As Medicare Advantage (MA) plans focus on improving member engagement for older Americans, a coordinated approach between primary care physicians (PCPs) and a member’s caregiver is important to enhancing whole-person care outcomes. In our recent webinar, Nick Bluhm, JD, vice president of legal & regulatory, and Stick Crosby, director of commercial strategy, explored the current policies surrounding caregiver support services.
“Much like a community health worker, caregivers are going to be a cultural bridge between the member and the PCP.”
Stick Crosby – Director of Commercial Strategy
Caregivers are a bridge
The caregiver plays a vital role in an MA member’s behavioral health care journey — acting as a bridge between the member and their PCP in critical transition stages of their care. The caregiver is an ongoing liaison between the patient and the PCP, relaying important health information and day-to-day activities to the provider while also ensuring appointment and medication compliance, which is intrinsically linked to improved health.
Ensure effective caregiver and member communication
In order to ensure effective caregiver engagement, real-time communication strategies are essential, especially during critical transitions like moving from acute care to home care. Establishing mechanisms for the exchange of important member information enables caregivers to provide real-time updates, improving the care experience for both members and caregivers.
The caregiver is also vital to a member’s long-term care engagement, which in many instances may include treatment for behavioral health issues that are intricately connected to chronic disease. MA plans should consider their critical role and influence and the unique support this population requires when integrating them into their overarching strategy for enhancing a member’s whole-person care outcomes.
A proactive data and communication strategy is essential
Caregiver insights offer essential data that often goes beyond what is typically captured in medical records, helping to close the gap between clinical visits and members’ real-time needs. Implementing a proactive strategy for data collection and communication is a crucial step of any member engagement initiative. It allows for early identification of rising risks, supports timely caregiver communication and prepares for the upcoming 2026–2027 interoperability mandates. This approach should extend beyond just prior authorization reporting by emphasizing the curation of structured data, particularly around member-reported and caregiver-reported outcomes, to provide a more comprehensive view of the member experience than traditional claims data can offer.
Take an operational approach to caregiver support
MA plans must decide whether to deliver caregiver support through the case management department or network. This choice influences the design and financing of the support, whether through fee schedules, value-based contracts or direct caregiver support supplemental benefits.
Decisions around when and how to deliver caregiver support impact both cost profiles and utilization patterns for an MA plan. Properly targeted support is an important factor in member experience and CMS quality measures, especially related to follow-up after hospitalization, rehospitalizations and emergency department visits. Tied directly to performance on MA CMS Star Ratings, these measures ultimately drive rebate dollars and enable plans to offer innovative benefits.
Caregiver supports, while not primary drivers of enrollment, do significantly impact retention, the member experience, and ultimately, the bottom line. In support of these findings, health plans should invest rebate dollars into supplemental caregiver benefits, including respite care, to both generate substantial cost savings and also enhance member and caregiver satisfaction.
“It’s important to establish lines of communication up front with caregivers so you can lean on them in key transitional moments—from outpatient to emergency to step-down or in-home services.”
Nick Bluhm, JD – Vice President of Legal & Regulatory
Facilitate intentional data integration to ensure sustainable investments
Health plans need to allow for intentional data integration between case management, clinical networks and caregiver support. This includes developing mechanisms that allow for the seamless exchange of real-time care updates improving the digital experience of both members and their caregivers. Health plans should target these supports based on a combination of claims data, clinical records, and patient- or caregiver-reported outcomes, ensuring alignment between provider actions and plan strategies.
A solid caregiver/PCP collaborative care strategy can have a profound impact on a member’s likelihood of accessing behavioral health services over time and staying on their treatment pathway. Recognizing the critical influence that a caregiver can play in an MA member’s care journey is an important first step, especially as it relates to how a member accesses and engages in their care longitudinally, which is becoming an increased focus for Star Ratings.
Britta Nordstrom is a senior marketing specialist, Nick Bluhm, JD, is vice president of legal and regulatory, and Stick Crosby is director of commercial strategy at Lucet, The Behavioral Health Optimization Company.
