Population management
Tracking
Every active patient is a digital twin: the patient data built it, the chosen interventions move it, and events advance it. The flag is computed, not entered: an open task past due, time in a stage beyond its clock, a deadline approaching with prerequisites open, or a handoff nobody picked up.
On the panel
13
Synthetic, de-identified
Falling behind
6
Needs attention today
Watch
2
Approaching a threshold
Blocked
2
4 overdue tasks across the panel
Showing 13 of 13
| Patient | Stage | Top open barrier | Next action | Open work | Status |
|---|---|---|---|---|---|
| AP-001 LBCL, 65 to 74, rural, Medicaid, out-of-network | 3. Coverage & Authorization 33 days of 31 Access: cleared, Candidacy: cleared, Approval: in_progress | High Single-case agreement / out-of-network 16 total, 6 blocking | Confirm the center’s caregiver requirement and any flexibility Nurse navigator5 days overdue | 5 open 1 overdue | Falling behindOne task is 5 days overdue |
| AP-005 LBCL, 26 to 64, urban, uninsured, not yet referred onward | 1. Diagnosis & Referral 27 days of 10 Access: blocked, Candidacy: not_started, Approval: not_started | High Late referral / progression before treatment 13 total, 4 blocking | Refer early — at first relapse / by 2nd line; do not wait Referring / community onc7 days overdue | 12 open 1 overdue | Falling behindOne task is 7 days overdue |
| AP-008 Myeloma, 65 to 74, rural, dual eligible, 76 to 150 miles | 3. Coverage & Authorization 22 days of 14 Access: cleared, Candidacy: cleared, Approval: in_progress | Watch Insurance coverage & prior-authorization 14 total, 4 blocking | Confirm the center’s caregiver requirement and any flexibility Nurse navigator6 days overdue | 3 open 1 overdue | Falling behindOne task is 6 days overdue |
| AP-012 Other NHL, 65 to 74, rural, commercial, over 150 miles | 1. Diagnosis & Referral 19 days of 10 Access: blocked, Candidacy: not_started, Approval: not_started | High Late referral / progression before treatment 16 total, 5 blocking | Refer early — at first relapse / by 2nd line; do not wait Referring / community onc9 days overdue | 12 open 1 overdue | Falling behindOne task is 9 days overdue |
| AP-011 Myeloma, 26 to 64, urban, Medicaid, limited English | 6. Recovery & Follow-up 34 days of 28 Access: cleared, Candidacy: cleared, Approval: cleared | High Financial toxicity / out-of-pocket burden 10 total, 4 blocking | Nothing open | 0 open | Falling behind34 days in recovery and follow-up, past the 28-day target |
| AP-003 Pediatric leukemia, rural, Medicaid, over 150 miles | 2. Candidacy Evaluation 26 days of 21 Access: cleared, Candidacy: in_progress, Approval: not_started | High Caregiver & psychosocial clearance 17 total, 6 blocking | Secure authorization before apheresis to avoid a stalled start Treatment-center teamDue in 15 days | 5 open | Falling behind26 days in work-up to candidacy decision, past the 21-day target |
| AP-006 B-cell ALL, 18 to 25, rural, Medicaid, over 150 miles | 2. Candidacy Evaluation 25 days of 30 Access: cleared, Candidacy: in_progress, Approval: not_started | Watch Caregiver & psychosocial clearance 16 total, 5 blocking | Verify benefits and secure prior authorization before apheresis Treatment-center teamDue in 18 days | 6 open | Watch25 days in work-up to candidacy decision, approaching the 30-day target |
| AP-010 LBCL, 75 plus, rural, Medicare, 76 to 150 miles | 2. Candidacy Evaluation 24 days of 30 Access: cleared, Candidacy: in_progress, Approval: not_started | High Eligibility / patient-selection hurdles 11 total, 3 blocking | Start caregiver planning now; explore paid-caregiver and respite options Social workDue in 14 days | 3 open | Watch24 days in work-up to candidacy decision, approaching the 30-day target |
| AP-009 Pediatric lymphoma, urban, commercial, under 25 miles | 4. Collection & Preparation 19 days of 42 Access: cleared, Candidacy: cleared, Approval: cleared | Moderate Pediatric / young-adult access gap 6 total, 3 blocking | Nothing open | 0 open | On track |
| AP-004 Myeloma, 65 to 74, suburban, Medicare Advantage | 2. Candidacy Evaluation 14 days of 30 Access: cleared, Candidacy: in_progress, Approval: not_started | Watch Insurance coverage & prior-authorization 5 total, 2 blocking | Apply Manatt Medicaid coverage solutions; escalate to society advocacy Advocacy / CBO partnerDue in 18 days | 8 open | On track |
| AP-002 LBCL, 26 to 64, urban, commercial, academic center | 4. Collection & Preparation 11 days of 42 Access: cleared, Candidacy: cleared, Approval: cleared | Watch Manufacturing / collection & vein-to-vein risk 1 total, 0 blocking | Plan bridging early with a standardized protocol; avoid bendamustine before apheresis Treatment-center teamDue in 13 days | 3 open | On track |
| AP-007 Mantle cell, 65 to 74, urban, commercial, under 25 miles | 5. Treatment 8 days of 21 Access: cleared, Candidacy: cleared, Approval: cleared | Watch Manufacturing / collection & vein-to-vein risk 1 total, 0 blocking | Nothing open | 0 open | On track |
| AP-7291A237 Multiple myeloma, Older adult (65–74), Urban / suburban, Medicare (traditional) New plan | 1. Diagnosis & Referral 0 days of 10 Access: in_progress, Candidacy: not_started, Approval: not_started | High Late referral / progression before treatment 11 total, 5 blocking | Set up a single point of contact / intake coordinator with the center Nurse navigatorDue in 21 days | 3 open | On track |
Thresholds are adjusted per patient, so a flag means behind relative to what is achievable for them.