Quick hello — who are we partnering with?

• Who will be our primary day-to-day contact for this initiative (role & name if known)? Options: VP, Care Management, Chief Nursing Officer, Director, Care Management, Clinical Program Manager, IT Integration Lead, Other (please specify)
• How urgent is this initiative on a scale from “monitoring” to “mission-critical” for your team right now? Options: Mission‑critical — immediate action required, High priority — within 30–90 days, Medium priority — this quarter, Lower priority — 6–12 months
• In one sentence, how would your team describe the primary goal we should be solving together?
• When you think about your care managers today, what single frustration do they mention first (e.g., caseload, documentation time, alert noise)?
• Which existing vendors, internal teams, or legacy tools are already involved in care management today? Options: EHR (Epic/Cerner/Allscripts), Claims platform, Analytics vendor, Existing case management system, Outreach/IVR vendor, No external vendors, Other

Who's actually holding the pen on decisions?

• Who must give final approval to purchase and/or deploy a new care management platform — and who could veto it? Options: VP Care Management, CMO/Medical Director, CIO/IT, Chief Nursing Officer, Finance/CFO, Compliance/Legal, Procurement, Other
• How do those decision-makers typically reach a decision — single approver, executive committee, or consensus across stakeholders? Options: Single approver, Executive committee, Consensus across multiple leaders, Procurement-led panel, Unclear / varies
• For each of the roles you selected, what does success look like to them? Please list role → top outcome or concern.
• Who outside of leadership (e.g., frontline nurses, utilization managers) will need to be convinced, and how do they usually express resistance? Options: Frontline nurses/care managers, Utilization review team, Provider partners, Quality/PI team, No frontline resistance expected, Other
• How do decisions get escalated when a pilot or vendor isn’t meeting expectations (timeline, SLA, outcomes)? Options: Immediate exec review, Operational remediation plan, Contract negotiation, Pause/stop pilot, We don’t have a clear escalation path

If this doesn’t move the needle, who feels the pressure?

• Whose performance, budget, or contract renewal is most exposed if avoidable ED visits and PMPM don’t improve? Options: VP Care Management, Chief Nursing Officer, CMO, Finance/CFO, Provider network leadership, Other
• Which measurable KPIs are non-negotiable for your team to consider this initiative successful within 6–12 months? Options: % reduction in avoidable ED visits, PMPM cost reduction, NCQA readiness/score improvement, HEDIS/utilization metrics, Clinician adoption/engagement, Member experience (Satisfaction)
• Please provide current baseline values (or best estimates) for the top 3 KPIs you selected above.
• What PMPM reduction target (approximate %) would satisfy finance in a 12‑month window? Options: >10%, 7–10%, 4–6%, 1–3%, No explicit target defined
• Who will be responsible for validating the financial outcomes (role/team)? Options: Finance/CFO, VP Care Management, Value-based contracting team, Third‑party actuary, Other

Audit day: could you pass right now?

• If an NCQA or state audit happened this week, which of these artifacts are ready and easily exportable? Options: Care manager caseload lists with timestamps, Documented clinical protocols, Training logs and competencies, Member outreach logs (calls/texts), ADT/claims intake logs, We do not have audit‑ready artifacts
• What’s the single biggest compliance or audit concern that keeps leadership up at night?
• Have you had any recent findings, notices, or corrective actions related to care management quality or audits? Options: Yes — corrective action required, Yes — minor findings, No, Unsure
• What specific evidence would satisfy auditors that your care management workflows meet contractual and NCQA standards?
• Who owns audit readiness and how many dedicated FTEs or hours per month can they commit to preparing artifacts? Options: Compliance lead, Quality/improvement team, Care management ops, No dedicated owner / shared responsibility

Data flows and integrations — where do projects actually get stuck?

