Papa is making a positive impact on the world and achieving product-market fit at the same time. Papa pairs older adults and families with Papa Pals for companionship and assistance with everyday tasks, creating the future of care and curing the epidemic of loneliness.

In the United States, 3.2 million people are retiring every single year. That's more than 60,000 people per week. At the same time, there's so much more loneliness in the world. Our extended families are moving farther and farther away, so sometimes, our aging parents just don't get the support that they need.

I sat down with Andrew Parker of Papa. His service connects Papa Pals with older adults and their families for companionship and help around the house, but it's also turning into pre-care, which is one of the biggest markets that's growing super fast. Let's get into it.

What is Papa?

Garry: Andrew, thank you so much for coming on the YouTube channel. You're working on something that's really touching a lot of people fighting the epidemic of loneliness in this country, and it's also making people quite a bit more healthy.

Andrew: Thank you for having me.

Garry: Let's start with the basics. What is Papa?

Andrew: Papa connects older adults and families to what we call Papa Pals, and they provide companionship, support and assistance. They'll drive your older family member or yourself to the doctor. They'll help them around the house. They'll teach them how to use computers or engage with the community. Really what we provide is family on demand. Most of our business goes through insurance companies, and we're nationwide today.

Garry: How did you get started, and how did you discover this problem? It's such a giant problem, and there's so much need. I'm sure there are a lot of people watching who are trying to figure out how to pick an idea or problem to work on.

Andrew: What's interesting is I have thousands of ideas. If you look at my notes, they're quite extensive, but when this came about, it was less of an idea and more of a personal thing that we went through as a family.

My grandfather, whom we called Papa, needed help, but he didn't need bathing and toileting, which is more traditional home care. So I thought we should connect him with a young, fun, energetic person — maybe a college student — and we did just that. We paired my papa with a young person, and he loved it. That was a big aha moment.

Then, I started looking into elder tech and elder care. At the time — three and a half years ago — 10,000 people would turn 65 each day. Three years later, 11,000 people are turning 65 each day. With that in mind and realizing I could build tech to improve the experience, I left my big boy job and decided to focus on Papa full time.

Garry: What was that like, getting started? What was that path to product-market fit?

Andrew: Well, it was a little difficult. I'm not an engineer. I'm more of a product and strategy and sales person. I knew a lot about healthcare, and I knew I could get this going. The first thing we did was build an app. We thought we could build something like a Tinder interface for older adults, and they'd be able to swipe left and right and choose a pal. The pal would be a young person that came over to spend time with them. That idea was fine, except we realized that our end user was actually the senior themselves. So we quickly had to pivot and actually remove all the tech and go to a 1-800 number, which called my cell phone early on. It would ping through an app the 20 or so Papa Pals we had manually vetted. That was the beginning of Papa and how we launched our consumer service, which was where we got our traction until we started to pivot into insurance. Pivoting into insurance and working with large Medicare companies is truly where we found our product-market fit, but it took about 10 months after launching to get into that path.

Garry: That sounds like a really big guiding principle: Talk to your users and figure out how you can meet them where they're at — and that includes their capability of using technology and comfort level with technology. That's really interesting that you started with something that would have worked maybe with a different set of users, but you looked down and said, "Hey, this set of users is not going to get how to do it, but they do know how to use a phone."

Andrew: Yeah, I remember being in a parking lot, having this conversation with my co-founder. We were so excited about the app, but if users didn't use the exact buttons in the way we hoped they would, it wouldn't work. So I said, "Why don't we just use a number?" We had this huge argument about the fact that that's not a tech company. I said, "Well, it doesn't have to be a tech company right now. Let's just get one user first, then two, then three, and as we can remove the human elements where appropriate, we can bring in tech."

That's what we've been doing ever since that moment: Empowering users in the way that they wanted to use it. Then, we realized the first tech we had to build wasn't actually a member app at all. It was more backend, logistic software, matching software, then an app for our companions that we call Pals. So we shifted our product focus to those things.

Garry: That's a crazy important lesson for people. Everyone runs out and makes an app first, and this is a good example of once it actually hits a real user, then you need to adjust. At the tech level, there was this adjustment from no app then move to phone then backend. At the business model level, there was also some shift. You are so good that a consumer can sign up and start using it. Perhaps that's how the first customers came in, but quickly, you realized that you need to sell to healthcare plans — or you can and you should. What was that process like?

