Solving Loneliness: Moving Beyond Connection to Engagement and Empowerment

Distancing has driven our national narrative for over a year. With guidance from the federal government down to local municipalities, we’ve constantly been encouraged to widen the space between ourselves and others—many times closing ourselves off entirely in quarantine, all in the name of public health. While it’s encouraging that this guidance has resulted in a reduction of deaths in the United States, even as the virus has caused nearly three million deaths worldwide, an unintended consequence of COVID-19 is a dangerous spike in what was a public health epidemic long before the first diagnosed case of COVID: Loneliness.

Loneliness and social isolation are making headlines almost daily, but in this extended news cycle, we have an opportunity to shape new solutions for the loneliness epidemic. This requires an intentional shift from merely creating connections—acknowledging needs and providing resources—to fostering critical engagement—the building of trusted relationships among patients and providers. Connections alone rarely solve problems; engagements absolutely do. That’s the simplicity of this otherwise bold “next-gen” strategy, and nowhere does this migration from connection to engagement matter more than in today’s health plans.

We know that the more a patient is engaged in their own healthcare, the greater the likelihood of improved health. As providers offer patients more decision-making opportunities and the means to access care in a timely fashion, we can expect to see healthier patients.

We also know that loneliness is an equal-opportunity accelerator of a host of critical conditions, both mental and physical. Dementia, heart disease, diabetes, stroke—the list is long. Solve loneliness and you significantly improve and extend human life. That loneliness is a predictor of deadly disease should signal a payor response of historic magnitude, given managed care’s mission of health promotion and disease prevention. As the old adage suggests, “it’s wiser to build a fence at the edge of a cliff than to put an ambulance down in the valley.”

Health plans have been in the fence-building business since their inception. Their executives know that encouraging better health and lifestyle practices among their members will reduce the chance of illness, and preventing illness means less money these companies will likely have to spend treating dangerous diseases in expensive environments like hospital emergency rooms. This is why health plans invest significantly in member education—offering resources from smoking cessation classes and fall prevention tips to healthy recipes and stress reduction techniques. This is how many health plans connect with their members to encourage healthy living, often producing great results.

Loneliness, however, is an issue where success isn’t likely to result from connections alone. This comes as no great surprise, with disconnection and isolation being at the very heart of the loneliness pathology. In its 2020 Loneliness Report, Cigna Corporation noted that three in five Americans, about 61 percent, reported feeling lonely. And those were 2019 numbers. I can only imagine the numbers once COVID arrived on the scene. That’s a lot of people potentially costing healthcare plans a wealth of money to treat a host of loneliness-associated chronic diseases.

What’s that sound? It’s the ambulance engine firing up as the fence stretches to capacity.

Encouragingly, some health plans around the country have started to expand from member connection to member engagement in a national health scheme that has all too often left the lonely behind. These plans are using a new set of tools to combat loneliness, recognizing the reality that meaningful and interactive patient engagements—those that are designed to solve problems—are contingent upon relationships built on trust and rapport.

In a white paper published last month, Phoenix-based Banner University Health Plans (BUHP) revealed that its use of a novel interactive platform, with empathetic technology and human intervention working in unison, after discharge from emergency room or inpatient care resulted in a substantial reduction in subsequent inpatient costs and emergency department use.

Analyzing the experiences of 1,170 members aged 18-103 years old, and comparing that data with a control group that did not access the digital platform, BUHP realized very substantial savings of $847 per member per month over a six-month period on this group of high-cost members. The platform was successful in overcoming common barriers to care management, such as low member engagement rates and failure of traditional outreach methods.

The primary feature of this platform from a company called Pyx Health is an engaging and entertaining chatbot named Pyxir who acts like a trusted friend in a coffee shop. He creates connections while fostering engagement, empowering people to take control of their chronic loneliness through sustained behavioral changes. When advanced levels of engagement are needed, members can have phone conversations with representatives from the platform’s compassionate support center who are equipped to make referrals to community support services.

These engagement tools are being used by health plans that serve large numbers of Medicaid and Medicare enrollees, as well as those serving at-risk pregnant women, transitional age youth, and other populations on whom loneliness frequently preys.

Among the many learnings from our time with COVID this past year is that loneliness is on the rise and tackling it requires a new vision with fresh ideas and policies. The good news is that the health plan market has started to make its moves. They recognize that connections with their members are critical, but that trusted engagements are the real keys to unlocking the loneliness solution.