Maria Smith
Complex Care · Eligible · 54 yo · Medicaid ID MCD-10234567
Current Care Plan
Open Care Plan Copilot →Diabetes management
Improve diabetes management.
Not yet SMART — specific, measurable, time-bound criteria missing.
Assessment
Open Assessment Copilot →Comprehensive Reassessment — NOT STARTED
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
Nothing has fired on this case yet. Completing the assessment or approving a care plan item runs the rules below.
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
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