Tom Sullivan | May 26, 2021
The issues of loneliness and isolation are near to the heart of Lisbeth Briones-Roberts. As the U.S.-born daughter of Mexican immigrants, in fact, she went through an identify crisis as a child.
“I didn’t fit completely in American culture or completely in Mexican culture. I often felt lonely,” Briones-Roberts says. “Over time, I became more comfortable with myself, but loneliness came back to my attention when I started working in the aging sector. Of course, then the pandemic hit and I saw how pervasive loneliness is and I wanted to do something about it.”
That something is SCAN Health Plan’s new Togetherness Program, which Briones-Roberts leads as SCAN’s Chief Togetherness Officer. It’s not just her, of course. Briones-Roberts is quick to credit the SCAN team for establishing the peer-to-peer program designed to reduce loneliness by connecting seniors during the pandemic and into the future by building on the success of its Member-to-Member Program.
What available data reveals about social isolation and loneliness
Preliminary surveys conducted as early as April 2020 suggested a 20-30 percent increase in isolation and loneliness weeks into the shelter-in-place and quarantine restrictions. In late February of 2020, the National Academies of Sciences, Engineering, Medicine published a report, The Health and Medical Dimensions of Loneliness in Older Adults, that determined “the health care systems remains an underused partner in preventing, identifying and intervening for social isolation and loneliness among adults over age 50.”
That research found that approximately 25 percent of Americans 65 and older are socially isolated and people over 50 are more likely to experience risk factors associated with isolation and loneliness, notably chronic illness and sensory impairments. The National Academies report also suggested that social isolation can increase an individual’s risk of premature death as much as smoking, obesity or physical inactivity, isolation is associated with a 50 percent increased risk of dementia, 29 percent increased risk of heart disease, 32 percent increased risk of stroke — and among heart failure patients loneliness is associated with a 4x increased risk of death, 68 percent increased risk of hospitalization and 57 percent increased risk of ED visits.
“People who are socially isolated, lonely and frail — that’s a dangerous problem,” Briones-Roberts says. “It’s important to address loneliness head on.”
What’s more, an article in the Journal of American Medical Association, found in that in April 2020 13.6 percent of US adults experiences symptoms of serious psychological distress compared to 3.9 percent in 2018 and in the same month 13.8 percent of U.S. adults indicated that they always or often felt lonely.
Lisbeth Briones-Roberts, SCAN Health Plan
A prescription for loneliness and isolation
SCAN’s intent is to create what Briones-Roberts described as “essentially a prescription with a dosage and frequency” to better understand the causes for each individual and, in turn, treat loneliness and isolation as health problems. She cited, as examples, how losing a loved one or making major life changes can lead to isolation.
“We have to have the right prescription for each person, and look at whether our interventions are working,” Briones-Roberts says. To measure that, SCAN will use the UCLA Loneliness Scale, pre- and post-participation in the Togetherness Program as well as the PHQ-9 (Patient Health Questionnaire).
Succeeding requires that executives make sure all their business line owners are thinking about employees, especially now since the pandemic has heightened the issues of isolation and loneliness. Briones-Roberts said this is critical now because it can be shameful for people to admit when they do not have social connections or when they feel lonely, isolated or both. That also means creating safe spaces for people to share and receive encouragement from others who they know will be accepting of the issues.
SCAN’s Togetherness Program will also include virtual and in-person classes to convene seniors with common interests, peer advocates and SCAN employees regularly calling members on the telephone, and tech support to help members connect via digital devices.
How SCAN thinks about ROI for Togetherness
While the Togetherness Program is new, SCAN has earned success with previous peer-to-peer initiatives. The organization’s Member-to-Member Program, established in 2016, trained people to contact other members to improve outcomes by normalizing difficult conversations around topics such as depression, increasing physical activity, falls prevention, urinary incontinence and pain management.
“We’ve been successful and now we are looking to leverage that for the next evolution in the program,” Briones-Roberts says. “One of the fantastic things about working with Sachin Jain, our CEO, is that he looks first at whether it’s the right thing to do regardless of ROI. That’s very liberating because now I can go out and work on it.”
That’s not to say ROI is ignored. Rather, when looking at a return, Briones-Roberts advises other executives to consider how much they spend on hospitalizations, over- and under-utilization of mental health, and weigh those against the opportunity to reduce expenses by addressing loneliness.
“We’re less worried about dollars and cents and instead think about driving real impact and measuring that,” Briones-Roberts adds. She also recommends that executives considering initiatives to address loneliness and isolation plan for the longer-term. SCAN, for its part, originally thought the Member-to-Member program would last for 1 year but it took 3-4 years to really demonstrate its full potential.
Togetherness: An emerging field?
While the concept of the program isn’t new, the Chief Togetherness Officer title is still novel. A quick search for Chief Togetherness Officer, in fact, leads straight to CareMore, where Jain served as CEO prior to SCAN and started a togetherness program.
“I am hopeful there will be a lot more Chief Togetherness Officers at other companies. It’s important that every industry and organization look at employees and its member base because every employer has employees who are lonely,” Briones-Roberts says. “I am hoping it becomes an emerging field.”
The U.K. and Japan, for instance, have ministers of health within the government of each. U.K. Prime Minister Theresa May appointed a Minister of Loneliness in 2018 as part of its first loneliness strategy and in 2019 the U.K.’s Department for Digital, Culture, Media and Sport announced Diana Barran as the Under Secretary for Civil Society with direct responsibility for loneliness. Even a U.K. soccer club hired a chief loneliness officer during the pandemic. Japan’s Prime Minister Yoshihide Suga appointed Tetsushi Sakamoto in February of 2021 to oversee the nation’s initiatives to address loneliness and isolation, which along with rising suicides, have become worsening problems amid the pandemic.
Whether the title includes togetherness or loneliness in it, Briones-Roberts shares some skills that are essential for an executive charged with driving the work.
“This is a complex issue and there are no easy solutions. Understanding social determinants of health and other causal factors leading to isolation are important knowledge skills,” she adds. “And you really have to be interested in people. I am fascinated by every single person I meet and hearing their life story. So it takes a healthy interest among the soft skills in addition to standard business and leadership skills.”