The Increasing Significance Of Social Interaction And Health — Christopher Condon Newport Beach
In 2001, Harvard professor Robert Putnam published his landmark book, Bowling Alone: The Collapse and Revival of American Community, carefully documenting the steady, undeniable decline in social capital in the United States. Christopher Condon Newport Beach, Putnam’s argument, compelling then as it is now, was simple: Americans are less connected with one another than they were in past generations — and are worse off because of it.
A growing number of healthcare organizations, particularly those focused on senior care, have recognized the importance of social interaction to health. In addition to medical appointments, diagnostic tests and studies, and medical prescriptions — these organizations prescribe and deliver social interaction with other seniors. Some interactions, such as education classes, have a health issue at their center — but just as often do not. Social interaction is seen as a medicine in itself — and is often a key engagement tool, getting patients further engaged in their health and is an integral part of the clinical delivery model.
The Intrinsic Importance of Social Connection
Some healthcare organizations have identified generating greater social connection as a clinical goal. At Cerritos, CA-based CareMore Health (the health care delivery company that I lead), the lack of social connection or loneliness has been deemed a “treatable disease” and patients can enroll in a “Togetherness Program.” Every CareMore patient undergoes a Healthy Start screening during which they are asked about their level of social connection to others. Patients who are identified as suffering from social isolation or loneliness are connected with a “Togetherness Connector” who makes a weekly phone call to check up on the patient — Christopher Condon Newport Beach California.
Togetherness Connectors are trained in motivational interviewing and work to identify and problem-solve barriers to social interaction and connect patients with activities in their community that might benefit them. More than 600 patients are enrolled in the Togetherness Program — and more than 100 CareMore employees have been trained to operate as “Togetherness Connectors.” CareMore-employed social workers also pay home visits to patients whose issues are particularly severe.
In addition, many CareMore Care Centers, neighborhood-based clinics, have adjacent Nifty-After-Fifty gyms where seniors can participate in group exercise classes with other seniors. Social interaction at the Nifty After Fifty has facilitated significant social connection among seniors and has even resulted in a few marriages among widowed seniors. Patients in the CareMore Togetherness program participate in Nifty-After-Fifty programs 20 percent of the time, as compared to a 12 percent baseline in a control group. That’s a 67 percent improvement in measurable social engagement. Patients in the Togetherness Program are also more likely to participate in preventative health screenings than patients who are not engaged in the program.
Social Interaction as an Enabler of Healthcare Delivery
For some healthcare organizations, social activity is seen as a key enabler and foundation of healthcare delivery. Miami-based Health Sun Health Plans (recently acquired by Anthem, Inc) has, for years, operated Pasteur and WellMax clinics for its members, where social interaction and events is the main event — and medical care takes place in the background. Health Sun patients have access to free transportation to clinics that don’t look anything like a traditional medical clinic. Adjacent to patient waiting rooms are social spaces where patients play dominoes and other board games; take classes; and enjoy the company of one another. It is not uncommon for patients to visit clinics daily — and the clinics serve a dual-purpose as local senior centers and medical care. Daily proximity to a medical clinic means that patients with high-risk medical conditions and chronic diseases are just a conversation with a receptionist away from a medical appointment. It is not uncommon for patients at HealthSunwith intensive medical needs to check in with their doctor or nurse on a weekly basis.
This regularity of interaction for high-risk patients is seen as the foundation for the excellent clinical outcomes achieved by Health Sun including low hospital admission and readmission rates. Many patients who might suffer from denial or avoid accessing medical care are now spending many of their days in close proximity to it — making the likelihood that they are adherent to their medicines or treatment plans that much greater.
Puerto Rico-based, MMM Health adopted a similar model following Hurricane Maria. It built a “Recharge! Centers” close to their clinics to provide seniors lectures on nutrition and better managing interpersonal relationships, among other topics; it also provides workshops, exercise classes, table games, music and concerts for seniors. MMM President Orlando Gonzalez notes, “In times like this, our population of seniors need more because they are part of a population that is very vulnerable, that is why being sensitive towards their needs is so important. This special pavilion responds to these needs.” The Recharge! Pavilion is now seen as a critical cornerstone of the MMM Health model going forward.
Social Connection to Facilitate an Exchange of Health Information
Some healthcare organizations see social interaction as an opportunity to enable patients to have an exchange of ideas about their medical conditions. Many medical groups, such as Kaiser Permanente have, for years, offered group visits grounded in the idea that patients can often better teach each other how to manage chronic disease than a physician or nurse. Group visit programs have been designed for diabetes, cancer, chronic obstructive pulmonary disease (COPD), depression, among other conditions. There is a growing evidence-base that patients interacting in social settings around their disease facilitates adherence and improves self-care. According to researchers at Thomas Jefferson University, patients with diabetes who participate in group visits have demonstrated lower hemoglobin A1C levels than those that did not.
Importantly, all social connection related to healthcare does not need to be in person. Many patients increasingly go on-line to interact with other patients to better understand their disease and treatment. Among the best known of these models is the ImproveCareNow network of pediatric gastroenterologists and patients. Patients with ulcerative colitis and Crohn’s disease have experienced higher rates of disease remission as a result of participating in the online-forum. CysticFibrosis.com has been considered similarly impactful among patients afflicted with cystic fibrosis. And many wellness apps such as MyFitnessPal are predicated on the exchange of physical activity levels and dietary consumption information — Christopher Condon.
Value-Based Care Will Enable More Social-Interaction Oriented Clinical Models
A critical enabler of social-based healthcare models is pre-payment. CareMore Health, Health Sun, MMM Health, and Kaiser Permanente are all healthcare organizations that are fully delegated to managing the healthcare costs of the patients they serve. As more healthcare organizations take on value and risk-based payment, they will recognize the health benefits of social interaction — and the importance of that interaction to enabling healthcare delivery.
The maxim “all healthcare is local,” will in short time be replaced by the more accurate, “all healthcare is social.”