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Digital Health
Regulated development and commercialization journeys where clinical, quality, and market access align.
Example organizations in this space:
Livongo (Teladoc)
Omada Health
Hims & Hers
Noom
This interactive experience is the shipped product itself — the same application code customers run in production, mounted read-only in your browser over a real sample journey. Not a video, not a mockup: because the demo and the product are one codebase, it can never drift from the real thing.
Inside this journey
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Pre-Sales
Qualify and diagnose before investing in a full evaluation cycle.
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Fit & Procurement Qualification
Confirm clinical use-cases, procurement timeline, budget band, decision-makers, and actuarial evidence needs before investing in a full discovery conversation.
Qualification Questions
Clinical use-cases and evidence needs
- Which clinical program(s) are you considering for coverage or a pilot?
- Which measurable outcome(s) must be demonstrated to justify coverage or expansion?
- What evidence threshold or actuarial proof would your team require to move to a discovery conversation or pilot?
Procurement timeline and drivers
- What is your target decision timeline for this opportunity?
- What is the primary driver of that timeline (for example formulary cycle, budget renewal, contract expiry, or regulatory deadline)?
Budget and commercial preferences
- Is there an allocated budget band or expected PMPM range for this type of program?
- Which commercial model do you prefer to evaluate first?
Decision-makers, technical fit, and next step
- Who needs to approve or formally influence a purchase like this?
- Will protected health information (PHI) be required for enrollment, reporting, or integration?
- Based on these answers, are you ready to schedule a 60-minute discovery meeting to validate clinical fit and actuarial assumptions?
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Outcome Discovery
Map clinical priorities, current workflows, target metrics, and stakeholder committees required for coverage or formulary decisions.
Discovery Questions
Start by describing the member group you care most about
- Tell me about the member population you want to impact most with diabetes prevention, musculoskeletal pain, or behavioral health programs
- How large is that population in covered lives and how many are actively eligible each month
- Which member segments or risk cohorts drive the majority of the clinical or financial burden you want to address
- Walk me through a typical member journey from identification in claims or eligibility to a clinician recommendation and eventual engagement
- When members are identified today, what percentage typically complete intake and how quickly do they first engage with support
- Who on your team currently owns cohort identification and referral for digital or vendor-delivered clinical programs
Where clinical priorities actually sit in your organization
- If your formulary or clinical committee could approve only one program change this year, which clinical outcome would you expect it to move and why
- Which committees and reviewers must sign off on clinical evidence, and what evidence types do they prioritize
- How do your clinical reviewers weigh FDA authorization compared with randomized controlled trial data and real-world engagement metrics
- Describe the last time the committee declined a digital program, what specific evidence or concern led to rejection
- Which quality measures, for example HEDIS measures or internal KPIs, are non-negotiable for clinical leadership when adding a new vendor
Where the member workflow breaks and why it matters
- What single point in your current workflow most often stops eligible members from engaging with a prescribed digital therapeutic
- Who receives the referral in your EHR or benefits platform and which steps are manual versus automated
- How many days typically pass between an eligibility or claims flag and vendor outreach, and how often does that delay exceed your target window
- When care teams try to enroll members, which downstream processes fail most often and what operational cost or risk does that create
- Which provider touchpoints would need the least friction to change in order to make prescribing a software therapeutic a normal part of workflow
If outcomes mattered more than pilots, what would change in your decisions
- If a vendor reliably delivered the A1C or PHQ-9 gains you expect, what would you be enabled to change in network management or population health programs
- Which clinical or financial thresholds would trigger formulary placement rather than an exploratory pilot
- What degree of engagement or completion rate would make you confident the outcome signal is not noise
- If a pilot proves the agreed outcomes, who in your organization has the authority to accelerate contracting and what timeline would they need
- What single contractual condition would make you refuse an outcomes-based commercial model regardless of clinical performance
