Health insurers are investing in Medicare Advantage programs and supplemental benefits to tackle social isolation and loneliness in older adults, but they may not be reaching all the enrolles who could benefit.
Whether health insurers' spending on programs to mitigate isolation and loneliness is reducing overall healthcare costs is unclear. A 2017 AARP analysis of Medicare data found socially isolated adults were associated with $7 billion in additional spending.
A number of companies launched initiatives during the COVID-19 pandemic, including virtual classes and peer support programs, to combat the issue. But while those efforts have continued, a lack of clear information on what exactly enrollees may have access to—and what they might be most likely to use—has added some confusion to insurers' efforts.
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More than half of the 2,500 adults surveyed in the National Poll on Healthy Aging in 2020 self-identified as lonely. In the 2023 poll, more than a third of the surveyed older adults reported the same. These conditions can be especially dangerous for those individuals and costly to the U.S. healthcare system. They can increase the risk of a variety of illnesses, including heart disease, stroke, diabetes, dementia and depression, according to the Centers for Disease Control and Prevention.
To combat the problem, Scan Health Plan in 2021 invested $3.8 million in its Togetherness Program, which connects the nonprofit health insurers 285,000 Medicare Advantage members to peer counselors. So far about 4,000 members across California, Arizona, Nevada, Texas and New Mexico have used the program, according to CEO Dr. Sachin Jain.
“We’ve seen people’s depression scores go down, their loneliness scores go down and we’ve seen referrals for behavioral health go through the roof,” Jain said.
The insurer has not yet determined if its program has reduced overall healthcare costs, but Jain said he thinks it could over time because lonely older adults sometimes unnecessarily use hospital emergency rooms and clinics for social connection.
“That is an expensive way to get people social contact,” Jain said. “A big part of what we are trying to create is a release valve for the healthcare system so that patients have somewhere to go when they do feel lonely or socially isolated.”
Dr. Nwando Olayiwola, senior vice president and chief health equity officer at Humana, said the company's program, which resulted in about a million enrollee screenings last year, could also be saving Humana money in unnecessary healthcare spending. However, she could not estimate how much the company has already invested.
Humana identified social isolation and loneliness as a health risk before the pandemic, and in 2021 began screening for both when members enroll in Medicare Advantage plans, according to Olayiwola. Staff at Humana’s CenterWell Primary Care Clinics also screen older adults for those conditions.
“We do know in aggregate that our members that report two or more social needs are much more likely to have emergency department use or hospitalization that could have been avoided,” Olayiwola said.
Plan members who self-identify as isolated or lonely are offered referrals to community social programs and free membership to fitness programs such as SilverSneakers, which is tailored to adults over age 65. Aetna has also been offering SilverSneakers memberships, as well as referrals to other community programs through its Resources for Living program.
Meanwhile, Clover Health is looking to an artificial intelligence-powered Clover Assistant tool to flag members who might be socially isolated or showing signs of loneliness. A team from the company's home care unit can be deployed into members' homes to make behavioral health assessments and connect them to local social programs.
Virtual and in-person classes, peer counseling, adult day programs and other social supports can be very effective in addressing social isolation and loneliness, according to San Francisco geriatrician Dr. Carla Perissinotto. However, Perissinotto said many of her patients don’t know what benefits their health insurance plans offer, and providers have a hard time navigating the myriad plans to connect patients to programs.
“We don’t have a central site to know what is available in plans on a given day and those are the kinds of things that are creating huge barriers for patients,” Perissinotto said.
An advocacy group for Medicare Advantage is also calling for more transparency around the private health plans' offerings. Last fall, Better Medicare Alliance sent a list of recommendations to Congress and the Centers for Medicare and Medicaid Services calling on CMS to include details on plans’ supplemental benefits on its Medicare Plan Finder website.
Perissinotto said insurers sometimes contribute to the confusion by changing benefits from one plan year to the next. This year, 142 Medicare Advantage plans offer adult day services as a supplemental benefit compared with 241 in 2023, according to healthcare consulting firm ATI Advisory. The firm also found the number of plans offering social needs benefits, such as club memberships, dropped from 447 last year to 300 this year.
Insurers sometimes drop supplemental benefits if not enough members utilize them, said Tyler Cromer, practice director at ATI Advisory. She said a “communication gap” could make it harder for insurers to determine which benefits are most useful to members.
“There is not great information about what beneficiaries want, value and need for social support,” Cromer said.
Humana is trying to fix the communication gap, according to Olayiwola. She said the company is working to determine how it can better inform Medicare Advantage members about plan benefits.
