AP-004

Myeloma, 65 to 74, suburban, Medicare Advantage

CAR-T · Phase 2, Candidacy Evaluation · 14 days in stage · 5 barriers, 2 blocking

On track

Delivery

Navigation plan

12 tasks are on this plan, 8 still open. The engine suggests 16 in total from this patient's barriers, so 4 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 center17 days overdue
DoneChange status for Refer early — at first relapse / by 2nd line; do not wait

Step 2 · Be accepted as a candidate

Clear

the center recommends treatment

Nothing on the plan clears this criterion yet.

Step 3 · Secure approval to proceed

1 flag

authorization and coverage in place

In the way: Insurance coverage & prior-authorization

Verify benefits and secure prior authorization before apheresis
Treatment-center teamReach: Payer / health planDue in 24 days
Not startedChange status for Verify benefits and secure prior authorization before apheresis

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

3 tasks

Set up a single point of contact / intake coordinator with the center
Nurse navigatorReach: Treatment center17 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 contact17 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 center17 days overdue
DoneChange status for Fast-track the pre-apheresis work-up to shorten decision-to-vein time

Confirm coverage & authorization

2 tasks

Apply Manatt Medicaid coverage solutions; escalate to society advocacy
Advocacy / CBO partnerReach: Community / advocacy orgDue in 18 days
Not startedChange status for Apply Manatt Medicaid coverage solutions; escalate to society advocacy
Track PA and keep appeal-letter templates ready
Nurse navigatorReach: Payer / health planDue in 20 days
Not startedChange status for Track PA and keep appeal-letter templates ready

Build the access plan

5 tasks

Route to a Financial Toxicity Tumor Board / comprehensive patient-assistance program
Financial counselorReach: Internal — no outside contactDue in 19 days
Not startedChange status for Route to a Financial Toxicity Tumor Board / comprehensive patient-assistance program
Run early SDOH screening to trigger travel & housing grants
Nurse navigatorReach: Internal — no outside contactDue in 25 days
Not startedChange status for Run early SDOH screening to trigger travel & housing grants
Screen with a validated financial-toxicity tool (COST) and start financial navigation
Financial counselorReach: Internal — no outside contactDue in 26 days
Not startedChange status for Screen with a validated financial-toxicity tool (COST) and start financial navigation
Maintain a ready assistance directory and enroll proactively
Nurse navigatorReach: Internal — no outside contactDue in 27 days
Not startedChange status for Maintain a ready assistance directory and enroll proactively
Enroll in patient-assistance travel programs + free/subsidized housing (e.g., Hope Lodge)
Social workReach: Community / advocacy orgDue in 29 days
Not startedChange status for Enroll in patient-assistance travel programs + free/subsidized housing (e.g., Hope Lodge)

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 oncNurse navigator

Referral received and accepted for work-up.

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.