Maria Smith
Complex Care · Eligible · 54 yo · Medicaid ID MCD-10234567
Current Care Plan
Open Care Plan Copilot →Annual behavioral health follow-up overdue
Maria will schedule and attend her annual behavioral health follow-up appointment with a licensed therapist to address her major depressive disorder and anxiety by 2026-10-30, ensuring she receives necessary support and interventions.
Assessment
Open Assessment Copilot →Comprehensive Reassessment — IN PROGRESS
Tasks, Alerts & Care Gaps
Workflow Orchestration
Rules + SLA engineRules fire only after a care manager approves something. Each item is routed to an owning team and given an SLA clock; anything past SLA escalates to the supervisor queue.
Automation history
- Care plan item approvedSep 15, 2026, 2:12 PM
Skipped 4 duplicates: Confirm and schedule an appointment with a behavioral health provider by 2026-09-22.; Provide Maria with a list of local behavioral health services available in her primary language, Spanish, by 2026-09-20.; Discuss with Maria the importance of attending this appointment and addressing her mental health by 2026-09-25.; Send updated care plan to PCP and member
- Care plan item approvedSep 15, 2026, 2:12 PM
Skipped 4 duplicates: Provide a referral to a registered dietitian for diabetes education by 2026-09-22.; Create a medication adherence plan to ensure consistent intake of metformin by discussing it with the pharmacy by 2026-09-29.; Set up a follow-up appointment with the PCP to monitor progress on diabetes management within one month.; Send updated care plan to PCP and member
- Care plan item approvedSep 15, 2026, 2:06 PM
- Confirm and schedule an appointment with a behavioral health provider by 2026-09-22. → routed to Care Manager, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
- Provide Maria with a list of local behavioral health services available in her primary language, Spanish, by 2026-09-20. → routed to Care Manager, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
- Discuss with Maria the importance of attending this appointment and addressing her mental health by 2026-09-25. → routed to Care Manager, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
Skipped 1 duplicate: Send updated care plan to PCP and member
- Confirm and schedule an appointment with a behavioral health provider by 2026-09-22. → routed to Care Manager, due Sep 16, 2026
- Care plan item approvedSep 15, 2026, 12:49 PM
- Provide a referral to a registered dietitian for diabetes education by 2026-09-22. → routed to Care Manager + Dietitian, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
- Create a medication adherence plan to ensure consistent intake of metformin by discussing it with the pharmacy by 2026-09-29. → routed to Care Manager + Dietitian, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
- Set up a follow-up appointment with the PCP to monitor progress on diabetes management within one month. → routed to Care Manager + Dietitian, due Sep 16, 2026Turn approved interventions into owned tasks · owner set by the rule that created it
- Send updated care plan to PCP and member → routed to Care Coordination, due Sep 18, 2026Distribute the updated care plan · owner set by the rule that created it
- Provide a referral to a registered dietitian for diabetes education by 2026-09-22. → routed to Care Manager + Dietitian, due Sep 16, 2026
- SLA breach sweepSep 15, 2026, 11:24 AM
- SLA breach: HbA1c screening overdue → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Annual behavioral health follow-up overdue → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Confirm PCP appointment → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Review medication list with pharmacy → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Schedule behavioral health follow-up → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Missed last two PCP appointments → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: Medication interruption detected - metformin → routed to Supervisor — Dana Whitfield, due Sep 15, 2026Escalate on SLA breach · escalations route to the supervisor queue
- SLA breach: HbA1c screening overdue → routed to Supervisor — Dana Whitfield, due Sep 15, 2026
Active rules (7) — configuration, not code
- Transmit assessment + care plan to PCPAssessment completed
The completed assessment and care plan have to reach the PCP; today that is a manually generated letter.
- Reset the reassessment clockAssessment completed
Completing a reassessment books the next one and moves the case due date out, instead of leaving it on a spreadsheet.
- Behavioral health co-management reviewAssessment completed
Co-managed behavioral health cases get a second reviewer rather than routing everything back to the primary CM.
- Turn approved interventions into owned tasksCare plan item approved
Each intervention on an approved care plan item becomes a routed, SLA-tracked task rather than free text inside a PDF.
- Distribute the updated care planCare plan item approved
An approved change to the care plan triggers distribution to the PCP and the member.
- Supervisor review on escalationAI suggestion approved
An approved escalation opens a short-SLA supervisor review instead of relying on someone noticing it.
- Care gap outreach on high-risk membersAI suggestion approved
An approved care gap on a high-risk member schedules member outreach so the gap has an owner and a clock.
Notes → Actions
Member says she has run out of metformin and has not seen her PCP for five months. She can attend next Tuesday afternoon.
Sarah Lee · Sep 15, 2026, 10:38 AM
Called member to confirm PCP follow-up; left voicemail, no callback yet.
Sarah Lee · Aug 18, 2026, 10:16 AM
Member reports difficulty affording insulin copay. Discussed patient assistance program options and will follow up next call.
Sarah Lee · Aug 11, 2026, 10:16 AM
Timeline
TASK: Send welcome packet
CARE GAP: HbA1c screening overdue
Member reports difficulty affording insulin copay. Discussed patient assistance program op…
TASK: Verify eligibility renewal
CARE GAP: Annual behavioral health follow-up overdue
Called member to confirm PCP follow-up; left voicemail, no callback yet.
TASK: Schedule behavioral health follow-up
CARE GAP: Colorectal cancer screening due
TASK: Confirm PCP appointment
ALERT: Missed last two PCP appointments
TASK: Review medication list with pharmacy
ALERT: Medication interruption detected - metformin
Case opened in CCA
Claim received — office visit, evaluation & management
Prescription fill recorded
Member says she has run out of metformin and has not seen her PCP for five months. She can…
ESCALATION: SLA breach: HbA1c screening overdue
ESCALATION: SLA breach: Annual behavioral health follow-up overdue
ESCALATION: SLA breach: Confirm PCP appointment
ESCALATION: SLA breach: Review medication list with pharmacy
ESCALATION: SLA breach: Schedule behavioral health follow-up
ESCALATION: SLA breach: Missed last two PCP appointments
ESCALATION: SLA breach: Medication interruption detected - metformin
TASK: Provide a referral to a registered dietitian for diabetes education by 2026-09-22.
TASK: Create a medication adherence plan to ensure consistent intake of metformin by discussing it with the pharmacy by 2026-09-29.
TASK: Set up a follow-up appointment with the PCP to monitor progress on diabetes management within one month.
TASK: Send updated care plan to PCP and member
TASK: Confirm and schedule an appointment with a behavioral health provider by 2026-09-22.
TASK: Provide Maria with a list of local behavioral health services available in her primary language, Spanish, by 2026-09-20.
TASK: Discuss with Maria the importance of attending this appointment and addressing her mental health by 2026-09-25.