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Research

Covid-19’s aftermath: How health plans can help seniors in isolation

    By: Stephanie Young and Jasmine DeSilva

    Covid-19 has placed an outsized burden on seniors. CDC data shows that 79% of Covid-19 deaths are in people aged 65+ and that the risk of death increases with age. In turn, public health officials have urged seniors to stay home and avoid physical contact with others, including restrictions on visitors and activities at long term care facilities. While physical distancing efforts may protect seniors’ physical health in the short-term, it could ultimately harm their mental health and ability to manage their chronic conditions in the long-term.

    We’ve identified 3 overarching challenges seniors face during Covid-19 due to physical distancing: loneliness, limited access to essential needs, and increased care avoidance. For each challenge, we’ve outlined multiple avenues plans can take to address it and prevent downstream medical costs, drawing from plan and health system examples as well as senior living organization initiatives previously highlighted by Advisory Board experts.

    Challenges plans face in supporting seniors during Covid-19


    Challenge 1: Seniors are at increased risk of experiencing loneliness and
    behavioral health concerns

    Why it’s difficult

    An April 2020 Advisory Board survey found that 8% of surveyed Medicare Advantage respondents aged 65+ want their insurer to help them cope with isolation. Researchers estimate that loneliness increases the risk of mortality from all causes and is associated with $6.7 billion in annual Medicare spending. The burdens of social isolation on seniors will surely grow given Covid’s impact on physical interactions, incomes, and public transportation.

    But social distancing shouldn’t mean social isolation. Physical, not social, distancing is necessary to prevent the virus’s spread. Experts argue that the term ‘social distancing’ could be misleading and counterproductive, recognizing the grave impacts of loneliness.

    What plans can do about it

    Help seniors safely socialize through online platforms

    Kaiser is partnering with Livongo to add the myStrength app to its portfolio of self-care tips and tools. The app has features specific to Covid-19 and isolation including resources to manage stress, parenting, and social isolation. App-based services like Element3 Health, Happy, and YourCoach allow seniors to virtually gather and receive emotional support.

    UnitedHealth Group is partnering with AARP Foundation to expand the nonprofit’s Connect2Affect platform which promotes social connection through a network of programs and services for anyone who feel isolated or lonely, particularly older adults. The publicly available online platform offers an Isolation Assessment, information on local services, and articles to help people “start living a connected life.”

    Repurpose member-facing staff to call seniors to identify needs and provide social connections

    SCAN Health Plan employs “SCAN Senior Advocates” who normally make birthday and welcome calls to senior members. During Covid-19, SCAN Senior Advocates listen for unmet needs during their regular calls, such as meals and medication refills. SCAN taps into members benefits and arranges for community services when necessary.

    Cigna launched a program in which plan staff reach out to Medicare members to monitor their health, well-being, and access to needs. Members can opt-in to receive follow-up calls from the same Cigna representative to cultivate meaningful connections.

    Invest in long-term senior companionship initiatives

    Florida Blue Medicare is partnering with Papa which connects seniors to nearby college students, “Papa pals,” who typically provide assistance with transportation, chores, and companionship. In light of Covid, Papa expanded their services in March to include virtual companionship via mobile phones or landlines and guidance to enable seniors to use technology. Papa pals will continue to assist with groceries and medication delivery. Eligible Florida Blue Medicare members can qualify for 120 hours of assistance per year.

    Start a letter writing campaign to keep seniors connected with outside community

    Legacy Healthcare, a residential care provider, piloted a "Letters of Love" pen pal program where volunteers across the country can write letters to its residents. In less than a week, Legacy matched over 400 of its residents to volunteers. The volunteers can send photos with their letters to help the residents feel more connected.


    Challenge 2: Seniors disproportionately face burdens when accessing essential needs

    Why it’s difficult

    The financial strain of Covid, in tandem with physical distancing, place an immense burden on seniors. A 2020 Advisory Board survey found that 11% of Medicare Advantage respondents aged 65+ lost wages in the past three months due to Covid-19. Additionally, everyday tasks like grocery shopping, picking up prescriptions, and exercising outside put seniors at risk of contracting the virus.

    Nutritious food, medication adherence, and regular exercise are fundamental to maintaining health and preventing downstream medical costs. JAMA Internal Medicine discussed Covid-19’s impact, noting that “changes in the types of foods eaten due to changes in food availability during shelter-in-place orders may precipitate the exacerbation of heart failure especially in older adults.” Moreover, an Annals of Internal Medicine report estimates that medication adherence causes nearly 125,000 deaths and 10% of hospitalizations, ultimately costing $100-$289 billion annually for the U.S. health care system.

    What plans can do about it

    Deliver meals through local community nonprofits

    Alignment Healthcare launched a meal delivery program that provides two weeks of meals to members who can’t access food. The program leverages a trained group of 50 volunteers and works with a community partner to deliver the prepared meals. As of March 26, they had served nearly 3,000 meals to members in need.

    CareSource is partnering with The Foodbank, Inc. to prepare 1,200 food boxes to seniors living below 200% of the poverty line. Each senior will receive a 14-day supply of food with three meals per day, totaling 50,400 meals.

    Simultaneously support restaurant workers and food insecure seniors

    Capital BlueCross delivered more than 5,000 meals or snacks to residents in seven Pennsylvania counties through food prepared by a restaurant located in one of the plan’s business offices.

