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Payers

The cost of physical medicine exceeds a quarter trillion dollars in the U.S. and is growing fast. For many health plans, these costs now represent more than 5% of their total medical expenditures—big enough to make a difference but not large enough to support an internal, expert management group.

Landmark is a utilization management company focused solely on physical medicine. We have been managing physical medicine benefits exclusively for health plans since 1985. Today we serve more than seven million health plan members throughout the country and promote evidence-based medicine in:

  • Physical, Occupational and Speech Therapy
  • Chiropractic and Acupuncture
  • Spine Surgery
  • Interventional Pain Management

Our services include utilization management, claims administration, and network leasing and development. For a more complete description, see Services and Solutions.

Landmark’s management approach is built on the premise that providers are individuals and as a result their performance is unique. It is simply a fact that across a given network practice patterns will vary greatly. We use risk-adjusted claims data to identify providers whose utilization varies from that of their peers and then focus our management on this subset of the network. As a result, less than half of all network providers and considerably less than half of all patient encounters are actively managed under one of our programs. However, the performance of all providers is continuously monitored using our web-based profiling tool, the Practitioner Performance Summary (PPS). Using the PPS, providers can track and manage their utilization metrics and each provider’s profile is updated monthly. Our data intensive management programs engender fact-based dialogues with providers about unjustified variation and best practice benchmarking. Our goal is to motivate and educate, not mandate.

The touchstone of our management lies in our proprietary clinical practice guidelines. We recognize that our programs are only as good as the treatment authorization decisions that we make every day and so we devote significant resources to keeping our guidelines at the state of the art. Just as important, our like-specialty case managers all have many years of “real world” experience and so understand the daily challenges of operating a clinic in a complex world of multiple payers and management systems. Finally, we are very sensitive of the need to maintain the plan’s goodwill with its network and members and so we strive to be easy to work with.

Landmark’s customer service, eligibility, claims and operational teams are exceptional in their ability to administer complex benefit designs, resolve administrative issues and provide high levels of customer satisfaction. We currently administer over 2,500 different benefit plans, from HMO's with fixed co-payments through the most complicated PPO, ASO and indemnity benefit plans.

We are confident that our enthusiasm, expertise and extensive experience will assist your health plan in achieving its financial and patient care goals.