Papa go-to-market is very valuable: Through health plans

Andrew: My career is in health plan strategy and sales, employers and health systems, so when I started Papa, naturally, the first thing I thought was to do what I was already doing and go after those same channels. Medicare is not an easy channel to go after, and there wasn't really a payment mechanism. We thought we couldn't get anyone to use it at that level if I couldn't get someone like the lady down the street to use it once.

So we had this dual track. Track one was to get users and traction on the lower level to at least have stories so we could understand what our members need and know what to build. Simultaneously, we were trying to sell into insurance companies. That is not an easy process, but it is our primary focus. Ninety-nine percent of our services are free to the member, paid by Medicare Advantage large health plans like Humana and Aetna, to name a few.

That's the real product-market fit for us, but that's a real challenge. You have to have compliance. You have to have the right tech that meets the needs of a health plan, which isn't always the most new tech. Also, you have to make sure you have reporting and an ROI story. You have to be good at selling, and you have to be a priority. These companies have millions of members and millions of leads, and you have to be the priority and understand the problem as it relates to them. So can you lower costs? Can you improve retention? There's something called star ratings, not to get too deep in it, and we shifted our whole business to focus on that, to really make sure that everything we thought was, "How does this bring value to the member? How does this bring value to the health plan? How does it bring value to the Pal?"

Garry: What was signing the first healthcare plan like? What we're used to, especially in the sales process, is getting that first one is really hard. What happens is you get in there, you deploy, and then, you get crazy stories of really extreme success. What did Papa end up doing for that first healthcare plan?

Andrew: So it was around October of 2018 when we went live with our first health plan partner, which was a national payer. They actually put out a story about how important loneliness is and how we can solve it with companions. It was almost like, "Ahh!" Right after that, I reached out to the person myself — we had 15 employees at the time — and I asked, "Oh hey, I see you're doing a loneliness project. We have a solution for that. It's called Papa, and I'd love to talk." So I got on a call. It was perfect timing but really challenging. It took maybe six months, which is fast.

I will say that knowing how to navigate that from previous experiences helped us a lot, but this was net new territory. At the time, it wasn't something they could pay for. It was very much like a pilot, and we shifted our entire company to focus on that. We stopped consumer. We put 100% of all hands on deck, and we started building. We made sure that whatever we committed to doing with the health plan, we were doing. We knocked it out of the park. We had high engagement. We had high usage. We improved healthcare outcomes. We lowered costs. We did all of those things. Then, at that time, Medicare actually decided to allow Medicare Advantage to pay for services like Papa. That was another huge moment for us. We were already set up to do that, but without that, we would've just been a completely different company. Once we got in with that first health plan, we proved that it worked exceptionally well, and we got our shot to go bigger. On January 1, 2020, we went live with 10 health plans, all at the same time.

Garry: That's awesome. Somewhere in there, you can just plant a flag that says "This is what product-market fit looks like." That's where we're at now: 300% to 500% annual growth, 15,000 Papa Pals out there, and more than 200 employees working for you. How does it feel? How's it going?

Andrew: It's going well, and it does feel great. We have incredible employees. We're trying to make a fun and engaging culture — to be a pal to everyone externally and internally — and I'm really enjoying it. At the same time, it's free to members. We're paying people to do this. It's paid for by the insurance and government, so it's a "feel good" business. When COVID-19 hit, it was another big challenge moment for us to say, "Oh, wow, we're sending young people into old people's homes." We didn't say, "Oh, we're in trouble" or "Oh, we're going to fail." It was more like, "How do we help people during this time period?"

Garry: The need is even greater.

Andrew: I know, and it just made Papa more important. No one's going to debate whether loneliness is an issue.

Garry: Now, everyone has a deep understanding.

Andrew: I call loneliness the only universal disease. Almost everyone's felt it in some capacity, so it's an interesting problem to solve.

Garry: One of the things that really blows me away is when you get to build a business that is this good but also fights something that is such a deeply felt and real problem in society. That's really when magic happens — when you get to do both and one enables the other. Because when this is a good business, that enables you to touch a lot more people, and that sort of enables you to spin the flywheel faster and faster.

