Solutions For Care Coordination

Facilitating Collaboration Between Clinicians and Their Patients

Patients' engagement and participation in their individual care plans is critical to a value-based care organizations' revenue, costs, and sustainability. However, while giving healthcare providers an integrated population health management platform is fundamental for success in managing patient populations, it falls short if an organization lacks resources to act on data insights it provides. This is where Lightbeam care coordination services come in.

Our clinical care team can administer activities on your behalf to improve patient care and reduce the need for costly medical services by helping patients and caregivers more effectively manage health conditions. Lightbeam’s care management services act as an extension of your team by facilitating collaboration among all clinicians, including regular patient communication, education, proactive engagement, early identification, and more.

We provide a custom model to fit your care management needs. With our care management extension services, you can outsource all care management activities, a portion of care management activities, or we can help cover care management activities until you are able to build an internal program.

We currently provide care management services for CMS covered programs, including AWV, CCM, and TCM.

Annual Wellness Visits

A Medicare-based program designed for providers to perform annually for patients. Included in this visit are key items which include: preventive services, health risk assessments, and more.

Chronic Care Management

Medicare has several care management programs designed to support patients with two or more chronic conditions in achieving an improved quality of life.

Transitional Care Mgmt.

A Medicare-based program designed to support patients who have recently been discharged from an in-patient setting to decrease the likelihood of readmission.

Care Team Extension Improves Patient Health Outcomes

In value-based care you are responsible for all patients. In a year you might see 600-800 patients of the total 1500-2000 attributed to you. We can help monitor them to reduce hospitalizations, ER visits, and improve health by engaging patients on a frequent basis.

LCS Diagram

Care Team Extension Benefits

Connect the full care team - Having all the available information helps to build the most impactful treatment plan. At Lightbeam, our team will centralize your data and reach out to all care team members.
Communicate with patients - Dedicated clinical staff will speak with patients on a regular basis to obtain current statuses, review treatment plans, provide education, and review progress between office visits.
Coordinate supporting services - Treatment plans for patients can involve several steps. Our team will coordinate appointments and any service needs for a higher rate of compliance.

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