1) Local management was disengaged from the job, not effective, and absent a lot of the time as the team grew and work increased.
2) Medical leadership was competent, but very hard on staff, and set a poor example by working long hours, and working sick. Very strong personalities and was aggressive with patients at times.
3) Top management, while talented and personable, are from out of state, and did not adequately research the market prior to establishing here in Portland. Primary care here is VERY difficult to collaborate with. This made launch very challenging for providers trying to coordinate care.
4) Launched with only TWO nurse practitioners, and patients that spanned geographically from Forest Grove to Gresham. Expected 24/7 call until more providers were hired. Did not bring the entire out of state team in to give extra support during launch. (trainers, additional providers).
5) Failed to find adequate support for providers 6 months into launch, requiring providers to work 60-70hrs plus call weekly.
6) Work Life balance was not a priority here, though they tried to promote this.
7) Pay was sub par for Portland; NPs are making well above average in the PDX metro area. At minimum should be paying them between $115K-$125K DOE. Later on offered sign on bonus to new recruits.
8) Poor preparation and training of staff. Too much team building and not enough orientation, developing policy and procedure prior to launch, trainers were mostly absent after launch, and also from out of state. Trainers also underqualified for this position, and should be comprised of masters-prepared nurses or advanced practice nurses: CNS, or NP. Should have been familiar with home health regulations and clinical procedures/equipment etc. Providers taught trainers what to implement.
9) On-call coverage was poor. Safety of providers was also a concern, with working too many hours.
10) Electronic Medical Record was awful. Developed by team out of the country, and non-medical. This slowed productivity and made the work for the NPs/MDs that much more difficult. Providers were doing ALL the data entry. This should have been ready to go prior to the launch. Market research here in PDX should have pointed management toward purchasing EPIC, as most of the health systems in PDX use it in one form or another, and communicate, at least on a limited basis, patient info within the systems.
11) Landmark has a contract with insurance companies, which mean the major priority is saving them money. Avoiding hospitalizations (but did not have adequate resources and coordination to treat/monitor in the home). Bottom line was the priority. Difficult to help patients when the very insurance company does not cover certain services, medications, etc.
12) Providers were also having to draw their own lab work and deliver to labs.
13) On-call phone system was a nightmare. Again, this should have been ready to go from the launch. Had to troubleshoot this constantly. Some patients couldn't reach providers as they were long-distance calls to provider cell phones that were California based (home base is Huntington Beach for Landmark).
14) More and more work piled onto providers to collect data for insurance company, including more heavily focused on coding and capturing demographics, etc.
15) If insurance contract is terminated, providers will have to ramp up new panels as they new insurance contracts are brought in. Initial visits with patients and a new panel are an incredible amount of work with how they have structured their business model, and having a poor EMR makes this even more challenging.