• If our engineers can’t get reliable access to ADT/claims/EHR data in the first 30 days, will the project pause or proceed with a reduced scope? Options: Pause until full data access, Proceed with reduced scope/pilot, Use synthetic/sample data until live feeds, Unsure
• Which of these data feeds are live or easily accessible today? Options: Real‑time ADT, Daily claims, Pharmacy claims, Lab results, SDOH screening data, EHR clinical notes, None / limited access
• Which systems/platforms are primary for your providers and payers (check all that apply)? Options: Epic, Cerner/Oracle, Allscripts, In-house EHR, Vendor claims platform (specify below), Other
• Do you have sample files, data dictionaries, or existing API specs we can review during technical kickoff? Options: Full documentation available, Partial / some examples, No documentation available
• What security, hosting, or legal constraints must we meet before connections are approved (e.g., on‑prem only, SOC2, BAAs)? Options: SOC2 Type II, HIPAA BAA required, On‑prem only / no cloud, Private network / VPN, State-specific security rules, Other
• Who owns integrations on your side and what SLA can they meet for development and testing?

Timeline pressure — perfect vs practical.

• If everything lined up today, when do you need measurable improvement to influence contract renewals or audits? Options: Immediate (within 30 days), Within 3 months, Within 6 months, Within 12 months, No specific deadline
• Is there an RFP or procurement milestone we must align with (date or window)? Options: RFP open/near (≤30 days), This quarter, Next quarter, 6–12 months, No RFP planned
• What pilot length and cohort size would your team consider sufficient to make a go/no‑go recommendation? Options: 4–8 weeks, small cohort (50–200), 3 months, medium cohort (200–1,000), 6 months, larger cohort (1,000+), Depends on metrics agreed
• Which internal gating milestones most often delay projects of this type? Options: Legal/BAA signoff, Data access approvals, Budget approval, Provider engagement / contracts, Clinician training availability, Other
• How much flexibility does procurement/finance have to approve phased commercial terms (pilot → scale)? Options: Highly flexible, Some flexibility with executive buy‑in, Fixed terms only, Unsure / varies

What would make you say yes — the deal clincher?

• What’s the single, non‑negotiable piece of evidence or guarantee you’d need to greenlight this platform?
• Which acceptance criteria must be demonstrably met at pilot completion for you to recommend scale? Options: Configured clinical workflows signed off, End‑to‑end live data integrations, Clinician adoption / task completion rate threshold, Observed reduction in ED visits vs baseline, NCQA artifact package ready, Financial validation of PMPM improvement
• What clinician adoption metric would feel like a success (e.g., % of care managers using the workspace daily)? Options: >90%, 75–90%, 50–74%, <50%, Unsure / qualitative only
• Who needs to be at the final commercial decision meeting? Options: VP Care Management, CMO/Medical Director, CIO/IT, Finance/CFO, Procurement, Compliance/Legal, Other
• What would be the ideal next artifact or step from us to help you move toward a decision (pick all that apply)? Options: Pilot plan & SOW, Data mapping template, ROI / PMPM model, NCQA audit checklist, Demo with your live sample data, Reference customer call
• Before we wrap up, what are you most afraid will go wrong if you pursue this change?

Quick Snapshot: Where Are You Today?

• In one short sentence, how would you describe the single biggest thing keeping your care management team from preventing avoidable ED visits today?
• Which of these pressures feels most urgent to leadership right now? Options: Rising avoidable ED visits, PMPM cost overruns, NCQA / audit readiness, Clinician burnout / caseloads, Provider integration delays, Other
• What is the typical RN care manager caseload (median or most common range)? Options: <30, 30–49, 50–79, 80–99, 100+
• On an average shift, how would you describe time split between documentation vs member outreach? Options: Mostly documentation (>60%), About even (40–60%), Mostly outreach (>60%), Highly variable day‑to‑day
• When did your avoidable ED rate begin to rise and what pattern have you seen since (steady, seasonal, cohort-driven)?

If We Keep Quiet About This, What Breaks Next?

