Starting Point: Who You Serve and Why

• Tell me about the patient cohorts your care management team prioritizes today. Options: High utilizers with frequent admissions, Complex chronic conditions, Post-discharge transition patients, Behavioral health with medical comorbidity, Social needs-driven risk, Other
• How many full-time equivalent care managers and related staff support those cohorts? Options: <5, 5-15, 16-50, 51-150, >150, Unsure
• When a high-risk patient moves across settings, what breaks first in your current workflow?
• List the data sources currently feeding a longitudinal patient view for your team. Options: Primary EHR, Claims/billing feed, Health information exchange, Lab/imaging systems, Behavioral health records, Social needs screenings, Community resource directory, No unified source, Other
• Name the one thing you could accomplish in the next 6 months that would prove this effort was worth it.

Where Coordination Actually Breaks

• Point to the recurring failure in your coordination process that costs you the most in avoidable admissions or escalations.
• How often do care transitions lack an identified owner or documented follow-up within 48 hours? Options: Almost always, Often, Sometimes, Rarely, Never
• Tell me about a recent patient whose care fractured across systems, what happened, and who flagged it first.
• How much time does a care manager typically spend reconciling patient records per week for a high-risk panel? Options: <30 minutes, 30-60 minutes, 1-3 hours, 3-6 hours, 6+ hours, Unsure
• Name the metric failure that would make you stop pursuing a vendor solution immediately.

Who Signs, Who Runs, Who Lives With It

• Who on your leadership team would veto this project if they saw no clear financial return? Options: VP of Care Management, Chief Financial Officer, Chief Medical Officer, Head of Population Health, IT Director, Other
• List the stakeholders who must approve pilot design, data sharing, and final sign-off. Options: VP Care Management, CFO/Finance, CMO/Medical leadership, IT/Engineering, Compliance/Privacy, Legal, Operations, Community partners, Other
• How do frontline care managers typically get involved in adoption decisions, are they piloted with, consulted, or bypassed? Options: Piloted and consulted, Consulted but not piloted, Brought in after decision, Bypassed entirely, Other
• Who will be the day-to-day owner for integration and data access on your side, title or role please.
• Should the identified sponsor change or leave before pilot completion, can the project continue and under what conditions? Options: Yes, with alternative sponsor, Yes, but timeline will slip, No, project would stop, Unsure

If Finance Asked for One Trusted Number

• If the CFO demanded one trusted metric to justify ongoing investment, which metric would you provide and why?
• Choose the outcomes you need to show in a 3 to 6 month pilot to obtain expansion approval. Options: ED visit reduction, 30-day readmission reduction, Per-member-per-month cost reduction, Improved risk stratification accuracy, Care manager time saved, Provider satisfaction, Other
• How do you currently attribute savings from care management to value-based contracts? Options: Claims-based attribution, Encounter-based estimates, Modeling and estimates, Not tracked, Other
• What is the minimum percent reduction in ED visits or readmissions you consider acceptable to justify expansion? Options: <5%, 5-10%, 11-20%, >20%, Unsure
• When the pilot hits its targets, what approvals or steps would need to happen for you to sign a multi-year agreement within 30 days?

The Other Solutions on Your Shortlist

• Which alternative are you most likely to select today, an incumbent, another vendor, or an internal build, and why? Options: Stay with incumbent, Switch to another vendor, Build internally, No decision yet, Other
• Provide the vendors or internal approaches you have evaluated so far. Options: Current incumbent vendor, Other external vendors, Internal build plan, Pilot with HIE, No active evaluation, Unsure, Other
• What would have to be true about your current approach for you to keep it rather than change to a new partner?
• Has anyone on your team proposed solving integrations or workflows internally instead of engaging an outside partner? Options: Yes, full internal build, Yes, partial internal work, No internal proposal, Unsure
• Assuming an incumbent matches pilot terms, what single change would still make you prefer a new partner?

