Big Papa is in the House

Brian Urban:                                           
Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today joining me all the way from sunny Miami, Florida is CEO of Papa, Andrew Parker. Andrew, welcome to our little show.

Andrew Parker:                                         
Thanks for having me today.

Brian Urban:                                           
Hey, this is going to be a lot of fun. We've gotten to know each other a little bit before our recording here, but we're going to dive a little bit deeper into Andrew, the man behind Papa, and talk a little bit more about what Papa is doing these days to not only address loneliness, deliver authentic compassion, but also address social determinants of health. So a lot of things for us to cover.
                                                       
But let's get our listeners familiar with you as the person. So take us back before starting up, operating, and becoming the CEO, founder of Papa, who's Andrew Parker, and how did you get into this? I know the story of the naming of your company, but how did you start to even get into wanting to address loneliness?

Andrew Parker:                                         
So I'll go back quickly. When I started my career, at first I was a salesperson, but I very quickly had an opportunity to join a company early in the telehealth space called MDLIVE, which ultimately ended up exiting to Cigna. And I learned a lot about healthcare, digital health, working with health plans. And what I realized while I was there is there could be a configurable way to solve the many problems of people in healthcare in general.
                                                       
And then fast forward, I had an experience with my grandfather, my papa. He needed assistance, he needed companionship, he needed support, he needed me, frankly. And I was busy at the time building MDLIVE. And so I thought, what if I paired papa with a friendly, caring, thoughtful person? So I put him on Facebook. Who wants to be a pal to my papa? And it didn't get a viral response per se. Some people responded. But I was able to interview, background check, and meet someone who became our first Papa Pal. Her name was Andrea, paired her with my grandfather, and he absolutely loved it.
                                                       
It was pretty eye-opening for me. My grandfather didn't like much, let alone a stranger coming to the home. So the fact that he was interested, excited, and he was supportive to me and my family was pretty eye-opening. And so with that, in 2017, I left MDLIVE, which I was there for about six years full time, and decided to start Papa to help older adults and families throughout their aging journey.

Brian Urban:                                           
And see, that portion of it, the first recruitment of a Papa Pal, I did not know, and it's actually a really nice use case in a study because your grandfather didn't like having any other not familiar people in. And I'm sure there was a phased approach of getting comfortable, but it seemed obviously to work out very well. And then you've created a really amazing community around this.

Andrew Parker:                                         
A hundred percent. I think what we realized is that people don't want to feel cared for, even though they do need care. And that's exactly what happened with my grandfather. And so we thought if we could create this new kind of compassionate human provider, which isn't a doctor or a nurse or a professional caregiver, they're what we now call pals. And they go through this very thoughtful onboarding and background check and interview and screening and training, a lot of what I did in the beginning, but now we use software to make sure that we could do that on scale across the United States.

Brian Urban:                                           
And obviously you had to put some intelligence to be able to get through traction into scale. And you've obviously done that, and you've done that in a very, I think, thoughtful way because you didn't just speed through being able to deliver a service. You took your time, you went into certain markets, you really had a target approach. And I think that's different from a lot of other health tech emerging innovation organizations, these days at least. So Papa's going on what now? Seven years, six years?

Andrew Parker:                                         
Six and a half years. Six and a half years, yeah, close. Every day counts, so you've got to write it down.

Brian Urban:                                           
And that's beautiful because obviously you developed a very firm ROI on the business side of this, but also, you've built this really amazing engagement model. I think a lot of people probably, you probably heard a lot of nos or a lot of negative responses when you were first building this, but it's safe to say you're definitely a techie by background and for sure now in this niche space, and a leader in engagement models in particular. So with the next phase of Papa, what else are you starting to put an innovation eye to?

