Medicare Advantage Plans Depend on Family Caregivers They Often Overlook

Health plans spend heavily on apps, wellness programs, and outreach efforts designed to get members to schedule checkups and refill prescriptions. Christine says they are often targeting the wrong person. For many people over 65, that work is actually handled by an adult child, usually a daughter, who is “calling and booking mom’s annual wellness visit, her mammogram, her chronic condition appointments, picking up meds, getting groceries, trying to be the key communicator with the provider and the plan.”

That disconnect has a cost. Star Ratings determine Medicare Advantage bonus payments, and the three medication adherence measures carry triple weight in the 2027 ratings. “Medications are very important,” Christine notes. “It’s a 3x weighted measure for star rating for health plans.”

Why haven’t plans solved this themselves? Christine says large insurers have the resources, but “the biggest challenge is they get in their own way, they’re too big, and they’ve got too many priorities.” Caregiver engagement keeps getting pushed into the following year’s budget, leaving an opening for a focused startup.

How Avanlee Care Built a Business Around Caregiver Engagement

Avanlee Care did not begin by selling to health plans. The company launched a consumer app in 2021 and, Christine says, attracted about 15,000 downloads, with roughly three-quarters of users active daily. In 2024, the team rebuilt around what had worked for families and aimed the product at a different customer: the health plan that benefits when caregivers get things done.

The company’s pricing is tied to that work. Plans pay a monthly fee for each member with an activated caregiver, along with performance payments when the platform helps get a vaccination, annual wellness visit, or mammogram scheduled. Caregivers can use one place to book appointments, manage medications, and order groceries and over-the-counter items through Walmart in all 50 states. Siblings can also split the cost: “It’s your turn to pay for mom’s groceries this week.”

Prescriptions are handled through Mark Cuban Cost Plus Drug Company, through a partnership announced in 2023. Christine points to the financial pressure families face: “The amount of money that is spent out of pocket, just related to taking care of an elderly parent and prescriptions, is just climbing.” Cuban, the company’s co-founder, described the collaboration in similar terms. “We are excited to work with Avanlee Care,” he said. “We share a common mission: to provide lower costs on prescribed medications, saving money for the unpaid family caregiver and their loved one, the care-receiver.”

The lesson for other founders, Christine says, is to identify the buyer that benefits from unpaid labor, then connect revenue to the outcomes that buyer is measured on.

Why the Founder Paused Fundraising to Focus on the Market

Christine moved from Montana to New York City in her early 20s. While working in tech and looking for a job, she had what she describes as a “chance encounter” with investor Esther Dyson, now Avanlee Care’s board chair. It happened on a Sunday afternoon at the Meetup building in SoHo, where Dyson, an investor in Meetup, met her as she stepped off the elevator. “She had no shoes on,” Christine remembers. Instead of discussing careers, Dyson asked, “What do you want to do with your life?”

Christine answered with the idea she could not stop thinking about. “I have this idea for a company because my mom is the primary caregiver for yet again another parent,” she said, adding that she did not “really know what that means to start a company.” Dyson’s response was direct. “We’ll start the company.” Then came blunt advice about fundraising. “You didn’t go to an Ivy League school, and your dad doesn’t sit on the board of Goldman Sachs, so it’s going to be hard for you to raise,” Christine recalls Dyson saying.

She went back to Montana, where it is cheaper to start a business, and met cofounder and CTO Chris Monson. Christine bootstrapped the early product. “I paid for most everything with the day job,” she says. Dyson wrote the first check in 2021.

Fundraising remained difficult. In 2023, Christine says she “hit a wall” and stopped raising money so she could focus on the product and the market. Founders, she explains, “just spend too much time talking to VCs,” even though they know the product best. She says the change “really just turned the corner for the company.”

Investors then began reaching out to her. David Tswamuno, founder of FairBridge VC, heard her StartUp Health interview, and his team contacted her about investing. FairBridge then introduced her to Melissa Bradley, founder and managing partner of BEA Venture Fund, which led the new round and filled “the first board seat we’ve opened in about four years,” Christine says.

“Avanlee Care is addressing an enormous and underutilized resource within healthcare,” Bradley says. “As healthcare organizations look for more effective ways to improve engagement and outcomes, Avanlee is offering the infrastructure to make caregivers part of that strategy. We believe that creates a significant opportunity to improve both the caregiver experience and healthcare outcomes at scale.”

Christine’s advice for women founders who keep hearing no is to “choose your investors like you would choose a spouse.”

What Family Caregivers Should Receive in Return

If caregivers are a resource health plans can use, what do caregivers get back? Christine’s first answer is time. A platform that gives a caregiver “two hours back” from phone calls and prescription chasing, while keeping costs down “so they don’t have to leave their job,” earns its place, she says. “That’s what makes this product really sticky for the end user, which is the adult daughter.”

Compensation is a harder issue. Christine says startups that pay family caregivers are mostly raising money through Medicaid rather than Medicare Advantage. “We’re more of an infrastructure company,” she says, though she would work with anyone who has “cracked the code on how to get caregivers paid.” In Avanlee’s caregiver survey, the top requests were help finding legal services, basic guidance on the caregiving role, and connections with nearby caregivers.

Her broader goal is about recognition. She wants “a world where healthcare acknowledges the primary caregiver” from the first day a parent needs help. The reason, she says, is practical. “In the next 10 to 15 years, that woman or male who’s the caregiver is going to be the senior themselves,” she said.