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Strategy and implementation for capturing appeal outcome data to build the flywheel
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| name | outcome-capture |
| description | Strategy and implementation for capturing appeal outcome data to build the flywheel |
| version | 1.0.0 |
| triggers | ["appeal_completed","user_returns_after_appeal","outcome_followup_scheduled"] |
Close the feedback loop on every appeal. Every outcome reported makes the system smarter for the next patient.
The flywheel depends on real-world outcome data. Without outcomes:
| Channel | Mechanism | Expected Yield |
|---|---|---|
| Email followup (day 30) | Automated Resend email with one-click buttons | 15-25% response rate |
| Email followup (day 60) | Second reminder if no response | 10-15% response rate |
| In-chat prompt | Ask returning users about past appeals | 30-40% response rate |
| Counselor reporting | SHIP counselors report outcomes as part of workflow | 80-90% response rate |
| Provider reporting | Practices know outcomes from remittance | 95%+ response rate |
| Field | Source | Stored In |
|---|---|---|
| outcome (approved/denied/partial) | User report | appeals.status |
| days_to_resolution | Calculated from appeal date | appeals.outcome_reported_at |
| icd10_codes, cpt_codes | From original appeal | appeals (already stored) |
| lcd_refs, ncd_refs | From original appeal | appeals (already stored) |
| carc_codes | From original appeal | appeals (already stored) |
"Report your outcome, get your next appeal free."
usage.appeal_count by 1 when outcome reportedappeals.status -> outcome valueappeals.outcome_reported_at -> timestampcoverage_paths -> increment use_count, set outcomesymptom_mappings -> boost if approved (+0.1), penalize if denied (-0.05)procedure_mappings -> boost if approved (+0.1), penalize if denied (-0.05)outcome_followups.responded_at -> timestampusage.appeal_count -> decrement by 1 (incentive)| File | Purpose |
|---|---|
app/src/lib/conversation-service.ts | scheduleOutcomeFollowups() after saveAppeal |
app/src/app/outcome/page.tsx | Token-based one-click outcome reporting page |
app/src/app/api/outcome-report/route.ts | API for token-based outcome submission |
app/src/skills/domain/outcome-prompting.ts | In-chat prompt for returning users |
supabase/functions/send-outcome-followup/ | Cron edge function for email reminders |
app/src/lib/learning.ts | checkOutcomeIncentive(), applyOutcomeIncentive() |