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Landmark Homes In on Chronically Ill Via Coordinated Model

Lisa Feldman
May 17, 2018

Reprinted with AIS Health permission from the May 3, 2018, issue of  Radar on Medicare Advantage

Through a new partnership with senior-focused provider organization Landmark Health, LLC and its affiliated medical groups, Humana Inc. this month will begin rolling out coordinated at-home care for Medicare Advantage members with multiple chronic conditions in seven states. The deal reflects insurers’ increasing interest in home-based care and marks the latest in a string of value-based pacts for Landmark, which aims to fill gaps in care and reduce avoidable utilization by providing 24/7 services to eligible patients.

The Huntington Beach, Calif.-based health care company was founded in 2013 by Adam Boehler, who was recently tapped to head the CMS Center for Medicare and Medicaid Innovation. Boehler and his colleagues at the time observed that traditional health plan levers such as network management and utilization management weren’t working for a specific subset of patients with multiple chronic conditions, explains Landmark President Chris Goldsmith in an interview with AIS Health.

“Landmark found that these frail and chronically ill patients were only seeing their primary care physicians two-and-a-half times a year, and for someone with that many medical conditions and medications, that was just not sufficient,” says Goldsmith. As a result, the group began reaching risk-based agreements with MA plans that were “looking for a new way to provide better care for these patients who because of all their conditions were very high utilizers of the health care system.”

Landmark has grown to serve more than 75,000 patients in 13 states. While the majority of its patients are in MA plans, the organization also has contracts with managed Medicaid, dual eligible and commercial plans and sees the potential for growth in those markets as well as in MA.

Goldsmith, who joined Landmark in October 2017 after having served in leadership roles at Envision Physician Services and Optum, asserts that what makes Landmark’s model unique and has led to its rapid growth trajectory is the intersection of three “mutually reinforcing” components. They are:

(1) The clinical model, which provides both longitudinal and urgent care. In delivering the former, Landmark deploys “Complexivists” — which include physicians, nurse practitioners and physician assistants — to where the patient is. While the majority of patients are seen in their homes, some are in long-term care or skilled nursing facilities, says Goldsmith.

On top of their own clinical backgrounds, Landmark provides its clinicians additional training on how to treat, manage and care for patients with six or more chronic conditions and who are typically taking 20 or more prescriptions. Eligible members are also able to spend more time with these clinicians than they would in a typical fee-for-service environment, although the program is not intended to replace primary care practice and Landmark encourages patients to continue to see their primary care physicians (PCPs), adds Goldsmith. Rounding out the gaps in care are the “Urgentivists,” the professionals who are available when their PCPs are not and can perform a diagnostic over the phone or an in-person examination that might help a patient avoid a trip to the emergency room.

 (2) The operational layer, which includes a 24/7 call center to coordinate in-home visits and urgent care. Supporting patients’ care is an interdisciplinary team comprised of pharmacists, social workers, nutritionists, behavioral health clinicians and dietitians who coordinate with the patient’s PCP, meet regularly to conduct a full panel management review of that patient and may be deployed to the home depending on the patient’s needs.

 (3) The risk-based financial model. “If we are able to avoid an admission, then that’s a significant savings to the system and we get rewarded for that from our risk-based contracts,” explains Goldsmith. “If we stay singularly focused on doing the absolute right thing for the patient and taking the best care of them that we can, then everything else works — the MA plan’s star measures, their medical loss ratio [and] our financials.”

The Humana program will roll out in phases over the next few months, starting in May with eligible MA HMO and PPO members in Washington state. Landmark in early April also unveiled a similar partnership with Blue Cross and Blue Shield of North Carolina and more than a year ago began offering its home-based services to MA members of Blue Cross and Blue Shield of Massachusetts.

When launching a program, Landmark performs “co-branded outreach” with the MA plan to alert members that they’re eligible for the 24/7 service at no cost, adds Goldsmith. Once members enroll, Landmark continues to reach out to them to set up introductory visits, bring in their interdisciplinary team and assess patients’ needs.

Since April 2017, Landmark and the Massachusetts Blues plan have helped 1,335 members better manage their health conditions. Each of these members has had an initial visit with a physician or nurse practitioner who has established a care plan and scheduled future visits, according to a spokesperson for the health plan. The insurer estimates that between 3,000 and 4,000 members are eligible for the program. These members make up 8% to 12% of the plan’s MA population and account for 20% to 25% of MA costs.

Mass Blue Plan Saw Positive Results

During the first year, Landmark also performed 657 urgent visits, 77 of which were at night, resulting in more than 160 avoided emergency department and hospital admissions.

“We’re thrilled to see such overwhelmingly positive results in the first year of the Landmark program,” remarks Bruce Nash, M.D., chief physician executive with the Massachusetts Blues plan. “Home visits allow providers to treat these members holistically, addressing everything from medication adherence to mental health needs, family support, nutrition and even potential fall risks. By providing care in the home with a truly integrated care team, we believe we have prevented many emergency room visits and hospitalizations, and most importantly, improved health outcomes and quality of life for members dealing with chronic and complex conditions.”

 by Lauren Flynn Kelly



Originally published May 17, 2018 8:00 AM updated Oct 25, 2018
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