Andrew: It's been an honor to be a part of this company. I mean, the stories that we hear… As an example, we went to a woman's house last month. She has mold in her house. She has COPD (Chronic Obstructive Pulmonary Disease). She has a breathing issue. She couldn't get in touch with her doctor, and she didn't know who her health plan was. Then, a Pal called her and said, "Hey, I'm a Pal, and I'm here with your health plan. How are you doing?" She said, "Oh, actually, I'm not doing that well, and here's why."

We help get them into the right path. Sometimes, we do it, and sometimes, our health plan has services that we help navigate. There are a lot of people that are falling into that crack, that people don't even think about. I mean, just imagine an older person sitting on the couch. They don't have a Peloton, and they don't know what a TikTok is. They barely know how to get to their refrigerator, which may not have that much food in it because they don't have a car. So social determinants of health are on the rise as a way to help people's health. If you're lonely and isolated, don't have a car, and don't have access to healthy food at home, you're going to be in trouble. The Pal can't solve all problems, but they can at least be there for you and navigate for you. So that's part tech, to make sure that happens in a smooth way and it's easy, but it's also a very much offline experience as well.

Papa is now pre-care: Helping people be more healthy

Garry: That sounds like it's one of the big discoveries from the Papa experience: this type of anti-loneliness. That's sort of what broke it open, but now, this is turning into the future of all healthcare, in that this is pre-healthcare, or being proactive, not late stage when it's intervention or trying to do a lot of things to help people after the fact. Pre-healthcare is about being proactive and helping people before anything serious actually happens.

Andrew: One hundred percent. I come from an urgent care, telehealth space where when we started that company, it didn't exist at all, and now almost every other week, a new company is doing that, which is very exciting. What we think about is there are a lot of reactive solutions but not that many proactive solutions.

We see the Pal as really a new type of provider. There aren't enough nurses. There aren't enough caregivers,and there aren't enough doctors. So by enabling a new provider type, mostly through removing toileting and bathing and creating companionship as a category and enabling it through tech, we're able to help with all of the things that fall through the cracks or the social determinants of health as some call it. We're making sure people know how to get to their doctor, making sure people know how to get their dentures, making sure people feel good and satisfied and giving them a good customer experience, which Medicare Advantage cares about because that's tied to their incentives.

There's finally this mechanism, which is called Medicare Advantage — there are more examples coming in the United States — that empowers organizations to care for the health of someone rather than just pay for it when they go to the doctor. Pals are really that missing piece to get them into the right set of care at the right time. There are services that exist if you break a leg or have cancer, but most of these services are waiting for you to get to those places. We really want to get there before that, and we've called it pre-care.

Now, we're thinking about it more as the front door. We're literally walking through your front door, into your home, where you feel most comfortable to provide you, as an older adult or a family member, with what we call true independence. We want to make sure we support people in the way they feel comfortable. They call seniors 65 and above — that's 40 or 50 years if you're lucky — all bunched into one category. That makes no sense. My dad's almost 65, and my grandma's 90. They're different people, and they need different things. If we can help them proactively, it's super powerful.

Garry: One of the things that is happening, that's really the wind at your back and why you're sort of the Vanguard of this type of pre-care, is actually the data. It sounds like data and research in healthcare is starting to show social determinants are incredibly important, and this is really something that's changing healthcare, doctors, awareness and policy right now.

Sometimes, you think about the way healthcare happens in hospitals. It feels very fixed, but I think this is a good example of how it's changing right now. Then, when those changes occur, very large businesses that can have a really big impact open up as businesses.

Andrew: One hundred percent. When I was at MDLIVE, which is where I was formerly, it was a telehealth company in the early days, and no one really knew what we were talking about. Video codec barely existed. FaceTime didn't exist. So it was hard for us. Then, the Affordable Care Act happened, and suddenly, a lot of shifts to value and thinking about lower sites of care happened. That was the first kick for MDLIVE and telehealth in general.

That same thing happened with Papa. If I started Papa 10 years prior, it may not have worked. Being in the right place at the right time is part of it, and seeing the trends is part of it — that earlier point of 10,000 people when I started and 11,000 people today. Obviously, COVID-19 has only significantly exacerbated the fact that social care is important. The health systems have gotten pretty good at taking care of sick people, and generally speaking, we're pretty good at maintaining those costs in the way that they should. It's still way too expensive, but we've done a really good job improving that.

