Cigna: Addressing Loneliness to Improve Physical Health and Mental Well-Being

Cigna is addressing loneliness to help improve physical health and mental well-being by drawing attention the issue to help destigmatize feelings of loneliness.

FOCUS:

We all feel lonely every now and then, but for nearly half of Americans the feeling is more frequent (link). In a survey conducted by Cigna in 2018, 46 percent of respondents reported sometimes or always feeling alone and 47 percent reported feeling left out (link). The findings showed the breadth and depth of loneliness in America and was a call to action for Cigna and others to address loneliness as a social determinant of health.

An analysis of Cigna’s U.S. Loneliness Index published in the American Journal of Health Promotion provides actionable insights for designing preventive health benefits and initiatives to decrease loneliness include:

• Excessive social media use can increase loneliness, but in moderation can create a sense of connectedness.
• In-person time with family and friends can provide a balance to social media use.
• Age plays a role, with loneliness decreasing with age.
• Everyday social behaviors are more strongly related to loneliness than gender, race or income.

Cigna is taking a number of other actions to help individuals, employers and communities:

• A brief, 10-question loneliness survey is now available on Cigna.com to encourage people to identify and address feelings of loneliness.
• Series of mental health articles to offer help and resources to address feelings of loneliness, depression, stress and other issues on Cigna.com.
• Encouraging all Americans to talk to their health care provider about their physical health and emotional well-being as part of the company’s Body and Mind Initiative.
• Offering a 24/7/365 Veteran Support Line open to all veterans, families and caregivers regardless of whether or not they are a Cigna customer that provides services and resources for pain management, substance use counseling and treatment, financial issues, food, housing and more.
• Cigna’s Employee Assistance Program (EAP) provides customers with live telephone advice and practical solutions on a wide range of issues that can cause stress and isolation, including parenting and childcare, senior care, legal and financial advice, and more. Cigna’s EAP also provides referrals to licensed behavioral health care providers to improve customers’ mental wellness.
• Offering Cigna customers a suite of digital health engagement tools such as Happify, iPrevail and Omada that seek to improve mental well-being, social connectivity and physical health.
• Cigna is also working to integrate behavioral health services into its collaborative care arrangements to ensure patients get the integrated care they need for their physical and mental well-being – as opposed to keeping care separate.

Aetna and Mercy Care Plan

Mercy Maricopa is an integrated physical and behavioral health Medicaid managed care plan administered by Aetna and serves patients in Maricopa County, AZ. In 2013, Mercy Maricope was awarded the Regional Behavioral Health Authority (RBHA) contract for Maricopa County by the Arizona Department of Health Services (ADHS). Mercy Maricopa provided behavioral health services to Medicaid eligible children and adults with a general mental health/substance use disorder (GMHSUD), integrated behavioral health and physical health services to Medicaid eligible adults with  serious mental illness (SMI), and crisis services, as well as a range of state-funded behavioral health services for individuals not eligible for Medicaid. Mercy Maricopa was the first RBHA to cover integrated physical and behavioral health services for Medicaid eligible individuals with an SMI. Additionally, Mercy Maricopa focuses on SMI populations who also experience homelessness, which includes more than 5,000 such individuals in Maricopa County, and contracts for other supportive services, including housing and employment supports

Focus:

NORC at the University of Chicago developed this case study of supportive service expansion for individuals with serious mental illness enrolled in the Mercy Maricopa Integrated Care Medicaid managed care plan in Maricopa County, Arizona, through a series of structured interviews with stakeholders ranging from service providers to patient advocates.This case study provides background and historical information on Mercy Maricopa and the population it serves and examines the 1) policy drivers, 2) partnerships, and 3) organizational decisions and staffing alignment that have influenced Mercy Maricopa’s implementation of expanded support services, including employment and housing supports. The case study also explores the successes and challenges identified by stakeholders.

Policy Drivers

Several key policy and legal drivers played a significant role in the implementation and expansion of supportive services for the serious mental illness and general mental health and substance use disorder populations in Maricopa County, specifically the Regional Behavioral Health Authority transition and the Arnold v. Sarn court decision.

Partnerships

Building partnerships with government officials, providers, and stakeholders involved with the serious mental illness community has been an important part of Mercy Maricopa’s process when designing, implementing, and expanding its care model. These partnerships have enabled Mercy Maricopa to create a system of care that is responsive to and anticipates the needs of its members.

Organizational Decisions and Staffing Alignment

Mercy Maricopa has made several strategic network and staffing decisions that have played important roles in the implementation of Mercy Maricopa’s expanded housing and employment support services program for individuals with serious mental illness.

Lessons Learned

• Establish a Member-Centered Framework: Mercy Maricopa takes a “member-centric” approach, focused on ensuring that members have maximized agency in obtaining and directing their services and supports.
• Strengthen and Maintain Stakeholder Partnerships: Mercy Maricopa leadership was deliberate about incorporating itself into the local network of organizations working with individuals with serious mental illness, enabling it to unify its service delivery approach by ensuring that strong connections with providers led to consistent and best practices across clinics.
• Nurture and Sustain Good Communication: Mercy Maricopa has worked closely with providers to help clearly communicate expectations, focus on improvement, and enhance relationships, promoting substantial growth and flexibility.
• Be Strategic with Resources: Strong partnerships with robust communication also encouraged Mercy Maricopa to identify strategic uses for limited resources.