State- and Employer-based Solutions to Address Social Isolation and Loneliness

In 2021, Third Horizon Strategies (THS) launched the Health Equity Project (HEP), a national effort to reinvest in marginalized communities by developing and promoting integrated, equitable health models. As part of its first phase, HEP collaborated with Pareto Intelligence and Algorex Health to develop issue briefs that explore the impacts of various social determinants of health (SDOH) on health outcomes and outline strategies that state Medicaid programs can adopt to promote health equity by addressing health-related social needs. The first three issue briefs focused on food insecurity, housing instability, and transportation. The latest issue brief discussed the negative impacts of isolation and loneliness, one of the top five SDOH identified by the CDC.

Social isolation is the lack of social connections, whereas loneliness is the feeling of being alone regardless of the amount of social contact a person may have. According to a report from AARP, loneliness costs Medicare an estimated $6.7 billion per year. Pareto Intelligence and Algorex Health cross-referenced models of neighborhood stress and social isolation with health conditions and hospital readmissions to assess the extent to which isolation and loneliness correlate with adverse health outcomes. The data showed that social isolation and loneliness were associated with a higher prevalence of behavioral health issues, including depression. Further, those with elevated social isolation scores had a significantly greater number of doctors’ visits and a very high risk of costly hospital readmission.

THS conducted an extensive literature review and identified a range of successful interventions that states can pilot, as well as ways that they can reimagine existing programs (e.g., home- and community-based solutions) to tackle social isolation and loneliness. Interventions should begin with screening. States are increasingly requiring SDOH screening of Medicaid members and should ensure that social isolation and loneliness are included in the screenings. One example of a social isolation screening instrument is the Lubben Social Network Scale, which assesses the frequency, closeness, and breadth of an individual’s contact with their social network. After identifying individuals experiencing social isolation or loneliness, systems should ensure that they include opportunities for pro-social activities and community-building programs in their referral networks. Community health workers or peer support specialists can be critical assets to help foster relationships and navigate individuals to community-based services.

As pandemic-driven allowances expire, millions of Americans are projected to lose Medicaid coverage. Thus, it is crucial that screening and support for social isolation and loneliness extend beyond Medicaid. According to research by Cigna, each lonely worker (61 percent of adults) may cost their employer nearly $4,200 per year in additional workdays lost. At the national level, this could cost the U.S. economy over $406 billion a year. As employers recognize the impact of SDOH on an employee’s overall well-being and redesign their workplace to foster and facilitate meaningful connections among their employees, they will not only help improve their employees’ health but ultimately improve their bottom line.

The transformation and integration of health and social systems will require the cooperation of all stakeholders. It is pertinent that Medicare, Medicaid, and employers prioritize SDOH in discussions around improving the health and well-being of individuals of all ages and identities. Stakeholders should begin by identifying and understanding the impacts of SDOH on overall well-being, as well as the relationships between different SDOH. In the next and final issue brief of the series, THS, Pareto Intelligence, and Algorex Health will be evaluating the impact of Adverse Childhood Experiences (ACEs), which are correlated with a host of other SDOH and adverse physical and behavioral health outcomes.

To learn more about the Health Equity Project, please visit https://projecthealthequity.org/