The Medicare Advantage (MA) landscape is undergoing some of the biggest changes the program has seen since it was first introduced in the late ‘90s. Most notably, regulatory shifts, rate changes, and trends showing increased utilization are affecting Centers for Medicare and Medicaid Services (CMS) Star Ratings, reimbursement, and revenue.
Multiple factors are converging at once, and health plans are looking for ways to set themselves up for success as they brace for further change. Strategies such as virtual-first services with integrated navigation support, digital solutions to improve member outreach, and algorithms for personalized care suggestions are making headlines. But there are parts of health care that will always require real, human connection.
For example, the most recent evaluation of CMS’ Accountable Health Communities (AHC) Model, published in May 2023, found that navigation alone—without on-the-ground, engaging support for members—is not enough. CMS’ report found that close to 80% of eligible beneficiaries signed on for navigation support available through the AHC Model, but more than half saw no benefit to health-related social needs, nor were they connected to community services.
In order to address the social drivers of health (SDoH) that account for upwards of 80% of health outcomes and advance the foundational activities that impact CMS Star Ratings, health plans need the right resources that can help members traverse the last mile of care delivery, and tools that can not only identify unmet needs, but close those gaps in short order.
Papa’s Companion Care Platform
At Papa, we’ve been focused on providing in-person, community-based companion care, at scale, since 2017. We work with Medicare Advantage, Medicaid, and Dual-Eligible Special Needs Health Plans to connect a network of caregivers, called Papa Pals, with members in need. Our Pals provide companionship, personalized non-medical care, and everyday assistance with household tasks, transportation, and more. Papa Pals have completed more than 2.2 million visits in over 7,300 cities across the U.S., forming close, trusted relationships with members.
As eyes and ears in the home, Papa Pals are uniquely positioned to uncover critical insights related to members’ health and wellbeing and help them make healthy choices. As a natural extension of this work, we can help health plans align these insights to measurable objectives, and translate them into action to improve plan performance.
Last week, we announced new impact programs that build on our core companion care offering, best-in-class technology platform, and social care navigation capabilities. Designed to address specific CMS directives and priorities, these programs help health plans provide high-quality, holistic care, improve member outcomes, advance health equity, and reduce costs.
As Papa’s business continues to evolve, we’re taking this next step to deliver even more value for health plans. Our experience building Papa, and feedback from our partners, has equipped us with an in-depth understanding of the challenges plans face today. We’ve set out to leverage the trusted, in-person support our Pals bring—enhanced by coordinated social care navigation—to address health plans’ growing needs and tackle their most persistent challenges.
Digital Health Literacy Program
Our first impact program, launched in October 2023, focuses on assessing, addressing, and reporting on a range of digital health literacy needs, aligned to health equity requirements from CMS. Starting this year, MA plans are required to screen their members for low digital health literacy, offer education, and make information about assessments and programs available for reporting to CMS.
Today, only a small percentage of MA members engage with telehealth, despite the fact that 97% of Medicare Advantage plans have a telehealth solution in place. In-person assistance is critical to drive adoption and boost digital health literacy, as less than one third of internet users aged 65+ feel very confident when using computers, smartphones, or other electronic devices.
Papa Pals have been providing various forms of technology assistance for years. Our Digital Health Literacy program builds on this work, adding additional assessments, reporting, and capabilities across four key areas: access, basic digital skills, signup for digital tools, and usage of digital tools. We provide health plans with the expertise and reporting needed to help their members bridge the digital divide.
Uncovering and Resolving Unmet Health-related Social Needs with SDoH Navigation
Our new SDoH Navigation program helps health plans close the loop on common barriers that can have a monumental impact on their members’ health: housing insecurity, food insecurity, home and environmental safety, transportation access, access to care, medical financial security, and community engagement.
Papa Pals and our team of social care navigators are uniquely positioned to identify and resolve health-related social needs, uncovering and providing a better understanding of the root cause of members’ health concerns, and taking the next step to facilitate action with support available through on-the-ground Papa Pals, health plans, and community resources.
We’ve seen this play out on our platform many times. Papa Pal Russell noticed member Emily, who lived alone, didn’t have a grab bar in her shower to prevent falls, and arranged for one to be installed. Papa Pal Michelle regularly takes Lacey, a young mother of four, to the foodbank, and advocates for her when she needs more for her family. Another Papa Pal learned of a $10,000 medical bill that was causing severe distress for one of their members. The Pal escalated the concern to one of Papa’s social care navigators, who coordinated between the insurer’s claims department, the hospital, and billing company to resolve the issue.
By leveraging Papa Pals, who become active in members’ homes and important allies in their health journeys, health plans are better equipped to reduce negative outcomes—and higher costs—associated with unmet needs.
We have a strong track record of demonstrated success in uncovering and resolving our members’ unmet social needs. Among a Washington-based health plan’s MA members who were identified as “socially isolated” and used Papa’s services, participants experienced a 19% increase in primary care visits, 5% reduction in emergency department visits, and 19% reduction in total cost of care.
Improving CMS Star Ratings with Papa’s Star Enhancement Program
Our new Star Enhancement program focuses on advancing actions that directly impact CMS Star Rating measures, ultimately helping our health plan partners close care gaps, advance health equity, achieve diagnosis-appropriate revenue, and improve Star Ratings.
In particular, we can help health plans close specific Star measures, such as health immunizations and preventive and disease-specific screenings, like cancer screenings and diabetic eye exams, as well as improve uptake of healthcare services foundational to CMS Star Ratings, such as annual wellness visits and in-home assessments.
We have already seen success via a 2023 pilot program among rural MA members with a diabetes or hypertension diagnosis and at least one Star measure care gap. Results showed members engaged with Papa had a 6% higher composite care gap compliance rate compared to a control group—meaning members enrolled in Papa’s services were more likely to complete a variety of screenings and appointments included in the “Managing Chronic Conditions” Star domain.
When just a 1% improvement can make the difference in reaching the next CMS Star Rating measure threshold, every closed care gap matters, and that’s especially true among harder-to-reach populations.
Leading with Human Help Where it Matters Most
We’ve learned a lot in the last six years at Papa. We know our greatest strength is our network of compassionate problem solvers, who do the work on the ground and behind the scenes to show up for our members every day.
This year, we’re doubling down on our human-led approach to deliver care that members—and health plans—need the most. There’s no substitute for real people, who live in the same communities as those they serve, understanding where support is needed, and making it happen. We do that at scale, thousands of times every day.
The editorial staff had no role in this post's creation.