Chris Johnson, CEO, Landmark Health

Chris Johnson joined Landmark in 2017 as the vice president and general manager responsible for launching the company’s New England operations. Prior to his CEO role, Chris served as Landmark’s head of corporate development, overseeing growth strategy, strategic partnerships, mergers and acquisitions, and public policy. Prior to Landmark, Chris was a principal at Innosight, a health care-focused growth strategy consultancy, and co-founder of Predilytics, a health care analytics business.

Through the Vision Series, Chris Johnson shares his vision for the aging health system of tomorrow with an emphasis on improving health care for seniors with better access to quality in-home care. He talks about the shift to value-based care and explains how providers can navigate the new landscape by leveraging technology to create and execute the most effective care plan for each individual.

Describe your vision for a health care system that is truly equipped to serve the aging population here in the U.S.

I think it’s very hard to grow old in the U.S. today. As people live longer, seniors are often living at home by themselves. Our health care system is becoming increasingly oriented around the hospital. For many folks who are getting older, frailer and managing the challenges of multi-morbid conditions, the hospital is not the ideal spot to receive care.

Proactively managing those conditions requires access to good primary care. And although we can’t provide a cure, we can help them manage those conditions within the constraints of their goals for the remainder of their life. The hospital is an amazing institution that offers incredible care, but the hospital should be reserved for conditions that need to be treated in the hospital, not for care we failed to provide in another community-based setting.

We need to find better ways to bring care to seniors without encumbering them with transportation and frailty challenges. It needs to be in their place of residence, especially as they get older. That should be an expectation of growing old, not an exception.

I have the privilege of leading Landmark, and we’re caring for around 300,000 patients with in-home primary care this year. My vision for the future is that in-home primary care won’t be a foreign concept but an expectation in senior care. It will be easy for seniors to access, maximizing the impact and proactively empowering them to manage their lives.

Primary care is just one part of it, however. I think we need to continue leveraging technology to provide more virtual services to our seniors. We need to think about home-centric forms of distribution, instead of facility-centric, to facilitate that change. In a lot of ways, it’s not health care, it’s just growing old. Health care needs to fit into growing old. We don’t want to fit growing old into health care for this population. It should always be anchored in, “How do we drive convenience; how do we drive a great experience for those seniors?”

If you could wave a magic wand and change one specific thing about the current experience aging Americans face, what would it be and why?

One thing I would like to see is access to care in the home, to the point where it is almost a right of being a senior in the U.S. By care at home, I mean the ability to deliver medical care in the home, not just at end-of-life, but throughout the entire aging journey.

Today, some folks have access to that care, but it has largely been driven by who their payer is and whether they’ve contracted with an organization that is able to deliver medical care in the home. It’s not available to everyone the way traditional home health is. Everyone in the U.S. generally has access to home health care, so I’d like to see that happen on the medical side so we can get ahead of challenges and proactively plan to help seniors age.

I think a lot about my grandmother. She moved into her house, I believe, when she was 18 years old, in 1943, right after she was married. She lived in that house until 2020. She passed away in early 2020. The most important thing for her as she got older was to be able to stay in her house and stay in her community and be with her cat. The system wants to move her to an assisted living facility, or a senior care community. That’s just not what she wanted to do. That was not what was important to her and what gave her excitement.

It was very hard to get the tools and services she needed to remain at her house. But if she’d had access to medical care there, it would have been a lot easier.

It also would have saved the health care system a lot of dollars because she ended up going to the hospital a number of times in her last year of life, many of which could have been managed effectively in her house if she had access to that care.

Because I saw what it was like for my grandmother, I want to see how that can change. The hospital isn’t great at managing the conditions of getting old and frail in the U.S. If anything, sometimes it can exacerbate those conditions when it’s trying to help.

What do you think individual care providers could do to facilitate smoother transitions of care for the aging population, and then ultimately, who should be responsible for overseeing continuity of care?