Data, Integrations, and Compliance Reality Check

• Identify the missing data feed or API gap most likely to delay or stop the deployment.
• Select the systems that must be connected for the pilot to work. Options: Primary EHR, Claims ingestion, HIE, Care management system, Lab system, Patient portal, Community resource directory, Other
• Provide the owner of API or integration access for those systems on your side, role or team name.
• How accessible is historical claims data for the cohorts, real-time, batched, or not available? Options: Real-time, Daily or weekly batches, Monthly or delayed, Not available, Unsure
• Are there legal or privacy reviews that routinely add more than four weeks to data sharing agreements? Options: Yes, routinely, Sometimes, No, Unsure
• When a required API is unavailable, what fallback approach is acceptable and how long would it add to the timeline?

Do You Have the People and Time

• If your implementation required a dedicated project manager and two technical staff, can you commit those headcounts for the pilot period? Options: Yes, confirmed, Yes, with approval, No, Unsure
• How many hours per week can frontline care managers realistically spend on training and pilot activities? Options: <2 hours, 2-5 hours, 6-10 hours, 10+ hours, Unsure
• Which internal teams will need to be involved during pilot execution? Options: Care management, IT/integration, Analytics/BI, Compliance, Operations, Finance, Community partners, Other
• Describe competing initiatives that could deprioritize this project in the next 90 days.
• Should named owners not be available by the proposed start date, would you pause, delay, or cancel the pilot? Options: Pause, Delay, Cancel, Proceed anyway, Unsure

Acceptance, Risks, and Clear Next Steps

• Assuming the pilot proves the target metric, what internal approvals remain before procurement can sign?
• Select the acceptance criteria that matter most for you to declare pilot success. Options: Data completeness and timeliness, User adoption rate, KPI improvement thresholds, Operational handoff readiness, Compliance sign-off, Other
• Are there specific compliance or contracting requirements that must be included before the pilot starts? Options: Business associate agreement, Data use agreement, Security assessment, State-specific consent, Other, None
• Indicate your target timeline to start pilot execution once scope is agreed. Options: Within 2 weeks, 2-6 weeks, 6-12 weeks, More than 12 weeks, Unsure
• In the event the pilot does not meet baseline data quality or connectivity within the initial 30 days, will you continue, pivot, or stop? Options: Continue with mitigation, Pivot scope, Stop the pilot, Unsure

• Solution Experience: Care-Manager Workflows

• Confirm the current state and its cost to your team
• You confirm the diagnosed current state and agree on the operational costs it creates for staff and utilization.
• Run a simulated patient scenario using a de-identified sample of your claims and EHR extracts and deliver the projected reductions in ED visits and readmissions before the next evidence review.
• You confirm the demonstrated workflow removes the key handoffs that caused missed follow-ups and would reduce avoidable ED visits and readmissions.
• Walk an end-to-end high-risk patient scenario
• Provide a de-identified sample set of high-risk patient records including recent claims, discharge summaries, and top social needs to support the simulation.
• Confirm data and integration assumptions that enable the workflow
• You agree on specific KPI definitions and the evidence required to demonstrate ROI to finance stakeholders.
• Identify the decision makers and data owners required to approve success criteria and schedule a follow-up evidence review with them.
• Define the measurable outcomes and acceptance criteria
• Validate this maps to your priority

• Solution Experience: Care-Manager Workflows
• Solution Experience Deck
• Solution Brief

• meeting
• slides
• document

• Integrate EHR Data Feeds
• Ingest and Normalize Claims Data
• Connect Health Information Exchange Feeds
• Integrate Community Resource Directory
• Build Longitudinal Patient Record with Identity Resolution
• Configure Risk Stratification Models
• Implement Care Plan Templates and Pathways
• Enable Task and Workflow Management
• Set Up Transitions-of-Care and Referral Workflows
• Deploy Patient Engagement Outreach (SMS/Calls/Portal)
• Enable Secure Cross-Provider Messaging
• Configure Population Health and Outcomes Dashboards
• Train Care Management Team on Platform Workflows
• Migrate Historical Care and Encounter Records

Integrate EHR Data Feeds

• Which EHR integration surfaces do you require (ADT, CCD/CCDA documents, FHIR API, custom HL7 v2 feeds)? Options: ADT, CCD/CCDA, FHIR API, HL7 v2 feed, Other
• How many distinct EHR systems need connectors (count by hospital and clinic sites)? Options: 1, 2-3, 4-10, 10+
• Do you need bi-directional writeback to the source EHR for care plan updates or task status? Options: Yes, No
• Specify the expected ADT latency requirement for near-real-time patient movement (for example under 5 minutes, under 30 minutes, daily batch). Options: Under 1 minute, Under 5 minutes, Under 30 minutes, Daily batch
• List the authentication methods your IT team supports for EHR integrations (OAuth2, SAML, VPN, API key). Options: OAuth2, SAML, VPN, API key, Other

