Solutions For Care Team Extension Services

Optimize & Execute Your Care Management Strategy

Custom Model to Fit Your Needs

Lightbeam helps your care management operations by providing a custom model that fits your needs and strategy. With our care management extension services, you can outsource:


Lightbeam provides a set of activities to improve patient care and reduce the need for costly medical services by helping patients and caregivers more effectively manage health conditions. Our care management services are an extension of your team, facilitating collaboration among all clinicians, including regular patient communication, education, proactive engagement, early identification, and more.

Managing high-cost, high-need patients requires significant collaboration and proactive engagement from the entire care team. Lightbeam can support facilities with all the tasks needed to manage your patient population.

Our state-of-the-art call center and clinically certified staffed RNs and Health Documentation Specialists adapt their processes to your practice, ensuring maximum efficiency with minimum interruption to your daily workflow.

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.

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.

“This partnership is instrumental in our growth strategy. Lightbeam has been a pivotal tool that has allowed us to shift from fee-for-service to value-based care much faster than we otherwise could have.”

Jeffrey Nelson, CIO - Millennium Physician Group

Our Platform

Data Aggregation

Combine data from multiple sources to create a unified patient registry from which actionable insights can be generated.

Data Analysis

Measure real-time performance, cost, risk, and productivity against strategy and goals to prevent unnecessary spending.

Risk Stratification

Focus your care coordination resources on patients prioritized by concurrent and predictive risk models.

Cohorts Builder

Enable resources with little or no programming experience to initiate complex queries and generate specific lists of patients.


Artificial Intelligence (AI)

Identify patients who are at risk of developing or undiagnosed chronic conditions.

Referral Management

Improve the efficiency of referrals by visually matching patients to the ideal provider based on 6 essential data points.

Lightbeam HIE

Streamline clinical data across complex environments and care settings leveraging a health information exchange.

Patient Engagement

Communicate bi-directionally with your patients using custom messaging tailored to personality type, including care plan steps, medication and visit reminders.

Physician Engagement

Engage providers at the point of care with the actionable insights they need to maximize quality and coding opportunities.

Care Management

Assign, monitor, and track custom or evidence based care plans and steps for patients enrolled in care management program.


Save time and simplify the end of year reporting experience to enhance your ACO participation efforts.

HCC Coding

Engage providers with coding compliance and suspecting information to ensure the highest levels of accuracy and reimbursement.

Our Services

Lightbeam advisors are value-based contract experts. They analyze the structure of your contracts to help you focus on the areas to optimize performance.
Lightbeam's Benchmark Assessment service provides personalized reports that analyzes your patient data. Areas of comparison include percentage of spend based on specialist, procedures, rendering provider, and more. Each area is compared to those around you and the national average.
Lightbeam helps you prioritize care manager resources by identifying high-cost, high-risk patients and then stratifying them by risk, looking at historical costs of care, diagnosis codes, social conditions, etc.
In context of your contracts and staff resources, Lightbeam leverages the power of data aggregation to identify patient populations that would benefit the most from care management intervention, based on preventative care programs.

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