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Medicare plan sends ‘pals’ to seniors

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                                Tim Barrage, a “Papa pal,” takes a break from doing yardwork for Gloria Bailey outside her home in Akron, Ohio. Bailey’s Medicare Advantage plan, SummaCare, sends pals to older adults to provide companionship, perform light housekeeping and run errands. Barrage usually visits Bailey once a week for two hours.

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    Tim Barrage, a “Papa pal,” takes a break from doing yardwork for Gloria Bailey outside her home in Akron, Ohio. Bailey’s Medicare Advantage plan, SummaCare, sends pals to older adults to provide companionship, perform light housekeeping and run errands. Barrage usually visits Bailey once a week for two hours.

Widowed and usually living alone, Gloria Bailey walks with a cane after two knee replacement surgeries and needs help with housekeeping.

So she was thrilled last summer when her Medicare Advantage plan, SummaCare, began sending a worker to her house in Akron, Ohio, to mop floors, clean dishes and help with computer problems. Some days, they would spend the two-hour weekly visit just chatting at her kitchen table. “I love it,” she said of the free benefit.

Bailey, 72, is one of thousands of seniors around the country being visited each week by employees of Papa Inc, a for-profit business. Known as “Papa pals,” their primary aim is to provide companionship to seniors and help with errands and light housework duties. Since 2020 more than 65 Medicare Advantage plans nationwide have signed up with Papa, a Miami­-based company, to address members’ loneliness — a problem exacerbated by the pandemic.

“It’s the best thing ever” to counteract social isolation, said Anne Armao, a vice president at SummaCare. More than 12% of the company’s 23,000 Ohio Medicare members used the Papa benefit in 2021.

SummaCare and other health plans also stand to benefit by sending Papa pals into members’ homes. The workers can help the plans collect more money from Medicare by persuading members to get annual wellness exams, fill out personal health risk assessments and undergo covered health screenings.

Accomplishing these steps helps plans in two ways:

>> By gleaning more information, plans could discover members have health issues that might earn higher reimbursement rates from Medicare.

>> Plans can boost their star ratings, which are based on more than 40 performance measures, including cancer, diabetes and blood pressure screenings; outcome measures such as controlling hypertension; and overall satisfaction with the plan. Plans that score at least four stars on a five-star scale receive bonuses from Medicare.

Bonus payments from the star ratings make up an increasing share of federal payments to these private Medicare Advantage plans, which are an alternative to traditional Medicare. In 2021, Medicare paid plans $11.6 billion in bonus pay, double the amount in 2017.

The federal government’s base pay for the plans is a monthly fee for each member, but it increases that amount based on the members’ health risks. So plans also get billions of dollars a year in extra payments by pinpointing members’ health problems through a variety of measures, including the health risk assessments.

Yet federal investigators have found these diagnoses do not always result in additional treatment or follow-up care to beneficiaries. As a result, the federal government is probably overpaying the Medicare health plans and wasting billions in taxpayer dollars, according to the Medicare Payment Advisory Commission, which advises Congress.

In a report in September, the Health and Human Services inspector general found 20 Medicare Advantage companies generated $5 billion in extra payments from the federal government for diagnoses identified through health risk assessments and chart reviews without documentation that the patients were treated for these issues.

Nearly half of Medicare enrollees get their coverage through Medicare Advantage.

Medicare Advantage plans often give doctors financial incentives to get patients to undergo health assessments. Plan workers repeatedly call patients with offers to send nurses or doctors to their homes to complete them. Health risk assessments are useful only if the health plans act on the information by making sure patients are getting treatment for those issues, said David Lipschutz, associate director of the Center for Medicare Advocacy.

Papa employees “are our eyes and ears who can learn so much from members in their homes,” Armao said. Pals look in refrigerators to see whether members have enough to eat, check on how members are feeling and remind them to take prescriptions.

Andrew Parker, who founded Papa in 2017 after finding a couple of college students to visit with his grandfather, take him to doctor appointments and do other errands, said he estimates his company will provide more than a million hours of companionship in 2022.

“Papas (pals) are very proactive and will call you to see how you are feeling and, maybe not on the first day, but over the course of the program, can ask, ‘Did you know your health plan would prefer if you had a wellness exam, and it could help you with your health?’” he said.

He said insurers often don’t know a member is facing a health issue until they see a medical claim. “We can identify things they don’t know about,” he said.

Until recently, Medicare rarely paid for nonhealth services. But Papa began working with Medicare Advantage plans in 2020, just one year after the program began allowing the private insurers to have more flexibility addressing members’ social needs, such as transportation, housing and food, which are not typically covered by Medicare but could influence health. Papa’s goal of addressing members’ loneliness took on even more significance during the pandemic.

Papa has more than 25,000 pals, with an average age of mid-30s. Before being hired, pals must undergo a criminal background check and a driving record review. After being hired, pals are trained on empathy, cultural competency and humility.

Michael Walling, 22, who works as a Papa pal near his home in Port Huron, Mich., said most seniors are receptive to getting help or having the chance to talk to someone for a couple of hours.

One of his clients has trouble walking, so Walling helps vacuum and mop her trailer and takes her to the grocery store. On Christmas Eve he even took her out to lunch. “It was to be my day off, but I didn’t want her to be alone on the holiday,” he said.

Tim Barrage, a former parole officer who visits Bailey and about a dozen other seniors in the Akron area each week, turned to Papa because he was looking for a flexible part-time job to supplement income from his firearm safety training businesses.

“I’ve done work in the garden, hanging up and taking down Christmas decorations, cleaning ovens or stovetops,” he said.

Each time he arrives at a member’s home, Papa directs him to find out how the member is feeling overall and then periodically ask about issues that can include the wellness exam and health risk assessment. At the end of the visit, he reports to Papa what serv­ices he provided and how the member interacted with him. He alerts his supervisors to a member’s potential health issues, and Papa connects with the health plan to address them.

Jennifer Kivi, manager of Medicare product development for Priority Health, a Michigan health plan, said members who have used the Papa service said it makes them feel less lonely. “If we can reduce their loneliness, it helps members feel better, and their physical health will improve,” she said.

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Kaiser Health News is a national newsroom that produces in-depth journalism about health issues.

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