But there are other factors here. Eighty percent of outcomes are driven by social determinants, and that's a pretty staggering number. When you go down and think about it, if someone's in a bad home environment where there's garbage everywhere, they're not eating, they don't have a car, they can't get their medicine because they can't afford it and other things, obviously you can't help somebody if they can't get to the place to help them. I think that's what we're trying to do: get everyone to that Day One position.

Garry: That makes sense. Switching gears a little bit, I feel like you're sharing so many amazing lessons. This is almost a MasterClass in starting out, being agile, listening to your user, finding product-market fit then scaling the business from this early thing to now, something that could touch a billion people. What are some of the things you wish you knew that you know now, that if you could send a message in a bottle to yourself when you first started out?

What Andrew Parker wishes he knew when he was starting out

Andrew: I don't think there's anything because if I didn't go through those experiences, I don't think I'd be in the place I am today. Going through those things lets you understand the nitty gritty nuances of what's supposed to become in the future.

We're now productizing everything, and everything's being tech-enabled. We're using machine learning and natural language processing. We're tracking things that we never would've considered before. But to do that in the beginning, before you really understand what you need to build, is really not going to be the right move. We didn't really know how to build those products at the time, so we had no choice but to do it that other way. That, I think, was super helpful now that we are building the products, to know the right path to go down. That's everything from thinking, "How do you call an older person? When do you call them? What do you say when you say hello? Is it hello? Is it hey?" So how do you systemize it over time? You can't figure that out unless you don't systemize it at first. I think that's a lesson: have a product mindset, but there are other ways to get to an answer that are probably cheaper and faster at least initially. I know entrepreneurs want to build scalable products — that's what we're doing now — but in the beginning, there's no red button; there's a lot of tiny buttons.

Garry: Do it unscalably initially. Once you figure it out, then scale it. Premature scaling is death for sure.

Andrew: One hundred percent. A lesson I did learn is that it's a hard transition going from a scrappy process to a product process. It's the right thing to do, but it's an evolution that we had to go through together — bringing product people into an environment that didn't have any product people and really starting that from scratch but two years into a company. It was an interesting lesson learned. I do wish we did it a little earlier, but even these lessons are super helpful for us. It's making us a better team from a culture perspective because we're learning from each other how to make this thing into the best scalable platform that we can.

Garry: That sounds like a really big transition. Do you have any words of advice for people who might have to look at going from a sales-led organization that's doing things unscalably to a product-led organization? I think Marc Andreessen was talking about this on Clubhouse the other night, and I thought it was super interesting. The danger when you're a software engineer is the culture fit question. Engineers code all day then at night, but they have a side project because they love coding so much. That's not something that other disciplines actually do. There's a "how do you speak each other's language" moment. The reality is that it takes a diversity of all of those different backgrounds and ways of thinking to build something that is as powerful as what you've built.

Andrew: Yeah, it's a very interesting thing. If I were to say the most important thing to do is to get through this process is to have a good perspective. You want that sales person to be leading the sales team. You want that engineer to be building, coding and working with the product teams. You want to have a product mindset while maintaining this customer support mindset. I think it's about helping others that aren't always able to get there to see the light and to say to the sales man or woman, "This is why we brought these people in, and you don't want them to be like you, but you also have to understand their mindset." Then also go to the tech side and say, "The reason they're doing this is because of the following..." and get them to understand. I do that with our team. I'll go and individually meet with them, but it's just more about trying to show people each other's light. I think that's been really helpful, and it's pretty cool to see our team evolve on every side of that coin. It's been really exciting to see, but there are growing pains going through that. I do think that in order to build a scalable healthcare company, you have to have both; you can't just have one.

Garry: It's hard but also doable, and you're doing it super well. Another thing I wondered if you could touch on is how part of going from unscalable to scalable often is tooling up, especially your processes around management, especially for people who spend a lot of time at the early stage. Part of the reason why we start companies that early is because we don't want to have a boss, and we want way less process so we can get things done. Then, there is this shift from pre-product-market fit to post. Once you catch the lightning in a bottle, you've got to switch over to management and OKRs. Are there any tips or lessons that came up as you scaled this that you could pass on?

Andrew's lessons for going from doing the unscalable to scaling

Andrew: I am not one to create processes. I'm a very off the cuff type of person. I know what I don't know, and I really want to make sure that our team remains focused. It's different when you have 10 team members, then 30 team members, then 50, then 200, and we'll have double that soon.