Andrew Parker:                                         
So getting a friendly, thoughtful, caring person to show up at the house, pretty much any county in the United States, it's incredibly complex. And so we spent our first five years at Papa understanding who are the right pals, how do we get them to use our services properly? How do we get them to do what we want them to do, but how do we get them to show up consistently at scale?
                                                       
And so we just passed over two million visits that we've done in the home across the United States, and we've done about as many virtual visits as well, because we do virtual and in-person, but a majority of our visits are in person. And to get that to happen consistently at scale is pretty complex. And so for our first five years, we've effectively exclusively worked on that, building software. As you mentioned, I'm a techie. I've evolved to become one. So implementing software processes and approaches with people to get them to show up consistently at scale.
                                                       
Now, our phase two of Papa, the next three years or so, is to continue to do that, make sure it's safe and secure and quality and really continue to understand who the pals are. But the second phase really is a programmatic approach to solving healthcare's problems. Most of things that happen to an individual in the United States and in general are social in nature. So about 80% of health outcomes, depending on where you get your data from, are driven by social, what we like to call drivers of health, loneliness, isolation, food insecurity, housing issues, a really big topic now in healthcare. Can we use our Papa Pals in a programmatic way to solve problems that arise in everyday life?
                                                       
So if you're lonely, yes, we've proven that, and I'll talk about some of that data in a little bit. If you're isolated, we can help with the loneliness aspects of that. And that's pretty core to what we do. We provide companionship. But we also drive people. We also help them with their medication. We also get them to their doctor appointments. We also help close care gaps. But it's all built on what we did in phase one, which we're continuing to do, which is really trust and friendship and companionship. When you have a platform of trust, then you're able to help people in other ways.
                                                       
Now I can tell you, oh, did you know we want you to do your in-home health assessment or your annual wellness visit? Oh, I've noticed you haven't picked up your medicine. Do you want me to go pick it up? Are you having a good day? And so we can really understand about our members' needs because we have this relationship with them.
                                                       
So we're going to leverage that relationship in a positive way to drive programmatic ways to solve their problems, whether that be related to star ratings, quality programs, digital health literacy, especially with a digital divide. There's one thing trying to tell someone to use telehealth. The other thing is to have someone sitting next to you, showing you how to use a telehealth device or a new mobile experience that your health plan offers and leveraging our Papa Pals to do so. But it's all built on what we built day one, what we're continuing to build every day, which is trust.

Brian Urban:                                           
I love that part of it because you and I both have and work with a lot of health plans. I work a lot with healthcare too, and I think trust as a form of currency is very expensive for health plans and healthcare to have. I think especially a lot of the socioeconomic, vulnerable populations that will show up to a physician or show up to an ER setting with an exacerbated condition because they simply don't trust or want to go or find the value in it or understand the need for preventative care.
                                                       
And I think it's on both sides of the spectrum here. So I think you're putting trust as currency back in the pockets now of health plans and healthcare that still really don't have it today. Do you think that's true? I mean, I do, because you're engaging upfront and you're coordinating things with them and the members in particular that you share. So it seems like trust as a currency is what you're putting back in the pockets of those stakeholders.

Andrew Parker:                                         
It's interesting. When I started Papa, it was kind of obvious to me that if my grandfather just had trust, he would be willing to do more things. He wouldn't feel like he's an invalid or being overly cared for. He would just feel like a human being. And we provide them what we call true independence. Most of our members are older adults themselves. Their families are aware of what's going on. We have technology and ways to share that with them. But it is really on trust. It's a new way of going about solving problems. And it's something that I think everyone understands inherently, but we're proving out through data.
                                                       
And so we see people going into the ER not because they have an actual emergency, but because they're anxious, nervous, lonely, isolated, not sure what to do, and they know that they could call 911, which they can and they should if they need to, but a lot of the times people end up going to the hospital because of a lack of trust or fear or some anxiety. And so we actually find through the data that we have in our studies that we've been able to lower ER utilizations quite dramatically. We had a population that lowered ER utilization 20%. We had another population that lowered ER utilization 34%. These are third party validated studies that really understand what's going on here.
                                                       
