Direct Contracting an Avenue for Growth at Landmark Health

Landmark Health is opening up new pathways to growth via participation in the Center for Medicare & Medicaid Innovation’s (CMMI) direct contracting program. Landmark has historically served Medicare Advantage beneficiaries, but the new payment models set to launch in 2021 will give the company access to the larger traditional Medicare population. 

The U.S. Centers for Medicare & Medicaid Services (CMS) has approved Landmark’s direct contracting application. A number of models exist under the auspices of direct contracting; Landmark will be working in the new entrant category of the global model. 

 “For us direct contracting is really the economic construct that’s going to allow us to expand from the 40% or so of Medicare beneficiaries who are in managed care to the 60% who are in traditional Medicare,” Chris Johnson, vice president of corporate development for Landmark, told Hospice News. “Across each of the 50 markets we serve, we know that there’s a massive number of patients in original Medicare who need access to this service. Our goal is really to make it ubiquitous.” 


Johnson is Landmark’s executive lead on the direct contracting initiative.

Within the global direct contracting model, providers bear 100% of the risk associated with eligible patients. Contracted agencies would have to choose between a Total Care Capitation option or a Primary Care Capitation option. This would be a capitated, risk-adjusted monthly payment for enhanced primary care services equal to 7% of the total cost of care.

Landmark intends to replicate the results it has gleaned in its work with Medicare Advantage patients within the larger population they will now be able to reach. Their in-home primary care, urgent care and primary care services are designed to support seriously ill seniors and generate cost savings by reducing inpatient stays, skilled nursing facility days and associated outpatient costs. 


To date among its Medicare Advantage population the company has achieved 20-25% reductions in medical loss ratios, 15-25% cuts in in-patient admissions and skilled nursing days, and 20% reduction of medical costs during the last 12 months of a patient’s life, according to Johnson.

The model will also allow Landmark to bring its palliative care services to many more patients.

“There are traditional Medicare patients that would certainly benefit from this interdisciplinary team-based, patient-centered holistic approach to care, where we can really identify what really matters most to patients and get them the care that they need further upstream,”Jill Schwartz-Chevlin, M.D., Landmark’s senior medical officer in charge of palliative medical management. “They currently don’t have access to this team-based approach in traditional Medicare; most of the services are not even covered. So we’ll be able to reach those patients better.”

Landmark’s care model is focused on elderly, frail patients with multiple chronic conditions. Most of the company’s patients suffer from six or more of those conditions, Johnson said. The average number is nine chronic health problems among their population. They currently serve about 120,000 patients with an average age of 78. Most patients typically receive 12 or more 45-to-60 minute clinical home visits and can contact Landmark to request additional help 24/7.

All of Landmark’s clinicians are trained to provide palliative care as well as urgent care in the home setting. The company partners with hospice providers to ensure seamless transitions of care when patients become eligible.

While Landmark in this first year of the program will operate within the new entrant category of the global model, the company plans in future years to also apply to the high-needs population direct contracting program. That model is geared towards organizations that serve Medicare fee-for-service beneficiaries who have complex needs, including dually eligible beneficiaries, who are aligned to the direct contracting entity through voluntary alignment or claims-based alignment.

“We think our business model of taking care of patients with high chronic disease burden is naturally aligned with the high needs population model,” Johnson told Hospice News. “Our model is really geared more at that really medically complex patient that needs pretty intensive in-home care.”

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