• If the current approach continues for the next 6–12 months, what will be the most painful operational or financial consequence?
• Which of these drivers do you believe is the primary upstream cause of the avoidable ED increases? Options: Poor post-discharge follow-up, Lack of SDOH support (housing/transportation), Medication non-adherence, Missed primary care access, Behavioral health crises, Risk stratification misses, Other
• Which member cohorts are disproportionately contributing to avoidable ED visits? Options: Top 1% utilizers, Top 5% chronic complex, Serious mental illness, Substance use disorder, Dual eligibles, High social risk (SDOH)
• How predictable are spikes in ED use (we can forecast them vs they feel random)? Options: Highly predictable, Somewhat predictable, Unpredictable, We haven't tried to forecast
• How quickly can your team currently deploy an outreach intervention to a flagged high-risk member (from signal to completed outreach)? Options: Same day, 1–3 days, 4–7 days, More than a week, Not tracked

Who Actually Owns the Decisions and the Day-to-Day?

• Who in your organization loses the most sleep when avoidable EDs rise—whose job title changes if this keeps happening?
• Which stakeholders must align to change a clinical workflow (select all who need to sign off)? Options: VP Care Management, Chief Medical Officer (CMO), CIO/IT, Finance, Chief Nursing Officer, Utilization Management Lead, Provider network leadership, Other
• Who is the operational owner for day‑to‑day care manager tooling and who is the executive sponsor for program outcomes?
• How aligned are the VP Care Mgmt, CMO, CIO and Finance on timeline and measurable targets for improvement? Options: Tightly aligned — shared targets and timeline, Mostly aligned but some disagreements, Major misalignment on priorities, We haven't had that discussion
• Who will be our primary point of contact for discovery and for data/integration discussions?

Hidden Data, Missing Signals — Where Things Go Dark

• Tell us about the last time a patient ‘fell through the cracks’ because a feed, alert, or data point failed to arrive—what happened?
• Which of these data sources do you currently receive and how reliable are they? Options: Real‑time ADT (reliable), Real‑time ADT (intermittent), Claims (daily/near‑real‑time), Claims (delayed batch), EHR CCD/C-CDA, Pharmacy claims, Labs, SDOH screening data, Provider outreach notes, None of the above
• Do you have a consistent unique identifier linking claims, ADT and EHR (e.g., member ID matched across systems)? Options: Yes — one canonical ID, Partially — matches for some feeds, No — matching is manual or missing, Unsure
• How often do you receive ADT alerts today? Options: Real‑time streaming, Near real‑time (minutes–hours), Daily batch, Irregular batches, Not currently receiving ADT
• About what percent of your active population has usable SDOH screening data attached to their profile? Options: 0–10%, 11–25%, 26–50%, 51–75%, 76–100%, We do not track this

A Day in the Life of Your Care Manager (Be Honest)

• If an outsider watched a care manager for a day, what would surprise them most about how work actually gets done?
• Which of these tasks occupy the largest slice of a care manager’s time? (select top 3) Options: Documentation/charting, Outbound outreach (calls/text), Care plan updates, Coordinating transportation/social supports, Prior auth/UM tasks, Data reconciliation/lookup, Inbox/fax processing, Other
• Which tools/systems do care managers toggle between most frequently? Options: EHR, Claims portal, ADT viewer, Legacy case management system, Excel trackers, Fax/phone, Secure messaging, Our platform (if applicable), Other
• How many separate systems does a care manager typically need to touch to complete a single outreach workflow (estimate)? Options: 1, 2, 3, 4+, Varies widely
• What single manual handoff or task creates the most delays in closing care gaps?

Failure Modes That Actually Cost You Money

• Which recurring failure mode would you point to if someone asked: ‘Where are we literally wasting dollars?’
• Which of these failure modes drive avoidable ED use in your population? Options: No timely post‑discharge contact, Missed medication reconciliation, Inaccurate risk stratification, Lack of transportation to follow‑up, Behavioral health escalation unmanaged, Provider access delays, Other
• How often do those failures occur for the highest‑risk cohort (approx % of cases)? Options: <10%, 10–25%, 26–50%, 51–75%, 76–100%, We don't track this
• When a failure occurs, how is it typically discovered (claims review, member complaint, clinician chart review, audit)? Options: Claims/retrospective review, Real‑time ADT/alerts, Member or provider complaint, Routine chart audits, We rarely discover failures systematically
• Do you currently run root‑cause analyses and store lessons learned so the same failure doesn’t recur? Options: Yes, consistently documented, Occasionally, Rarely, Never

Audit Day: Can You Produce the Paper Trail?