And what you realize is most of it is people are just anxious. And so they say, well, I'm lonely. I don't know what to do today. I'm going to go to the hospital. I'm going to call 911. I have a little bit of a stomach issue. Maybe I should call 911. And of course, we don't want to prevent from someone from going to needed services, but a lot of times they don't need these services. What they need is a friendly person in the house spending time with them.
                                                       
And you see that across many domains. People not taking their medicine, people not exercising, people not eating. A lot of this comes down to trust and of course not having these things. If you're food insecure and you have a trusted advisor in the home that we call a pal, they could identify those things. You're going to tell them these things that you maybe wouldn't tell your health system or your health plan, which you likely wouldn't. But with your pal, you have this relationship, and through that relationship, you end up informing them of these things. The pal can now take you to a local community-based organization. Maybe it's a food bank. They could sign you up for the food benefit that your health plan got for them. You can sit with them and eat with them and make them feel comfortable and have a conversation.
                                                       
And so the fact that 80% of health outcomes are driven by social needs, you can't solve those in a transactional way. You have to have a trusted person in the home physically with them. And we believe the biggest solve to healthcare issues in America is actually humans. We have technology. We of course leverage technology to make sure someone gets there to follow up, to track the data. But from our perspective, especially in the older adult cohort, trust is really critical.

Brian Urban:                                           
It's so interesting that the way that you're talking about this obviously says how unique your model is because there is others that have done this in a much softer way. I think you have such a strong foundation in terms of Medicare Advantage beneficiaries, SDOH supplemental benefits being integrated into theirs as part of the ecosystem and health plans offerings. But it also seems like the path that you've taken, you've had probably some creative CFOs at health plans that have wanted to prove out the ROI with you, that have wanted to show the value realization with Papa being able to have this engagement model that's way upstream, that addresses loneliness, that has way downstream positive impacts on reducing or apprioritizing healthcare utilization.
                                                       
So I guess I'm curious, have you felt some of your interactions in the C-suite working with different health plans, they're wanting to take these creative risks and know that it's not a clinical heavy play, but it will have really measurable clinical outcomes that are reducing ER visits and spend and stays? I mean, I'm curious, a lot of creative CFOs had to have worked with you well to build this thing out to show the success, too. I'm curious of your experience there.

Andrew Parker:                                         
We try to make it easy for them. We are since the beginning convinced that the best way to solve most of people's day-to-day healthcare issues, especially the social ones, is a human being as a pal. And that's what we built around. I think we always hear these stories about loneliness being an issue. My grandfather passed away. My grandmother, who was the healthiest human being ever, was suddenly left by herself. Mia and her family were there, but she got cancer unfortunately and passed away. I mean, we used to talk about mind, body, and soul, and now we talk about whole person health.
                                                       
And so I think the creative CFOs were the ones that were really interested in Papa in the beginning. Now it's really most, if not all CFOs, because you've seen the rise of the issues associated with how do we support someone from a whole person perspective. This has been ingrained in our lifestyles at our age group, at older adults, at younger adults. I mean, loneliness is a disease. It's a disease. It's equivalent to other chronic illnesses. It's equivalent to smoking 15 cigarettes a day. If you look at the disease state to someone who smokes that much and the disease state to someone who's lonely, based on surveys, you see very similar correlation as it relates to their chronic illnesses, their use of the ER facilities and other hospital services, other physician services. And so I think the healthcare system is waking up to that.
                                                       
And then of course you've got to prove it. Does it actually show up in their bottom line, in their claims reduction, in their revenue increasing? And so we are really thinking about it in the same way healthcare organizations do, with triple aim. You want more members, you want to retain those members. So that's kind of a marketing aspect. There's definitely Papa value there. We even hear members saying, "Oh, I want to go to a help plan that has Papa. My health plan I have now, I want to get more hours, so I'm going to look for a health plan that has the most available hours." And so member retention is pretty significant.
                                                       