What's standing between pilot and rollout
- Which specific integration failures in past projects caused deployment to stall and what fixed them
- Do you have any procurement blackout dates, board approval windows, or policy freezes that would prevent a pilot from starting in the next 90 days
- Who must approve data sharing agreements and BAAs, and how long do those approvals typically take in your organization
- How clean and timely are your eligibility and claims feeds, and who owns remediation if fields or timestamps are missing
- What regulatory or payer approvals would be required before members can be proactively enrolled in a prescribed software therapeutic
- Which single technical or legal risk would cause you to halt the project immediately
The other options you are weighing, and why they might win
- Name the external vendors, incumbent solutions, and any internal programs you are actively considering instead of an outside therapeutic vendor
- What would have to be true about your current in-house approach for you to keep it rather than contract with an external vendor
- Has anyone on your team proposed building this capability internally, who would lead it, and how would you resource it
- Which incumbent features, measurement approaches, or contractual terms would a new option be required to match or exceed
- If an incumbent matched clinical evidence and price, what other factors would still make you switch to a new partner
- How quickly could an internal build be approved and resourced if leadership chose that route
Operational gates and technical reality checks
- Which backend systems must be connected for enrollment, tracking, and outcomes reporting, and are production APIs available
- Who on your side will own integration work and how many full time equivalents can they dedicate during a pilot
- How up to date is member contact and consent data for outreach, and can you permit automated vendor outreach to those members
- What latency or completeness thresholds do you require for claims, lab, and encounter feeds to trust outcome signals
- Are there security attestations, penetration tests, or third-party privacy reviews that must be completed before a production connection is allowed
- If we cannot obtain production claims access within your target window, what alternative measurement approach would you accept for the pilot
Decision timing and the things that speed it up
- If a short pilot hit the agreed outcomes and engagement targets, what would allow you to sign a full contract that same week
- Which stakeholders need to be present and supportive at final approval, and which single person could veto the deal
- How does your procurement and legal calendar map onto a 3 month pilot followed by contract negotiation, are there known timeline blockers
- What budget cycle constraints would force you to delay a decision even if clinical leadership supported it
- Which commercial structure do you prefer for this type of program
- How soon would you want to begin a discovery pilot if timelines and approvals aligned
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Solution Experience
Anchor how the regulated programs deliver measurable outcomes using the buyer's member journeys, published evidence, and realistic scenarios.
Solution Experience
- Solution Experience Session
- Confirm the current state and its cost to your team
- You confirm that a mapped member journey plus the presented evidence plausibly delivers the clinical outcomes you require for coverage decisions.
- Deliver a tailored evidence packet including peer-reviewed study PDFs, real-world engagement curves, and a one-page mapping of each study endpoint to your committee criteria.
- You agree the evidence package and modeled impact meet initial criteria for actuarial review and next-step pilot design.
- Agree the decision criteria the evidence must meet
- Run a member-level simulation on the provided de-identified sample cohort and deliver a modeled PMPM and utilization impact for review.
- Walk a representative member journey end-to-end
- Provide a de-identified representative sample cohort with baseline clinical distributions and current utilization, and confirm the target decision date for the clinical/actuarial committee.
- You commit to providing a representative de-identified sample cohort and the decision timeline so the seller can produce a tailored actuarial simulation.
- Show the published evidence mapped to your metrics
- Confirm the list of stakeholders who must sign off on clinical evidence and the actuarial assumptions to ensure the next pilot scope matches internal gates.
- Translate outcomes to actuarial impact in a realistic scenario
- Validate alignment with your committee needs
- Validation checkpoint, Is this what you meant when you said you needed clinical evidence sufficient for formulary and actuarial review?
- Solution Experience Session
- Solution Experience Deck
- Solution Brief
- meeting
- slides
- document
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Solution Scope
Define program modules, enrollment pathways, integrations (eligibility, claims, EHR), responsibilities, and measurable outcome metrics.
