Managed Healthcare Executive: Defeating Loneliness

Health technology may help patients struggling with loneliness.

Loneliness costs, and loneliness kills.

It is well documented that loneliness—the discrepancy between the number and quality of relationships that one desires and those one actually has—dramatically increases the risk for mental and physical disease. Loneliness contributes to a wide range of conditions, including dementia, heart disease and stroke. It afflicts those of all ages, including the elderly, postpartum women and even young people, who are affected at higher rates. President-Elect Joe Biden’s Surgeon General nominee and current co-chair of his coronavirus task force, Vivek Murthy, has written that loneliness and social isolation are “associated with a reduction in life span similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity.” Research published in the journal Perspectives on Psychological Science shows that loneliness can increase one’s risk of mortality by 45%, making it more dangerous than air pollution, obesity and excessive alcohol use. A 2010 AARP Foundation study found that over one-third of U.S. adults — 2.6 million — are chronically lonely.

Beyond its impact on these individuals and their loved ones and caregivers, loneliness takes a profound economic toll, particularly on our healthcare system. Parkland Health and Hospital System, based in Dallas, analyzed organizational data and found that 80 patients accounted for 5,139 emergency department visits in one year, at an estimated cost of $14 million. Loneliness was the primary factor for those visits.

Loneliness is a chronic condition that health plans nationwide are beginning to address with a new sense of urgency. Traditionally, in dealing with behavioral health and social determinants of health (SDOH) — healthcare, education, community, economics and the like — insurers have relied on the interaction of clinicians with their patients to identify needed treatment or care. That model ignores the fact that most behavioral health and SDOH needs arise outside of the clinical environment. Individuals at risk of loneliness-related adverse health often do not present themselves to clinicians in a timely manner. The medical community has had little success in determining which patients have immediate loneliness-induced needs, contributing to spiraling health declines and otherwise avoidable emergency department visits and hospitalizations.

One proven solution to loneliness and social isolation is to provide human connection and companionship, with special attention to those moments when medical intervention is required. These steps appear simple, but particularly in this time of the COVID-19 pandemic, getting and staying in contact with at-risk individuals can be challenging. Enter technology.

Forward-thinking health plans are today employing digital tools to monitor and interact with their vulnerable enrollees. The most effective of these technologies use software programs, including mobile apps, to engage with at-risk individuals on a highly personalized basis. They interact in human-like conversation, providing day-long companionship, particularly in the overnight hours when the lonely are most isolated and vulnerable. These services offer spirit-lifting messaging and self-management tips, while at the same time monitoring individuals’ responses to determine when their health is in potentially dangerous decline and when human intervention is required.

Digital caregiving has the distinct advantage of being scalable, meaning that it can deliver comprehensive services to an expanding client base, meeting even pandemic-level demand.

There is one significant shortcoming with digital care, and that is seen in instances where human interaction is absolutely required. Recognizing that, the best loneliness support programs incorporate compassionate human intervention which brings trained support staff into phone contact with individuals at the first signs of mental or physical decline and at any time the individual desires such interaction. These phone sessions produce more nuanced support and evaluation, which can de-escalate a loneliness crisis or trigger interventions such as meal deliveries, transport to doctors or emergency medical attention.

One major health plan found that this type of integrated loneliness care reduced inpatient treatment costs by 46%. To encourage wider adoption of such proven technology/intervention systems to diagnose and treat loneliness, the CPT Editorial Panel should establish an appropriate billing code.

The nation’s health plans are giving loneliness the heightened attention it deserves. Their increasing embrace of sophisticated technology to manage this critical health threat means that more of us will weather the holiday blues, the pandemic’s imposition of social isolation and all the other internal and external pressures that push us to the edge of loneliness-induced anxiety, desperation and decline.

For loneliness, there is a remedy, and it may be just a digital or human interaction away.

Cindy Jordan is founder and CEO of Pyx Health, a mobile solution that reduces loneliness and social isolation by connecting with health plan members outside of the traditional care setting.