AP-003

Pediatric leukemia, rural, Medicaid, over 150 miles

CAR-T · Phase 2, Candidacy Evaluation · 26 days in stage · 17 barriers, 6 blocking

Falling behind26 days in work-up to candidacy decision, past the 21-day target

Delivery

Navigation plan

12 tasks are on this plan, 5 still open. The engine suggests 51 in total from this patient's barriers, so 39 have no owner yet. Statuses persist here.

Completion criteria, in order

Three things that each have to be true before treatment can happen. Work here unblocks everything downstream, which is why it sits above the rest of the plan rather than inside it.

Step 1 · Reach a center

1 flag

referred and accepted for evaluation

In the way: Late referral / progression before treatment

Refer early — at first relapse / by 2nd line; do not wait
Referring / community oncReach: Treatment center29 days overdue
DoneChange status for Refer early — at first relapse / by 2nd line; do not wait

Step 2 · Be accepted as a candidate

2 flags

the center recommends treatment

In the way: Caregiver & psychosocial clearance · Eligibility / patient-selection hurdles

Push for fitness-based (not age-based) selection using real-world evidence
Treatment-center teamReach: Treatment center29 days overdue
DoneChange status for Push for fitness-based (not age-based) selection using real-world evidence
Request a fast-track, shared referrer–center eligibility assessment
Treatment-center teamReach: Treatment center29 days overdue
DoneChange status for Request a fast-track, shared referrer–center eligibility assessment
Confirm the center’s caregiver requirement and any flexibility
Nurse navigatorReach: Treatment centerDue in 16 days
Not startedChange status for Confirm the center’s caregiver requirement and any flexibility

Step 3 · Secure approval to proceed

3 flags

authorization and coverage in place

In the way: Single-case agreement / out-of-network · Insurance coverage & prior-authorization · Coverage lag after approval

Secure authorization before apheresis to avoid a stalled start
Treatment-center teamReach: Payer / health planDue in 15 days
Not startedChange status for Secure authorization before apheresis to avoid a stalled start
Verify benefits and secure prior authorization before apheresis
Treatment-center teamReach: Payer / health planDue in 17 days
Not startedChange status for Verify benefits and secure prior authorization before apheresis
Start the single-case agreement / out-of-state enrollment as early as possible
Treatment-center teamReach: Payer / health planDue in 19 days
Not startedChange status for Start the single-case agreement / out-of-state enrollment as early as possible
Check the payer’s current medical policy and timeline before committing
Nurse navigatorReach: Payer / health planDue in 25 days
Not startedChange status for Check the payer’s current medical policy and timeline before committing

Feasibility and support

Work that makes treatment possible and bearable rather than permitted. Regroup it along whichever axis matches how you are working today.

Refer & establish candidacy

4 tasks

Set up a single point of contact / intake coordinator with the center
Nurse navigatorReach: Treatment center29 days overdue
DoneChange status for Set up a single point of contact / intake coordinator with the center
Use a standardized identification trigger (If they RECUR, refer)
Referring / community oncReach: Internal — no outside contact29 days overdue
DoneChange status for Use a standardized identification trigger (If they RECUR, refer)
Fast-track the pre-apheresis work-up to shorten decision-to-vein time
Treatment-center teamReach: Treatment center29 days overdue
DoneChange status for Fast-track the pre-apheresis work-up to shorten decision-to-vein time
Arrange prehab / optimization to improve pre-treatment fitness
Nurse navigatorReach: Treatment center29 days overdue
DoneChange status for Arrange prehab / optimization to improve pre-treatment fitness

Handoffs

An explicit transfer of responsibility, tracked separately from tasks because the failure mode is different: nobody is late and nobody is idle, the work simply has no owner until somebody acknowledges it.

Referring / community oncSocial work

Family needs lodging and travel support arranged before the work-up can finish.

Not acknowledged

Every task traces back to a barrier that actually fired for this patient.

The plan is not separate authoring. It is the assessment projected forward.
That is what makes it maintainable at all.