Ingest and Normalize Claims Data

• Which claims file formats do you receive from payers (X12 837, 835 remittance, payer CSV exports)? Options: X12 837, X12 835, Payer CSV export, Custom file
• How frequently are claims batches provided or refreshed by your payers (daily, weekly, monthly)? Options: Daily, Weekly, Monthly, Ad hoc
• Describe how payer claim fields should map to the platform's clinical episode identifiers (for example, which payer fields represent service dates, provider NPI, and claim adjudication status).
• Do you require adjudicated-claim level cost fields normalized to a payer taxonomy and standard cost bucket? Options: Yes, No
• What minimum completeness threshold should we use to accept a claims ingest run (for example 95% of expected claim count)? Options: 90%, 95%, 99%, Custom

Connect Health Information Exchange Feeds

• Identify the HIE exchange protocols in scope (Direct, NwHIN, FHIR query endpoints, query-based APIs). Options: Direct, NwHIN, FHIR query, Query API, Other
• How many regional HIE endpoints must be connected? Options: 1, 2-5, 6+
• Are patient-level consent directives included in the HIE payloads you will share (consent flags, disclosure restrictions)? Options: Yes, No, Partial
• Specify the message formats you expect to normalize from HIE (CCDA, FHIR bundles, custom XML). Options: CCDA, FHIR Bundle, Custom XML, Other
• List the named owner and SSO provisioning contact for each HIE endpoint.

Integrate Community Resource Directory

• Describe the directory formats you use for community resources (CSV exports, public API, LDAP, vendor feed). Options: CSV export, Public API, LDAP, Vendor feed, Other
• How often does your community resource inventory change and require sync (daily, weekly, monthly)? Options: Daily, Weekly, Monthly, Ad hoc
• Does the directory include eligibility rules, service capacity, and referral contact details for each resource? Options: Yes, No, Partial
• What matching attributes should be used to link directory entries to patient social needs (address, zip + SDoH category code, service category)? Options: Address, Zip + SDoH code, Service category, Phone/email
• Who will be the operational owner for community referral updates and how should stale listings be handled?

Build Longitudinal Patient Record with Identity Resolution

• Estimate the number of patient identity sources that will feed the longitudinal record (EHR MRNs, payer IDs, HIE IDs, manual records). Options: 1-2, 3-5, 6-10, 10+
• Select the matching logic you prefer for identity resolution (deterministic on SSN/name/DOB, probabilistic match with threshold, rules-based hybrid). Options: Deterministic (exact), Probabilistic, Hybrid rules-based, Custom
• Confirm whether you require a reconciliation UI for duplicate MRNs and a workflow to merge or link records. Options: Yes, No
• Define the minimum data completeness for a longitudinal record to be considered active (for example one encounter in 12 months plus demographics and problem list). Options: One encounter in 12 months + demographics, Two encounters in 12 months, Custom
• Provide the identifiers we should persist for cross-reference (MRN, payer member ID, NPI of primary clinician).

Configure Risk Stratification Models

• Select the risk models you want enabled (claims-based utilization model, EHR clinical-risk model, SDoH-informed model, custom model). Options: Claims-based utilization, EHR clinical-risk, SDoH-informed, Custom
• How frequently should risk scores refresh (real-time on ADT/claims, nightly batch, weekly rolling)? Options: Real-time, Nightly, Weekly, Other
• State the positive predictive value or sensitivity threshold you require for targeted outreach cohorts (for example PPV >= 30% or sensitivity >= 70%). Options: PPV >= 20%, PPV >= 30%, Sensitivity >= 70%, Custom
• Confirm whether model explainability fields should be surfaced in the care manager UI (top contributing factors per patient). Options: Yes, No
• Estimate the pilot cohort size acceptable for validating model performance before system-wide rollout (by patient count or by clinic). Options: 100-500 patients, 500-2,000, 2,000+

