As health plans get longer leashes when it comes to addressing social determinants of health, loneliness among seniors has become a crucial target for Medicare Advantage insurers.
The Centers for Medicare & Medicaid Services has opened new avenues for supplemental benefits in MA that target the social determinants of health beginning in the 2019 plan year. For 2020, CMS is allowing plans to cover benefits such as meal delivery for people with chronic conditions.
Social isolation and loneliness have emerged as a large focus for this population. Loneliness can have significant implications on health; a 2010 study, for example, found that socially isolated people were 50% more likely to die prematurely.
Seniors are at particular risk, as they may face mobility challenges or may fall out of contact with friends and family. A recent study from CVS Health found that 24% of people 65 and older have no one living nearby to support them and 27% don’t know where they can go to meet new people.
William Shrank, M.D., Humana chief medical officer, told FierceHealthcare that managed care organizations are “uniquely positioned” to identify people who struggle with loneliness and address these challenges.
“Social isolation is a really important one for us,” he said. “There’s really compelling evidence and data demonstrating strong relationships between social isolation and health outcomes.”
Humana tracks “Healthy Days—a measure defined by the Centers for Disease Control and Prevention that monitors how often a person’s physical and mental health is good—and found that seniors who were socially isolated experience significantly more unhealthy days."
Shrank and his team at Humana have partnered with several organizations to offer point solutions for loneliness. Silver Sneakers fitness classes, for example, offer an opportunity for both exercise and to visit with peers, he said.
Loneliness is also becoming a market for tech startups, such as Papa, which provides “grandchildren on-demand” to seniors. College students who work with Papa visit with seniors and assist with chores and errands.
Humana is one of several insurers that covers Papa’s services; it’s piloting the program in multiple markets. Caraline Coats, vice president of Bold Goal and population health strategy at Humana, told FierceHealthcare that these pilots have produced strong anecdotal evidence so far.
Seniors look forward to the visits with their Papa Pals, she said. A member who might otherwise struggle to get out of bed, for example, will get up early because they’re excited—the visits and the social interaction can restore a lost sense of purpose, she said.
“I often say you don’t have to be a statistician to realize something good is going on here,” Coats said.
Aetna will also be partnering with Papa in 2020, the insurer announced this week. It also provides coverage for Silver Sneakers classes, with a focus on “Beyond the Gym” options, which are classes held in locations like senior centers.
Robert Mirsky, M.D., chief medical officer for Aetna Medicare, told FierceHealthcare that the goal is to ensure that solutions are of high value to the seniors using them. Not every member may want to go to the gym, and may instead be trying to find an avenue back into their favorite activities.
“What are the social settings where seniors are going?” he said. “How can we meet them there and then find out what they enjoy doing?”
Building a data ecosystem
Aetna revealed its slate of benefits that target social isolation alongside a new Social Isolation Index that it will use to identify members at high risk.
The index is built on data from both claims and “multidimensional information” on the social determinants. Once a member is identified as being at high risk for social isolation, consultants within Aetna’s Resources for Living program will proactively make contact.
Mirsky said that members will have access to several community resources through the program, and that the approach will be personalized to meet their needs.
“Every person is isolated for a different reason,” Mirsky said.
Through the Index, Aetna can build toward a model that puts social isolation in the greater context of a member’s wellness, he said.
“It’s about having a plan that leverages your coverage and your benefits but also takes advantage of the amazing community resources that are out there,” Mirsky said.
Coats said Humana is working similarly to build a “data ecosystem” to target social concerns like isolation and is treating social determinants of health like other gaps in care. Having that base of data ensures the insurer can identify the most effective solution for the member’s needs.
Starting with loneliness also builds a foundation to tackle a member’s other social concerns, she said.
“Social isolation and loneliness is the start to so many other social determinants of health,” she said. “They likely have a transportation issue and they likely have a food insecurity issue—something else is going on. I think it’s important to study it.”