The second thing is cost reduction. We've been able to prove, as I mentioned earlier, we lower ER utilization 20 to 34% depending on the cohort of population, depending on the population we're looking at. We've seen readmission improving. Every one in seven remits reduction. We've seen actually in a study that we did in Washington state, a total cost of care reduction by six percent. And a lot of this to me, to us at Papa seemed obvious, and then we had to go out there and improve it.
                                                       
So we've done 10 plus third-party validated studies to show retention, to show cost reduction, and to show quality improvements. We're getting people to their annual wellness visits. We're scheduling in-home health assessments. We're getting them their medication, we're signing them up for the programs that are valuable to them in their community. And so these pals, I joke they're like ninjas. They go in, they build a positive relationship with our members. They understand their needs. We listen to our customers, the health plans understand what their needs are, and then we develop a programmatic approach to solving that, leveraging in a positive way companionship to support people throughout their lives.

Brian Urban:                                           
Wow. The one thing that strikes me as so interesting is you had to have the creative CFOs and leaders that were early adopters, just like anything. And now it's everyone. And I wish the industry was like that, was more of those creative risk takers that were willing to push things forward when it's a very obvious thing here. You're tackling the human condition. Regardless, I love the journey you're on.
                                                       
You said something earlier, Andrew, I want to go back to. It's finding the right balance of human interaction and technology intervention or technology engagement. So how do you strike that balance? Because obviously you have a very unique model in the market of anyone that's even close to having this type of companionship, a loneliness addressing solution. But how do you find the right balance between tech and human with the individuals and the lives that you serve?

Andrew Parker:                                         
I think technology is a required support system for what we do. Papa, this year we'll do over a million visits. We've traveled over six million miles. We've done millions of interactions virtually, which we refer to as human interactions. All of this, though, is the pursuit to get a pal, to build a relationship with a member primarily in the home.
                                                       
So where we do leverage technology is when I leave your house, and I'm a pal, and we had a great time, we went to the grocery store, we got you medicine, we talked about your life, we looked at photos of your children, maybe we went on a nice walk. Well, I left. You're not going to see me tomorrow. So can you interact with me still? Can you interact with Papa still? We do that virtually. We do that through our care team, which is 350 people across the United States, as well as our Papa Pal Network, which we have about 30,000 pals across the United States.
                                                       
And yes, virtual is awesome. AI is awesome. We should be leveraging these technologies to empower users. But at the end of the day, a good majority of what older adults need is a human. I always think about my own family members. My grandmother a couple of weeks ago was calling my cell phone, and every time she called me, it went to voicemail. And my grandma texted me. And she's able to text. So she does know to use technology in her own way. We use text in many ways to support our members. I'll talk about that in a minute. But she texts me and says, "Andrew, I don't know why you would block my phone number. Every time I call you, my phone goes to voicemail." And I try to call her and I can't. It's literally blocked. And I look at my phone, of course I would never block my grandmother. I love her.
                                                       
And I said, "You know what? I'm going to come over." I'm texting her, "I'm coming over, Grandma." So I took off a Friday afternoon. I went to her house. And she unintentionally blocked me. It's not that she doesn't know how to use technology, she's just not an expert at it in any way, shape, or form. And she has shaky hands and she's moving fast and somehow unintentionally, which it's too easy to do this, but she blocked me. And so she needed me, a person in the home, to help her to unblock it. And then after, we're now able to FaceTime, we're able to text with each other. She's engaged with me specifically.
                                                       
So about 60% of our visits, Brian, are what we call Preferred Pal visits. So it means Brian has chosen Andrew as his preferred pal, and every week or two weeks or three weeks or whatever our scheduled visits are, I come over. And in between through a mass number, which is technology we built, this is dedicated to you and I. This is dedicated to my member and the pal. I have a mass number where they can call me on the weekends, they could call me when I'm not there. They could text me as well. And if for any reason we want to remove that or it requires to go to an escalation, we have software that can we push that number to our call center or push that number to our partner client care teams.
                                                       
And so technology is a really important logistical aspect. Technology is a really great follow up aspect, but the core of our product, and we believe the core way to solve the problem for older adults especially, is a human. And that's what we do here at Papa.