Scope Configuration
- Provision FDA-authorized digital therapeutic licenses
- Deploy patient mobile therapeutic application
- Provide certified health coach support (asynchronous messaging & live video)
- Integrate eligibility feed for member enrollment
- Integrate claims feed for utilization and outcomes mapping
- Configure EHR prescription and referral connector
- Enable connected device integration (CGM and wearable data)
- Activate outcomes reporting dashboard for clinical and actuarial review
- Deliver peer-reviewed clinical outcomes and real-world evidence package
- Operate engagement and retention protocols (in-app nudges and coach outreach)
- Administer outcomes-based billing, reconciliation, and performance guarantees
- Execute BAA and HIPAA security onboarding
- Train clinicians and care managers on referral and enrollment workflows
Scope Questions
Provision FDA-authorized digital therapeutic licenses
- Which license model do you plan to purchase for covered lives?
- How many unique member licenses are required at initial go-live?
- Who in your organization will be the license administrator (name and role) responsible for entitlements and reporting?
- What regulatory or procurement artifact must the license purchase reference (e.g., contract PO number, formulary change request ID)?
- Where should license activation windows align to your enrollment cadence (for example, alignment to annual benefits effective date or rolling monthly enrollment)?
- Describe any internal approval thresholds that will gate license purchase (e.g., actuarial sign-off on expected savings, pharmacy & therapeutics committee approval).
Deploy patient mobile therapeutic application
- Which distribution channels must the app support for your members (iOS App Store, Google Play, enterprise app distribution, EHR prescription link)?
- How many daily active users (DAU) do you expect during the pilot and at steady state?
- When members enroll via an EHR or benefits portal, which identifier should the app accept for account matching (member ID, subscriber ID, email, hashed identifier)?
- What localization or accessibility requirements must the app satisfy (languages, WCAG level, large-text mode)?
- Which mobile-device management or security policies must the app comply with for your member population (remote wipe, data-at-rest encryption)?
- Provide the acceptance criteria for app deployment to your member base (for example: install success rate >= 90% within 14 days for targeted cohort, crash-free rate >= 99.5%).
Provide certified health coach support (asynchronous messaging & live video)
- Which coaching modalities do you want enabled for your members?
- How many coach-to-member full-time-equivalent (FTE) capacity do you estimate for your initial enrolled cohort?
- Which credentialing or scope-of-practice constraints does your compliance team require for coaches (licensed clinician, certified health coach, behavioral health specialist)?
- What response-time SLA do you require for coach messaging triage (e.g., initial response within 24 hours, urgent triage within 4 hours)?
- Who will handle clinical escalation from coaches into your care management workflows and what is the escalation pathway artifact (pager, EHR inbox, secure email)?
- Describe the metrics that will define adequate coaching coverage for your organization (message response rate, session completion rate, coach-to-member ratio).
Integrate eligibility feed for member enrollment
- Which eligibility feed standard do you currently support or prefer for daily member updates?
- How frequently must membership updates be delivered to the platform (hourly, daily, weekly)?
- Which identifier should be authoritative for member matching across feeds and claims (medical record number, member ID, subscriber ID, hashed SSN)?
- What fields must appear in the eligibility feed for enrollment automation (effective date, plan type, coverage tier, termination date)?
- Confirm any privacy constraints on sending PHI in eligibility feeds (consent required, limited data set, de-identified flow).
- Which security authentication method is required for the eligibility interface (OAuth2 with client credentials, mutual TLS, SFTP credentials)?
Integrate claims feed for utilization and outcomes mapping
- Which claims data standard will you provide for mapping (X12 837, FHIR Claim resource, CSV with adjudicated lines)?
- Which claim-level fields are required to map clinical outcomes (service date, CPT/HCPCS codes, ICD-10, paid amount, NDC for drugs)?
- How long is claims adjudication lag in your environment that we must account for when calculating outcomes (30, 60, 90, 120+ days)?
- Who on your analytics team will own claims data validation and what artifact confirms successful mapping (data dictionary, reconciliation report)?
- Provide the acceptance criteria for claims-to-outcome mapping accuracy (for example: claim line match rate >= 98% against enrollment population, paid-amount reconciliation within 2%).
- Which patient-level identifiers will claims include to enable linkage to program participants (member ID, subscriber ID, encrypted token)?
Configure EHR prescription and referral connector
- Which EHR systems must be supported for prescription/referral (list the EHR vendor and version in free response)?