• If an auditor requested evidence of timely follow‑up and interventions for a sampled cohort, would you be confident in producing it within 48 hours? Options: Yes — fully confident, Somewhat — would take effort, No — would take weeks, We don't have auditable records
• Which documentation elements are reliably captured today (select all that are consistently stored)? Options: Care plans, Contact attempts/logs, Risk stratification scores, Intervention details and outcomes, Referrals and closed‑loop confirmations, Consent and SDOH assessments
• What percentage of charts would you estimate meet NCQA care management documentation standards today? Options: >90%, 70–90%, 50–69%, 30–49%, <30%, Unknown
• How long would it take you to run member‑level reports linking interventions to outcomes for an audit (e.g., 12 months of interventions vs ED visits)? Options: <1 day, 1–3 days, 1–2 weeks, More than 2 weeks, Not possible currently
• What specific documentation or systems gaps would most likely cause an audit finding?

What Small Fix Would Feel Like a Miracle?

• If one modest change could reduce avoidable EDs among your highest‑risk 10% by 20%, what change would you pick first?
• Which of these interventions do you already have some evidence for within your organization? Options: Focused post‑discharge outreach, Automated ADT->workflow routing, SDOH navigation services, Medication reconciliation workflows, Behavioral health rapid response, None of the above
• What quick wins could realistically be tested in a 60–90 day pilot?
• What constraints would most likely prevent a fast pilot (select all that apply)? Options: Limited data access/integration, Security/privacy review timelines, Staff bandwidth, Contracting/commercial approval, Budget constraints, Provider engagement
• Who internally would need to sign off to greenlight a 60–90 day pilot? Options: VP Care Management, CMO, CIO/IT, Finance, Compliance/Privacy, Operational sponsor (director), Other

How We'll Measure Progress — Metrics That Matter

• Are your current success metrics set up to be actionable (linked to workflows and roles) or mostly retrospective KPIs? Options: Actionable and tied to workflows, A mix of both, Mostly retrospective KPIs, We haven't defined clear metrics
• Which outcome measures would you prioritize for a first pilot (select up to 3)? Options: Avoidable ED visits, PMPM cost, 30‑day readmissions, Care manager time saved, NCQA readiness score, Member satisfaction/engagement, HEDIS gap closure
• What attribution window would your finance team accept to link intervention to cost impact? Options: 30 days, 60 days, 90 days, 180 days, 12 months
• What is the minimum measurable percent improvement you would require to consider a pilot commercially viable? Options: >5%, 5–10%, 11–20%, >20%, Undecided / depends on cohort
• Who will own ongoing measurement and reporting once a pilot moves to scale? Options: VP Care Management, Quality/Analytics team, Population Health team, Finance, Third‑party vendor, Other

Next Smart Steps — Commitments, Risks, and Red Flags

• What is the single biggest red flag that would make you stop a deployment in the first 90 days?
• Which of the following must be in place before you consider a pilot (minimum set)? Options: Access to ADT feeds, Claims data for cohort definition, Identified pilot cohort, Operational owner and staff time, Security/BAA in place, Executive sponsorship
• Do you have any fixed deadlines (RFP due date, NCQA audit, contract renewal) that would constrain our timeline? Options: Yes — specify dates below, No fixed deadlines, Unsure
• What would meaningful progress look like at 30 / 90 / 180 days (one line each)?
• Are you open to a focused 6–8 week discovery engagement that produces: prioritized failure modes, data map, pilot design, and a timeline? Options: Yes — ready to start, Maybe — need to confirm stakeholders, No — prefer a different approach

Start with Your Story

• Tell us your role and the one-sentence reason you invited us to this conversation.
• How long have you been accountable for care management at this plan? Options: Less than 1 year, 1–2 years, 3–5 years, 6–10 years, More than 10 years
• Who are the key stakeholders we should be speaking with on this initiative (please list titles and their primary concern)?
• What single event or metric change most clearly triggered urgency right now (e.g., ED visits up 15%, upcoming NCQA audit, contract renewal)? Options: Avoidable ED increase, Upcoming NCQA/contract audit, Rising PMPM costs, Provider escalation/complaints, Other
• If you could capture how this situation feels to you in three words, what would they be?