Implement Care Plan Templates and Pathways

• Choose the care plan templates to provision (transitions-of-care discharge plan, CHF pathway, diabetes management, behavioral health outreach). Options: Transitions-of-care discharge, CHF pathway, Diabetes management, Behavioral health outreach, Custom
• Approximate the number of template variations required to reflect site-specific ordersets or protocols. Options: 1-2, 3-5, 6-10, 10+
• Indicate whether you require condition-specific decision support embedded in pathways (for example escalation triggers when a 7-day post-discharge visit is missing). Options: Yes, No
• Provide the clinical roles that should be assigned to pathway tasks (nurse care manager, social worker, PCP). Options: Nurse care manager, Social worker, Primary care provider, Behavioral health, Other
• How will you measure adherence to pathways (for example percent of patients with completed follow-up within 7 days)? Options: % with follow-up in 7 days, Task completion rate, Time-to-first-contact, Custom

Enable Task and Workflow Management

• Choose the task types to support (outreach, medication reconciliation, referral follow-up, social needs navigation). Options: Outreach, Medication reconciliation, Referral follow-up, Social needs navigation, Other
• State the expected average daily task volume per care manager (approximate number). Options: <10, 10-30, 31-60, 60+
• Indicate whether you need SLA-based reminders and escalation rules for overdue tasks. Options: Yes, No
• Who should receive workload-balancing rules (by team, by region, by risk tier)? Options: By team, By region, By risk tier, No balancing
• When should automated reassignment occur for unacknowledged tasks (after 24 hours, 48 hours, or custom interval)? Options: 24 hours, 48 hours, Custom

Set Up Transitions-of-Care and Referral Workflows

• Identify the points of transfer to instrument in the workflow (ED discharge, inpatient discharge, SNF transfer, outpatient referral). Options: ED discharge, Inpatient discharge, SNF transfer, Outpatient referral, Other
• Does your team require electronic referral acceptance with closed-loop status updates from the receiving organization? Options: Yes, No, Partial
• Are there existing referral forms or CCDA sections we must map into the referral payload? Options: Yes, No
• How will you define successful transition closure for acceptance criteria (for example completed clinic visit within 7 days)? Options: Visit within 7 days, Medication reconciliation completed, Patient contact made, Custom
• Outline the expected EHR send/receive formats for referrals (referral CCD, FHIR ReferralRequest, HL7 custom) and any transformation rules.

Deploy Patient Engagement Outreach (SMS/Calls/Portal)

• Outline the outreach channels to deploy (SMS, automated voice calls, portal messages) and required opt-in proof. Options: SMS, Automated voice, Portal message, Other
• When should outreach be triggered relative to events (for example within 24 hours of discharge, 48 hours after no-show)? Options: Within 24 hours, 48 hours, 3-7 days, Custom
• Document the consent workflow and message content constraints for SMS in your state (for example TCPA opt-in, language requirements). Options: TCPA opt-in required, Language translations required, Consent on file, Other
• Assign the owner for escalation from engagement (care manager, nurse triage, behavioral health team). Options: Care manager, Nurse triage, Behavioral health, Other
• Detail any carrier or gateway throttling rules that will affect send cadence (per-minute/per-day limits).

Enable Secure Cross-Provider Messaging

• Define the message types required for cross-provider exchange (care plan updates, referral acceptances, closed-loop task notifications). Options: Care plan updates, Referral acceptances, Closed-loop notifications, Other
• Assign the authentication and SSO approach for provider users across organizations (SAML, OAuth2, IDP federation). Options: SAML, OAuth2, IDP federation, Other
• Document the allowable clinical attachments and size limits (CCDA, PDFs, image links) and any redaction rules. Options: CCDA, PDF, Image links, Other
• Explain how clinicians will provide consent for receiving messages from outside their organization. Options: Explicit opt-in, Implicit via policy, Signed agreement, Other
• Detail the acceptance criteria that will validate secure cross-provider messaging (delivery success rate, encryption standards, and end-to-end delivery time). Options: Delivery success >=99%, TLS1.2+ & at-rest encryption, Delivery within 5 minutes, Custom

