From less loneliness and ED utilization to more screening and CMS equity alignment, "we've got the data to show it," says Papa exec Dr. Ellen Rudy.
The Problem: Loneliness has become an epidemic. This "chronic, unmanaged, and persistent" problem isn't just a social, it's medical—especially among older, lower-income Americans. And the data proves it. For this D-SNP population (dual-eligible special needs), severe loneliness:
- Is 50% higher than for other groups (Papa study);
- Leaves 40-50% of D-SNP with no one to help them in times of need (forthcoming Papa State of Social Health report); and
- Contributes to less timely or appropriate use of medical care.
This "silent cry for help"—as Dr. Ellen Rudy calls it—would be challenging enough. But loneliness intersects with other healthcare challenges: post-pandemic financial recovery, stark inequality, and population-specific needs like maternal health and hospital readmissions.
Dr. Rudy should know. She is the Head of Research and Social Impact at Papa, the nation's first curated human companionship platform to address loneliness, key social drivers of health (SDOH) and, increasingly, the medical issues associated with them. From its direct-to-consumer beginnings, Papa now serves payers (Medicare, Medicaid, and commercial health plans as well as employers) and their members.
The D-SNP data above is among the company's newest, which Rudy shared more of in an exclusive interview with HealthLeaders.
Expanding to meet intersectional payer goals
How does the model work? Payers identify their objectives, Papa designs and implements solutions—and their companion reimbursement codes—and Rudy studies their impact. These solutions have expanded from core companionship services ("Papa Pals") to Social Care Navigation (SCN).
Since its founding in 2017, Papa Pals have provided members with companionship, assistance with the Instrumental Activities of Daily Living (IADLs; e.g., cooking, cleaning, transportation, laundry, finances) and care gap reminders for the CMS Stars Program. While these in-home and virtual visits already represent an intersection of social-medical needs, SCN operates behind the scenes with wraparound services.
SCNs assist Papa Pals in these roles and provide health plan clients with on-the-ground support to address their members' unmet needs and advance population health management strategies.
Papa expanded SCN in April 2023, following a limited rollout in 2022. Per the associated press release, SCN is committed to "uncovering and resolving barriers to members' whole health . . . before they escalate into greater issues." Rudy affirms this focus and its Digital Health Literacy Services.
As part of SCN, the company uses its Papa Social Index at enrollment and annually to assess digital health literacy and other unmet social needs. Papa then reports assessment outcomes to health plan clients for measurement.
Scaling to meet upstream and downstream payer needs
Citing internal data, a Papa spokesperson states that Pals have completed more than 1.8 million visits with members since the company's inception. Papa is on track to complete nearly 1 million visits in 2023, a 57% year-over-year increase.
The April press release notes that "more than a quarter of Papa's health plan clients use Social Care Navigation," with these benefits: "As health plans continue to focus on moving care upstream, Social Care Navigation plays a critical role in advancing proactive care measures, like preventive screenings, vaccinations, and health risk assessments . . . The result is a high-touch and differentiated member experience to reduce downstream health care costs. reduce downstream health care costs."
These up- and downstream benefits are showing up in Papa results. One claims analysis shows that Papa has effected an 11% decrease in hospital readmissions while a second demonstrated a 20% reduction in ER visits, and increased cancer screenings (5.4% for breast cancer, 3.7% for colorectal cancer).
"These are incredible results," says Rudy, "given that the people we impact most are often the hardest to reach."
Aligning with CMS equity efforts
Papa's aim to reach even more people in need is timed well with CMS' growing equity goals.
"Papa is an organic solution for health equity," says Rudy.
The pitch to payers is that Papa can provide these solutions more effectively than payers can on their own. With the exception of Pals, Papa and payer staff are similar: registered nurses, case managers, social workers, dieticians. But key differences remain.
"Health plans face staffing shortages and less flexibility in terms of the hours and services they can provide, and at what cost," says Rudy. "Payer nurses and community health workers are often limited in what they can do."
She returns to Papa Pals as a key advantage: "Pals are there, first and foremost, to meet the needs of the member."
There is more work to do, including how to reimburse these emerging services. Many Papa services are reimbursed under the 2018 Chronic Care Act (CCA). The CCA expanded supplemental benefits beyond the traditional (dental, vision, etc.) to chronic and social needs.
"That was a game-changer for all SDOH companies," emphasizes Rudy, citing U.S. Surgeon General Vivek Murthy's 2023 Advisory encouraging payer involvement in loneliness and isolation: "Insurance companies should provide adequate reimbursement for time spent assessing and addressing concerns about social disconnection (e.g., isolation, loneliness, low social support, poor relationship quality), and incorporate these measurements into value-based payment models."
Rudy adds: "If companies want to get more of this work done, we have to have the reimbursement codes."
Laura Beerman is a contributing writer for HealthLeaders.
Loneliness has intersections with other healthcare issues, such as post-pandemic financial recovery, which makes it a worthwhile challenge to find solutions for.
New data from Papa offers proof points as the organization expands its services and payer partnerships to respond.