Solutions For Medicare Advantage

Creating Cultural, Financial, and Clinical Alignment

The Lightbeam platform combines and analyzes data from various claims and clinical systems to provide a single source of actionable information to help payers manage their beneficiaries and provider networks. The more data we can consume, the more we can help improve your revenue streams through cost containment, avoidance, and quality improvements.

Actionable Insights at the Point of Care

Lightbeam provides insights from the plan level down to the provider and patient level to help you quickly identify areas of overspend, non-compliance, or patients who can benefit from additional care management. These insights are automatically distributed to the point of care, empowering your participating providers to make more informed decisions in real time.

Boost HCC Coding Accuracy, HEDIS Scores, and Star Ratings

Our approach to streamline payer data management gives you the insights needed to optimize risk scoring accuracy while operating as efficiently as possible. Our solutions integrate care management, risk stratification, analytics, and many more solutions to help drive quality outcomes and reduce the total cost of care.

The complicated health insurance marketplace presents confusion and challenges your ability to develop meaningful relationships with physicians and beneficiaries. At the end of the day, we want to partner with you for long-term success.

Upcoming Webinar - Thought Leadership Series

Population Management: Using Data to Intervene with High-Risk Members

South Bend Clinic

“Lightbeam helped us transform PCP engagement from care silos to care integration. We use the Lightbeam Patient Facesheet everyday to engage our providers and front-line staff for their quality initiatives.”

Andrea Cichra, The South Bend Clinic

Lightbeam provides the solutions and services you need to maintain control, no matter what the future of healthcare brings.


Evaluate Risk Adjustment Factor (RAF) Impact
HCC codes directly impact the overall RAF score for MA plans. If providers don’t code correctly, reimbursements will be inaccurate. Even an increase as little as .01 in RAF can be worth $8-9 per member per month.


Analyze Current HCC Coding Opportunities
Did you know that each year, CMS assumes conditions for patients no longer exist? Even for conditions like “amputation”. With access to claims, labs, and clinical data, healthcare organizations can identify “suspect codes” that suggest a patient has a condition that has not yet been diagnosed.


Maximize Quality Measures & Negotiate STAR Bonus
Quality scores are used by CMS to pay MA Plans; STAR reporting. By helping MA plans improve on quality, STAR bonuses are earned.

Lightbeam provides visibility into HCC coding for MA plans, showing patients HCC eligibility status which (when coded accurately) increases the average RAF score for the population, generating reimbursement dollars. Lightbeam also shows “suspect” codes that may otherwise be missed.

Lightbeam places this information at the point of care, when the patient is in the exam room, ensuring conditions are accurately tracked and coded.

How Is This Acheived?

Robust insights drive active engagement to deliver transformative results

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 patient.


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.

Meet other organizations who are already saving with Lightbeam.

Millennium FL In the 2017 performance year, Millennium Physician Group's Track 3 ACO earned an impressive $29.7 million in shared savings.
Rio Grande Valley TX In the 2015 performance year, Rio Grande Valley Health Alliance saved $8.6 million leveraging Lightbeam’s Population Health Solutions.
South Bend Clinic IN Since The South Bend Clinic partnered with Lightbeam, the ACO has been able to supply reports to physicians based on aggregated claims and clinical information.
Maury Regional TN Serving six primary counties, Maury Regional Health is the largest healthcare provider between Nashville and Huntsville, Alabama.

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