In 2001, Harvard professor Robert Putnam published his seminal book, Bowling Alone: The Collapse and Revival of American Community, carefully documenting the continued and undeniable decline of social capital in the United States. Putnam’s argument, compelling then as it is today, was simple: Americans are less connected to each other than they were in generations past – and are worse because of that.
A growing number of healthcare organizations, especially those focused on care of the elderly, have recognized the importance of social interaction for health. In addition to medical appointments, diagnostic tests and studies, and medical prescriptions, these organizations prescribe and offer social interaction with other seniors. Some interactions, such as education classes, have a health issue at their core, but just as often not. Social interaction is seen as a medicine in itself and is often a key engagement tool, empowering patients to become more involved in their health and is an integral part of the clinical delivery model.
The intrinsic importance of the social bond
Some health care organizations have identified the creation of greater social connection as a clinical goal. At Cerritos, Calif., CareMore Health (the healthcare delivery company I run), lack of social connection or loneliness was considered a “treatable illness” and patients can sign up for a ” solidarity program ”. Each CareMore patient undergoes a Healthy Start screening during which they are asked about their level of social connection with others. Patients identified as socially isolated or lonely are put in touch with a “connector set” who makes a weekly phone call to check on the patient’s condition.
Usability Connectors are trained in motivational interviewing and work to identify and resolve barriers to social interaction and connect patients with activities in their community that could be of benefit to them. Over 600 patients are enrolled in the Ensemble program and over 100 CareMore employees have been trained to function as “Connectors Together”. CareMore social workers also make home visits to patients with particularly serious problems.
Additionally, many CareMore Care Centers, neighborhood clinics, have adjacent Nifty-After-Fifty gyms where seniors can participate in group exercise classes with other seniors. Social interaction at Nifty After Fifty facilitated important social bonds among the elderly and even resulted in a few marriages among the elderly widows. Patients in the CareMore Togetherness program participate in Nifty-After-Fifty programs 20 percent of the time, compared to a baseline of 12 percent in a control group. This is a 67% improvement in measurable social engagement. Patients in the Ensemble program are also more likely to participate in preventive health examinations than patients who do not participate in the program.
Social interaction as a catalyst for health care delivery
For some healthcare organizations, social activity is seen as a key enabler and foundation for healthcare delivery. Miami-based Sun Health health plans (recently acquired by Anthem, Inc) has, for years, operated Pasteur and WellMax clinics for its members, where social interaction and events are the main event and medical care takes place in the background. Health Sun patients have access to free transportation to clinics that look nothing like a traditional medical clinic. Next to patient waiting rooms are social spaces where patients play dominoes and other board games; take courses; and enjoy each other’s company. It is not uncommon for patients to visit the clinics on a daily basis, and the clinics serve as both local centers for the elderly and medical care. The daily proximity to a medical clinic means that patients with high-risk medical conditions and chronic illnesses only have a conversation with a receptionist outside of a medical appointment. It is not uncommon for HealthSun patients with intensive medical needs to see their doctor or nurse on a weekly basis.
This regularity of interaction for high-risk patients is considered the foundation for the excellent clinical results achieved by Health Sun, including low hospital admission and readmission rates. Many patients who might suffer from denial or avoid accessing medical care now spend most of their days in close proximity to it, further increasing the likelihood that they will adhere to their medications or drugs. their treatment plans.
Puerto Rico-based MMM Health adopted a similar model in the aftermath of Hurricane Maria. He built a “Recharge!” Centers ”near their clinics to offer lectures on nutrition and better management of interpersonal relationships to seniors, among other topics; it also offers workshops, exercise classes, board games, music and concerts for seniors. MMM President Orlando Gonzalez notes, “At times like this our senior population needs more because they are part of a very vulnerable population, which is why it is so important to ” be sensitive to their needs. This special pavilion meets these needs. The recharge! Pavilion is now considered the cornerstone of the MMM Health model going forward.
Social connection to facilitate exchange of health information
Some healthcare organizations see social interaction as an opportunity for patients to have an exchange of ideas about their medical conditions. Many medical groups, such as Kaiser Permanente, have for years offered group visits based on the idea that patients can often teach each other better how to manage chronic conditions than a doctor or nurse. Group visiting programs have been designed for diabetes, cancer, chronic obstructive pulmonary disease (COPD), depression, among other conditions. There is growing evidence that patients interacting in social contexts around their disease facilitate adherence and improve self-management. According to researchers at Thomas Jefferson University, diabetic patients who participated in group visits had lower hemoglobin A1C levels than others.
It is important to note that not all social connections related to health care need to be in person. Many patients are increasingly going online to interact with other patients to better understand their disease and treatment. Among the best known of these models is the Improve Care Now network of pediatric gastroenterologists and patients. Ulcerative colitis and Crohn’s disease patients experienced higher rates of disease remission due to their participation in the online forum. CysticFibrosis.com was considered to have a similar impact in patients with cystic fibrosis. And many wellness apps like MyFitnessPal rely on exchanging information about physical activity levels and food consumption.
Value-based care will enable clinical models more focused on social interaction
Prepayment is a critical enabler of social health care models. CareMore Health, Health Sun, MMM Health, and Kaiser Permanente are all healthcare organizations fully responsible for managing the health costs of the patients they serve. As more healthcare organizations embrace value and risk based payment, they will recognize the health benefits of social interaction and the importance of this interaction in enabling social interaction. health care delivery.
The maxim “all health care is local” will soon be replaced by the more precise maxim: “all health care is social”.