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Medicare Advantage Plans Medicaid MCOs PACE Programs Area Agencies on Aging

The Payer Case
for Companion Care.

One page. Everything your compliance, clinical, and contracting teams need to evaluate a supplemental benefit contract with Boojee Companion Care.

Request a Plan Briefing ↓ See the Evidence →

The Financial Case

Socially isolated older adults cost Medicare an estimated $6.7 billion more per year — approximately $1,608 in extra spend per beneficiary, driven largely by avoidable hospital and skilled-nursing use.

A companion program that reduces isolation and closes care gaps pays for itself against even a fraction of that avoidable spend — at a PMPM that is a rounding error on your medical loss ratio.

Source: AARP Public Policy Institute / Stanford analysis, publicly reported. Cited as a publicly reported estimate, not a peer-reviewed RCT.

Business Case Builder

Build your plan's
internal business case.

Use your own population size and assumptions. We show the real program cost at our published pricing, and the sector isolation-cost context your actuaries already know — so you can model the break-even without us inventing numbers for you.

Program Cost + ROI Context Calculator

Model the numbers yourself.

Inputs are yours. Program cost uses our real published pricing. The isolation-cost context uses the AARP / Stanford publicly reported sector figure ($1,608/beneficiary/yr) — pre-filled so you can adjust it to your own estimate. Output is illustrative. Nothing here is a guarantee.

Enter the total number of members or residents in scope for this program.

Pre-filled with $1,608 — the AARP / Stanford publicly reported sector estimate. Change this to your own figure.

How many members do you expect to actively participate? This is your assumption — we have no enrollment data (pre-pilot).

20%

Program Cost (real pricing)

$—

Estimated annual program cost
— enrolled members × our real published pricing

Tier applies based on enrolled count.

—

Your Modeled Isolation-Cost Context

$—

Enrolled members × $1,608/yr (your assumption)
Source: AARP/Stanford publicly reported estimate — your figure to change.

This is your modeled figure using the assumption you entered above — not a promised savings number. We have no outcome data.

Break-Even Coverage

—%

The program pays for itself if it offsets —% of your modeled isolation-related cost for enrolled members.

Shown math: program cost ÷ modeled context cost × 100. Both figures are estimates — see disclaimer below.

Illustrative estimates only — not a guarantee or projection. Program cost uses Boojee Companion Care published list pricing (see below). The isolation-cost context uses the publicly reported AARP / Stanford sector figure ($1,608/beneficiary/yr) or your own entered figure — this is a sector estimate, not a Boojee outcome or promise. Boojee Companion Care is pre-pilot with no enrolled members and no outcome data. We cannot tell you what fraction of isolation-related cost this program will offset for your population — that depends on engagement, clinical design, and factors we have not yet measured. Model with your own actuarial assumptions; treat this calculator as a starting point for internal conversation, not a vendor savings guarantee. Every figure shown is clearly derived from your inputs plus cited sector data.

Our Published Pricing (used in cost calculation above)

$48/resident/mo — add-on per-resident rate $998/mo — Community Pilot (up to 25 residents) $2,998/mo — Enterprise (larger deployments) PMPM quoted — Health-plan contracts (request briefing)

Calculator applies whichever is lower — $48/member/mo or the $998/mo Community Pilot flat — for up to 25 enrolled, then $2,998/mo Enterprise flat for 26+ enrolled. Health plans receive a PMPM quote — use the briefing form below. Pricing subject to contract.

Request a Plan Briefing ↓

We'll model the PMPM for your actual enrolled population and walk your team through the SSBCI evidence package.

Reimbursement Pathways

Three routes to payment.
One is ready now.

Insurance does not pay for a "loneliness program" via a magic CPT code. The money flows two primary ways — here is an honest ranking of what is achievable, how, and what each requires of the plan or provider.

Start with Pathway 1. The PMPM vendor contract is the Papa / Pyx Health model — it requires no CPT codes, no billing department, and is the fastest path to a signed contract. Pathways 2 and 3 are real but require state-by-state or clinical-partner work that makes them Phase 2 or later.
Most Achievable — Start Here

Pathway 1

Health-Plan Vendor Contract, Paid PMPM

Medicare Advantage supplemental benefit (SSBCI / standard) or Medicaid MCO contract. The plan pays a monthly per-member fee. This is the Papa and Pyx Health model — both contract with 70–100+ plans respectively on this basis. No CPT codes. No billing department. One contract.