Are We Comfortable With 'Good Enough'?

• If nothing changes, what does 'good enough' look like for your care management program in 12 months—and who will bear the consequences? Options: Stable workflows but rising costs, NCQA scores decline, Higher audit risk/penalties, Worse member outcomes/readmissions, Other
• How has the 15% increase in avoidable ED visits translated into financial or contractual pressure for your team (examples, dollar estimates, or penalties)?
• Which quality or contractual thresholds are you most worried about missing if performance doesn’t improve? Options: NCQA accreditation metrics, State Medicaid contract KPIs, HEDIS/Stars measures, Internal care management targets, Other
• Who inside finance, legal, or executive leadership is actively asking about care management performance—how vocal are they and how often do they request updates? Options: Daily, Weekly, Monthly, Quarterly, Only on request
• What would an unacceptable outcome look like to you—both operationally and politically—if we fail to reverse current trends?

Where the Day Really Goes

• Which single task consumes the most clinical time but produces the least measurable impact? Options: Clinical documentation, Manual data reconciliation, Outbound calling/logistics, Updating trackers/Excel, Prior authorization/phone tag, Other
• On an average day, how many members does a nurse care manager actively manage (typical caseload)? Options: <20, 20–40, 41–60, 61–80, 81–100, >100
• What percentage of a care manager’s time is spent on direct member outreach versus documentation and coordination? Options: >75% outreach, 50–75% outreach, 25–50% outreach, <25% outreach
• Which workflows currently require manual cross-checking across multiple systems (give 1–3 concrete examples)?
• Can you describe a recent member case where the current workflow failed to prevent an avoidable ED visit—what happened and why?

What Keeps Your Clinicians Awake at Night?

• If a new platform doesn’t make your clinicians’ lives measurably easier within 30 days, would leadership consider stopping the rollout? Options: Very likely, Somewhat likely, Unlikely, Depends on pilot results
• What are the three most common frustrations nurses or care coordinators voice about your current tools or processes?
• Tell us about prior technology rollouts—what worked, what failed, and what you learned about clinician adoption?
• Which adoption levers have the most influence in your organization (e.g., incentives, protected time, clinical champions, mandatory training)? Options: Clinical champions, Incentives/bonuses, Protected workflow time, On-site coaching, Mandated compliance, Other
• How do you measure clinician burden or burnout today (surveys, turnover, time-motion studies, other)? Options: Surveys, Turnover rates, Time-motion data, Anecdotal reports, Not measured

What Success Actually Looks Like (Show Me the Money and the Metrics)

• If finance asked for one number to justify this investment in 12 months, what single metric would close the deal for you? Options: PMPM reduction, Avoidable ED % reduction, Total cost of care reduction, NCQA readiness score, Return on Investment (ROI), Other
• What is your target for that metric (specific percentage or dollar amount) and what is today’s baseline?
• What attribution window do you consider fair for measuring impact (e.g., 30, 60, 90, 180 days) for avoidable ED and PMPM improvements? Options: 30 days, 60 days, 90 days, 180 days, Other
• Beyond the headline metric, what operational indicators will tell you a rollout is on track (examples: outreach completion rate, risk stratification precision, closed-loop referrals)?
• How confident are you in your current data and analytics to measure those outcomes reliably? Options: Highly confident, Somewhat confident, Low confidence, Not confident at all

Data & Integration: Nightmare or Launchpad?