- Which prescription or referral mechanism do you prefer for clinician workflow (SMART on FHIR prescription, direct referral via EHR in-basket, orderable clinical decision support link)?
- How should referral metadata be populated (problem list entry with ICD-10, medication list with RxNorm, custom referral reason code)?
- What user experience do you expect for clinicians after sending a referral (confirmation message in-basket, auto-close visit task, patient-facing enrollment link)?
- Which authentication mechanism do your EHR instances require for connector integrations (SMART on FHIR with user-level scopes, service account OAuth2)?
- Estimate expected weekly referral volume from clinicians during the first 90 days.
Enable connected device integration (CGM and wearable data)
- Which device classes must be integrated for your program (continuous glucose monitor CGM, activity trackers, smart scales)?
- Which device data standards or vendor interfaces do you require support for (FHIR Device/Observation, vendor API with OAuth, CSV export)?
- What data cadence do you need from CGM/wearable sources for outcome calculations (real-time stream, 15-minute batches, daily summary)?
- Which clinical thresholds from devices must trigger coach outreach or clinical escalation (A1C-equivalent glucose time-in-range <X%, sustained high glucose >Y mg/dL)?
- Who will manage device consent and provisioning for members (care manager, clinician, member self-service)?
- Describe any data retention or de-identification rules for device telemetry required by your privacy policy.
Activate outcomes reporting dashboard for clinical and actuarial review
- Which outcome measures must the dashboard report for your reviewers (A1C change LOINC, PHQ-9 score change, opioid Rx count, utilization by CPT/ICD-10)?
- Which data refresh cadence do your clinical and actuarial stakeholders require (near real-time, daily, weekly, monthly)?
- Which user roles within your organization should have dashboard access and what level of detail for each role (aggregate only, member-level drilldown, actuarial export)?
- What visualization or export formats are required for actuarial review (CSV exports of claims-linked outcomes, PDF executive summary, API access to raw data)?
- Provide the acceptance criteria for the outcomes dashboard (for example: metric reconciliation with your actuarial model within 5% over the pilot period).
- Which compliance artifacts must accompany dashboard access (signed DPA, role-based access roster, SOC2 attestation)?
Deliver peer-reviewed clinical outcomes and real-world evidence package
- Which evidence artifacts are required for your clinical committee review (peer-reviewed RCT PDFs, real-world evidence cohort reports, statistical analysis plan)?
- How should participant-level de-identified results be delivered for your internal analysis (CSV with hashed identifiers, secure data enclave access, runbook and metadata)?
- Who on your clinical outcomes team will sign off that the evidence package meets formulary standards and what artifact documents that sign-off (committee memo, meeting minutes)?
- Which time windows do you require for real-world evidence (6-month outcomes, 12-month follow-up, 24-month longitudinal)?
- Indicate any specific subgroup analyses you require for your population (age bands, comorbidity flags, baseline A1C or PHQ-9 strata).
- What format do you prefer for statistical summaries submitted for actuarial review (SAS/SQL-ready table, R output, Excel pivot-ready)?
Operate engagement and retention protocols (in-app nudges and coach outreach)
- Which engagement interventions should be enabled for your members (push notifications, email sequences, coach outreach triggers)?
- What cadence for automated nudges aligns with your member engagement goals (daily tips, weekly check-ins, milestone-based triggers)?
- Which dropout threshold should trigger re-engagement by a coach (no app activity for 7 days, 14 days, 30 days)?
- Who will approve content for member communications and what artifact documents approval (copy deck, marketing sign-off email)?
- Provide measurable retention targets for the pilot and steady state (for example: 30-day retention >= 40%, 90-day completion >= 25%).
- Which opt-out or consent options must be honored in your communications (do not contact lists, member-level consent preferences)?
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Pilot Evaluation
Run a scoped pilot to validate engagement, clinical outcome signals, and integration feasibility against agreed acceptance criteria before final contracting.