Brian Urban:                                           
I like that you said you can have that Preferred Pal. I actually didn't even think about that, but that right there is one of the very strong foundations, I think, to your model that builds trust and does it in a natural way, not a forced way at all, and not like an incentive-based way, but a very natural way. And in thinking about, I don't always like to go back to the business side, but I can't help but think the amazing expansion since about 2019, that CMS was allowing some additional SDOH supplemental benefit designs to take place. United, Cigna, these gigantic private health plans jumped into it. And it seems like they've put together lots of models that are very just kind of a spray approach. They're just these huge menus and it's not really personalized. And maybe we're going to get there a little bit sooner than later I hope.
                                                       
But I'm curious of what you've seen in that supplemental benefit design where Papa is just truly a unique integration. And it is personalized. I mean, for me, it looks like it is a personalized approach rather than, hey, you get access to a food medically tailored meal cart from someone or a transportation program for these five different vendors. It seems like you go in and probably fit really nice there. Is this just a nice coincidence that CMS caught up with what you've been developing and now you fit so nicely in the MA space? What's your take on the supplemental benefit design space as it stands today and where Papa fits?

Andrew Parker:                                         
It's evolved a lot. When we started Papa in 2018 or '17, really you couldn't offer Papa as a benefit into a Medicare Advantage. And I saw with my own personal experience the obvious need of a personal approach, as you're mentioning, which we think is a person. A person can effectively be configured to use technical terms, leveraging our technology to support the many nuances of older adults, which by the way, change quite frequently. You could have a fall, suddenly you need a pal every day. You could unfortunately get cancer or need dialysis or something like that, and unfortunately you need a pal every day.
                                                       
But we provide you this true independence, as I mentioned, in a personalized way. And we feel like these other benefits are great. We need food, we need home support, we need other things related to everyday life. We need internet to be able to access these great benefits, to be able to talk to our doctors through telehealth. These things are important, but some of the biggest barriers that people have, there are ways to support that.
                                                       
Every health plan pretty much has transportation, for example, but not everyone is getting transportation. In fact, we see if you're lonely or severely lonely, your barrier to transportation increases by 70%. It's not because you don't have transportation, you likely do, but you're an older person. You're sitting in your house by yourself. You don't know what to do. You don't know who to turn to. Yes, you know your health plan exists, but a lot of times you don't know that they offer transportation, or by the way, you're not comfortable. And so the pals don't come in like task rabbits, checking off boxes. They go in purely to build a friendship with you.
                                                       
And over time, they build a preferred relationship with you. As I mentioned, 60%, I believe it'll be closer to 80% early next year, just because as we grow our membership, people get more preferred relationships. But through these, you have this trust. And now I can say, "Hey, I can drive you somewhere. I will remove your barrier to transportation. I see you have a food benefit. Did you know that? Do you want me to sign you up for it? Do you want me to be here and eat a meal with you while you're hungry and we could eat together? I'll bring my own food. You have your food to the benefit." And so we feel the pals are kind of on top of these different things that may exist to help facilitate them and engage them. 
                                                       
Just to give you one top point, and hopefully we talk about it a little bit more, Papa is one of the most engaging products that exist in healthcare. I come from telehealth. We spent all of our time trying to get people to use telehealth benefits. I used to joke back in the MDLIVE days, the number one way to drive a telehealth benefit forward is to get everyone sick at the same time. That was just a joke. I didn't know that Covid would happen, of course, but it was something I understood. There had to be this big moment.
                                                       
