Rethinking Healthcare Delivery in America: A Framework for Growth and Sustainability

The case for supporting caregivers as an integral part of the healthcare team, with examples of innovation from Geisinger, Rush University Medical Center, and Duke University School of Nursing.

Nearly 48 million adults in the U.S. care for another family member — an estimate that the Centers for Disease Control and Prevention (CDC) is closely monitoring and now calls “a public health problem” for millions of Americans receiving care, as well as those providing it.

Understanding the challenge

The importance of the healthcare market for healthcare – and the economy in general – cannot be overstated. Research conducted by AARP estimates the unpaid work provided by caregivers with 36 billion hours or $600 billion, more than all out-of-pocket healthcare spending in 2021.

Currently, approximately 58 million adults are 65 years or older. That’s about 17 percent of the population, a number expected to grow to 22 percent by 2040. Without a doubt, America’s aging population will continue to have a major impact on our society – from the economy in general to the healthcare sector in particular . But volunteer care as a sector remains a largely fragmented and disjointed ecosystem.

While some healthcare systems and community-based organizations provide basic education and limited resources to healthcare providers, this is not an area of ​​high strategic priority or significant investment for most healthcare executives or industry leaders.

But given industry trends such as rising healthcare costs, the shortage of healthcare professionals (particularly in rural areas), the growing demand for chronic care management, and the requirements to shift more care to the home, there are good reasons for healthcare leaders to reconsider the importance of this cohort and find ways to leverage their presence in more impactful ways.

Here, we take a brief look at recent federal government-led initiatives, share some programs developed by forward-thinking healthcare systems, and propose a technology-enabled framework that healthcare leaders can use to reimagine the role of healthcare providers to give.

Increasing urgency and new legislation

The Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2017 called for the creation of the Family Caregiving Advisory Council to provide advice and recommendations, including identifying best practices, to the Secretary of the U.S. Department of Health and Human Services. Human Services (HHS) on recognizing and supporting informal caregivers.

A recent report includes 26 recommendations collected through a wide range of industry surveys and listening sessions conducted between 2019 and 2021. One of the five priority areas identified in the report calls for greater emphasis on integrating the healthcare provider into the processes and systems of which they have traditionally been a part. ruled out.

In April 2023, the White House issued an Executive Order on Expanding Access to Quality Care and Supporting Healthcare Providers. Although the decision covers a wide range of childcare and elderly care issues, there are some key elements that focus on the latter, including:

  • Innovative new healthcare payment and service delivery models focused on dementia care, including caregiver support.
  • Investing in better ways to evaluate and set caregiver expectations in the Acute Hospital Care at Home program.
  • Ensure that hospitals actively involve informal caregivers in the discharge planning process.
  • Promoting best practices such as partnerships with community organizations and utilizing resources from the Administration for Community Living and the Agency for Healthcare Research and Quality.

It is too early to know what impact the recent regulations and related recommendations to entities like HHS and CMS will have on healthcare systems and payers, but recent trends indicate that leading advocacy groups and the government are seriously recognizing that investing in and supporting unpaid caregivers play an important role. initiative.

“The need for healthcare delivery support connected to individual healthcare systems and entire communities is only growing and will require greater scalability and efficiency as the healthcare industry capitalizes on leveraging healthcare delivery to control costs, improve quality and impact the healthcare experience . ”

It is clear that payers and providers are looking at new incentives to invest in more infrastructure and resources to advocate, integrate in more meaningful ways, and provide more ongoing support to caregivers and their families. And in some cases, there may be penalties if you don’t do more.

How should healthcare leaders approach the healthcare industry given its inherent lack of structure and organization?

Innovative healthcare programs

For healthcare organizations that already have care delivery resources and programs in place today, now is the time to evaluate those initiatives and look for ways to aggressively expand what is working. Others can follow their example.

