Aetna Partnership Decreases Member Social Determinant: Loneliness

Medicare Advantage plans collaborate with companionship companies to meet non-medical needs and collect data that grows member trust and revenue.

Let the word "lonely" sink in for a minute—really sink in.

We’ve all felt its sting, even in the middle of a crowded room or in a loving home where no one seems to want for anything.

But COVID-19 cleared those crowded rooms, especially for people experiencing what has become a companion to the pandemic: more isolation paired with greater need. Two companies want to change all that by partnering: Aetna and for-profit Papa. Together, the companies are achieving double-digit reductions in loneliness among Aetna members through a new brand of caregiving.

Such partnerships help expand the lead Medicare Advantage (MA) plans have over traditional Medicare as supplemental benefits and SDOH gains importance.

HealthLeaders spoke with Dr. Jamie Sharp, VP and CMO of Aetna Medicare (Aetna is a CVS Health Company), and Andrew Parker, founder and CEO of Papa, about how and why their partnership works.

Severe need meets significant improvement and program expansion

A recent eHealth survey found that 39% of nearly 4,000 Medicare beneficiaries said the pandemic has increased their sense of loneliness and isolation.

Through Aetna and Papa's partnership, this gives the insurer a more complete picture of how their members are doing. Papa clients can sign up for the free service through their health plan or employer. More than 65 MA payers—from state plans like Ohio’s SummaCare and Michigan’s Priority Health to national players like Aetna—are Papa customers.

Aetna’s partnership with Papa began in 2020 but that wasn’t the start of what the payer saw was a significant problem.

"Even before the pandemic, we knew social isolation was a big issue for our seniors," says Sharp.

How big? Aetna reports that during 2020, 80% of its eligible Florida members reported feeling severely lonely and depressed. "These are astounding numbers," says Sharp. "These statistics on social factors rival smoking and heart disease."

After using the Papa companionship benefit, 86% of Aetna’s participating members in Florida noted improvements in their feelings of loneliness. Following the positive pilot, Aetna expanded its Papa partnership to seven more states—Nevada, California, Illinois, Michigan, North Carolina, Pennsylvania, and Indiana—and with comparable results.

In 2021, 62% of Aetna PPO members and 52% of Aetna Dual Eligible Special Needs Plan (D-SNP) members reported feeling much less lonely and happier overall after using the companionship services. This included a reduction in reported "unhealthy days," the number of days in the last month where a member reports their physical or mental health was not good.

New regulations create new customers

Before 2019, MA plans would not have been a Papa customer segment. New Medicare regulations that allow private payers to offer non-medical services have created a value-added and supplemental benefits boon that adds complexity to an already competitive MA market.

"We knew we had to prioritize benefits to address social determinants of health," says Aetna’s Sharp. "Things like our Healthy Food Benefits Card and Utilities Debit Card," which help people pay for groceries and their electric bill and which many MA plans are now offering—often in high-need pilot markets first, followed by expansion.

"Health plans love providing great experiences and value to members," notes Parker, of Papa. "A focus on wellness and customer experience aligns with a health plan’s brand, while helping them address needs proactively versus reactive."

Capitation is part of the model, with Papa receiving a per-member per-month fee to provide a host of services that may reveal additional member needs over time.

An SDOH focus

This partnership is an example of the growing people-and-platform needs that health plans meet by contracting with companies like Papa. Parker adds: "With the plans, we identify member needs looking at markets, counties, and ZIP codes. Our algorithms help us make better decisions and partner with plans on what their gaps are. This also creates best practices for enrollment, targeting, and communication."

The data Papa collects is added to broader social data that the company already has or acquires from its health plan partners. "Social determinants of health are something we’re all focused on, all health plans," says Aetna’s Sharp. "We know how important it is to get the information we have to Andrew and his team."

And for plans to get information back.

Good for people and business

One of Parker’s observations (that "healthcare is becoming real health care") speaks to the greater reach payers have into members’ lives—and will be expected to have as federal SDOH requirements take shape.

The payer and companionship services relationship is good for people in need and good for business, impacting the risk coding and screening numbers that increase reimbursement and incentives tied to the MA Star Ratings program. Providing these types of services expands the growing advantage MA plans have over traditional Medicare, which does not generally cover them. It may also address growing caregiver challenges. Caring for caregivers while expanding and directing their capacity is a critical need.

Editor's note: This story was updated on April 8, 2022.