How Independence Blue Cross Combines CAHPS, Age-Friendly Models and Benefits Navigation For Caregiver Support

The payer’s partnership with Carallel addresses multiple industry pressures.

Too many epidemics are invisible or forgotten.

The pandemic reminded us of healthcare disparities that had existed for decades. The U.S. Surgeon General sounded the alarm on something Americans were already feeling: lonely. And now: the critical role that family caregivers play in a healthcare system that hasn’t really helped them.

To address the latter, Independence Blue Cross and Carallel have expanded a partnership that supports the caregivers of Independence Medicare Advantage members. The program gives loved ones access to expert advice, practical assistance, planning resources, support groups, and connections with Carallel's Care Advocates.

HealthLeaders spoke with Dr. Heidi Syropoulos, Medical Director of Government Markets with Independence, and Shara Cohen, CEO of Carallel, who described:

• how their program launched with hospital discharges and how it expanded;
• how a multi-week, high-touch program design earned a 90+ Net Promotor Score (NPS); and
• how program satisfaction intersects with payment incentives to expand payer caregiver investment.

“Caring for a loved one can be very rewarding, but it also takes a huge, huge toll on the person who's providing the care,” says Syropoulos. At Independence, we really wanted to ease that burden, even just a little bit, by offering extra help and helping connect caregivers to the right resources.”

Cohen adds: “The fact that healthcare organizations have had limited involvement with caregivers is a real gap. Independence has asked very proactively, ‘How do you fill that gap? How do you create that connection and create a relationship with a key person in the whole-person circle of care?’”

Today’s caregivers face significant challenges

Cohen notes that 80% of home care is provided by a family caregiver. That care runs the gamut from paying bills from 2,000 miles away to helping a loved one get dressed on a daily basis.

The Carallel CEO and Independence executive paint a stark picture of caregiving today.

“Caregivers do every job from the janitor to the CEO and everything in between. But they are often hidden and left out of the healthcare system,” says Cohen.

Syropoulos adds: “Being a caregiver is like being diagnosed with a disease — you’ve been given a job that you didn't want, that you didn't even know existed, that you didn't apply for, that you often are not qualified for, and that you can't quit.”

“Also, you’re not going to be paid. This is essentially what chronic disease management is in the 21st century. There's just not enough money to go around. There should be. At Independence, we really wanted to ease that burden, even just a little bit, by offering extra help and helping connect caregivers to the right resources.”

Insight #1: The most dissatisfied health plan members

How did Independence and Carallel decide which members to target first?

“The members who rated the plan worst all have one thing in common: they had all been admitted to the hospital or a nursing home recently,” says the Independence exec.

This insight led Independence and Carallel to create the Post-Acute Care Initiative, which has now expanded.

“Going into the hospital is just a painful, complicated thing to do,” says Syropoulos. “That transition of care between leaving a facility and coming back is significant. So we thought, ‘Here’s a place where we need to do something better.”

Cohen adds: “If you think about that moment in time when somebody is discharged, it's not that they're healthy. It's just that they're not sick enough to stay in the hospital.”

“Hospitalizations are a high friction point for family members trying to interact with health plans . . . That was one of the first program measures.”

It was exciting, Cohen adds, that the Independence team recognized these collective factors and wanted to create caregiver relationships that would impact both CAHPS and cost outcomes.

The Post-Acute Care Initiative and the Age-Friendly Model

Introduced in January 2023, the Independence-Carallel program features:

1. Early contact: Independence Case Managers (CMs) contact all members admitted to a hospital or nursing home as soon as possible after admission. CMs identify if there is a caregiver and explain the program benefits.
2. Early enrollment: Carallel enrolls interested caregivers post-discharge and designs structured touchpoints between caregivers and care advocates, including 24/7 resources that support caregiver resilience.
3. A manageable, well-executed plan: Caregiver assistance includes help with complex tasks like advanced-care planning, finding and vetting at-home or residential support.
4. Case manager collaboration: Independence CMs stay involved to help ensure the member’s experience is a good one.

The program incorporates the Age-Friendly Health Systems model, which supports adults and their family caregivers with “four evidence-based elements of high-quality care, known as the ‘4Ms’: What Matters, Medication, Mentation, and Mobility.”

When Syropoulos learned of the health system model, she thought: “Hmm, why aren’t Medicare Advantage companies Age Friendly? We should be.” She and her Government Markets team pursued a health plan recognition program but shifted their focus to implementing 4M principles to improve the care for older Independence members.

Program results: Satisfaction, expansion, and cost targets

“We feel strongly that caregiver support helps improve health outcomes for the members that they care for — that members feel heard and satisfied,” notes Syropoulos.

That would appear to be true. The Post-Acute-Care Initiative has a Net Promotor Score (NPS) of 90+. The NPS measures customer loyalty and satisfaction with a single question: "On a scale of 0 to 10, how likely are you to recommend our product/service to a friend or colleague?" An NPS above 70 is rare.

“90 plus shows that caregivers are overwhelmingly satisfied with the program.”

The Post-Acute-Care Initiative was designed to include eight weeks of touchpoints but around 50% of caregivers request support beyond that period with 12 program/caregiver interactions on average.

“We had full recognition that we would go at the caregiver’s pace,” says Cohen. “We were going to design the program with flexibility to their preferences.”

The post-acute program expanded in January 2024 to include the Dementia/Alzheimer’s Carallel Plus Program and additional support for all members in case management.

“The more we can help caregivers navigate benefits, access to services, and avenues to be more involved, I think we’ll see results in the cost, experience and quality of care,” the Carallel CEO adds.

“CAHPS is your friend”

Why focus on caregiver support now? Medicare reimbursement cuts and annual CMS Medicare Advantage program regulations.

“I can tell you one overarching reason: the Medicare Advantage plans in this space,” says Syropoulos. “That has completely to do with the CMS Star Ratings program. Stars is about quality and customer satisfaction. There are a lot of clinical outcome measures, but CAHPS is completely about customer service.”

CAHPS is the Consumer Assessment of Healthcare Providers and Systems and includes questions about member satisfaction with their health plan and providers.

“Those questions in CAHPS are highly weighted in the Star Ratings so you have to do well in that survey,” says Syropoulos, stressing its importance.

“CAHPS is your friend. You need to really pay attention to member pain points. We're all consumers of healthcare and can list tons of pain points. So now think about a frail, elderly, 85-year-old who lives alone.”

“If you do well with Stars and you’re a four-star plan or above, you get a significant bonus. That is part of the P&L of that division of the company. So, it does come down to finances. That's just a reality.”

Cohen adds: “We didn’t get into this just to cut costs. We got into it because we think this is really going to help members and create satisfaction with the plan. Decreasing cost of care is an added bonus.”

“It's not that people haven't wanted to do this. You just have to figure out how to pay for it.”