Medicare May Cover Help Managing an Aging Parent’s Care

Transcript of Interview: “Medicare May Cover Help Managing an Aging Parent’s Care”

Mike Barnes: [00:00:00] Today we’re talking a little bit about Medicare, and Medicare, it’s kind of confusing sometimes, but it can help in more ways than you might expect.

Kim Barnes: Most of us generally think of Medicare just in the context of health insurance, but there are benefits that can actually help us not be so overwhelmed. Today we’re joined by Jenny Lee of a company named Hera, and Hera is a company that helps manage those Medicare care that we need. So Jenny, let’s just start with how does it work?

Jenny Lee: Yeah. So we offer dedicated, individuals, so we call them heroes, and they’re like, it’s like having a social worker or nurse as part of the family. And they really step in to take that second full-time job off the shoulders of adult daughters and sons who’ve been juggling it all for their parents, to help make sure that their parent gets the best care that they need.

It’s actually navigating the system, navigating insurance, taking all the phone calls, doing the paperwork, coordinating with the doctors, and keeping that older adult safely at home. And the best part is we’re covered by Medicare, so [00:01:00] 90% of our families pay $0 out of pocket with us

Kim Barnes: It seems like this is something that so many people need, but this, it’s ver- fairly new, and that’s why a lot of people don’t know about it, correct?

Jenny Lee: Yeah. there are new codes that came out in 2024 in Medicare to help pay for this care navigation and healthcare references care management for older adults. And it really spurred out of this, multi-year studies that showed if you help older adults that have chronic conditions navigate the healthcare system, it leads to less unnecessary hospitalizations, less cost for the system at large.

And so we’ve created a company completely tailored around these codes and really making sure that these older adults get the right navigation and, day-to-day coordination support

Kim Barnes: Let’s start with who’s eligible to get this kind of care and this ca- kind of management

Jenny Lee: Yes. so any patient with original Medicare and a chronic condition qualify with us, as well as if they have a, Medicare Advantage plan. [00:02:00] it just depends on the state and where we’re contracted, and we’re growing that really actively

Kim Barnes: And what kinds of conditions are covered? Yeah.

Jenny Lee: Yeah. So examples are, dementia, Parkinson’s, and different shapes of Alzheimer’s. Those tend to be a really common one, but it can also be, things like, chronic heart failure, or it can even be things like diabetes. It just depends. and any chronic condition that they’re seeing cl- getting clinical care for that’s complex to manage, our clinicians will meet and really discuss and authorize for eligibility

Mike Barnes: I see firsthand what Kim goes through helping her mother who lives about three hours away and trying to figure out, okay, what do I need to do? I need to call Medicare now. Now I need to call the doctor’s office about this. I need to call- Do I need a referral? A referral for this. I need to call the nurse practitioner for this.

She gets so busy, and I’ll come home from work, and she’ll be pulling her hair out. Give us an example of how Hera and how this can help someone like Kim

Jenny Lee: Yeah. Let’s say that, you’re an adult [00:03:00] daughter and you have a parent that is actually coming out of the hospital. And of course, in that moment, you’re getting 10 different calls left, right, and center. You don’t know who’s who. You also don’t know who’s great to work with, and you also don’t know what you don’t know.

So in that moment, we are working with your hospital social worker. We are making sure the referrals that they’re placing are actually happening. That could mean we’re coordinating with the five different home health agencies that are calling you and making sure you’re getting the right one, actually coordinating with them, figuring out that aid schedule.

Now we’re also making sure you have the right durable medical equipment for your parent as they’re coming home in that transition and setting up the home safely for that transition back home. We’re also making sure that now that maybe your parent can no longer cook their own meals, we’re getting meal delivery in place.

we also are coordinating rehab, in- in-home rehab for providers to come in and help strengthen and do that PT and OT and ST to get them back rehabilitated. then once the situation is stabilized, we start thinking longer term. Okay, what are the right insurance community benefits we need to tap [00:04:00] into to keep your parent at home safe and in an affordable way, right?

it just depends on the, the older adult. Sometimes, we’ll tap into local community resources. Sometimes we’ll tap into more federal benefits that are available. It can be even things like getting your parent onto Medicaid, and then once they’re on Medicaid, advocating for additional home care hours to make sure that they can actually stay at home safely.

So we really work with families until, end of life really

Kim Barnes: And that would work, that would be kind of the same scenario if they were having to go into skilled nursing or rehab, kind of having a stop there. well

Jenny Lee: Yeah. And it doesn’t need to be a trigger event. Of course, we meet a lot of families that are in crisis mode, but it’s better when we meet them before the crisis mode. We’ve built rapport up front, we really understand the home, we understand support resources in place, and we’ve been the one coordinating that, so that if in a worst-case scenario a crisis does happen, we can quickly step in.

