My grandmother has lived just outside Boston since 1944, raising five sons in the same home. As she got older it got harder to stay. Her going to a nursing home may have eased others’ minds, but it wasn’t what she wanted.

Ultimately, she was able to die at home years ago. It was nothing special that it involved a social worker level of support to coordinate care and her travel to the clinic. It is worth noting that it has not taken precedence over the current state of facility-based care delivery.

Ranked one of the top three states by the Commonwealth Fund and the second-healthiest state by the United Health Foundation, Massachusetts ranks as one of the nation’s best healthcare systems in 2017. established a position.

However, cost and health disparities continue to be major obstacles. One in four of her residents reports not needing medical or dental care because of the cost. Emergency departments, hospital outpatient and acute care, and hospital utilization are above national averages, contributing to higher costs, and the state ranks him 37th in preventable hospitalizations. . The Massachusetts Health Policy Board has passed sustainable growth goals for health care spending statewide. In her first five years he is 3.6% and in 2018 he is 3.1%. Unfortunately, healthcare costs have averaged 3.59% annually since that benchmark was established.

It was in this setting that Landmark, Massachusetts, and my stories collided. When I was asked to introduce the home integrated care model to the state where I have lived my whole life. Already established in New York, California, Washington, and Oregon, Landmark connects social workers, behavioral health providers, clinical pharmacists, and nursing care managers to deliver true preventative care and address the social determinants of health. Brought home a multidisciplinary care team composed of: We started negotiating value-at-risk contracts with local medical insurance in Boston.

Our patients receive an average of 6-8 visits per year from Landmark physicians or advanced practice providers. We also provide 24/7 triage for urgent medical issues to avoid unnecessary hospital visits. This alternative model intrigued me because my grandmother’s struggles were on the back of my mind.

From 2018 to 2019, Massachusetts health care spending grew 4.3%. The Massachusetts Health Policy Board’s spending containment efforts include limiting the sites that can be billed as outpatient departments of hospitals and implementing site-neutral payments to combat the spillover effects of the health care system buying out physician practices. was included. Landmark grew in the ultimate site-neutral location, patient homes, throughout Greater Boston. Tailoring care to the individual patient’s daily habits improved outcomes at a lower cost.

In 2020, 17% of Medicare beneficiaries will have five or more chronic conditions, and at least 2 million Medicare beneficiaries will be completely homebound with little access to home care. As a result, perceptions of where and how people age have changed dramatically over the course of the pandemic. There are good reasons for this. Home is where the daily health care activities of patients with an average age of 77, with more than 8 chronic conditions and taking more than 12 of her medications take place. Landmark’s results tell a 26% decrease in mortality and a 20% decrease in healthcare costs over the past 12 months. Sending a clinician to your home isn’t cheap, but the 25% reduction in hospital admissions shows that our model pays for itself in one year.

Orienting the system around providing emergency medical care has created a public health emergency to show that too much pressure is being put on one end of the system. Massachusetts’ large healthcare system has a strong reputation for healthcare reform and innovation, flowing downstream. We can change the trajectory of what it means to get older in the United States. We had a solution all along. here, at home.


Chris Johnson is CEO of Landmark Health.



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