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Blue Shield of California and Blue Shield of California Promise Health Plan (Blue Shield Promise), an affiliate of Blue Shield of California, are offering this new home-care program for members with multiple chronic conditions.

This is an invitation-only program for eligible Blue Shield of California/Blue Shield Promise members. If you are eligible you and your doctor will receive a letter inviting you to participate. Eligibility is determined based on your health, and the number and type of chronic conditions you have.

Overview

When people are managing multiple medical conditions, it is a valuable service to have a team of medical professionals who come to them, in the place they live. Landmark’s in-home medical teams will work with members and primary care providers (PCPs) to manage their conditions, so they can stay healthy at home, with fewer trips to the hospital.

The Landmark team does not replace a member’s PCP or other specialists. Members continue to see the providers they know and trust, and they have access to the additional support of a Landmark in-home medical team. The Landmark team visits the member according to their schedule and may include: physicians, nurse practitioners, physician assistants, nurse care managers, pharmacists, behavioral health specialists, social workers and ambassadors.

Landmark providers are available via phone 24/7, so these chronically ill members can get expert advice even when their regular doctor’s office is closed. They can provide wellness visits, urgent care, or post-hospital care all in the comfort of the eligible member’s home.

Benefits

This program is available to eligible Blue Shield or Blue Shield Promise members with multiple chronic conditions at no additional cost to eligible members. There is no co-pay for services provided by Landmark.

Who qualifies Landmark care provides
Patients with coverage under a Blue Shield commercial HMO or PPO, or Medicare Advantage benefit plan Home-based medical care led by physicians, nurse practitioners or physician assistants
Patients with six or more chronic health conditions Post-acute visits and urgent care visits
  24/7 availability via telephone
  Team-based interdisciplinary care: behavioral health specialist, pharmacist, nurse care manager, dietitian and social worker
Chronic conditions that qualify patients for Landmark’s program:

Patients are eligible for the Landmark program if they have six or more of the following conditions:*

  • Atrial fibrillation
  • Cancer
  • Cerebral vascular disease
  • Chronic kidney disease
  • Coronary heart disease
  • Dementia
  • Depression
  • Diabetes
  • Heart failure
  • Hypertension
  • Lung disease
  • Peripheral vascular disease
  • Cirrhosis with or without complications

* Medicare members must have at least five of the above conditions.

 

More

Who is Landmark?

Landmark is a community-based medical group that specialize in home-based care to chronically ill patients. Landmark’s providers do not take the place of patients’ PCP – they communicate and work collaboratively with the patient’s PCP and specialists. Its proven clinical model reinforces the primary physicians’ in-office care plan and provides the additional high-touch care that chronically ill patients with complex health conditions require.

How does the Landmark program work?

Blue Shield identifies members who are eligible to participate based on their health, and the number and type of chronic conditions they have. 

Eligible Blue Shield and Blue Shield Promise members will receive a letter from Blue Shield/Blue Shield Promise and Landmark, inviting them to participate in the program and providing details about how it works. They then receive a follow-up call from a Landmark professional to set up an introductory appointment in their residence. The member can accept or decline the offer.

The first visit lasts about 60 minutes, and a schedule is then set up by Landmark. Once a member is participating with the program, Landmark’s medical team sets up a collaborative communications schedule with the member’s PCP.

What services does Landmark provide?
  • Medical, behavioral and social care in an in-home setting
  • Urgent care home visits
  • Wellness visits
  • Post-discharge visits
  • 24/7 telephone support

The Landmark service is part of the growing suite of comprehensive in-home care services designed to improve the quality of and access to health care for our members.

To read more about our collaboration with Landmark, please visit our News Center.

Disclaimer

This is an invitation-only program for eligible Blue Shield of California/Blue Shield Promise members. Patients who are eligible will receive a letter inviting them to participate. Eligibility is determined based on health, and the number and type of chronic conditions a patient has.


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