Rising healthcare costs are putting pressure on payors to improve patient outcomes while managing budgets. This shift toward value-based care focuses on quality, care coordination, and cost efficiency, creating opportunities for solutions that deliver both financial and member-centered results.
Non-medical long-term home care has emerged as a high-ROI solution, stabilizing members at home, reducing high-cost utilization and supporting sustainable cost management strategies.
The Centers for Medicare & Medicaid Services defines value-based care as a framework designed to reduce unnecessary utilization while addressing individuals’ medical and social needs through improved care coordination.
According to the latest federal projections, U.S. healthcare spending was expected to reach about $5.6 trillion in 2025, continuing its upward trajectory. A long-term care accounts for a growing share of total costs; non-medical home care offers a cost-effective wat to support members while helping payors manage budgets.
Why Payors Are Rethinking Long-Term Care
Cost Drivers in Aging Populations
The U.S. population age 65 and over grew nearly five times faster than the total population from 1920 to 2020, according to the 2020 census.
Older adults are more likely to live with multiple chronic conditions, functional limitations and cognitive decline, contributing to increased demand on the U.S. health care system, higher utilization and long‑term care costs.
According to the Centers for Disease Control and Prevention (CDC), more than 90 percent of adults aged 65 and older live with at least one chronic condition, and over half have two or more, increasing the complexity and cost of care management for payors.
Non‑medical support in the home, such as assistance with activities of daily living (ADLs), mobility, meal preparation and safety monitoring, helps prevent manageable needs from escalating into costly medical events, reducing avoidable utilization and total cost of care.
As these challenges grow, payors are seeing the direct impact on utilization and high-cost care events.
High-Cost Utilization Risks
When daily support needs go unmet, payors often experience higher rates of emergency department (ED) visits, inpatient admissions and earlier-than-necessary placement into institutional care. Falls, unmanaged chronic conditions and social isolation are among the leading drivers of preventable utilization for older adults.
Institutional long-term care adds financial pressure. Facility-based care continues to be one of the costliest options for caregivers, with evidence showing that community- and home-based services can be a cost-effective alternative.
By providing high-quality non-medical support in the home, payors can stabilize members earlier, reduce hospital utilization and delay or avoid transitions into higher-cost care settings, improving financial and quality outcomes.
How Non-Medical Care Reduces Total Cost of Care
Daily Support That Prevents Escalation
Non-medical long-term care provides daily support with activities of daily living, mobility, meal preparation, safety monitoring and more. These services not only help members stay independent but also give families peace of mind knowing someone is watching for early changes in health.
The BrightStar Care® workforce solution extends your care team, observing small shifts in health status and alerting clinicians or payors before emergencies occur.
Non-medical care also reduces caregiver burnout and supports family members, indirectly lowering healthcare utilization and improving adherence to care plans.
Reduced Emergency and Inpatient Utilization
Home-based non-medical care provides early intervention that can significantly reduce ED visits and inpatient admissions compared with members without such support.
For payors, fewer ED visits and inpatient admissions translate directly into measurable cost savings and more predictable long-term care spend.
Delayed or Avoided Institutional Care
Facility-based long-term care remains one of the highest-cost categories for payors. Non-medical support in the home allows older adults to remain at home longer, delaying or avoiding costly transitions to nursing facilities or other institutional settings.
By reducing their reliance on high-cost care settings, payors can achieve substantial return on investment while members maintain dignity, comfort and independence in familiar surroundings.
According to U.S. News & World Report, the approximate monthly cost of full-time non-medical home care is $5,720, compared with $11,522 for a private nursing home room.
Measuring ROI for Payors
Key Financial Metrics
Non-medical long-term care delivers measurable financial benefits for payors.
Key metrics include:
- Reduced ED visits: Regular, non-medical support can significantly reduce emergency department visits among older adults.
- Delayed placement in a nursing facility: Home health services enabled recipients to remain at home for an average of eight months or longer than those without support.
Providing early, consistent non-medical care helps prevent costly acute events, giving payors more predictable budgets and lowering financial risk for high-need members.
Quality of Life and Member Satisfaction
Home-based, non-medical care preserves independence, enhances safety and improves satisfaction for individuals and peace of mind for their families. Members who receive consistent support are less likely to experience social isolation, falls or medication errors (key drivers of preventable utilization).
High-quality care coordination contributes to retention and engagement in health plans, which is particularly important for Medicare Advantage and long-term care insurance programs that rely on member satisfaction and plan performance metrics to qualify for value-based incentives.
Connecting Financial and Quality Outcomes
When cost savings are paired with better member experiences, payors see a clear ROI. Keeping members safely at home, preventing unnecessary ED visits and hospitalizations, and delaying institutional care improves both financial outcomes and quality of care.
Payors that partner with a scalable, well-coordinated non-medical home care solution can achieve real cost reductions while meeting value-based care goals—delivering stronger bottom-line results and improved experiences for the members they serve.
Real-World Evidence and Testimonials
Data and real-life examples show that home-based non-medical care not only reduces costs but also helps members remain safe, independent and engaged in their communities.
- A study of Indiana Medicaid beneficiaries enrolled in Home‑ and Community‑Based Services (HCBS) found that greater use of services like attendant care and homemaking was associated with a significantly lower risk of transitioning into nursing homes, suggesting that daily support services help older adults remain in their homes longer.
- State‑level research on HCBS spending indicates that higher investment in home‑ and community‑based services is associated with fewer low‑care residents in nursing homes, suggesting that community supports can reduce unnecessary institutional placement among individuals with lower acuity needs.
- Research examining HCBS use and Medicare post‑acute care found that Medicaid‑funded HCBS was associated with increased use of home health care and reduced skilled nursing facility stays, indicating a shift toward home‑based care following hospital discharge.
BrightStar Care’s Long-Term Care Model
Scalable Non-Medical Care Delivery
BrightStar Care delivers consistent, high-quality at-home care nationwide. This scalable national footprint gives insurers confidence in expanding home care programs and ensures members have access to local, reliable support wherever they live.
RN Oversight and Care Coordination
All clinical services include RN-led care and oversight, providing an added layer of safety and quality. Nurses monitor member conditions, guide care teams and ensure adherence to payor standards, creating a seamless extension of the insurer’s care network. This approach supports consistency, quality and positive health outcomes at every touchpoint.
Reporting and Payor Collaboration
BrightStar Care offers real-time dashboards and outcome metrics that provide actionable insights into member health, utilization trends and cost impact.
This level of transparent reporting:
- Fosters accountability
- Helps payors track program performance
- Clearly demonstrates the value of home-based care in reducing the total cost of care and improving member satisfaction
By combining a nationwide network, clinical oversight and transparent reporting, BrightStar Care enables payors to confidently invest in non-medical long-term care programs that deliver measurable ROI, stabilize post-acute care spend and enhance both financial and member-centered outcomes.
Non-medical long-term care is a proven way for payors to reduce high-cost utilization, delay nursing home placement, and enhance member satisfaction—all while achieving measurable ROI. BrightStar Care delivers measurable ROI through RN-led oversight, scalable national delivery and transparent outcome reporting.
Insurers can leverage our workforce solution to stabilize post-acute spend while keeping members safe, independent and engaged in their home environments.