“Caregivers are overlooked by the healthcare system. When you look at the way that healthcare services are coded and billed for in the U.S., there’s no role for the caregiver there,” said Tomorrow Health CEO Vijay Kedar
He made this declaration last week during an interview at ViVE, a healthcare innovation conference in Nashville. To address the burden faced by caregivers across the country, Kedar argued that the U.S. healthcare system should expand its reimbursement for the care they provide.
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He founded his company in 2018 to address the challenges he witnessed firsthand when he was his mother’s caregiver. When Kedar was coordinating his mother’s home care after she was hospitalized for a serious lung condition, he realized just how inefficient the process was.
“Despite being in healthcare myself, and despite growing up in a family of physicians and having a natural support system in place, it was still so incredibly challenging to navigate that ecosystem and ultimately to get her the support that she needed,” Kedar said.
When his mother was discharged from the hospital, her physician gave Kedar a list of prescriptions for medications and told him that he needed to find her a CPAP machine and respiratory therapy. From her insurance plan, Kedar received a PDF document with the names of a few dozen providers, along with their addresses and phone numbers. Kedar was lost, left unsure about how to best structure a care plan for his mother and ill-equipped to determine which providers would give her the best quality care.
Once he was finished with the difficult process of choosing providers for his mother, he faced the ongoing task of coordinating care across a fragmented system. This is something most Americans aren’t prepared to handle — especially when they’re in the vulnerable position of just having experienced their loved one go through a healthcare episode.
“We’re at a position now where we’ve got 41 million unpaid caregivers across the country. And you know, most of these folks are middle-aged folks managing the care of their parents. They have little medical or clinical training, and most of them have full time jobs. And then we add the burden of what oftentimes feels like a full time job of coordinating and managing care in this complex ecosystem. I think it oftentimes becomes far too challenging,” Kedar explained.
His startup, based in New York, helps hundreds of thousands of patients transition from the hospital and manage chronic conditions by making it easier to access home care. It allows patients and their families to buy the medical supplies and equipment they need by matching them with suppliers spanning more than 40,000 products and services. Tomorrow Health’s data-driven matching process considers quality, devices’ clinical appropriateness, insurance coverage and geography.
The company’s platform is designed to track and manage every step of delivering at-home care, from prescription to payer billing to fulfillment, Kedar said. While he believes this technology helps alleviate some of the burden that caregivers face when transitioning their loved ones to at-home care, he argued that it is not enough.
Ensuring that caregivers aren’t forgotten by the U.S. healthcare system will “take a lot of collaboration between regulators and clinical teams,” Kedar declared.
He argued that caregivers deserve direct reimbursement. Not only is caregiving physically and emotionally taxing, but it can also cause severe financial strain. Many caregivers across the U.S. take time off work and spend their own money to support their loved ones’ care, Kedar pointed out.
“We have a regulatory framework right now where reimbursement exists on the Medicaid side, but you don’t see that reflected in Medicare or Medicare Advantage programs. That’s the biggest void to fill in my opinion,” he explained. “When we look at the breadth of unpaid caregiving in the U.S., we’re now seeing 1.5 billion unpaid working hours, which has a tremendous negative impact on the care the folks receive and also causes economic strain on many of these families. So increasing that reimbursement can really go a long way.”
Kedar had a couple recommendations about how to give caregivers more of their due.
He said that there are opportunities for more state governments to expand their tax breaks to caregivers. He also said that the healthcare system can build on the foundation that the CARE Act provided.
The CARE Act requires hospitals to record the name of a patient’s caregiver on their medical record, inform caregivers when their loved one will be discharged, and provide them with education about the care they will need to provide or coordinate at home. Kedar said that this regulation could be “taken a step further” by ensuring that caregivers have better access to resources to help them facilitate transitions of care and apply for reimbursement if they’re eligible.
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