Elizabeth Newman, Senior Editor

Conversations with my mother are occasionally like chatting with the dog from “Up” who yells “Squirrel!”

What begins with a comment about my renovated kitchen jumps to my sister’s childhood allergies to how my mom apparently bought out the toddler department in Dick’s Sporting Goods. But the crux of the story is she and my father have started swimming again  — she went to Dick’s to find swim goggles — and they now belong to multiple gyms.

“Why?” I asked, given that I feel belonging to even one gym feels like a commitment akin to marriage.

“Oh, it’s all through SilverSneakers,” she chirped.

SilverSneakers, as many of you know, is a much beloved program for seniors that has recently been in the news. That’s because UnitedHealthcare, as of Jan. 1, no longer offers the program to more than 2 million customers using Medicare Advantage or Medigap insurance in certain states.

Instead, United says it is directing people to its own program, Renew Active, which has more than 7,000 sites at no cost.

Whether United finds as much success with its own program remains to be seen — certainly, local news stories have found reasonably unhappy seniors dolefully putting aside cash to stick with their favorite gym. But it’s a good reminder, as Avalere Health experts mentioned in their 2019 outlook last week, of how providers, insurers and pharmacy giants are looking at social determinants of health. These include not only access to a gym, but factors such as family, housing and education. It begs the question: What are long-term care providers, and vendors, doing to address these “softer” factors in healthcare?

For one, CVS and Aetna announced Monday they were sponsoring a five-year $100 million initiative to support nonprofits working on social factors around health, Bloomberg Law reports.

One concrete aspect: The CVS Health-Aetna Foundation initiative will provide free health screenings and funding to address tobacco and opioid use, according to Larry Merlo, president and chief executive officer of CVS Health, who spoke at the National Press Club Jan. 14.

CVS stores also will give 20% of its spaces to healthcare services, such as Minute Clinics, to check blood glucose levels and offer “concierge” services to help consumers with their health insurance.

Part of this is strategy on the part of CVS, which has faced criticism for the possible behemoth created by the merger with Aetna. But Merlo said he believes the company can help patients connect to primary care providers when they need one.

The big question — and one I hope CVS, which owns Omnicare, considers — is whether it also can help connect seniors to post-acute care services. This can range from information about joint replacements and rehab facilities to helping family members needing help for someone with dementia. While I doubt the entity wants to move into the realm of depression or cognitive screenings for seniors, long-term care providers should think creatively about partnerships.

For all our focus on the day-to-day, skilled nursing executives must put aside time for pursuing bigger strategies, such as what or who it brings to the table related to social factors around health. What is to stop you from requiring each member of your team to submit an idea focused around quality improvement, increasing census or maximizing reimbursement?

While it all can feel overwhelming, the place to start is by reminding your teams that they can start small. Whenever I’m stuck on a big writing project, I remind myself of this passage from Anne Lamott’s “Bird by Bird.”

“Thirty years ago my older brother, who was ten years old at the time, was trying to get a report written on birds that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table close to tears, surrounded by binder paper and pencils and unopened books about birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him put his arm around my brother’s shoulder, and said, ‘Bird by bird, buddy. Just take it bird by bird.’”

Follow Senior Editor Elizabeth Newman @TigerELN.