Loneliness, CAHPS and Medicare: Novel approaches

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A member's experience of their health plan is a critical element of the healthcare ecosystem. It’s not the same as member satisfaction, instead, member experience is centered on the perception of interactions with providers and the plan. For MA-PD plans, CMS relies on the MA-PD Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey as the agency’s primary means of assessing patient experience. This survey is overseen by the Agency for Healthcare Research and Quality (AHRQ).  CAHPS® data is also included in MA plan Star Ratings which are made available to members to help them choose their plan. As a result of recent CMS policy decisions, CAHPS survey-derived MA Star Rating measures (member experience) are becoming a more heavily weighed component of health plan quality ratings and payments.

Due to the emphasis CMS places on the importance of member experience, Medicare plans seek strategies that enhance the member experience using communication tools to improve health literacy and care coordination. However, the current CAHPS survey doesn’t include questions about loneliness. As a chronic condition that impacts physical health, mental health, and overall perceptions, addressing loneliness is essential in improving the patient experience.

Solving for loneliness in your Medicare plan could reduce overall costs by 64%.  Learn how. >>

So what novel approaches can Medicare plans take to identify lonely members, integrate loneliness treatments and improve CAHPS scores?

A female doctor discussing loneliness with her patient.

Medicare plans realize the impact of loneliness

Over the past few years, Medicare plans have targeted loneliness. The data regarding the impact of loneliness on health and costs have made it worth examining. There’s a correlation between loneliness and the risk of early death, and experts have cited it as a “public health emergency.” Studies link it to an array of conditions, including Alzheimer’s disease, cardiovascular disease, type 2 diabetes, cancer and more. 

Medicare plans have also categorized chronic loneliness as different from social isolation and not just a symptom of depression or other mental illnesses.

The impact of loneliness is devastating to your plan members’ experiences. Their perceptions of care are skewed due to their loneliness. There are physical changes in the body as well when a person is chronically lonely, which further exasperate a person’s ability to engage in health care decisions or treatments. Those biological components include elevated cortisol production and chronic inflammation

As a result, those that suffer from loneliness often misread facial expressions and tone of voice, perceiving social interactions in a distorted reality. 

This feeds into members becoming unengaged with their plans and providers. All these factors impact how the lonely use health services. They are more likely to visit emergency departments and be admitted to the hospital, distorting their healthcare experience. 

There is a direct relationship between SDOH and the propensity for loneliness

There is significant data that demonstrate this association. A study from the Journal of American Medical Association (JAMA) concluded that social isolation is an SDOH. The data represented that higher 30-day mortality rates occurred due to social isolation for patients in long-term care facilities. 

Pyx Health’s data further links these elements. We determined that a health plan client’s members were 110 percent more likely to identify “safety” SDOH needs when they are lonely. The “safety” issue includes everything from domestic violence to the risk of falling. With SDOH screening and predictive engagement tools, plans can tailor the care approach to be specific. Identification of lonely members puts you in a better position to alleviate SDOH needs, too.

CMS began to offer more flexibility in the design of supplemental benefit (an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare) to address SDOH needs including interventions to address loneliness.

Will these supplemental programs help mitigate loneliness? These programs seek to minimize SDOH concerns, but there are other steps plans can take to improve the patient experience. 

Pairing seniors with companions

Some plans have expanded their initiatives and partnered with private and nonprofit companies that offer companionship to seniors they identify as lonely or socially isolated. Again, this companionship can be beneficial, but it doesn’t truly address or treat loneliness. 

Chronic loneliness is much more complex than simply needing company. Your members can be chronically lonely and have people around them. The disconnect in a lonely brain isn’t fixed by increasing social interactions. Providing this service to lonely members may have little to no impact on their experience. 

Increasing and personalizing communications

Another broad step that plans have implemented is increasing and personalizing communications. This requires being data-driven and collecting information about individual member experiences. When plans do so, they can deliver more tailored communications, such as medication messaging to support adherence, chronic disease programs or other specific services. Plans also have processes to communicate with their members post-hospitalization — to prevent readmission which lonely members are more at risk if intervention does not occur.

Communicating in multiple channels is also necessary, including patient portals, emails, text messages and mailings. Communication is a pillar of experience but plans again run into issues with member engagement for lonely members. Loneliness impedes engagement and can prevent the member from consuming the helpful information and acting on it. 

The novel approach to treating loneliness: Technology and human connection

The strategies described above can have some effect on loneliness and experience. However, even with a concerted effort, your plan may still fall short. That’s why you need to take a unique approach and use a program that marries technology and human connection. With solution-based interventions, members have the support to make connections and build confidence in self-managing relationships. 

Plans have new tools available to them that:

  • Act as an SDOH screener to understand the barriers members face.
  • Solve or mitigate barriers in ‘real-time’ when possible and connect the member back to the plan for issues that can not be addressed immediately.
  • Improve member engagement by impacting how members use services.
  • Provide evidence-based treatments for loneliness.
  • Deliver actionable data to plans to support engagement, care continuity and experience.

The Pyx Health platform offers this holistic approach to treating loneliness with user-friendly technology and compassionate human interaction outside traditional care settings. It works by first screening for SDOH and the propensity for loneliness. Once identified, your members will go through our evidence-based program, proven to decrease loneliness, improve engagement of plan services and social supports and reduce costs. 

Explore the details of the program and how it supports Medicare plans.

Cover of Medicare Executive Brief