Papa to more closely align with insurers, promising cost reductions and best-in-class safety

Eldercare company Papa is looking to drive deeper support for insurance plans through new offerings focused on Star ratings and social determinants of health.

These programs will lower medical costs for insurers’ members while still delivering in-person companionship seniors often crave, the company said.

Papa caregivers, known as Papa Pals, conducted more than one million visits in 2023, primarily in person. These visits help seniors navigate around their homes, complete chores and assist with technology, among other tasks.

“Phase one of Papa was really developing a national network of friendly companions that can help with instrumental activities of daily living,” Papa CEO Andrew Parker told Fierce Healthcare. “We’ve always intended to develop a solution to help plans in more ways. It’s what we’re calling phase two of Papa.”

Parker said the company sees high levels of utilization and engagement for people who most need the services. In higher needs populations, close to 30% of people enroll in Papa, with up to 85% of those enrollees using Papa on some cadence.

Now, the company is pitching Papa as a way for health plans to improve their Star ratings—by enlisting pals to drive members to annual wellness visits and preventive disease screenings.

The services also allow plans to address social determinants of health needs. Caregivers and Papa’s own internal analytics identify areas of need such as housing or food insecurity, internet access and gaps in transportation to better serve members.

One Papa case study found that among rural Medicare Advantage (MA) members with diabetes or hypertension and at least one Star measure care gap, from May to December 2022, Papa’s services resulted in a 6% higher composite care gap compliance rate. In other words, Papa members attended more star ratings-related screenings and appointments. Even a 1% improvement in a Star rating can have a significant impact on quality scores, said Parker.

The new programs are an attempt for the company to move past serious safety complaints that plagued Papa, as revealed by Bloomberg in May 2023. More than 1,200 complaint reports were logged by Papa detailing sexual harassment and assault by seniors and caregivers.

Parker said 99.9% of in-person interactions go without a member-reported safety concern, but the company is always working to reduce complaints to zero. He said the average visit rating by seniors for caregivers is 4.8 out of 5. The company recently invested in new security protocols and background checks and has brought in trust and safety advisers.

“We are really moving on from this moment and continuing to push forward,” he said. "We're very proud of the trust and safety work that we've done, but we're not done yet. We'll never stop, but we do believe we're the gold standard in trust and safety.

U.S. Senate Committee on Aging Chairman Bob Casey, D-Pennsylvania, has requested information from Papa several times, most recently in March. Parker said the company has responded to 100% of the senator’s requests and has turned over more than 1,000 pages to federal officials.

Major insurers like Cigna, Humana, Aetna, Molina Healthcare and several Blue Cross plans chose not to renew their partnerships with Papa, Bloomberg reported. Parker declined to comment on which plans, and how many, currently work with Papa, but said many are continuing their partnerships and the majority of those plans are looking to increase their involvement.

Cigna now uses Homethrive, a virtual companionship solution, to tackle isolation and loneliness. Cigna did not respond to a request for comment clarifying the insurer’s approach to in-person companionship care and its relationship with Papa today.

Homethrive, an Illinois-based company, previously had a page on its website detailing a partnership with Papa, but the content on that page appears to be wiped. Homethrive did not respond to a request for comment regarding its current relationship with Papa.

An analysis conducted by a national actuarial firm found that MA members that use Papa experienced a 9% reduction in medical cost.

This was accomplished through an 18% reduction in inpatient hospital admissions and a 22% decrease in skilled nursing facility use. Instead, home health services and outpatient services increased 6% and 5%, respectively.

For members that had more than three Papa visits per month, medical costs decreased by 30%, and 19% for members averaging more than two visits per month, the analysis found.

“The overwhelming majority of adults want to remain in their homes and communities as they recover and age, yet many lack the social support and resources necessary to safely do so,” said Kelsey McNamara, head of research and impact at Papa, in a statement. “Most of a person’s perceived needs after a hospital discharge, for example, are social, not clinical."

The analysis included 2,386 MA members from a regional health plan enrolled in Papa from January 2021 through August 2023. Program impact was analyzed using risk-normalized allowed claims costs and utilization eights months before and following program enrollment, the company said.

“Plans care about three things: Lowering costs, keeping members happy and healthy, and retaining their members,” said Parker. “We’ve proven that we can do all three.”