Addressing Loneliness and Isolation During COVID-19

COVID-19 and the social distancing measures implemented to slow its spread has altered life for millions and exacerbated a loneliness crisis in America. Here’s what some health plans have done to mitigate the impact of social isolation and bolster well-being, along with thoughts on addressing these issues beyond the pandemic.

One in five US adults have reported feeling lonely or isolated, according to a Kaiser Family Foundation survey, and that was before COVID-19 disrupted life as we know it—temporarily ending gatherings, limiting physical proximity, and leading to shelter at home mandates. These types of pandemic-related developments have only revved up existing feelings of disconnection for many and brought the topics of loneliness and isolation—and their impact on mental and physical health—to the fore.

Research has linked loneliness and social isolation to an increased risk of a wide array of physical and mental conditions, including anxiety, depression, weakened immune system, cognitive decline, and heart disease. However, there are ways to combat the adverse effects, and many insurers have taken steps in an attempt to do just that.

“While keeping members physically healthy may be a plan’s first priority, with so many people—especially seniors—dealing with increased isolation and loneliness during the pandemic, it’s important to focus on members’ mental health as well,” said Cory Busse, VP of Performance Strategy at NovuHealth—a health care consumer engagement company that has worked with plans across the country to improve performance and consumer health.

Many plans use programs designed to help members feel supported and connected, he told First Report Managed Care, and one example is NovuHealth’s Healthy Connections for HOS program. It features a series of “podcast-like phone calls” that reach out to Medicare Advantage members with content geared toward both physical and mental well-being.

The program enables plans to proactively and regularly touch base with members while offering supportive content meant to help members feel better about themselves and their health. Programs like this are relatively inexpensive because they utilize communication channels such as outbound and inbound Interactive Voice Response (IVR), Mr Busse noted, and the related costs “pale in comparison to the hidden costs associated with the rising tide of deferred care.”

Loneliness and isolation are a serious impact of the COVID-19 crisis, added Kristine Grow, a spokesperson for America’s Health Insurance Plans (AHIP), and it is important to ensure that individuals have pathways to support good mental health and well-being. Health insurance providers have come up with a variety of tools and pathways to help individuals in this regard, she told First Report Managed Care, and the trade association has compiled an online listing that details examples of the actions taken by various health plans in response to COVID-19.

Some have taken steps to support vulnerable populations in particular. SCAN Health Plan, for instance, launched an employee “all hands” effort. This involved calling members to ensure they have what they need to stay healthy while at home, focusing first on the socially isolated or high-risk. Among this group are those who live alone, people who are homebound, or individuals on oxygen.

Similarly, ConnectiCare began a “Peace of Mind” initiative to offer members additional support during the pandemic. Nurse care managers called members who could be more at risk due to medical conditions or age to deliver critical information and help keep them safe. And EmblemHealth initiated an outreach campaign geared toward its most vulnerable members, providing a human connection to those who could be suffering from extended stretches alone. 

Other initiatives, meanwhile, have zeroed in on younger populations. Blue Shield of California teamed up with DoSomething.org to develop a mental health guide and help youth deal with stress and anxiety during the crisis. The digital campaign included text, email, and social media to encourage young people to share their tips for combating anxiety. The aim was to reduce stigma, raise awareness, and encourage youth to seek help.

Still other efforts are broader in nature, making tech tools available to all plan members. A variety of insurers, such as Priority Health, have offered free access to a mental wellness app called myStrength to help users combat anxiety, stress, depression, and feelings of social isolation.

Overview of One Plan’s Approach

During a webinar hosted on May 1 by the National Institute for Health Care Management Foundation, a panel of experts shared research and insight on the impact of loneliness on health and discussed strategies for improving social connectedness to boost happiness and well-being.

During the talk, Kelli Tice Wells, MD, senior medical director of medical affairs at Florida Blue, described the health plan’s implementation of a comprehensive approach intended to prevent social isolation and ensure access to care during the COVID-19 pandemic.