• Which integration, if delayed or inaccurate, is most likely to derail deployment? Options: Claims feed, Real-time ADT alerts, EHR interoperability (read/write), Pharmacy/PDMP, Lab results, SDOH feeds, Other
• Which data standards and transfer methods are your systems currently able to support out-of-the-box (select all that apply)? Options: FHIR APIs, HL7 v2, SFTP flat files, Custom APIs, CCDA, Other
• Describe any legal, firewall, or vendor restrictions that typically slow down data sharing with third parties.
• Do you have sample datasets or a sandbox environment we can use for end-to-end testing, and if so, what’s the process to request access? Options: Yes — immediate access, Yes — requires approvals, Planned but not ready, No sandbox available
• What are your minimum acceptable data latency and completeness thresholds for real‑time alerts and claims ingestion? Options: Real-time (<1 hour), Near real-time (1–24 hours), Daily, Weekly

Audit, Compliance, and NCQA — What’s at Stake?

• If an auditor requested evidence of care management impact today, what could you produce immediately? Options: Case-level notes with outcomes, Aggregated reports by cohort, Limited manual samples, No reliable artifacts, Other
• Have you had recent audit findings related to care management or documentation—if yes, what were the gaps called out? Options: Yes — documentation gaps, Yes — data/reporting gaps, Yes — process gaps, No recent findings, Not sure
• What artifacts does leadership expect us to deliver to support NCQA readiness (examples: protocol adherence logs, staff training records, closed-loop referrals)?
• Who in your organization is responsible for audit responses and NCQA evidence assembly (title/role)?
• What timeline do you have to demonstrate audit/NCQA readiness (e.g., next 3 months, 6 months, by contract renewal)? Options: Immediately (0–3 months), 3–6 months, 6–12 months, More than 12 months

What Would Make Us an Irreplaceable Partner?

• What would make you say, at the end of this project, 'this vendor saved our renewal'? Options: Rapid measurable impact, Full audit readiness, Seamless clinician adoption, Flexible commercial terms, Strong data governance/support, Other
• What commercial or contractual flexibilities would be most important to you (pilot pricing, milestone payments, SLAs, risk-sharing)? Options: Pilot pricing, Milestone-linked payments, Performance-based risk sharing, Standard licensing, Other
• What operational responsibilities must your team retain versus what you expect the vendor to own during deployment?
• Who are the decision-makers and approvers for contract sign-off and funding, and what cadence do they require for updates? Options: VP Care Management, CMO, CIO/CTO, Finance Director, General Counsel, Other
• If we proposed a phased pilot for a high‑acuity cohort, what success criteria would make you ready to scale? Options: X% reduction in avoidable ED, Y PMPM savings, Clinician time saved per day, Successful data integrations, Positive clinician satisfaction

Start: Who You Are and What Keeps You Up at Night

• Which best describes your role and primary responsibility for care management? Options: VP Care Management, Chief Nursing Officer, Director of Case Management, Clinical Operations Lead, Chief Medical Officer, CIO/IT leader, Finance/Actuarial, Other (please specify)
• What is your top strategic priority for your care management program this 12-month cycle? Options: Reduce avoidable ED visits, Improve NCQA readiness, Reduce PMPM costs, Improve clinician capacity/adoption, Data/integration modernization, Other (please describe)
• Which range best describes an average nurse care manager caseload today? Options: <40, 40–59, 60–79, 80–99, 100+
• How many members are covered under the care management program we’d be discussing? Options: <5,000, 5,000–25,000, 25,001–100,000, 100,001–500,000, 500,001+
• Which systems or tools are your care teams actively using today? (select all that apply) Options: Legacy case management software, EHR/Provider portal, Claims platform, Excel/Google Sheets, Fax/email queues, Home-grown dashboards, Third-party care platform, Other
• Describe one recent day-in-the-life moment that best captures the friction your care team faces (brief story)

Are You Losing Ground Without Realizing It?