- success_criteria
- current_state
- decision_readiness
- stakeholders
- gaps
- desired_state
- gaps
- success_criteria
- stakeholders
- desired_state
- current_state
- decision_readiness
- stakeholders
- decision_readiness
- current_state
- desired_state
- success_criteria
- gaps
- success_criteria
- current_state
- decision_readiness
- gaps
- desired_state
- decision_readiness
- decision_readiness
- decision_readiness
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Mutual Commit
Finalize commercial structure (PMPM or outcomes-based), legal terms (BAA/DPA/MSA), performance guarantees, and governance cadence for rollout.
Agreement Modules
- Order Form / Pricing Schedule
- Master Subscription Agreement (MSA)
- Data Processing Agreement (DPA)
- HIPAA Business Associate Addendum (BAA)
- Performance Guarantee Addendum
- Governance & Rollout Cadence Agreement
- Security & Compliance Attestation
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Deployment
Lock readiness facts and configuration values before execution begins.
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Pre-Deployment Readiness
Confirm data access, security attestations, integration endpoints, owners, timelines, and operational dependencies required for execution.
Pre-Deployment Questions
Environment and access
- Which production systems will the integration touch? (check all that apply; we use these to size endpoints and sequence work)
- Is a non-production (staging/test) environment available for integrations, or will testing occur against production with a scheduled window? (this determines our testing plan and credential staging)
- Named owner for handing API credentials and endpoint access (provide name, role, and best contact — so we can schedule the credential handoff)
Data and configuration
- Which member identifiers will be used to match members across systems? (select all that apply; informs matching logic — do not paste values)
- Who owns field mapping and mapping approval for each feed (buyer, seller, or joint)? (this tells us who will sign off on the mappings)
- Are historical member records required to be backfilled before go-live, post-go-live, or not required? (this affects migration scope and schedule)
People and ownership
- Named deployment program owner (project manager) from the buyer side — provide name, role, and contact (so we can align status cadence)
- List named owners (name, role, contact) for these workstreams: Integration/IT, Security/Compliance, Clinical/Medical, Operations/Enrollment (leave blank if not yet assigned)
- Is the buyer operations team staffed and prepared to manage enrollments at go-live? (we need this to confirm required seller support and coach staffing)
Timing and constraints
- Target go-live date or quarter (enter a specific date or quarter; this schedules cutover, training, and acceptance testing)
- Are there blackout windows, regulatory review dates, or committee approvals that will block deployment activities? (select all that apply; specify details in the DeploymentConfig if selected)
- Security and compliance readiness: which of the following are in place or provided by the buyer (select all that apply; confirming these reduces legal/security gating time)
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Integration & Configuration
Capture exact configuration values the deployment team will use — API credentials, feed specs, field mappings, and EHR prescription/workflow settings.
Configuration Details
ENVIRONMENTS & ENDPOINTS
- Select the deployment environment for this build (Default: production)
- Enter the platform API base URL for the selected environment (format: https://api.your-subdomain.example — enter the full base URL)
AUTHENTICATION & CREDENTIAL IDENTIFIERS
- Select the authentication method buyer systems will use for API integration (Default: OAuth2 Client Credentials). Note: we collect only non-secret identifiers here; secrets are exchanged via your secrets manager at kickoff.
- Enter the non-secret identifier the buyer will supply for authentication (e.g., client_id OR key name OR certificate name). Do NOT paste secrets.
FEEDS & TRANSFER
- Provide the canonical name for the membership/eligibility feed to map (use the filename prefix or feed identifier as delivered by the buyer, format: source-eligibility-feed)
- Select the feed transfer method for membership/eligibility (Default: SFTP)
FIELD MAPPINGS & EHR WORKFLOW
- Provide the exact member ID field name as it appears in the feed (header name or JSON path — e.g., member_id or $.member.identifier)
- Provide the exact member email field name as it appears in the feed (header name or JSON path). If email is not provided, enter 'none'.
- Select the EHR prescription/workflow method to enable in the clinical workflow (Default: EHR orderable)
- Provide the EHR orderable code identifier or workflow task name as it should appear in the EHR / clinical task list (enter 'none' if not applicable)
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Deployment
Execute rollout with named owners, coach staffing, enrollment sequencing, training, monitoring, and escalation paths.
