Our Thoughts About Loneliness are Changing; Now Our Actions Must, Too

What begins as a niche on the margins often expands to the mainstream. It happens in almost every industry: computer technology had humble origins in the garages of hobbyists to becoming the dominant influence on modern life. We are experiencing similar transitions across healthcare, including the adoption of telehealth or virtual care. It’s also occurring in the critical area of isolation and loneliness, where the impact of those conditions on health are emerging into the bright light of our awareness. As the U.S. Surgeon General, Vivek Murthy, MD, said recently, “There are more adults struggling with loneliness than have diabetes. Yet think about the discrepancy in the attention that we give to these two conditions.” That is beginning to change.

When I founded Papa in 2017, it was premised on the belief that loneliness and social isolation were conditions that had a profound impact on mental and physical health – and could be improved through intervention. While ripe for systemic transformation, the industry did not have the tools for sweeping change. I felt what those computer hobbyists in their garages must have felt — sure in my belief but aware of the enormity of the challenge.

As social determinants of health become a common conversation in healthcare, loneliness and social isolation are rising to the forefront. The statistics are staggering. According to the Centers for Disease Control and Prevention, social isolation significantly increases a person’s risk of premature death from all causes; is responsible for a 50% increased risk of dementia; a 29% increased risk of heart disease; higher rates of depression, anxiety, and suicide; a 68% increased risk of hospitalization; and the medical costs associated with loneliness and social isolation for people aged 65+ are estimated to be $6.7 billion.

In 2018, the U.S. Centers for Medicare & Medicaid Services took game-changing action when a new rule gave Medicare Advantage plans greater freedom to establish a variety of innovative benefits, such as transportation to medical appointments, home delivery of meals — and companionship service. In doing so, CMS created an opportunity for the healthcare industry, particularly health plans, to develop and deploy innovative solutions to this long-neglected problem.

Since that time, we’ve seen notable growth in the movement toward expanding benefits. Currently, the average beneficiary can select from 39 Medicare Advantage plans that provide benefits addressing the SDoH. At Papa, we are working with about 70 Medicare Advantage and managed Medicaid clients to improve health, and reduce loneliness, through social connection and support, where members are allotted a certain number of hours with a trusted pal who offers companionship, issue-spotting in the home, and a connection to community or plan resources. Through that trusted 1:1 relationship, those pals are able to identify and close care gaps both socially and clinically, from addressing fall risks in the home to helping individuals schedule and travel to their annual wellness check.

Increasingly, the healthcare industry, including insurers, is recognizing the value of non-traditional approaches to enhance member experience and outcomes, and to reduce and ultimately eliminate determinants that disproportionately affect marginalized groups. Notably, the benefits of companion care align with the outcomes plans measure for ROI in key areas, including member experience, medication adherence, social support, behavioral health issues, social needs and insecurities (e.g., transportation, food access), healthcare access/compliance, and home safety. For instance, we’ve found health plan members who enroll in Papa are 70% more likely to renew with their plan, as compared to members who don’t enroll with Papa. And a randomized controlled study of chronically ill Humana members found 69% of individuals who received Papa’s companion care services improved their loneliness score, while 39% were no longer considered lonely at all.

Our awareness of loneliness and social isolation is becoming top of mind. But so much more can be done. As we’ve witnessed the loneliness trend become epidemic over the past two years, we’ve realized just how pervasive the situation is. At Papa, we saw a 67% increase from 2020 to 2022 in individuals who reported severe loneliness, an extreme form of loneliness, during our initial assessments. And while one might assume the prevalence of severe loneliness would have decreased from 2021-2022, the opposite is true – it continued to mount, increasing by 25%.

Thankfully, real human connection delivered through companion care, is having a measurable impact. Sixty percent of severely lonely individuals who actively participated in their health plan’s Papa program experienced clinical improvements and moved to a lower category of loneliness, reducing their risk of dementia and poor health outcomes, including premature death after hospitalizations. This is the moment to make SDoH, including loneliness and social isolation, the focus of healthcare, with commensurate investment against these circumstances that disproportionately drive health outcomes.

I was inspired to build Papa in order to solve an acute need with my grandfather. Since that time, the realization that loneliness affects us all in some form, and should be considered a health issue and a societal one, has become more widespread.

What it means to come together, in our increasingly atomized and digital world, is one of the great challenges of the 21st century. I’m grateful this public health crisis is finally receiving industry attention – and now, our actions must match. With awareness comes responsibility. Let’s create a world where no one has to go it alone.