In-home care startups looking to address cracks in the health care system have seen those cracks — as well as their businesses — grow larger during the COVID-19 pandemic.
Papa, an on-demand companionship service company, set out to address a loneliness epidemic when it launched in 2018. Today, quarantines and infection fears have created an environment for seniors that’s lonelier than ever.
Likewise, Tomorrow Health — a medical equipment company focused on the home — has seen the lack of access to the right resources for in-home care patients worsen during the public health emergency.
The atmosphere is now filled with contradicting headwinds and tailwinds, but ultimately, these companies are hoping their worth has shone through it all.
“There is not a skilled nursing facility in all of our futures. We simply can’t afford it, the government can’t afford it,” Chuck Hector, the chief revenue officer at Papa, said Tuesday during the Home Health Care News Capital+Strategy event. “We’re going to have to live at home.”
Miami-based Papa partners with Medicare Advantage (MA) plans to address social determinants of health in seniors. Its “Papa Pals,” usually college students, visit seniors at their homes to help them with daily activities or to keep them company.
“Many of us are going to need [assistance] to be able to support us and help us a few times per month — going grocery shopping and doing those basic things,” Hector said. “We’ve seen terrific expansion of our services both in-home and virtually.”
When COVID-19 surfaced in the U.S., Papa launched “Assistance from a Distance,” a virtual platform to help Papa Pals and seniors connect during quarantines and stay-at-home periods.
The virtual platform won’t replace in-person visits from Papa Pals in the future, but has forced Papa to invest in a digital service that will be available to the seniors they serve in the future. Papa Pals have also helped seniors acclimate to technology, in general, during the pandemic, which has helped them connect with their families and other health care providers.
On Tomorrow Health’s end, the company has noticed two primary trends since COVID-19 began spreading throughout the country.
“The first was the acceleration and the growth in demand for home-based care,” Vijay Kedar, the founder and CEO of Tomorrow Health, said during Capital+Strategy. “We also saw tremendous access issues across the market because many folks couldn’t get access to the critical medical equipment they needed.”
Tomorrow Health was built to address that problem, which existed before COVID-19, Kedar said.
The New York City-based startup is backed by venture capital firm Andreessen Horowitz. Its primary goal is to build out an Amazon-like service to navigate the in-home medical equipment landscape.
Tomorrow Health’s capabilities have grown significantly since it was launched earlier this year, and it even partnered with the New York City mayor’s office to help facilitate needed equipment to providers and patients in the area while the city was the epicenter of the COVID-19 crisis.
“We’ve also been a partner to a range of [providers] to assist them in leveraging our technology and operations to streamline their workflows and enable them to serve patients more holistically and more effectively,” Kedar said. “But most importantly, it’s given us the opportunity to serve a wide base of patients in need, many of which have been either infected or affected by the COVID-19 pandemic.”
Avoiding the roadblocks
Regulation has always been a roadblock for home-based care providers, as well as businesses adjacent to the home health and home care industries.
An obvious example is the barriers — both from a regulatory and operational perspective — that have been in place for virtual care to be conducted.
“Converting to a digital solution has been so significant for us,” Hector said. “And after 10 years and the telemedicine space, I’m still scratching my head. I’m like, ‘Oh, it only took a pandemic for us to get utilization to where it needed to be.’”
But the regulatory challenges that Papa and Tomorrow Health face go beyond basic virtual challenges.
“There have been many unexpected challenges,” Hector said. “If a state shuts down in-home services, for example, what does that mean to the person or the member receiving life-saving cancer treatment or kidney dialysis? So, we’d have to quickly lobby with those health plans to work within the context of those state mandates, to make sure that we were providing services that were accepted. Under these extreme circumstances, that posed a pretty big barrier.”
Papa went, as Hector said, from being the fun, in-home services company to being a clinical lobbyist vying against regulations with pretty large consequences.
Additionally, Papa has been tracking closely the dispute between California and rideshare companies such as Uber and Lyft. Having to provide gig workers — or Papa Pals — with benefits as full-time employees would be a major pain point for the company.
“That would become an operational showstopper for us,” Hector said. “Our Papa pals are college students and youthful workers that prefer the flexibility of being able to work whenever they want.”
Still, despite the regulatory hurdles that have become even more confusing during a public health emergency, Kedar is bullish that the health care system will look better in the end.
“We saw in many of our payer dialogues coming into this year that home-based care was a top-five priority for many organizations, and with the COVID pandemic, that has accelerated to either a top-one or top-two priority,” Kedar said. “We’ve seen our partners take tremendous strides to meet the new needs of the new normal. And it has resulted in, ultimately, what I think is a much more sustainable and more resilient health care operating ecosystem.”