Every Medicare Advantage plan is wrestling with the same problem: They have data, they have outreach programs, and they have vendors. What they don't always have is a reliable way to get to the members who need them most and advance the Stars, quality, and risk adjustment objectives that depend on those connections.
This operational disconnect was at the center of a panel discussion on member engagement at The 15th Annual Medicare Stars, HEDIS®, Quality & Risk Summit in Chicago. Alongside experts from mPulse, Sagility Health, PlanPlus by Curant Health, and Blooming Health, Papa's Chief Commercial Officer, Austin Weaver, shared how the conversation in the market has shifted and what that means for plans navigating one of the most demanding operating environments in the program’s history.
Plan expectations are evolving as market pressures shift.
"The idea of acquiring and retaining membership has moved to a story of: ‘I have acute pressure points and I need to solve them,’" Austin observed. "And in particular, ‘I need to solve the end of the challenge—the last mile I have to compete in.’"
Plans aren't just trying to run better outreach programs. They're trying to close specific gaps with specific members, and two things keep getting in the way: getting there in person, and getting all the way across the finish line.
Both challenges are especially acute with socially isolated and medically complex members—exactly the population where the financial pressure is often concentrated.
Other panelists echoed the broader operational strain. Michell Butler from PlanPlus described the "simplified compression" many health plans are living under—having to do more with fewer resources, relying on vendor partners to bring new ideas rather than defaulting to what's always been done. Brian Heacox from mPulse pointed to the shifting mix of Star measures, including triple-weighted HOS measures and CAHPS, and the opportunity to use claims data more proactively—identifying signals of member burden before outreach begins rather than after. Krithika Srivats from Sagility Health pointed to the operational inefficiencies of fragmented, multi-vendor environments, where outreach from multiple teams can pile up without coordination, creating member abrasion rather than engagement.
Reaching the member is only half the battle. Trust opens the door.
When the conversation turned to connecting with hard-to-reach members, Austin highlighted what fundamentally sets Papa's model apart from purely digital or telephonic approaches: the ability to show up in person.
“We offer something unique—it's not someone in a white coat. It's someone to spend time with the member and offer help,” he said. “That ability to offer help is what gets members to open the door, complete the assessment, follow through on the appointment, and share what's going on in their lives.”
Companionship earns the trust that makes action possible. A Papa Pal showing up to help a member prepare for discharge, get to an annual wellness visit, or complete a health risk assessment isn't just executing a task—they're building a relationship that makes members feel supported and safe.
Alexandra Grullon from Blooming Health spoke to a complementary piece of this: the value of bi-directional information capture across the member journey, following up not just at 24 hours post-discharge, but a week and two weeks after that to build a fuller picture of what's blocking members from following through on their care plan.
It's a model that aligns closely with how Papa supports members after a care transition. Papa Pals provide in-person assistance throughout the critical 30-day post-discharge window, helping members prepare their home environment, pick up medications, access nutritious foods, and get to follow-up appointments, while surfacing the barriers that put recovery at risk before they result in a readmission.
Attribution and ROI: The conversation is evolving.
No panel on engagement would be complete without grappling with the ROI question.
Austin described a meaningful shift in how Papa structures its model: "We moved to a model where you get the return if there's a result. Assigning that type of risk—where we only get paid if a care gap is closed, if the action was actually taken—has been a major movement."
That's a significant statement in a market where health plans have grown skeptical of engagement spend that doesn't connect to measurable outcomes. Paying for a scheduled and completed annual wellness visit, not just an outreach attempt, changes the incentive structure.
Krithika emphasized the discipline required to actually demonstrate ROI: "Establish your measurement framework before you start the program—and give it enough time to work. Most programs fail not because they don't generate results, but because the framework wasn't in place to capture them."
Durable engagement requires more than the right vendor.
The panel closed on the organizational question: Where should engagement live within a plan, and what makes it stick?
Krithika made the case for the contact center as the logical hub: 60% of members contact it at some point, and plans that have centralized engagement ownership there have seen real results. Brian pointed to the value of a dedicated team that can see across channels and call out when programs overlap or conflict.
Regardless of where engagement ownership sits organizationally, Austin emphasized the baseline requirement for any lasting strategy: a proven way to reach the members who fall through the digital and telephonic cracks. "There are a lot of ways plans are trying to drive engagement on quality objectives. We're the part that gets there in person to facilitate it."
That distinction matters more than ever. Digital tools, AI workflows, and telephonic outreach all have a role. But for members who are isolated, medically complex, or simply hard to reach through traditional channels, the human presence in the home isn't a nice-to-have. It's often the only path to the outcome the plan is trying to achieve.