With Papa, you can call us on the phone. You could text us. You could send an email to connect to us. You could call your Papa Pal and ask them to help you coordinate on your behalf. We built features to allow that. And so this human being kind of removes all these barriers and opens up the world to an older adult, whether it being help with transportation or food or medicine or getting them to the doctor. And we used to call it grandkids on demand. And that's really what we built.
                                                       
It's a friendly extension to your family, and it's wildly engaging. In fact, we see it even more engaging with the most difficult population to engage. We see more engagement. [inaudible 00:24:54] step population sees about 20 to 30% of them enroll in Papa, meaning use it once, and they use it 300% more than the typical MA member. Why? They need it. They're more isolated, they're less technically involved, technically inept.
                                                       
And so the Pals become a almost mandatory resource for higher needs populations that we're spending a lot of time focused on, D-SNP, SSBCI, VBID, or other high needs populations, because without us doing anything special outside of building our really special product, we see these high needs populations use Papa like crazy. And it's because they need it. And when you solve people's problems, they use it, and then they get access to these other things that they kind of have barriers to, generally speaking,

Brian Urban:                                           
It's amazing because when you mentioned the D-SNP population, my mind instantly goes back maybe even five, definitely 10 years prior. And you think about the only things they had access to with consistent human interaction was in-home nursing care. And it's clinical, and that's usually transactional. And that's it.
                                                       And I was going to ask you what makes your model so darn unique? And also it is what makes it so complex. As you were describing it, saying the little things that are probably very difficult to have a track to or measure to, just for me, maybe not for your obviously software, but how they just call someone up and say, "Hey, I need my phone unlocked." Or, "Hey, I just need, I can't open this door, this jar, or tie my shoe." Little things that aren't a very short, hard line to clinical, but they mount up to this invaluable and tangible value from a human to human interaction. All these little intricate things that can be solved by having someone in person.
                                                       I like the grandkids on demand. That's seriously it as a definition in a lot of ways, but it's so much more enhanced. So is that what makes your model so unique, these little intangible, invaluable things that happen from a pal to a member?

Andrew Parker:                                         Well, if people just take a step back and think about what do you do for your own family, that's what Papa is doing for the health plan. But a good majority of what you do for your own family is the tangible stuff. Yes, it's nuance, it's personalized, it's specific to the day. And it doesn't always exactly translate on a day-to-day basis to, oh, I did this task, I saved 200 bucks. But a good majority of it does. A good majority of it does.
                                                       So every single client of ours looks at analysis, claims, data, all these things to understand was there cost reduction? There always is because the people that end up using Papa the most end up showing up at the hospital unnecessarily, end up not going to their doctor, end up not doing their HRA, end up giving their health plan bad ratings because they don't even know their health plans. So from a CAHPS score perspective, we've seen significant increase. We've seen people move for that measure from a four to five and so on, on a star ratings perspective.
                                                       And so the pals aren't always going in there, be like, okay, today I'm doing these 10 things. They just go there and they understand the members. And yes, over time we may say, "Hey, take them to the doctor." Over time we may say, "Hey, sign them up for this program that they got through their digital health program." But it's nuanced.
                                                       And so I give you the example with my grandmother. We had a member a couple of months ago, her name was Manuela. She had diabetes. She didn't take care of it. She unfortunately had to have her leg amputated. So a pal can't do much there, of course, other than be supportive, which we are. But that's pretty significant, because Manuela had no way to get to the doctor to get her new prosthetic leg. She was by herself. She would've not been able to be mobile at all without a pal. She called her pal. That wasn't the first time calling the pal. She knew this pal. They'd been seeing each other for weeks and weeks and weeks, for maybe three, four months.
                                                       
And then three, four months, and she's like, "I now have time to go and get a new prosthetic." And so she went with her pal to get a new prosthetic, and there's this really cute video I could share after of the pal singing with the member together, "These boots are made for walking," and they just walk out of the health system together after she got a new leg. And this changed this person's life.

Brian Urban:                                           
That's awesome.

