The Impact of Caregiving on Mental Health

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In the first installment of our women's health video series, Avalere sits down with Dr. Madhavi Vemireddy of caregiving platform Cleo to discuss the impact caregiving can have on one’s mental health.


Shareef: Hello and welcome to our first installment speaking with innovators in and around women's health. My name is Shareef Ghanem and I'm a managing director within Avalere's M& A advisory practice. I'm joined today by my dear friend, Dr. Madhavi Vemireddy, CEO of Cleo. Today, we are here to discuss the intersection of mental health and caregiving. Before we get started, Madhavi, could you introduce yourself and share a little bit more about Cleo and the organization's mission? Madhavi: Yes. Thank you, Shareef. So I'm Madhavi Vemireddy. I'm a physician by training, been in population health for over 20 years. I'm the CEO of Cleo. Joined Cleo a couple of years ago through the acquisition of a company that I started called Care Tribe that was focused on supporting family caregivers. Cleo, today, supports all families across all life stages. We do that by bringing together our team of experts, of allied health professionals that are supporting families, our dedicated guides and specialists, coupled with our digital platform that's powered by Advanced Analytics. We are supporting over 200 customers today, over 2 million eligible lives and our supporting members across 70 countries. Shareef: Very cool. So maybe to jump into our first question, the theme for today is the intersection of mental health and caregiving. Obviously, within the broader context of our focus on women's health over the next few weeks. I think we'd be remiss if we didn't start with some of the data, which I think is pretty clear. One in five individuals are the caregiver for either an adult loved one or a child with special needs. Obviously, the burden of caregiving disproportionately borne by women, I would love from your perspective, Madhavi, how have you seen the public discourse and understanding of the needs of caregivers evolve over time? Madhavi: Yeah, it's a great question. We're seeing even the definition of caregiving broaden, right? Because to your point, one in five is taking care of a loved one with special healthcare needs. But if you look at the broader definition of caregiving, over 70% of a workforce is caregiving and that starts at parenting for a child all the way through taking care of an elder loved one. And I think what also is a lot more data to support that, caregivers are actually at a much higher risk for their own mental health, their physical health, their self-care. So it's really, I see it as that intersection between family health and whole person health, right? It's really looking at the needs of the entire family unit. What does the care recipient need? What does the caregiver need? We know what impacts one will impact the other. So really having that broader family-centered care model is critical because today I think what's happening is the focus is primarily on whole person health and we're not understanding who are the individuals that are taking care of that care recipient and what's the health impact of that caregiver. Because if that caregiver is at the stage of burnout or has significant mental health strain, not only is their health impacted, but I think their ability to care for a loved one is going to be significantly impacted. Shareef: So maybe we dig in there a little bit further, Cleo is named one of the most innovative companies by Fast Company in part because of its work pioneering metrics to measure caregiver burden. And can you tell us a little about the family health index, how it works, how you all have used it at Cleo to support caregivers? Madhavi: Yeah, absolutely. So I think based on my experience being in population health and seeing really the health and wellness needs of our family caregivers, it was really important for us at Cleo to develop out this population health approach, really going beyond concierge care because a lot of companies today, when they focus on caregiving support, they're really focused more on the logistical needs. How do I connect you to community resources? How do I help address social determinants of care? Which is obviously a critical component, but it's not the entire set of needs. And so, when I talk about a population health approach, it's supporting all family caregivers no matter where they are in that caregiving journey. And we developed out the family health index as an analytic tool looking at seven dimensions of health, their confidence for caregiving, their connectedness, how they view their caregiving balance, also their self-care, their mental health, their general health and their family support. And that allows us to understand overall are they at higher risk for burnout and mental health strain? Where are they when they first join Cleo? Are they at that stage of burnout where we know we need to engage with them quickly, help identify those risk factors, help get them the right coaching support as well as the logistical support so we can track improvement over time. And in some cases also connect them to other benefits within their ecosystem. So one of our key findings is that for those that take that family health index and our members will get a real-time report so they can see how they're doing across those seven dimensions. But we have 45% of our families fail a PHQ4s. So the PHQ4s are patient health questionnaire, that's screening for early symptoms of anxiety and depression, so 45% are failing. And we're able to look at that data across what life stage that family is in, what their specific caregiving situation may be, where they're located around the world, or how many individuals are they taking care of, are they taking care of just a parent versus they're in a sandwich generation. So we can see what are those factors that are putting you at higher risk for burnout or higher risk for mental health strain. One of our insights is that parents of teenagers have the greatest risk to their mental health. What we've seen is they are more likely to have a severe score on their PHQ4, 25% of them have a severe score compared to about 8% across all other caregivers. And so what we do is we try to identify where do they need help. Maybe they need help with their confidence of how do even have a conversation with their child. Maybe they need help with positive parenting tips. Maybe they need to find mental health support for their child as well as maybe for themselves. So it's really identifying what are the set of interventions that are going to best support a family. And then what we do is if they have a mental health strain, we'll track in about six to eight weeks to say, based on our emotional wellness coaching, based on the support that we're providing, did we make an improvement? And what's interesting is 78% of our families that retake the PHQ4 after we've supported them show improvement in their score. So that improvement could mean we've brought them down a certain severity level or they go from having mild symptoms to now basically having a normal score. It just really highlights the fact that caregiving, and that burden of caregiving can really be at the root cause of the mental health strain. And so it's really important to identify these families early on. So we're catching it before it manifests as a diagnosis. And also, that we are addressing that root cause. Many times they don't need to go on to have treatment. They really need to... The coaching support by itself can really address some of that burden and that mental health strain. And so really getting them the support they need can set them up where they are thriving. Shareef: Really helpful, perhaps we end on a forward thingy note. As you think about the state of play for caregivers, what do you see on the horizon in terms of policy opportunities or otherwise to improve how we support caregivers? Madhavi: Yeah. No, I think it's an excellent question. There's obviously been a lot of work done by the national strategy on caregiving to look at opportunities of where we can identify who is caregiving because most people are caregiving, but don't even self-identify as a caregiver. And so that's why having that broad population health approach is important. So you're identifying families early on. Second, I think, is making sure that caregivers are really part of the care team. We're offering them caregiver training as part of their physician interaction, but we are really supporting them understanding where the specific education they need, the training they need, monitoring their health and wellbeing as we monitor the health and wellbeing of the care recipient. And I think it's really enabling this family-centered care model. So we moved from, you think about the triple aim, the quadruple aim. Now, I think the- Shareef: The quintuple aim. Madhavi: The quintuple. I think we need to go to the next level and add in family caregivers to those key pillars of not only looking at the care recipient, the care delivery team, health equity, but also looking at the needs of the family caregivers. Shareef: Really interesting. Well, Madhavi, thank you so much for your time today. And to our audience, thank you for tuning in. Please keep an eye out for these sorts of insights posted throughout the month.

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