How do I get everyone to swim in the same lane, the same direction and make sure they're focused on the right things? I think my natural management style has always been pretty hands-off. I say, "Okay, you go do this with this team," and you go and do it. Then, we found out about COVID-19, and we all had to shift at the same time to the same focus.

We brought in a head of finance who has a consulting background and is really smart, and he brought some of these processes to bear, one of which was OKRs, so objectives and key results. When I read about it and learned about it, it fit perfectly with what I always was doing. We all pivoted to focus on one goal, which was to turn on virtual across our business. We'd never heard of OKRs or as my head of sales calls it, KPIs for millennials, but that's helped us manage the ship.

We work together in a bottom-up approach, collaboratively coming together and saying, "Here are our five company goals. What does this mean to you? Let's just track towards it." We're actually very serious about it. We track it all in Notion. It has a progress bar, and we know where everyone is in it. It's very transparent, and it's perfect because I don't like saying "Garry, what'd you do today?" I just want to help you do the thing that we decided together would be your mission. That's really the way I think is the best way to manage and to scale in our type of business. The team's really bought into it, even the ones that pushed back at first. It's been super valuable.

Garry: One of the things I've learned about OKRs in particular is that everyone really focuses on the objectives. They focus on what we're going to do, what we're saying we're going to do, negotiating what will actually happen, what is a stretch, and what we can't do.

Andrew: Exactly. We don't just "yes" the process.

Garry: OKRs can become a nightmare if you have a laundry list of 80 things or five things or seven things, but you only have resources to do two. That's the prioritization and estimation part of the OKR that I think is the trickiest part for people.

Andrew: What's been helpful for us is I think we have a realistic understanding of what's possible. How do we get to 10 million eligible members next year? Is that possible? Then, we backtrack down and find out it is possible, but it's a huge stretch. Then, we agree on it, and I say, "But are you sure?" I'm trying to help the team by saying, "Well, you're saying you're going to get churn down to 5% a month. Are you just saying that because that's a stretch, or can you get there? Have you thought about that and how does that relate to your individual KRs?" I think we're good at that as a team so far, but this is our first cycle, so let's see if we crash and burn.

Another thing I learned about OKRs is that it can't be a box. One thing we realized after we came up with the OKRs was that we weren't focusing on one of them enough. Someone said, "Well, the OKRs aren't that way." I said, "I'll throw those OKRs in the garbage." If the company is having a major problem or a major thing that we need to work on, we need to jump on that as a team. We came together and actually made that specific KR our number one objective. It went from a small KR on a team to becoming our number one objective, and everyone agreed to it. Now, we're reorganized around that mission. I'm a huge fan of them, and it's perfect for my personal style of managing.

Garry: That's awesome. You are hiring also, and I'm sure growing. Anytime you're in super hypergrowth mode, you're always looking for the absolute best people. What are some of the roles that you're looking to bring on right now?

Papa is hiring

Andrew: We recently launched Papa's Companionship, which is care navigation to help people navigate their benefits, then Papa Health, which is virtual primary care, so we'll connect someone to a doctor over the phone or internet using the Pals to support it. We are hiring in all departments, including product managers, engineers, user research, product designers and business analysts. Data science is a big thing for us and so is healthcare analytics. That's a lot of things, but we're hiring for almost every role. We're also hiring for customer service and care support as well, at every level. We have some big leadership roles, which I'll be announcing soon, so things are moving in the right direction. It's a fun place to be, and obviously, I'm biased, but we are looking for the best talent. We are a Miami-based company, but we're a hybrid organization. Everything was set up to be virtual to begin with so people could work remote or from wherever.

Garry: That's awesome. This is probably one of the best places to learn if you have any interest in marketplaces, healthtech or fighting the loneliness epidemic. Learning from Andrew and his team is definitely one of the most awesome places to go to work, so definitely check out www.joinpapa.com/careers.

Andrew, thanks a lot for hanging out. The amount of reach and just how many people you're helping, the scale of it boggles my mind. I feel super lucky to get a chance to know you so early and to be a very small part of this very big journey.

Andrew: Thank you for believing in us in the beginning. Thank you so much for having me.

For more conversations like the above, along other leadership and startup topics, be sure to check out my YouTube channel and subscribe. To stay up-to-date with all the latest Papa news, follow them on Twitter.