So we actually meet a lot of families that, have an older adult with a chronic condition, maybe it’s cognitive decline to some capacity, [00:05:00] and we’re working with them when they’re already stable, but we’re getting the right things in place to just make sure that they, can continue to stay safely at home.

And then if, yeah, if there’s an event, we step in

Mike Barnes: I hate to bring up money, but it’s a factor that it, involves a lot of us and affects a lot of us. But for most, people going through this, it’s not gonna cost them little, if any. Correct?

Jenny Lee: Yes, about 90% of our families pay $0 out of pocket. So if they have an original Medicare plan or sometimes a Medicare Advantage plan and a supplemental plan, so that could be like United ARP, it could be Medicaid, whatever that supplemental plan is, then they pay $0 out of pocket. They’re completely covered.

Now, if they don’t have a supplemental plan, then they will typically pay about $17 an hour as co-insurance, and then we’re communicating before, throughout, all of that

Kim Barnes: Right. So you have a dedicated person to you that would be the person that I, can call Jenny. I mean, it wouldn’t be you, but I can call Jenny, when I’m [00:06:00] having an issue because they’re gonna, there’s gonna be one person that really knows our situation

Jenny Lee: Yeah, and we become the first call that handles the rest of the calls. you, today are probably coordinating with 10 different shapes of providers, have your own phone book that you’re managing, and then you’re also always chasing down the people that never call you back. We go and do that for you.

So we’re gonna be that first call that handles the rest. We’re gonna be advocating for your parent, and making sure they get what they need. we’re not just placing a referral. We’re making sure it actually goes through and it happens. That’s what we see is actually the biggest problem. There are other people that have tried this.

There are other people that have, I know maybe you have a social worker at a hospital working for you on, a case-by-case basis for a specific resource, or maybe there’s a community, care manager that you’ve worked with in the past. What we’ve typically heard is there’s been a little bit of trust lost in the system.

There’s someone that’s promised to help, and they didn’t really quite follow through. You ended up being the one to chase it [00:07:00] down and make sure that it happens, and so that’s … we say we’re in the business of trust, ultimately at the end of the day. And so our job is to continue to always earn trust with families.

And how we measure that is actually 95% of families choose to stay with us every month, and that to us is the biggest indicator of, okay, we’ve built trust with this family. We’re showing we’re driving outcomes for them. We’re actually showing that we’re, delivering on what we promised, and that’s actual outcomes to the family.

Kim Barnes: Yeah, I, can tell stories about the three weeks it took me to get my mom a wheelchair- when she was being released from skilled nursing, having broken her femur, so she could not walk, and it took three weeks to get a wheelchair. Anyway, that’s a whole nother … We could go on.

Jenny Lee: Yeah. Imagine, right? For your mom, those three weeks, what life was like, right? And,

Kim Barnes: I mean, the

Jenny Lee: probably not, it’s actually, it’s worsening the scenario. And so the best outcome for the healthcare system is that she gets that wheelchair ASAP. She gets rehab therapy immediately, right? She’s recovering and she’s getting stronger.

that is the right outcome that we all [00:08:00] want

Mike Barnes: But the, biggest problem there is that someone like Kim, who’s not used to this, you’ve never had a mother who’s broken a femur and tried to get a wheelchair. So you don’t know the steps to go through, and you just get so overwhelmed and you don’t know what to do. So I’m assuming that you’ve heard a lot of great response from people who you’ve helped already

Jenny Lee: Yeah. Our families, it’s actually the thing that always fuels me to keep going is, the quotes that we hear every single day where they say, “Wow, you all are my lifeline.” And, I think we’ve changed so many lives at this point, that it’s really remarkable. We call our care managers heroes, and they really are heroes, and they step in for the heroes of the families that have been doing this role to date, and it’s been really, incredible.

But honestly, a l- a lot of it couldn’t happen without some of the technology that we build. So we build technology for our heroes, and the reason that we do that is not like we don’t ever want AI to be talking to old Rudolph. That’s not the intent. [00:09:00] we want humans doing what humans do best, which is fostering human connection and showing up for families in what is the most emotionally charged moment of their lives.

But what our technology allows us to do is we are able to constantly learn real time. Okay, this PT now has a two-week wait list. Okay, this, n- nutritional program now has a new eligibility requirement that they didn’t have before, or we actually just discovered an affordable hoarding resour- resource that services this rural zip code, or we are able to generate Medicaid long-term care appeal letters in two minutes instead of the six hours it used to take our care managers, right?