The decision was made early on that clearly presented information, updated often, would be the key to ensuring that members would feel supported. There were efforts made to engage members in one-on-one conversations, for instance, using nurses and social workers. “We engage them to proactively reach out to members, check on their health, help with food and rent and utilities and those kinds of things,” she said during the webinar, “because we have a team of social workers who are already engaged in that work.” And any member with a COVID-19 diagnosis receives a call to ensure that they have what they need to complete their isolation and quarantine period and to connect to whatever services might be indicated.

Another measure taken was the implementation of a toll-free hotline staffed 24 hours a day and open to members as well as anyone in the community who might feel the need to connect and receive help with stress management. “We began to hear very early on just how anxious our members were about what they were seeing and their own fears about their health as the number of cases across the country began to increase,” Dr Tice Wells explained.

Surveying members and paying attention to the types of questions asked helped lead to the development of educational material shared via various modes of communication, such as webinars. Initially, these covered general topics. As time went on, however, they became more targeted and specific. Multiple channels were used to distribute video messaging, too, which addressed issues such as hand washing or social distancing one at a time to allow for the consumption of information in an easy, actionable manner.

Other Florida Blue efforts focused on at-risk populations. Early on, it was recognized that as elective procedures were postponed, some members were not seeking services due to fear or a lack of understanding as to how they could access their care provider. To address this issue, all provider offices in the plan’s network were called to assess their status, determine whether they were open or closed, and find out whether they were offering virtual services. That information was compiled to work on better assisting certain patient groups, like those with chronic disease, and to ensure members had actionable information that would enable them to connect to care.

Older members became a group of interest as well. The obvious reason relates to the infection itself. “But more primarily and more critically is the work that was already in flight to address social isolation issues in our Medicare population,” Dr Tice Wells said. “In our case, we had long partnered with the Council on Aging, and we’re able to leverage that relationship to craft some specific messaging and host some events,” she added, which provided an opportunity to speak about various issues faced by this population in particular.

Some of those initial conversations revealed just how difficult it was for many seniors to transition to virtual care. An existing partnership with Papa, which pairs older adults with pals for companionship and help with everyday tasks, helped address this issue. While the program is geared toward tackling social isolation, as a young person comes by to assist with chores or play a game, there are organic opportunities to help with technological challenges as well.

Yet another COVID-related concern highlighted by Dr Tice Wells related to food insecurity. As supply chains were interrupted, the sources for much of the supplemental food services went away. “We have had to step in and try to address that in a manner that keeps folks out of crisis,” she said. Florida Blue connected with organizations like Meals on Wheels to address food supply for its senior members, for whom meal delivery—and even just that brief interaction with another person—are critically important.

Thinking Past the Pandemic

A silver lining of the COVID-19 pandemic is that it may provide an opportunity for health plans to think through how they might better address issues like loneliness and isolation for their members after this crisis has come and gone. One of the critical lessons learned, according to Mr Busse, is that members want far more communication from their insurers.

Despite the proactive measures taken by various health plans, new data shows a gap between how plans communicate with their members and what those members expect. A JD Power 2020 US Commercial Member Health Plan Study released on May 14 found that 6 in 10 members indicated they were never contacted by their plan with COVID-19 information and nearly 5 in 10 said they feel their plan has not shown concern for their health since the pandemic reached the United States.

Another important takeaway is that in the wake of the pandemic, plans are learning to leverage telehealth visits to make sure members receive the care they need even when they aren’t able to schedule an in-person appointment. The Centers for Medicare and Medicaid Services, which regulates both Medicaid and Medicare Advantage plans, relaxed regulations to allow for dozens of covered telehealth services, including many behavioral health services, Mr Busse pointed out.

“Whether these newly covered telehealth services will still be covered after the pandemic has subsided remains to be seen, but it’s safe to say that telehealth will play a much bigger role in the delivery of health care services than it did pre-pandemic,” he added. “The accelerated adoption of telemedicine has given plans and providers a powerful tool in addressing physical and mental health.”