AP-005

LBCL, 26 to 64, urban, uninsured, not yet referred onward

CAR-T · Phase 1, Diagnosis & Referral · 27 days in stage · 13 barriers, 4 blocking

Falling behindOne task is 7 days overdue

Delivery

Navigation plan

12 tasks are on this plan, 12 still open. The engine suggests 40 in total from this patient's barriers, so 28 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 center7 days overdueAwaiting a response from the payer
BlockedChange 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 centerDue in 16 days
Not startedChange status for Push for fitness-based (not age-based) selection using real-world evidence
Confirm the center’s caregiver requirement and any flexibility
Nurse navigatorReach: Treatment centerDue in 19 days
Not startedChange status for Confirm the center’s caregiver requirement and any flexibility
Request a fast-track, shared referrer–center eligibility assessment
Treatment-center teamReach: Treatment centerDue in 22 days
Not startedChange status for Request a fast-track, shared referrer–center eligibility assessment

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 19 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

5 tasks

Arrange prehab / optimization to improve pre-treatment fitness
Nurse navigatorReach: Treatment centerDue in 5 days
Not startedChange status for Arrange prehab / optimization to improve pre-treatment fitness
Ensure disability accommodations so assessment is equitable
Nurse navigatorReach: Treatment centerDue in 5 days
Not startedChange status for Ensure disability accommodations so assessment is equitable
Set up a single point of contact / intake coordinator with the center
Nurse navigatorReach: Treatment centerDue in 7 days
Not startedChange status for Set up a single point of contact / intake coordinator with the center
Fast-track the pre-apheresis work-up to shorten decision-to-vein time
Treatment-center teamReach: Treatment centerDue in 9 days
In progressChange status for Fast-track the pre-apheresis work-up to shorten decision-to-vein time
Use a standardized identification trigger (If they RECUR, refer)
Referring / community oncReach: Internal — no outside contactDue in 14 days
Not startedChange status for Use a standardized identification trigger (If they RECUR, refer)

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

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.