Story by HHCN freelance reporter Judith Ruiz-Branch

In-home medical care provider Landmark Health believes “house calls” can pay off in the long-run for its patients. Now, it’s releasing the numbers to prove it.

Landmark and its affiliated medical groups recently released a study from a cohort that documented how the provider’s clinical home care model impacted thousands of patients over a multi-year period.

The study included over 36,000 patients who were under Landmark’s care between the start of 2016 and June 30, 2018. All participants were Medicare Advantage (MA) patients and lived in multiple states in New England.

Landmark used a matched cohort that identified variances between populations, including geography, health conditions, sex and age, among other factors.

Additionally, Landmark compared engaged and unengaged populations. Engaged patients were in active communication and “touch” with Landmark staff, while unengaged patients qualified for Landmark’s services but did not receive consistent care.

An analysis showed findings in three key areas of care: life expectancy and risk of death, cost of care and patient satisfaction.

Patients who were involved in Landmark’s program, within at least nine months from the time of engagement, had a 26% lower chance of death compared to the unengaged population. Meanwhile, the overall cost of care was reduced by 20% in the last 12 months of life, even for patients who did not elect hospice.

And finally, patient satisfaction scores — using net promoter score, an industry standard — were in the 90th percentile. 

In-home care paying off

The findings of the study were first released at the Center to Advance Palliative Care (CAPC) National Seminar in Atlanta in November, the largest palliative care seminar in the country.

The study was meant to look at how Landmark manages its patients with its model of care. Specifically, how its innovative approach to taking care of frail seniors is paying off.

“As patients are trending towards end of life, how do you effectively establish the goals of care for a patient in concert with what their conditions are and what the clinical health care system can offer them, and then deliver upon that,” Dr. Scott Mancuso, Landmark’s chief clinical officer, told Home Health Care News. 

“I think too often, … patients at the end of life become overwhelmed with the complexity of the health care system, so at Landmark, we spend a lot of time proactively identifying what their conditions are, what’s their longitudinal risk and what’s the opportunity around the health care system, meaning how can the health care system positively benefit the patient amongst their known condition?”

Mancuso is one of three clinical officers for Landmark, overseeing the company’s West Coast region and tasked with spearheading its care model. He is board-certified in internal medicine and palliative care, and heads the company’s national palliative care and post-acute care programs.

Broadly, Mancuso says a lot of care is delivered in the ineffective order of: ER, hospital and then discharge. So it’s not that providers in the system don’t know how to manage the population, he said, it’s just that the way the system is set up is completely misaligned with the incentives between the provider and the patient.

That’s why, he said, Landmark built a model focused on what the challenges are: frailty, medical management and social determinants.

“It’s not being the smartest doctor to know what’s the third or fourth medicine to add on to the diabetes regimen; it’s more how do you address the more simplistic issues up front that have the most dramatic impact on, really, the downstream outcomes,” Mancuso said.

That’s where Landmark’s staff of social workers, dietitians, pharmacists, nurses, advanced practice providers, ER doctors and palliative care providers come in. The Huntington Beach, California-based company, which recently announced its new chief information officer, is one of the largest risk-based provider groups in the United States, caring exclusively for complex, chronic populations.

Landmark’s patients typically have a minimum of six chronic conditions.

In addition to in-home patient care, Landmark also boasts its 24/7 model, which provides telephone and care services for eligible members. Landmark and its medical teams carry out house calls across 13 states.

“To have all these resources available to us on a team that’s competent in managing the frail, polychronic senior, to bring that into the home at [1 a.m.], you just prevented someone from declining to the point that they got so sick that it didn’t just put them at risk for being in the hospital, they got so sick that it puts them at risk of dying,” Mancuso said.

Mancuso says it’s not that everyone needs Landmark. The recent findings are just a push to providers to begin thinking more proactively within a system that caters to them instead of their patients.

“How the system is built versus bringing proper care into the home for those patients that truly need it … that’s really what our study has shown,” he said.

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