Most people have a desire to live out their final years in their own homes, according to a recurring AARP survey. But an inability to perform daily activities—also known as functional decline—might mean that a senior citizen will spend those final years in an assisted living facility instead. One of the primary triggers of functional decline is a stay in the hospital, as evidenced by “high rates of mortality and nursing home placement” post-hospitalization, according to a study published in the Journal of American Geriatrics Society.
It’s a well-known problem that health practitioners and researchers have been trying to solve for years: how can they treat geriatric patients—most of whom will statistically have multiple chronic medical issues—without putting them in hospitals and potentially triggering an early decline?
One company, Landmark Health—which provides comprehensive in-home health care with a focus on prevention—is achieving marked success with its methods. Even though most of Landmark’s patients are around 80 years old with at least six chronic medical conditions, it has been able to reduce hospitalizations and days in skilled nursing facilities by 15-25% and reduce mortality by 26%, according to Chris Johnson, the company’s new CEO.
“The idea is that we’re providing incredibly proactive care for folks—before they get sick—to help them manage their many chronic conditions so that they don’t get exacerbated or flare up in a way that results in them ultimately needing to call 911, and we’re able to do that by partnering really closely with their existing care teams, extending that care into the home, and having a very comprehensive medical team that’s designed to meet the needs that these frailer more medically complex patients need,” Johnson told California Business Journal. “The hospital should exist for things that we’re not able to manage in the community, not because we’re failing to manage things in the community.”
Landmark Health’s model is optimized for patient-centric hospital operations. For older patients especially, dealing with multiple health conditions can quickly spiral into a rabbit warren that is difficult to navigate—the inaccessibility of which then begins to affect their health. With Landmark, each patient has a comprehensive medical team that includes doctors, advanced practice providers, behavioral health specialists, pharmacists, social workers, and nurses all working together on the unique needs of their senior patient. And whereas a typical doctor’s visit may be only 20 minutes once or twice a year, Landmark patients see their team around once a month, for a minimum of 45 minutes—longer, if that’s what the patient needs.
“It’s all interconnected, so the patient isn’t working with five different teams. It’s one team that’s doing all the things and bringing the right resources to bear. That’s been kind of the secret sauce to how we operate,” Johnson says.
Providing proactive and frequent medical care that decreases the likelihood of hospitalization also saves money. A 2019 data analysis by UnitedHealth Group found that avoidable emergency room visits added $32 billion in costs to the healthcare system. Landmark Health works on a value-based model, assuming financial risk for the client’s health services and getting paid based on how effective they are at improving their patients’ health outcomes. If Landmark doesn’t save its partnering health insurance companies money by preventing hospitalizations or time at a rehab facility post-hospitalization—it doesn’t get paid.
“This core concept of ‘an ounce of prevention’ is generating a lot of return by preventing the need for expensive hospitalizations or expensive stays at skilled nursing facilities; and not only that, but it’s what our patients want,” Johnson says. “It’s not easy, but by tailoring our care to the individual patient’s needs, we can improve outcomes at lower cost.”
Providing services in-home is more expensive than in a clinic setting, but these costs are almost always offset by the prevention of hospitalizations.
“It’s a much higher quality of life for patients, and in general, generates tremendous savings for the health system as well,” says Johnson.
He was drawn to Landmark in part because he had watched his own grandmother struggle within a traditional brick-and-mortar, siloed healthcare system that wasn’t always appropriate—or accessible—for a person in their 80s. He felt that Landmark was onto something innovative; they were “challenging the orthodoxy” of a monolithic and segmented healthcare model optimized for the providers’ efficiency, rather than the patients’ needs—and he wanted to be a part of that movement.
“My grandmother wanted to grow old and continue to live in her house; that was really important for her to continue to remain at home. She had lived in the same house since 1943, and that was her safe place, but it became very hard. The existing (healthcare) system just wasn’t equipped. But you can see how with models like Landmark’s, you can really help make sure that their end-of-life experience is what our seniors deserve.”
As new CEO, Johnson wants to continue with that transformative vision and become even more “integrated into the fabric of care delivery” in the communities they serve. Landmark is currently in 18 states, serving 175,000 patients, and this year, they have plans to be in at least 22 states, serving 300,000 patients.
“As we do that, we know that we’ll be able to improve the clinical outcomes that we get, and that ultimately manifests in patients being able to spend more healthy days at home in their community, surrounded by their family, and their neighbors and friends,” Johnson says. “The net of that will generate tremendous savings for the overall health care system that allows the government and health system to reinvest those dollars in additional benefits.”
He would also like to see the Landmark model of senior healthcare delivery go from novel idea to a more ubiquitous standard of care in the U.S., replacing the acute-centered model that currently prevails.
“This model of care that’s persisted over the last several decades, that has been moving all forms of care delivery into the acute hospital setting—is that the right direction for care delivery in the U.S.?” he concludes. “Or should we really be thinking about—how do we instead move care delivery closer to the consumer, closer to the patient, and adapt to their definition of convenience, their definition of quality and outcomes? And I think that’s an area that Landmark has led, and hopes to continue to lead, into the future of healthcare.”
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