    Harvard Pilgrim is donating to community organizations that help restaurants deliver takeout meals to families in need and help put restaurant workers back to work.

    Offer increased flexibility on medication refills and partner with organizations to offer free medication delivery

    Many plans such as Aetna, AvMed, and Priority Health are partnering with pharmacy vendors to provide free delivery of eligible prescription medications.

    Additionally, many plans are allowing early refills for up to 90-day supplies of most prescription maintenance medications.

    Provide tailored exercise resources to help seniors stay physically and socially active

    Alignment Healthcare, a Medicare Advantage plan, is partnering with Peerfit Move to offer free at-home workout videos to its members. Peerfit Move is specifically designed for people over the age of 65 to provide easy access to a variety of fitness and wellness solutions.

  • Hillcrest Retirement Community is hosting exercise classes through video calls and YouTube, allowing them to exercise with peers while physically distancing.


  • Challenge 3: Seniors may be avoiding necessary medical care due to wariness over receiving in-person care

    Why it’s difficult

    Given the rapid spread of Covid-19, most health plans paused their in-person care management programs indefinitely for high-risk senior members, while increasing their remote monitoring and telehealth presence. Protecting at-risk seniors in the near-term could have long-term impacts on their health, and many plans note significant declines in necessary primary care visits during the epidemic. Long before the Covid-19 outbreak, 50% of surveyed private insurance members reported skipping primary care visits and as much as 51% of surveyed consumers avoided necessary medical care.

    Health plans will be forced to re-envision their primary care strategies and member care experience until a vaccine is available. While most seniors have a device with internet access at home, only 11% have used it to talk by video to a health care provider as of mid-March 2020. Plans will need to over-communicate with seniors around different modes of care available to prevent continued care avoidance and facilitate improved care management.

    What plans can do about it

    Proactively call seniors to identify and address physical and behavioral health needs

    ConnectiCare launched a “Peace of Mind” initiative to provide members with additional support during the coronavirus pandemic. ConnectiCare nurse care managers have called nearly 10,000 members who may be more vulnerable to the coronavirus due to medical conditions or their age and giving them critical information to help keep them safe. The initiative assisted with a variety of needs ranging from prescription drugs to billing questions and telemedicine services to dealing with stress and anxiety caused by the member’s current situation.

    A Midwest plan is redeploying care management staff that would typically visit members in-person to call the 20% highest-risk Medicare members. The staff identifies social, behavioral health, and clinical needs over the phone and refers them to providers and other resources as needed.

    Humana has made more than 500,000 proactive calls to members to address their health concerns and social and behavioral challenges related to the epidemic. The plan also provides a member support line with specially trained call center employees to help support Medicare Advantage beneficiaries with specific coronavirus questions and concerns, including live assisting with telehealth.

    Create a virtual-first mentality through on-demand and self-service options

    Florida Blue is adding a free-to-member virtual care partner, Teladoc, for seniors and others on its Medicare Advantage plans. Florida Blue’s dedicated Covid-19 virtual assistant on their website automatically guides users through educational content or through a series of questions to check for Covid-19 symptoms and related risk factors. Based on the assessment results, the tool directs users to contact their primary care provider for next steps, to the Florida Blue Center nurses for answers to commonly asked questions about COVID-19 and connection to community resources, or to immediate care options as needed.

    Cigna is either transferring or redeploying hundreds of on-staff nurses and physicians to support telehealth as the plan expands its offerings in this area.

    Plans should also focus on improving seniors’ technology skills through training resources or by enlisting the help of family members, friends, and caregivers. Plans can also encourage and help facilitate conversations between the patient, caregiver/family member, and care manager.

    Make it safer for seniors to receive in-person care if necessary

    Humana will deliver safety kits that include masks and educational materials to all of its MA members over the next several months to make visits to physician practices safer as they begin to reopen for non-emergent care. While cost-sharing for telehealth and behavioral health visits will also be waived through the end of 2020, Humana is ensuring MA members who aren’t reached by telemedicine won’t defer necessary care, especially those with chronic conditions.


    6 steps plans should take now (and later) to serve their senior members

    What to do in the short-term

    1. Focus first on identifying and serving seniors experiencing complete social isolation which may prevent them from accessing immediate and basic needs like food and medications and puts them at higher risk of loneliness and behavioral health concerns.
    2. Play a more active role in educating on Covid-19 and providing safety resources such as face masks as stay at home orders relax and seniors are forced to make difficult decisions around physical distancing.

    What to do in the long-term

    1. Facilitate consistent social connection for seniors to provide companionship and prevent loneliness as the country goes through bouts of physical distancing.
    2. Provide exercise and wellness resources to help seniors stay physically active in the safety of their home.
    3. Identify plan staff that are member-facing and create action plans to redeploy them for high-risk senior support should physical distancing requirements become more of a normal occurrence.
    4. Establish various modes of support outside of in-person encounters (e.g., telephonic, texting, remote monitoring, virtual visits) for seniors with chronic conditions, behavioral health conditions, and social needs (e.g., food insecurity, housing).

    Even as businesses open up and elective surgeries resume, life won’t return to “normal” for vulnerable populations until a vaccine is available. Until then, seniors will likely be advised to practice some degree of physical distancing. If seniors’ social, behavioral, and medical care needs are left unaddressed during this time, it may result in higher medical costs in the long-term.

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