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My grandmother lived outside of Boston in the house where she raised her five children since 1944. As she got older, it became harder for her to keep up. Her going to the nursing home might have eased someone else’s mind, but it wasn’t what she wanted.
Finally, she was able to die at home a few years ago. It was not unusual to include: her social worker to coordinate support-level care and transportation to her doctor’s offices. It is surprising that these cost-effective interventions are still not prioritized in the systems and facility-based care delivery environment in Massachusetts, even after years of expressing the need for alternatives.
One of the top three states by the Commonwealth Fund and the second healthiest state by the United Health Foundation, Massachusetts established itself as one of the top performing health care systems in the nation in 2017.
But price and health disparities remain major barriers. About 1 in 4 residents reported going without essential medical or dental care because of cost. Emergency department, hospital outpatient, and hospital services are above the national average, contributing to higher costs and ranking 37th in preventable hospitalizations. The Massachusetts Health Policy Commission has set a statewide goal of sustainable growth in health care spending: 3.6% for the first five years, then 3.1% for 2018. Unfortunately, since that measure was established, health care costs have averaged 3.59% annually.
It was in this area that our stories collided—Landmark, Massachusetts, and mine—when I was asked to lead the introduction of a home-based integrated care model to the state, where I’ve lived all my life. Already established in New York, California, Washington and Oregon, Landmark brings home an interdisciplinary care team comprised of social workers, behavioral health providers, clinical pharmacists and nurse care managers. We began negotiating risk-based pricing contracts with local health plans in Boston.
Our patients average six to eight visits with their Landmark physician or primary care provider. And when urgent care issues arise, call 24/7 to identify and avoid unnecessary hospital visits. I was intrigued by this alternative model because my grandfather’s struggles were dominant. What surprised me the most was that no one was doing this.
From 2018 to 2019, Massachusetts health care spending growth was 4.3 percent. The Massachusetts Health Policy Commission’s efforts to control costs, such as limiting hospital outpatient department fees and implementing site-independent payments, have prevented health systems from taking a big hit in purchasing physician practices. A landmark has grown throughout Greater Boston in the ultimate station-neutral space: the patient’s home. By tailoring care to the patient’s daily routines, we have improved outcomes at lower costs.
In the year By 2020, 17 percent of Medicare beneficiaries will have five or more chronic conditions and at least two million Medicare beneficiaries will be completely out of home, with little chance of receiving care at home. And as a result, when the pandemic hit, where and how people aged changed dramatically—for good reason. Home is where daily health care is performed for our patients, who are an average of 77 years old with more than eight chronic diseases and more than 12 medications. Landmark’s results speak for themselves: a 26% reduction in mortality and a 20% reduction in medical costs over the past 12 months. Bringing clinics home isn’t cheap, but with a 25% reduction in hospital admissions, our model pays for itself within a year.
It took a public health emergency to show that orienting a system around acute care delivery puts too much pressure on one end of the system. And with a reputation for health reform and innovation, the largest health systems in Massachusetts swim to the bottom. We can change the direction of what age means in the United States. We’ve got the solution all the time. Here, at home.
Chris Johnson is CEO of Landmark Health.
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