Payers could be key in helping solve the nation's caregiving crisis

It's an issue Americans face every day: an older parent the family no longer believes should be operating a vehicle because of potential harm to themselves or others. But if that family was receiving expert caregiving support from the parent's health plan, the issue may be able to be avoided altogether, thereby saving the parent — and the payer — money on medical costs.

"Caregiving in a solution is something that over the next few years is going to be integral," Evan Falchuk told Becker's. "It's really focused on the part of the population that is invisible to the health plan, because nothing really bad has happened yet."

Mr. Falchuk is CEO of Family First, a Boston-based company that assists caregivers with determining a course of action when they're facing caregiving challenges that may include clinical, nonclinical, financial and family dynamics.

As the popularity of Medicare Advantage plans continues to rise, he says payers have the opportunity to improve members' care outcomes by offering caregiving support directly to family members.

For the older parent continuing to drive a vehicle, that support may look like assistance in determining that certain medications or a neurological condition led to the inability to drive safely. If that is determined before an accident occurs, the medical costs associated with an accident could potentially be avoided.

"If you're a Medicare Advantage plan, you're paying for the care of people as they get older and go through this process,'' Mr. Falchuk said. "We believe that if you help the caregiver, you really improve the quality and cost of care that the person they're caring for receives."

While there is a lot of ongoing investment by Medicare Advantage carriers to improve coverage, Mr. Falchuk says the problem has only become worse since the pandemic. Many individuals once interested in managed care or nursing home facilities now view them as dangerous during times of crisis, and more Americans are juggling at-home careers, children and elderly caregiving responsibilies. That's not to mention millions of older Americans don't have the financial or other resources to get their own care managed.

Payers certainly do recognize this issue and have capitalized recently on the opportunity to better integrate their plans with in-home care. 

Humana purchased home and hospice care provider Kindred at Home for $5.7 billion in August. UnitedHealth Group's Optum is looking to close on a $5.4 billion deal to acquire home-health and hospice provider LHC Group later this year.

"I think the opportunity for payers is to go further upstream and say, maybe it's possible to avoid needing those kinds of in-home services overall," Mr. Falchuk said.

For payers that directly offer caregiving solutions to families through their members, he says they could see improvements in medication adherence, corrected care paths, improved family dynamics and lower claims costs, readmission rates and avoidable hospitalizations.

"The other piece why payers would want to do this is that for Medicare Advantage plans, they've got star ratings that the federal government gives them," he said. "Providing a service that really helps people through these most difficult situations is a really good way to improve that."

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