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AP-008

Myeloma, 65 to 74, rural, dual eligible, 76 to 150 miles

CAR-T · Phase 3, Coverage & Authorization · 22 days in stage · 14 barriers, 4 blocking

Falling behindOne task is 6 days overdue

Delivery

Navigation plan

12 tasks are on this plan, 3 still open. The engine suggests 43 in total from this patient's barriers, so 31 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 center25 days overdue
    Done

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 center25 days overdue
    Done

  • Request a fast-track, shared referrer–center eligibility assessment

    Treatment-center teamReach: Treatment center25 days overdue
    Done

  • Confirm the center’s caregiver requirement and any flexibility

    Nurse navigatorReach: Treatment center6 days overdueAwaiting a response from the payer
    Blocked

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 21 days
    In progress

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

6 tasks

  • Set up a single point of contact / intake coordinator with the center

    Nurse navigatorReach: Treatment center25 days overdue
    Done

  • Use a standardized identification trigger (If they RECUR, refer)

    Referring / community oncReach: Internal — no outside contact25 days overdue
    Done

  • Fast-track the pre-apheresis work-up to shorten decision-to-vein time

    Treatment-center teamReach: Treatment center25 days overdue
    Done

  • Arrange prehab / optimization to improve pre-treatment fitness

    Nurse navigatorReach: Treatment center25 days overdue
    Done

  • Ensure disability accommodations so assessment is equitable

    Nurse navigatorReach: Treatment center25 days overdue
    Done

  • Check for a nearer community / outpatient CAR-T program

    Nurse navigatorReach: Treatment center25 days overdue
    Done

Confirm coverage & authorization

1 task

  • Track PA and keep appeal-letter templates ready

    Nurse navigatorReach: Payer / health planDue in 14 days
    In progress

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.