• When you saw a 15% rise in avoidable ED visits, what did you most fear was silently failing in your program? Options: Risk stratification, Timely outreach/contacts, Transition-of-care follow-up, Data timeliness/alerts, Clinical protocol adherence, Other (please specify)
• Over what time period did this increase emerge, and how consistent is the trend across lines of business? Options: Last 3 months, 3–6 months, 6–12 months, More than 12 months, Trend varies by line
• Which member cohorts show the largest increase in avoidable ED use? Options: High-acuity chronic (e.g., CHF, COPD), Behavioral health / SUD, Complex pediatric, Dual-eligible, Transition-of-care recently discharged, Not sure / mixed
• Who internally first raised the alarm about the trend and what did they say was happening? (capture the narrative)
• How long have you tolerated these outcomes before treating it as an emergency? Options: We acted immediately, Within weeks, A few months, Over a year, Only now addressed due to audit/RFP pressure

What's Burning for Your Care Teams Right Now?

• If a nurse could wipe one task from their day, what would it be—and how would that extra time be used to prevent avoidable ED visits?
• Approximately how many minutes per day does a care manager spend on documentation vs. direct member outreach? Options: <60 mins documentation / >240 outreach, 60–120 mins documentation / 120–240 outreach, 120–240 mins documentation / 60–120 outreach, >240 mins documentation / <60 outreach, Don't have precise split
• Which manual tasks cause the most context-switching or missed follow-ups? (select up to 3) Options: Faxing referrals, Claims reconciliation, ADT alert triage, Manual appointment scheduling, Social needs referral tracking, Duplicate documentation across systems, Other
• Tell us about a recent patient case where care team workload or tooling directly led to a missed intervention (what happened, impact)
• How do care managers describe their level of burnout or frustration on a typical day? Options: Severe burnout, High stress but managing, Moderate frustration, Generally OK, Unsure / not asked

How Do You Define Success — And Where Might We Be Blind?

• If finance demands measurable PMPM savings within 12 months, what reduction feels realistic to you and why might that expectation miss the true value? Options: >10% PMPM, 5–10% PMPM, 1–5% PMPM, Target is unclear, Value likely in quality metrics more than PMPM
• Which success signals are most persuasive for your executive team? (select top 2) Options: Avoidable ED visits, PMPM cost reduction, NCQA readiness/compliance, 30/60/90 day readmission reduction, Care manager capacity/utilization, Member experience/satisfaction
• What baselines do you currently have for those signals, and how confident are you in their accuracy? Options: Strong, reliable baselines, Reasonable but some gaps, Partial data only, No reliable baselines, Unsure
• What attribution window would you consider credible for showing impact on ED visits or PMPM (and why)? Options: 30 days, 60 days, 90 days, 6 months, 12 months
• Who must sign off on success before you consider a pilot 'validated' (list roles and one requirement each)?

Where Does Data Break Down (And Who Owns the Fix)?

• Which single data gap causes the most missed interventions today? Options: ADT latency, Missing SDOH data, Delayed claims, Incomplete med lists/pharmacy, Inconsistent provider notes, Consent/access/legal restrictions
• Which data sources are you able to ingest reliably today? (select all that apply) Options: Real-time ADT, Pharmacy claims, Medical claims, Laboratory results, SDOH screenings, Provider EHR notes, State HIE feeds, None/limited
• How often do data delays or mismatches create a demonstrable missed outreach opportunity? Options: Daily, Weekly, Monthly, Rarely, Don't track
• Who in your organization is responsible for resolving integration failures or data mapping issues? Options: IT / Integration team, Vendor/third-party integrator, Data analytics/BI, Clinical informatics, Shared responsibility, No clear owner
• Describe a specific incident where a data gap led to an avoidable ED visit or audit exposure (what data, what went wrong)

If We Could Fix One Workflow Today, Which Would Move the Needle?

• Which single workflow change would free the most nursing time and reduce avoidable ED visits? Options: Automated ADT triage + tasks, Unified clinician workspace, Automated SDOH referrals, Risk-stratified outreach cadence, Medication reconciliation automation, Other (please specify)
• For the workflow you chose, who is the primary owner today and who will own it after improvement? Options: Nurse care managers, Clinical supervisors, Population health team, IT/Analytics, Vendor partner, Other
• Outline the typical steps in that workflow and where failures most commonly occur (brief)
• Which patient cohort would you pilot this workflow on first? Options: Highest-utilizers (top 1%), High-acuity chronic conditions, Post-discharge within 7 days, Behavioral health with comorbidities, Dual-eligible, Other
• What immediate, measurable acceptance criteria would convince you the workflow is working? Options: Reduction in ED visits for cohort, Increased completed outreach rate, Improved documentation time saved, Improved NCQA checklist items, Other

Partnership Rules: What Would Truly De‑Risk This Rollout?

