For Community Providers

• Medical Doctors
• Advanced Practice Providers
• Behavioral Health Specialists
• Social Workers
• Nurse Care Managers
• Pharmacists
• Care Coordinators
• Healthcare Ambassadors
• Palliative Care Experts

This interdisciplinary care team is designed to help PCPs close quality gaps and amplify PCP care through urgent acute interventions, routine visits and thorough documentation – while giving patients maximized access to quality care.

Landmark does not take the place of patients’ PCPs. Landmark providers follow patients across the healthcare delivery system into their place of residence to ensure adherence to the PCP’s care plan.

Your billing and patient interaction remain the same, such as with routine wellness visits. Landmark is offered often at no cost to your patients in most markets as an extra dimension of support to the care you provide.

Landmark’s interdisciplinary care team is accessible to eligible patients and their PCPs 24/7

• Landmark acts as an in-home urgent care, offering diagnosis of acute conditions and immediate clinical interventions such as IV Lasix and antibiotics, wound care, real time blood draws, etc.
• Landmark treats patients longitudinally through screening and management of social determinants of health, thorough patient and caregiver education, medication reconciliation, fall risk assessments, home food assessment, advanced care planning, etc.
• Landmark can see patients post-discharge within 72 hours to ensure patient stabilization and understanding of any new medications or instructions.

By phone, direct message, secure fax or mail. The value of this program depends on strong communication and collaboration among the PCP, the PCP’s care management staff, and the Landmark provider and Complexivist® care team.

Landmark’s health plan partners identify eligible members based on their current health state, number of chronic conditions, and complex health needs. All Landmark patients have multiple chronic health conditions, and many also face social and behavioral barriers to health.

PCPs can call Landmark’s provider line to ask questions, receive a list of eligible patients on their panel, or refer eligible patients to Landmark.