This article was written by Lisa Miller.

Healthcare and Social Isolation

Social isolation and the impact on health is a vital consideration for healthcare providers, to such an extent that it has been described as America’s “next public health issue.”
The definition of social isolation
Social isolation can be defined as quantifiable social disconnectedness, a near complete absence of contact between an individual and wider society.
It encompasses a number of factors, such as:

• The size and structure of social networks.
• The frequency and duration of social interactions.
• The extent of social support received by an individual.

One in five US adults report feeling socially isolated or lonely and the older population is especially vulnerable to the effects of social isolation[1]. By 2035, the Census Bureau predicts there will be 78 million people in the US aged 65 and over.
It is no exaggeration to say that social isolation is at risk of reaching epidemic proportions.
The impact of social isolation on health

Multiple research studies highlight the health impacts of social isolation on both physical and mental health conditions.  These include high blood pressure, heart disease, stroke, obesity, anxiety, depression, cognitive decline and high mortality rates.
Under the ACA (The Affordable Care Act), the Center for Medicare and Medicaid (CMS) has instituted reimbursement models which focus on value-based care.
Value based care requires hospitals and other healthcare providers to improve patient outcomes at a lower cost in order to obtain maximum reimbursement for their services. But there are additional considerations which must be taken into account, as well as clinical issues.
Social Determinants of Health (SDOH)
In addition to clinical issues, providers must consider a patient’s “social needs” and how they may impact health, recovery and overall well-being. These social needs are known as Social Determinants of Health (SDOH).
The World Health Organization (WHO) defines SDOH as “The conditions in which people are born, grow, live, work and age”.  Specifically, they include access to housing, healthy food, clean air and water, education, transportation, and social connection.
Social isolation as a social determinant leads to poor health outcomes.
Social isolation as a social determinant leads to poor health outcomes. Click To Tweet
To address these issues, hospitals are ideally tasked with three key goals:

• Keeping patients healthy.
• Maintaining low rates of infection.
• Maintaining low readmission rates after a hospital stay.

The economic benefits of achieving these goals (i.e. the payment for services received by insurance companies, including Medicaid/Medicare), as well the ability to serve their community, are crucial to the hospital’s stability.
The American Hospital Association (AHA) states that:
“….hospitals and health systems—as anchor organizations or placed-based economic engines in their communities—have the opportunity to make meaningful upstream investments to improve community health.”
In this article, we have included critical information from some key research reports to identify what social isolation is and how it relates to health and healthcare costs.
Loneliness and social connection
Is social isolation the same as loneliness?
The AARP (formerly the American Association of Retired Persons) offers the following definitions:

• “Social isolation is objective, with measurable factors like the size of one’s social network, the frequency of contact with that network, availability of transportation, and the ability to take advantage of support resources.
• Loneliness is more personal and subjective — that is, how people perceive their experience and whether they feel they lack the connections, companionship or sense of belonging that we need as humans[2].”

Furthermore, both social isolation and loneliness are related to public health issues, leading to a rise in obesity and a detrimental effect on mental health. Research suggests.

• Few patients discuss loneliness with their healthcare provider. Equally, few are asked about the impact of isolation or loneliness on their health condition.[3]
• Poor social relationships were associated with a 29% increase in the risk of coronary heart disease and almost a third higher risk of stroke[4].
• Social isolation has a financial impact. Medicare spends approximately $134 for each socially isolated elderly adult, equating to an estimated $6.7 billion in additional Medicare spending, every year[5].

Social isolation is also a high risk factor for mortality.
To resolve the issues relating to loneliness that impact on health requires the participation and involvement of healthcare providers and the healthcare community as a whole. SDOH must be included in this consideration which have a significant impact on patient outcomes. The Center for Disease Control suggests that the impact of SDOH on patient outcomes is greater than the impact of the actual delivery of health services[6].
Initiatives to address social isolation