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Success
Review clinical and financial outcomes against success signals, maintain a shared channel for issues and enhancements, and run recurring outcome reviews.
Success Reviews
- Go-live Health Check (weeks 1-4)
- First Outcomes Measurement (weeks 4-10)
- Acceptance Gate Review (around day 90)
- Quarterly Outcome Review
- Annual Clinical and Financial Outcomes Review
Issues & Enhancements
- Deliver the actuarial reconciliation file showing PMPM calculation inputs and claims linkage for the quarter.
- Publish the acceptance decision record including pass/fail status and named signatory to the shared workspace within 24 hours.
- For failed or conditional criteria, deliver a remediation schedule with milestones and measurement windows within 5 business days.
- If remediation is required, schedule a final verification checkpoint with required data extracts to confirm closure of each criterion.
- Rolling outcomes and trend review
- Confirm quarterly trajectory for 30-day retention rate and PMPM medical cost savings and document any variances from targets recorded in Solution Scope.
- Prioritize the top 3 operational or product enhancements and agree target dates for resolution or next checkpoints.
- Ensure the shared issues channel reflects current status and escalation owners for all high-priority items.
- Re-confirm success criteria and owners
- Publish a prioritized enhancement backlog with expected delivery quarters for the top 3 items.
- Update the shared issues channel with escalation contacts and a 48-hour SLA for critical production incidents.
- Year-end clinical outcomes presentation
- Validate the annual clinical outcomes and financial impact with the actuarial inputs required for payer reporting.
- Document persistent blockers that affect sustained outcomes and agree remediation milestones for year two.
- Confirm the ongoing measurement and governance cadence for sustained outcome monitoring and reporting.
- Deliver the year-end actuarial workbook with claims linkage, cohort definitions, and sensitivity analyses.
- Publish a year-two operations plan addressing persistent blockers with mitigation milestones and timelines.
- Share finalized annual outcomes slides and dashboard exports for the buyer's internal committees and actuarial review.
- Confirm the enrollment and claims feeds are ingesting data and mapping fields as expected.
- Validate that initial user onboarding flows and coach assignment are functioning and producing first-week activations.
- List all critical blockers with agreed remediation actions and checkpoint dates prior to the first measurement meeting.
- Publish a short deployment health summary documenting feed status, API test results, and any mapping exceptions.
- Deliver a corrected field-mapping spec or patch for any failed feed within 7 calendar days.
- Circulate an issues tracker with remediation owners and checkpoint dates for the first measurement meeting.
- Data provenance and quality check
- Confirm the measurement cohort and data sources are accurate and reproducible for ongoing reporting.
- Identify the top 2 root causes for performance gaps against eligible-to-enrolled conversion rate and 12-week completion rate.
- Agree a time-bound corrective action plan with clear deliverables and dates to reach the acceptance gate.
- Deliver a cleaned, source-linked dataset and updated cohort definition for independent validation within 7 calendar days.
- Implement the agreed enrollment funnel changes and report a 2-week progress update with conversion metrics.
- Adjust coach staffing or outreach cadence and provide projected impact on 12-week completion rate within 10 business days.
- Restate acceptance criteria and numeric targets
- Produce a documented acceptance decision with pass/fail status for each acceptance criterion recorded in Pilot Evaluation.
- If any criteria failed, agree a remediation plan with clear metrics and a final resolution date.
- Publish the acceptance record and the named buyer signatory to the shared success channel.
- Actuarial and financial reconciliation
- Year-end financial and actuarial review
- Present measured outcomes against each criterion
- Present first measurement results
- Deployment and integration validation
- Open issues and enhancement backlog
- Document pass/fail per criterion
- Persistent blockers and operational lessons learned
- Diagnose root causes for gaps
- Early onboarding and activation signals
- Governance and ongoing measurement cadence
- Blockers and escalation review
- Agree corrective actions and timeline
- Shared channel housekeeping and escalation paths
- Named signatory acceptance decision
- Agree immediate remediation actions
- Remediation plan for unmet criteria