On October 15th, 2024, the Primary Care Collaborative (PCC) hosted a webinar on how Medicare can foster stronger relationships between primary care teams and caregivers.
As the U.S. population ages, caregiving needs are becoming increasingly complex. Medicare now covers caregiver support services under the Medicare Physician Fee Schedule, reducing the burden on physicians by enabling other care team members to provide assistance.
The panelists—Peter Hollmann (Brown Medicine), Morgan Daven (Alzheimer’s Association), Alexandra Drane (ARCHANGELS), and Nancy LeaMond (AARP)—discussed strategies to implement these services, many of which have been provided informally in the past. The session was moderated by PCC Board Vice Chair Susan Edgman-Levitan (John D. Stoeckle Center for Primary Care Innovation – Massachusetts General Hospital).
Opening the conversation, Edgman-Levitan highlighted the understated role of unpaid caregivers in our health care system in managing chronic conditions and major illness.
Dr. Hollmann then provided an overview of the new Medicare codes for caregiver training, covering behavioral management, activities of daily living (ADL) and instrumental ADLs (IADL). He highlighted proposed 2025 changes, including the expansion of telemedicine services, and stressed the importance of individualized treatment plans and the role of various healthcare professionals in delivering these services.
LeaMond emphasized the critical role of family caregivers, discussing the economic impact of caregiving on families and the broader workforce as the complexity and demands on family caregivers increases. She called for greater recognition and support for caregivers, including legislative action to reduce financial strain and increase access to resources.
Daven focused on the specific challenges facing dementia caregivers, including emotional, physical and financial burdens. He stressed the need for health care systems to provide better support for primary care clinicians to aid caregivers, especially those caring for individuals with dementia.
Drane highlighted the mental health challenges that caregivers face, particularly those in the “sandwich generation” responsible for caring for both their own children and aging parents. This included data on the prevalence of caregiving roles and the high rates of suicide among these caregivers. She called for a cultural shift in how caregivers are viewed, advocating for mental health support to prevent burnout and improve overall well-being.
Edgman-Levitan then asked the panelists about the factors that will determine the success of Medicare’s new caregiver training services. Daven emphasizes the need for feasibility in practice, integration into the workflow and flexibility in care delivery, highlighting the importance of community referral networks. Drane stressed the need for clear, understandable and concise communication with caregivers and the importance of starting with self-awareness.
The panelists also discussed how Medicare’s caregiver training services could evolve. Hollmann envisioned a future where primary care is more integrated and team-based, with increased reliance on telehealth and group visits. He sees this broadening the definition of what a primary care practice is as a whole.
Daven and Drane emphasized the need for clear communication with caregivers and flexible, community-based care models.
When discussing policy, LeaMond praised CMS’s efforts and called for bipartisan legislation to streamline processes and provide financial relief through tax credits and HSA provisions.
Drane highlighted the need for policies that address the mental health and financial challenges caregivers face, advocating for human-centered approaches.
To close, the panelists underscored the importance of integrating caregivers into the care process and the need for consistent support and financial recognition to provide comprehensive care. They agreed that Medicare’s expanded caregiver training services represent a significant step forward, but ongoing policy and practice improvements are needed to fully address caregivers’ needs.
Resources
Caregiver Intensity Index
ARCHANGELS’ Caregiver Intensity Index (CII) is a web-based caregiver ‘quiz’ designed to engage caregivers, assess the intensity of their current caregiving situation, and provide a score with their specific intensity buffers and drivers.
This score first validates their experiences and then connects them to caregiver resources based on their results. The CII engages caregivers over time and across a spectrum of intensity.
Families Caring for an Aging America – National Academy of Sciences, Engineering, and Medicine (2016)
This report describes the growing role of family caregivers (sometimes called informal caregivers) and the supports they need to fulfill their important roles. The report also recommended that Medicare develop and test mechanisms to ensure that family caregivers are routinely identified and that their needs are assessed and supported in the delivery of health care and long-term services and supports.
CMS Resources
Medicare begin covering caregiver training services this year (2024). Caregiver training can be provided by a range of clinician types, in different settings, and in individual and group sessions.
- Health Equity Services in the 2024 Physician Fee Schedule Final Rule – Centers for Medicare and Medicaid Services (CMS)
- Health-Related Social Needs FAQ – Centers for Medicare and Medicaid Services
In addition, there is a new CMMI demonstration model called GUIDE to support persons with dementia and their caregivers.