Andrew Parker:                                         
And so there's endless, countless stories that are like this that are hard for us to always understand in advance. But afterwards, it's so obvious. Without Papa, Manuela would be on our couch, not able to move literally. And a pal has truly what we feel changed their life, and it's something we're proud of. We want to build a big business. We want to help millions and millions of people. But the most proud thing that we do at Papa is on a daily basis, help people, help people with their nuanced needs that vary, that change.
                                                       
Manuela is now good from that perspective, but she needs to get her medicine. She needs to go to her follow-up appointments. She needs to use telehealth. So these are nuance. It's hard to track all this in a document, but we do it through identifying things that happen in the home, have health plans tell us what they're looking to solve. And of course, the number one way we understand members is they tell us because they trust us.

Brian Urban:                                           
Yeah, that trust piece, again, my head keeps going back to that all the time because I think the fact is a lot of health plans are the last to know on a lot of things, if people move, if people pass away, and it's very difficult for them to directly contact an individual, especially of more of a socioeconomically vulnerable nature, because of that trust barrier and they think it's a bill or they think it's a task they have to do that's going to be bothersome. I think that too. I flat out don't-

Andrew Parker:                                         
Me too.

Brian Urban:                                           
Nope. No way. But if there's a middle person that bridges that and adds, I think the value has never been there for a lot of health plans, it builds that currency back for them as trust. I love that.
                                                       
Andrew, I was thinking about the year that's behind us now. We're going into '24. This is going to go live in '24. I think folks will listen to this more in the year of '24. But the surgeon general had made this advisory, loneliness, it's not only, like you were saying, it's a disease, but it's inherently in our society, it's an epidemic. It's going to be very difficult to solve and to address.
                                                       
But there's so many different things to do with that. So do you think progress has been made since that advisory, that announcement earlier this year, and do you think we're going in the right direction? Do you think your organization is propelling the conversation of addressing loneliness? I think you're a part of that for sure. Do you feel like you're a part of that? Whether you realize it or not, I think Papa really is leading that conversation. Not to build your ego right now, but you're leading that conversation in healthcare. Was that intentional or-

Andrew Parker:                                         
It happened. Yeah. Well, I'll just tell you, so when I started Papa, I just noticed my grandpa needed assistance and help. And then we quickly realized after we started it, this is in 2017, early 2018, that loneliness is a disease. And we've been talking about loneliness, actually in Y Combinator, I remember this big slide that literally just said, loneliness is a disease, and all the investors in healthcare, people in the audience kind of perked up. And then we showed a video of this fabulous member we had. He passed away, rest in peace, Sam. He was like 98 years old when he passed away. He's one of our first members. And you see, he's a fun guy. He likes being engaged. He's very talkative. He was sitting by himself in his house for years and years. So no matter how engaged you are as a person, no matter how lively you are, if you don't have that response from another human being, it's impossible.
                                                       
And so back then we were talking about, 2017, 2018, loneliness is a disease. The US surgeon general actually called the email me before he was the US surgeon general and said, "I'm writing a book on loneliness. I would love for Papa and me to help." I thought it was a fake email actually at first. And I ended up responding and I ended up meeting with him. He's just such a wonderful future thinker, obviously a healthcare leader in America, and taking a topic that I think most brushed to the side and rose it up to the top, to the maximal level in the government. And then now there's the World Health Organization, as you mentioned. He wrote an 80 page or so policy type document around loneliness. I saw Hillary Rodham Clinton wrote an expose recently as well. I believe it was in The Atlantic.
                                                       
And so loneliness has kind come again. I would call this the second wave of loneliness because it was being talked about in 2017, 2018. Now it's come back in a really big way. I mean, I believe the changes that occurred to the world in Covid opened up everyone's eyes to say, wow, loneliness is a disease. It's not only affecting older people, it's affecting our age groups. It's affecting younger people with social media and being removed. And it's a real problem.
                                                       
