Home health care helps the elderly and reduces costs

My grandmother has lived just outside Boston since 1944, in the same house where she raised her five children. As she got older, it became harder to stay. While she may have eased everyone else’s mind for her to go to a nursing home, it wasn’t what she wanted at all.

Eventually, she managed to die at home a few years ago. What she did was not extraordinary: the level of support from a social worker to coordinate care and transportation to her doctor’s office. It is remarkable that these cost-effective interventions still do not take priority over the status quo of facility-based systems and care delivery in Massachusetts, even after the years have highlighted the dire need for alternatives.

Ranked 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 best performing health systems in the country in 2017.

But cost and health disparities continued to be a major obstacle. As many as 1 in 4 residents reported that they did not need medical or dental treatment due to the cost. Emergency room, outpatient and acute care, and hospital use were above the national average, contributing to high costs and ranking the state 37th for preventable hospitalizations. The Massachusetts Health Policy Commission has approved a state-level target for sustainable growth in health care spending: 3.6% for the first five years, then 3.1% for 2018. Unfortunately, since that was established. benchmark, health expenditure averaged 3.59% per annum.

It was in this environment that our stories collided – that of Landmark, Massachusetts and mine – when I was asked to launch the integrated home care model’s entry into the state, where I have lived my whole life. Already headquartered in New York, California, Washington and Oregon, Landmark has brought home an interdisciplinary care team made up of social workers, behavioral health workers, clinical pharmacists, and nursing executives to deliver true preventative care and address the social determinants of health. . We started in Boston negotiating risk and value contracts with local health plans.

Our patients average six to eight visits per year from their Landmark physician or advanced practice provider. And when urgent care issues arise, we’re available 24/7 to evaluate and avoid unnecessary hospital visits. This alternate model intrigued me, as my grandmother’s struggles were number one. What surprised me the most, though, was that no one else was doing it.

From 2018 to 2019, Massachusetts health spending growth was 4.3 percent. Efforts by the Massachusetts Health Policy Commission to control spending included limiting sites that can be billed as hospital clinics and implementing site-independent payments in an effort to counter the knock-on effects of health systems purchasing health care. medical studies. Landmark grew across Greater Boston in the last site-neutral location: a patient’s home. By adapting care to the individual patient’s daily habits, we have improved outcomes at lower cost.

In 2020, up to 17% of Medicare beneficiaries have five or more chronic conditions, and at least two million Medicare beneficiaries are completely homebound, with little access to home care. And as a result, over the course of the pandemic, the perception of where and how people age has changed dramatically, for good reason. The home is the place where daily health care takes place for our patients, who are an average of 77 years old with more than eight chronic diseases and over 12 drugs. Landmark’s results speak for themselves: a 26% reduction in mortality rates and a 20% reduction in medical expenses over the past 12 months. Sending doctors home isn’t cheap, but a 25% reduction in hospital admissions shows that our model pays for itself over the course of a year.

It took a public health emergency to demonstrate that orienting a system around acute care delivery puts too much pressure on one end of the system. And with all of its reputation for healthcare reform and innovation, Massachusetts’ great healthcare systems are swimming downstream. We can change the trajectory of what it means to grow old in the United States. We have always had the solution. Right here, at home.


Chris Johnson is the CEO of Landmark Health.

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