The relationship between social isolation, health, and healthcare utilization is complex. Several initiatives exist to combat social isolation and promote the inclusion of older adults into society. These include:
The Coalition to End Social Isolation and Loneliness which aims to “engage diverse stakeholders, increase public awareness, promote innovative research, and advocate for policy change that combats the adverse consequences of social isolation and loneliness and advances approaches that improve social connectedness for all Americans[7].”
The World Health Organization (WHO) has created the Global Network for Age-friendly Cities and Communities and recommends identifying and supporting networks for older adults, providing access to appropriate assist devices, and developing confidence in using technology.
The UK government launched a Loneliness Strategy in 2018, appointing a Minister for Loneliness. Furthermore, the UK’s National Institute for Health and Clinical Excellence (NICE) recommends healthcare practitioners identify and address social isolation among older adults.
Here in the US, the Centers for Disease Control and Prevention, and Centers for Medicare and Medicaid Services (CMS)—recommend that health systems collect information on social determinants of health, ideally in electronic health records.
The American Hospital Association (AHA) also recommends holistic care, including attention to social determinants of health, to improve patient satisfaction. This in turn can lead to increased reimbursement, higher levels of patient loyalty and have a positive impact on employee retention[8].
The AHA also promotes the case for hospitals to invest in affordable housing to improve community health[9]. The organization has been influential in addressing the social needs of the community and how hospitals should be involved. Supporting affordable housing is already an emerging strategy for many hospitals and health systems[10].

Accelerating Investments for Healthy Communities (AIHC) enables healthcare providers to expand their commitment to affordable housing. Examples of this strategy in action include:

• Kaiser Permanente recently pledged $200 million to invest in housing across the country.
• Nationwide Children’s Hospital announced the creation of a $20 million fund to finance 170 multi-family rental units on the South Side of Columbus.
• Dignity Health in San Bernardino worked with community partners and the State of California to leverage more than $20 million dollars for a housing project that is expected to create hundreds of units of affordable and market-rate housing.

According to the Robert Wood Johnson Foundation, if implemented strategically, community investments can benefit hospitals in the following ways:

• Financial returns on investment from successful projects.
• Bottom line returns on investment from improved community health.
• Non-financial benefits like having a healthier workforce, for example, reduced levels of crime and improved relationships with the community.

The foundation also notes [11]:
“When anchor institutions such as hospitals and health systems partner with the community, they empower the community in a way that would not have been possible without outside financial expertise and capital. In communities that have the ability to attract and leverage investment capital, this kind of partnership can be critical.”
The foundation’s senior vice president of program, Don Schwarz, MD, MBA emphasizes the unique position of hospitals and health systems to influence health in their communities.
Social isolation: A priority for healthcare providers in 2020
We have summarized the findings of these multiple studies below, which reiterate our experience at VIE Healthcare when partnering with healthcare organizations across the US:

• Social isolation is a social determinant of health that causes multiple health problems.
• Hospitals and health systems are tasked by the Center for Medicare and Medicaid to partner with their communities to address the population health needs of their patients.
• Both financial incentives (increased revenue through increased reimbursement) and social commitment to improve the quality of health in the community should be high priorities for hospitals and health systems in 2020.

Financial incentives and social commitment to improve the quality of community health should be high priorities for the healthcare sector in 2020. Click To Tweet

• Under the leadership and guidance of the American Hospital Association, many hospitals have already begun steps to find solutions and improve health in their communities through strategic partnerships and investments.

VIE Healthcare collaborates with your hospital to achieve these goals in 2020 and beyond.
[1] https://www.ncbi.nlm.nih.gov/books/NBK537912/
[2] AARP 2018 National Survey of Adults 45 and older- Loneliness and Social Connection
[3] https://doi.org/10.1371/journal.pmed.1000316
[4] Studies; Heart 2016; 102:1009–1016. Doi: 10.1136/heartjnl-2015-308790
[5] https://doi.org/10.26419/res.00234.001
[6] https://www.beckershospitalreview.com/healthcare-information-technology/leveraging-social-determinants-of-health-data-for-value-based-care-success.html
[7] https://www.endsocialisolation.org/our-members
[8] https://www.aha.org/system/files/hpoe/Reports-HPOE/2017/housing-role-of-hospitals.pdf
[9] https://www.aha.org/issue-brief/2019-04-24-making-case-hospitals-invest-housing
[10] https://www.aha.org/system/files/media/file/2019/05/AIHC_issue_brief_final.pdf
[11] https://www.rwjf.org/en/blog/2017/03/can-hospitals-defy-tradition.html