Here are some examples of innovation:

  • Geisinger has had great success with its LIFE Geisinger program to help seniors live independently in the community, cutting costs for participants in half since the program’s introduction.
  • Rush University Medical Center piloted a dedicated Caregiver Intervention program in 2020 that prioritizes caregivers through both system-level changes and direct interventions from caregivers.
  • Planetree International has pioneered new care programs and practices for its members, including groundbreaking language that reflects how “everyone is a caregiver” as part of its person-centered care philosophy and approaches.
  • Duke University School of Nursing has launched the Duke Elder Family/Caregiver Training (DEFT) Center, a new training and education program on everything from engaging family caregivers in post-discharge care to addressing health inequities and social determinants of health .

Leveraging a technology framework

Within the technology industry, there are several key business strategies—particularly the concepts of platforming, scaling, and network effects—that healthcare executives can use to reimagine the role of healthcare providers: from a somewhat disjointed and less efficient presence to a role that is even more important. powerful, resource-rich and impactful movement, and one that generates even greater value for both those receiving care and for the healthcare sector itself.

Rethinking the healthcare frameworkRethinking the healthcare framework

Platform action

In the tech industry, platforming refers to the use of software or technology to create a foundation or infrastructure that allows other applications or services to be built on top of it. Think of computer operating systems, social networks, gaming systems, etc.

In many ways, care delivery lacks that foundation because it is so individual in nature: each caregiver and family member experiences the journey on their own, with little training, few resources, and significant isolation.

Even experienced healthcare professionals who become caregivers often mention the same steep learning curves and frustrations that others experience when navigating the “healthcare system.”

By finding ways to platform care delivery, the healthcare industry would create a stronger foundation for healthcare providers that delivers greater efficiency and success, and allows more entities to connect and support care delivery in the community.

Some examples could be:

  • The creation of formal healthcare functions or departments within a healthcare system or healthcare plan.
  • Leverage existing electronic and personal health record systems to meet the unique needs of caregivers and family members.
  • Forming more robust and innovative community partnerships to meet the needs of healthcare providers.


Scaling refers to a system’s ability to handle an increasing amount of traffic or work without sacrificing performance or stability. The concept is immediately applicable to healthcare provision, both at the level of the individual family and at the level of the community or the entire sector.

Individual healthcare needs often follow a common and predictable trajectory – often starting slowly with nominal demands on time and resources, but growing over time, sometimes even accelerating exponentially in later stages.

Likewise, the need for care delivery support connected to individual health care systems and entire communities is only growing and better scale and efficiency will be needed if the health care industry is to capitalize on the use of care delivery to control costs, improve quality and influence healthcare experience.

Scaling is an important concept that enables companies to grow their businesses, address market dynamics, and overcome limitations that might otherwise hinder success.

Some examples of scaling within the healthcare provider ecosystem could be:

  • Using hospital-at-home, home care and remote monitoring models.
  • Leveraging telehealth and virtual care initiatives.
  • Leveraging AI and robotics in ways that Germany, Japan and other countries have been able to do.

Network effect

The network effect in technology and business refers to the idea that the more people or devices use a given service, the more valuable it becomes to everyone involved, and the more it attracts others to the same platform or network.

It’s all about the power of community and impact, with value growing exponentially as more and more people connect. Social media networks like Facebook and TikTok can be the ultimate example of highly successful network effects.

Some examples of creating a network effect within healthcare provision could be:

  • More aggressive, employer-based caregiver engagement and support programs. Employers are directly affected by productivity and absenteeism resulting from employees’ healthcare needs.
  • Take advantage of online learning platforms and tools such as Coursera, distance learning and free higher education courses.
  • Expand and tap into support groups, influencers, and social media channels more aggressively.

These strategies, drawn from the technology and startup industries, are just a few examples of how care delivery can be expanded and made more integral to healthcare. And while it is not intended to be an exhaustive list of ideas or solutions, it can provide an innovative approach to ensuring the healthcare market is robust, supported and able to meet the growing demands of the healthcare sector and aging population of our society.