• What specific data access commitments would you need from a vendor to feel comfortable starting a pilot? Options: Full ADT feed access, Claims file access (daily/weekly), Direct EHR read/CCDA, SDOH screening feeds, Role-based test accounts, Other
• Which legal or compliance constraints are immediate blockers (e.g., state PHI rules, data residency, consent)? Options: State PHI variations, Consent management gaps, Data residency/hosting, Audit trail requirements, None obvious, Other
• What SLAs or uptime commitments would be non‑negotiable for critical feeds (ADT/claims)? Options: Near-real-time (<5 min), Hourly, Daily, Batch weekly, Not sure—need guidance
• How would you prefer governance to be structured during pilot and scale (roles, cadences)? Options: Weekly steering + ops, Biweekly review + escalation, Monthly exec review, Ad-hoc as issues arise, Other
• What resources (FTE hours, technical support, clinical time) can you commit during the first 90 days? Options: Minimal (10–20 hrs/wk), Moderate (20–50 hrs/wk), Substantial (>50 hrs/wk), Unsure—need internal check

What's the Real Roadblock to Change?

• When procurement conversations start, what single objection typically kills momentum? Options: Budget constraints, Security/compliance concerns, Integration complexity, Clinical adoption risk, Lack of leadership buy-in, Other
• Who are the decisive stakeholders in an RFP or procurement vote, and what is each most worried about?
• What is your typical procurement timeline from RFP to contract signature? Options: <3 months, 3–6 months, 6–9 months, 9–12 months, >12 months
• What internal change management or training capacity do you have to drive clinician adoption? Options: Dedicated training team, Clinical champions only, Shared across teams, Limited/no capacity, Unsure
• Share an example where a technically viable solution failed because clinicians wouldn't change behavior—what happened and why?

How Will We Validate — What Counts as Proof?

• If the platform reduced ED visits by 10% for your pilot cohort, who needs to see which data to believe it's real? Options: VP Care Mgmt (trend reports), CIO (technical logs/feeds), Finance (PMPM calculations), CMO (clinical audit), QA/compliance (NCQA evidence)
• What formal end‑to‑end tests with live data do you require before accepting a pilot result? Options: ADT alert to task creation, Claims ingestion to risk score update, SDOH referral flow to closure, Clinician workflow simulation with live notes, All of the above, Other
• What sample size and time window would you consider statistically and operationally persuasive for pilot outcomes? Options: Small cohort, rapid signals (n<500, 30–60 days), Moderate cohort (500–5,000, 90 days), Large cohort (>5,000, 6–12 months), Depends on metric
• Which dashboards or reports must be available at pilot close to support stakeholder sign‑off? Options: ED visits trend by cohort, PMPM cost delta, Completed outreach rates, NCQA readiness checklist, Clinician time-saved reports, All of the above
• What would be your minimum acceptance criteria for moving from pilot to phased rollout? Options: Predefined % reduction in ED visits, Predefined % increase in completed outreach, Positive ROI within 12 months, NCQA audit items met, Combination of metrics

Commitment & Next Steps — Are You Ready to Try Something Different?

• Reflecting on this conversation, how ready is your organization to commit to a 90-day pilot focused on one high-acuity cohort? Options: Ready now, Ready with minor approvals, Need internal alignment (weeks), Not ready this quarter, Unsure
• Who are the three people we should include in the pilot kickoff to avoid surprises, and what is each person's must-have outcome?
• Which patient cohort would you prefer to target for an initial pilot (name and approximate size)?
• What communication channel and cadence do you prefer for pilot updates? Options: Weekly email + monthly review, Weekly stand-up calls, Biweekly dashboard reports, Ad-hoc as issues arise, Other
• What is your single biggest remaining concern about starting a pilot with our platform?