So we are always making sure that our heroes get to deliver care that’s worthy of our parents. That’s our… That’s what we always say internally. that’s our brand promise. And so it wouldn’t be possible also without the technology that we’re building, and that’s also why this has never been possible before.

it’s this wave of there are these new Medicare codes, this new wave of technology that allows us to constantly be learning and, basically turning what used to be the little black book of social workers. this [00:10:00] data hasn’t existed online, and now we’re turning that into– We’re learning that in the platform so that every hero that helps any family is able to benefit from that

Kim Barnes: And will this work with a patient whether they are in their home or whether they’re in independent living or assisted living?

Jenny Lee: Yeah, we have patients across the board. We do specialize in helping older adults age at home since that’s the main preference that we see, but we have patients in every facility shape

Kim Barnes: Where- wherever they live, wherever they call home. Yeah. And, this is… Yeah, and this is really personal to you

Jenny Lee: Yeah. yeah, it all started, I… So I’ve spent my career in technology, but most recently at a mental health tech company. And, I was always trying to figure out, what is my life’s work gonna be? And for me, that meant finding a customer that I just loved and s- wanted to serve and wanted to champion.

And it was very serendipitous. At the same time, my grandmother ended up passing, and she’d had a 20-year battle with dementia. And it was my aunt that was that alpha daughter of the family that had taken [00:11:00] everything on her shoulders to take care of her. And we were talking at the memorial service, and what struck me was sh- it was never about clinical care.

it was always every time, it was every time my grandmother left the doctor’s office, every time she left the hospital, wh- where my aunt said, “It feels like I have this second full-time job to figure out. And if I don’t figure this out, your grandmother is actually not going to get to stay at home safely.

this is on me, but I don’t know the healthcare system. I’m completely lost. I’m spending hours on the phone, hours online, just trying to figure it all out, and always a little bit doubting myself. am I making the right decision here? Am I making the right decision for her?” And ultimately, at the end of the day, all those hours that she spent on that, she actually wasn’t getting to spend with my grandmother in her last chapter of life, right?

And so that, for me, was like, this is this universal human problem we’re all going to go through. Why is it so broken, and what can we do about it? And so started pulling at that thread and realizing that, I ended up meeting… [00:12:00] I talked to about probably 100 other adult sons and daughters and well spouses who were all facing this, and met just two families who paid privately for a concierge care manager, and they called them the savior of the century, and it completely changed their lives.

And that was when I started thinking through, “Okay, how do you make something like this affordable for the rest of America?” You often hear this forgotten middle class that end up just depleting their assets taking care of their parents, or their parents end up depleting their assets until they’re on Medicaid.

and that’s the population that, my own family falls in and who I was really passionate about building for

Kim Barnes: Yeah. So if somebody has a parent that they, that has chronic conditions and they think, “Okay, I could really use some help. I could use a hero,” what do they need to do?

Jenny Lee: Yeah, they just need to go to hellohera.com. That’s hello H-E-R-A.com, and we have a contact form there or a phone number that they can call if they wanna call immediately. But once they fill out that contact form, we will get back to them, within just one day, and they will get to have a complimentary consult call with our [00:13:00] onboarding team.

So you’ll get to speak to a human. They’re gonna really understand what’s bringing you to Hera, and make sure that we’re also explaining how we can help your parent collect any insurance information to make sure that, your parent’s qualified, and that if there is any cost at all, that we’d be upfront about that and communicate that, and then they’ll book you for the assessment

Mike Barnes: Speaks to a human, something we’re not used to a lot of times.

Kim Barnes: That’s right.

Mike Barnes: Yeah. Ginny, thanks so much for everything that you’re doing for, everyone. We really appreciate it

Jenny Lee: Yeah, this is my life’s work. I’m really happy to be doing it

Mike Barnes: That’s great. I, think what we’re learning here is that I, I think it’s great news that Medicare isn’t just for trying to help you feel better. It can help us, the adult children, in so many ways not be so overwhelmed.

Kim Barnes: Well, and I think too that because we think of just the, all the things that we don’t know.

There are so many things out there that as the adult child, I don’t know what options are out there and what benefits are available, and so you, you gotta, learn, and that’s what we’re trying to help people understand is what might be available.

Mike Barnes: The [00:14:00] help is out there. Hey, if there’s any other topic you’d like us to discuss, please let us know.

Parenting Aging Parents.

*This transcript is auto-generated. Please excuse any typos or mistakes.