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How it Works
In-Home Medical Care by Mobile Providers
Landmark Health partners with health plans to bring house calls to patients living with multiple chronic conditions. Landmark’s providers – physicians, nurse practitioners and physician assistants – go to the homes of patients to help keep them well, and provide urgent care when needed.
Landmark does not replace patients’ primary care providers (PCPs). They help patients follow care plans in the home. PCPs are kept in-the-know with visit notes after each home visit, and are consulted if there are recommended changes to care or medications.
New Landmark Patients
Patients must qualify for the Landmark program through their health plan. If you are eligible for Landmark’s care, here’s what you can expect:
You’ll receive a letter from your health plan introducing Landmark Health.
Then Landmark’s outreach team will call to discuss the program and schedule a house call visit with a Landmark provider.
During this initial visit, we’ll ask about you and your health goals, review Landmark’s services and medical consents, discuss your medical history and conduct a physical.
Once you are a Landmark patient, you will have access to Landmark providers any time of the day or night, including weekends and holidays.
Learn More About the Areas We Service
Interested in experiencing a Landmark house call? Ride along with some of our providers as they visit patients in their homes.
Existing Landmark Patients
If you are currently a Landmark patient, you have access to Landmark’s providers and full specialized care team. We will help keep you well at home and treat you in place when needed. This is concierge medicine that comes to you, whether you are worried about a suspicious spider bite, are feeling blue, or concerned about coming down with the flu.
Services Available to You
Our visits are designed around your health needs and schedule. Everything from checking your vitals, and reviewing your medications, to cultivating in-depth discussions around the kitchen table that aren’t possible during medical office visits.
24/7 Phone Care
Sometimes you aren’t feeling well when your doctor’s office is closed or your PCP is too busy to see you. You’re not sure if you should wait, go to an urgent care, or even go to the hospital. Landmark patients can call their care team any time of the day or night to help make these decisions and receive urgent care in their home if needed.
Living with multiple chronic conditions may mean that you have several doctors, not to mention worried family members or caregivers. Landmark can be a single source that considers your whole health and helps facilitate communication to everyone involved. We can also make recommendations to your health plan for additional services and care that you should receive, including physical therapy, home health nurses, walkers and more.
Receive urgent diagnoses and treatments at home, including fluids, medications, prescriptions, labs and X-rays. No appointment is necessary and you can avoid the drive to urgent care or the hospital, in addition to the wait, the germs and the bills.
Coming home from the hospital or skilled nursing facility can be a challenge. Many patients are re-admitted within a few weeks as new diagnoses and medications can be confusing. Landmark providers meet you at home, review discharge instructions and medications, and help you coordinate follow-up appointments.
Specialized Care Teams
As a Landmark patient, you have access to a full team of people working to help you meet your health goals and stay well at home.
Physician, Nurse Practitioner, Physician Assistant
Highly educated and experienced providers. Experts in delivering medical care to patients in the home. Ongoing training to address chronic conditions in place.
Behavioral Health Specialist
Visit patients in the home and listen with dignity and respect. Assess the need for ongoing treatment, medication and social support.
Review medications and ensure optimal drug selection. Meet with patients over the phone or in person to answer their medication questions and educate them on how best to take them.
Nurse Care Manager
Work with patients over the phone and in collaboration with the Landmark provider. Acts as an advocate for patients’ health and life goals.
Work with patients in their home and help connect them to community resources that may improve their health and well-being.
Counseling on how food can impact overall health, including diet recommendations. Small, low-cost changes can lead to big health improvements.
Work with patients in the home and over the phone to gather information that helps Landmark providers better care for patients.
Complexivists® and Urgentivists™
Landmark patients frequently have higher healthcare needs because they are often managing multiple chronic conditions. Their conditions are persistent and may require interventions to proactively identify and resolve illness or disability. To address this, our providers go through extensive education and training to help care for patients with complex needs. Beyond medical care, our providers see to the long-term physical, social and mental health and well-being of patients. We’re evolving the roles of providers to meet the needs of these patients.
A complexivist is a physician or advanced practice provider who brings high-quality care to complex patients, where they reside. These providers act like hospitalists at home.
An urgentivist is a physician or advanced practice provider who treats patients urgently in place. These providers are available without appointments to visit patients at home when an assessment or care is needed quickly.