Launch and scale CCM, RPM, RTM, APCM, PCM, TCM, and AWV programs without hiring staff, managing devices, or worrying about audits. Predictable monthly Medicare revenue with minimal provider time required.
In the real world, not just in theory.
Family medicine, internal medicine, and general practice clinics managing aging or underserved populations. Predictable monthly Medicare revenue with audit-ready documentation.
Mission-driven organizations serving complex and dual-eligible patients. Scalable APCM-first programs with high engagement, zero-copay patient models.
Cardiology, endocrinology, pulmonology, nephrology, and similar specialties. Condition-specific care pathways with focused RPM, RTM, and PCM programs.
No care coordinator hiring required. Our fully managed model handles outreach, monitoring, documentation, and compliance.
Our AI-enhanced workflows support routine care management activities: patient outreach, check-ins, documentation, and monitoring. Your clinical team stays in control, with clear escalation for situations requiring clinical judgment.
Compliance and audit defense are built into the core of our platform.
We eliminate double documentation, reduce staff dependency, and fit into how small and mid-sized practices actually operate.
For many practices, APCM replaces the complexity of traditional CCM.
Our AI is transparent, supervised, and purpose-built for healthcare.
Six steps that take care management off your plate entirely.
We continuously analyze EHR data to identify patients eligible for care management programs based on diagnoses, utilization, and payer rules.
Patients are enrolled through compliant phone, SMS, or in-practice workflows with documented consent. Joint enrollment efforts significantly improve participation.
Patients receive ongoing outreach, monitoring, and education through AI-assisted workflows and connected devices when applicable.
Urgent or clinically significant issues are routed to your team immediately. Non-urgent items are queued for review at your convenience.
Every interaction is documented automatically and validated against Medicare requirements.
Billing workflows are generated only after compliance checks are complete and are ready for submission or handoff to your billing team.
Operated end-to-end so you can focus on patient care.
A modern alternative to traditional CCM with no time tracking, tiered reimbursement based on patient complexity, and simplified monthly billing.
Learn more →Structured monthly care coordination for patients with two or more chronic conditions. The foundation of care management for many practices.
Learn more →Physiological monitoring using connected devices like BP monitors, glucose meters, and scales. Real-time data visibility for clinical decisions.
Learn more →Therapy-focused monitoring for musculoskeletal, respiratory, and behavioral health conditions through patient-reported outcomes.
Learn more →Focused management for patients with a single high-risk chronic condition requiring intensive, specialty-specific care pathways.
Learn more →Post-discharge follow-up within 2 business days to reduce readmissions through medication reconciliation and care gap closure.
Learn more →Tools and workflows to identify preventive care gaps and support AWV completion with health risk assessments and prevention plans.
Learn more →Add-on support for patients with depression, anxiety, or other behavioral health needs integrated into primary care.
Learn more →Powered by AI, built for compliance.
We integrate with leading EHRs to avoid duplicate work and keep records consistent. No manual data entry required. Works with Epic, Athenahealth, eClinicalWorks, NextGen, Allscripts, and more.
So your team doesn't have to.
We handle the heavy lifting of care management, including outreach, monitoring, documentation, compliance, and billing workflows, so your team does not need to hire or manage care coordinators.
While CareStream proactively enrolls patients through automated outreach and follow-up, enrollment works best when practices participate directly.
Optional services to accelerate growth and operations.
For practices looking to grow patient volume, strengthen their brand, and improve online presence.
For practices seeking operational and financial advantages through our network of Management Services Organizations.
Optional end-to-end billing support for practices that want a single partner.
See how CareStream can launch compliant, scalable care management in your practice.