It can be very hard to ask an individual provider to have oversight over those transitions because it’s complicated today. A lot of providers are in fee-for-service arrangements. They’re not being paid or compensated for all the work involved with care coordination. There is a ton of complexity because it’s not just Mrs. Smith going into this skilled nursing facility. There are 20 other Mrs. Smiths and they’re going to different facilities. It’s hard to manage the admissions and discharges occurring at different facilities on different time frames, without accurate notification to an individual provider.

I believe it should be the primary care provider helping inform those decisions. It needs to be done in a value-based care paradigm where the provider is rewarded and compensated for all of the investment, ensuring smooth transitions from the acute facility back into the home.

The primary care provider who  has a longitudinal relationship with their patient understands that the patient’s goals can create the most effective care plan, creating value for society. That will lead to lower utilization in the senior population and reinvestment in other services.

We need to think differently about the individual provider and look at them as a part of a value-based care organization with the resources to invest in the technology and understand each patient’s health journey. They have the analytics to help the provider make those decisions.

What role does technology play in allowing individuals to age well? From your perspective as the CEO of Landmark, is there a certain technology development or arena that excites you most, especially when it comes to addressing age-related challenges in the U.S. health care system?

Technology has been a core part of the Landmark story from very early on. We’ve used technology to ensure we’re getting the right care, to the right patient, at the right time. It’s not a patient-facing technology, but it has empowered our physicians and practitioners to practice true population health for the patients they serve.

We give them tools to provide the right care for the patients they’re in front of, but also the intelligence to understand, “What’s going on with all the other patients on my patient panel? Who do I need to see next in order to get in front of a potential hospitalization or other conditions?” That is the core of Landmark, and it has helped us help providers to take on a value-based care mindset.

That is the secret sauce of our success. We often use this notion of an iceberg. We talk about the iceberg because there’s a lot below the surface with an iceberg that you don’t see. That’s the heart and soul of our model, what’s driven our success. You see the providers and the care delivery teams out in the market. What you don’t see is all of the investment and capabilities built to support the care delivery through predictive analytics and EMR platforms that lead to more effective decisions out in the field.

On the consumer side, we’re seeing a natural demographic shift where the 70 year old of 2022 uses email and smartphones, and they’re bringing those things into their senior years. Once you form that relationship with technology, it’s there to stay. When we were getting started, none of our patients even wanted text message reminders for their appointments. Now, when we ask, everyone signs up for it. It’s just the standard way of operating. I think the senior population is getting comfortable with technology and that’s exciting. This trend will help democratize the way that we get new, innovative services to seniors.

Virtual care has taken off through COVID, and we’re just scratching the surface of the ways that technology can shift more care into the home for even broader populations of seniors going forward. I don’t know what those things are yet, but the next stages of value-based care and technology-enabled care in the home are exciting.

What do you see as the single biggest hurdle to achieving better care for the aging population?

One of the big factors in providing better care for seniors is the global adoption of true value-based care provider groups that are taking responsibility for the total cost and experience of their seniors’ health care. That needs to be combined with a new definition of “good patient care.”

We have a lot of metrics for measuring quality of care, but I think we can distill that patient experience down into a couple of things. One is the sentiment behind the experience driven by their feelings toward the provider and team. Two is whether the provider and team helped them achieve their health goals. Value-based care allows us to take on that view and advocate for what’s right for our patients at all times.

Those items coupled together would dramatically change the way we are able to provide care for the aging community. The shift to value-based care is not just about doing everything we can from a science and health perspective; it’s about listening to family members and patients so we can help them achieve their goals.

The U.S. health care system has been set up to operate as fee-for-service, and the hurdle is that we’re shifting towards value-based care, but we’re not shifting fast enough. There has been a migration toward fee-for-service and hospital-centric models while we should be moving  toward value-based care and primary care driven in the community.

How could individuals set themselves up for success in navigating today’s system for the aging population?

I’m a huge believer that an aging senior should be able to find a primary care provider who can spend time with them, understand what’s important to them and build a strong primary care relationship. If it happens in the home, I think that’s even better. But finding a physician who has time for you, that can turn into the biggest advocate you need.

My hope is that in the future, every primary care provider is like that. Today, that’s not true. There are still so many in the fee-for-service flywheel that it can be hard to find, but I know they exist in every market — if you can find them, that’s the key today.

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