MedCity Influencers, Consumer / Employer

Health plans can help combat the epidemic of loneliness for older Americans

Centers for Medicare & Medicaid Services only recently gave the green light for Medicare Advantage (MA) plans to provide a wider range of benefits that address social determinants of health. With that new charge, it’s time for health care payers to join the fight against loneliness.

senior, loneliness, tablet

The Covid-19 pandemic has been incredibly devastating to older Americans. Not only because they face an increased likelihood of death and complications from the virus, but also because of the lockdowns and social distancing that drove them indoors and alone. In fact, during the pandemic more than half of older adults reported feeling socially isolated, compared to only 27 percent pre-pandemic.

Even as vaccines have enabled many pre-pandemic activities to safely resume, we must not forget the social and community needs of our most vulnerable populations, particularly now in the colder winter months with an Omicron-prompted surge of cases. Chronic loneliness is not just about feeling alone — it’s a health risk that deeply affects the mental and physical well-being of seniors, and we must do all we can to address it.

It’s well-established that loneliness is as much of a risk factor for one’s physical well-being as chronic conditions like heart disease, or diabetes. In fact, isolation among older adults is linked to a nearly four times increased risk of death, 68 percent increased risk of hospitalization, and 57 percent increased risk of emergency department visits. On top of that, according to The National Institute for Health Care Management (NIHCM) Foundation, the federal government spends $6.2 billion annually on social isolation-related care for older adults. Despite the profound health consequences — and the associated costs — the healthcare system remains an underused partner in preventing, identifying, and intervening for social isolation among older adults.

Currently, most of the services and supports that exist to combat social isolation come from fragmented volunteer and nonprofit groups, or family members and friends. That’s in part because the Centers for Medicare & Medicaid Services only recently gave the green light for Medicare Advantage (MA) plans to provide a wider range of benefits that address social determinants of health. With that new charge, it’s time for health care payers to join the fight against loneliness. Health plans have access to insights about their members that can inform a more coordinated strategy for addressing isolation, more so than any other group could do on its own. They usually have the scale and resources to reach seniors. And on top of it all, many health plans — such as MA plans — have a financial incentive to prevent social isolation.

Additionally, as the lines between payer and provider organizations fade and give birth to a new breed of payvidor organizations, these integrated care models offer new pathways through which social determinants of health, like isolation, can be addressed.

First, plans can identify who is most at-risk for isolation and loneliness, for instance, by determining if a senior lives alone, if a spouse recently passed away, or if their care team has expressed concern. They also have direct lines of communication with primary care physicians, data on access to transportation, insight into members’ socioeconomic status, and self-reporting options to identify affected individuals. Some MA plans use human “care guides” to help their members navigate healthcare and payvidors have in-house care teams, both of whom can identify members who exhibit Health Risk Assessment (HRA) depression symptoms or utilize words like “lonely, alone, isolated” in communications with the plan.

Once those at-risk are identified, there are many ways to deliver connectedness. There are specialized providers that will connect seniors with a “Pal” for general company and assistance with everyday tasks. Many MA plans have covered the cost of gym memberships or classes designed to improve physical health and build relationships, but few have made investments in comprehensive strategies for keeping members socially engaged over the long-term.

Sometimes, all you need to offer is a way for seniors to meet each other on a more genuine level beyond what social media can provide, a challenge when the world of work disappears from their lives and it is harder to get around. The goal is not just to offer a medium to have them get to know each other, but to utilize peer-to-peer connections as health-promoting tools to help protect against the negative physical and mental impacts of isolation.

One example of the above is plans launching virtual social clubs, which in our experience leads to great engagement from participating seniors. That’s not to say that implementation of a more robust social program like this will be simple. One serious hurdle health plans will need to overcome is that many members don’t see their plan as a true partner in their health journeys. As plans expand services to address social determinants of health, like isolation, they will need to build trust with members who may be skeptical of this type of engagement from their insurance provider.

Loneliness is a condition that entails no scientific leap or expensive technology to cure, but it is critical to the health of older Americans. There is a Medicare Advantage boom right now, and the flexibility granted by the government allows space for experimentation and creative thinking when it comes to program development specifically aimed at combating isolation. It’s time that health payers and payvidors seize this moment for the health and well-being of all our seniors.

Photo: FG Trade, Getty Images

Jeremy Delinsky, the Chief Operating Officer of Devoted Health, was formerly the Chief Technology Officer at athenahealth, an electronic health record company. He also previously served as a member of the Health IT Standards Committee, and was the founding Board Chair of the CommonWell Health Alliance.

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