And I think most people before wouldn't have raised their hands, said I'm lonely or I'm isolated, or I have mental health issues, or behavioral health issues. But now people are. So of all the things that have happened over the last few years, I think at least one positive thing is people are generally feeling more comfortable talking about these real issues that I think used to be considered a bit soft. And now they're obvious, because everyone has felt loneliness. Pretty much everyone has felt loneliness. I have.
                                                       
And so older adults that are not necessarily technically evolved as the same as you and I would be, but though that is a little bit of a general statement, that may not have access to the same tools and technology of groups of friends that you and I may have, they're at a larger deficit. And so by trying to solve at least that one problem, Papa is not a panacea. We can't solve all problems. We can't solve all loneliness. We can be a big resolve for older adults and lower income individuals that need support with loneliness.
                                                       
But I think about really companionship as an umbrella, that you don't have a car, you have food insecurity. Your house is a mess. You don't know how to access your healthcare services. And so it kind of falls under that category of what we think of as companionship, which is house help, driving people somewhere, teaching them how to use technology, and really engaging them in a way that the healthcare system hasn't. And so that's what Papa's here to do.

Brian Urban:                                           
I think you're deploying some of the most athletic public health, community health workers in the country. And I'm not sure always your model is looked as the public health benefit, maybe just addressing loneliness and that everything, the single attribute underneath it, but you have a huge squadron of next generation public health impact makers. And that's how I think about your model, not just from the business side, but really what you're doing for a societal change.
                                                       
And I mean, think about the 65 plus population, about 90 million is what we're looking at over the next five, six years, and how many of them are going to have cognitive, physical challenges, loneliness challenges that need addressed, just simply need to pop a pal, just need a pal. But there's just so many angles to look at your business and what you've done as putting together this unique community.
                                                       
I want to look into the future a bit, Andrew. So now you're going on seven years alive here. You've got some amazing success. You've measured how you help. Beautiful ROI that stretches across the healthcare continuum, not just certain points of care, but a lot of things upstream that affect downstream. What's Papa going to be in the next phase here? What are you going to be in the next five years? If I talk to you again in 2029 or so, what's Papa going to be then?

Andrew Parker:                                         
I got scared when you said 2029. I feel like we're getting pretty close here actually. Time is flying. Papa wants to, and our mission is to create a new kind of care built on human connection. There's a shortage of providers, a shortage of nurses, caregivers. There's something like almost 400,000 shortage of caregivers over the next decade or so. And so there needs to be a new kind of care, and we feel like we're tech enabling that through our software and processes and our new Network of Pals. We have today 30,000 Papa Pals across the United States. I hope to have 100,000 Papa Pals to support millions and millions of older adults and families.
                                                       
In the next three years, I believe the pals will continue to get more programmatic, where we can understand consistently at scale, what are the needs of older adults and individuals across the United States? What you need today could change. Understanding those needs, tracking those needs, and actually closing the gap on those needs. A lot of people are saying, okay, and we're being required by the government, let's understand the social needs of older adults and families. That's okay. We know people are food insecure. We have to know these things. Data, as you know, is critical.
                                                       
We believe we are the only company that can deploy human in the home across the United States at scale, at such a high quality, in such a safe way, and to do the things that matter to that person. Again, not to go in and check boxes and replace any other types of care, but we are a new kind of care built on human connection, and we want to be able to use our software nationally to be able to support millions and millions of older adults and families.

Brian Urban:                                           
Wow. I'm excited to see the next iteration of Papa. It is just the beautiful stories is how many people you help. So I'm excited to see the content, too, built out on all these beautiful stories because it's encouraging. It's showing the great side of healthcare that isn't hard clinical in nature, that occurs in the home and in the community. So this is fantastic.
                                                       
Andrew Parker, thank you for joining our show today. I really appreciate the time and the insights you've given us into Papa here.

Andrew Parker:                                         
Thank you, Brian. Thank you so much. I'm excited for the show.

Brian Urban:                                           
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