Following the “Dark Thread” of Loneliness

Years before the COVID-19 pandemic, loneliness was being flagged by then

U.S. Surgeon General Vivek Murthy as a rising epidemic and public health

concern. Loneliness, he warned, runs “like a dark thread” through other

physical and mental issues such as addiction, anxiety, and depression.


And while the social isolation of the pandemic has unquestionably added fuel

to this slow-burning fire, it has also done us a great service by revealing the

many ways social, environmental, mental and physical health factors

converge and conspire against our personal and public health.

So, now that we see these risks in a new light, and recognize the

interconnectedness, what do we do about it?


At Crossover Health, our approach is rooted in the understanding that the

traditional sick care model only captures some 20% of what influences

people’s health. We therefore make it a priority to ask about, and do whatever

we can to address, the other 80%. As part of our “Be Well” model, we

regularly screen members for a set of behavioral/social indicators, including

alcohol use, partner violence, depression and anxiety, housing insecurity, and

financial instability.


As social determinants go, loneliness is often misunderstood and easily

missed. Unlike social isolation, which can be observed and measured,

loneliness is subjective – often defined as the self-perceived gap between the

expectations and reality of one’s social connections. Due to stigma and

shame, it’s often hidden from view. And five years after Murthy brought it to

the highest levels of public awareness, few primary care physicians screen for

it today – an unfortunate gap and missed opportunity.

So what did we learn about loneliness? Of the more than 26,000 members

we’ve screened since we began nearly a year and a half ago, 1 in 4 screened

positive for loneliness . Of those who reported being lonely, 49% also reported

being anxious, depressed, or both. Interestingly, as shown in the figure below,

while anxiety and depression steadily tapered off after late 2020,

corresponding with initial rollout of COVID vaccines, rates of loneliness are

holding stubbornly steady.


At Crossover we use this information to direct people to health coaches, offer

a personalized curriculum or other resources, or simply begin a conversation

with patients to learn more. In this way, consistent with our team-based

integrated care model, we take the time to proactively address the

whole-person needs of our members, building trust by doing what’s right for



In a time when not much seems to be predictable, one thing we can be certain

of is that loneliness isn’t going away anytime soon.. But having brought

loneliness out into the light, we now need to systematically address it along

with the rest of the 80% of factors that add up to being well. To follow the

thread of loneliness and understand how it weaves through the fabric of

Primary Health, we must take a truly comprehensive, integrated approach to

care. Doing so will allow us to have patient conversations we wouldn’t

otherwise have, spot signals we would otherwise miss, and intervene early to

keep people well.

About the Author


As Chief Medical Officer at Crossover Health, Dr. Ezeji-Okoye oversees the

company’s national Medical Group, consisting of interdisciplinary care teams

who deliver Crossover’s Advanced Primary Health model to members. He has

a passion for population health and redesigning systems to drive

improvements in quality and efficiency beyond medical intervention.

About Crossover Health

With two state-of-the art Care Centers in Seattle and Bellevue, Crossover is

bringing a new approach to employee healthcare, and an ongoing

commitment to whole-person health. Crossover Health is a leader in delivering

value-based hybrid care. The company’s national medical group delivers – at

scale – Primary Health, a proven care model driven by an interdisciplinary

team inclusive of primary care, physical medicine, mental health, health

coaching and care navigation. With a focus on wellbeing and prevention that

extends beyond traditional sick care, Crossover builds trusted relationships

with its members and flexibly surrounds them with care— in-person, online,

and anytime— based on the member preference. Combining a sophisticated

approach to data analytics that incorporates social determinants of health,

Crossover delivers concrete results and measurable value for employers,

payers, and most importantly, members. Together we are building health as it

should be and engaging a community of members to live their best health. To

learn more, visit crossoverhealth.com or follow us on social media


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