What this requires

  • SSBCI or supplemental benefit authorization in the plan's Evidence of Coverage
  • CY2025 SSBCI evidence bibliography (we build this with you)
  • UCLA-3 + PHQ-2/9 baseline and tracking data for the bid file
  • Care-gap closure hooks: AWV, HRA, covered screenings
  • 24/7 human escalation + crisis protocol (988)
  • HIPAA BAA + SOC 2 (in progress; BAA available)
  • General-wellness posture memo for compliance team

Sources: KFF Health News (Papa plan contracts); Pyx Health (MA / Medicaid MCO page); CMS CMS-4205-F (CY2025 SSBCI rule).

Proven for Companion Tech

Pathway 2

Medicaid HCBS / State Aging-Services Line-Item

State Medicaid waivers (1915(c)/(i)), Area Agency on Aging programs, and PACE (capitated) organizations. ElliQ operates at scale via this channel — Washington State authorized a Medicaid reimbursement code for it; NYSOFA placed 800+ units via a state-funded AAA program. PACE programs can include a companion under their all-inclusive capitation.

What this requires

  • State-by-state approval (non-repeatable across states)
  • Alignment to a waiver service definition or aging-services grant
  • Device/service provisioning + member support
  • Outcome reporting to the state agency or AAA
  • PACE: capitation covers it — no separate code needed

Sources: Fierce Healthcare (WA Medicaid ElliQ code); NYSOFA ElliQ initiative (800+ placement); CMS PACE capitation overview. ElliQ figures are vendor/program impact-survey data, not peer-reviewed RCTs.

Phase 2 — Clinical Partner

Pathway 3

Clinician-Billed RTM / CCM Codes

A physician or QHP bills — we are the data-capture and engagement layer. RTM 98978 (CBT/adherence monitoring, 30-day device supply) or CCM 99490 (chronic care management time) are the closest fits. We do NOT bill these ourselves. This is a partnership with a provider group willing to treat our monitoring module as part of their documented care management.

What this requires

  • Physician/QHP order + patient consent
  • Clinician documents time against our check-in / screening data
  • RTM: ≥16 days of data per 30 days for device-supply codes
  • CCM: 2+ chronic conditions, 20 min/month clinician time documented
  • RPM does NOT fit — loneliness is not physiologic data
  • Z60.2 / SDOH Z-codes support but do not pay on their own

Sources: ThoroughCare (RTM 2025 codes); CMS RPM rules; APTA RTM advisory. RTM device status for a general-wellness companion is unsettled — pursue via a clinical partner willing to own the billing side.

What We Deliver

The artifacts your plan's
bid file actually needs.

We do not sell a vague "wellness engagement program." We deliver specific evidence artifacts that map to specific requirements in the SSBCI rule and the Stars/HEDIS quality story.

SSBCI Evidence
Validated Loneliness + Mood Screening (Pre/Post Delta)

UCLA-3 at intake and on rolling schedule (the same instrument Pyx Health uses at onboarding). PHQ-2 → PHQ-9 and GAD-7 paired in every outcome cycle. Pre/post deltas computed per member and reported to the plan in the format the CMS SSBCI evidence bibliography requires. All instruments are public domain — no license fees that inflate your per-member cost.

Stars / HEDIS
Care-Gap Closure — AWV / HRA / Covered Screenings

Proactive nudges to members for Annual Wellness Visit, Health Risk Assessment, and preventive screenings — with completion tracking reported back to the plan. This is the core mechanism Papa uses to justify its plan contracts and Star rating story. We build the same lever into every engagement cycle.

Engagement Proof
Engagement Telemetry — Activation, Frequency, Retention

Activation rate, sustained daily/weekly check-in rate, and retention metrics — the engagement proof your plan's value-based contract requires. Companion-initiated daily check-ins maintain high interaction frequency (the ElliQ NYSOFA program reported ~30 interactions/day, 6 days/week as its engagement benchmark — cited as program impact-survey data, not our result).

Crisis Protocol
24/7 Human Escalation + Crisis Protocol (988)

The hard payer procurement requirement that many vendors fail. Any conversation containing risk language, or a PHQ-9 item 9 score above zero, triggers immediate escalation to a human and delivery of 988 Suicide & Crisis Lifeline resources. Every escalation is documented with timestamp, severity, reason, and resolution — the audit trail your compliance team will ask for.

