The Health Affairs blog post published this week, “Shifting the Burden? Consequences Of Postacute Care Payment Reform On Informal Caregivers” speaks to the key role caregivers play in facilitating post-acute discharge to the home and advocates additional innovative alternative payment models. Post-acute spending is a rapidly increasing driver of US healthcare costs. In 2015, Medicare spent nearly $60 billion on institutional post acute care. As the blog post points out, “recent evaluations have found that cost savings achieved under alternative payment models are driven almost entirely by a decrease in the use of inpatient postacute care. This trend is largely the result of a compensatory increase in the number of patients who are being discharged directly home, and thus bypassing the postacute care setting altogether.” In addition, many patients strongly prefer to return home rather than move to an institutional setting, even temporarily. Amongst the rapid change and healthcare challenges of 2019, this is a rare opportunity that aligns patients, payers and provider health systems. The unsung heroes that enable the direct discharge to home are caregivers. The longstanding professional companions, the husbands, wives, daughters, sons, friends and neighbors. In 2019 Medicare Advantage was expanded to allow coverage for non-skilled needs to support activities of daily living. Some payers have begun learning how to best leverage this tireless workforce: identify and answer Social Determinants of Health, home safety, relay disease specific information back to providers and payers who want to know and help. In-home support for patients and their caregivers needs rapid acceptance and expansion, our loved one’s lives, and $60 billion, are on the line.