DocGeriatric care management shifts the locus of care from the clinic to the home—where 99% of elder care actually happens and where most families are left to navigate alone.tor talking with a senior patient at home
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Last February, a 96-year-old man who had spent his entire life fiercely independent had a fall. He was stranded on the floor for hours before help arrived, then hospitalized—and approved for just 40 hours of home care per week, not enough to return home safely. A Hera care manager filed multiple Medicaid long-term care appeals, then an expedited external appeal. He won 24/7 live-in coverage, was discharged home, and has been there since.
That story is what geriatric care management looks like when it works. The problem is that Medicare has never paid for it—unless you know exactly which billing codes to use. Jenny Lee, founder and CEO of Hera, read the entire 2024 CMS physician fee schedule to find those codes, then built a company around what she discovered.
Jenny Lee, founder and CEO of Hera, read the entire 2024 CMS physician fee schedule to find the Medicare billing codes that make geriatric care management affordable for the forgotten middle class—families who earn too much for Medicaid but can't afford $250-an-hour private care.
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When Lee's grandmother died after a long battle with dementia, what shook her most wasn't the grief. It was what she witnessed afterward. Her aunt, an architect raising children and running a career, had been the family's unofficial care coordinator for years, absorbing every hospital discharge, every insurance call, every medication confusion without complaint. At the memorial, Lee realized her aunt had been silently breaking apart the whole time.
She went on to interview more than 100 adult children caring for aging parents, and every conversation sounded the same. "They all said the same thing. They were like, 'I’m lost. I’m spending hours on the phone, hours online, running into dead end after dead end,'" Lee told me. "They're like, 'I just want to be a daughter, or I just want to be a son again.'"
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Only two families reported a different experience, and both had hired a private geriatric care manager—a social worker who navigates the system professionally. The going rate: $250 an hour.
Lee identified three tiers of families facing elder care: the wealthy, who can write the check; the low-income, who at least have Medicaid as a frayed safety net; and what she calls "the forgotten middle class," who deplete their savings until Medicaid finally kicks in.
She built Hera for the third group. Over 11,000 Americans turn 65 every day, and 90% of older adults have at least one chronic condition that qualifies for Medicare-covered support—a demographic wave that is landing hardest on women in midlife, as I previously reported, caught between aging parents and their own children while holding careers together.
The financial exposure behind that gap is staggering. Even among upper-middle-class couples with lifetime earnings over $4.75 million, nearly half will spend down their assets to qualify for Medicaid if they require long-term care for five or more years, according to the Roosevelt Institute. Harvard’s Joint Center for Housing Studies estimates that 29% of adults age 75 and older who live alone fall into what researchers call the “forgotten middle”—they cannot afford assisted living but do not qualify for public assistance. Perhaps most strikingly, 62% of Americans mistakenly believe Medicare will cover nursing home costs if they need them—a misconception that leaves the middle class financially exposed precisely when they are most vulnerable.
Here is the direct answer most families cannot find: Medicare does not pay for traditional geriatric care managers, who charge $75 to $250 an hour that families pay entirely out of pocket, according to the National Institutes of Health. But Medicare does cover Chronic Care Management, a separate billing category for coordinated care navigation for beneficiaries with two or more qualifying chronic conditions. The distance between those two sentences is the business Hera is built on.
The CCM codes exist because CMS identified a real failure point: Treatment plans collapse when patients can't execute them after leaving the clinic. Benefits navigation, medication coordination, Medicaid appeals, referrals to home care—none of it is clinical work but all of it determines whether clinical care takes hold. Primary care physicians are eligible to bill these codes but almost never do. The reimbursement doesn't justify hiring dedicated staff and the coordination work falls outside what most practices are structured to deliver.
"Physicians are not trying to do this type of work," Lee explained. "This is understanding what is covered by your insurance, what resources exist that you're not taking advantage of." Hera's answer was to vertically integrate the entire function—bringing physicians in-house to authorize care, then building a specialist workforce around the coordination itself. Ninety percent of Hera families pay nothing out of pocket.
That billing model carries a question any partner or investor will ask: what happens if CMS tightens or eliminates the CCM codes Hera depends on? Lee is direct about it. “As the healthcare system continues to shift toward outcomes and total cost of care, we expect that value to be supported through a range of models. We’re already seeing that demand from Medicare Advantage plans, ACOs, and health systems. The way it’s paid for may evolve, but the need and the value we deliver doesn’t.”
Hera's internal motto is "chase pain"—not the polished opportunity or the whitespace in a large projected market, but the actual, daily pain of families in crisis. Operationally, that philosophy shows up in granular, unglamorous detail.
"You can never use the word 'supervision' in a Medicaid long-term care appeal. It's an automatic denial," Lee emphasized. "Things like that don't exist anywhere on the internet." This is what she calls the social worker's little black book: Institutional knowledge accumulated over careers of navigating a system that communicates almost exclusively through rejection. Hera's AI platform, Hera OS, is being built to capture and deploy that knowledge systematically. Every Hero—currently 50% social workers, 50% nurses—executes with the collective expertise of the entire network, updated in real time as wait lists shift, eligibility criteria change, and local resources come and go.
"Healthcare is still largely built around the patient visit, not everything that happens in between or after. Hera is focused on orchestrating that critical last mile of care," observes Amit Kumar, partner at Accel, which led Hera's seed round alongside IA Ventures and Box Group.
Hera has never spent a dollar on customer acquisition—every family arrives through a health system referral or word of mouth, a zero-cost distribution channel built entirely on clinical trust.
Hera’s differentiation is consistent across every comparable category: Medicare reimbursement, a dedicated care manager, AI in the back office. Tech-enabled care-navigation platforms—Devoted Health on the Medicare Advantage side, ThoroughCare and Prevounce on clinic software, Transcarent and Included Health on the employer side—don’t combine all three for the family of an Original Medicare beneficiary. Home-care agencies like Right at Home and Visiting Angels staff aides for daily living tasks but don’t bill CCM codes or package care navigation as a covered benefit. For a family that already has a home-care agency, Hera plays quarterback across doctors, benefits, and medications—the agency handles the hands-on care.
The closest analogue is the independent geriatric care manager—a social worker doing the same assessment, navigation, and advocacy a Hera Hero does, at $125 to $250 an hour, entirely out of pocket. Hera wraps that expertise into a Medicare-billed service with W-2 care managers and standardized workflows. The work is the same. The cost to the family is not.
Independent industry analysts affirm the broader shift Hera represents. Technology platforms purpose-built for elder care management—centralizing health records, care plans, and medication schedules in a single interface—are increasingly viewed as essential infrastructure for delivering individualized senior care, reducing the information fragmentation that families currently navigate alone, according to a 2024 analysis by BGO Software. Hera’s AI-enabled back office is designed to do exactly that—at scale, and at no cost to the family.
The cost comparison clarifies what is actually at stake. A traditional private geriatric care manager runs hundreds of dollars per month out of pocket—local expertise and deep advocacy, but priced out of reach for most middle-class families. A Hera Hero delivers similar functions: assessment, care planning, navigation, benefits coordination. For an older adult on Original Medicare, the out-of-pocket cost is typically $0, subject to standard Part B cost-sharing for those without supplemental coverage, according to the Rural Health Information Hub. The third option—families doing it themselves—carries no direct fee but an enormous hidden one: unpaid family caregiving was valued at roughly $600 billion in economic output in 2021, per the Roosevelt Institute—absorbed largely by adult daughters, at significant cost to their careers, health, and retirement security. Full control, high burnout, and a high risk of missed benefits is not a trade-off most families are making consciously. It is the one they make by default.
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