Today, in-home medical care provider Landmark Health has a footprint that covers about 15 states and roughly 50 communities. Two years ago, its footprint was less than half of that.
The rapid growth of the Huntington, California-based company closely aligns with a larger trend: the widespread expansion of health care services into the home. This trend has been going on for a decade, but has recently ramped up due to the coronavirus.
Founded in 2013, the PE-backed Landmark and its physician-led teams deliver routine preventive care, post-discharge care, behavioral health care and social services in the home. The company — which operates on a 24/7 basis, 365 days per year — also delivers urgent care services.
Across its footprint, Landmark is responsible for 114,000 patients. It recently partnered with the large managed health care company Aetna in New York to give up to 40,000 individuals access to advanced in-home geriatric care.
Overall, the company has partnered with four national health plans, with a fifth partnership in the works. That momentum for Landmark began before the COVID-19 crisis began, but it has accelerated significantly since, CEO Nick Loporcaro told Home Health Care News.
“COVID-19 has literally shone a spotlight on what it is we do, why we do it and the need for what we do,” Loporcaro said. “We went from zero to 24 markets in the first four or five years of our business. We went from 24 to 48 in the last two years. I see that rate of growth doubling — if not tripling — in a post-COVID-19 world.”
An untapped market
Landmark regularly performs a wide variety of interventions in the home. Those interventions include wound care, IV fluids, in-home laboratory and imaging services, as well as treatments for fevers, colds, respiratory infections and more.
Apart from Landmark, other recent examples of in-home care bullishness among payers include Aetna’s recent partnership with WellBe Senior Medical in Chicago and Humana’s $100 million investment in at-home primary care company Heal.
Representing a conservative estimate, Loporcaro believes that 2 to 4 million people could benefit from the services that Landmark provides — in the Medicare Advantage population alone. Expand that to Medicare and apply it to in-home primary care services in general, and that conservative estimate becomes 4 to 5 times that number, he said.
For Landmark, the focus on in-home care amid the COVID-19 emergency has meant that it doesn’t have to pitch itself to payers as much.
“We’re in the enviable position of not having to go out and knock on so many doors,” Loporcaro said. “Groups that we were talking to and that were contemplating this [in-home strategy] a year or year and a half ago are now asking us when they can start up.”
And that goes beyond payers, too.
At this point, it’s any health care group that has taken on an at-risk contract. Organizations of all shapes and sizes are now realizing that they need to offer an array of services in the home to better manage their patient populations, according to Loporcaro.
“They’re all trying to get there. We’ve already tackled the hard part, and we’re going downstream when everybody else is trying to come upstream,” Loporcaro said. “[All we need to do] is continue to execute and continue delivering on our commitments.”
Landmark will likely continue to benefit from significant industry tailwinds, as COVID-19 forces the senior population to stay in their homes and insurers look for new ways to keep their members healthy.
But it also made its own luck pre-pandemic. Its relationship with Aetna predated COVID-19’s existence, for example.
“We actually started the discussion with Landmark pre-pandemic, almost two years ago,” Lauren Casalveri, Aetna’s vice president and chief Medicare officer in New York, previously told HHCN. “So at that time, we identified the need to provide more ways of support to our members who have multiple chronic illnesses. The Landmark services will help us toward that goal.”
Early on, Landmark decided to invest in the back-end of its business and build its own proprietary data platform. That platform gave the company the opportunity to capitalize on its successes, which have come in bunches of late.
“There is a flywheel effect,” Loporcaro said. “The more [partners] we’ve signed on, the more data we get, the more we continue to learn. And then scaling [the business] itself ends up helping us invest more.”
Getting to a comfortable place in business after investing in itself has allowed Landmark to get to a point where it can accept risk right away.
The company has converted a lot of its contracts to percentage-of-premium, risk-based contracts. It’s also willing to offer up higher guarantees immediately because of its ability to now underwrite some of that risk initially.
An extra partner in care
While Landmark is considered an in-home medical provider, it is not there to replace a primary care physician. Instead, it is supplementing that doctor, who likely does not have the time to see his or her most complex patients as much as they need to be seen.
When Landmark first enters a market, there is often this feeling that they are entering into competition with primary care providers, Loporcaro said, which is why the company has an outreach team to connect with their patients’ providers to make sure they know that’s not the case.
“We are truly a complement to them,” Loporcaro said. “They’ve got a panel of 2,000, 2,500 patients. The portion that we take on may just be a handful of that panel. And these are the truly complex patients that they don’t have time to see. They’re the folks they know they can’t take care of well enough. They actually end up becoming a real good referral source for us because they’ll then say, ‘Hey, I’ve got five other patients that I’m struggling taking care of.’”
The relationship is mutually beneficial. Landmark is able to collect data and information in the home that wouldn’t be available to the primary care providers otherwise, passing it onto them as appropriate.
Everybody is in the loop on visit notes and anything else that may have come up while in the patient’s home, Loporcaro said.
In each region the company is active in, Landmark also partners with home health, home care and hospice providers, especially for referrals. It has also considered entering into those specialties as a company.
“We have looked at if we should be in home care and if we should be partnering at a different level and have decided to date not to get into any direct relationships from an M&A-type perspective,” Loporcaro said. “But in each of our markets and the communities we serve, we know the home care and home health providers, so we do work with them.”
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