Clinicians are starting to look at the role that poverty, race, and other social determinants play in a person’s health, but what about social connectedness — how do friendship, family, and loneliness play into a person’s medical needs?
Large health care systems have yet to take up the fight in a meaningful way, but that could be changing. On Monday, CareMore, a unit of Anthem Insurance that offers coverage and health care to more than 100,000 members across seven states, is introducing a campaign to help some of the US population’s most socially isolated people: seniors.
CareMore’s “Be in the Circle: Be Connected” program is the brainchild of Dr. Sachin Jain, the company’s president. As a college junior at Harvard in 2001, Jain studied under Robert Putnam, author of the seminal book “Bowling Alone,” about America’s fraying social fabric, and Dr. Donald Berwick, a health care policy guru who, at the time, was studying the impact of “group visits” for diabetics, among other things.
Jain continued tracking the issue in his career as a physician and researcher, and when he joined CareMore, he saw how seniors, in particular, suffer from loneliness. “A lot of times their major social interaction comes from medical appointments,” he said. “And I thought, is there a way for us to actually serve them better than we have?”
Jain spoke by phone with STAT last week as he readied for the rollout of the new program. This interview has been condensed and edited.
How do loneliness and physical health intersect for seniors?
Getting old in America isn’t easy for many people. Things like the death of one’s spouse, your family getting dispersed across a broad geography, people’s friends passing away — even folks who are very social or connected gradually begin to lose those connections with others in their life. Oftentimes that leads to a decline in people’s self-care, so they’re not taking medicines regularly, not exercising with any regularity, not participating in social activities, and health outcomes suffer. So we see loneliness as both being a result of medical problems, and a cause of medical problems.
We’re trying to reframe loneliness as a treatable medical condition that can be treated. As physicians, we typically only ask patients about things we feel we can help them with. A lot of times, loneliness is staring us in the face, but we don’t ask patients about it because we don’t have anything to offer to solve their problem. So our clinicians are now offering interventions to make patients less lonely.
We have about 1,100 members who’ve self-identified as being either lonely or socially isolated. So, we’ve got an initial team of three outreach workers led by a social worker who will connect with folks regularly by phone to offer consistent and positive support. And we’ll soon launch a “friendly visitor” program, where some of our seniors will get home visits.
We’re redesigning our care centers, so the waiting areas will be repositioned as social spaces where seniors can drop in and just be there. We believe this may improve health outcomes. If you’re a patient with chronic disease and you’re going to the care center for social interaction, you’re more likely to ask for your blood sugar or weight to be checked.
And we also have senior-focused gyms called “Nifty After Fifty” at most of our care centers, and a lot of the programs there are focused on creating social connection for seniors, as well as helping them with exercise. At CareMore we have a saying: “If exercise and social interaction were a drug, we think it’d be a blockbuster.” I met a couple yesterday who are CareMore members — both were widowed and they met at a “Nifty After Fifty” and got married there.
What’s the business case for this?
We’re a pre-paid health care system — a Medicare Advantage plan and delivery system, like the VA or any system that both insures and delivers care. So if our patients are healthier and less socially isolated, they’ll get admitted to the hospital less, take better care of themselves, and their overall costs will be lower.
In a fee-for-service world, you wouldn’t necessarily see the savings because your revenue comes from delivering more services. But we have to manage all our expenditures within a fixed budget. And we expect significant savings as a result of this model.
How do you get your physicians into this mix?
We appointed the health care industry’s first Chief Togetherness Officer, Robin Caruso, to oversee all aspects of this initiative. It’s about supporting every one of our 700 clinical staff in taking this on as an issue, and making it something they assess, and look for, and treat. We just had our all-team meeting, and there wasn’t a moment of greater applause than when we announced this. Everyone intuitively recognizes this as an issue for the seniors we care for. It’s about as real as it gets.
How replicable is this for other systems that are set up like yours?
It’s very replicable. And from my perspective, the goal isn’t just to do it at CareMore — it’s frankly to create a social movement around loneliness as a medical problem that can be treated. We’re trying to create national momentum around the issue, where more health care providers and organizations see addressing senior loneliness as their responsibility. Lots of people have tried to solve this problem by writing about it, and calling attention to it. We need to demonstrate that we can build and scale interventions that work to solve it. So we’ll be tracking outcomes very closely for these first 1,100 members, and the proof will be in the data and the results.
I view this akin to smoking. One of the things that Robin says is that loneliness is the new smoking. That’s how we have to think about senior loneliness in 2017.