SDOH Risk Intel
SDOH / Z-Code Capture (Z60.2 + Z55–Z65)

Structured detection of social-determinant risk — living alone, food insecurity, transport barriers, housing — surfaced in conversation and passed to the plan for clinician documentation. Z60.2 ("Problems related to living alone") and the Z55–Z65 family enriches your risk capture and HEDIS picture. Z-codes support claims but are not a payment source on their own; they are captured here as a plan intelligence asset.

Payer Report
Monthly / Quarterly Outcome Report — Payer Format

The standing deliverable: members enrolled and retained, UCLA-3 and PHQ-9 pre/post deltas, care-gap actions triggered and completed, escalations raised and resolved, SDOH flags captured. Formatted as the exhibit you attach to your SSBCI evidence bibliography and quarterly plan review. The caregiver dashboard shows a live version of this artifact.

Compliance Posture

What we have, what's in
progress, and what's not.

We are a pilot-stage program. We tell you exactly where we are on every compliance item — because your contracts team will ask, and fabricating readiness is worse than being honest about the roadmap.

3 Built
1 In Progress
1 Active Gap
1 Required — Before Scale

HIPAA-Eligible Infrastructure

Lambda, DynamoDB, Polly, and Bedrock are AWS HIPAA-eligible services covered under Amazon's BAA program. We say "HIPAA-eligible" not "HIPAA compliant" — compliance is a program, not a product feature. A signed AWS BAA must be executed before real PHI is stored; we have not done this for production yet. BAA available on health-plan contracts.

Built — BAA to execute

Crisis Protocol — 988 + Human Escalation

PHQ-9 item 9 above zero or risk language in conversation triggers immediate escalation: 988 Suicide & Crisis Lifeline delivered to the member, CRISIS-severity alert raised to the caregiver/plan dashboard, full audit log entry created. This is a hard design requirement, not a configurable option.

Live in care engine

Consent-First Architecture

The API gate refuses all health data writes without an explicit consent record on file. Consent is timestamped, scoped, and revocable. A right-to-erasure / purge workflow is on the production roadmap (consent withdrawal currently records the withdrawal but does not retroactively delete prior data).

Built — purge workflow roadmap

FDA General-Wellness / Non-Device Posture

We operate in the FDA general-wellness lane per the agency's January 6, 2026 guidance. We screen, track, engage, and route to humans — we do not diagnose, treat, or name conditions as findings. This keeps us non-device and satisfies the payer's crisis-escalation requirement simultaneously. A general-wellness posture memo is available for your compliance team on request.

Posture memo on request

SOC 2 Type I

SOC 2 Type I is on our roadmap for the first payer contract. We do not have it yet. Our AWS architecture — scoped IAM roles, DynamoDB encryption at rest, append-only audit logging, HIPAA-eligible services — is designed to pass Type I controls. We will obtain Type I before going live with real member data at plan scale.

Roadmap — before plan scale

Clinical Governance — Named Advisor

A named clinical advisor (MD or LCSW) governing screening thresholds, escalation rules, and outcome report methodology is a hard payer procurement requirement. We are actively recruiting this role. We will not claim it is filled until it is. This is the one item your compliance team will rightfully flag as a gap today — it is in progress.

In recruitment — required before plan contract
Honesty note on evidence: We cite sector evidence (AARP $6.7B / $1,608 isolation cost; ElliQ 95%/80% self-reported improvement; Pyx Health 2.5:1 claims ROI) as vendor/program impact-survey data and publicly reported estimates — not peer-reviewed RCTs and not our results. We do not yet have enrolled members. Our first pilot will generate the first real outcome data for this program. This is exactly the honesty posture CMS's SSBCI evidence rule rewards — plans get in trouble when they fabricate outcomes, not when they accurately describe what their evidence demonstrates.

Request a Plan Briefing

Let's build the PMPM case
for your plan's population.

We'll walk your contracting and clinical teams through the SSBCI evidence package, PMPM model, compliance posture, and outcome reporting cadence. Preparation time for a first call: two business days.

Payer Partnership Intake

Request a Plan Briefing

For Medicare Advantage plans, Medicaid MCOs, AAAs, and PACE programs. Tell us about your population and we'll come prepared.

Submit this form
We prepare SSBCI package
Briefing call in 2 business days

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