The Family Caregiver: Value-Based Care's Overlooked Team Member

A Different Perspective on Value-Based Care

At a recent caregiving conference in Utah, I listened to Dr. Norma Coe from the University of Pennsylvania discuss the economics of family caregiving. Her presentation challenged me to think about an opportunity that may be hiding in plain sight within Value-Based Care.

Having spent 36 years working across health plans, healthcare technology, and care delivery transformation, I have seen significant investments in care management, analytics, clinical interventions, and technology designed to improve outcomes while managing costs.

Yet one of the people most directly involved in a patient’s daily care often remains outside the formal care delivery model: the family caregiver.

Consider what happens when an older adult returns home after hospitalization. The clinical team develops a discharge plan, provides instructions, and arranges follow-up care. But once home, a family member frequently becomes responsible for helping put that plan into practice: managing medications, monitoring symptoms, coordinating appointments, and recognizing when something is wrong.

We depend on caregivers to translate clinical recommendations into daily action. But how consistently do we assess their readiness, prepare them, or measure the clinical and economic impact of their contribution?

What if one of the next opportunities to improve Value-Based Care is not another clinical intervention, but more deliberately integrating the family caregiver into care delivery?

The Economic Contribution of Family Caregivers

Family caregiving has always been part of how societies care for sick and aging people. Formal recognition and support vary, but care has never stopped at the hospital door.

Dr. Coe’s presentation brought the economic implications into focus. AARP’s 2026 estimate puts the replacement value of unpaid family caregiving at approximately $1 trillion annually. But the value of caregiving cannot be captured by a replacement-wage calculation alone. We also need to consider effects on patient outcomes, healthcare utilization, caregiver employment, financial security, and quality of life.

For Value-Based Care, the distinction matters. If caregivers help improve outcomes or avoid utilization, their contribution has economic significance beyond unpaid hours. And if those contributions come at substantial personal cost, we must ask whether our models are creating value or merely shifting costs to families.

The Overlooked Member of the Care Delivery Team

For organizations operating under Value-Based Care arrangements, the implications extend beyond recognizing caregivers’ economic contribution. They raise a more fundamental question about how we design and deliver care.

Consider the investments health plans and risk-bearing providers make in care management. We identify high-risk patients, develop individualized care plans, monitor clinical indicators, and coordinate interventions. Yet I have seen the hamster wheel of hospital and health plan care managers repeatedly trying to reach patients and determine whether those plans are being followed.

Meanwhile, medication adherence, follow-up appointments, sleep, nutrition, and mental well-being may be strongly influenced by a family or community caregiver. That person may also recognize a change in condition before anyone on the formal care team knows about it.

In effect, caregivers are already participating in care delivery, often without the preparation, information, or ongoing support available to other members of the team.

What if we approached caregiver involvement with the same discipline we apply to other elements of care management? We could identify caregivers, assess their willingness and readiness, include them in care planning with appropriate consent, and establish clear channels for communication and escalation.

The goal is not to transfer additional responsibilities to families. It is to support the responsibilities they already carry and recognize when professional help is needed.

What Does the Evidence Tell Us?

Research suggests that deliberate caregiver integration can improve outcomes. A 2017 systematic review and meta-analysis of 15 randomized trials found that discharge-planning interventions involving family caregivers were associated with approximately 25% lower relative risk of hospital readmission at 90 days and 24% lower relative risk at 180 days.

These findings matter for organizations trying to reduce avoidable utilization. They do not prove that caregiver education alone produced the improvement. The studies evaluated multifaceted discharge and transitional-care interventions.

The UCLA Alzheimer’s and Dementia Care Program provides another example. Its comprehensive approach includes care management and caregiver support; an evaluation found lower Medicare spending and fewer long-term nursing home admissions. Those outcomes cannot be attributed to caregiver support in isolation. CMS’s GUIDE Model also explicitly includes caregiver education, coordination, and respite, although its results are still being evaluated.

Together, these examples suggest that the opportunity extends beyond offering another standalone caregiver program. It may lie in redesigning existing care management so that caregivers are recognized, prepared, and supported as participants in the care team.

We invest significant resources in care management programs designed to improve outcomes and reduce avoidable utilization. But are we overlooking an opportunity to improve the effectiveness of those investments by more systematically integrating family caregivers into the care delivery process, while proactively identifying and addressing caregiver burnout?

Creating Economic Value Without Shifting the Burden

The potential economic value of integrating family caregivers into care delivery extends across patients, healthcare organizations, and families.

Patients may benefit from better continuity of care, improved adherence to treatment plans, earlier recognition of complications, and potentially fewer avoidable hospitalizations. For health plans and risk-bearing providers, these improvements could translate into better outcomes, reduced utilization, and lower total cost of care.

But much of the work required to achieve those outcomes falls on family and community caregivers. They contribute time, may sacrifice income or career opportunities, and absorb physical and emotional stress. If healthcare organizations rely more heavily on them without providing support, we risk shifting costs from the system to families. Sustained caregiving strain can also undermine caregivers’ own health, creating additional needs for care.

That is not sustainable value creation. It is cost shifting.

The opportunity is to build a model in which each participant can play a role effectively. Patients receive better care; healthcare organizations make more effective use of care management investments; and caregivers receive the education, resources, decision support, and professional assistance they need without compromising their own well-being.

The economic question is not simply how much unpaid care families can provide. It is whether investing in caregivers can improve outcomes while reducing the combined costs borne by the healthcare system and families. That is the value proposition worth testing.

Conclusion

Family caregivers are already part of healthcare delivery, whether our care management models formally recognize them or not.

The opportunity is not to ask families to take on more responsibility. It is to recognize the role they already play and invest in helping them succeed. In my experience, clinical teams try to do this whenever they can. What is often missing is the infrastructure and operating model for training, communicating with, assessing burnout in, and supporting family and community caregivers as part of the care team.

For Value-Based Care arrangements, a deliberate focus on this space could improve outcomes, reduce avoidable healthcare costs, and create a more sustainable experience for families. The existing evidence gives us good reason to pursue it.