

The issue of social isolation is especially pronounced in the senior population that Caruso works with at CareMore Health, with patients sometimes trying to recover from the death of a spouse or lacking meaningful human connection outside of the clinic.

Last year, Caruso was named as the CareMore Health’s first Chief Togetherness Officer, charged with figuring out how to combat patients’ social isolation in a way that could be integrated into the clinical care workflow. CareMore Health is an integrated care organization based in Southern California that is a division of health insurer Anthem and serves around 150,000 Medicare and Medicaid beneficiaries across eight states.

At the MedCity ENGAGE conference in San Diego from Nov. 6-7, Caruso will be on hand to highlight how the organization has tackled the issue head-on, improving the social and physical well-being of their Medicare population in the process.

CareMore’s Togetherness program started with identifying the company’s members that self reported as living alone and having poor to no support networks and calling them up.

One of the first people Caruso spoke to was a man who picked up while he was on the golf course, he told her he’d been exercising, his blood pressure was down and he was waiting to meet a friend.

“I’m thinking ‘well this guy is not socially disconnected.’ However he went he went on to tell me his story that for two years after his wife died, he didn’t leave his house and his health dramatically went down,” Caruso said in a phone interview.

After moving in with his family and going to CareMore for his first HealthyStart medical assessment, the man saw a brochure about a support group for those looking to get over the loss of a loved one, which eventually got him reengaged and reconnected with others.

“I’m like, ‘I’m going to be calling people that aren’t engaged like you. What is your advice?'” Caruso said. “The first thing he said was ‘You’re not going to come to you, you’re going to have to find them and then the other thing he said was connect him to the younger generation.'”

Caruso took that advice to heart and used it to inform the development of her program. The focus on loneliness and social health cues also required some retraining of staff toward relationship and trust building and away from the pure transnational information gathering that is generally the hallmark of a clinician call.

“We really focus a lot on how to have conversations that really drive connections and it’s by taking out judgment and really developing empathy so by the second call they go ‘Wow you really are just calling to see how I’m doing,” Caruso said.


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In order to integrate awareness about social isolation as part of the clinical practice, CareMore worked on developing a loneliness scale and incorporating that data into the electronic medical record to have the information accessible to dietitians, social workers and physicians.

The organization also made the program a key focus when signing up new beneficiaries and educating members through events like forums where community-based organizations and social isolation experts would discuss the issue.

As part of a rethinking of loneliness and its connection to health, CareMore has also started to redesign its facilities to emphasis social interactions and developing programming like guitar lessons, volunteer outings and exercise classes to give members a sense of meaning and purpose in their life.

Increasingly classes are also being organized to help seniors access and use platforms like Facebook and text messaging to help them interact and share their lives with younger family members.

The program’s success has led to thinking about how best to scale it to more patients through an expansion into Medicare Advantage and, next year, into Medicaid populations in certain communities.

One way the company has been able to grow its impact is through leveraging the entire Anthem organization and enlisting employees outside of CareMore to “adopt” a Togetherness member and conduct a weekly call.

Caruso relayed a conversation she had with one of those adopters and how its helped her create a much more personal relationship with the company’s members who she doesn’t interact with on a daily basis.”

“She said ‘I really can see the difference it’s making her her eyes just having this friendly call and it’s made me a better worker, I see the importance of connection and teamwork. But it also made me a better daughter and a better granddaughter that I am now paying attention to my parents and making sure that they have you know people around them in their lives,'” Caruso said.

Picture: Getty Images, CasarsaGuru

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