Configure Population Health and Outcomes Dashboards

• Explain which KPIs are required on population health dashboards (30-day readmission rate, ED visits per 1,000, care gap closure). Options: 30-day readmission, ED visits per 1,000, Care gap closure, Custom
• How often must the dashboards refresh and what latency is acceptable for near-real-time views? Options: Real-time, Near real-time (<15 min), Hourly, Daily
• Name the user roles that need dashboard access and required role-based filters (care manager, director of population health, finance). Options: Care manager, Director of population health, Finance, Other
• Explain whether external reporting compliance standards must be met (for example CMS reporting or payer-specific VBC reporting) and which fields map to those reports.
• Name the acceptance thresholds for dashboard accuracy (for example data accuracy >= 98% and refresh latency under 15 minutes) required for go-live sign-off. Options: Data accuracy >=95%, Data accuracy >=98%, Refresh latency <15 minutes, Custom

• Subscription Order Form
• Master Services Agreement (MSA)
• Statement of Work (SOW) — Implementation
• Service Level Agreement (SLA)
• Data Processing Agreement (DPA) / HIPAA Business Associate Addendum (BAA)
• Acceptance Criteria & Go-Live Signoff
• Implementation Governance Charter
• Change Order Agreement
• Security & Compliance Attestation

• Go-live Health Check
• First Measurement Review
• Acceptance Gate Review
• Quarterly Success Review

• Publish the KPI trend summary and the quarter action plan to the shared workspace before the next review.
• Schedule targeted workflow training sessions for teams identified with low adoption within the next 30 days.
• Restate acceptance criteria and targets from Solution Scope
• Produce a documented acceptance decision with pass/fail recorded for each Solution Scope criterion and a named buyer signatory when applicable.
• If any criteria failed, establish a remediation plan with measurable checkpoints and resolution dates.
• Confirm the incumbent system decommission status or formal retention plan and verify data migration or archival completion.
• Publish the Acceptance Gate decision document listing pass/fail per criterion and include the buyer signatory and date.
• Log remediation items for failed criteria into the shared backlog with resolution timelines and re-evaluation dates.
• Confirm and document the incumbent decommission or retention plan and the status of data migration or archival.
• KPI trend review vs Solution Scope targets
• Confirm whether weekly active care manager counts and referral closure rates are trending toward Solution Scope targets and identify required corrective steps if not.
• Prioritize the top 3 backlog items for the coming quarter and set target completion dates.
• Agree any configuration or training changes needed to sustain metric improvements and schedule their execution.
• Update the shared backlog with the quarter's prioritized items and target completion dates.
• Schedule refresher training for teams with below-threshold adoption and circulate attendance windows.
• Re-confirm success criteria and owners
• Confirm the deployment is functionally complete and integrations are delivering the expected data feeds.
• Validate that named owners for each acceptance criterion in Solution Scope are correct and committed to their responsibilities.
• Identify and document critical blockers with agreed remediation actions and dates.
• Produce and circulate a deployment validation report summarizing integration status, data gaps, and remediation plan.
• Log each blocker into the shared backlog with reproduction steps and target resolution dates.
• Schedule a short follow-up health check within 14 days to verify remediation progress.
• Present first outcome dataset vs Solution Scope targets
• Determine whether ED visit rate and 30-day readmission rate are trending toward Solution Scope targets or require remediation.
• Identify the top 2 root causes for any metric shortfalls and agree concrete corrective actions with timelines.
• Confirm the data sources and transformations used to compute each metric are correct and documented for future audits.
• Publish the analyzed outcome dataset with lineage notes and any data-quality caveats to the shared workspace.
• Create remediation tasks for configuration, training, or integration fixes with target dates leading to the Acceptance Gate.
• Present outcome evidence vs each criterion
• Open issues and enhancement backlog review
• Deployment and data flow validation
• Review operational adoption metrics
• Document pass/fail decisions and capture buyer signatory
• Early adoption signals and usage patterns
• Configuration drift and care-model adjustments
• Root cause analysis for gaps
• Blockers and open issues triage
• Agree corrective actions and timeline to Acceptance Gate
• Adoption and training follow-up
• Agree remediation plan for any failed criteria
• Agree immediate remediation actions
• Legacy incumbent wind-down and data archival checkpoint
• Agree next quarter action plan and owners