Care Pathways — Command Center

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Business Context & Information Flow

How Care Pathways drive nudges, revenue, and patient outcomes

What This Page Does

The Care Pathway Engine tracks every patient through evidence-based clinical journeys from initial screening to long-term maintenance. Each pathway is built on published clinical guidelines (ADA, ACC/AHA, NCCN, ACOG, KDIGO) and maps the exact ICDdiagnosis and CPTprocedure codes relevant at each stage. This ensures clinical decisions are codified, reimbursable, and auditable.

Information Flow

Patient Enrolled

Assigned to pathway

Screening

ICD: Z13.x | CPT: labs

Diagnosis

ICD confirmed | imaging

Treatment

CPT procedures billed

Follow-Up

Outcomes tracked

Maintenance

Ongoing wellness

Drives Nudge Engine

Stage transitions auto-generate nudges (e.g., "Advance to Treatment" triggers provider outreach)
Overdue pathways trigger escalation nudges to care coordinators
Next Best Action from each stage feeds directly into nudge content templates
Stage-specific ICD codes determine which care gap nudges to fire

Revenue Impact

Each stage has a revenue range ($200 - $50,000) based on CPT reimbursement rates
Revenue Opportunity KPI shows pipeline value of active pathways
CPT codes map to claims & billing — ensures no revenue leakage from uncoded procedures
Cross-sell/up-sell detected when patients qualify for multiple pathways (e.g., Cardiac + Diabetes)

Clinical Quality

Pathways follow ADA, ACC/AHA, NCCN, ACOG, KDIGO evidence-based guidelines
ICD-10-CM codes ensure accurate diagnosis documentation for quality measures (HEDIS, MIPS)
Overdue detection flags patients falling behind clinical timelines
Stage completion rates feed provider scorecards and value-based care contracts

Who Uses This

Care Coordinators — advance patients through stages, monitor overdue Clinicians — view clinical codes, guidelines, next best actions Revenue Cycle — track CPT-based revenue pipeline by pathway Leadership — pathway completion rates, overdue counts, revenue opportunity

Active Pathways

In Treatment

Revenue Opportunity

Completed

Pathway Distribution

Stage Funnel

Pathway

Stage

Search (patient, ICD, CPT)

ESC

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Notifications

Pathway Details

Quick Start a Journey