Published on September 22, 2021
If you’re happy and you know it, clap your hands— Joe Raposo
If you’re happy and you know it, clap your hands
If you’re happy and you know it, then your face will surely show it
If you’re happy and you know it, clap your hands
Do you remember what it was like to sing “If you’re happy and you know it” with classmates and clap your hands? Chances are, no matter how much you did or didn’t want to participate, you ended up enjoying yourself and feeling closer to the people around you. That’s the power of connection which, it turns out has a bigger impact on the quality of our lives and health than we might imagine.
80 years ago, researchers at Harvard University launched a remarkable pair of studies, known collectively as the Harvard Study, that are still ongoing today. The findings help us understand the importance of social connectedness in long-term health and well-being.1,2 For health plans and providers increasingly accountable for the health status of their member/patient populations, these insights show that it’s possible to engage more effectively with members to preserve good health or intervene before any health problems worsen.
As usual, turning such insight into action remains a challenge. That’s why Carrot Health developed our new Community Connectedness Index (CCI).
The combined Harvard study began in 1942 and included 724 men. Every two years, researchers visited each of these men to conduct in-depth interviews about their lives. These visits included medical examinations and data from medical records. That research has since become the longest longitudinal study on adulthood and aging ever conducted.
268 of the men were sophomores at Harvard. After the study began, many quickly went off to fight in World War II. Some were traumatized by their experiences. But when they returned, they all resumed lives of privilege and promise.
The remaining 456 men were Boston teenagers who came from some of the inner city’s poorest neighborhoods, and grew up in troubled or struggling families. They had few of the advantages afforded their Harvard cohort and less likelihood of success, status and fortune.
Yet, happiness and quality of life were not clearly dictated by social status, financial well-being, education, career potential, or even genetics. In each cohort, there were people who thrived and others who faltered and “failed.” Some of the Harvard men turned out to be wildly successful, including John F. Kennedy, the future President of the United States. Others suffered the ravages of alcoholism, disease, and mental illness. Some of the inner city men lived long and healthy lives with happy marriages, good jobs and stable family situations. Others remained mired in generational poverty and chronic illness.
To the researchers’ surprise, the study revealed that one factor correlated more strongly than any other with long-term health and wellbeing: social connectedness. The men who were most connected to their communities, their families and their partners lived the healthiest and happiest lives.
Carrot Health built its Community Connectedness Index (CCI) to test the practicality of that theory among populations broader and more diverse than the Harvard Study.
In crafting our CCI model, we developed a long list of activities that serve as proxies for social connectedness. These include voting, charity work, religious attendance, book club membership, and pet ownership, among many other data points.
We then cross-referenced this score with care utilization data for three distinct member populations – one enrolled in Individual Family Plans (IFP), one enrolled in Medicare Advantage plans (MA), and the rest receiving benefits through Medicaid (MC).
This data pointed to some interesting observations. In aggregate, the people with the highest degree of social connectedness had the highest total cost of care. The second highest total cost of care came from the people with the lowest social connectedness scores.
Utilization costs look differently, however, when examining those plans (and their member populations) separately. In MA programs, the least connected people incur the highest costs. In contrast, in IFP and Medicaid plans, the most connected people were the most expensive while the least connected were the least expensive.
How can we account for these variations across programs? We made a series of hypotheses based on the make-up of those cohorts.
IFP members span a range of ages and circumstances related to their employment and economic status. They are under 65 and may be purchasing insurance on their own because they work independently or for a small company, or because they are temporarily between jobs. Meanwhile, Medicaid members tend to be sicker and poorer than IFP or MA members. Most, but not all, are under 65.
Perhaps IFP and Medicaid members who had high community connectedness scores also engaged with the healthcare system more consistently, while those with low connectedness scores may lack the support, interest, resources or “health” to engage more with their providers. Longer term, this lack of engagement with the healthcare system may exacerbate poor health conditions and lead to greater healthcare costs, while those engaged with the system may be helping to keep their conditions managed and their costs under control.
The Medicare Advantage cohort is over 65. They tend to be younger and financially better-off than the average Medicare member, and more engaged with their own health needs. As evidence, they’ve made active consumer decisions about plan benefits that suit their individual needs and preferences.
Perhaps the MA members who are most connected to their communities are also healthy and active, and have less need of healthcare services. It’s not surprising, then, that those who are less connected cost more since studies show that loneliness and social isolation have a negative impact on health status3 and that impact increases as people age and their health and life challenges compound.
Overall, this cursory analysis emphasizes that not all member populations are the same, and utilization patterns vary with age, income and other factors. It is important to be as precise as possible about the needs and characteristics of specific populations and cohorts.
In next month’s Insight, we’re going to dig deeper into care utilization patterns to determine how community connectedness influences care costs across a variety of care access points. And we’re going to also look at the relationship between community connectedness and the risk of social determinants of health through Carrot Health’s Social Risk Grouper scores.
In the meantime, if you’re happy and you know it, you know what to do…