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Landmark uses house calls to reduce hospitalization for sickest patients

In an interview, Landmark Health Chief Medical Officer and co-founder Dr. Michael Le said house calls provide a way for healthcare providers to get a better understanding of their patients needs and challenges beyond a doctor's office. Landmark will take part in the HLTH conference next week.

Note: Michael Le will take part in the HLTH panel discussion “Bringing Health Back Home” on Tuesday, October 29 from 9:20 am to 10 am with Asheesh Saksena of Best Buy Health, Sumant Ramachandra of Baxter International, Nita Somers of Honor, and moderated by Neda Amini of Plug and Play. Landmark Health will also be at Booth K-533 in the exhibitor hall.

Dr Michael Le, co-founder and chief medical officer for Landmark Health, LLC and shareholder and president of multiple medical groups across the country (collectively “Landmark”), recalled growing up with a father who would make house calls to care for patients who couldn’t make it into the office of his small town Massachusetts practice. He remembers their appreciation that he could take some extra time to bring the care to them. But by the time Le entered medical school, he thought, “those days were long gone; house calls were a thing of the past.”

Or so it would seem. The push for healthcare innovation has led to several companies bringing back house calls both in person and through telehealth as a way of addressing patients’ lack of transportation options, to make care delivery more efficient, as well as a way to provide care for particularly sick patients, frequently with multiple chronic conditions.

Michael Le of Landmark Health

One of the reasons Le co-founded Landmark was based on what he saw when he was training as a hospitalist. He recalled that patients seen in nursing homes and post-discharge clinics would sometimes end up back in the hospital even though he directly witnessed their improvement. When he would visit patients in their homes, he would find evidence of hoarding, fall risks, empty refrigerators because they would forget to shop or didn’t have access to transportation, enough money or mobility. They would fail to get their medication or didn’t take it regularly.

“With the lack of support and the behavioral and social barriers they face, it became clear why [these patients] can’t stay out of the hospital. We couldn’t see these things in the 15 minutes we spend with patients in the doctor’s office,” Le said. “It is very eye opening when we see patients in their homes because there is no place to hide.”

The Landmark family of companies includes Landmark medical groups around the country. These medical groups employ physicians, psychiatrists, addictionologists, nurse practitioners, physician assistants, nurses, social workers, pharmacists, and dietitians to help health plans treat their sickest patients. These patients typically represent 5 percent to 10 percent of their members — mainly Medicare Advantage but also Medicaid, dual eligible, and commercial patients. By helping these health plans manage risk, they can save them money and improve care by avoiding unnecessary visits to the emergency room and reducing hospital admissions. They do that in part by being available to patients 24/7, visiting patients in their homes when they need care, both urgently and on a regular schedule. The company, which launched in 2013 currently has contracts with 14 health plans across 14 states covering 100,000 patient lives. To date, they have done 400,000 home visits, 80,000 of them unscheduled, urgent visits. In 2020 alone, they will be making over 335,000 visits.

“When we launch into a new market, the health plan will introduce us to the primary care physicians. Typically, Landmark will see 5-10 patients from each primary care physician’s panel who are their sickest patients,” said Le.

Although they are equipped for the kind of events that would send patients to urgent care or emergency room visits, Landmark also addresses preventive care needs. Le said their physicians can draw blood, check labs, administer IV medications, provide IV fluids if patients are dehydrated, check for urinary infections, do ultrasounds and more.

Le emphasized that Landmark does not seek to replace primary care physicians but are more like an in-home specialist group. Different from home health, which is usually staffed by nurses or non-clinical workers, this is doctors, nurse practitioners, and physician assistants coming to the patients’ home and providing robust supplemental medical, behavioral and palliative care, along with social services. When Landmark expands into new markets, they meet with primary care physicians to explain the parameters of their program. The goal is to coordinate care between members of their own group, the health plans’ specialists, and the patient’s primary care physician.

“We are a high-risk medical group and management services company, with providers credentialed by our partner health plans to create a highly collaborative network to benefit the plan’s most complex members. The nice thing about our model is that we provide a lot of proactive, preventive care, such as educating patients so they know why it is important to take their medications, and warning signs/symptoms red flags for when they should call us.”

One patient experience Le highlighted was a 75-year-old Navy veteran with metastatic lung cancer with metastasis in the brain. He had been hospitalized pre-Landmark for side effects of his chemotherapy and was dehydrated. But a compromised immune system from the chemo led him to get an infection during his hospital stay and he got much weaker. After enrolling with Landmark, he had a similar episode, but this time called Landmark and was able to be treated with IV fluids in the comfort of his home. Le also recalls seeing a change in this patient when his granddaughter bounded into his room, who was his pride and joy. Landmark aggressively treated his symptoms and coordinated care with his physicians so that he could spend his remaining time at home with his family and particularly his granddaughter who gave him so much enjoyment.

To back up the impact Landmark has had, Le noted that the company’s health plan partners see a 39 percent reduction in ER visits in the first six months of working with the group. There is also a 30 percent to 40 percent reduction in hospitalizations and a 90 percent completion rate for advanced directives. He is particularly proud of the 50% reduction in mortality rate for patients engaged in the Landmark program compared to similarly matched patients without Landmark services.

Looking ahead to the future, Le sees a lot of healthcare shifting away from brick and mortar facilities “Our hope, especially for the sickest and frailest, is that our model will someday become a standard of care.”

Photo: Getty Images

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